Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Myocardial ischemic events after non-cardiac surgery is still a serious problem, especially in older, high-risk patients. However, the prevalence and risk factors of blood pressure (BP) abnormalities, which may possibly lead to myocardial ischemic attack, have not been reported. Our aim is to elucidate predictive factors of postoperative BP abnormalities following a minor-to-moderate surgery, employing preoperative left ventricular diastolic function. Patients who underwent cardiac echocardiogram examination and received oral and maxillofacial surgery under general anesthesia were enrolled. The echocardiographic parameters of diastolic function were compared between patients who had postoperative BP abnormalities (hypertension-systolic blood pressure [SBP] ≥ 170 mmHg-or hypotension-SBP < 80 mmHg-episode) that required therapeutic interventions until 7 days after surgery and those who had no BP abnormalities. Of the 173 patients analyzed, 25 (14.4%) had BP abnormalities. BP abnormalities patients were older, having a larger proportion of diabetes mellitus, lower E/A ratio and e', and larger E/e' and left atrial dimension than those without BP abnormalities. Subanalyses revealed that the independent risk factors responsible for hypertension episodes (14 patients) were the mean e' (odd ratio [OR]: 0.434; 95% confidence interval [CI]: 0.229-0.824), diabetes mellitus (OR: 5.018; 95% CI: 1.030-24.436), SBP at hospitalization (OR: 1.099; 95% CI: 1.036-1.165), and operation time (hour; OR: 1.326; 95%CI: 1.109-1.586), while hypotension episodes (11 patients) were associated solely with operation time (OR: 1.206; 95% CI: 1.046-1.391). In conclusion, left ventricular diastolic dysfunction, increased insulin resistance, boosted SBP at hospitalization, and prolonged operation should be taken into consideration as risk factors of postoperative BP abnormalities, especially hypertension, following minor-to-moderate surgery.

DOI： 10.1536/ihj.17-612

PubMed

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

18p-症候群は，18番染色体短腕の欠失により生じる染色体異常症候群であり，精神遅滞や言語の遅れが報告されている．また，全身麻酔に関しては心臓血管疾患の評価が推奨されている．われわれは精神遅滞と肺高血圧症を有する18p-症候群患者の全身麻酔管理下での下顎埋伏智歯抜歯術を経験したので報告する．
患者は22歳男性で，かかりつけ歯科医で下顎両側埋伏智歯周囲炎の診断を受けた．歯科医は患者の行動を管理することが困難と判断し，当院口腔外科に紹介され，行動管理目的に全身麻酔管理下での抜歯が計画された．
本症例は精神遅滞と肺高血圧症を有する18p-症候群患者であった．そのため，心臓血管内科医に術前の循環動態の評価を依頼し，麻酔中の循環動態の管理についても入念に術前検討を行った．また，精神遅滞に伴う興奮による循環動態の変動を防ぐために麻酔前後の行動管理の方法に関して小児科医とも十分に協議した．
入室時の興奮を避け，肺血管抵抗の上昇による肺高血圧症の悪化を避けるために鎮静下で手術室に入室した．肺高血圧症の管理に準じた麻酔管理下で下顎埋伏智歯抜歯を行った．
本症例を通じて，精神遅滞と肺高血圧症を有する18p-症候群患者に安全な全身麻酔下での治療を行うためには，患者の精神愛護に配慮し循環動態の変動を避けることが重要であり，その周術期の管理計画立案については各専門診療科医との術前の協議が不可欠であると考えられた．

DOI： 10.14958/jjsdh.39.28

Other Link： https://doi.org/10.14958/jjsdh.39.28

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Endothelial dysfunction is observed in several cardiovascular diseases, where endothelium-dependent vasodilation is impaired by oxidative stress. However, the time course of endothelial function during the perioperative period of a minor-to-moderate surgery, and the effects of atherosclerotic risk factors and employed general anesthetics on recovery of endothelial function, are unknown. Endothelial function of 30 patients was evaluated as the reactive hyperemia index (RHI) of reactive hyperemia peripheral arterial tonometry. RHI was measured on day before surgery (control), immediately after surgery (Day 0), day after surgery (Day 1), and day 4 after surgery (Day 4) in patients with no functional limitations who were scheduled for oral and maxillofacial surgery of around 3 hours. Sevoflurane- or propofol-based anesthesia supplemented with an opioid analgesic remifentanil was employed. The control RHI was 2.26 ± 0.64. The RHI significantly decreased to the lowest level on Day 0 (1.52 ± 0.28), recovered on Day 1 (2.07 ± 0.58), and improved further on Day 4 (2.55 ± 0.83). Multiple linear regression analysis revealed that recovery of the RHI from Day 0 to Day 4 was impaired by diabetes mellitus (P = 0.0313), obesity (BMI ≥ 25; P = 0.0166), hyperuricemia (uric acid ≥ 6.0 mg/dL; P = 0.0416) and sevoflurane-based anesthesia (P = 0.0308). These findings suggest that endothelial function as evaluated by the RHI is severely suppressed on the day of a minor-to-moderate surgery, and that it improves until the 4th postoperative day on average. Recovery of endothelial function is impaired by diabetes mellitus, obesity, hyperuricemia, and sevoflurane-based anesthesia.

