研究者詳細 - 森松　博史

論文 - 森松　博史

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Consistently low levels of histidine-rich glycoprotein as a new prognostic biomarker for sepsis: A multicenter prospective observational study 査読

Naoya Kawanoue, Kosuke Kuroda, Hiroko Yasuda, Masahiko Oiwa, Satoshi Suzuki, Hidenori Wake, Hiroki Hosoi, Masahiro Nishibori, Hiroshi Morimatsu

PLOS ONE 18 ( 3 ) e0283426 - e0283426 2023年3月

掲載種別：研究論文（学術雑誌）出版者・発行元：Public Library of Science (PLoS)

Background

Few sepsis biomarkers accurately predict severity and mortality. Previously, we had reported that first-day histidine-rich glycoprotein (HRG) levels were significantly lower in patients with sepsis and were associated with mortality. Since the time trends of HRG are unknown, this study focused on the time course of HRG in patients with sepsis and evaluated the differences between survivors and non-survivors.

Methods

A multicenter prospective observational study was conducted involving 200 patients with sepsis in 16 Japanese hospitals. Blood samples were collected on days 1, 3, 5, and 7, and 28-day mortality was used for survival analysis. Plasma HRG levels were determined using a modified quantitative sandwich enzyme-linked immunosorbent assay.

Results

First-day HRG levels in non-survivors were significantly lower than those in survivors (mean, 15.7 [95% confidence interval (CI), 13.4–18.1] vs 20.7 [19.5–21.9] μg/mL; P = 0.006). Although there was no time × survivors/non-survivors interaction in the time courses of HRG (P = 0.34), the main effect of generalized linear mixed models was significant (P < 0.001). In a univariate Cox proportional hazards model with each variable as a time-dependent covariate, higher HRG levels were significantly associated with a lower risk of mortality (hazard ratio, 0.85 [95% CI, 0.78–0.92]; P < 0.001). Furthermore, presepsin levels (P = 0.02) and Sequential Organ Function Assessment scores (P < 0.001) were significantly associated with mortality. Harrell’s C-index values for the 28-day mortality effect of HRG, presepsin, procalcitonin, and C-reactive protein were 0.72, 0.70, 0.63, and 0.59, respectively.

Conclusions

HRG levels in non-survivors were consistently lower than those in survivors during the first seven days of sepsis. Repeatedly measured HRG levels were significantly associated with mortality. Furthermore, the predictive power of HRG for mortality may be superior to that of other singular biomarkers, including presepsin, procalcitonin, and C-reactive protein.

DOI： 10.1371/journal.pone.0283426

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Outcomes associated with unrecognized acute kidney injury in postoperative pediatric cardiac patients. 国際誌

Satoshi Kimura, Kazuyoshi Shimizu, Tatsuo Iwasaki, Tomoyuki Kanazawa, Takashi Morimatsu, Takeru Hatano, Hiroshi Morimatsu

Pediatric nephrology (Berlin, Germany) 2023年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The present retrospective study was carried out to determine the incidence of unrecognized cardiac surgery-associated acute kidney injury (CSA-AKI) due to infrequency of serum creatinine (SCr) measurements in pediatric cardiac patients and to assess the association between unrecognized CSA-AKI and clinical outcomes. METHODS: This study was a single-center, retrospective study of pediatric patients who underwent cardiac surgery. Patients were diagnosed with CSA-AKI based on SCr measurements, and unrecognized CSA-AKI was defined under the assumptions that there had been only one or two SCr measurements within 48 h after surgery: CSA-AKI unrecognized by one SCr measurement (AKI-URone), CSA-AKI unrecognized by two SCr measurements (AKI-URtwo), and CSA-AKI recognized by one and two SCr measurements (AKI-R). The change of SCr from baseline to postoperative day 30 (delta SCr30d) was assessed as a surrogate of kidney recovery. RESULTS: In a total of 557 cases, 313 patients (56.2%) were diagnosed with CSA-AKI, 188 (33.8%) of whom had unrecognized CSA-AKI. Delta SCr30d in the AKI-URtwo group and delta SCr30d in the AKI-URone group was not significantly different from delta SCr30d in the non-AKI group (p = 0.67 and p = 0.79, respectively). There were significant differences in the durations of mechanical ventilation, serum B-type natriuretic peptide levels, and lengths of stay in hospital between the non-AKI group and the AKI-URtwo group and between the non-AKI group and the AKI-URtwo group. CONCLUSIONS: Unrecognized CSA-AKI due to infrequent SCr measurements is not rare and is associated with prolonged mechanical ventilation, high postoperative BNP level, and prolonged length of stay in hospital. A higher resolution version of the Graphical abstract is available as Supplementary information.

