Faculty Profiles - MORIMATSU Hiroshi

MISC - MORIMATSU Hiroshi

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Central pontine myelinolysis after living donor liver transplantation

57 ( 9 ) 1136 - 1138 2008

生体肝移植術中呼気一酸化炭素濃度の動態とその意義について

松﨑孝, 森松博史, 高橋徹, 林真雄, 佐藤哲文, 佐藤健治, 清水裕子, 松三昌樹, 森田潔

日本Shock学会雑誌 23 ( 2 ) 85 - 89 2008

MRSA敗血症に合併した腸腰筋膿瘍の2症例.

谷真規子, 森松博史, 戸田雄一郎, 片山浩, 森田潔

ICUとCCU 32 ( 12 ) 1149 - 1154 2008

酸塩基平衡の新しい考え方 Stewart Approach

森松博史

臨床麻酔 33 ( 臨増 ) 431 - 440 2008

Validation of PIM, PRISM, and PELOD for children with congenital heart disease in pediatric cardiac care unit

Yuichiro Toda, Hiroshi Morimatsu, Moritoki Egi, Tatsuo Iwasaki, Kazuyoshi Shimizu, Tionloyuki Kanazawa, Satoshi Suzuki, Kiyoshi Morita

CRITICAL CARE MEDICINE 35 ( 12 ) A7 - A7 2007.12

Application of simplified Stewart methodology to pediatric patients with acute kidney injury in a cardiac care unit

Hiroshi Morimatsu, Moritoki Egi, Yuichiro Toda, Kiyoshi Morita

CRITICAL CARE MEDICINE 35 ( 12 ) A269 - A269 2007.12

Stewart has come to the bedside: Is it time to use the Stewart methodology routinely?

Hiroshi Morimatsu

CRITICAL CARE MEDICINE 35 ( 10 ) 2456 - 2457 2007.10

Comparison of contamination between conventional three-way stopcock and needleless injection device: A randomized controlled trial

Jun Oto, Masaji Nishimura, Hiroshi Morimatsu, Hiroshi Katayama, Mutsuo Onodera, Hideo Takahashi, Jun Takezawa

MEDICAL SCIENCE MONITOR 13 ( 10 ) CR417 - CR421 2007.10

Language：English Publisher：INT SCIENTIFIC LITERATURE, INC

Background: Intraluminal contamination of catheter hubs has been recognized as the most frequent cause of catheter-related blood stream infections. We have investigated the efficacy of a new hub device. Placenta SC (R) (PNSC), in preventing endoluminal catheter contamination, compared to a conventional three-way stopcock.
Materials/Methods: Adults patients requiring an intravascular catheter placement for at least 48 hours in intensive care units were randomly assigned to receive either the infusion device with the newly designed hub, PNSC(P group, n=89), or with a conventional three-way stopcock (C group,n=73). To evaluate intraluminal contamination, we examined the bacteria isolated in the inline bacterial filters which were attached to downstream of the injection ports. In assition to the clinical study,we conducted a bench study to investigate if use of protection caps or strict disinfection technique prevented intraluminal contamination with this new needleless connector.
Results: The incidence of bacterial contamination was not significantly different between the groups (P roup9/89(10.1%) vs. C group 6/73(8.2%). P=0.79). There was no correlation between the numbers of injections,durations of the use of the device or the microbial contamination rate. In the bench study, protection caps and disinfection technique significantly decreased microbial transfer from the hub to the fluid space.
Conclusion: We concluded that the use of the new hub device did not reduce endoluminal bacteriol contamination rate in comparison with that of a three way stopcock. Intraluminal bacterial contamination may be reduced by either strict disinfection technique or when a protection cap is use.

