2021/12/26 更新

写真a

スズキ サトシ
鈴木 聡
SUZUKI Satoshi
所属
岡山大学病院 助教
職名
助教
外部リンク

学位

  • 医学博士 ( 岡山大学 )

研究キーワード

  • 集中治療

  • 麻酔

  • 酸素療法

  • 重症患者

  • 呼吸

研究分野

  • ライフサイエンス / 麻酔科学

  • ライフサイエンス / 救急医学  / 集中治療

所属学協会

 

論文

  • Intraoperative fluid therapy and postoperative complications during minimally invasive esophagectomy for esophageal cancer: a single-center retrospective study.

    Yukiko Hikasa, Satoshi Suzuki, Yuko Mihara, Shunsuke Tanabe, Yasuhiro Shirakawa, Toshiyoshi Fujiwara, Hiroshi Morimatsu

    Journal of anesthesia   34 ( 3 )   404 - 412   2020年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: Compared with open thoracotomy, minimally invasive esophagectomy (MIE) methods, such as transhiatal or thoracoscopic esophagectomy, likely have lower morbidity. However, the relationship between intraoperative fluid management and postoperative complications after MIE remains unclear. Thus, we investigated the association of cumulative intraoperative fluid balance and postoperative complications in patients undergoing MIE. METHODS: This single-center retrospective cohort study examined patients undergoing thoracoscopic esophagectomy for esophageal cancer in the prone position. Postoperative complications included pneumonia, arrhythmia, thrombotic events and acute kidney injury (AKI). We compared patients with higher and lower intraoperative fluid balance (higher and lower than the median). Multivariable logistic regression analyses were performed to estimate the odds ratio of intraoperative fluid balance status on the incidence of postoperative complications. RESULTS: In total, 135 patients were included in the study. Postoperative complications occurred in 43 (32%), including cardiac arrhythmia (n = 12, 9%), thrombosis (n = 20, 15%), pneumonia (n = 13, 10%), and AKI required hemodialysis (n = 1, 1%). Patients with a higher fluid balance had higher incidence of complications than those with a lower fluid balance (46% vs. 18%, p < 0.001). After adjusting for age, ASA-PS ≥ III, blood loss, and the use of radical surgery, the higher intraoperative fluid balance group was significantly and independently associated with postoperative complications (adjusted OR 5.31, 95% CI 2.26-13.6, p < 0.0001). CONCLUSIONS: In patients undergoing thoracoscopic esophagectomy in the prone position, a greater intraoperative positive fluid balance was independently associated with a higher incidence of complications.

    DOI: 10.1007/s00540-020-02766-y

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  • Oxygen administration for postoperative surgical patients: a narrative review. 国際誌

    Satoshi Suzuki

    Journal of intensive care   8   79 - 79   2020年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Most postoperative surgical patients routinely receive supplemental oxygen therapy to prevent the potential development of hypoxemia due to incomplete lung re-expansion, reduced chest wall, and diaphragmatic activity caused by surgical site pain, consequences of hemodynamic impairment, and residual effects of anesthetic drugs (most notably residual neuromuscular blockade), which may result in atelectasis, ventilation-perfusion mismatch, alveolar hypoventilation, and impaired upper airway patency. Additionally, the World Health Organization guidelines for reducing surgical site infection have recommended the perioperative administration of high-dose oxygen, including during the immediate postoperative period. However, supplemental oxygen and hyperoxemia also have harmful effects on the respiratory and cardiovascular systems, with several clinical studies having reported an association between high perioperative oxygen administration and worse clinical outcomes. Recently, the increased availability of new and short-acting anesthetic drugs, comprehensive pharmacological knowledge, postoperative multimodal analgesia, and new minimally invasive surgery options could result in lower incidences of postoperative hypoxemia. Moreover, recommendations promoting high oxygen administration to prevent surgical site infections have been challenged, considering the lack of scientific investigations, and have not been widely accepted. Given the potential harmful effects of hyperoxemia, routine postoperative oxygen administration might not be recommended. Recent clinical studies have indicated that a conservative approach to oxygen therapy, where oxygen administration is titrated to achieve slightly lower oxygen levels than usual, could be safely implemented and decrease acutely ill patients' susceptibility to hyperoxemia. Based on current evidence, appropriate monitoring, including peripheral oxygen saturation, and oxygen titration should be required during postoperative oxygen administration to avoid both hypoxemia and hyperoxemia. Future trials should therefore focus on determining the optimal oxygen target during postoperative care.

    DOI: 10.1186/s40560-020-00498-5

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  • Prolonged Tachycardia with Higher Heart Rate Is Associated with Higher ICU and In-hospital Mortality. 査読

    Hayashi M, Taniguchi A, Kaku R, Fujimoto S, Isoyama S, Manabe S, Yoshida T, Suzuki S, Shimizu K, Morimatsu H, Momota R

    Acta medica Okayama   73 ( 2 )   147 - 153   2019年4月

  • Conservative versus conventional oxygen therapy for cardiac surgical patients: A before-and-after study. 査読 国際共著 国際誌

    Glenn M Eastwood, Matthew J Chan, Leah Peck, Helen Young, Johan Mårtensson, Neil J Glassford, Hidetoshi Kagaya, Satoshi Suzuki, Sean Galvin, George Matalanis, Rinaldo Bellomo

    Anaesthesia and intensive care   47 ( 2 )   175 - 182   2019年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Avoiding hypoxaemia is considered crucial in cardiac surgery patients admitted to the intensive care unit (ICU). However, avoiding hyperoxaemia may also be important. A conservative approach to oxygen therapy may reduce exposure to hyperoxaemia without increasing the risk of hypoxaemia. Using a before-and-after design, we evaluated the introduction of conservative oxygen therapy (target SpO2 88%-92% using the lowest FiO2) for cardiac surgical patients admitted to the ICU. We studied 9041 arterial blood gas (ABG) datasets: 4298 ABGs from 245 'conventional' and 4743 ABGs from 298 'conservative' oxygen therapy patients. During mechanical ventilation (MV) and while in the ICU, compared to the conventional group, conservative group patients had significantly lower FiO2 exposure and PaO2 values ( P < 0.001 for each). Accordingly, using the mean PaO2 during MV, more conservative group patients were classified as normoxaemic (226 versus 62 patients, P < 0.01), fewer as hyperoxaemic (66 versus 178 patients, P < 0.01) and no patient in either group as hypoxaemic or severely hypoxaemic. Moreover, more ABG samples were hyperoxaemic or severely hyperoxaemic during conventional treatment ( P < 0.001). Finally, there was no difference in ICU or hospital length of stay, ICU or hospital mortality or 30-day mortality between the groups. Our findings support the feasibility and physiological safety of conservative oxygen therapy in patients admitted to ICU after cardiac surgery.

