211 results on '"Mitsunobu Nakamura"'
Search Results
2. High versus low positive end-expiratory pressure setting in patients receiving veno-venous extracorporeal membrane oxygenation support for severe acute respiratory distress syndrome: study protocol for the multicentre, randomised ExPress SAVER Trial
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Yoshihiro Hagiwara, Nobuaki Shime, Tsukasa Yagi, Yoshitaka Ogata, Takayuki Ogura, Yosuke Matsumura, Kazuki Matsumura, Kunihiko Takahashi, Takeshi Yoshida, Ginga Suzuki, Shinichiro Ohshimo, Daisuke Kasugai, Keiki Shimizu, Jun Hamaguchi, Ken Ishikura, Hitoshi Kikuchi, Mitsuaki Nishikimi, Kenji Fujizuka, Tatsuhiko Anzai, Junki Ishii, Toshiyuki Aokage, Tokuji Ikeda, Ken Katsuta, Daisuke Konno, Noriyuki Hattori, Tomoyuki Nakamura, Tatsuhiko Iino, Shinichi Kai, Haruka Hashimoto, Yumi Igarashi, Mitsunobu Nakamura, and Shingo Ichiba
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Medicine - Abstract
Introduction While limiting the tidal volume to 6 mL/kg during veno-venous extracorporeal membrane oxygenation (V-V ECMO) to ameliorate lung injury in patients with acute respiratory distress syndrome (ARDS) is widely accepted, the best setting for positive end-expiratory pressure (PEEP) is still controversial. This study is being conducted to investigate whether a higher PEEP setting (15 cmH2O) during V-V ECMO can decrease the duration of ECMO support needed in patients with severe ARDS, as compared with a lower PEEP setting.Methods and analysis The study is an investigator-initiated, multicentre, open-label, two-arm, randomised controlled trial conducted with the participation of 20 intensive care units (ICUs) at academic as well as non-academic hospitals in Japan. The subjects of the study are patients with severe ARDS who require V-V ECMO support. Eligible patients will be randomised equally to the high PEEP group or low PEEP group. Recruitment to the study will continue until a total of 210 patients with ARDS requiring V-V ECMO support have been randomised. In the high PEEP group, PEEP will be set at 15 cmH2O from the start of V-V ECMO until the trials for liberation from V-V ECMO (or until day 28 after the allocation), while in the low PEEP group, the PEEP will be set at 5 cmH2O. Other treatments will be the same in the two groups. The primary endpoint of the study is the number of ECMO-free days until day 28, defined as the length of time (in days) from successful libration from V-V ECMO to day 28. The secondary endpoints are mortality on day 28, in-hospital mortality on day 60, ventilator-free days during the first 60 days and length of ICU stay.Ethics and dissemination Ethics approval for the trial at all the participating hospitals was obtained on 27 September 2022, by central ethics approval (IRB at Hiroshima University Hospital, C2022-0006). The results of this study will be presented at domestic and international medical congresses, and also published in scientific journals.Trial registration number The Japan Registry of Clinical Trials jRCT1062220062. Registered on 28 September 2022.Protocol version 28 March 2023, version 4.0.
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- 2023
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3. Corynebacterium ulcerans pneumonia treated with venovenous extracorporeal membrane oxygenation: a case report
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Yoshihiko Takahashi, Shu Utsumi, Gaku Sugiura, Kenji Fujizuka, Hiroyuki Suzuki, and Mitsunobu Nakamura
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Corynebacterium ulcerans ,Extracorporeal membrane oxygenation ,Pneumonia ,Infectious and parasitic diseases ,RC109-216 - Abstract
We report the first case of airway obstruction due to toxin-producing Corynebacterium ulcerans, successfully managed with venovenous extracorporeal membrane oxygenation (V-V ECMO). A woman aged 73 years who was living with companion animals was intubated for pneumonia of unknown origin and treated with an empirical antimicrobial agent. Corynebacterium species were detected in the sputum and treated as commensal bacteria. Subsequently, the patient suddenly could not ventilate because of central airway obstruction caused by pseudomembrane formation. Therefore, V-V ECMO was initiated. Additional mass spectrometry identified the Corynebacterium species as C. ulcerans. After treatment with antitoxin, the patient was successfully weaned from V-V ECMO. Hence, in patients in contact with companion animals who present with respiratory failure and pseudomembrane formation, C. ulcerans pneumonia should be suspected and treated with antitoxin. C. ulcerans pneumonia may result in an inability to ventilate due to pseudomembrane formation. Therefore, treatment strategies including V-V ECMO should be considered in such cases.
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- 2023
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4. Effect of a systematic lung-protective protocol for COVID-19 pneumonia requiring invasive ventilation: A single center retrospective study.
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Yoshihiko Takahashi, Shu Utsumi, Kenji Fujizuka, Hiroyuki Suzuki, Noritaka Ushio, Yu Amemiya, and Mitsunobu Nakamura
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Medicine ,Science - Abstract
The benefits of introducing a systematic lung-protective protocol for coronavirus disease 2019 (COVID-19) pneumonia requiring invasive ventilation in the intensive care unit (ICU) are unknown. Herein, we aimed to evaluate the clinical effects of introducing such a protocol in terms of mortality, duration of ventilation, and length of ICU stay. In this single-centre, retrospective, quality comparison study, we identified patients with COVID-19 pneumonia who received invasive ventilation in our ICU between February 2020 and October 2021. We established a systematic lung-protective protocol for the pre-introduction group until March 2021 and the post-introduction group after April 2021. Patients who did not receive invasive ventilation and who underwent veno-venous extracorporeal membrane oxygenation in a referring hospital were excluded. We collected patient characteristics at the time of ICU admission, including age, sex, body mass index (BMI), comorbidities, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, and Murray score. The study outcomes were ICU mortality, length of ICU stay, and duration of ventilation. The pre-introduction and post-introduction groups included 18 and 50 patients, respectively. No significant differences were observed in sex, BMI, SOFA score, APACHE II score, and Murray score; however, age was lower in the post-introduction group (70 vs. 56, P = 0.003). The introduction of this protocol did not improve ICU mortality. However, it reduced the ICU length of stay (26 days vs. 11 days, P = 0.003) and tended to shorten the duration of ventilation (15 days vs. 10 days, P = 0.06). The introduction of the protocol was associated with a decrease in the length of ICU stay and duration of ventilation; however, it did not change mortality. The application of the protocol could improve the security of medical resources during the COVID-19 pandemic. Further prospective multicentre studies are needed.
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- 2023
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5. Comparison of the efficacy of continuous intravenous infusion versus intramuscular injection of epinephrine for initial anaphylaxis treatment
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Kenji Fujizuka, Mitsunobu Nakamura, Junichi Tamura, and Keiko Kawai‐Kowase
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adverse event ,anaphylaxis ,biphasic reaction ,epinephrine ,intravenous infusion ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Aim Continuous intravenous (CIV) infusion of epinephrine for the treatment of anaphylaxis may be required if symptoms do not improve after intramuscular (IM) injection. As CIV infusion permits precise dose adjustment, we compared treatment course and adverse events following CIV infusion and IM injection of epinephrine for the management of anaphylaxis. Methods Medical records of patients, who were treated for anaphylaxis with epinephrine, were 18 years or older, and were admitted to our department from April 2005 to March 2016, were retrospectively reviewed. The cases were categorized as CIV infusion or IM injection, and treatment course and outcomes were compared between the two groups. Results Of the 142 eligible cases, there were 78 in the CIV infusion group and 64 in the IM injection group. The CIV infusion group had lower systolic blood pressure, more respiratory symptoms, and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, but required a lower total dose of epinephrine, had fewer adverse events after epinephrine administration, and showed lower incidence of biphasic reactions. In addition, compared with the IM injection group, time to administration of epinephrine was significantly longer (P
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- 2022
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6. Prediction of arterial extravasation in pelvic fracture patients with stable hemodynamics using coagulation biomarkers
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Makoto Aoki, Takayuki Ogura, Shuichi Hagiwara, Mitsunobu Nakamura, and Kiyohiro Oshima
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Trauma ,Pelvic fracture ,Coagulopathy ,Arterial extravasation ,Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Determining the presence of an active arterial hemorrhage in the acute phase is important as a treatment strategy in patients with pelvic fracture. The purpose of this study was to evaluate whether coagulation biomarkers could predict arterial extravasation, especially in pelvic fracture patients with stable hemodynamics. Methods We studied patients with a pelvic fracture who had a systolic blood pressure above 90 mmHg and lactate level less than 5.0 mmol/L on hospital arrival. Patients were divided into two groups: those with arterial extravasation on enhanced computed tomography (CT) or angiography (extravasation [+] group) and those without arterial extravasation (extravasation [−] group). Coagulation biomarkers measured on arrival were statistically compared between the two groups. Predictive ability of arterial extravasation using coagulation biomarkers was evaluated by receiver-operating characteristic analyses provided area under the receiver-operating characteristic curves (AUROC) and diagnostic indicators with optimal cutoff point including sensitivity, specificity, positive and negative predictive values, and diagnostic odds ratio (DOR). Results Sixty patients were analyzed. Fibrin degradation products (FDP), D-dimer, prothrombin time–international normalized ratio (PT–INR), and the ratio of FDP to fibrinogen were significantly higher in the extravasation (+) group than in the extravasation (−) group (FDP, 242 μg/mL [145–355] vs. 96 μg/mL [58–153]; D-dimer, 81 μg/mL [41–140] vs. 39 μg/mL [21–75]; PT–INR, 1.09 [1.05–1.24] vs. 1.02 [0.98–1.08]; and ratio of FDP to fibrinogen, 1.06 [0.85–2.01] vs. 0.46 [0.25–0.74]). The highest AUROC was with a ratio of FDP to fibrinogen of 0.777 (95% confidence interval, 0.656–0.898), and the highest predictive ability in terms of DOR was with a ratio of FDP to fibrinogen (sensitivity, 0.76; specificity, 0.76; DOR 9.90). Conclusion Coagulation biomarker could predict of arterial extravasation in pelvic fracture patients with stable hemodynamics.
