Faculty Profiles - MIYAWAKI Takuya

Papers - MIYAWAKI Takuya

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Stress induces changes of internal standard genes of amygdala. Reviewed International journal

Shigeru Maeda, Ichiro Nakatsuka, Takuya Miyawaki, Takuo Kuboki, Masahiko Shimada

Brain research. Molecular brain research 140 ( 1-2 ) 133 - 7 2005.10

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

In this study, we tested changes of internal standard genes of the brain after electrical tail shock in rats. The level of 28S rRNA of the amygdala was increased significantly after the stress. There was no significant change in GAPDH, beta-actin, 36B4 mRNA and 28S rRNA at the subfornical organ and the hippocampus.

常用薬剤に関する実態調査顎口腔領域に関する副作用および歯科治療に使用する薬剤との相互作用について Reviewed

森貴幸, 宮脇卓也, 嶋田昌彦

有病者歯科医療 14 ( 2 ) 155 - 156 2005.9

本院における自己血輸血準備および実施の状況について Reviewed

吉田啓太, 前田茂, 友安弓子, 西周子, 樋口仁, 糀谷淳, 宮脇卓也, 嶋田昌彦

日本歯科麻酔学会雑誌 33 ( 3 ) 428 - 432 2005.7

Language：Japanese Publisher：(一社)日本歯科麻酔学会

自己血輸血はその安全性のために,多くの領域の手術で用いられている.これによって血液を介した感染症を予防することができる.岡山大学歯学部附属病院では過去数年の間に自己血輸血が増加した.しかしその適応は主治医の主観的な判断に委ねられている.そこでわれわれは過去5年間に行われた予定手術のなかで,自己血輸血について調査した.われわれは198症例について調査し,そのほとんどが顎骨移動術であった.上下顎骨同時移動術,下顎骨移動術および上顎骨移動術の手術件数はそれぞれ91,93および10例であった.出血量の平均値は330.2ml,169.9mlおよび232.5mlであった.出血量が600mlを超えた症例の割合はそれぞれ11,4.3および0%であった.準備した自己血の量は,それぞれ448.3ml,409.6mlおよび382.2mlであった.上下顎骨同時移動術に対しては80.2%の症例で貯血式自己血が用意された.下顎骨移動術に対しては67.7%の症例で希釈式自己血が用意された.貯血式自己血輸血が実施されたのは上下顎骨同時移動術の9.5%の症例においてであり,他の顎骨移動術では実施されなかった.同種血輸血は全く必要でなかったことから,自己血輸血の目的は達成されたと思われる.一方で,現状での希釈式輸血については,有効性に疑問があり,再考する必要があると思われた(著者抄録)

知的障害者の歯科治療におけるICF(国際生活機能分類)の応用 Reviewed

前田茂, 北ふみ, 竹内教子, 宮脇卓也, 有岡享子, 森貴幸, 石田瞭, 江草正彦, 嶋田昌彦

日本歯科医療福祉学会雑誌 10 ( 1 ) 23 - 24 2005.6

大学病院における摂食・嚥下リハビリテーション外来の臨床統計 Reviewed

石田瞭, 有岡享子, 森貴幸, 北ふみ, 前田茂, 宮脇卓也, 嶋田昌彦, 江草正彦

日本歯科医療福祉学会雑誌 10 ( 1 ) 25 - 26 2005.6

ヒト末梢血単核球のインターロイキン6反応に対するミダゾラムの作用機序に関する研究 Reviewed

宮脇卓也, 嶋田昌彦

PHARMACOANESTHESIOLOGY 17 ( 1 ) 43 - 44 2005.6

岡山大学歯学部附属病院(現:岡山大学医学部・歯学部附属病院)における同種血輸血準備および実施の状況について Reviewed

吉田啓太, 前田茂, 友安弓子, 西周子, 樋口仁, 糀谷淳, 宮脇卓也, 嶋田昌彦

日本歯科麻酔学会雑誌 33 ( 2 ) 234 - 238 2005.4

Language：Japanese Publisher：(一社)日本歯科麻酔学会

自院における1999年4月から2004年3月までに行われた待機手術145例を対象に,手術室における同種輸血準備量,輸血実施状況,出血量およびcrossmatch-to-transfusion ratio(C/T比)を術式ごとに分類し,検討した.輸血実施率およびC/T比はType & Screen導入後は,導入前に比べて有意に少なく,いずれの時期でも出血量は術式に関係なく平均500ml以下であり,Type & Screenで問題なく対応できると思われた