DOI： 10.1536/ihj.17-143

PubMed

Other Link： https://www.jstage.jst.go.jp/article/ihj/59/3/59_17-143/_article

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

Background:
Dopamine receptors comprise two subgroups, Gs protein-coupled “D1-like” receptors (D1, D5) and Gicoupled “D2-like” receptors (D2, D3, D4). In airways, both dopamine D1 and D2 receptors are expressed on airway smooth muscle and regulate airway smooth muscle force. However, functional expression of the dopamine D1 receptor has never been identified on airway epithelium. Activation of Gs-coupled receptors stimulate adenylyl cyclase leading to cyclic AMP (cAMP) production, which is known to induce mucus overproduction through the cAMP response element binding protein (CREB) in airway epithelial cells. We questioned whether the dopamine D1 receptor is expressed on airway epithelium, and whether it promotes CREB phosphorylation and MUC5AC expression.
Methods:
We evaluated the protein expression of the dopamine D1 receptor on native human airway epithelium and three sources of cultured human airway epithelial cells including primary cultured airway epithelial cells, the bronchial epithelial cell line (16HBE14o-), and the pulmonary mucoepidermoid carcinoma cell line (NCI-H292) using immunohistochemistry and immunoblotting. To characterize the stimulation of cAMP through the dopamine D1 receptor, 16HBE14o- cells and NCI-H292 cells were treated with dopamine or the dopamine D1 receptor agonists (SKF38393 or A68930) before cAMP measurements. The phosphorylation of CREB by A68930 in both 16HBE14o- and NCI-H292 cells was measured by immunoblot. The effect of dopamine or A68930 on the expression of MUC5AC mRNA and protein in NCI-H292 cells was evaluated by real-time PCR and immunofluorescence staining, respectively.
Results:
The dopamine D1 receptor protein was detected in native human airway epithelium and three sources of cultured human airway epithelial cells. Dopamine or the dopamine D1-like receptor agonists stimulated cAMP production in 16HBE14o- cells and NCI-H292 cells, which was reversed by the selective dopamine D1-like receptor antagonists (SCH23390 or SCH39166). A68930 significantly increased phosphorylation of CREB in both 16HBE14o- and NCI-H292 cells, which was attenuated by the inhibitors of PKA (H89) and MEK (U0126). Expression of MUC5AC mRNA and protein were also increased by either dopamine or A68930 in NCI-H292 cells.
Conclusions:
These results suggest that the activation of the dopamine D1 receptor on human airway epithelium could induce mucus overproduction, which could worsen airway obstructive symptoms.

DOI： 10.1186/s12931-018-0757-4

PubMed

Other Link： https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-018-0757-4

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Background:
Secretion of hormones, which antagonize the action of insulin, is facilitated in response to surgery, and acute resistance to the action of insulin develops. Our aim is to elucidate the effects of intraoperative glycemic control by glucose-insulin (GI) infusion on postoperative complications and outcomes in major oral and maxillofacial surgery.
Findings:
Thirty patients aged ≥ 60 years undergoing a radical operation of oral malignant tumors with tissue reconstruction (≥ 8 h) were analyzed. In the GI group, regular insulin was continuously applied with glucose-added acetate Ringer's solution (5-10 g glucose per 500 mL). Blood glucose was adjusted within the target concentration of 80-120 mg/dL. In the control group, combination of acetate Ringer's solution containing 1% (W/V) glucose and lactate Ringer's solution, which contains no glucose, was employed. Perioperative clinical parameters, incidence of hypoalbuminemia, and postoperative complications, i.e., surgical site infection, necrosis of a reconstructed flap, bacteremia, hypotension, or pneumonia, were compared. Both serum total protein and albumin concentrations (postoperative day 1 [Day1]) were higher in the GI group. The mean infusion rate of glucose during surgery (mg/kg/h) was independently associated with the decrease in both serum total protein and albumin concentrations from the control to Day1. No difference was found between the groups in the incidence of postoperative complications and the days required until discharge, except less incidence of hypoalbuminemia in the GI group.
Conclusions:
Application of additional glucose during major oral and maxillofacial surgery preserved serum albumin concentration. However, it did not lead to less postoperative complications and less days until discharge.