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- 2019
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7. Accuracy of the first interpretation of early brain CT images for predicting the prognosis of post-cardiac arrest syndrome patients at the emergency department
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Mitsuaki Nishikimi, Takayuki Ogura, Kota Matsui, Kunihiko Takahashi, Kenji Fukaya, Keibun Liu, Hideo Morita, Mitsunobu Nakamura, Shigeyuki Matsui, and Naoyuki Matsuda
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Cardiac arrest ,Post-cardiac arrest syndrome ,Neurological prognosis ,Brain CT scan ,Targeted temperature management ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Early brain CT is one of the most useful tools for estimating the prognosis in patients with post-cardiac arrest syndrome (PCAS) at the emergency department (ED). The aim of this study was to evaluate the prognosis-prediction accuracy of the emergency physicians’ interpretation of the findings on early brain CT in PCAS patients treated by targeted temperature management (TTM). Methods This was a double-center, retrospective, observational study. Eligible subjects were cardiac arrest patients admitted to the intensive care unit (ICU) for TTM between April 2011 and March 2017. We performed the McNemar test to compare the predictive accuracies of the interpretation by emergency physicians and radiologists and calculated the kappa statistic for determining the concordance rate between the interpretations by these two groups. Results Of the 122 eligible patients, 106 met the inclusion criteria for this study. The predictive accuracies (sensitivity, specificity) of the interpretations by the emergency physicians and radiologists were (0.34, 1.00) and (0.41, 0.93), respectively, with no significant difference in either the sensitivity or specificity as assessed by the McNemar test. The kappa statistic calculated to determine the concordance between the two interpretations was 0.66 (0.48–0.83), which showed a good conformity. Conclusions The emergency physicians’ interpretation of the early brain CT findings in PCAS patients treated by TTM was as reliable as that of radiologists, in terms of prediction of the prognosis.
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- 2018
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8. The safety of a novel early mobilization protocol conducted by ICU physicians: a prospective observational study
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Keibun Liu, Takayuki Ogura, Kunihiko Takahashi, Mitsunobu Nakamura, Hiroaki Ohtake, Kenji Fujiduka, Emi Abe, Hitoshi Oosaki, Dai Miyazaki, Hiroyuki Suzuki, Mitsuaki Nishikimi, Alan Kawarai Lefor, and Takashi Mato
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Early mobilization ,Protocol ,Safety ,ICU physicians ,Medical devices ,Acute phase ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background There are numerous barriers to early mobilization (EM) in a resource-limited intensive care unit (ICU) without a specialized team or an EM culture, regarding patient stability while critically ill or in the presence of medical devices. We hypothesized that ICU physicians can overcome these barriers. The aim of this study was to investigate the safety of EM according to the Maebashi EM protocol conducted by ICU physicians. Methods This was a single-center prospective observational study. All consecutive patients with an unplanned emergency admission were included in this study, according to the exclusion criteria. The observation period was from June 2015 to June 2016. Data regarding adverse events, medical devices in place during rehabilitation, protocol adherence, and rehabilitation outcomes were collected. The primary outcome was safety. Results A total of 232 consecutively enrolled patients underwent 587 rehabilitation sessions. Thirteen adverse events occurred (2.2%; 95% confidence interval, 1.2–3.8%) and no specific treatment was needed. There were no instances of dislodgement or obstruction of medical devices, tubes, or lines. The incidence of adverse events associated with mechanical ventilation or extracorporeal membrane oxygenation (ECMO) was 2.4 and 3.6%, respectively. Of 587 sessions, 387 (66%) sessions were performed at the active rehabilitation level, including sitting out of the bed, active transfer to a chair, standing, marching, and ambulating. ICU physicians attended over 95% of these active rehabilitation sessions. Of all patients, 143 (62%) got out of bed within 2 days (median 1.2 days; interquartile range 0.1–2.0). Conclusions EM according to the Maebashi EM protocol conducted by ICU physicians, without a specialized team or EM culture, was performed at a level of safety similar to previous studies performed by specialized teams, even with medical devices in place, including mechanical ventilation or ECMO. Protocolized EM led by ICU physicians can be initiated in the acute phase of critical illness without serious adverse events requiring additional treatment.
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- 2018
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9. A novel scoring system for predicting the neurologic prognosis prior to the initiation of induced hypothermia in cases of post-cardiac arrest syndrome: the CAST score
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Mitsuaki Nishikimi, Naoyuki Matsuda, Kota Matsui, Kunihiko Takahashi, Tadashi Ejima, Keibun Liu, Takayuki Ogura, Michiko Higashi, Hitoshi Umino, Go Makishi, Atsushi Numaguchi, Satoru Matsushima, Hideki Tokuyama, Mitsunobu Nakamura, and Shigeyuki Matsui
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Post-cardiac arrest syndrome ,Neurological prognosis ,Induced hypothermia ,CAST score ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background The aim of this study was to develop a scoring system for identifying the post-cardiac arrest syndrome (PCAS) patients with a good potential for recovery prior to the initiation of induced therapeutic hypothermia. Methods A multi-center, retrospective, observational study was performed. Data of a total of 151 consecutive adults who underwent induced hypothermia after cardiac arrest (77 learning cases from two hospitals and 74 validation cases from two other hospitals) were analyzed. Results In the learning set, 8 factors (initial rhythm, witnessed status and time until return of spontaneous circulation, pH, serum lactate, motor score according to the Glasgow Coma Scale (GCS), gray matter attenuation to white matter attenuation ratio (GWR), serum albumin, and hemoglobin) were found to be strongly correlated with the neurological outcomes. A tentative scoring system was created from the learning data using these factors, and the predictive accuracy (sensitivity and specificity) was evaluated in terms of both internal validation (0.85 and 0.84) and external validation (cutoff 50%: 0.95 and 0.90, 30%: 0.87 and 0.98, 15%: 0.67 and 1.00). Finally, using all the data, we established a post-Cardiac Arrest Syndrome for induced Therapeutic hypothermia (CAST) score to predict the neurologic prognosis prior to initiation of induced hypothermia. Conclusions The CAST score was developed to predict the neurological outcomes of PCAS patients treated by induced hypothermia. The likelihood of good recovery at 30 days was extremely low in PCAS patients with a CAST score of ≤15%. Prospective validation of the score is needed in the future.
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- 2017
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10. Necrotising fasciitis with extensive necrosis caused by Lactobacillus: a case report
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Nagayama, Jun, Sato, Takeo, Takanori, Ishida, Kouji, Koga, and Mitsunobu, Nakamura
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- 2024
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11. Necrotising fasciitis with extensive necrosis caused by Lactobacillus: A case report
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Nagayama, Jun, primary, Sao, Takeo, additional, Takanori, Ishida, additional, Kouji, Koga, additional, and Mitsunobu, Nakamura, additional
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- 2024
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12. Risk factors for bleeding complications during venovenous extracorporeal membrane oxygenation as a bridge to recovery
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Akira Kawauchi, Keibun Liu, Mitsunobu Nakamura, Hiroyuki Suzuki, Kenji Fujizuka, and Minoru Nakano
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Biomaterials ,Extracorporeal Membrane Oxygenation ,Risk Factors ,Biomedical Engineering ,Humans ,Medicine (miscellaneous) ,Hemorrhage ,Bioengineering ,General Medicine ,Retrospective Studies - Abstract
Bleeding complications during venovenous extracorporeal membrane oxygenation (V-V ECMO) can be critical. However, there is limited information on the associated risk factors. This study investigated the risk factors for bleeding complications during V-V ECMO as a bridge to recovery.This single-center retrospective study enrolled 59 patients (bleeding and non-bleeding groups) who received V-V ECMO from 2012 to 2020, to evaluate whether peak activated partial thromboplastin time (APTT) value, lowest platelet count, and mobilization to sitting on the edge of the bed during V-V ECMO were risk factors for bleeding complications, defined according to the Extracorporeal Life Support Organization guidelines. Age, sex, body mass index, Sequential Organ Failure Assessment score, and ECMO duration before bleeding complications were covariates in the multivariate logistic regression analysis.Thirty-one (53%) participants experienced 36 bleeding complications; the ECMO cannulation site, gastrointestinal tract, and nasopharyngeal region were the most common bleeding sites. The use of transfusion products and length of ECMO and intensive care unit stay were significantly and medical costs were non-significantly increased in the bleeding group. Peak APTT (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, p 0.01) was significantly associated whereas the lowest platelet count (OR 0.96, 95% CI 0.82-1.13, p = 0.66) was unassociated with bleeding complications during ECMO. Achieving mobilization (OR 0.14, 95% CI 0.02-1.17, p = 0.07) decreased the trend of risk for bleeding complications.Peak APTT might be an independent modifiable factor for bleeding complications during V-V ECMO. The protective effect of mobilization during V-V ECMO requires further investigation.
