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Find video protocols related to scientific articles indexed in Pubmed.
Fibrinogen Measurements in Plasma and Whole Blood: A Performance Evaluation Study of the Dry-Hematology System.
Anesth. Analg.
PUBLISHED: 09-17-2014
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An accurate and rapid determination of fibrinogen level is important during hemorrhage to establish a timely hemostatic intervention. The accuracy of fibrinogen measurements may be affected by the specific methodology for its determination, fluid therapies, and anticoagulant agents. The dry-hematology method (DRIHEMATO®) is a novel approach to determine fibrinogen levels in plasma and whole blood based on thrombin-activated coagulation time. We hypothesized that plasma or whole blood fibrinogen level using the dry-hematology method would be similar to those measured with conventional plasma fibrinogen assays.
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Novel approaches in management of perioperative coagulopathy.
Curr Opin Anaesthesiol
PUBLISHED: 08-21-2014
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The recent advances in hemostatic monitoring, and discussion of the clinical implications of hemostatic therapies based on different blood components and factor concentrates.
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Allergen analysis of sea urchin roe using sera from five patients.
Int. Arch. Allergy Immunol.
PUBLISHED: 08-16-2014
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Sea urchin roe can cause anaphylactic reactions the first time they are consumed; therefore, careful clinical attention should be paid to their effects. However, no previous study has examined the allergens in sea urchin roe using sera from more than one patient. We attempted to identify sea urchin allergens using sera from 5 patients with sea urchin allergies.
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Strength estimation of a moving 125Iodine source during implantation in brachytherapy: application to linked sources.
J. Radiat. Res.
PUBLISHED: 07-01-2014
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This study sought to demonstrate the feasibility of estimating the source strength during implantation in brachytherapy. The requirement for measuring the strengths of the linked sources was investigated. The utilized sources were (125)I with air kerma strengths of 8.38-8.63 U (?Gy m(2) h(-1)). Measurements were performed with a plastic scintillator (80 mm × 50 mm × 20 mm in thickness). For a source-to-source distance of 10.5 mm and at source speeds of up to 200 mm s(-1), a counting time of 10 ms and a detector-to-needle distance of 5 mm were found to be the appropriate measurement conditions. The combined standard uncertainty (CSU) with the coverage factor of 1 (k = 1) was ?15% when using a grid to decrease the interference by the neighboring sources. Without the grid, the CSU (k = 1) was ?5%, and an 8% overestimation due to the neighboring sources was found to potentially cause additional uncertainty. In order to improve the accuracy in estimating source strength, it is recommended that the measurment conditions should be optimized by considering the tradeoff between the overestimation due to the neighboring sources and the intensity of the measured value, which influences the random error.
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WURCS: the Web3 unique representation of carbohydrate structures.
J Chem Inf Model
PUBLISHED: 06-04-2014
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In recent years, the Semantic Web has become the focus of life science database development as a means to link life science data in an effective and efficient manner. In order for carbohydrate data to be applied to this new technology, there are two requirements for carbohydrate data representations: (1) a linear notation which can be used as a URI (Uniform Resource Identifier) if needed and (2) a unique notation such that any published glycan structure can be represented distinctively. This latter requirement includes the possible representation of nonstandard monosaccharide units as a part of the glycan structure, as well as compositions, repeating units, and ambiguous structures where linkages/linkage positions are unidentified. Therefore, we have developed the Web3 Unique Representation of Carbohydrate Structures (WURCS) as a new linear notation for representing carbohydrates for the Semantic Web.
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Pathophysiology of Cardiopulmonary Bypass: Current Strategies for the Prevention and Treatment of Anemia, Coagulopathy, and Organ Dysfunction.
Semin Cardiothorac Vasc Anesth
PUBLISHED: 05-31-2014
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The techniques and equipment of cardiopulmonary bypass (CPB) have evolved over the past 60 years, and numerous numbers of cardiac surgical procedures are conducted around the world using CPB. Despite more widespread applications of percutaneous coronary and valvular interventions, the need for cardiac surgery using CPB remains the standard approach for certain cardiac pathologies because some patients are ineligible for percutaneous procedures, or such procedures are unsuccessful in some. The ageing patient population for cardiac surgery poses a number of clinical challenges, including anemia, decreased cardiopulmonary reserve, chronic antithrombotic therapy, neurocognitive dysfunction, and renal insufficiency. The use of CPB is associated with inductions of systemic inflammatory responses involving both cellular and humoral interactions. Inflammatory pathways are complex and redundant, and thus, the reactions can be profoundly amplified to produce a multiorgan dysfunction that can manifest as capillary leak syndrome, coagulopathy, respiratory failure, myocardial dysfunction, renal insufficiency, and neurocognitive decline. In this review, pathophysiological aspects of CPB are considered from a practical point of view, and preventive strategies for hemodilutional anemia, coagulopathy, inflammation, metabolic derangement, and neurocognitive and renal dysfunction are discussed.