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Continuous renal replacement therapy: A worldwide practice survey

Shigehiko Uchino, Rinaldo Bellomo, Hiroshi Morimatsu, Stanislao Morgera, Miet Schetz, Ian Tan, Catherine Bouman, Ettiene Macedo, Noel Gibney, Ashita Tolwani, Heleen Oudemans-van Straaten, Claudio Ronco, John A. Kellum

INTENSIVE CARE MEDICINE 33 ( 9 ) 1563 - 1570 2007.9

Language：English Publisher：SPRINGER

Objective: Little information is available regarding current practice in continuous renal replacement therapy ( CRRT) for the treatment of acute renal failure ( ARF) and the possible clinical effect of practice variation. Design: Prospective observational study. Setting: A total of 54 intensive care units ( ICUs) in 23 countries. Patients and participants: A cohort of 1006 ICU patients treated with CRRT for ARF. Interventions: Collection of demographic, clinical and outcome data. Measurements and results: All patients except one were treated with venovenous circuits, most commonly as venovenous hemofiltration ( 52.8%). Approximately one- third received CRRT without anticoagulation ( 33.1%). Among patients who received anticoagulation, unfractionated heparin ( UFH) was the most common choice ( 42.9%), followed by sodium citrate ( 9.9%), nafamostat mesilate ( 6.1%), and low- molecular- weight heparin ( LMWH; 4.4%). Hypotension related to CRRT occurred in 19% of patients and arrhythmias in 4.3%. Bleeding complications occurred in 3.3% of patients. Treatment with LMWH was associated with a higher incidence of bleeding complications ( 11.4%) compared to UFH ( 2.3%, p = 0.0083) and citrate ( 2.0%, p = 0.029). The median dose of CRRT was 20.4ml/ kg/ h. Only 11.7% of patients received a dose of > 35 ml/ kg/ h. Most ( 85.5%) survivors recovered to dialysis independence at hospital discharge. Hospital mortality was 63.8%. Multivariable analysis showed that no CRRT- related variables ( mode, filter material, drug for anticoagulation, and prescribed dose) predicted hospital mortality. Conclusions: This study supports the notion that, worldwide, CRRT practice is quite variable and not aligned with best evidence.

DOI： 10.1007/s00134-007-0754-4

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Heme oxygenase-1: A fundamental guardian against oxidative tissue injuries in acute inflammation

T. Takahashi, H. Shimizu, H. Morimatsu, K. Inoue, R. Akagi, K. Morita, S. Sassa

MINI-REVIEWS IN MEDICINAL CHEMISTRY 7 ( 7 ) 745 - 753 2007.7

Language：English Publishing type：Book review, literature introduction, etc. Publisher：BENTHAM SCIENCE PUBL LTD

Free heme contributes as a major threat to the oxidative tissue injuries because it catalyzes the formation of reactive oxygen species. When free heme concentration is increased, it results in the induction of heme oxygenase-1 (1401), which then breaks free heme down. As such, HO-1 plays a pivotal role in the protection of tissues from oxidative injuries.

DOI： 10.2174/138955707781024517

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Peak exhaled carbon monoxide concentration after reperfusion influenced hyperbilirubinemia early after liver transplantation.

Takashi Matsusaki, Hiroshi Morimatsu, Tom Takahashi, Masaki Matsumi, Kiyoshi Morita

AMERICAN JOURNAL OF TRANSPLANTATION 7 557 - 558 2007.5

Septic acute kidney injury in critically ill patients: Clinical characteristics and outcomes

Sean M. Bagshaw, Shigehiko Uchino, Rinaldo Bellomo, Hiroshi Morimatsu, Stanislao Morgera, Miet Schetz, Ian Tan, Catherine Bouman, Ettiene Macedo, Noel Gibney, Ashita Tolwani, Heleen M. Oudemans-van Straaten, Claudio Ronco, John A. Kellum

CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY 2 ( 3 ) 431 - 439 2007.5

Language：English Publisher：AMERICAN SOCIETY NEPHROLOGY

Sepsis is the most common cause of acute kidney injury (AKI) in critical illness, but there is limited information on septic AKI. A prospective, observational study of critically ill patients with septic and nonseptic AKI was performed from September 2000 to December 2001 at 54 hospitals in 23 countries. A total of 1753 patients were enrolled. Sepsis was considered the cause in 833 (47.5%); the predominant sources of sepsis were chest and abdominal (54.3%). Septic AKI was associated with greater aberrations in hemodynamics and laboratory parameters, greater severity of illness, and higher need for mechanical ventilation and vasoactive therapy. There was no difference in enrollment kidney function or in the proportion who received renal replacement therapy (RRT; 72 versus 71%; P=0.83). Oliguria was more common in septic AKI (67 versus 57%; P<0.001). Septic AKI had a higher in-hospital case-fatality rate compared with nonseptic AKI (70.2 versus 51.8%; P<0.001). After adjustment for covariates, septic AKI remained associated with higher odds for death (1.48; 95% confidence interval 1.17 to 1.89; P=0.001). Median (IQR) duration of hospital stay for survivors (37 [19 to 59] versus 21 [12 to 42] d; P<0.0001) was longer for septic AKI. There was a trend to lower serum creatinine (106 [73 to 158] versus 121 [88 to 184] mu mol/L; P=0.01) and RRT dependence (9 versus 14%; P=0.052) at hospital discharge for septic AKI. Patients with septic AKI were sicker and had a higher burden of illness and greater abnormalities in acute physiology. Patients with septic AKI had an increased risk for death and longer duration of hospitalization yet showed trends toward greater renal recovery and independence from RRT.

DOI： 10.2215/CJN.03681106

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IL-11はヘム蛋白安定化作用により四塩化炭素肝障害に対して保護作用を示す

高橋徹, 川上朋子, 清水裕子, 井上一由, 森松博史, 片山浩, 松三昌樹, 森田潔

Shock : 日本Shock学会雑誌 22 ( 1 ) 62 - 62 2007.4

ラット出血性ショック後急性肺障害に対するウリナスタチンの治療効果

井上一由, 高橋徹, 井戸佳奈, 清水裕子, 森松博史, 森田潔

Shock : 日本Shock学会雑誌 22 ( 1 ) 36 - 36 2007.4

ラット出血性ショック後急性肺障害に対するウリナスタチンの保護効果のメカニズム

井上一由, 高橋徹, 井戸佳奈, 清水裕子, 森松博史, 森田潔

Shock : 日本Shock学会雑誌 22 ( 1 ) 54 - 54 2007.4

ラット出血性ショックモデルにおける急性肺障害に対するCO吸入の保護効果

井上一由, 高橋徹, 井戸佳奈, 清水裕子, 森松博史, 森田潔

Shock : 日本Shock学会雑誌 22 ( 1 ) 63 - 63 2007.4

The effect of albumin concentration on plasma sodium and chloride measurements in critically ill patients

David A. Story, Hiroshi Morimatsu, Moritoki Egi, Rinaldo Bellomo

ANESTHESIA AND ANALGESIA 104 ( 4 ) 893 - 897 2007.4

Language：English Publisher：LIPPINCOTT WILLIAMS & WILKINS

BACKGROUND: We tested the hypothesis that the difference between indirect and direct sodium assays would be related to the plasma albumin concentration. Further, we proposed that differences between indirect and direct chloride assays might be explained by interference from other plasma constituents, particularly bicarbonate, and possibly albumin.
METHODS: We studied 300 critically ill patients at the time of admission to the intensive care unit (ICU) and compared each patient's plasma sodium and chloride measurements from a central laboratory assay (indirect electrode) and an ICU blood gas machine assay (direct electrode).
RESULTS: The central laboratory sodium measurement was, on average, 2.1 mmol/L more than the ICU assay, limits of agreement 1.8-2.4 mmol/L greater, P < 0.001. The central laboratory chloride measurement was, on average, I mmol/L less than the ICU assay (limits of agreement 1.3-0.7 mmol/L less, P < 0.001). All correlations between the assay differences and plasma constituents were weak except for a moderately strong correlation between differences in sodium measurements and albumin. The difference in plasma sodium concentration between the assays (central laboratory ICU) increased as the plasma concentration albumin decreased (difference 6.2-0.16 albumin (g/L); P < 0.001, r = -0.46, r(2) = 0.22).
CONCLUSIONS: The central laboratory and ICUs assays are analytic-ally, statistically, and clinically different for both sodium and chloride. Unless taken into account, the differences could be large enough in hypoalbuminemic populations (such as critically ill patients) to affect clinical diagnosis and decision making.