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- 2022
13. シートベルトにより生じた鈍的腹部大動脈損傷の2例(Prevalent sites and conditions of blunt abdominal aortic injury caused by seat belt: Case series)
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高橋 慶彦 (Yoshihiko Takahashi), 丸山 潤 (Jun Maruyama), 中村 光伸 (Mitsunobu Nakamura), 西村 朋也 (Tomoya Nishimura), and 小橋 大輔 (Daisuke Kobashi)
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- 2021
14. Conformational Switching of Pyrenes Associated on Hairpin Loop Region by DNA B‐Z Transition
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Mitsunobu Nakamura, Hibiki Yoshioka, and Tadao Takada
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General Chemistry - Published
- 2022
15. Photoresponsive Porphyrin‐DNA Complexes Constructed through Intercalation‐like Binding
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Tadao Takada, Nao Shimogaki, Moe Naruo, Mitsunobu Nakamura, and Kazushige Yamana
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Organic Chemistry ,Physical and Theoretical Chemistry ,Analytical Chemistry - Published
- 2022
16. 新型コロナウイルス感染症による重症呼吸不全患者に対して搬送元病院でV–V ECMOを導入し,搬送を行った1例(Transportation of acute respiratory failure patient infected severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) with veno–venous ECMO: a case report)
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雨宮 優 (Yu Amemiya), 神尾 芳恵 (Yoshie Kamio), 中村 光伸 (Mitsunobu Nakamura), 小橋 大輔 (Daisuke Kobashi), 鈴木 裕之 (Hiroyuki Suzuki), and 藤塚 健次 (Kenji Fujizuka)
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- 2020
17. Clinical efficacy of a systematic lung-protective protocol for COVID-19 pneumonia requiring invasive ventilation: A single-center retrospective study
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Yoshihiko Takahashi, Shu Utsumi, Kenji Fujizuka, Hiroyuki Suzuki, Noritaka Ushio, Yu Amemiya, and Mitsunobu Nakamura
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Background The benefits of introducing a systematic lung-protective protocol for patients with coronavirus disease (COVID-19) pneumonia and who require invasive ventilation in the intensive care unit (ICU) are unknown. Herein, we aimed to evaluate the clinical effects of introducing such a protocol in the context of mortality, duration of ventilation, and length of ICU stay. Methods In this single-center, retrospective, quality comparison study, we identified patients with COVID-19 pneumonia who received invasive ventilation in our ICU between February 2020 and October 2021. We established a systematic lung-protective protocol for the pre-introduction group until March 2021 and the post-introduction group after April 2021. Patients who did not receive invasive ventilation and who underwent veno-venous extracorporeal membrane oxygenation in a referring hospital were excluded. We collected patient characteristics at the time of ICU admission, including age, sex, body mass index (BMI), comorbidities, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, and Murray score. The study outcomes were ICU mortality, length of ICU stay, and duration of ventilation. Results The pre-introduction and post-introduction groups included 18 and 50 patients, respectively. No significant differences were observed in sex, BMI, SOFA score, APACHE II score, and Murray score; however, age was lower in the post-introduction group (70 vs. 56, p = 0.003). The introduction of this protocol did not improve ICU mortality. However, it reduced the ICU length of stay (26 days vs. 11 days, p = 0.003) and tended to shorten the duration of ventilation (15 days vs. 10 days, p = 0.06). Conclusions The introduction of the protocol was associated with a decrease in the length of ICU stay and duration of ventilation; however, it did not change mortality. The application of the protocol could improve the security of medical resources during the COVID-19 pandemic. Further prospective multicentre studies are needed.
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- 2022
18. Methicillin resistant staphylococcus aureus (MRSA)多発膿瘍経過中に発症し,ステロイドが著効したDrug reaction with eosinophilia and systemic symptoms(DRESS)の1例(A case report: Corticosteroid effective Drug reaction with eosinophilia and systemic symptoms (DRESS) due to antibiotics drugs)
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中村 光伸 (Mitsunobu Nakamura), 高橋 慶彦 (Yoshihiko Takahashi), 雨宮 優 (Yu Amemiya), 藤塚 健次 (Kenji Fujizuka), 鈴木 裕之 (Hiroyuki Suzuki), 町田 浩志 (Hiroshi Machida), and 小倉 祟以 (Takayuki Ogura)
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- 2020
19. 剖検にて頸胸髄の融解壊死を認めたクロルフェナピル中毒の1例(Chlorfenapyr poisoning with liquefactive necrosis of the cervical and thoracic cord: an autopsy case report)
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小橋 大輔 (Daisuke Kobashi), 堀口 真仁 (Masahito Horiguchi), and 中村 光伸 (Mitsunobu Nakamura)
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- 2020
20. シートベルトにより生じた鈍的腹部大動脈損傷の2例(Prevalent sites and conditions of blunt abdominal aortic injury caused by seat belt: Case series)
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(Jun Maruyama), 丸山 潤, primary, (Daisuke Kobashi), 小橋 大輔, additional, (Mitsunobu Nakamura), 中村 光伸, additional, (Tomoya Nishimura), 西村 朋也, additional, and (Yoshihiko Takahashi), 高橋 慶彦, additional
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- 2021
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21. Severe caffeine poisoning successfully treated with high flow continuous hemodialysis
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Daisuke Kobashi, Yoshito Kamijo, Tomoki Hanazawa, Tomohiro Yoshizawa, and Mitsunobu Nakamura
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Emergency Medicine ,General Medicine - Published
- 2022
22. Stacked Thiazole Orange Dyes in DNA Capable of Switching Emissive Behavior in Response to Structural Transitions
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Aoi Nakano, Kazushige Yamana, Mamoru Fujitsuka, Tadao Takada, Koma Nishida, Shuya Fan, Yurika Honda, Mitsunobu Nakamura, and Kiyohiko Kawai
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Photochemistry ,Excimer ,Biochemistry ,chemistry.chemical_compound ,Molecule ,Transition Temperature ,Benzothiazoles ,Molecular Biology ,Amination ,Fluorescent Dyes ,chemistry.chemical_classification ,Biomolecule ,Circular Dichroism ,Organic Chemistry ,RNA ,Nucleic Acid Hybridization ,DNA ,Fluorescence ,Monomer ,Spectrometry, Fluorescence ,chemistry ,Nucleic acid ,Quinolines ,Molecular Medicine ,Oxidation-Reduction - Abstract
Functional nucleic acids with the capability of generating fluorescence in response to hybridization events, microenvironment or structural changes are valuable as structural probes and chemical sensors. We now demonstrate the enzyme-assisted preparation of nucleic acids possessing multiple thiazole orange (TO) dyes and their fluorescent behavior, that show a spectral change from the typical monomer emission to the excimer-type red-shifted emission. We found that the fluorescent response and emission wavelength of the TO dyes were dependent on both the state of the DNA structure (single- or double-stranded DNA) and the arrangement of the TO dyes. We showed that the fluorescent behavior of the TO dyes can be applied for the detection of RNA molecules, suggesting that our approach for preparing the fluorescent nucleic acids functionalized with multiple TO dyes could be useful to design a fluorescence bioimaging and detection technique of biomolecules.