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The effect and duration of prophylactic platelet transfusions before insertion of a central venous catheter in patients with bone marrow failure evaluated with point-of-care methods and flow cytometry.
Anesth. Analg.
PUBLISHED: 05-24-2014
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Patients with bone marrow failure and severe thrombocytopenia are frequently given prophylactic platelet transfusion before interventions. The clinical effects of such transfusions, however, are poorly defined. We performed a prospective observational study on patients with bone marrow failure scheduled for prophylactic platelet transfusion before the insertion of a central venous catheter. The objectives were to evaluate the effect and duration of prophylactic platelet transfusions on central venous catheter insertion in thrombocytopenic patients with bone marrow failure.
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Carbon Dioxide Pneumoperitoneum Led to No Severe Morbidities for the Elderly During Laparoscopic-Assisted Distal Gastrectomy.
Ann. Surg. Oncol.
PUBLISHED: 05-08-2014
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Our purpose was to evaluate the perioperative safety of laparoscopic-assisted distal gastrectomy (LADG) in elderly patients with clinical stage I gastric cancer.
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Home blood pressure control after the great East Japan earthquake in patients on chronic hemodialysis.
Ther Apher Dial
PUBLISHED: 04-12-2014
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At 14:46 on 11 March 2011, northeastern Japan was struck by a major earthquake measuring 9.0 on the Richter scale (the Great East Japan Earthquake). Several reports have suggested a transient blood pressure (BP) increase after a major earthquake, but its impact on BP in chronic dialysis patients has not been reported. In a retrospective review of 25 hemodialysis patients who were residents of Koriyama City, changes in the morning home BP after the earthquake were investigated. Home systolic and diastolic BPs were significantly elevated 1 week after the earthquake (158?±?16?mm?Hg vs. 151?±?13?mm?Hg, P?
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A case of olfactory neuroblastoma detected by (18)F-FDG PET/CT.
Clin Nucl Med
PUBLISHED: 03-26-2014
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Olfactory neuroblastoma is an uncommon malignant neoplasm of the superior nasal cavity. We report a case of a 78-year-old woman who presented with frontal headache and proptosis of the right eye. CT revealed a nasoethmoid mass with diffuse calcifications. FDG PET/CT demonstrated intense FDG uptake by a main nasoethmoid tumor and metastatic lesions in the cervical lymph nodes. Histologic examination confirmed olfactory neuroblastoma.
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A phase II study of paclitaxel and carboplatin with a biweekly schedule in patients with epithelial ovarian cancer: Gynecologic Cancer Network trial.
J Nippon Med Sch
PUBLISHED: 03-12-2014
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The objective of this multicenter phase II study was to evaluate the effects of biweekly paclitaxel and carboplatin combination chemotherapy on response rate and toxicities in patients with epithelial ovarian cancer.
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Clinical applicability of rapid thrombelastography and functional fibrinogen thrombelastography to adult liver transplantation.
Liver Transpl.
PUBLISHED: 03-03-2014
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Unlike kaolin thrombelastography (k-TEG), the clinical utility of rapid thrombelastography (r-TEG) and functional fibrinogen thrombelastography (FF-TEG) has not been tested in liver transplantation (LT). These thrombelastography techniques were simultaneously performed at the time of the skin incision (the baseline) and 30 minutes after graft reperfusion (III?+?30) for 27 consecutive adult LT patients. k-TEG and r-TEG parameters [alpha angle (?) and maximum amplitude of the clot (MA)] were compared in addition to the assay time. Estimated FF-TEG fibrinogen levels were compared with plasma fibrinogen measurements. At the baseline, the values of Spearman's correlation coefficient (r) between k-TEG and r-TEG were moderate for ? (r?=?0.40, P?=?0.06) and strong for MA (r?=?0.90, P?
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Appendicitis with psoas abscess successfully treated by laparoscopic surgery.
