Faculty Profiles - MORIMATSU Hiroshi

【周術期の呼吸管理】術後合併症ハイリスク患者の周術期呼吸管理

岡原修司, 清水一好, 塩路直弘, 森松博史

麻酔 67 ( 5 ) 511 - 517 2018.5

Decrease in Histidine-Rich Glycoprotein as a Novel Biomarker to Predict Sepsis Among Systemic Inflammatory Response Syndrome. Reviewed

Kuroda K, Wake H, Mori S, Hinotsu S, Nishibori M, Morimatsu H

Critical care medicine 46 ( 4 ) 570 - 576 2018.4

Incidence of Pulmonary Complications with the Prophylactic Use of High-flow Nasal Cannula after Pediatric Cardiac Surgery: Prophylactic HFNC Study Protocol.

Naohiro Shioji, Tomoyuki Kanazawa, Tatsuo Iwasaki, Kazuyoshi Shimizu, Tomohiko Suemori, Hirokazu Kawase, Satoshi Kimura, Yasutoshi Kuroe, Hiroshi Morimatsu

Acta medica Okayama 72 ( 2 ) 193 - 196 2018.4

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

We will investigate the incidence of postoperative pulmonary complications (PPCs) with the prophylactic use of a high-flow nasal cannula (HFNC) after pediatric cardiac surgery. Children < 48 months old with congenital heart disease for whom cardiac surgery is planned will be included. The HFNC procedure will be commenced just after extubation, at a flow rate of 2 L/kg/min with adequate oxygen concentration to achieve target oxygen saturation ≥ 94%. This study will reveal the prevalence of PPCs after pediatric cardiac surgery with the prophylactic use of HFNC.

DOI： 10.18926/AMO/55862

小児の麻酔中における人工呼吸器設定

金澤伴幸, 岩崎達雄, 清水一好, 末盛智彦, 森松博史

日本臨床麻酔学会誌 38 ( 2 ) 250 - 255 2018.3

Language：Japanese Publisher：日本臨床麻酔学会

小児患者は、年齢・体重・身長がさまざまであり、麻酔中の人工呼吸器設定は一定の条件下ですべての患者を管理することはできない。成長発達に伴い体格が変化するため、それぞれに合わせた設定が必要である。また、小児患者は成人に比べ呼吸数が多い、気道が狭いなどの特徴を持ち、それら呼吸生理学・解剖学に基づいた呼吸器設定や気管チューブ選択が必要である。すなわち小児の人工呼吸器設定を適切に行うには、まず小児の呼吸生理学を理解する必要がある。全身麻酔下の呼吸生理学は自発呼吸下のそれとは異なるため、本稿では、まず小児の自発呼吸下での呼吸生理学を正しく理解しそれを全身麻酔下人工呼吸に応用する方法を解説する。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01620&link_issn=&doc_id=20180319160017&doc_link_id=%2Fci4jjsca%2F2018%2F003802%2F020%2F0250-0255%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2018%2F003802%2F020%2F0250-0255%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

胸腺腫摘出術後の抜管時に冠動脈攣縮から心停止に至った1例

吹田晃享, 清水一好, 金澤伴幸, 松岡義和, 森松博史

日本臨床麻酔学会誌 38 ( 2 ) 142 - 147 2018.3

Language：Japanese Publisher：日本臨床麻酔学会

胸腺腫摘出術術後の抜管時に冠動脈攣縮から心停止に至ったと考えられる1例を経験した。症例は60歳、男性。術前評価で冠動脈器質的異常を認めなかったが、喫煙など複数の冠攣縮危険因子を有していた。腫瘍の浸潤性や術中循環動態の不安定性から、胸骨正中切開、静脈バイパス併用下胸腺腫摘出手術を行った。手術終了後にST上昇先行の心停止を発症したが、蘇生後の心機能回復は良好で、後遺症なく独歩退院した。術後の冠動脈攣縮誘発試験陽性から、心停止の原因は冠攣縮が強く疑われた。高侵襲手術などの手術因子、麻酔覚醒や薬剤投与などの術中因子が合わさり、冠攣縮に伴う心停止に至ったと考えられた。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01620&link_issn=&doc_id=20180319160002&doc_link_id=%2Fci4jjsca%2F2018%2F003802%2F002%2F0142-0147%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2018%2F003802%2F002%2F0142-0147%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery. Reviewed