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- 2021
23. A Progressive Early Mobilization Program Is Significantly Associated With Clinical and Economic Improvement
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Takayuki Ogura, Mamoru Komatsu, Mitsunobu Nakamura, Hiroaki Ohtake, Takashi Mato, Alan Kawarai Lefor, Kunihiko Takahashi, Keibun Liu, Kenji Fujiduka, Hiroyuki Suzuki, Hitoshi Oosaki, Emi Abe, Mitsuaki Nishikimi, and Dai Miyazaki
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Male ,medicine.medical_specialty ,Organ Dysfunction Scores ,medicine.medical_treatment ,Sedation ,Comorbidity ,Critical Care and Intensive Care Medicine ,Severity of Illness Index ,Tertiary Care Centers ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Clinical Protocols ,Adrenal Cortex Hormones ,Severity of illness ,Extracorporeal membrane oxygenation ,medicine ,Humans ,Hospital Mortality ,Hospital Costs ,Prospective cohort study ,Early Ambulation ,Aged ,Quality of Health Care ,Retrospective Studies ,Aged, 80 and over ,Mechanical ventilation ,business.industry ,Hazard ratio ,Age Factors ,030208 emergency & critical care medicine ,Retrospective cohort study ,Length of Stay ,Middle Aged ,Respiration, Artificial ,Community hospital ,Intensive Care Units ,030228 respiratory system ,Emergency medicine ,Female ,medicine.symptom ,business - Abstract
OBJECTIVES To determine whether a progressive early mobilization protocol improves patient outcomes, including in-hospital mortality and total hospital costs. DESIGN Retrospective preintervention and postintervention quality comparison study. SETTINGS Single tertiary community hospital with a 12-bed closed-mixed ICU. PATIENTS All consecutive patients 18 years old or older were eligible. Patients who met exclusion criteria or were discharged from the ICU within 48 hours were excluded. Patients from January 2014 to May 2015 were defined as the preintervention group (group A) and from June 2015 to December 2016 was the postintervention group (group B). INTERVENTION Maebashi early mobilization protocol. MEASUREMENTS AND MAIN RESULTS Group A included 204 patients and group B included 187 patients. Baseline characteristics evaluated include age, severity, mechanical ventilation, and extracorporeal membrane oxygenation, and in group B additional comorbidities and use of steroids. Hospital mortality was reduced in group B (adjusted hazard ratio, 0.25; 95% CI, 0.13-0.49; p < 0.01). This early mobilization protocol is significantly associated with decreased mortality, even after adjusting for baseline characteristics such as sedation. Total hospital costs decreased from $29,220 to $22,706. The decrease occurred soon after initiating the intervention and this effect was sustained. The estimated effect was $-5,167 per patient, a 27% reduction. Reductions in ICU and hospital lengths of stay, time on mechanical ventilation, and improvement in physical function at hospital discharge were also seen. The change in Sequential Organ Failure Assessment score and Sequential Organ Failure Assessment score at ICU discharge were significantly reduced after the intervention, despite a similar Sequential Organ Failure Assessment score at admission and at maximum. CONCLUSIONS In-hospital mortality and total hospital costs are reduced after the introduction of a progressive early mobilization program, which is significantly associated with decreased mortality. Cost savings were realized early after the intervention and sustained. Further prospective studies to investigate causality are warranted.
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- 2019
24. External validation of a risk classification at the emergency department of post-cardiac arrest syndrome patients undergoing targeted temperature management
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Takayuki Ogura, Mitsunobu Nakamura, Kazuki Nishida, Naoyuki Matsuda, Taku Iwami, Mitsuaki Nishikimi, Shigeyuki Matsui, and Kunihiko Takahashi
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Male ,medicine.medical_specialty ,Post-cardiac arrest syndrome ,medicine.medical_treatment ,Risk classification ,Acute medicine ,030204 cardiovascular system & hematology ,Emergency Nursing ,Targeted temperature management ,Therapeutic normothermia ,Risk Assessment ,Sensitivity and Specificity ,Prognostic score ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Hypothermia, Induced ,Health Status Indicators ,Humans ,Medicine ,Neurological prognosis ,Therapeutic hypothermia ,Registries ,Post cardiac arrest ,High severity ,rCAST ,Aged ,business.industry ,External validation ,030208 emergency & critical care medicine ,Recovery of Function ,Emergency department ,Middle Aged ,Prognosis ,Emergency medicine ,Emergency Medicine ,Female ,CAST ,Emergency Service, Hospital ,Cardiology and Cardiovascular Medicine ,business ,Out-of-Hospital Cardiac Arrest - Abstract
Introduction There are no established risk classification for post-cardiac arrest syndrome (PCAS) patients at the Emergency Department (ED) undergoing targeted temperature management (TTM). The aim of this study was to externally validate a simplified version of our prognostic score, the “post-Cardiac Arrest Syndrome for Therapeutic hypothermia score” (revised CAST [rCAST]) and estimate the predictive accuracy of the risk classification based on it. Methods For the external validation, we used data from an out-of-hospital cardiac arrest (OHCA) registry of the Japanese Association for Acute Medicine (JAAM), which is a multicenter, prospective registry of OHCA patients across Japan. Eligible patients were PCAS patients treated with TTM at 33–36 °C between June 2014 and December 2015. We validated the accuracy of rCAST for predicting the neurological outcomes at 30 and 90 days. Results Among the 12,024 OHCA patients, the data of 460 PCAS patients treated by TTM were eligible for the validation. The areas under the curve of rCAST for predicting the neurological outcomes at 30 and 90 days were 0.892 and 0.895, respectively. The estimated sensitivity and specificity of the risk categories for the outcomes were as follows: 0.95 (95% CI: 0.92–0.98) and 0.47 (0.40–0.55) for the low (rCAST: ≤5.5), 0.62 (0.56–0.68) and 0.48 (0.40–0.55) for the moderate (rCAST: 6.0–14.0), and 0.57 (0.51–0.63) and 0.95 (0.91–0.98) for the high severity category (rCAST: ≥14.5). Conclusions The rCAST was useful for predicting the neurological outcomes with high accuracy in PCAS patients, and the three grades was developed for a risk classification based on the rCAST.
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- 2019
25. Lessons Learned in Helicopter Operations During a Large Multiagency Disaster Prevention Drill in Japan
- Author
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Yuki Saoyama, Youichi Yanagawa, Seiji Mimura, and Mitsunobu Nakamura
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Engineering ,Aircraft ,Aviation ,Natural Disasters ,Disaster Planning ,030204 cardiovascular system & hematology ,Emergency Nursing ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Aeronautics ,Cabinet (file format) ,Earthquakes ,Humans ,Natural disaster ,Government ,Drill ,Emergency management ,business.industry ,030208 emergency & critical care medicine ,Air Ambulances ,computer.file_format ,Tsunamis ,Emergency Medicine ,The Internet ,business ,computer ,Coast guard - Abstract
Objective In 2018, the Cabinet Office executed a disaster prevention drill based on the scenario that Nankai had a megathrust earthquake and a large tsunami hit Tokushima Prefecture. The purpose of this study was to summarize the key lessons learned in the review of the Department of Aviation Operation for Tokushima Prefecture in this drill. Methods This report was based on a review using data from the Japan emergency medical information sharing system that can be accessed via the Internet. Results In the disaster drill, the doctor helicopter (DH) headquarters of Tokushima Prefecture at Takamatsu Airport was able to procure 2 actual DHs and 2 mock DHs. The Department of Aviation Operation within the Tokushima Prefectural Government was able to procure 1 actual helicopter belonging to the Coast Guard and 8 mock helicopters (4 belonging to the military and 4 to the fire department). There were 29 flights, including actual and mock flights, and 44 victims were medically transported. Conclusion By making flight plans with each organization concerned, we were able to share the basic rules, concepts, and management approaches of flights among the responding organizations. Disaster planners should have at least a passing familiarity with the aviation capabilities of the local helicopter emergency medical service and other helicopter operations.
- Published
- 2019
26. ドクターヘリとドクターカーの分業による効果的な病院前診療についての検討(The investigation about an effective pre–hospital medicine, considering area division responded by Doctor–Heli or Doctor–Car)
- Author
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堀口 真仁 (Masahito Horiguchi), 町田 浩志 (Hiroshi Machida), 中野 実 (Minoru Nakano), 小橋 大輔 (Daisuke Kobashi), 小倉 崇以 (Takayuki Ogura), and 中村 光伸 (Mitsunobu Nakamura)
- Published
- 2018
27. Differential effect of mild therapeutic hypothermia depending on the findings of hypoxic encephalopathy on early CT images in patients with post-cardiac arrest syndrome
- Author
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Shigeyuki Matsui, Mitsunobu Nakamura, Kazuki Nishida, Kenji Fukaya, Keibun Liu, Mitsuaki Nishikimi, Naoyuki Matsuda, Kunihiko Takahashi, and Takayuki Ogura
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Emergency Nursing ,Targeted temperature management ,Gastroenterology ,Brain ct ,03 medical and health sciences ,0302 clinical medicine ,Hypothermia, Induced ,Internal medicine ,Humans ,Medicine ,In patient ,Post cardiac arrest ,Coma ,Hypoxia, Brain ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,fungi ,Brain ,030208 emergency & critical care medicine ,Recovery of Function ,Odds ratio ,Hypoxic Encephalopathy ,Middle Aged ,Hypothermia ,Cardiopulmonary Resuscitation ,Logistic analysis ,Emergency Medicine ,Female ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Out-of-Hospital Cardiac Arrest - Abstract
Introduction The aim of this study was to evaluate the differential effects of mild therapeutic hypothermia (MTH) in post-cardiac arrest syndrome (PCAS) patients depending on the presence/absence of hypoxic encephalopathy (HE) in the early brain CT images obtained before the initiation of MTH. Methods We conducted a retrospective review of the data of a total of 129 patients with PCAS who were treated by MTH (34 °C) or normothermia treatment (NT) (35 °C or 36 °C), and had undergone brain CT examination prior to the initiation of these treatments. We divided the subjects into 4 groups, namely, the HE(−)/MTH, HE(−)/NT, HE(+)/MTH, and HE(+)/NT groups, for evaluating the interaction effect between the two variables. Then, we compared the neurological outcomes between the HE(−)/MTH and HE(−)/NT groups by multivariate logistic analysis. Good outcome was defined as a Cerebral Performance Category score of ≤2 at 30 days. Results The percentages of subjects with a good outcome in the HE(−)/MTH and HE(−)/NT group were 68.9% (42/61) and 36.1% (13/36), respectively (p = .003), while those in the HE(+)/MTH and HE(+)/NT groups were lower, at 7.4% (2/27) and 20.0% (1/5), respectively (p = .410), suggesting a statistically significant interaction effect between the two variables (pinteraction = 0.002). In the HE(−) group, MTH was associated with a higher odds ratio of a good outcome as compared to NT (OR 6.80, 95% CI 1.19–38.96, p = .031). Conclusions The effect of MTH in patients with PCAS differed depending on the presence/absence of evidence of HE on the early CT images.