World J. Gastroenterol.
PUBLISHED: 02-25-2014
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Although acute appendicitis is a common disease, retroperitoneal abscesses are rarely observed. Here, we report a case consisting of a psoas abscess and cutaneous fistula caused by appendicitis. The patient was a 56-year-old male who was introduced to our institution due to an intractable right psoas abscess. Imaging tests had been performed over the previous 3 years; however, clinicians could not find the origin of the abscess and failed to resolve the problem. A successful operation was performed via a laparoscopic approach, and 17 mo have passed without recurrence. The advantage of laparoscopic surgery is well understood in cases of appendicitis with abscesses. However, the indication for laparoscopic approach is not clear for retroperitoneal abscesses. From our experience, we can conclude that appendicitis with retroperitoneal abscesses can be managed and treated using a laparoscopic approach.
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Laparoscopic partial resection for hemangioma in the third portion of the duodenum.
World J. Gastroenterol.
PUBLISHED: 02-08-2014
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Benign duodenal tumors are rare and less common than malignant tumors. Furthermore, vascular lesions of the duodenum, including hemangiomas, are rare causes of gastrointestinal bleeding. This report describes a case with bleeding hemangiomas in the third portion of the duodenum and jejunum and their successful treatment using a laparoscopic approach. There is no report of totally laparoscopic resection for tumor in the third portion of duodenum. After performing a laparoscopic Kocher maneuver, the location of the duodenal hemangioma was confirmed by endoscopic and laparoscopic observation. The lesion was excised using ultrasonic coagulating shears and the defect in the duodenal wall was sutured laparoscopically. The hemangioma of the jejunum was treated extracorporeally through a 3.0 cm umbilical incision. The operating time was 241 min and blood loss was negligible. The postoperative course was uneventful. For benign duodenal tumors in the third portion, if endoscopic resection is not adapted, this less invasive technique may be a standard treatment.
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Successful laparoscopic gastric resection and safe introduction of a single-incision technique for gastric submucosal tumors located near the esophagogastric junction.
Surg. Today
PUBLISHED: 02-06-2014
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Laparoscopic gastric resection cannot be easily applied for submucosal tumors near the esophagogastric junction (NEJ-SMTs). Furthermore, there have been no reports of single-incision laparoscopic surgery (SILS) for NEJ-SMTs. We evaluated our laparoscopic surgical outcomes for NEJ-SMTs, including a newly introduced phase of SILS.
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Estimation of ?-ray dose in air and soil from Fukushima Daiichi Power Plant accident.
J. Radiat. Res.
PUBLISHED: 02-05-2014
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Following the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident of 2011, which deposited radionuclides across Tohoku and northern Kanto, ?-ray dose evaluation has been performed to estimate radiation exposure for small creatures like insects as well as human skin. Using the Monte Carlo radiation transport code MCNP-4C, we calculated the ?-ray dose for (129m)Te, (129)Te, (131)I, (132)Te, (132)I, (134)Cs and (137)Cs in air as a function of altitude and in soil. These calculations of ?-dose rate for each radionuclide were conducted for the conditions following the FDNPP accident, with (137)Cs deposition assumed to be 1000 kBq/m(2). Beta-ray dose rate was found to be ?10-fold (resp. 5-fold) higher than the ?-ray dose rate in the soil (resp. on the ground surface) at ?20 days after deposition, and ?4-fold (resp. 1.7-fold) higher after 6 months or more. For convenience, the height dependence of the ratio for 0, 10, 30, 90, 180 and 365 days after deposition was obtained by a fitting function. The cumulative 70 µm ?-ray dose at 30, 60 and 90 days after deposition was estimated to be 35, 45 and 53 mGy for the ground surface, and 61, 79 and 92 mGy in the soil, respectively. These results can be used to estimate the external ?-ray exposure for small creatures as well as for human skin.
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Skin autofluorescence predicts cardiovascular mortality in patients on chronic hemodialysis.