    DOI: 10.1177/0310057X19838753

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  • Perioperative Management of a Child With Glucose Transporter Type 1 Deficiency Syndrome: A Case Report. 査読

    Yoshida T, Shimizu K, Suzuki S, Matsuoka Y, Morimatsu H

    A&A practice   11 ( 2 )   35 - 37   2018年7月

  • Current Ventilator and Oxygen Management during General Anesthesia: A Multicenter, Cross-sectional Observational Study. 査読 国際誌

    Satoshi Suzuki, Yuko Mihara, Yukiko Hikasa, Shuji Okahara, Takuma Ishihara, Ayumi Shintani, Hiroshi Morimatsu, Akiko Sato, Sachio Kusume, Hidekuni Hidaka, Hidehiko Yatsuzuka, Masahiro Okawa, Makoto Takatori, Shinsei Saeki, Takeshi Samuta, Hiroaki Tokioka, Toshiaki Kurasako, Masato Maeda, Mamoru Takeuchi, Akihito Hirasaki, Michio Kitaura, Hideki Kajiki, Osamu Kobayashi, Hiroshi Katayama, Hideki Nakatsuka, Satoshi Mizobuchi, Seiji Sugimoto, Masataka Yokoyama, Kazuhito Kusudo, Kensuke Shiraishi, Toshio Iwaki, Tatsuhiko Komatsu, Yasuo Hirai, Tetsufumi Sato, Masakazu Kimura, Takeshi Yasukawa, Motonobu Kimura, Masahiro Taniguchi, Yutaka Shimoda, Yoji Kobayashi, Mitsunori Tsukioki, Nobuki Manabe, Eiji Ando, Makoto Kosaka, Takashi Tsukiji, Chika Tokura, Yasuhiro Asao, Masatoshi Sugiyama, Kozo Seto

    Anesthesiology   129 ( 1 )   67 - 76   2018年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia. METHODS: A multicenter, cross-sectional study was conducted to describe current ventilator management, particularly oxygen management, during general anesthesia in Japan. All adult patients (16 yr old or older) who received general anesthesia over 5 consecutive days in 2015 at 43 participating hospitals were identified. Ventilator settings and vital signs were collected 1 h after the induction of general anesthesia. We determined the prevalence of potentially preventable hyperoxemia (oxygen saturation measured by pulse oximetry of more than 98%, despite fractional inspired oxygen tension of more than 0.21) and the risk factors for potentially substantial oxygen exposure (fractional inspired oxygen tension of more than 0.5, despite oxygen saturation measured by pulse oximetry of more than 92%). RESULTS: A total of 1,786 patients were found eligible, and 1,498 completed the study. Fractional inspired oxygen tension was between 0.31 and 0.6 in 1,385 patients (92%), whereas it was less than or equal to 0.3 in very few patients (1%). Most patients (83%) were exposed to potentially preventable hyperoxemia, and 32% had potentially substantial oxygen exposure. In multivariable analysis, old age, emergency surgery, and one-lung ventilation were independently associated with increased potentially substantial oxygen exposure, whereas use of volume control ventilation and high positive end-expiratory pressure levels were associated with decreased potentially substantial oxygen exposure. One-lung ventilation was particularly a strong risk factor for potentially substantial oxygen exposure (adjusted odds ratio, 13.35; 95% CI, 7.24 to 24.60). CONCLUSIONS: Potentially preventable hyperoxemia and substantial oxygen exposure are common during general anesthesia, especially during one-lung ventilation. Future research should explore the safety and feasibility of a more conservative approach for intraoperative oxygen therapy.

    DOI: 10.1097/ALN.0000000000002181

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  • Associations between intraoperative ventilator settings during one-lung ventilation and postoperative pulmonary complications: A prospective observational study 査読 国際誌

    Shuji Okahara, Kazuyoshi Shimizu, Satoshi Suzuki, Kenzo Ishii, Hiroshi Morimatsu

    BMC Anesthesiology   18 ( 1 )   13 - 13   2018年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BioMed Central Ltd.  

    Background: The interest in perioperative lung protective ventilation has been increasing. However, optimal management during one-lung ventilation (OLV) remains undetermined, which not only includes tidal volume (VT) and positive end-expiratory pressure (PEEP) but also inspired oxygen fraction (FIO2). We aimed to investigate current practice of intraoperative ventilation during OLV, and analyze whether the intraoperative ventilator settings are associated with postoperative pulmonary complications (PPCs) after thoracic surgery. Methods: We performed a prospective observational two-center study in Japan. Patients scheduled for thoracic surgery with OLV from April to October 2014 were eligible. We recorded ventilator settings (FIO2, VT, driving pressure (ΔP), and PEEP) and calculated the time-weighted average (TWA) of ventilator settings for the first 2 h of OLV. PPCs occurring within 7 days of thoracotomy were investigated. Associations between ventilator settings and the incidence of PPCs were examined by multivariate logistic regression. Results: We analyzed perioperative information, including preoperative characteristics, ventilator settings, and details of surgery and anesthesia in 197 patients. Pressure control ventilation was utilized in most cases (92%). As an initial setting for OLV, an FIO2 of 1.0 was selected for more than 60% of all patients. Throughout OLV, the median TWA FIO2 of 0.8 (0.65-0.94), VT of 6.1 (5.3-7.0) ml/kg, ΔP of 17 (15-20) cm H2O, and PEEP of 4 (4-5) cm H2O was applied. Incidence rate of PPCs was 25.9%, and FIO2 was independently associated with the occurrence of PPCs in multivariate logistic regression. The adjusted odds ratio per FIO2 increase of 0.1 was 1.30 (95% confidence interval: 1.04-1.65, P =0.0195). Conclusions: High FIO2 was applied to the majority of patients during OLV, whereas low VT and slight degree of PEEP were commonly used in our survey. Our findings suggested that a higher FIO2 during OLV could be associated with increased incidence of PPCs.

    DOI: 10.1186/s12871-018-0476-x

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  • A Case of Refractory Systemic Capillary Leak Syndrome (Clarkson's Disease) during Pregnancy 査読

    Yukiko Hikasa, Masao Hayashi, Satoshi Suzuki, Hiroshi Morimatsu

    ACTA MEDICA OKAYAMA   70 ( 6 )   497 - 501   2016年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OKAYAMA UNIV MED SCHOOL  

    A 32-year-old woman, pregnant with twins, presented with a chief complaint of general fatigue. Her general condition had rapidly deteriorated since her last visit to the primary obstetrician; the patient was then referred to our hospital because of suspected fetal death. She underwent emergency cesarean section because fetal death had indeed occurred, and she was then admitted to the intensive care unit (ICU). On ICI: admission, she was found to he in shock. Laboratory analysis revealed extreme hemoconcentration and a low albumin level, and initially, septic shock with obstetric complications was suspected. However, because she did not respond to conventional therapy but instead, rapidly developed severe generalized edema, systemic capillary leak syndrome (SCLS) was diagnosed. The patient remained in shock for several days until undergoing plasma exchange (PE), despite some earlier empirical treatments. She eventually recovered from profound shock status and was discharged from the ICU without sequelae. Among potentially effective treatments, PE seemed to be the most reasonable choice for the treatment of her SCLS.

    DOI: 10.18926/AMO/54814

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  • Targeted therapeutic mild hypercapnia after cardiac arrest: A phase II multi-centre randomised controlled trial (the CCC trial) 査読

    Glenn M. Eastwood, Antoine G. Schneider, Satoshi Suzuki, Leah Peck, Helen Young, Aiko Tanaka, Johan Martensson, Stephen Warrillow, Shay McGuinness, Rachael Parke, Eileen Gilder, Lianne Mccarthy, Pauline Galt, Gopal Taori, Suzanne Eliott, Tammy Lamac, Michael Bailey, Nerina Harley, Deborah Barge, Carol L. Hodgson, Maria Cristina Morganti-Kossmann, Alice Pebay, Alison Conquest, John S. Archer, Stephen Bernard, Dion Stub, Graeme K. Hart, Rinaldo Bellomo

    RESUSCITATION   104   83 - 90   2016年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER IRELAND LTD  

    Background: In intensive care observational studies, hypercapnia after cardiac arrest (CA) is independently associated with improved neurological outcome. However, the safety and feasibility of delivering targeted therapeutic mild hypercapnia (TTMH) for such patients is untested.
    Methods: In a phase II safety and feasibility multi-centre, randomised controlled trial, we allocated ICU patients after CA to 24 h of targeted normocapnia (TN) (PaCO2 35-45 mmHg) or TTMH (PaCO2 50-55 mmHg). The primary outcome was serum neuron specific enolase (NSE) and S100b protein concentrations over the first 72 h assessed in the first 50 patients surviving to day three. Secondary end-points included global measure of function assessment at six months and mortality for all patients.
    Results: We enrolled 86 patients. Their median age was 61 years (58, 64 years) and 66 (79%) were male. Of these, 50 patients (58%) survived to day three for full biomarker assessment. NSE concentrations increased in the TTMH group (p = 0.02) and TN group (p = 0.005) over time, with the increase being significantly more pronounced in the TN group (p(interaction)=0.04). S100b concentrations decreased over time in the TTMH group (p &lt; 0.001) but not in the TN group (p = 0.68). However, the S100b change over time did not differ between the groups (p(interaction)=0.23). At six months, 23 (59%) TTMH patients had good functional recovery compared with 18 (46%) TN patients. Hospital mortality occurred in 11 (26%) TTMH patients and 15 (37%) TN patients (p = 0.31).
    Conclusions: In CA patients admitted to the ICU, TTMH was feasible, appeared safe and attenuated the release of NSE compared with TN. These findings justify further investigation of this novel treatment. (C) 2016 Published by Elsevier Ireland Ltd.