- Published
- 2018
28. Circularly polarized luminescence of helically assembled pyrene π-stacks on RNA and DNA duplexes
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Kazuo Akagi, Kazushige Yamana, Tadao Takada, Mitsunobu Nakamura, and Fuyuki Ota
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Luminescence ,010402 general chemistry ,Excimer ,01 natural sciences ,Catalysis ,Analytical Chemistry ,chemistry.chemical_compound ,Organophosphorus Compounds ,Drug Discovery ,Uridine ,Spectroscopy ,Pharmacology ,Pyrenes ,010405 organic chemistry ,Circular Dichroism ,Organic Chemistry ,Nucleic Acid Heteroduplexes ,RNA ,DNA ,Fluorescence ,0104 chemical sciences ,Crystallography ,chemistry ,Duplex (building) ,Pyrene - Abstract
In this report, we describe the circularly polarized luminescence (CPL) of the RNA duplexes having one to four 2′-O-pyrene modified uridines (Upy) and the DNA duplexes having two, four, and six pyrene modified non-nucleosidic linkers (Py). Both the pyrene π-stack arrays formed on the RNA and DNA double helical structures exhibited pyrene excimer fluorescence. In the pyrene-modified RNA systems, the RNA duplex having four Upys gives CPL emission with glum value of
- Published
- 2018
29. Photocurrent Enhancement in DNA-Scaffolded Chromophore-Aggregate-Functionalized Systems Containing Multiple Types of Chromophores
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Ayumi Jomura, Kazushige Yamana, Tadao Takada, and Mitsunobu Nakamura
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Photocurrent ,chemistry.chemical_compound ,Electron transfer ,Aggregate (composite) ,chemistry ,Organic Chemistry ,Physical and Theoretical Chemistry ,Chromophore ,Photochemistry ,DNA ,Analytical Chemistry - Published
- 2017
30. 新型コロナウイルス感染症による重症呼吸不全患者に対して搬送元病院でV–V ECMOを導入し,搬送を行った1例(Transportation of acute respiratory failure patient infected severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) with veno–venous ECMO: a case report)
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(Daisuke Kobashi), 小橋 大輔, primary, (Hiroyuki Suzuki), 鈴木 裕之, additional, (Kenji Fujizuka), 藤塚 健次, additional, (Yu Amemiya), 雨宮 優, additional, (Yoshie Kamio), 神尾 芳恵, additional, and (Mitsunobu Nakamura), 中村 光伸, additional
- Published
- 2020
- Full Text
- View/download PDF
31. Methicillin resistant staphylococcus aureus (MRSA)多発膿瘍経過中に発症し,ステロイドが著効したDrug reaction with eosinophilia and systemic symptoms(DRESS)の1例(A case report: Corticosteroid effective Drug reaction with eosinophilia and systemic symptoms (DRESS) due to antibiotics drugs)
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(Yoshihiko Takahashi), 高橋 慶彦, primary, (Takayuki Ogura), 小倉 祟以, additional, (Mitsunobu Nakamura), 中村 光伸, additional, (Hiroshi Machida), 町田 浩志, additional, (Hiroyuki Suzuki), 鈴木 裕之, additional, (Kenji Fujizuka), 藤塚 健次, additional, and (Yu Amemiya), 雨宮 優, additional
- Published
- 2020
- Full Text
- View/download PDF
32. 剖検にて頸胸髄の融解壊死を認めたクロルフェナピル中毒の1例(Chlorfenapyr poisoning with liquefactive necrosis of the cervical and thoracic cord: an autopsy case report)
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(Daisuke Kobashi), 小橋 大輔, primary, (Masahito Horiguchi), 堀口 真仁, additional, and (Mitsunobu Nakamura), 中村 光伸, additional
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- 2020
- Full Text
- View/download PDF
33. A Luminescent Perylenediimide as a Binding Ligand for Pyrimidine/Pyrimidine Mismatches Within a DNA Duplex
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Kazushige Yamana, Yu Umakoshi, Mitsunobu Nakamura, and Tadao Takada
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chemistry.chemical_classification ,Pyrimidine ,010405 organic chemistry ,Chemistry ,Stereochemistry ,Base pair ,General Chemistry ,010402 general chemistry ,Ligand (biochemistry) ,01 natural sciences ,Small molecule ,0104 chemical sciences ,chemistry.chemical_compound ,Duplex (building) ,A-DNA ,Nucleotide ,DNA - Abstract
Synthetic small molecules with a binding affinity to mismatched base pairs have been widely studied because of their potential applications in chemotherapeutic drugs and diagnostic tools for the detection of single nucleotide variations. In this paper, a luminescent ligand, a perylenediimide (PO) derivative, which is capable of binding to mismatched base pairs within a DNA duplex and generating a strong fluorescence upon the binding event, was demonstrated. Fluorescence enhancement of PO upon the binding to pyrimidine/pyrimidine mismatches were prominent and reached ca. 100-fold for a C/C mismatched base pair, which was visually observed. This result represents the best performance as a fluorescence turn-on response among the existing mismatch binding ligands.
- Published
- 2017
34. Ultrasound-Guided Resuscitative Endovascular Balloon Occlusion of the Aorta in the Resuscitation Area
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Mitsunobu Nakamura, Kenji Fujizuka, Minoru Nakano, Alan Kawarai Lefor, Takayuki Ogura, and Kousuke Shiroto
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Male ,Aortic arch ,medicine.medical_specialty ,Time Factors ,Resuscitation ,Aortic Diseases ,Hemorrhage ,Dissection (medical) ,Femoral artery ,030204 cardiovascular system & hematology ,Balloon ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,medicine ,Humans ,Radial artery ,Aorta ,Aged ,Retrospective Studies ,Ultrasonography ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Abdominal aorta ,030208 emergency & critical care medicine ,Balloon Occlusion ,Middle Aged ,medicine.disease ,Surgery ,Catheter ,Fluoroscopy ,Emergency Medicine ,Female ,Radiology ,business - Abstract
Background In trauma resuscitation with resuscitative endovascular balloon occlusion of the aorta (REBOA), urgent and accurate placement of the catheter in the resuscitation area without fluoroscopy can shorten the time from admission to REBOA, allowing rapid, temporary control of bleeding. Discussion The experience-based protocol in our center for ultrasound-guided REBOA in the resuscitation area without fluoroscopy is as follows: the femoral artery is punctured and a guidewire inserted; sonography is used to verify that the guidewire is in the abdominal aorta; the position of the balloon is confirmed with ultrasound after estimating the distance to the clavicle, and the pressure in the radial artery and sheath is used to monitor correct positioning; connect the pressure transducer to the catheter sheath for continuous monitoring of the blood pressure in the sheath, and inflate the balloon until the blood pressure tracing at the sheath has disappeared; check the pulse in the left radial artery, and withdraw the catheter slightly if the pulse in the radial artery is not palpable or is decreased (if this pulse is not palpable or decreased, the balloon is in the aortic arch). In this retrospective review of our REBOA protocol, between April 2012 and March 2016, 34 patients were enrolled. Two patients had complications, including dissection of the femoral artery in one and difficult percutaneous vascular access in another. Median time needed to complete the procedure was 8 min. Overall, 24 of 34 patients survived more than 24 h (72%), and overall mortality was 47%. Patients who lived more than 24 h, and then died had severe traumatic brain injury or septic shock. Conclusions Ultrasound-guided REBOA is presented. Monitoring the blood pressure in the left radial artery allows us to determine adequate positioning of the balloon, and the blood pressure in the catheter sheath located in the femoral artery should also be monitored to prevent aortic injuries caused by the overinflation of the balloon.