Ther Apher Dial
PUBLISHED: 01-24-2014
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Tissue accumulation of advanced glycation end products (AGE) is thought to contribute to the progression of cardiovascular disease (CVD). Skin autofluorescence, a non-invasive measure of AGE accumulation using autofluorescence of the skin under ultraviolet light, has been reported to be an independent predictor of mortality associated with CVD in Caucasian patients on chronic hemodialysis. The aim of this study was to assess the predictive value of skin autofluorescence on all-cause and cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis. Baseline skin autofluorescence was measured with an autofluorescence reader in 128 non-Caucasian (Japanese) patients on chronic hemodialysis. All-cause and cardiovascular mortality was monitored prospectively during a period of 6 years. During the follow-up period, 42 of the 128 patients died; 19 of those patients died of CVD. Skin autofluorescence did not have a significant effect on all-cause mortality. However, age, carotid artery intima-media thickness (IMT), serum albumin, high-sensitivity C-reactive protein (hsCRP), skin autofluorescence and pre-existing CVD were significantly correlated with cardiovascular mortality. Multivariate Cox regression analysis showed skin autofluorescence (adjusted hazard ratio [HR] 3.97; 95% confidence interval [CI]1.67-9.43), serum albumin (adjusted HR 0.05; 95% CI 0.01-0.32), and hsCRP (adjusted HR 1.55; 95% CI 1.18-2.05) to be independent predictors of cardiovascular mortality. The present study suggests that skin autofluorescence is an independent predictor of cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis.
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Pilot study of liraglutide effects in non-alcoholic steatohepatitis and non-alcoholic fatty liver disease with glucose intolerance in Japanese patients (LEAN-J).
Hepatol. Res.
PUBLISHED: 01-23-2014
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Non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of metabolic syndrome, is associated with an increased risk of developing lifestyle-related diseases including type 2 diabetes, cardiovascular disease and cerebral vessel disease. No current drug therapy provides the ideal effects of decreasing hepatic inflammation while simultaneously improving liver fibrosis. Liraglutide is a glucagon-like peptide-1 receptor agonist that affects the histological findings in patients with non-alcoholic steatohepatitis (NASH). This study was conducted to evaluate the effect and action of liraglutide for biopsy-proven NASH.
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A dosimetry method for low dose rate brachytherapy by EGS5 combined with regression to reflect source strength shortage.
J. Radiat. Res.
PUBLISHED: 01-20-2014
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The post-implantation dosimetry for brachytherapy using Monte Carlo calculation by EGS5 code combined with the source strength regression was investigated with respect to its validity. In this method, the source strength for the EGS5 calculation was adjusted with the regression, so that the calculation would reproduce the dose monitored with the glass rod dosimeters (GRDs) on a water phantom. The experiments were performed, simulating the case where one of two (125)I sources of Oncoseed 6711 was lacking strength by 4-48%. As a result, the calculation without regression was in agreement with the GRD measurement within 26-62%. In this case, the shortage in strength of a source was neglected. By the regression, in order to reflect the strength shortage, the agreement was improved up to 17-24%. This agreement was also comparable with accuracy of the dose calculation for single source geometry reported previously. These results suggest the validity of the dosimetry method proposed in this study.
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Study on detecting spatial distribution of neutrons and gamma rays using a multi-imaging plate system.
Appl Radiat Isot
PUBLISHED: 01-11-2014
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In order to measure the spatial distributions of neutrons and gamma rays separately using the imaging plate, the requirement for the converter to enhance specific component was investigated with the PHITS code. Consequently, enhancing fast neutrons using recoil protons from epoxy resin was not effective due to high sensitivity of the imaging plate to gamma rays. However, the converter of epoxy resin doped with (10)B was found to have potential for thermal and epithermal neutrons, and graphite for gamma rays.
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Near-threshold (7)Li(p,n)(7)Be neutrons on the practical conditions using thick Li-target and Gaussian proton energies for BNCT.
Appl Radiat Isot
PUBLISHED: 01-08-2014
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The near threshold (7)Li(p,n)(7)Be neutrons generated by incident proton energy having Gaussian distribution with mean energies from 1.85 to 1.95MeV, were studied as a practical neutron source for BNCT wherein an RFQ accelerator and a thick Li-target are used. Gaussian energy distributions with the standard deviation of 0, 10, 20 and 40keV for mean proton energies from 1.85 to 1.95MeV were surveyed in 0.01MeV increments. A thick liquid Li-target whose dimensions were established in our previous experiments (i.e., 1mm-thick with 50mm width and 50mm length) was considered in this study. The suitable incident proton energy and physical dimensions of Pb layer which serves as a gamma absorber and a Polyethylene layer which is used as a BDE were surveyed by means of the concepts of TPD. Dose distribution were calculated by using MCNP5. A proton beam with mean energy of 1.92MeV and a Gaussian energy distribution with a standard deviation of 20keV at a current of 10mA was selected from the viewpoint of irradiation time and practically achievable proton current. The suitable thicknesses of Pb gamma absorber was estimated to be about 3cm. The estimated thickness of the polyethylene BDE was about 24mm for an ideal proton current of 13mA, and was 18mm for a practical proton current of 10mA.