Hironobu Toda, Kazufumi Nakamura, Koji Nakagawa, Atsuyuki Watanabe, Toru Miyoshi, Nobuhiro Nishii, Kazuyoshi Shimizu, Masao Hayashi, Hiroshi Morita, Hiroshi Morimatsu, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 82 ( 3 ) 775 - 782 2018.2

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

BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) is useful for detecting myocardial injury and is expected to become a prognostic marker in patients undergoing non-cardiac surgery. The aim of this pilot study evaluating the efficacy of β-blocker therapy in a perioperative setting (MAMACARI study) was to assess perioperative myocardial injury (PMI) in elderly patients with preserved ejection fraction (EF) undergoing non-cardiac surgery.Methods and Results:In this prospective observational cohort study of 151 consecutive patients with preserved EF and aged >60 years who underwent non-cardiac surgery, serum levels of hs-cTnT were measured before and on postoperative days 1 and 3 after surgery. PMI was defined as postoperative hs-cTnT >0.014 ng/mL and relative hs-cTnT change ≥20%. A total of 36 (23.8%) of the patients were diagnosed as having PMI. The incidence of a composite of cardiovascular events within 30 days after surgery, including myocardial infarction, stroke, worsening heart failure, atrial fibrillation and pulmonary embolism, was significantly higher in patients with PMI than in patients without PMI (odds ratio (OR) 9.25, P<0.001, 95% confidence interval (CI) 2.65-32.3). Multivariate analysis revealed that left ventricular diastolic dysfunction defined by echocardiography was independently associated with PMI (OR: 3.029, 95% CI: 1.341-6.84, P=0.008). CONCLUSIONS: PMI is frequently observed in elderly patients undergoing non-cardiac surgery. Diastolic dysfunction is an independent predictor of PMI.

DOI： 10.1253/circj.CJ-17-0747

Randomized Controlled Trial of Epidural versus Patient-controlled Intravenous Analgesia for Postoperative Pain Control after Laparoscopic Gastrectomy. Reviewed

Kikuchi S, Kuroda S, Nishizaki M, Matsusaki T, Mitsuhashi T, Kuwada K, Kagawa S, Morimatsu H, Fujiwara T

Acta medica Okayama 72 ( 1 ) 95 - 98 2018.2

人工呼吸器離脱時の吸入酸素濃度に関する研究単施設前向き無作為化比較試験

石井賢造, 森松博史, 兵頭剛, 日高秀邦, 藤重有紀, 佐倉考信, 横尾千加子, 矢島悠太, 木村貴一, 大村浩之

日本集中治療医学会雑誌 25 ( Suppl. ) [O65 - 4] 2018.2

試作Tele ICUシステムの病院間使用

清水一好, 木村雅一, 鈴木聡, 林真雄, 森松博史

日本集中治療医学会雑誌 25 ( Suppl. ) [O76 - 7] 2018.2

ラットくも膜下出血モデルにおける皮質脱分極、脳波、脳組織障害の評価

高杉祐二, 菱川朋人, 清水智久, 新治有径, 杉生憲志, 武田吉正, 森松博史, 伊達勲

脳血管攣縮 33 56 - 56 2018.2

NADH fluorescence imaging and the histological impact of cortical spreading depolarization during the acute phase of subarachnoid hemorrhage in rats Reviewed International journal

Tomohisa Shimizu, Tomohito Hishikawa, Shingo Nishihiro, Yukei Shinji, Yuji Takasugi, Jun Haruma, Masafumi Hiramatsu, Hirokazu Kawase, Sachiko Sato, Ryoichi Mizoue, Yoshimasa Takeda, Kenji Sugiu, Hiroshi Morimatsu, Isao Date

Journal of Neurosurgery 128 ( 1 ) 137 - 143 2018.1

Language：English Publishing type：Research paper (scientific journal) Publisher：American Association of Neurological Surgeons