Intravenous sedation for dental patients with intellectual disability. Reviewed

Takuya Miyawaki

Journal of intellectual disability research : JIDR 48 764 - 768 2004.11

Authorship：Lead author,　Corresponding author Publishing type：Research paper (scientific journal)

<h4>Background</h4>The poor quality of oral health care for people with intellectual disability (ID) has been recognized, and the strong fears about dental treatment suggested as a major reason for disturbances of visits to dentists by such patients. Intravenous sedation is a useful method for relieving the anxiety and fear of such patients about dental treatment, and is frequently essential for ID patients undergoing dental treatment. However, decision regarding the dose of sedative required to be administered for an adequate level of sedation is difficult because the effect of sedation cannot be adequately assessed in patients with severe ID. As an appropriate sedative dose for dental patients with ID has not been fully established, we investigated sedative doses required and the effect of sedation in patients with ID, compared with other dental patients.<h4>Methods</h4>We reviewed the anaesthetic records of dental patients with ID (73 cases) and other dental patients (19 cases) aged between 20 and 29 years who had undergone intravenous sedation with midazolam and propofol in Okayama University Dental Hospital, from January 2000 to December 2000. Intravenous sedation was induced with a bolus intravenous administration of midazolam (2-3 mg) and maintained with a continuous infusion of propofol. The dose of propofol was titrated to achieve an adequate level of sedation: asleep but responding to painful stimulation. The efficacy of sedation, the required doses of propofol, and the wake-up times were investigated for all subjects. The efficacy of sedation was evaluated by judging whether the patient became cooperative and allowed the dental treatment to be carried out or not. The complications induced by intravenous sedation were also evaluated in each subject. Differences in variables between subjects with ID and other subjects were analysed using the Mann-Whitney U-test.<h4>Results</h4>Intravenous sedation was effective for dental treatment in all subjects with or without ID. The required dose of propofol in subjects with ID was 4.74 mg/kg/h (2.63-10.33 mg/kg/h), significantly higher than that required for other subjects (3.31, 1.72-4.80 mg/kg/h). Wake-up times of subjects with ID were similar to those of the other subjects. Severe complications were not seen during or after intravenous sedation.<h4>Conclusion</h4>The results of this study show that intravenous sedation is a useful method for dental patients with ID as well as for other dental patients, but indicate that dental patients with ID need higher doses of sedative to obtain an adequate level of sedation.

DOI： 10.1111/j.1365-2788.2004.00598.x

ICF(国際生活機能分類)の障害者歯科での応用重度知的障害を伴った患者の評価 Reviewed

北ふみ, 前田茂, 宮脇卓也, 竹内教子, 森貴幸, 石田瞭, 江草正彦, 嶋田昌彦

障害者歯科 25 ( 4 ) 628 - 633 2004.10

Language：Japanese Publisher：(一社)日本障害者歯科学会

国際生活機能分類(ICF)を歯科に受診した知的障害者に対して応用することを考えた.ICFの適応方法についてはWHOからいくつかの提案がなされているが,本邦においては,厚生労働省の支援により普及啓発事業を推進している.そこで,ICFにより障害のある人を評価し,そして社会参加を目標としたより適切なリハビリテーションの計画を立案するため,ICFを用いて受診した知的障害を伴った歯科患者の評価を行った.重度の知的障害者では社会参加の可能性には限界があった.ICFを歯科において有効に活用するためには,リハビリテーションの概念を導入することが必要であることが示唆された