    DOI: 10.1016/j.resuscitation.2016.03.023

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  • Conservative oxygen therapy in mechanically ventilated patients following cardiac arrest: A retrospective nested cohort study 査読 国際誌

    Glenn M. Eastwood, Aiko Tanaka, Emilo Daniel Valenzuela Espinoza, Leah Peck, Helen Young, Johan Martensson, Ling Zhang, Neil J. Glassford, Yu-Feng Frank Hsiao, Satoshi Suzuki, Rinaldo Bellomo

    RESUSCITATION   101   108 - 114   2016年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER IRELAND LTD  

    Background: In mechanically ventilated (MV) cardiac arrest (CA) survivors admitted to the intensive care unit (ICU) avoidance of hypoxia is considered crucial. However, avoidance of hyperoxia may also be important. A conservative approach to oxygen therapy may reduce exposure to both.
    Methods: We evaluated the introduction of conservative oxygen therapy (target SpO(2) 88-92% using the lowest FiO(2)) during MV for resuscitated CA patients admitted to the ICU.
    Results: We studied 912 arterial blood gas (ABG) datasets: 448 ABGs from 50 'conventional' and 464 ABGs from 50 'conservative' oxygen therapy patients. Compared to the conventional group, conservative group patients had significantly lower PaO2 values and FiO(2) exposure (p &lt; 0.001, respectively); more received MV in a spontaneous ventilation mode (18% vs 2%; p = 0.001) and more were exposed to a FiO(2) of 0.21 (19 vs 0 patients, p = 0.001). Additionally, according to mean PaO2, more conservative group patients were classified as normoxaemic (36 vs 16 patients, p &lt; 0.01) and fewer as hyperoxaemic (14 vs 33 patients, p &lt; 0.01). Finally, ICU length of stay was significantly shorter for conservative group patients (p = 0.04). There was no difference in the proportion of survivors discharged from hospital with good neurological outcome (14/23 vs 12/22 patients, p = 0.67).
    Conclusions: Our findings provide preliminary support for the feasibility and physiological safety of conservative oxygen therapy in patients admitted to ICU for MV support after cardiac arrest (Trial registration, NCT01684124). (C) 2015 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.resuscitation.2015.11.026

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  • Urinary Neutrophil Gelatinase-Associated Lipocalin as Predictor of Short- or Long-Term Outcomes in Cardiac Surgery Patients 査読

    Mercedes Garcia-Alvarez, Neil J. Glassford, Antoni J. Betbese, Jordi Ordonez, Victoria Banos, Marta Argilaga, Alfonso Martinez, Satoshi Suzuki, Antoine G. Schneider, Glenn M. Eastwood, M. Victoria Moral, Rinaldo Bellomo

    JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA   29 ( 6 )   1480 - 1488   2015年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

    Objectives: To determine the ability of urinary neutrophil gelatinase-associated lipocalin (uNGAL) to predict cardiac surgery-associated acute kidney injury (CSA-AKI), continuous renal replacement therapy (CRRT), mortality, and a composite outcome of major adverse kidney events at 365 days (MAKE(365)), and to investigate the influence of cardiopulmonary bypass (CPB) on NGAL release.
    Design: A prospective observational study.
    Setting: A single-center university hospital.
    Participants: A cohort of 288. adult cardiac surgery patients.
    Interventions: uNGAL was measured at baseline, immediately after surgery, and on days 1 and 2 postoperatively. The authors used the recent Kidney Disease Improving Global Outcomes consensus criteria to define CSA-AKI.
    Measurements and Main Results: CSA-AKI occurred in 36.1% of patients. uNGAL rapidly became significantly higher in patients who developed AKI, with peak value immediately after surgery (349.9 [76.6-1446.6] v 90.1 [20.8-328] ng/mg creatinine; p &lt; 0.001). No measure of uNGAL (peak, postsurgery, day 1 or 2 postsurgery) accurately predicted CSA-AKI, CRRT, mortality, or MAKE365. However, immediately after surgery, CPB induced greater uNGAL release compared with off-pump surgery (265.5 mu mol/L [71-989.6] v 48.7 ng/mg creatinine [17-129.8]; p &lt; 0.001). Moreover, such early uNGAL release correlated with CPB duration (r = 0.505; p &lt; 0.001) but not with peak serum creatinine values on day 3 or 7 after surgery.
    Conclusions: uNGAL had a limited predictive ability for CSA-AKI or other relevant clinical outcomes after cardiac surgery and appeared to be more closely related to the use and duration of CPB. Thus, its levels may represent the aggregate effect of an inflammatory response to CPB as well as a renal response to cardiac surgery and inflammation. (C) 2015 Elsevier Inc. All rights reserved.

    DOI: 10.1053/j.jvca.2015.05.060

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  • Atelectasis and mechanical ventilation mode during conservative oxygen therapy: A before-and-after study 査読 国際誌

    Satoshi Suzuki, Glenn M. Eastwood, Mark D. Goodwin, Geertje D. Noe, Paul E. Smith, Neil Glassford, Antoine G. Schneider, Rinaldo Bellomo

    JOURNAL OF CRITICAL CARE   30 ( 6 )   1232 - 1237   2015年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

    Purpose: The purpose of the study is to assess the effect of a conservative oxygen therapy (COT) (target SpO(2) of 90%-92%) on radiological atelectasis and mechanical ventilation modes.
    Materials and methods: We conducted a secondary analysis of 105 intensive care unit patients from a pilot before-and-after study. The primary outcomes of this study were changes in atelectasis score (AS) of 555 chest radiographs assessed by radiologists blinded to treatment allocation and time to weaning from mandatory ventilation and first spontaneous ventilation trial (SVT).
    Results: There was a significant difference in overall AS between groups, and COT was associated with lower time-weighted average AS. In addition, in COT patients, change from mandatory to spontaneous ventilation or time to first SVT was shortened. After adjustment for baseline characteristics and interactions between oxygen therapy, radiological atelectasis, and mechanical ventilation management, patients in the COT group had significantly lower "best" AS (adjusted odds ratio, 0.28 [95% confidence interval {CI}, 0.12-0.66]; P = .003) and greater improvement in AS in the first 7 days (adjusted odds ratio, 0.42 [95% CI, 0.17-0.99]; P = .049). Moreover, COT was associated with significantly earlier successful weaning from a mandatory ventilation mode (adjusted hazard ratio, 2.96 [95% CI, 1.73-5.04]; P &lt; .001) and with shorter time to first SVT (adjusted hazard ratio, 1.77 [95% CI, 1.13-2.78]; P = .013).
    Conclusions: In mechanically ventilated intensive care unit patients, COT might be associated with decreased radiological evidence of atelectasis, earlier weaning from mandatory ventilation modes, and earlier first trial of spontaneous ventilation. (C) 2015 Elsevier Inc. All rights reserved.

    DOI: 10.1016/j.jcrc.2015.07.033

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  • Paracetamol therapy and outcome of critically ill patients: a multicenter retrospective observational study 査読

    Satoshi Suzuki, Glenn M. Eastwood, Michael Bailey, David Gattas, Peter Kruger, Manoj Saxena, John D. Santamaria, Rinaldo Bellomo

    Critical Care   19 ( 1 )   162   2015年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BioMed Central Ltd.  