- Published
- 2017
35. Investigation of Japan Disaster Medical Assistance Team response guidelines assuming catastrophic damage from a Nankai Trough earthquake
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Kenichi Oshiro, Kazuma Morino, Tetsuro Kiyozumi, Mitsunobu Nakamura, Hideaki Anan, Masato Homma, Osamu Akasaka, Hisayoshi Kondo, Yuichi Koido, Yasuhiro Otomo, Norihiko Yamada, and Shinichi Nakayama
- Subjects
emergency hospital services ,transportation of patients ,Medical treatment ,intensive care units ,business.industry ,Critically ill ,General Engineering ,030208 emergency & critical care medicine ,Original Articles ,medicine.disease ,Medical care ,03 medical and health sciences ,0302 clinical medicine ,natural disasters ,Nankai trough ,Disaster medicine ,Patient Transport ,Intensive care ,medicine ,Original Article ,030212 general & internal medicine ,Medical emergency ,Natural disaster ,business - Abstract
Aim Transporting critically ill patients outside of disaster-affected areas for treatment is an important activity of Japan Disaster Medical Assistance Teams (DMATs). We investigated whether this activity is possible after possible catastrophic damage from a Nankai Trough earthquake. Methods Japan was divided into three areas based on the level of predicted damage (definitely, possibly, and non-affected areas). A survey of DMATs and the locations of emergency base hospitals and intensive care units (ICUs) in each area was carried out, and the ability to support disaster areas was investigated. Next, a survey of wide-area medical transport by Self-Defense Force aircraft and the medical transport abilities of helicopter ambulances was carried out. The numbers of ICU beds in each area were compared, and the capacity to accept patients was investigated. Finally, subjects for further study were examined. Results The number of DMATs that could be sent from non-affected areas was insufficient. The number of patients that can be transported by Self-Defense Force aircraft and helicopter ambulance during the first 3 days was determined to be 1,443. The number of patients that can be accepted by ICUs in non-affected areas was insufficient. A system needs to be developed to provide medical treatment for critically ill patients within disaster areas during the acute phase. This will require DMAT operational reforms and the creation of logistics systems such as the supply of resources for earthquake-reinforced hospitals. Conclusion In addition to patient transport, systems to provide medical care inside disaster-affected areas are needed.
- Published
- 2017
36. Photocurrent enhancement by a local electric field on DNA-modified electrodes covered with gold nanoparticles
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Kazushige Yamana, Tadao Takada, Kazue Syunori, and Mitsunobu Nakamura
- Subjects
Materials science ,Light ,Photochemistry ,Metal Nanoparticles ,02 engineering and technology ,Imides ,01 natural sciences ,Biochemistry ,Analytical Chemistry ,Electric field ,Electrochemistry ,Environmental Chemistry ,Irradiation ,Electrodes ,Perylene ,Spectroscopy ,Photocurrent ,business.industry ,010401 analytical chemistry ,DNA ,Electrochemical Techniques ,021001 nanoscience & nanotechnology ,0104 chemical sciences ,Colloidal gold ,Electrode ,Optoelectronics ,Gold ,0210 nano-technology ,business ,Excitation - Abstract
We here describe a photocurrent generation system exploiting gold nanoparticles (AuNPs) that cover perylenediimide-DNA complexes on electrode surfaces. Enhanced photocurrents were generated by the irradiation of the AuNPs, attributed to the efficient excitation of the perylenediimides by a local electric field on the surface of the AuNPs.
- Published
- 2019
37. Accurate and quick predictor of necrotizing soft tissue infection: Usefulness of the LRINEC score and NSTI assessment score
- Author
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Mitsunobu Nakamura, Keiko Kawai-Kowase, Jun'ichi Tamura, and Tomofumi Harasawa
- Subjects
0301 basic medicine ,Microbiology (medical) ,Male ,Multivariate statistics ,medicine.medical_specialty ,Scoring system ,030106 microbiology ,Logistic regression ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Clinical Decision Rules ,Medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Fasciitis, Necrotizing ,Aged ,Retrospective Studies ,Receiver operating characteristic ,business.industry ,Vital Signs ,Soft Tissue Infections ,Retrospective cohort study ,Odds ratio ,Middle Aged ,Infectious Diseases ,Logistic Models ,Risk indicator ,Case-Control Studies ,Soft tissue infection ,Female ,business - Abstract
Objective The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is a diagnostic tool for necrotizing soft tissue infection (NSTI), which is validated and is considered to have high diagnostic value. However, some experts criticize LRINEC score for consisting of laboratory test results only. Methods In this single-center retrospective study, we created a new scoring system (NSTI assessment score; NAS), which also incorporated vital signs as another diagnostic tool for NSTI using cases from our hospital and also evaluated diagnostic accuracy of LRINEC score. We identified NSTI predictors by comparing 24 NSTI patients and 80 non NSTI patients using uni- and multivariate logistic regression analysis, and created NAS based on odds ratio of variables which are statistically significant in the multivariate model. Results We identified mean arterial pressure, C-reactive protein, hemoglobin, serum creatinine, and glucose as a predictor for NSTI. The maximum value of NAS was 11 points with the cut-off value of 6. Sensitivity, specificity, positive predictive value, and negative predictive value of the NAS for diagnosis of NSTI were 87.5%, 91.3%, 75.0%, and 96.1%, respectively. Area under the receiver operating characteristic curve was 0.926 (0.851–1.00) for the NAS and 0.903 (0.833–0.973) for the LRINEC score, and they were not statistically different (p = 0.167). Conclusion The NAS has high diagnostic accuracy in predicting NSTI, and is comparable with the LRINEC score. The NAS needs to be validated in other cohorts in the future.
- Published
- 2019
38. Controlling Pyrene Association in DNA Duplexes by B- to Z-DNA Transitions
- Author
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Kazushige Yamana, Mitsunobu Nakamura, and Tadao Takada
- Subjects
Circular dichroism ,Stereochemistry ,010402 general chemistry ,01 natural sciences ,Biochemistry ,Fluorescence ,Z-DNA ,chemistry.chemical_compound ,DNA nanotechnology ,DNA, Z-Form ,Molecular Biology ,Fluorescent Dyes ,Molecular switch ,Pyrenes ,010405 organic chemistry ,Circular Dichroism ,Organic Chemistry ,Chromophore ,0104 chemical sciences ,chemistry ,Molecular Medicine ,Pyrene ,Nucleic Acid Conformation ,DNA, B-Form ,DNA - Abstract
B- to Z-DNA transitions play a crucial role in biological systems and have attracted the interest of researchers for their applications in DNA nanotechnology. DNA and DNA analogues have also been used as templates to construct helical chromophore associations with π interactions. In this work, the B- to Z-DNA transition-induced switching of pyrene in an association manner was evaluated using DNA duplexes with non-nucleosidic pyrene residues in the middle of d(CG) repeat sequences. One of the pyrene-labeled DNAs was shown to exhibit inverted exciton coupled circular dichroism signals upon pyrene association through a B- to Z-DNA transition. This observation indicates that pyrene association switches the DNA conformation from right- to left-handed. Interestingly, the fluorescence of the pyrene-labeled DNA duplex also dynamically changed upon switching of the pyrene in an association-based manner. Taken together, these studies demonstrate that pyrene-labeled DNA shows promise as a chiroptical molecular switch.
- Published
- 2019
39. Templated Arrays of Multichromophores and Oligonucleotides Supported by Metal Interactions and Their Functional Relevance
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Mitsunobu Nakamura, Kazushige Yamana, and Tadao Takada
- Subjects
Metal ,Materials science ,Oligonucleotide ,visual_art ,visual_art.visual_art_medium ,Nanotechnology ,Relevance (information retrieval) - Published
- 2019
40. Role of disseminated intravascular coagulation in severe sepsis
- Author
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Satoshi Gando, Atsushi Shiraishi, Kazuma Yamakawa, Hiroshi Ogura, Daizoh Saitoh, Seitaro Fujishima, Toshihiko Mayumi, Shigeki Kushimoto, Toshikazu Abe, Yasukazu Shiino, Taka-aki Nakada, Takehiko Tarui, Toru Hifumi, Yasuhiro Otomo, Kohji Okamoto, Yutaka Umemura, Joji Kotani, Yuichiro Sakamoto, Junichi Sasaki, Shin-ichiro Shiraishi, Kiyotsugu Takuma, Ryosuke Tsuruta, Akiyoshi Hagiwara, Tomohiko Masuno, Naoshi Takeyama, Norio Yamashita, Hiroto Ikeda, Masashi Ueyama, Satoshi Fujimi, Osamu Tasaki, Yasumitsu Mizobata, Hiraku Funakoshi, Toshiro Okuyama, Iwao Yamashita, Toshio Kanai, Yasuo Yamada, Mayuki Aibiki, Keiji Sato, Susumu Yamashita, Kenichi Yoshida, Shunji Kasaoka, Akihide Kon, Hiroshi Rinka, Hiroshi Kato, Hiroshi Okudera, Eichi Narimatsu, Toshifumi Fujiwara, Manabu Sugita, Yasuo Shichinohe, Hajime Nakae, Ryouji Iiduka, Yuji Murata, Mitsunobu Nakamura, Yoshitake Sato, Hiroyasu Ishikura, Yasuhiro Myojo, Yasuyuki Tsujita, Kosaku Kinoshita, Hiroyuki Yamaguchi, Toshihiro Sakurai, Satoru Miyatake, Takao Saotome, Susumu Yasuda, and Yasuaki Mizushima
- Subjects
Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Aged ,Retrospective Studies ,Disseminated intravascular coagulation ,Aged, 80 and over ,Septic shock ,business.industry ,Mortality rate ,Incidence (epidemiology) ,Organ dysfunction ,Hematology ,Disseminated Intravascular Coagulation ,Middle Aged ,medicine.disease ,Log-rank test ,030220 oncology & carcinogenesis ,Female ,medicine.symptom ,Multiple organ dysfunction syndrome ,business ,circulatory and respiratory physiology - Abstract
Background Disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome (MODS) plays pivotal roles in severe sepsis. Objectives We performed a multicenter, prospective data collection study and retrospectively analyzed the data to confirm the role of DIC in severe sepsis. Methods Eligible patients were ICU patients who met the definitions of severe sepsis, and 1013 patients were included. DIC scores as well as disease severity and the development of MODS on the day of the diagnosis of severe sepsis (day 0) and at day 3 were evaluated. The primary outcome was hospital mortality, and MODS on days 0 and 3 was the secondary outcomes. Results The overall mortality rate of severe sepsis was 21.5%, and the prevalence of DIC was 50.9% (516/1013). DIC patients were more seriously ill and exhibited a higher prevalence of MODS (32.0% vs. 13.1%) on day 0 and worse mortality rate (24,8% vs. 17.5%) than non-DIC patients. DIC patients also showed a lower survival probability than non-DIC patients (Log rank p = 0.028). Logistic regression analyses after propensity score adjustment for potential confounders confirmed a significant association between DIC and MODS and hospital death in the patients with severe sepsis. The new development of DIC and persistent DIC from days 0 to 3 were associated with a high incidence of MODS and low survival probability. Conclusions The mortality rate of severe sepsis has been improved; however, DIC is still associated with the poor prognosis of these patients. Evaluating the dynamic changes in the DIC status may improve the prediction capability.