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Comparative evaluation of direct thrombin and factor Xa inhibitors with antiplatelet agents under flow and static conditions: an in vitro flow chamber model.
PLoS ONE
PUBLISHED: 01-01-2014
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Dabigatran and rivaroxaban are novel oral anticoagulants that specifically inhibit thrombin and factor Xa, respectively. The aim of this study is to elucidate antithrombotic properties of these anticoagulant agents under arterial and venous shear conditions. Whole blood samples treated with dabigatran or rivaroxaban at 250, 500, and 1000 nM, with/without aspirin and AR-C66096, a P2Y12 antagonist, were perfused over a microchip coated with collagen and tissue thromboplastin at shear rates of 240 and 600 s(-1). Fibrin-rich platelet thrombus formation was quantified by monitoring flow pressure changes. Dabigatran at higher concentrations (500 and 1000 nM) potently inhibited thrombus formation at both shear rates, whereas 1000 nM of rivaroxaban delayed, but did not completely inhibit, thrombus formation. Dual antiplatelet agents weakly suppressed thrombus formation at both shear rates, but intensified the anticoagulant effects of dabigatran and rivaroxaban. The anticoagulant effects of dabigatran and rivaroxaban were also evaluated under static conditions using thrombin generation (TG) assay. In platelet-poor plasma, dabigatran at 250 and 500 nM efficiently prolonged the lag time (LT) and moderately reduce peak height (PH) of TG, whereas rivaroxaban at 250 nM efficiently prolonged LT and reduced PH of TG. In platelet-rich plasma, however, both anticoagulants efficiently delayed LT and reduced PH of TG. Our results suggest that dabigatran and rivaroxaban may exert distinct antithrombotic effects under flow conditions, particularly in combination with dual antiplatelet therapy.
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A TPD and AR based comparison of accelerator neutron irradiation fields between (7)Li and W targets for BNCT.
Appl Radiat Isot
PUBLISHED: 10-22-2013
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The characteristics of moderator assembly dimension was investigated for the usage of (7)Li(p,n) neutrons by 2.3-2.8MeV protons and W(p,n) neutrons by 50MeV protons. The indexes were the treatable protocol depth (TPD) and advantage depth (AD). Consequently, a configuration for W target with the Fe filter, Fluental moderator, Pb reflector showed the TPD of 5.8cm and AD of 9.3cm. Comparable indexes were found for the Li target in a geometry with the MgF2 moderator and Teflon reflector.
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Thoracoscopic esophagectomy in the prone position for esophageal cancer with right aortic arch: case report.
Anticancer Res.
PUBLISHED: 10-15-2013
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A congenital anomaly of the right aortic arch (RAA) is rare, and esophageal cancer associated with the vascular ring is even more rare. In such cases, it is very important to understand the anatomical situation in the upper mediastinum in order to perform a safe and curative operation. A 52-year-old man who presented with odynophagia was admitted to our department after a diagnosis of advanced esophageal cancer. Chest computed tomography revealed an RAA with an aberrant subclavian artery and showed that the esophagus was completely encircled by the RAA, aortic diverticulum, and pulmonary artery. By the thoracoscopic view with the patient in the prone position, we were able to easily and safely identify the anatomical location of the upper mediastinum and successfully perform thoracoscopic esophagectomy. To the best of our knowledge, this is the first report of a patient undergoing total thoracoscopic esophagectomy in the prone position without thoracotomy.
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Antithrombotic effects of PAR1 and PAR4 antagonists evaluated under flow and static conditions.
Thromb. Res.
PUBLISHED: 08-19-2013
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Thrombin-mediated activation of human platelets involves the G-protein-coupled protease-activated receptors PAR1 and PAR4. Inhibition of PAR1 and/or PAR4 is thought to modulate platelet activation and subsequent procoagulant reactions. However, the antithrombotic effects of PAR1 and PAR4 antagonism have not been fully elucidated, particularly under flow conditions.
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Management of hemorrhage in cardiothoracic surgery.