DOI： 10.1007/s00467-023-05925-x

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Dexmedetomidine improves acute lung injury by activating autophagy in a rat hemorrhagic shock and resuscitation model. 国際誌

Yifu Lu, Hiroko Shimizu, Ryu Nakamura, Yaqiang Li, Risa Sakamoto, Emiko Omori, Toru Takahashi, Hiroshi Morimatsu

Scientific reports 13 ( 1 ) 4374 - 4374 2023年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

Dexmedetomidine (DEX) can reduce lung injury in a hemorrhagic shock (HS) resuscitation (HSR) model in rats by inhibiting inflammation. Here, we aimed to investigate if these effects of DEX are due to autophagy activation. Therefore, we established HSR rat models and divided them into four groups. HS was induced using a blood draw. The rats were then resuscitated by reinjecting the drawn blood and saline. The rats were sacrificed 24 h after resuscitation. Lung tissues were harvested for histopathological examination, determination of wet/dry lung weight ratio, and detection of the levels of autophagy-related marker proteins LC3, P62, Beclin-1, and the ATG12-ATG5 conjugate. The morphological findings of hematoxylin and eosin staining in lung tissues and the pulmonary wet/dry weight ratio showed that lung injury improved in HSR + DEX rats. However, chloroquine (CQ), an autophagy inhibitor, abolished this effect. Detecting the concentration of autophagy-related proteins showed that DEX administration increased LC3, ATG12-ATG5, and Beclin-1 expression and decreased P62 expression. The expression levels of these proteins were similar to those in the HSR group after CQ + DEX administration. In summary, DEX induced autophagic activation in an HSR model. These findings suggest that DEX administration partially ameliorates HSR-induced lung injury via autophagic activation.

DOI： 10.1038/s41598-023-31483-1

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Therapeutic plasma exchange in postpartum HELLP syndrome: a case report. 国際誌

Nana Kojima, Kosuke Kuroda, Makiko Tani, Tomoyuki Kanazawa, Kazuyoshi Shimizu, Jota Maki, Hisashi Masuyama, Hiroshi Morimatsu

JA clinical reports 9 ( 1 ) 9 - 9 2023年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Postpartum hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is more difficult to treat than HELLP syndrome during pregnancy. We describe a case of postpartum HELLP syndrome that responded to plasma exchange (PE) therapy. CASE PRESENTATION: A 30-year-old primipara woman was hospitalized for gestational hypertension at 33 weeks of gestation and underwent an emergent cesarean section at 36 weeks and 6 days of gestation due to rapidly progressing pulmonary edema. After delivery, liver dysfunction and a rapid decrease in platelet count were observed, and the patient was diagnosed with severe HELLP syndrome. She experienced multiple organ failure despite intensive care, and PE therapy was initiated. Her general condition dramatically stabilized within a few hours of PE therapy. CONCLUSION: It is controversial whether PE therapy should be used primarily in the management of HELLP syndrome, but early initiation of PE therapy could be effective for severe HELLP syndrome.

DOI： 10.1186/s40981-023-00602-2

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Anesthetic management of a patient with Osler-Weber-Rendu syndrome with multiple pulmonary arteriovenous malformations and pheochromocytoma for femoral artificial bone replacement: a case report. 国際誌

Toshiharu Hiyoshi, Kazuyoshi Shimizu, Satoshi Kimura, Toshiki Naritani, Hiroshi Morimatsu