岡山大学歯学部附属病院における5年間の院内救急症例の検討 Reviewed

友安弓子, 吉田啓太, 西周子, 北ふみ, 樋口仁, 糀谷淳, 前田茂, 宮脇卓也, 嶋田昌彦

日本歯科麻酔学会雑誌 32 ( 5 ) 624 - 625 2004.10

Language：Japanese Publisher：(一社)日本歯科麻酔学会

平成10年3月〜15年3月の院内救急症例(全身的偶発症)36例について分析した.男性18例,女性18例,年齢は4〜85歳(平均54.8歳),偶発症の内訳は基礎疾患増悪15例,過換気症候群7例,神経性ショック6例,誤飲5例,痙攣,発熱,胸部不快感が各1例であった.誤飲は男性に多く,過換気症候群は女性に多かった.発生時期は歯科治療中が最も多く23例,次いで局所麻酔薬注入中・直後6例,歯科診療前4例,歯科治療後3例の順であった.既往歴は循環器疾患11例,喘息4例,アレルギー4例,腎・泌尿器系疾患3例,精神疾患2例などで,基礎疾患増悪群には循環器疾患既往例が多かった.重篤な症例の代表として,狭心症の既往があり義歯調整後に胸痛を訴えた75歳女性例を提示した

下顎骨腫瘍切除および遊離骨皮弁による再建術後に発症した無症候性肺塞栓症の1症例 Reviewed

西周子, 宮脇卓也, 吉田啓太, 友安弓子, 北ふみ, 糀谷淳, 前田茂, 吉濱泰斗, 嶋田昌彦

日本歯科麻酔学会雑誌 32 ( 3 ) 379 - 380 2004.7

Language：Japanese Publisher：(一社)日本歯科麻酔学会

72歳男.高血圧症,高脂血症で内服加療中である.右下顎エナメル上皮腫により,腫瘍切除術,下顎骨区域切除術,腓骨皮弁および外側大腿皮弁による再建術,気管切開を施行した.前投薬として,塩酸ヒドロキシジン,硫酸アトロピンおよびファモチジンを筋注した.麻酔導入は,チオペンタールで急速導入を行い,臭化ベクロニウムで筋弛緩を得た後,経鼻挿管を行った.維持は,笑気,酸素,セボフルランで行った.術後,低酸素血症が持続した.心電図,心エコー,CTスキャン検査より,肺動脈のマクロの塞栓は否定的であるが,右下肢静脈に血栓が認められ,ミクロの塞栓が疑われるため,ヘパリンの静脈内投与を開始した.右下肢深部静脈血栓は消失していたが,右肺動脈上葉枝の血栓は顕著化していた.再発予防のため術後9日目よりワーファリンの経口投与を開始した.術後42日目,右上葉の血流欠損像は消失していた

Prevalence of blood pressure levels and hypertension-related diseases in Japanese dental patients. Reviewed International journal

Takuya Miyawaki, Fusanori Nishimura, Atsushi Kohjitani, Shigeru Maeda, Hitoshi Higuchi, Fumi Kita, Masahiko Shimada