J. Cardiothorac. Vasc. Anesth.
PUBLISHED: 08-06-2013
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Bleeding is an important issue in cardiothoracic surgery, and about 20% of all blood products are transfused in this clinical setting worldwide. Transfusion practices, however, are highly variable among different hospitals and more than 25% of allogeneic blood transfusions have been considered inappropriate. Furthermore, both bleeding and allogeneic blood transfusion are associated with increased morbidity, mortality, and hospital costs. In the past decades, several attempts have been made to find a universal hemostatic agent to ensure hemostasis during and after cardiothoracic surgery. Most drugs studied in this context have either failed to reduce bleeding and transfusion requirements or were associated with severe adverse events, such as acute renal failure or thrombotic/thromboembolic events and, in some cases, increased mortality. Therefore, an individualized goal-directed hemostatic therapy ("theranostic" approach) seems to be more appropriate to stop bleeding in this complex clinical setting. The use of point-of-care (POC) transfusion and coagulation management algorithms guided by viscoelastic tests such as thromboelastometry/thromboelastography in combination with POC platelet function tests such as whole blood impedance aggregometry, and based on first-line therapy with fibrinogen and prothrombin complex concentrate have been associated with reduced allogeneic blood transfusion requirements, reduced incidence of thrombotic/thromboembolic and transfusion-related adverse events, and improved outcomes in cardiac surgery. This article reviews the current literature dealing with the management of hemorrhage in cardiothoracic surgery based on POC diagnostics and with specific coagulation factor concentrates and its impact on transfusion requirements and patients outcomes.
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Efficacy of combination of Ezetimibe 10 mg and rosuvastatin 2.5 mg versus rosuvastatin 5 mg monotherapy for hypercholesterolemia in patients with type 2 diabetes.
Lipids Health Dis
PUBLISHED: 07-30-2013
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Statins are used to treat hypercholesterolemia in patients with type 2 diabetes mellitus, but many of these patients fail to achieve the target LDL-C level. Recent reports have suggested that a synergistic effect can be obtained by concomitant administration of the cholesterol absorption inhibitor ezetimibe and a statin. However, in patients with type 2 diabetes who are already being treated with satins, it remains unclear whether it is more effective to add ezetimibe or to increase the statin dose. Therefore, this study was performed to examine the effects of these two regimens on LDL-C and lipoproteins.
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Hypertrophic cranial pachymeningitis in MPO-ANCA-related vasculitis: a case report and literature review.
Fukushima J Med Sci
PUBLISHED: 07-12-2013
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A 75-year-old woman presented with rapidly progressive glomerulonephritis with positive results for anti-myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA). Corticosteroid therapy was successfully introduced. However, 7 months later, magnetic resonance imaging revealed marked swelling in the falx cerebri and high density regions were apparent on gallium scintigraphy, leading to diagnosis of hypertrophic cranial pachymeningitis (HCP). Symptoms improved with intensified corticosteroid therapy, but radiological examination 9 months later revealed right nasal sinus inflammation accompanied by osteolytic change. Granulomatosis with polyangiitis (Wegeners) was finally diagnosed. HCP is an important complication in MPO-ANCA-related vasculitis, and needs to be considered during the clinical course.
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Measurement of the strength of iodine-125 seed moving at unknown speed during implantation in brachytherapy.
J. Radiat. Res.
PUBLISHED: 06-30-2013
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The aim of this study is to demonstrate the feasibility of estimating the strength of the moving radiation source during patient implantation. The requirement for the counting time was investigated by comparing the results of the measurements for the static source with those for the source moving at 2, 5, 10 and 20 cm s(-1). The utilized source was (125)I with an air-kerma strength of 0.432 U (?Gym(2)h(-1)). The detector utilized was a plastic scintillation detector (8 cm × 5 cm × 2 cm in thickness) set at 8 cm away from the needle to guide the source. Experiments were conducted in order to determine the most desirable counting time. Analysis using the maximum of the measured values while the source passed through the needle indicated that the results for the moving source increased more than those for the static source as the counting time decreased. The combined standard uncertainty, with the coverage factor of 1, was within 4% at the counting time of 100 ms. This investigation supported the feasibility of the method proposed for estimating the source strength during the implantation procedure, regardless of the source speed. The method proposed is a potential option for reducing the risk of accidental replacements of sources with those of incorrect strengths.
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Roles of thrombelastography and thromboelastometry for patient blood management in cardiac surgery.