OBJECTIVE Although cortical spreading depolarization (CSD) has been observed during the early phase of subarachnoid hemorrhage (SAH) in clinical settings, the pathogenicity of CSD is unclear. The aim of this study is to elucidate the effects of loss of membrane potential on neuronal damage during the acute phase of SAH. METHODS Twenty-four rats were subjected to SAH by the perforation method. The propagation of depolarization in the brain cortex was examined by using electrodes to monitor 2 direct-current (DC) potentials and obtaining NADH (reduced nicotinamide adenine dinucleotide) fluorescence images while exposing the parietal-temporal cortex to ultraviolet light. Cerebral blood flow (CBF) was monitored in the vicinity of the lateral electrode. Twenty-four hours after onset of SAH, histological damage was evaluated at the DC potential recording sites. RESULTS Changes in DC potentials (n = 48 in total) were sorted into 3 types according to the appearance of ischemic depolarization in the entire hemisphere following induction of SAH. In Type 1 changes (n = 21), ischemic depolarization was not observed during a 1-hour observation period. In Type 2 changes (n = 13), the DC potential demonstrated ischemic depolarization on initiation of SAH and recovered 80% from the maximal DC deflection during a 1-hour observation period (33.3 ± 15.8 minutes). In Type 3 changes (n = 14), the DC potential displayed ischemic depolarization and did not recover during a 1-hour observation period. Histological evaluations at DC potential recording sites showed intact tissue at all sites in the Type 1 group, whereas in the Type 2 and Type 3 groups neuronal damage of varying severity was observed depending on the duration of ischemic depolarization. The duration of depolarization that causes injury to 50% of neurons (P50) was estimated to be 22.4 minutes (95% confdence intervals 17.0-30.3 minutes). CSD was observed in 3 rats at 6 sites in the Type 1 group 5.1 ± 2.2 minutes after initiation of SAH. On NADH?uorescence images CSD was initially observed in the anterior cortex∗it propagated through the entire hemisphere in the direction of the occipital cortex at a rate of 3 mm/minute, with repolarization in 2.3 ± 1.2 minutes. DC potential recording sites that had undergone CSD were found to have intact tissue 24 hours later. Compared with depolarization that caused 50% neuronal damage, the duration of CSD was too short to cause histological damage. CONCLUSIONS CSD was successfully visualized using NADH?uorescence. It propagated from the anterior to the posterior cortex along with an increase in CBF. The duration of depolarization in CSD (2.3 ± 1.2 minutes) was far shorter than that causing 50% neuronal damage (22.4 minutes) and was not associated with histological damage in the current experimental setting.

DOI： 10.3171/2016.9.JNS161385

Effect of an enhanced recovery after surgery protocol in patients undergoing pancreaticoduodenectomy: A randomized controlled trial. Reviewed

Takagi K, Yoshida R, Yagi T, Umeda Y, Nobuoka D, Kuise T, Hinotsu S, Matsusaki T, Morimatsu H, Eguchi J, Wada J, Senda M, Fujiwara T

Clinical nutrition (Edinburgh, Scotland) 2018.1

Histidine-rich glycoprotein as an excellent biomarker for sepsis and beyond. Reviewed International journal

Masahiro Nishibori, Hidenori Wake, Hiroshi Morimatsu

Critical care (London, England) 22 ( 1 ) 209 - 209 2018

Language：English

Sepsis remains a critical problem with high morbidity and mortality worldwide. One of the problems we have in critical care is the need to find a good biomarker of sepsis to determine the existence of bacterial infection and the severity of patients. This would enable us to start appropriate treatment at an earlier stage of the disease course. We propose that decreases in the plasma protein histidine-rich glycoprotein (HRG) is an excellent biomarker of sepsis compared with the current markers. Based on the novel pathophysiological roles of HRG in the cascade of events during sepsis, we also discuss the potential for supplemental therapy with purified HRG.

DOI： 10.1186/s13054-018-2127-5

Perioperative respiratory management in high risk patients

Is supplemental oxygen necessary for intraoperative lung protective ventilation?