Community dental health 21 ( 2 ) 134 - 7 2004.6

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

OBJECTIVE: To investigate the prevalence of blood pressure levels and hypertension-related diseases and to evaluate the risks associated with dental patients in Japan. RESEARCH DESIGN: Retrospective cross-sectional. METHOD: Blood pressure levels and medical histories of hypertension-related diseases obtained from 3,811 adult outpatients consulting a University Dental Hospital were investigated. Blood pressure levels were compared with those reported in the Japanese national survey obtained from a standard Japanese population. The relationships between gender or age and blood pressure level or the rate of the subjects with a hypertension-related disease were evaluated. RESULTS: Mean values of blood pressure in the present study were similar to those in the Japanese national survey. Among hypertension-related diseases, hypertension showed the highest prevalence (10.9%) in subjects. Blood pressure levels and the rates of subjects with hypertension-related diseases were significantly related to increasing age. Elderly subjects had a tendency to combine hypertension or high blood pressure with hypertension-related diseases. Further, 20.4% of subjects who had not been diagnosed with hypertension had high blood pressure. Among them, 1.5% had blood pressure more than 180/110 mmHg. CONCLUSIONS: The results suggested that blood pressure levels of dental patients would reflect the prevalence of blood pressure levels and hypertension in the Japanese general population, and that high blood pressure and increasing age are the greatest risk factors in the medical status of dental patients. Furthermore, because many subjects examined were unaware of their high blood pressure levels, caution is required prior to performing dental procedures.

Effects of isoflurane-induced and prostaglandin E(1)-induced hypotension on cytokine responses to oral and maxillofacial surgery. Reviewed International journal

Takuya Miyawaki, Atsushi Kohjitani, Shigeru Maeda, Hitoshi Higuchi, Masahiko Shimada

Journal of clinical anesthesia 16 ( 3 ) 168 - 72 2004.5

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

STUDY OBJECTIVE: To evaluate the effect of induced hypotension with isoflurane or prostaglandin E(1) (PGE(1)) on cytokine responses to surgery. DESIGN: Prospective, randomized study. SETTING: University hospital. PATIENTS: 24 ASA physical status I and II patients undergoing elective oral and maxillofacial surgery. INTERVENTIONS: Patients were randomly allocated to three groups be anesthetized in the normotension (Control group), isoflurane-induced hypotension (Isoflurane-H group), and PGE(1)-induced hypotension (PGE(1)-H group). Mean arterial pressure during hypotension was maintained at approximately 80% of baseline values. MEASUREMENTS AND MAIN RESULTS: Blood samples were taken before induction of anesthesia and during and after hypotension. Plasma tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels were measured using enzyme-linked immunosorbent assay. There were no differences in TNF-alpha or IL-10 levels among the groups. However, the elevation of the plasma IL-6 level in the PGE(1)-H group was found during hypotension, compared with the control group (p < 0.05). CONCLUSIONS: PGE(1)-induced hypotension has an effect on IL-6 response to oral and maxillofacial surgery.

Serum cortisol level and depth of propofol-induced sedation [1] Reviewed

Takuya Miyawaki, A. Kohjitani, S. Maeda, F. Kita, H. Higuchi, M. Shimada

Acta Anaesthesiologica Scandinavica 48 ( 3 ) 384 - 385 2004.3

Management of oral surgery in patients with hereditary or acquired angioedemas: review and case report. Reviewed International journal

Shigeru Maeda, Takuya Miyawaki, Shinsuke Nomura, Toshiyuki Yagi, Masahiko Shimada

Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 96 ( 5 ) 540 - 3 2003.11

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

Angioedemas are a rare but significant event in simple oral surgery because they can cause an acute life-threatening laryngeal edema. We report a case of a tooth extraction in a patient with hereditary angioedema, for which the C1-inhibitor (C1-INH) concentration administered effectively controlled edema during and after extraction. We also review case reports of oral surgery management in patients with hereditary and acquired angioedemas. In 2 of 36 cases, laryngeal edema occurred after teeth extraction. One was considered to be a type 2 acquired angioedema, which tolerates replacement therapy with fresh frozen plasma. The other case was managed only with danazol, and it was suggested that this was on occasion insufficient. Safety of oral surgery on patients with angioedema depends on the type of angioedema and the availability of C1-INH concentration. An exact diagnosis of the type of angioedema is needed to know the effect of replacement therapy with C1-INH.