- Published
- 2019
41. Abstract 04: The Most Accurate Massive Transfusion Prediction Score at the Scene of Injury: The Pre-Hospital Traumatic Bleeding Severity Score
- Author
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Minoru Nakano, Takayuki Ogura, Kenji Fujizuka, Keibun Liu, Mitsunobu Nakamura, and Hiroshi Machida
- Subjects
Resuscitation ,Prediction score ,medicine.medical_specialty ,Ideal (set theory) ,MT protocol ,business.industry ,Physiology (medical) ,Emergency medicine ,medicine ,Early activation ,Cardiology and Cardiovascular Medicine ,business ,Massive transfusion - Abstract
Background: Determination of the need for massive transfusion (MT) at the scene of injury is ideal for early activation of a MT protocol. We created and reported The Pre-hospital Traumatic Bleeding Severity Score (ph-TBSS) that is a simple and highly accurate scoring system to predict the need for MT at the scene of injury. However, the comparison study about the predictive value between the ph-TBSS and other MT predictors is not performed. Patients and Methods: A diagnostic comparison study using the registry data of the Gunma Prefectural Helicopter Emergency Medical Service (HEMS) was conducted. Records between Sep. 2012 and Apr. 2017 were reviewed, and adult trauma patients transported by the HEMS were included. A physician in the HEMS is always on board, primary survey including abdominal sonography scanning is performed at the scene of injury, and lactate was measured by portable equipment. The potential predictors of MT (10 units or more of packed red blood cells transfusion within 24 hours of injury) at the scene of injury were defined as following; The ph-TBSS, Assessment of Blood Consumption (ABS) score, the shock index, lactate concentration, and the presence of cold sweat. Each predictor was retrospectively calculated or reviewed from the registry data. Each predictive value was analyzed by the area under the receiver operating characteristic curve (AUROC) and the AUROC comparison analysis was performed. Results: 1025 patients were analyzed. Each AUROC for MT was following; ph-TBSS vs ABC score vs shock index vs lactate concentration vs presence of cold sweat = 0.97 [0.96-0.98] vs 0.83 [0.81-0.85] vs 0.89 [0.87-0.91] vs 0.91 [0.90-0.93] vs 0.70 [0.67-0.72]. The AUROC of the ph-TBSS was significantly higher compared to the AUROC of the other predictors (Bonferroni adjusted p Conclusion: At the scene of injury, the ph-TBSS represented the highest predictive value for MT, compared to the ABC score, shock index, lactate concentration, or presence of cold sweat.
- Published
- 2018
42. DNA-Templated Synthesis of Perylenediimide Stacks Utilizing Abasic Sites as Binding Pockets and Reactive Sites
- Author
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Mitsunobu Nakamura, Misa Ido, Akane Ashida, Kazushige Yamana, and Tadao Takada
- Subjects
Biosensing Techniques ,Imides ,010402 general chemistry ,01 natural sciences ,Biochemistry ,Reductive amination ,chemistry.chemical_compound ,Functional importance ,Binding site ,Perylene ,Molecular Biology ,chemistry.chemical_classification ,Binding Sites ,Bioconjugation ,Molecular Structure ,010405 organic chemistry ,Biomolecule ,Organic Chemistry ,DNA ,Chromophore ,Combinatorial chemistry ,0104 chemical sciences ,chemistry ,Molecular Medicine ,Hydrophobic and Hydrophilic Interactions ,Biosensor - Abstract
DNA is considered to be a promising biomolecule as a template and scaffold for arranging and organizing functional molecules on the nanoscale. The construction and evaluation of DNAs containing multiple functional molecules that are useful for optoelectronic devices and sensors has been studied. In this paper we report the efficient incorporation of perylenediimide (PDI) units into DNA by using abasic sites both as binding sites and as reactive sites and the construction of PDI stacks within the DNA structure, accomplished through the preorganization of the PDI units in the hydrophobic pocket within the DNA. Our approach could become a valuable method for construction of DNA/chromophore hybrid structures potentially useful for the design of DNA-based devices and biosensors.
- Published
- 2016
43. Aeromedical Transport Operations Using Helicopters during the 2016 Kumamoto Earthquake in Japan
- Author
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Tomokazu Motomura, Mitsunobu Nakamura, Hideaki Anan, Hisayoshi Kondo, Atsushi Hirabayashi, Hiroshi Machida, Hisashi Matsumoto, Naomi Otsuka, Nobutaka Yamauchi, Yuichi Koido, Kenji Fujizuka, and Tomoko Satoh
- Subjects
Male ,Emergency Medical Services ,Time Factors ,Aviation ,media_common.quotation_subject ,Earthquake disaster ,Nurses ,Disaster Planning ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Pregnancy ,Physicians ,medicine ,Command and control ,Earthquakes ,Humans ,030212 general & internal medicine ,media_common ,Government ,Emergency management ,business.industry ,030208 emergency & critical care medicine ,General Medicine ,Air Ambulances ,medicine.disease ,Satellite Communications ,Transportation of Patients ,Management system ,Government Office ,Female ,Medical emergency ,business ,Welfare ,Delivery of Health Care - Abstract
More than 6,000 people died in the Great Hanshin (Kobe) Earthquake in 1995, and it was later reported that there were around 500 preventable trauma deaths. In response, the Japanese government developed the helicopter emergency medical service in 2001, known in Japan as the "Doctor-Heli" (DH), which had 46 DHs and 2 private medical helicopters as of April 2016. DHs transport physicians and nurses to provide pre-hospital medical care at the scene of medical emergencies. Following lessons learned in the Great East Japan Earthquake in 2011, a research group in the Ministry of Health, Labour and Welfare developed a command and control system for the DH fleet as well as the Disaster Relief Aircraft Management System Network (D-NET), which uses a satellite communications network to monitor the location of the fleet and weather in real-time during disasters. During the Kumamoto Earthquake disaster in April 2016, 75 patients were transported by 13 DHs and 1 private medical helicopter in the first 5 days. When medical demand for the DHs exceeded supply, 5 patients, 8 patients, and 1 patient were transported by Self-Defense Force, Fire Department, and Coast Guard helicopters, respectively. Of the 89 patients who were transported, 30 (34%) had trauma, 3 (3%) had pulmonary embolisms caused by sleeping in vehicles, and 17 (19%) were pregnant women or newborns. This was the first time that the command and control system for aeromedical transport and D-NET, established after the Great East Japan Earthquake in 2011, were operated in an actual large-scale disaster. Aeromedical transport by DHs and helicopters belonging to several other organizations was accomplished smoothly because the commanders of the involved organizations could communicate directly with each other in person within the Aviation Coordination Section of the prefectural government office. However, ongoing challenges in the detailed operating methods for aeromedical transport were highlighted and include improving shared knowledge and training across the organizational framework. These are particularly important issues to address given the Nankai Trough and Tokyo inland earthquakes that are predicted for the near future in Japan.
