49 research outputs found
Precise evaluation of bilateral pulmonary artery banding for initial palliation in high-risk hypoplastic left heart syndrome
No full textObjectivesIn patients with high-risk hypoplastic left heart syndrome (HLHS), the Norwood operation (NW) in the neonatal period still results in high mortality compared with other cardiac surgery. Bilateral pulmonary artery banding (bPAB), a very effective initial procedure for HLHS, for which the specific evaluation is as yet unsatisfactory, was performed, and we report our findings in the present study.MethodsWe have performed bPAB since 2006. A total of 17 patients with HLHS or a variant underwent bPAB before the NW. Echocardiography was performed between bPAB and the NW, and the flow acceleration just after bPAB and before NW was evaluated. Before the NW, a catheter examination was also performed.ResultsbPAB was performed at 6.6 ± 0.6 days of age, and the NW at 130 ± 88 days. The patients’ mean body weight (BW) was 2.5 ± 0.4 kg at bPAB and 4.0 ± 1.1 kg at the NW. The length of the tape for bPAB was 9.9 ± 0.6 mm in the right pulmonary artery (RPA) and 9.4 ± 0.6 mm in the left (LPA) because the RPA was usually wider than the LPA. The tape width was 2 mm in all cases. The catheter examination was performed at 95 ± 85 days after bPAB. The arterial oxygen saturation (SaO2) was 71% ± 8.6%. Multivariate regression analysis revealed that SaO2 was estimated well using 4 factors: the banding size of the RPA, BW at bPAB, BW at NW, and BW in the period between bPAB and catheter examination (R2 = 0.79). Echocardiography just after bPAB showed that the blood flow at the bPAB had accelerated to 3.0 ± 0.8 m/s in the RPA and 3.3 ± 0.8 m/s in the LPA (P = .004). The estimated pressure gradient was 39.2 ± 17.6 mm Hg in the RPA and 46.1 ± 23.0 mm Hg in the LPA (P = .006). The blood flow at bPAB was accelerated to 3.7 ± 0.7 m/s in the RPA and 4.0 ± 0.6 m/s in the LPA before NW (P = .013). The estimated pressure gradient was 62.6 ± 27.6 mm Hg in the RPA and 56.1 ± 19.6 mm Hg in the LPA before NW (P = .014). The catheter examination revealed mean wedge pressures of 18.0 ± 7.2 mm Hg for the RPA and 16.2 ± 4.3 mm Hg for the LPA. The operative mortality rate was 0%. One patient required a repeat operation to adjust the bPAB, and prolonged pleural effusion was observed in 1 case.ConclusionsThe postoperative SaO2 after bPAB correlated closely with the banding size and BW at bPAB, NW and during the period after bPAB. Because the mean PA pressure before NW was low enough for single ventricular circulation, the bPAB in this study was an effective option for high-risk patients undergoing HLHS or a variant. We believe the bPAB sizes used were suitable and were determined as follows: BW plus 7 mm for the LPA and BW plus 7.5 mm for the RPA
Fontan Failure and Thrombosis of Total Cavo-Pulmonary Connection Conduit
No full textThe immediate postoperative period of Fontan operation is frequently complicated by hemodynamic instability, sometimes requiring fenestration of the conduit. Thrombosis of total cavo-pulmonary connection conduit warrants early intervention to prevent systemic and pulmonary embolism. We report a case of Fontan failure requiring fenestration; which was further complicated by thrombosis of total cavo-pulmonary connection conduit and managed with anticoagulants.
Keywords: congenital heart disease; fontan procedure; thrombosis
Investigation of Phase Transition for BaTiO3 Nanoparticles Using a Laboratory-Grade High-Temperature X‑ray Diffractometer
No full text
WEB ブンショ カラ ノ キギョウ ジョウホウ ノ チュウシュツ オヨビ ギョウシュ ブンルイ ヨソク ニ カンスル ケンキュウ
No full text滋賀大学修士（データサイエンス）master thesi
A Study on Application of Elastic Theory for Computing Flexural Stresses in Preflex Beam
No full textThis paper presents the step-by-step procedure for using Elastic Theory to calculate the internal stresses in composite bridge girders prestressed by the Preflexing Technology, called Prebeam in Japan and Preflex beam worldwide. Elastic Theory approaches preflex beams the same way as it does the conventional composite girders. Since preflex beam undergoes different stages of construction, calculations are made using different sectional and material properties. Stresses are calculated in every stage using the properties of the specific section. Stress accumulation gives the available stress in a section of interest. Concrete presence in the section implies prestress loss due to creep and shrinkage, however; more work is required to be done in this field. In addition to the graphical presentation of this application, this paper further discusses important notes of graphical comparison between the results of an experimental-only research carried out on a preflex beam, with the results of simulation based on the elastic theory approach, for an identical beam using Finite Element Modeling (FEM) by the author
Diabetes mellitus itself increases cardio- cerebrovascular risk and renal complications in primary aldosteronism
No full textThis is a pre-copyedited, author-produced version of an article accepted for publication in The Journal of Clinical Endocrinology & Metabolism following peer review. The version of record Aya Saiki, Michio Otsuki, Daisuke Tamada, Tetsuhiro Kitamura, Iichiro Shimomura, Isao Kurihara, Takamasa Ichijo, Yoshiyu Takeda, Takuyuki Katabami, Mika Tsuiki, Norio Wada, Toshihiko Yanase, Yoshihiro Ogawa, Junji Kawashima, Masakatsu Sone, Nobuya Inagaki, Takanobu Yoshimoto, Ryuji Okamoto, Katsutoshi Takahashi, Hiroki Kobayashi, Kouichi Tamura, Kohei Kamemura, Koichi Yamamoto, Shoichiro Izawa, Miki Kakutani, Masanobu Yamada, Akiyo Tanabe, Mitsuhide Naruse, Diabetes Mellitus Itself Increases Cardio-Cerebrovascular Risk and Renal Complications in Primary Aldosteronism, The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 7, July 2020, Pages e2531–e2537 is available online at: https://doi.org/10.1210/clinem/dgaa177.Context: The prevalence of diabetes mellitus (DM) in patients with primary aldosteronism (PA) is higher than in those with essential hypertension and the general population. Although DM is a common major risk factor for cardio-cerebrovascular (CCV) diseases and renal complications, details of its effects in PA have not been demonstrated. Objective: The aim of this study was to determine the effects of coexistent DM on the risk of CCV events and progression of renal complications in PA patients. Design: A multi-institutional, cross-sectional study was conducted. Patients and Methods: PA patients experienced between January 2006 and October 2016 and with available data of CCV events and DM were enrolled from the Japan PA registry of the Japan Primary Aldosteronism Study/Japan Rare Intractable Adrenal Diseases Study (n = 2524). CCV events and renal complications were compared between a DM group and a non-DM group by logistic and liner-regression analysis. Results: DM significantly increased the odds ratio (OR) of CCV events (OR 1.59, 95% CI: 1.05- 2.41) and that of proteinuria (OR 2.25, 95% CI: 1.59-3.16). DM correlated significantly with declines in estimated glomerular filtration rate (β = .05, P = .02). Conclusions: This the first report to demonstrate the presence of DM as an independent risk factor for CCV events and renal complications, even in PA patients. Management of DM should be considered in addition to the specific treatment of PA