    Introduction: In this study, we aimed to examine the association between paracetamol administration in the intensive care unit (ICU) and mortality in critically ill patients. Methods: We conducted a multicenter retrospective observational study in four ICUs. We obtained information on paracetamol use, body temperature, demographic, clinical and outcome data from each hospital's clinical information system and admissions and discharges database. We performed statistical analysis to assess the association between paracetamol administration and hospital mortality. Results: We studied 15,818 patients with 691,348 temperature measurements at 4 ICUs. Of these patients, 10,046 (64%) received at least 1g of paracetamol. Patients who received paracetamol had lower in-hospital mortality (10% vs. 20%, P &lt
    0.001), and survivors were more likely to have received paracetamol (66% vs. 46%
    P &lt
    0.001). However, patients treated with paracetamol were also more likely to be admitted to the ICU after surgery (70% vs. 51%
    P &lt
    0.001) and/or after elective surgery (55% vs. 37%
    P &lt
    0.001). In multivariate logistic regression analysis including a propensity score for paracetamol treatment, we found a significant and independent association between the use of paracetamol and reduced in-hospital mortality (adjusted odds ratio =0.60 (95% confidence interval (CI), 0.53 to 0.68), P &lt
    0.001). Cox proportional hazards analysis showed that patients who received paracetamol also had a significantly longer time to death (adjusted hazard ratio =0.51 (95% CI, 0.46 to 0.56), P &lt
    0.001). The association between paracetamol and decreased mortality and/or time to death was broadly consistent across surgical and medical patients. It remained present after adjusting for paracetamol administration as a time-dependent variable. However, when such time-dependent analysis was performed, the association of paracetamol with outcome lost statistical significance in the presence of fever and suspected infection and in patients in the lower tertiles of Acute Physiology and Chronic Health Evaluation II scores. Conclusions: Paracetamol administration is common in the ICU and appears to be independently associated with reduced in-hospital mortality and time to death after adjustment for multiple potential confounders and propensity score. This association, however, was modified by the presence of fever, suspected infection and lesser illness severity and may represent the effect of indication bias.

    DOI: 10.1186/s13054-015-0865-1

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  • A pilot feasibility, safety and biological efficacy multicentre trial of therapeutic hypercapnia after cardiac arrest: study protocol for a randomized controlled trial 査読

    Glenn M. Eastwood, Antoine G. Schneider, Satoshi Suzuki, Michael Bailey, Rinaldo Bellomo

    TRIALS   16   135   2015年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BIOMED CENTRAL LTD  

    Background: Cardiac arrest causes ischaemic brain injury. Arterial carbon dioxide tension (PaCO2) is a major determinant of cerebral blood flow. Thus, mild hypercapnia in the 24 h following cardiac arrest may increase cerebral blood flow and attenuate such injury. We describe the Carbon Control and Cardiac Arrest (CCC) trial.
    Methods/Design: The CCC trial is a pilot multicentre feasibility, safety and biological efficacy randomized controlled trial recruiting adult cardiac arrest patients admitted to the intensive care unit after return of spontaneous circulation. At admission, using concealed allocation, participants are randomized to 24 h of either normocapnia (PaCO2 35 to 45 mmHg) or mild hypercapnia (PaCO2 50 to 55 mmHg). Key feasibility outcomes are recruitment rate and protocol compliance rate. The primary biological efficacy and biological safety measures are the between-groups difference in serum neuron-specific enolase and S100b protein levels at 24 h, 48 h and 72 h. Secondary outcome measure include adverse events, in-hospital mortality, and neurological assessment at 6 months.
    Discussion: The trial commenced in December 2012 and, when completed, will provide clinical evidence as to whether targeting mild hypercapnia for 24 h following intensive care unit admission for cardiac arrest patients is feasible and safe and whether it results in decreased concentrations of neurological injury biomarkers compared with normocapnia. Trial results will also be used to determine whether a phase IIb study powered for survival at 90 days is feasible and justified.

    DOI: 10.1186/s13063-015-0676-3

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  • A pilot assessment of alpha-stat vs pH-stat arterial blood gas analysis after cardiac arrest 査読

    Glenn M. Eastwood, Satoshi Suzuki, Cristina Lluch, Antoine G. Schneider, Rinaldo Bellomo

    JOURNAL OF CRITICAL CARE   30 ( 1 )   138 - 144   2015年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

    Purpose: Resuscitated cardiac arrest (CA) patients typically receive therapeutic hypothermia, but arterial blood gases (ABGs) are often assessed after adjustment to 37 degrees C (alpha-stat) instead of actual body temperature (pH-stat). We sought to compare alpha-stat and pH-stat assessment of Pao(2) and Paco(2) in such patients.
    Materials and methods: Using ABG data obtained during the first 24 hours of intensive care unit admission, we determined the impact of measured alpha vs calculated pH-stat on Pao(2) and Paco(2) on patient classification and outcomes for CA patients.
    Results: We assessed 1013 ABGs from 120 CA patients with a median age of patients 66 years (interquartile range, 50-76). Median alpha-stat Pao(2) changed from 122 (95-156) to 107 (82-143) mm Hg with pH-stat and median Paco(2) from 39 (34-46) to 35 (30-41) mm Hg (both P &lt; .001). Using the categories of hyperoxemia, normoxemia, and hypoxemia, pH-stat estimation of Pao(2) reclassified approximately 20% of patients. Using the categories of hypercapnia, normocapnia, and hypocapnia, pH-stat estimation of Paco(2) reclassified approximately 40% of patients. The mortality of patients in different Pao(2) and Paco(2) categories was similar for pH-stat and alpha-stat.
    Conclusions: Using the pH-stat method, fewer resuscitated CA patients admitted to intensive care unit were classified as hyperoxemic or hypercapnic compared with alpha-stat. These findings suggest an impact of ABG assessment methodology on Pao(2), Paco(2), and patient classification but not on associated outcomes. (C) 2014 Elsevier Inc. All rights reserved.

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  • Pulse pressure variation-guided fluid therapy after cardiac surgery: A pilot before-and-after trial 査読

    Satoshi Suzuki, Nicholas C. Z. Woinarski, Miklos Lipcsey, Cristina Lluch Candal, Antoine G. Schneider, Neil J. Glassford, Glenn M. Eastwood, Rinaldo Bellomo

    JOURNAL OF CRITICAL CARE   29 ( 6 )   992 - 996   2014年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

    Purpose: The aim of this study is to study the feasibility, safety, and physiological effects of pulse pressure variation (PPV)-guided fluid therapy in patients after cardiac surgery.
    Materials and methods: We conducted a pilot prospective before-and-after study during mandatory ventilation after cardiac surgery in a tertiary intensive care unit. We introduced a protocol to deliver a fluid bolus for a PPV &gt;= 13% for at least &gt;10 minutes during the intervention period.
    Results: We studied 45 control patients and 53 intervention patients. During the intervention period, clinicians administered a fluid bolus on 79% of the defined PPV trigger episodes. Median total fluid intake was similar between 2 groups during mandatory ventilation (1297 mL[interquartile range 549-1968] vs 1481 mL [807-2563]; P =. 17) and the first 24 hours (3046 mL [interquartile range 2317-3982] vs 3017 mL [2192-4028]; P = .73). After adjusting for several baseline factors, PPV-guided fluid management significantly increased fluid intake during mandatory ventilation (P = .004) but not during the first 24 hours (P = .47). Pulse pressure variation-guided fluid therapy, however, did not significantly affect hemodynamic, renal, and metabolic variables. No serious adverse events were noted.
    Conclusions: Pulse pressure variation-guided fluid management was feasible and safe during mandatory ventilation after cardiac surgery. However, its advantages may be clinically small. (C) 2014 Elsevier Inc. All rights reserved.