知的障害者歯科治療時の静脈内鎮静法におけるBispectral Index(BIS値)と覚醒時間との関係 Reviewed

北ふみ, 前田茂, 江草正彦, 森貴幸, 宮脇卓也, 嶋田昌彦

障害者歯科 24 ( 4 ) 540 - 544 2003.10

Language：Japanese Publisher：(一社)日本障害者歯科学会

知的障害者歯科治療時の静脈内鎮静法におけるBISモニターの有用性を評価するために,Bispectral Index(BIS値)と覚醒時間との関係を検討した.対象は静脈内鎮静法下に歯科治療を受けた知的障害者症例10例とし,ミダゾラムの単回静注の後,プロポフォールを持続投与した.薬剤の総投与量の中央値は,ミダゾラム3mg,プロポフォール215mgであった.また,プロポフォールの平均投与速度は6.6mg/kg/hrであった.歯科治療終了時,および歯科治療後のBIS値と覚醒時間には有意な相関関係が認められた.しかし,歯科治療中のBIS値と覚醒時間には有意な相関関係が認められなかった.したがって,歯科治療終了時のBIS値を高くすることによって,覚醒を速くできるのではないかと考えられ,知的障害者歯科治療時の静脈内鎮静法におけるBISモニターの有用性が示唆された

プロポフォールの中枢神経抑制作用に関する電気生理学的研究 Reviewed

樋口仁, 舩橋誠, 宮脇卓也, 美藤純弘, 糀谷淳, 嶋田昌彦, 松尾龍二

岡山歯学会雑誌 22 ( 1 ) 165 - 176 2003.6

Language：Japanese Publisher：岡山歯学会

ラットの新鮮脳海馬スライスにGABA A受容体拮抗薬ピクロトキシンを投与しててんかん様の自然発火を惹起させ,これにプロポフォールを投与したところ,濃度依存的に自然発火の頻度,持続時間が減少した.又,Schaffer側枝の電気刺激で惹起したてんかん様バースト発火に対しても,プロポフォールは濃度依存的に持続時間を減少させた.更にピクロトキシン及びAMPA型グルタミン酸受容体拮抗薬CNQX存在下でSchaffer側枝の電気刺激により誘発した興奮性シナプス後電位に対し,プロポフォール投与で振幅,持続時間は減少した.ピクロトキシン及びNMDA型グルタミン酸受容体拮抗薬CPP存在下での誘発電位に対してもプロポフォール投与は電位の持続時間を減少させた.次に細胞内パルス通電により生ずる海馬CA1ニューロンの膜電位変化に対し,プロポフォールを投与したところ,これらの膜電位変化は著明に減少した.プロポフォールが過分極作動性内向き電流(H電流)を抑制し,膜電位の過分極,膜抵抗の増加を引き起こすことが示された

Suppression of the hyperpolarization-activated inward current contributes to the inhibitory actions of propofol on rat CA1 and CA3 pyramidal neurons. Reviewed International journal

Hitoshi Higuchi, Makoto Funahashi, Takuya Miyawaki, Yoshihiro Mitoh, Atsushi Kohjitani, Masahiko Shimada, Ryuji Matsuo

Neuroscience research 45 ( 4 ) 459 - 72 2003.4

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

Intracellular and field potential recordings were taken from the hippocampal CA1 and CA3 neurons in rat brain slices to investigate the effects of 2,6 di-isopropylphenol (propofol) on the neuronal excitability during GABA(A)-C1 channel blockade by picrotoxin (100 microM). Propofol produced a membrane hyperpolarization and an inhibition of the magnitude of the 'voltage sag' that was mediated by the activation of a hyperpolarization-activated inward current (I(H)). Propofol (>100 microM) decreased the spontaneous discharge rate of epileptiform burst responses in CA1 neurons up to 38+/-6% of the control level. Propofol also markedly reduced the duration of both spontaneous and evoked epileptiform burst responses. A propofol-induced decrease in the spontaneous discharge rate in CA3 neurons was coincident with that in CA1 neurons. The effects of propofol on the membrane potential and spontaneous discharge rate but not on the duration of burst responses were duplicated by ZD7288 (potent selective antagonist for I(H) channels), indicating that the blockade of I(H) significantly contributes to reduction of cell's excitability. The present study suggests that various actions including suppressive effects on I(H) contribute to the anesthetic and anti-convulsant properties of propofol.