DOI： 10.1186/s40981-018-0148-3

PubMed

Other Link： https://jaclinicalreports.springeropen.com/articles/10.1186/s40981-018-0148-3

Total pages：599   Responsible for pages：366-372   Language：Japanese Book type：Textbook, survey, introduction

Total pages：254   Responsible for pages：59-66   Language：Japanese Book type：Textbook, survey, introduction

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：東京臨床出版(株)  

小児歯科治療時に全身的偶発症を生じ、残念ながら不幸な転帰をたどった事例が度々報道され、われわれ歯科医師だけでなく、社会的な関心事にもなっている。
最近の事例をふりかえると、①平成12年（2000年）福岡市南区において、２歳児に複数の歯科医師が輪番でう歯の治療を行い、死亡した事例（抑制下、局所麻酔下、ラバーダム装着下に約1時間の歯科治療）や、②平成14年（2002年）埼玉県深谷市において、4歳児がリドカインによるアナフィラキシーショックで死亡した事例（局所麻酔下、ラバーダム装着下）1）などをきっかけとして、平成15年（2003年）以降は、日本小児歯科学会において専門医・認定医を対象とする小児の救急蘇生法講習会が定期的に開催されるようになり、学会員に緊急事態における基本的な知識や初期対応の学習機会が設けられた[平成21年（2009年）で終了]。しかしその後も、③平成16年（2004年）大阪市において２歳８か月のトリーチャー・コリンズ症候群患児が、歯科治療中に窒息死した事例2）、④平成29年（2017年）7月、福岡県において２歳児の死亡事例（抑制下、局所麻酔下、ラバーダムを装着下で約1時間の歯科治療）が起こっている。④の事例は、急性リドカイン中毒による低酸素脳症とされている。日本小児歯科学会は平成30年１月17日付けで、レストレーナーやタオル等で身体抑制下に治療を行う際は、パルスオキシメーターを含む生体モニターで監視すること等を明記した文書を公開している。
これらの4例の共通点は、未就学の年少児に対して、抑制下にラバーダム装着下の歯科治療が行われていることであるが、そのような症例は日本中で数えきれないほどあり、ほとんどは安全に歯科治療が行えているので、単純に抑制がいけないとか、ラバーダムがいけないという議論は的を射ていない。アナフィラキシーショックと確定しているのは②の1例のみであるが、局所麻酔薬、表面麻酔薬や歯科薬剤によるアレルギー反応が関連する病態では、幼児は舌や上気道粘膜の浮腫により容易に上気道の狭窄をきたし、もともと機能的残気量が少なく、手術室のように投与している酸素濃度も高くないので、気道狭窄あるいは閉塞するとごく短時間のうちに低酸素血症に陥り心停止に至るのであろう。

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Event date： 2019.3

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：鹿児島市  

Event date： 2018.11

Language：Japanese   Presentation type：Poster presentation  

Venue：東京都  

Event date： 2018.10

Language：Japanese   Presentation type：Poster presentation  

Venue：奈良市  

Event date： 2018.7

Language：Japanese   Presentation type：Poster presentation  

Venue：北九州市  

Event date： 2018.7

Language：Japanese   Presentation type：Poster presentation  

Venue：北九州市  

Award type：Award from Japanese society, conference, symposium, etc.  Country：Japan

　近年高齢者で、心臓が硬くて広がりにくい（左室拡張障害）ため、見かけの心機能は保たれているのに心不全症状を呈する患者さんが増加しています。私たちは、左室拡張障害がある患者さんでは、歯科手術後に異常高血圧や心筋虚血を生じやすいことを報告しています。
　本研究では、指先で簡便に測定できる加速度脈波加齢指数（AGI）が、左室拡張機能を表す僧帽弁輪移動速度に相関し、僧帽弁輪移動速度に独立して影響を与えることを明らかにしました。