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- 2018
44. Rapid Electron Transfer of Stacked Heterodimers of Perylene Diimide Derivatives in a DNA Duplex
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Kazushige Yamana, Mitsunobu Nakamura, Ami Takata, Mamoru Fujitsuka, Tadao Takada, Syunya Ishino, and Tetsuro Majima
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Fluorophore ,010405 organic chemistry ,Base pair ,Dimer ,Organic Chemistry ,General Chemistry ,DNA ,010402 general chemistry ,Photochemistry ,Imides ,01 natural sciences ,Fluorescence ,Catalysis ,0104 chemical sciences ,Electron Transport ,chemistry.chemical_compound ,Electron transfer ,chemistry ,Diimide ,A-DNA ,Base Pairing ,Dimerization ,Perylene ,Fluorescent Dyes - Abstract
The preparation of homo- and heterocomplexes composed of the parent perylene diimide (PH) and pyrrolidine-substituted perylene diimide (PN) in DNA and rapid electron transfer in these complexes, which has been analyzed by steady-state fluorescence and femtosecond transient absorption measurements, have been demonstrated. The DNA molecules possessing PH and PN were prepared through a recently developed method that involved the reaction of enzymatically generated abasic sites with the amino groups of the perylene diimide molecules, through which these molecules can be incorporated as base surrogates within the DNA base stack. Melting temperature analysis showed that the PH and PN monomers, and their homo- and heterodimers, contribute to the stabilization of the DNA duplex, and is comparable to that of natural base pairs. Fluorescence measurements showed that PH in a single-stranded oligopyrimidine showed a strong fluorescence, whereas the fluorescence of PH was completely quenched upon pairing with PN (PH/PN) through duplex formation. The transient absorption measurements showed that a rapid electron-transfer reaction in the stacked PH/PN heterodimer occurred on a sub-picosecond timescale, which allowed highly efficient fluorescence quenching. The PH/PN pair, which served as a fluorophore and quencher, were utilized to design molecular beacon probes with a high signal/noise ratio. The PH/PN pair was also capable of forming a stable, stacked dimer structure and induced rapid electron transfer that could serve as a good signal reporter for fluorescent nucleic acid detection.
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- 2018
45. Accuracy of the first interpretation of early brain CT images for predicting the prognosis of post-cardiac arrest syndrome patients at the emergency department
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Hideo Morita, Mitsunobu Nakamura, Kunihiko Takahashi, Keibun Liu, Takayuki Ogura, Naoyuki Matsuda, Shigeyuki Matsui, Kota Matsui, Mitsuaki Nishikimi, and Kenji Fukaya
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medicine.medical_specialty ,Post-cardiac arrest syndrome ,Concordance ,medicine.medical_treatment ,Targeted temperature management ,Critical Care and Intensive Care Medicine ,law.invention ,Brain ct ,03 medical and health sciences ,0302 clinical medicine ,Cohen's kappa ,McNemar's test ,law ,medicine ,Neurological prognosis ,Brain CT scan ,business.industry ,Research ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,Emergency department ,Cardiac arrest ,Intensive care unit ,Emergency medicine ,Observational study ,business ,030217 neurology & neurosurgery - Abstract
Background Early brain CT is one of the most useful tools for estimating the prognosis in patients with post-cardiac arrest syndrome (PCAS) at the emergency department (ED). The aim of this study was to evaluate the prognosis-prediction accuracy of the emergency physicians’ interpretation of the findings on early brain CT in PCAS patients treated by targeted temperature management (TTM). Methods This was a double-center, retrospective, observational study. Eligible subjects were cardiac arrest patients admitted to the intensive care unit (ICU) for TTM between April 2011 and March 2017. We performed the McNemar test to compare the predictive accuracies of the interpretation by emergency physicians and radiologists and calculated the kappa statistic for determining the concordance rate between the interpretations by these two groups. Results Of the 122 eligible patients, 106 met the inclusion criteria for this study. The predictive accuracies (sensitivity, specificity) of the interpretations by the emergency physicians and radiologists were (0.34, 1.00) and (0.41, 0.93), respectively, with no significant difference in either the sensitivity or specificity as assessed by the McNemar test. The kappa statistic calculated to determine the concordance between the two interpretations was 0.66 (0.48–0.83), which showed a good conformity. Conclusions The emergency physicians’ interpretation of the early brain CT findings in PCAS patients treated by TTM was as reliable as that of radiologists, in terms of prediction of the prognosis.
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- 2018
46. ドクターヘリとドクターカーの分業による効果的な病院前診療についての検討(The investigation about an effective pre–hospital medicine, considering area division responded by Doctor–Heli or Doctor–Car)
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(Daisuke Kobashi), 小橋 大輔, primary, (Takayuki Ogura), 小倉 崇以, additional, (Masahito Horiguchi), 堀口 真仁, additional, (Hiroshi Machida), 町田 浩志, additional, (Mitsunobu Nakamura), 中村 光伸, additional, and (Minoru Nakano), 中野 実, additional
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- 2018
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47. Photoresponsive DNA Monolayer Prepared by Primer Extension Reaction on the Electrode
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Kazushige Yamana, Yuta Kawano, Mai Takemura, Mitsunobu Nakamura, and Tadao Takada
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Photocurrent ,Photochemistry ,Chemistry ,Substrate (chemistry) ,Nanotechnology ,DNA ,Surfaces and Interfaces ,Condensed Matter Physics ,Combinatorial chemistry ,Primer extension ,chemistry.chemical_compound ,Monolayer ,Electrochemistry ,Molecule ,General Materials Science ,Photosensitizer ,Primer (molecular biology) ,Deoxyuracil Nucleotides ,Electrodes ,Spectroscopy - Abstract
We describe a simple and convenient method for the preparation of photoresponsive DNA-modified electrodes using primer extension (PEX) reactions. A naphthalimide derivative was used as the photosensitizer that was attached to the C5-position of 2'-deoxyuridine-5'-triphosphate (dUTP(NI)). It has been found that dUTP(NI) is a good substrate for the PEX reactions using KOD Dash and Vent (exo-) enzymes in solutions to incorporate naphthalimide (NI) moieties into the DNA sequences. On the electrode surface immobilized with the primer/template DNA, the PEX reactions to incorporate dUTP(NI) molecules into the DNA sequence were found to efficiently proceed. With this solid-phase method, the DNA monolayers capable of generating photocurrent due to the photoresponsive NI molecule can be constructed. It was shown that the photocurrent generation was significantly suppressed by a single-nucleotide mismatch included in the primer/template DNA, which is applicable for the design of photoelectrochemical sensors to discriminate single-nucleotide sequences.
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- 2015
48. Photocurrent Generation through Charge-Transfer Processes in Noncovalent Perylenediimide/DNA Complexes
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Mamoru Fujitsuka, Akane Ashida, Kazushige Yamana, Kiyohiko Kawai, Tadao Takada, Misa Ido, Tetsuro Majima, and Mitsunobu Nakamura
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Photocurrent ,Binding Sites ,Base Sequence ,Base pair ,Chemistry ,Molecular Sequence Data ,Organic Chemistry ,Cationic polymerization ,DNA ,Electrochemical Techniques ,General Chemistry ,Chromophore ,Imides ,Photochemical Processes ,Photochemistry ,Catalysis ,Electron Transport ,Photoexcitation ,Electrode ,Flash photolysis ,Molecule ,Coloring Agents ,Base Pairing ,Electrodes ,Perylene - Abstract
The charge-transfer process in noncovalent perylenediimide (PDI)/DNA complexes has been investigated by using nanosecond laser flash photolysis (LFP) and photocurrent measurements. The PDI/DNA complexes were prepared by inclusion of cationic PDI molecules into the artificial cavities created inside DNA. The LFP experiments showed that placement of the PDI chromophore at a specific site and included within the base stack of DNA led to the efficient generation of a charge-separated state with a long lifetime by photoexcitation. When two PDI chromophores were separately placed at different positions in DNA, the yield of the charge-separated state with a long lifetime was dependent upon the number of A-T base pairs between the PDIs, which was explained by electron hopping from one PDI to another. Photocurrent generation of the DNA-modified electrodes with the complex was also dependent upon the arrangement of the PDI chromophores. A good correlation was obtained between observed charge separation and photocurrent generation on the PDI/DNA-modified electrodes, which demonstrated the importance of the defined arrangement and assembly of organic chromophores in DNA for efficient charge separation and transfer in multichromophore arrays.
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- 2015
49. A case of fulminant pseudomembranous colitis leading to cardiac arrest
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Takayuki Ogura, Tomofumi Harasawa, Minoru Nakano, Eiji Takahashi, Dai Miyazaki, Osamu Otsuka, Kenji Fujizuka, and Mitsunobu Nakamura
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medicine.medical_specialty ,business.industry ,Internal medicine ,Fulminant ,medicine ,Pseudomembranous colitis ,business ,Gastroenterology - Published
- 2015
50. A rare complication with feeding tube insertion: a case of intramural esophageal dissection
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Minoru Nakano, Satoshi Okamori, Tomofumi Harasawa, Yu Amemiya, Mitsunobu Nakamura, Yoshihiko Nakamura, Kenji Fujizuka, and Kenichi Iizuka
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medicine.medical_specialty ,Feeding tube insertion ,business.industry ,General surgery ,medicine ,Dissection (medical) ,business ,Complication ,medicine.disease ,Surgery - Published
- 2015
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