Shuji Okahara, Satoshi Suzuki, Hiroshi Morimatsu

Pulmonary and Critical Care Medicine 3 ( 1 ) 2018

A Case of Cardiac Arrest Due to Coronary Vasospasm on Extubation Following Thymectomy

Koukyou SUITA, Kazuyoshi SHIMIZU, Tomoyuki KANAZAWA, Yoshikazu MATSUOKA, Hiroshi MORIMATSU

THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 38 ( 2 ) 142 - 147 2018

Okahara, S., Shimizu, K., Shioji, N., Morimatsu, H.

Japanese Journal of Anesthesiology 67 ( 5 ) 2018

Quercetin attenuates neuropathic pain in rats with spared nerve injury

Noriko Muto, Yoshikazu Matsuoka, Kyosuke Arakawa, Masako Kurita, Hiroki Omiya, Arata Taniguchi, Ryuji Kaku, Hiroshi Morimatsu

Acta Medica Okayama 72 ( 5 ) 457 - 465 2018

Language：English Publishing type：Research paper (scientific journal) Publisher：Okayama University

Quercetin is a flavonoid widely found in plants and marketed to the public as a supplement. Several studies have reported its effect on glial cells. This study aimed to examine the effect of quercetin on the development of neuropathic pain and the underlying mechanism in a spared nerve injury (SNI) rat model. Male Sprague- Dawley rats randomly assigned to the control or the quercetin group were subjected to SNI of the sciatic nerve. We measured pain behaviors on the hind paw and glial fibrillary acidic protein (GFAP) in the dorsal root ganglion (DRG) and spinal cord. Oral administration of 1% quercetin, begun before surgery, attenuated mechanical allodynia compared to the control group at days 7 and 10 after SNI. On the other hand, established pain was not attenuated in a post-dose group in which quercetin was begun 7 days after SNI. Quercetin inhibited GFAP in the satellite glial cells of the ipsilateral L5 DRG on day 7 compared to the control group. Quercetin suppressed the development of neuropathic pain through a mechanism partly involving the inhibition of satellite glial cells. As its safety is well established, quercetin has great potential for clinical use in pain treatment.

Prolonged-duration pulsed radiofrequency is associated with increased neuronal damage without further antiallodynic effects in neuropathic pain model rats

Kyosuke Arakawa, Ryuji Kaku, Masako Kurita, Yoshikazu Matsuoka, Hiroshi Morimatsu

Journal of Pain Research 11 2645 - 2651 2018

Language：English Publishing type：Research paper (scientific journal) Publisher：Dove Medical Press Ltd.

Aim of investigation: Pulsed radiofrequency (PRF) is a safe and effective approach for treating neuropathic pain. However, the optimal treatment conditions and analgesic mechanisms of PRF remain unclear. The aim of our study was to assess the beneficial and adverse effects of prolonged-duration PRF and the analgesic mechanisms of PRF treatment with neuropathic pain rats. Methods: Male Sprague Dawley rats received L5 spinal nerve ligation (SNL) for developing neuropathic pain. Fourteen days after L5 SNL surgery, they were divided into three groups according to duration of PRF current for 6 minutes, 12 minutes, and none. PRF current was delivered via direct visualization adjacent to the L5 dorsal root ganglion (DRG). Pain behavior was evaluated every week after L5 SNL surgery, until day 28. Seven days after PRF treatment, L5 DRG tissue was harvested to detect levels of activating translation factor 3 (ATF3
a marker of neuronal damage) and hyperpolarization-activated cyclic nucleotide (HCN)-gated cation channels (key factors in neuropathic pain) using quantitative PCR. Results: Before PRF application, withdrawal thresholds were significantly lower than at baseline and did not differ significantly between the three groups. After PRF application, withdrawal thresholds in the PRF6 and PRF12 groups were significantly increased compared to those in the sham group. However, those in the PRF6 and PRF12 groups did not differ significantly. The expression level of ATF3 mRNA in the PRF12 group was significantly higher than that in the sham group (P&lt
0.01), but the expression of HCN1 and HCN2 channels did not differ significantly between the three groups. Conclusion: Prolonged PRF exposure, from 6 to 12 minutes, was not only ineffective but also associated with increased neuronal damage. These findings do not support prolonged PRF exposure as a helpful treatment for neuropathic pain. In this study, the involvement of HCN channels in the antiallodynic effects of PRF was uncertain.

DOI： 10.2147/JPR.S168064