JA clinical reports 9 ( 1 ) 6 - 6 2023年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Osler-Weber-Rendu syndrome is characterized by mucocutaneous telangiectasia and arteriovenous malformations in organs. Anesthesia for patients with Osler-Weber-Rendu syndrome is challenging due to complications and physiological changes. CASE PRESENTATION: The case was a 49-year-old female with Osler-Weber-Rendu syndrome, multiple pulmonary arteriovenous malformations and pheochromocytoma who presented for femoral bone head fracture with metastatic adenocarcinoma. The patient was scheduled to undergo bone tumor resection and artificial bone replacement, being positioned laterally with a planned operation duration of 5 h. Anesthesia was managed with spinal and epidural anesthesia, combined with sedation by sevoflurane using a supraglottic airway (SGA) device under spontaneous breathing. Her intraoperative and postoperative courses were uneventful. CONCLUSION: Neuraxial anesthesia combined with general anesthesia using an SGA device to maintain spontaneous ventilation in order to minimize the risk of rupture of pulmonary arteriovenous malformations could be an option.

DOI： 10.1186/s40981-023-00600-4

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合併増大号今月の臨床最善で最新の産科麻酔診療をめざして妊産婦急変対応妊産婦の心肺蘇生

木村貴一, 金澤伴幸, 森松博史

臨床婦人科産科 77 ( 1 ) 193 - 199 2023年1月

Decreased expression of hyaluronan synthase and loss of hyaluronan-rich cells in the anterior tibial fascia of the rat model of chemotherapy-induced peripheral neuropathy. 査読国際誌

Ruilin Wang, Yoshikazu Matsuoka, Nobutaka Sue, Kosuke Nakatsuka, Chika Tsuboi, Hiroshi Morimatsu

Pain reports 8 ( 4 ) e1088 2023年

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Previous studies on chemotherapy-induced peripheral neuropathy (CIPN) have focused on neuronal damage. Although some studies have revealed that the fascia is an important sensory organ, currently, we do not know about chemotherapy drug-induced fascial dysfunction. OBJECTIVES: This study aimed to explore the fascia as a nonneural cause of mechanical hypersensitivity in CIPN by investigating the expression of hyaluronic acid synthase (HAS) and histology of the fascia in an animal model of CIPN. METHODS: Rats were intraperitoneally administered with vincristine (VCR). Mechanical hypersensitivities of the hind paw and the anterior tibial muscle were assessed. The expression of HAS mRNA in the fascia of the anterior tibial muscles was quantitated using reverse transcription polymerase chain reaction. Immunohistochemistry was also performed for HAS2, hyaluronic acid-binding protein, and S100A4 in the fascia. RESULTS: Vincristine administration significantly decreased mechanical withdrawal thresholds in the hind paw and the anterior tibial muscle after day 3. Quantitative polymerase chain reaction showed significant downregulation of HAS mRNAs in the fascia of VCR-treated rats. Immunohistochemical analysis showed that the number of cells with strong HAS2 immunoreactivity, classified as fasciacytes by morphology and colocalized marker S100A4, decreased significantly in the VCR group. CONCLUSION: Hyaluronic acid plays a critical role in somatic pain sensation. Damaged fascia could be a possible cause of musculoskeletal pain in patients with CIPN. This study suggests that fascia is a nonneural cause and novel therapeutic target for chemotherapy-induced "peripheral neuropathy."

DOI： 10.1097/PR9.0000000000001088

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Depolarization time and extracellular glutamate levels aggravate ultraearly brain injury after subarachnoid hemorrhage 査読

Satoshi Murai, Tomohito Hishikawa, Yoshimasa Takeda, Yasuko Okura, Miki Fushimi, Hirokazu Kawase, Yu Takahashi, Naoya Kidani, Jun Haruma, Masafumi Hiramatsu, Kenji Sugiu, Hiroshi Morimatsu, Isao Date