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  • Intensive care clinicians' opinion of conservative oxygen therapy (SpO₂ 90-92%) for mechanically ventilated patients. 査読

    Eastwood GM, Peck L, Young H, Suzuki S, Garcia M, Bellomo R

    Australian critical care : official journal of the Confederation of Australian Critical Care Nurses   27 ( 3 )   120 - 125   2014年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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  • Conservative Oxygen Therapy in Mechanically Ventilated Patients: A Pilot Before-and-After Trial 査読

    Satoshi Suzuki, Glenn M. Eastwood, Neil J. Glassford, Leah Peck, Helen Young, Mercedes Garcia-Alvarez, Antoine G. Schneider, Rinaldo Bellomo

    CRITICAL CARE MEDICINE   42 ( 6 )   1414 - 1422   2014年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    Objectives: To assess the feasibility and safety of a conservative approach to oxygen therapy in mechanically ventilated ICU patients.
    Design: Pilot prospective before-and-after study.
    Setting: A 22-bed multidisciplinary ICU of a tertiary care hospital in Australia.
    Patients: A total of 105 adult (18 years old or older) patients required mechanical ventilation for more than 48 hours: 51 patients during the conventional before period and 54 after a change to conservative oxygen therapy.
    Interventions: Implementation of a conservative approach to oxygen therapy (target Spo(2) of 90-92%).
    Measurements and Main Results: We collected 3,169 datasets on 799 mechanical ventilation days. During conservative oxygen therapy the median time-weighted average Spo(2) on mechanical ventilation was 95.5% (interquartile range, 94.0-97.3) versus 98.4% (97.3-99.1) (p &lt; 0.001) during conventional therapy. The median Pao(2) was 83 torr (71-94) versus 107 torr (94-131) (p &lt; 0.001) with a change to a median Fio(2) of 0.27 (0.24-0.30) versus 0.40 (0.35-0.44) (p &lt; 0.001). Conservative oxygen therapy decreased the median total amount of oxygen delivered during mechanical ventilation by about two thirds (15,580 L [8,263-29,351 L] vs 5,122 L [1,837-10,499 L]; p &lt; 0.001). The evolution of the Pao(2)/Fio(2) ratio was similar during the two periods, and there were no difference in any other biochemical or clinical outcomes.
    Conclusions: Conservative oxygen therapy in mechanically ventilated ICU patients was feasible and free of adverse biochemical, physiological, or clinical outcomes while allowing a marked decrease in excess oxygen exposure. Our study supports the safety and feasibility of future pilot randomized controlled trials of conventional compared with conservative oxygen therapy.

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  • Mortality Related to Severe Sepsis and Septic Shock Among Critically III Patients in Australia and New Zealand, 2000-2012 査読

    Kirsi-Maija Kaukonen, Michael Bailey, Satoshi Suzuki, David Pilcher, Rinaldo Bellomo

    JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION   311 ( 13 )   1308 - 1316   2014年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:AMER MEDICAL ASSOC  

    IMPORTANCE Severe sepsis and septic shock are major causes of mortality in intensive care unit (ICU) patients. It is unknown whether progress has been made in decreasing their mortality rate.
    OBJECTIVE To describe changes in mortality for severe sepsis with and without shock in ICU patients.
    DESIGN, SETTING, AND PARTICIPANTS Retrospective, observational study from 2000 to 2012 including 101 064 patients with severe sepsis from 171 ICUs with various patient case mix in Australia and New Zealand.
    MAIN OUTCOMES AND MEASURES Hospital outcome (mortality and discharge to home, to other hospital, or to rehabilitation).
    RESULTS Absolute mortality in severe sepsis decreased from 35.0% (95% CI, 33.2%-36.8%; 949/2708) to 18.4% (95% CI, 17.8%-19.0%; 2300/12 512; P&lt;.001), representing an overall decrease of 16.7% (95% CI, 14.8%-18.6%), an annual rate of absolute decrease of 1.3%, and a relative risk reduction of 47.5% (95% CI, 44.1%-50.8%). After adjusted analysis, mortality decreased throughout the study period with an odds ratio (OR) of 0.49 (95% CI, 0.46-0.52) in 2012, using the year 2000 as the reference (P&lt;.001). The annual decline in mortality did not differ significantly between patients with severe sepsis and those with all other diagnoses (OR, 0.94 [95% CI, 0.94-0.95] vs 0.94 [95% CI, 0.94-0.94]; P = .37). The annual increase in rates of discharge to home was significantly greater in patients with severe sepsis compared with all other diagnoses (OR, 1.03 [95% CI, 1.02-1.03] vs 1.01 [95% CI, 1.01-1.01]; P&lt;.001). Conversely, the annual increase in the rate of patients discharged to rehabilitation facilities was significantly less in severe sepsis compared with all other diagnoses (OR, 1.08 [95% CI, 1.07-1.09] vs 1.09 [95% CI, 1.09-1.10]; P&lt;.001). In the absence of comorbidities and older age, mortality was less than 5%.
    CONCLUSIONS AND RELEVANCE In critically ill patients in Australia and New Zealand with severe sepsis with and without shock, there was a decrease in mortality from 2000 to 2012. These findings were accompanied by changes in the patterns of discharge to home, rehabilitation, and other hospitals.

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  • Hyperoxemia in critically mechanical ventilation patients: A factor yet to be fit for intensivists-Authors' reply 査読

    Satoshi Suzuki, Glenn M. Eastwood, Rinaldo Bellomo

    JOURNAL OF CRITICAL CARE   29 ( 1 )   173 - 173   2014年2月

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    記述言語:英語   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

    DOI: 10.1016/j.jcrc.2013.10.002

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  • Near-infrared spectroscopy of the thenar eminence to estimate forearm blood flow 査読

    Nicholas C. Z. Woinarski, Satoshi Suzuki, Miklos Lipcsey, Natalie Lumsden, Jaye Chin-Dusting, Antoine G. Schneider, Michael Bailey, Rinaldo Bellomo

    CRITICAL CARE AND RESUSCITATION   15 ( 4 )   323 - 326   2013年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:AUSTRALASIAN MED PUBL CO LTD  

    Background: Near-infrared spectroscopy of the thenar eminence (NIRSth) can be used at the bedside to assess tissue oxygenation (Sto(2)), the reperfusion response to ischaemia and the tissue haemoglobin index (THI). Its ability to estimate forearm blood flow (FBF) has not previously been assessed.
    Objectives: We aimed to test whether short-lived venous occlusion-induced changes in NIRSth-derived THI (Delta THI/minute) correlate with strain gauge plethysmography (SGP) measurements.
    Methods: We measured FBF in nine volunteers with SGP by venous occlusion, while estimating Delta THI. Measurements were obtained in two forearm positions (elevated and horizontal) at baseline and during induced hyperaemia.
    Results: We performed 246 paired measurements at rest and after occlusion-induced hyperaemia. At rest, mean SGP-estimated FBF was 3.5-3.6 mL/dL/minute at baseline, compared with 12.9-13.6 mL/dL/minute during hyperaemia. At rest, Delta THI was 6.1-8.2/minute, compared with 29.7-32.5/minute during hyperaemia. Delta THI was a significant predictor of SGP FBF (P&lt;0.01), with stronger correlation during hyperaemia (P&lt;0.01). An equation was developed to convert Delta THI/minute into FBF at mL/dL/minute (FBF=0.362 x Delta THI/minute + 0.864).
    Conclusions: NIRSth can be used to estimate FBF. Given its portability and its ability to also measure Sto(2) and vascular reactivity, NIRSth can assist in providing a comprehensive bedside assessment of the forearm circulation in critically ill patients.