Mexiletine inhibits nonadrenergic noncholinergic lower oesophageal sphincter relaxation in rabbits. Reviewed International journal

Atsushi Kohjitani, Takuya Miyawaki, Makoto Funahashi, Yoshihiro Mitoh, Ryuji Matsuo, Masahiko Shimada

European journal of pharmacology 465 ( 1-2 ) 145 - 51 2003.3

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

Nonadrenergic noncholinergic (NANC) nerves are known to be nitrergic and to have an important role in the regulation of gastrointestinal motility and function. Cardiac antiarrhythmic therapy in humans is accompanied by a high incidence of gastrointestinal side-effects. We investigated the effect of mexiletine, a class Ib antiarrhythmic drug, on NANC lower oesophageal sphincter relaxation. Mexiletine concentration dependently inhibited the NANC relaxation induced by 30 mM KCl (EC(50)=4.4 x 10(-6) M); the production of 3',5'-cyclic guanosine monophosphate (cGMP) after KCl stimulation was concentration dependently decreased. The relaxation induced by the exogenous nitric oxide (NO) donor, diethylamine NONOate (10(-5) M), was not inhibited by mexiletine, and the cGMP production after diethylamine NONOate application was not altered. Mexiletine did not alter the activity of NO synthase. These findings suggest that mexiletine inhibits NANC relaxation via NO-cGMP pathway modulation, possibly by inhibiting myenteric nitrergic neurotransmission in the lower oesophageal sphincter in rabbits.

Ketamine and midazolam differentially inhibit nonadrenergic noncholinergic lower esophageal sphincter relaxation in rabbits: role of superoxide anion and nitric oxide synthase. Reviewed International journal

Atsushi Kohjitani, Takuya Miyawaki, Makoto Funahashi, Hitoshi Higuchi, Ryuji Matsuo, Masahiko Shimada

Anesthesiology 98 ( 2 ) 449 - 58 2003.2

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

BACKGROUND: The authors previously reported that ketamine and midazolam inhibited nitric oxide-mediated nonadrenergic noncholinergic (NANC) lower esophageal sphincter (LES) relaxation nitric oxide-3',5'-cyclic guanosine monophosphate pathway modulation. The mechanisms inhibiting the NANC relaxation by ketamine and midazolam were investigated. METHODS: The isometric tension of circular distal esophageal muscle strips from Japanese White rabbits was examined. NANC relaxation was induced by KCl (30 mm) in the presence of atropine (3 x 10(-6) m) and guanethidine (3 x 10(-6) m). Nitric oxide synthase activity in the absence and presence of ketamine and midazolam was analyzed using the biochemical conversion of L-[3H]arginine to L-[3H]citrulline. RESULTS: The ketamine-induced inhibition of the NANC relaxation was partly reversed by superoxide dismutase (200, 400 U/ml) but not by catalase (100 U/ml). Ketamine concentration-dependently inhibited the relaxation induced by N-ethylethanamine:1,1-diethyl-2-hydroxy-2-nitrosohydrazine (diethylamine NONOate) and S-nitrosoglutathione. The NANC relaxation itself was not affected by superoxide dismutase. The midazolam-induced inhibition of the NANC relaxation was reversed neither by superoxide dismutase nor by catalase, and midazolam did not affect the relaxations induced by nitric oxide donors. The nitric oxide synthase activity was concentration-dependently suppressed by midazolam, but there was no marked effect of ketamine. Pyrogallol, a superoxide generator, inhibited the NANC and the diethylamine NONOate-induced relaxations. The pyrogallol-induced inhibition of the NANC relaxation was reversed by superoxide dismutase. CONCLUSION: These findings suggest that ketamine inhibits NANC LES relaxation by the extracellular production of superoxide anion, and that midazolam inhibits it by the inhibition of nitric oxide synthase activity.

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