DOI： 10.1213/01.ane.0000258015.87381.61

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Patient and kidney survival by dialysis modality in critically ill patients with acute kidney injury

S. Uchino, R. Bellomo, J. A. Kellum, H. Morimatsu, S. Morgera, M. Schetz, I. Tan, C. Bouman, E. Macedo, N. Gibney, A. Tolwani, H. Oudemans-Van Straaten, C. Ronco

INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS 30 ( 4 ) 281 - 292 2007.4

Language：English Publisher：WICHTIG EDITORE

Using a large, international cohort, we sought to determine the effect of initial technique of renal replacement therapy (RRT) on the outcome of acute renal failure (ARF) in the intensive care unit (ICU). We enrolled 1218 patients treated with continuous RRT (CRRT) or intermittent RRT (IRRT) for ARF in 54 ICUs in 23 countries. We obtained demographic, biochemical and clinical data and followed patients to either death or hospital discharge. Information was analyzed to assess the independent impact of treatment choice on survival and renal recovery. Patients treated first with CRRT (N=1006, 82.6%) required vasopressor drugs and mechanical ventilation more frequently compared to those receiving IRRT (N=212, 17.40%), (p < 0.0001). Unadjusted hospital survival was lower (35.8% vs. 51.9%, p < 0.0001). However, unadjusted dialysis-independence at hospital discharge was higher after CRRT (85.5% vs. 66.2%, p < 0.0001). Multivariable logistic regression showed that choice of CPPT was not an independent predictor of hospital survival or dialysis-free hospital survival. However, the choice of CRRT was a predictor of dialysis independence at hospital discharge among survivors (OR: 3.333, 95% Cl: 1.845 - 6.024, p < 0.0001). Further adjustment using a propensity score did not significantly change these results. We conclude that worldwide, the choice of CRRT as initial therapy is not a predictor of hospital survival or dialysis-free hospital survival but is an independent predictor of renal recovery among survivors.

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Effects of a novel palatinose based enteral formula (MHN-01) carbohydrate-adjusted fluid diet in improving the metabolism of carbohydrates and lipids in patients with esophageal cancer complicated by diabetes mellitus

Toshiya Fujiwara, Yoshio Naomoto, Takayuki Motoki, Kaori Shigemitsu, Yasuhiro Shirakawa, Tomoki Yamatsuji, Masafumi Kataoka, Minoru Haisa, Toshiyoshi Fujiwara, Maritoki Egi, Hiroshi Morimatsu, Motohiko Hanazaki, Hiroshi Katayama, Kiyoshi Morita, Kenji Mizumoto, Takanobu Asou, Hirofumi Arima, Hajime Sasaki, Motoi Matsuura, Mehmet Gunduz, Noriaki Tanaka