Scientific Reports 12 ( 1 ) 2022年12月

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

Abstract

Early brain injury after aneurysmal subarachnoid hemorrhage (SAH) worsens the neurological outcome. We hypothesize that a longer duration of depolarization and excessive release of glutamate aggravate neurological outcomes after SAH, and that brain hypothermia can accelerate repolarization and inhibit the excessive release of extracellular glutamate and subsequent neuronal damage. So, we investigated the influence of depolarization time and extracellular glutamate levels on the neurological outcome in the ultra-early phase of SAH using a rat injection model as Experiment 1 and then evaluated the efficacy of brain hypothermia targeting ultra-early brain injury as Experiment 2. Dynamic changes in membrane potentials, intracranial pressure, cerebral perfusion pressure, cerebral blood flow, and extracellular glutamate levels were observed within 30 min after SAH. A prolonged duration of depolarization correlated with peak extracellular glutamate levels, and these two factors worsened the neuronal injury. Under brain hypothermia using pharyngeal cooling after SAH, cerebral perfusion pressure in the hypothermia group recovered earlier than that in the normothermia group. Extracellular glutamate levels in the hypothermia group were significantly lower than those in the normothermia group. The early induction of brain hypothermia could facilitate faster recovery of cerebral perfusion pressure, repolarization, and the inhibition of excessive glutamate release, which would prevent ultra-early brain injury following SAH.

DOI： 10.1038/s41598-022-14360-1

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その他リンク： https://www.nature.com/articles/s41598-022-14360-1

小児の全身麻酔下におけるPatient State indexと呼気終末セボフルラン濃度の関連性単施設後ろ向き研究

清水達彦, 金澤伴幸, 吉田翼, 佐倉考信, 木村聡, 清水一好, 岩崎達雄, 森松博史

日本小児麻酔学会誌 27 ( Suppl. ) 172 - 172 2022年10月

小児の全身麻酔下におけるPatient State indexと呼気終末セボフルラン濃度の関連性単施設後ろ向き研究

清水達彦, 金澤伴幸, 吉田翼, 佐倉考信, 木村聡, 清水一好, 岩崎達雄, 森松博史

日本小児麻酔学会誌 27 ( Suppl. ) 172 - 172 2022年10月

Correlation between Mean Arterial Pressure and Regional Cerebral Oxygen Saturation on Cardiopulmonary Bypass in Pediatric Cardiac Surgery.

Yu Pan, Qingqing Song, Tomoyuki Kanazawa, Hiroshi Morimatsu

Acta medica Okayama 76 ( 5 ) 557 - 564 2022年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

Some pediatric cardiac patients might experience low regional cerebral oxygen saturation (rSO2) during surgery. We investigated whether a pediatric patient's mean arterial pressure (MAP) can affect the rSO2 value during cardiopulmonary bypass (CPB). We retrospectively analyzed the cases of the pediatric patients who underwentcardiac surgery at our hospital (Jan. -Dec. 2019; n=141). At each MAP stage, we constructed line charts through the mean of the rSO2 values corresponding to each MAP and then calculated the correlation coefficients. We next divided the patients into age subgroups (neonates, infants, children) and into cyanotic congenital heart disease (CHD) and acyanotic CHD groups and analyzed these groups in the same way. The analyses of all 141 patients revealed that during CPB the rSO2 value increased with an increase in MAP (r=0.1626). There was a correlation between rSO2 and MAP in the children (r=0.2720) but not in the neonates (r=0.06626) or infants (r=0.05260). Cyanotic CHD or acyanotic CHD did not have a significant effect on the rSO2/MAP correlation. Our analysis demonstrated different patterns of a correlation between MAP and rSO2 in pediatric cardiac surgery patients, depending on age. MAP was positively correlated with rSO2 typically in children but not in neonate or infant patients.

DOI： 10.18926/AMO/64037

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高齢者に対する大腸がん治療の個別化を考える周術期管理チーム介入により高齢Frail大腸癌患者に対する手術の安全性は向上したか

寺石文則, 庄司良平, 賀島肇, 松三雄騎, 重安邦俊, 近藤喜太, 黒田新士, 香川俊輔, 松岡義和, 森松博史, 藤原俊義

日本癌治療学会学術集会抄録集 60回 OWS9 - 3 2022年10月

Opioid free anesthesiaは必要か? Opioid-Free Anesthesiaのウィークポイント OFAは必要ない!