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  • Current oxygen management in mechanically ventilated patients: A prospective observational cohort study 査読

    Satoshi Suzuki, Glenn M. Eastwood, Leah Peck, Neil J. Glassford, Rinaldo Bellomo

    JOURNAL OF CRITICAL CARE   28 ( 5 )   647 - 654   2013年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

    Purpose: Oxygen (O-2) is the most common therapy in mechanically ventilated patients, but targets and dose are poorly understood. We aimed to describe current O-2 administration and titration in such patients in an academic intensive care unit.
    Materials and Methods: In consecutive ventilated (&gt; 48 hours) patients we prospectively obtained fraction of inspired O-2 (FIO2), pulse oximetry O-2 saturation (SpO(2)) and arterial O-2 tension (PaO2) every 6 hours. We calculated the amount of excess O-2 delivery and the intensivists' response to hyperoxemia (SpO(2) &gt; 98%).
    Results: During 358 mechanical ventilation days in 51 critically ill patients, median calculated excess O-2 delivery was 3472 L per patient. Patients spent most of their time with their SpO(2) &gt; 98% (59% [29-83]) and PaO2 between 80 and 120 mm Hg (59% [38-72]). In addition, 50% of all observations showed hyperoxemia and 4% severe hyperoxemia (PaO2 &gt; 202.5 mm Hg). Moreover, 71% of the calculated total excess 263,841 L of O-2 was delivered when the FIO2 was 0.3 to 0.5. When hyperoxemia occurred with an FIO2 between 0.3 and 0.4, for 88% of episodes, no FIO2 adjustments were made.
    Conclusions: Excess O-2 delivery and liberal O-2 therapy were common in mechanically ventilated patients. Current O-2 therapy practice may be suboptimal and further investigations are warranted. (C) 2013 Elsevier Inc. All rights reserved.

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  • Hypophosphatemia in critically ill patients 査読

    Satoshi Suzuki, Moritoki Egi, Antoine G. Schneider, Rinaldo Bellomo, Graeme K. Hart, Colin Hegarty

    Journal of Critical Care   28 ( 4 )   536 - e19   2013年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Purpose: The aim of this study was to assess the association of phosphate concentration with key clinical outcomes in a heterogeneous cohort of critically ill patients. Materials and Methods: This was a retrospective observational study at a general intensive care unit (ICU) of an Australian university teaching hospital enrolling 2730 adult critically ill patients. Results: We studied 10 504 phosphate measurements with a mean value of 1.17 mmol/L (measurements every 28.8 hours on average). Hyperphosphatemia (inorganic phosphate [iP] concentration &gt
    1.4 mmol/L) occurred in 45% and hypophosphatemia (iP ≤ 0.6 mmol/L) in 20%. Among patients without any episodes of hyperphosphatemia, patients with at least 1 episode of hypophosphatemia had a higher ICU mortality than those without hypophosphatemia (P = .004). In addition, ICU nonsurvivors had lower minimum phosphate concentrations than did survivors (P = .009). Similar results were seen for hospital mortality. However, on multivariable logistic regression analysis, hypophosphatemia was not independently associated with ICU mortality (adjusted odds ratio, 0.86 [95% confidence interval, 0.66-1.10]
    P = .24) and hospital mortality (odds ratio, 0.89 [0.73-1.07]
    P = .21). Even when different cutoff points were used for hypophosphatemia (iP ≤ 0.5, 0.4, 0.3, or 0.2 mmol/L), hypophosphatemia was not an independent risk factor for ICU and hospital morality. In addition, timing of onset and duration of hypophosphatemia were not independent risk factor for ICU and hospital mortality. Conclusions: Hypophosphatemia behaves like a general marker of illness severity and not as an independent predictor of ICU or in-hospital mortality in critically ill patients. © 2013 Elsevier Inc.

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  • Normothermic extracorporeal human liver perfusion following donation after cardiac death 査読

    Rinaldo Bellomo, Bruno Marino, Graham Starkey, Bhao Zhong Wang, Michael A. Fink, Nan Zhu, Satoshi Suzuki, Shane Houston, Glenn Eastwood, Paolo Calzavacca, Neil Glassford, Brenton Chambers, Alison Skene, Antoine G. Schneider, Daryl Jones, Andrew Hilton, Helen Opdam, Stephen Warrillow, Nicole Gauthier, Lynne Johnson, Robert Jones

    CRITICAL CARE AND RESUSCITATION   15 ( 2 )   78 - 82   2013年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:AUSTRALASIAN MED PUBL CO LTD  

    Liver transplantation is a major life-saving procedure and donation after cardiac death (DCD) has increased the pool of potential liver donors.
    However, livers procured after DCD are at increased risk of primary graft dysfunction and biliary tract ischaemia. Normothermic extracorporeal liver perfusion (NELP) may increase the ability to protect, evaluate and, in future, transplant DCD livers.
    We conducted a proof-of-concept experiment using a human liver procured by DCD (deemed not suitable for liver donation) to assess the short-term (3 hours) feasibility,, histological effects and functional efficacy of NELP.
    We used an extracorporeal membrane oxygenation circuit with separate hepatic artery and portal vein perfusion to achieve physiological perfusion pressures, and coupled this with parenteral nutrition and an insulin infusion. We achieved NELP with evidence of liver function (bile production, paracetamol removal and control of ammonia, bilirubin and lactate levels) for 3 hours. There was essentially normal liver and biliary tract histology after 8 hours of perfusion.
    Our experiment justifies further investigation of the feasibility and efficacy of human DCD liver preservation by NELP.

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  • Normothermic extracorporeal perfusion of isolated porcine liver after warm ischaemia: a preliminary report 査読

    Rinaldo Bellomo, Satoshi Suzuki, Bruno Marino, Graeme K. Starkey, Brenton Chambers, Michael A. Fink, Bao Zhong Wang, Shane Houston, Glenn Eastwood, Paolo Calzavacca, Neil Glassford, Alison Skene, Daryl A. Jones, Robert Jones

    CRITICAL CARE AND RESUSCITATION   14 ( 3 )   173 - 176   2012年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:AUSTRALASIAN MED PUBL CO LTD  

    Liver transplantation is a major life-saving procedure, and donation after cardiac death (DCD) has increased the pool of potential liver donors.
    However, DCD livers are at increased risk of primary graft dysfunction and biliary tract ischaemia. Normothermic extracorporeal liver perfusion (NELP) may increase the ability to protect, evaluate and, in future, transplant DCD livers.
    We conducted proof-of-concept experiments using a DCD model in the pig to assess the short-term (4 hours) feasibility and functional efficacy of NELP. Using extracorporeal membrane oxygenation, parenteral nutrition, separate hepatic artery and portal vein perfusion, and physiological perfusion pressures, we achieved NELP and evidence of function (bile production, paracetamol removal, maintenance of normal ammonia and lactate levels) for 4 hours in pig livers subjected to 15 and 30 minutes of cardiac arrest before explantation.
    Our experiments justify further investigations of the feasibility and efficacy of human DCD liver preservation by ex-vivo perfusion.

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  • Effect of tranexamic acid on blood loss in pediatric cardiac surgery: a randomized trial 査読

    Kazuyoshi Shimizu, Yuichiro Toda, Tatsuo Iwasaki, Mamoru Takeuchi, Hiroshi Morimatsu, Moritoki Egi, Tomohiko Suemori, Satoshi Suzuki, Kiyoshi Morita, Shunji Sano

    JOURNAL OF ANESTHESIA   25 ( 6 )   823 - 830   2011年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER TOKYO  

    Purpose The benefit of tranexamic acid (TXA) in pediatric cardiac surgery on postoperative bleeding has varied among studies. It is also unclear whether the effects of TXA differ between cyanotic patients and acyanotic patients. The aim of this study was to test the benefit of TXA in pediatric cardiac surgery in a well-balanced study population of cyanotic and acyanotic patients.
    Methods A total of 160 pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (81 cyanotic, 79 acyanotic) were included in this single-blinded, randomized trial at a tertiary care university-affiliated teaching hospital. Eighty-one children (41 cyanotic, 40 acyanotic) were randomly assigned to a TXA group, in which they received 50 mg/kg of TXA as a bolus followed by 15 mg/kg/h infusion and another 50 mg/kg into the bypass circuit. The other 79 patients were randomly assigned to a placebo group. The primary end point was the amount of 24-h blood loss.
    Results The amount of 24-h blood loss was significantly less in the TXA group than in the placebo group [mean (95% confidence interval): 18.6 (15.8-21.4) vs. 23.5 (19.4-27.5) ml/kg, respectively; mean difference -4.9 (-9.7 to -0.01) ml/kg; p = 0.049]. This effect of TXA was already significant at 6 h [9.5 (7.5-11.5) vs. 13.2 (10.6-15.9) ml/kg, respectively; mean difference -3.47 (-7.0 to -0.4) ml/kg; p = 0.027]. However, there was no significant difference in the amount of blood transfusion between the groups. There was also no statistical difference in the effect of TXA in each cyanotic and acyanotic subgroup.
    Conclusion TXA can reduce blood loss in pediatric cardiac surgery but not the transfusion requirement (http://ClinicalTrials.gov number NCT00994994).