JOURNAL OF SURGICAL RESEARCH 138 ( 2 ) 231 - 240 2007.4

Language：English Publisher：ACADEMIC PRESS INC ELSEVIER SCIENCE

Background. During perioperative management of patients with gastrointestinal cancer complicated by diabetes mellitus, adequate alimentation is required, but we often face difficulties associated with hyperglycemia and other accompanying complications. Recently, we investigated the effects of a novel palatinose based enteral formula (MHN-01) in suppressing post-prandial hyperglycemia and improving lipid metabolism in experimental animals and perioperative management of patients with esophageal cancer complicated by diabetes mellitus.
Materials and methods. We gave normal rats and rats with type 2 diabetes mellitus a single oral dose of fluid diet, and analyzed comparatively the time course of blood glucose level in each group until 3 h after the dose. In both the normal rat group and the type 2 diabetes group, peak blood glucose level after the MHN-01 dose was significantly lower than after a dose of ordinary fluid diet and was comparable to the peak level after a dose of a fluid diet rich in MUFA (monounsaturated fatty acid). We allowed normal mice free access to fluid diet for 43 days, and measured their body fat levels. Fat accumulation was significantly lower in mice given MHN-01 than in mice given ordinary fluid diet. We also analyzed the respiratory quotient and resting energy expenditure of normal Sprague-Dawley rats fed by MHN-01 or an ordinary fluid diet. The respiratory quotient of the MHN-01 group was significantly lower than the ordinary fluid group, although the resting energy expenditure of both groups was almost the same level. The effect of MHN-01 was estimated to be based on improvement of lipid metabolism.
Results. Between 2003 and 2005, among 164 patients who underwent radical thoracic esophagectomy and/or reconstruction for esophageal carcinoma at Okayama University Hospital, nine patients (5.5%) were diagnosed with diabetes mellitus in preoperative screening and were treated with MHN-01. Clinical courses of two cases with severe status of diabetes mellitus were presented as successful case reports of MHN-01.
Conclusion. MHN-01 was very useful in perioperative management of patients complicated by diabetes mellitus, unable to ingest food p.o. such as esophageal cancer or other diseases. (c) 2007 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jss.2006.06.025

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A neutrophil elastase inhibitor, sivelestat, ameliorates lung injury after hemorrhagic shock in rats

Yuichiro Toda, Toru Takahashi, Kyoichiro Maeshima, Hiroko Shimizu, Kazuyoshi Inoue, Hiroshi Morimatsu, Emiko Omori, Mamoru Takeuchi, Reiko Akagi, Kiyoshi Morita

INTERNATIONAL JOURNAL OF MOLECULAR MEDICINE 19 ( 2 ) 237 - 243 2007.2

Language：English Publisher：PROFESSOR D A SPANDIDOS

Hemorrhagic shock followed by resuscitation (HSR) causes neutrophil sequestration in the lung which leads to acute lung injury (ALI). Neutrophil elastase (NE) is thought to play a pivotal role in the pathogenesis of ALI. This study investigated whether sivelestat, a specific NE inhibitor, can attenuate ALI induced by HSR in rats. Male Sprague-Dawley rats were subjected to hemorrhagic shock by withdrawing blood so as to maintain a mean arterial blood pressure of 30 +/- 5 mm Hg for 60 min followed by resuscitation with the shed blood. HSR-treated animals received a bolus injection of sivelestat (10 mg/kg) intravenously at the start of resuscitation followed by continuous infusion for 60 min (10 mg/kg/h) during the resuscitation phase, or the vehicle. Lung injury was assessed by pulmonary histology, lung wet-weight to dry-weight (W/D) ratio, myeloperoxidase (MPO) activity, gene expression of tumor necrosis factor (TNF)-alpha and inducible nitric oxide synthase (iNOS), DNA binding activity of nuclear factor (NF)-kappa B, and immunohistochemical analysis of intercellular adhesion molecule (ICAM)-1. HSR treatment induced lung injury, as demonstrated by pulmonary edema with infiltration of neutrophils, the increase in lung W/D ratio, MPO activity, gene expression of TNF-alpha and iNOS, and DNA-binding activity of NF-kappa B, and enhanced expression of ICAM-1. In contrast, sivelestat treatment significantly ameliorated the HSR-induced lung injury, as judged by the marked improvement in all these indices. These results indicate that sivelestat attenuated HSR-induced lung injury at least in part through an inhibition of the inflammatory signaling pathway, in addition to the direct inhibitory effect on NE.

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