清水達彦, 金澤伴幸, 吉田翼, 佐倉考信, 木村聡, 清水一好, 岩崎達雄, 森松博史

日本小児麻酔学会誌 27 ( Suppl. ) 77 - 77 2022年10月

小児心臓手術の人工心肺中の急激なCO2貯留を脳波モニターで早期に検出できた1症例

米澤みほこ, 金澤伴幸, 吉田翼, 佐倉孝信, 清水達彦, 木村聡, 清水一好, 岩崎達雄, 森松博史

日本小児麻酔学会誌 27 ( Suppl. ) 172 - 172 2022年10月

高齢者に対する大腸がん治療の個別化を考える周術期管理チーム介入により高齢Frail大腸癌患者に対する手術の安全性は向上したか

寺石文則, 庄司良平, 賀島肇, 松三雄騎, 重安邦俊, 近藤喜太, 黒田新士, 香川俊輔, 松岡義和, 森松博史, 藤原俊義

日本癌治療学会学術集会抄録集 60回 OWS9 - 3 2022年10月

くも膜下出血の病態ラットSAH single injection modelにおける脳波抑制時間がearly brain injuryに及ぼす影響

高杉祐二, 菱川朋人, 清水智久, 村井智, 春間純, 平松匡文, 徳永浩司, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳循環代謝 34 ( 1 ) 84 - 84 2022年10月

【周術期における免疫学:基礎と臨床】周術期管理における免疫関連薬剤

吉田翼, 松岡義和, 森松博史

麻酔 71 ( 9 ) 976 - 979 2022年9月

【一般の麻酔科医が知っておくべき産科麻酔の知識】無痛分娩

松岡勇斗, 金澤伴幸, 森松博史

臨床麻酔 46 ( 9 ) 1153 - 1158 2022年9月

記述言語：日本語出版者・発行元：真興交易(株)医書出版部

無痛分娩に関連した母児の死亡、後遺障害の個別案件が続いたことを受けて、無痛分娩の安全な提供体制の構築が求められている。本邦における無痛分娩普及率は、欧米と比較すると低いが、その割合は着実に増してきている。今後、麻酔科医による無痛分娩の需要は高まっていく可能性があり、産科麻酔を専門としない麻酔科医にとっても無痛分娩に関する最低限の知識は持っておく必要があると思われる。(著者抄録)

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【周術期における免疫学:基礎と臨床】周術期管理における免疫関連薬剤招待

吉田翼, 松岡義和, 森松博史

麻酔 71 ( 9 ) 976 - 979 2022年9月

Histidine-rich glycoprotein as a novel predictive biomarker of postoperative complications in intensive care unit patients: a prospective observational study. 査読国際誌

Masahiko Oiwa, Kosuke Kuroda, Naoya Kawanoue, Hiroshi Morimatsu

BMC anesthesiology 22 ( 1 ) 232 - 232 2022年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Decrease in histidine-rich glycoprotein (HRG) was reported as a cause of dysregulation of the coagulation-fibrinolysis and immune systems, leading to multi-organ failure, and it may be a biomarker for sepsis, ventilator-associated pneumonia, preeclampsia, and coronavirus disease 2019. However, the usefulness of HRG in perioperative management remains unclear. This study aimed to assess the usefulness of HRG as a biomarker for predicting postoperative complications. METHODS: This was a single-center, prospective, observational study of 150 adult patients who were admitted to the intensive care unit after surgery. Postoperative complications were defined as those having a grade II or higher in the Clavien-Dindo classification, occurring within 7 days after surgery. The primary outcome was HRG levels in the patients with and without postoperative complications. The secondary outcome was the ability of HRG, white blood cell, C-reactive protein, procalcitonin, and presepsin to predict postoperative complications. Data are presented as number and median (interquartile range). RESULTS: The incidence of postoperative complications was 40%. The HRG levels on postoperative day 1 were significantly lower in patients who developed postoperative complications (n = 60; 21.50 [18.12-25.74] µg/mL) than in those who did not develop postoperative complications (n = 90; 25.46 [21.05-31.63] µg/mL). The Harrell C-index scores for postoperative complications were HRG, 0.65; white blood cell, 0.50; C-reactive protein, 0.59; procalcitonin, 0.73; and presepsin, 0.73. HRG was independent predictor of postoperative complications when adjusted for age, the presence of preoperative cardiovascular comorbidities, American Society of Anesthesiologists Physical Status Classification, operative time, and the volume of intraoperative bleeding (adjusted hazard ratio = 0.94; 95% confidence interval, 0.90-0.99). CONCLUSIONS: The HRG levels on postoperative day 1 could predict postoperative complications. Hence, HRG may be a useful biomarker for predicting postoperative complications.

DOI： 10.1186/s12871-022-01774-7

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