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  • Postoperative coil embolization of residual MAPCAs greatly improved left heart failure in a patient after corrective surgery for pulmonary atresia, ventricular septal defect and MAPCAs 査読

    Masako Kinoshita, Kazuyoshi Shimizu, Yuichiro Toda, Satoshi Suzuki, Tomohiko Suemori, Tatsuo Iwasaki, Toru Takahashi, Kiyoshi Morita

    Japanese Journal of Anesthesiology   59 ( 11 )   1441 - 1445   2010年11月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    A male child, aged 1 year, with pulmonary atresia, ventricular septal defect and major aorto-pulmonary collateral arteries (PA, VSD, MAPCA) underwent corrective surgery including MAPCA ligation uneventfully. A few hours after admission to the ICU, severe heart failure, refractory to aggressive cardiac support including epinephrine infusion, became worse. Emergent cardiac catheterization on postoperative day 5 demonstrated the residual MAPCA and its occlusion by coil embolization dramatically resolved heart failure, indicating that the primary cause of this hemodynamic instability was likely excessive left-to-right shunt due to MAPCA. Residual LR shunt should be kept in mind to be a rare but significant cause of postoperative serious heart failure.

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  • Successful use of intravenous amiodarone for refractory ventricular fibrillation just after releasing aortic cross-clamp 査読

    Satoshi Suzuki, Tatsuo Iwasaki, Hiroshi Morimatsu, Nagisa Yokoi, Mayuko Matsuoka, Tomohiko Suemori, Tomoyuki Kanazawa, Kazuyoshi Shimizu, Yuichiro Toda, Kiyoshi Morita

    Japanese Journal of Anesthesiology   59 ( 10 )   1266 - 1270   2010年10月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    Amiodarone is widely used in Europe and the United States for refractory ventricular fibrillation (VF) in various situations, such as VF after myocardial infarction or out-of-hospital cardiac arrest. We report a case of successful treatment with amiodarone of refractory VF immediately after releasing aortic cross-clamp in cardiac surgery. A 66-year-old man suffering from severe aortic stenosis underwent aortic valve replacement (AVR). General anesthesia was induced with propofol and remifentanil, and subsequently AVR was performed under cardiopulmonary bypass. Just after releasing aortic cross-clamp, VF occurred, and it continued despite multiple trials of cardioversion with direct current (DC) shocks of 20 J or 30 J. Furthermore, some DC shocks of 30 J or 50 J after administering lidocaine 60 mg and 0.5 mol·l-1 magnesium sulfate 20 ml were also ineffective. Then, nifekalant 20 mg was administered and DC shocks of 50 J were repeated intermittently, but VF still persisted. Eventually, VF disappeared after a final DC shock of 50 J with intravenous amiodarone 125 mg. Overall duration of VF was 60 minutes. The patient's trachea was extubated three days after the surgery without any complications. Intravenous amiodarone may be one of the most useful remedies for some types of arrhythmias including persistent VF.

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  • Perioperative management for open balloon atrial septostomy immediately after caesarean section in a baby with hypoplastic left heart syndrome and intact atrial septum 査読

    Nagisa Yokoi, Yuichiro Toda, Satoshi Suzuki, Tomoyuki Kanazawa, Tomohiko Suemori, Kazuyoshi Shimizu, Tatsuo Iwasaki, Kiyoshi Morita

    Japanese Journal of Anesthesiology   59 ( 10 )   1308 - 1310   2010年10月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    Hypoplastic left heart syndrome (HLHS) with intact atrial septum (IAS) is an extreme type of single ventricle physiology among congenital heart diseases, in which a baby cannot supply oxygenated blood into systemic circulation without alternative pathway. We report the case of the neonate undergoing open balloon atrial septostomy (BAS) and bilateral pulmonary artery banding (PAB) soon after scheduled caesarean sections (C/S). A 35-year-old female was pregnant and fetal echocardiography at 32 weeks revealed one of the twins as HLHS/IAS. Severe hypoxia soon after birth was suspected. Thus, scheduled C/S followed by open BAS was planned. At 36 weeks of gestation, the mother was anesthetized with spinal bupivacaine and the female baby with HLHS/IAS was delivered. After diagnosed definitely by pediatric cardiologists, her trachea was intubated by anesthegiologists and umbilical catheters were placed by neonatologists. Then the baby was transferred to neighboring operating theater for BAS 68 minutes after the birth, while her SpO2 was maintained around 75-85% through serial procedures. Open BAS and PAB were performed under general anesthesia without any hemodynamic instability or severe hypoxia. Cooperation among anesthegiologists, neonatologists, pediatric cardiologists, and cardiac surgeons is mandatory in order to successfully complete such a rushed procedure.

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  • Responses to surgical stress after esophagectomy: Gene expression of heat shock protein 70, toll-like receptor 4, tumor necrosis factor-α and inducible nitric oxide synthase. 査読

    Suzuki S, Morimatsu H, Omori E, Shimizu H, Takahashi T, Yamatsuji T, Naomoto Y, Morita K

    Molecular medicine reports   3 ( 5 )   765 - 769   2010年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.3892/mmr.2010.335

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  • Acid-base variables in patients with acute kidney injury requiring peritoneal dialysis in the pediatric cardiac care unit 査読

    Hiroshi Morimatsu, Yuichiro Toda, Moritoki Egi, Kazuyoshi Shimizu, Takashi Matsusaki, Satoshi Suzuki, Tatsuo Iwasaki, Kiyoshi Morita

    JOURNAL OF ANESTHESIA   23 ( 3 )   334 - 340   2009年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER TOKYO  

    We aimed to clarify the acid-base abnormalities of patients with acute kidney injury (AKI) requiring peritoneal dialysis (PD) in pediatric cardiac care units.
    A retrospective observational study was conducted in a pediatric cardiac care unit in a tertiary care university hospital. The subjects were 40 patients with AKI requiring PD between 2003 and 2005, and controls matched by type of surgery and body weight. Acid-base variables, including blood gas data and electrolytes, were assessed. The Stewart-Figge variables, including strong ion difference apparent (SIDa), strong ion difference effective (SIDe), and strong ion gap (SIG), were calculated.
    Blood gas analyses showed that the PD group was more acidemic, with a lower mean bicarbonate and a lower mean base excess, typical features of metabolic acidosis. The strong ion analyses revealed that the PD group had lower mean sodium and albumin concentrations. Based on the Stewart-Figge methodology, SIDa was smaller in the PD group than in the control group, but SIG was similar in the two groups. Receiver-operating characteristic curve analyses showed that serum albumin was the only prognostic factor associated with PCCU mortality, even after adjustment for PD treatment.
    Patients with AKI requiring PD in a pediatric cardiac care unit had significant metabolic acidosis compared to controls matched by the type of surgery and body weight. Hyponatremia and hypoalbuminemia were characteristics of these patients. The calculated SIDa was smaller in the PD than in the control group. Only the serum albumin had a significant prognostic value.

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  • Non-overt disseminated intravascular coagulation scoring for critically ill patients: The impact of antithrombin levels 査読

    Moritoki Egi, Hiroshi Morimatsu, Christian J. Wiedermann, Makiko Tani, Tomoyuki Kanazawa, Satoshi Suzuki, Takashi Matsusaki, Kazuyoshi Shimizu, Yuichiro Toda, Tatsuo Iwasaki, Kiyoshi Morita

    THROMBOSIS AND HAEMOSTASIS   101 ( 4 )   696 - 705   2009年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SCHATTAUER GMBH-VERLAG MEDIZIN NATURWISSENSCHAFTEN  

    Validation of a scoring algorithm for non-overt disseminated intravascular coagulation (DIC) proposed by the International Society on Thrombosis and Haemostasis (ISTH) is still incomplete. It was the objective of this study to assess the impact of including AT to non-overt DIC scoring on the predictability for intensive care unit (ICU) death and the later development of overt-DIC defined by the Japanese Ministry of Health and Welfare (JMHW) or the ISTH. We performed a retrospective observational study conducted in 364 patients in critical care. Coagulation parameters obtained daily for DIC screening were utilised for scoring. There were 194 and 196 patients scored as positive non-overt DIC with and without AT, respectively; diagnostic agreement between the two was 78%. As compared with patients without non-overt DIC, these non-overt DIC patients had significantly higher mortality. In 37 ICU non-survivors, positive non-overt DIC scoring with AT preceded ICU death by a median of 6.8 days, which was significantly earlier as compared with a median of 5.4 days for non-overt DIC without AT (p=0.022). In patients who developed overt-DIC after admission, the time period from positive non-overt DIC to positive overt-DIC was significantly longer when AT was utilised (overt-DIC ISTH; 1.3 days vs. 0.1 days, p=0.004, overt-DIC JMHW; 2.5 days vs. 2.0 days, p=0.04, with AT vs. without AT, respectively). Non-overt DIC scoring predicted a high risk of death in critically ill patients. When information on AT levels was included, non-overt DIC scoring was found to predict development of overt-DIC significantly earlier than non-overt DIC scoring without AT.

    DOI: 10.1160/TH08-07-0448

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  • Anesthetic management of pediatric patients with insulinoma using continuous glucose monitoring 査読

    Motoko Manabe, Hiroshi Morimatsu, Moritoki Egi, Satoshi Suzuki, Ryuji Kaku, Masaki Matsumi, Kiyoshi Morita

    Japanese Journal of Anesthesiology   58 ( 6 )   757 - 759   2009年

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    Insulinomas are rare tumors, the incidence of which is 1-2 per million. Patients with insulinomas present with symptoms of hypoglycemia secondary to insulin hypersecretion. Surgical resection is a treatment of choice and offers the only chance of cure. The important points in anesthesia are the precaution against hypoglycemia until tumor resection and the control of rebound hyperglycemia soon after tumor resection. We report the anesthetic management of a 5-year-old patient with insulinoma. Soon after the induction of anesthesia, the continuous glucose monitoring was commenced. Until the tumor resection, 10% glucose infusion was required to avoid hypoglycemia. Then, insulin infusion was continued to maintain blood glucose level around 150 mg·dl-1. All glucose management was guided with continuous glucose monitoring. This is a first case report to show the feasibility and usefulness of continuous glucose monitoring in management of pediatric insulinoma patients. As the blood glucose was dramatically altered during perioperative period, frequent blood glucose measurements or continuous glucose monitoring is mandatory during perioperative period of insulinoma resection.

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書籍等出版物

  • 麻酔 2021年9月号 査読

    ( 担当: 分担執筆 ,  範囲: 周術期酸素投与,周術期体温管理と術後予後(手術部位感染を中心に))

    克誠堂出版  2021年8月 

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    記述言語:日本語 著書種別:学術書

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  • 心臓血管麻酔Positive and Negativeリスト25 : その麻酔管理方法にエビデンスはあるのか?

    山蔭, 道明, 平田, 直之, 吉川, 裕介(麻酔科学)( 担当: 分担執筆 ,  範囲: 心臓血管手術後の呼吸管理)

    中外医学社  2020年9月  ( ISBN:9784498055469

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    総ページ数:iii,199p   記述言語:日本語 著書種別:教科書・概説・概論

    CiNii Books

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  • 人工呼吸管理・NPPVの基本、ばっちり教えます

    西村匡司( 担当: 分担執筆 ,  範囲: 酸素療法)

    羊土社  2019年8月 

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    記述言語:日本語 著書種別:教科書・概説・概論

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  • Clinical Engineering 2019年8月号 Vol.30 No.8 (クリニカルエンジニアリング)

    ( 担当: 分担執筆 ,  範囲: 酸素療法のいま)

    学研メディカル秀潤社  2019年7月  ( ISBN:4780906199

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    総ページ数:120   著書種別:教科書・概説・概論

    ASIN

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  • 救急医学 2019年3月号 救急医学研究 入門!

    ( 担当: 分担執筆 ,  範囲: 研究課題の見つけ方(医師編))

    2019年2月 

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    記述言語:日本語 著書種別:教科書・概説・概論

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MISC

  • INTRAOPERATIVE FLUID THERAPY IN VIDEO-ASSISTED THORACOSCOPIC ESOPHAGECTOMY: A RETROSPECTIVE STUDY

    Yukiko Hikasa, Satoshi Suzuki, Tomoyuki Kanazawa, Masao Hayashi, Takashi Matsusaki, Kazuyoshi Shimizu, Hiroshi Morimatsu

    CRITICAL CARE MEDICINE   44 ( 12 )   2016年12月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    Web of Science

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  • Conservative Oxygen Therapy in Mechanically Ventilated Patients Reply

    Rinaldo Bellomo, Satoshi Suzuki, Glenn M. Eastwood

    CRITICAL CARE MEDICINE   42 ( 9 )   E631 - E631   2014年9月

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    記述言語:英語   掲載種別:速報,短報,研究ノート等(学術雑誌)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    DOI: 10.1097/CCM.0000000000000472

    Web of Science

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  • Letter by Eastwood et al Regarding Article, "Association Between Postresuscitation Partial Pressure of Arterial Carbon Dioxide and Neurological Outcome in Patients With Post-Cardiac Arrest Syndrome"

    Glenn M. Eastwood, Satoshi Suzuki, Rinaldo Bellomo

    CIRCULATION   129 ( 1 )   E9 - E9   2014年1月

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    記述言語:英語   掲載種別:速報,短報,研究ノート等(学術雑誌)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    DOI: 10.1161/CIRCULATIONAHA.113.004554

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  • REAL TIME HOST&apos;S RESPONSES TO SURGICAL STRESS AFTER ESOPHAGECTOMY: GENE EXPRESSIONS OF HEAT SHOCK PROTEIN 70, TOLL-LIKE RECEPTOR 4, TUMOR NECROSIS FACTOR-ALPHA, AND INDUCIBLE NITRIC OXIDE SYNTHASE

    Satoshi Suzuki, Hiroshi Morimatsu, Emiko Omori, Hiroko Shimizu, Toru Takahashi, Kiyoshi Morita

    CRITICAL CARE MEDICINE   37 ( 12 )   A58 - A58   2009年12月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    Web of Science

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  • ALTERATIONS OF PITUITARY HORMONES AFTER PEDIATRIC CARDIAC SURGERY

    Kazuyoshi Shimizu, Hiroshi Morimatsu, Yuichiro Toda, Moritoki Egi, Tomohiko Suemori, Satoshi Suzuki, Tatsuo Iwasaki, Kiyoshi Morita

    CRITICAL CARE MEDICINE   37 ( 12 )   A113 - A113   2009年12月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    Web of Science

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  • Hyperglycemia and the outcome of pediatric cardiac surgery patients requiring peritoneal dialysis.

    Egi M, Morimatsu H, Toda Y, Matsusaki T, Suzuki S, Shimizu K, Iwasaki T, Takeuchi M, Bellomo R, Morita K

    Int J Artif Organs   31 ( 4 )   309 - 316   2008年

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  • 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年12月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    Web of Science

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