Transfus Med Rev
PUBLISHED: 06-14-2013
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The value of thrombelastography (TEG) and thromboelastometry (ROTEM) to improve perioperative hemostasis is under debate. We aimed to assess the effects of TEG- or ROTEM-guided therapy in patients undergoing cardiac surgery on the use of allogeneic blood products. We analyzed 12 trials including 6835 patients, 749 of them included in 7 randomized controlled trials (RCTs). We collected data on the amount of transfused allogeneic blood products and on the proportion of patients who received allogeneic blood products or coagulation factor concentrates. Including all trials, the odds ratios (ORs) for transfusion of red blood cell (RBC) concentrates, fresh-frozen plasma (FFP), and platelets were 0.62 (95% confidence interval [CI], 0.56-0.69; P<.001), 0.28 (95% CI, 0.24-0.33; P<.001), and 0.55 (95% CI, 0.49-0.62; P<.001), respectively. However, more than 50% of the patients in this analysis were derived from one retrospective study. Including RCTs only, the ORs for transfusion of RBC, FFP, and platelets were 0.54 (95% CI, 0.38-0.77; P<.001), 0.36 (95% CI, 0.25-0.53; P<.001), and 0.57 (95% CI, 0.39-0.81; P=.002), respectively. The use of coagulation factor concentrates was reported in 6 studies, 2 of them were RCTs. The ORs for the infusion of fibrinogen and prothrombin complex concentrate were 1.56 (95% CI, 1.29-1.87; P<.001) and 1.74 (95% CI, 1.40-2.18; P<.001), respectively. However, frequencies and amounts were similar in the intervention and control group in the 2 RCTs. It is presumed that TEG- or ROTEM-guided hemostatic management reduces the proportion of patients undergoing cardiac surgery transfused with RBC, FFP, and platelets. This presumption is strongly supported by similar ORs found in the analysis including RCTs only. Patient blood management based on the transfusion triggers by TEG or ROTEM appears to be more restrictive than the one based on conventional laboratory testing. However, evidence for improved clinical outcome is limited at this time.
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Predicting time to ovarian carcinoma recurrence using protein markers.
J. Clin. Invest.
PUBLISHED: 06-06-2013
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Patients with ovarian cancer are at high risk of tumor recurrence. Prediction of therapy outcome may provide therapeutic avenues to improve patient outcomes. Using reverse-phase protein arrays, we generated ovarian carcinoma protein expression profiles on 412 cases from TCGA and constructed a PRotein-driven index of OVARian cancer (PROVAR). PROVAR significantly discriminated an independent cohort of 226 high-grade serous ovarian carcinomas into groups of high risk and low risk of tumor recurrence as well as short-term and long-term survivors. Comparison with gene expression-based outcome classification models showed a significantly improved capacity of the protein-based PROVAR to predict tumor progression. Identification of protein markers linked to disease recurrence may yield insights into tumor biology. When combined with features known to be associated with outcome, such as BRCA mutation, PROVAR may provide clinically useful predictions of time to tumor recurrence.
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HLA-DPB1*04:01 allele is associated with non-obstructive azoospermia in Japanese patients.
Hum. Genet.
PUBLISHED: 06-04-2013
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Azoospermia is defined by absence of sperm in the semen and can either be caused by obstruction of the seminal tract (obstructive azoospermia) or by defects in spermatogenesis (non-obstructive azoospermia, NOA). Previous studies reported that specific alleles and single nucleotide polymorphisms (SNPs) in the human leukocyte antigen (HLA) region were associated with NOA in East Asians. We attempt to expand upon previous findings by genotyping more HLA genes and to replicate SNP associations by focusing on Japanese NOA patients. HLA typing of six genes (HLA-A, -B, -C, -DRB1, -DQB1, and -DPB1) was done on 355 NOA patients using SSO-Luminex assay while genotyping of two previously reported SNPs (rs498422 and rs3129878) was done on 443 patients and 544 fertile males using TaqMan assay. Association between the HLA alleles and SNP with NOA was assessed with Chi squared and logistic regression tests. We found that HLA-DPB1*04:01 [corrected p value, P(c) 7.13 × 10(-6); odds ratio (OR) 2.52], DRB1*13:02 (P(c) 4.93 × 10(-4), OR 1.97), DQB1*06:04 (P(c) 8.94 × 10(-4), OR 1.91) and rs3129878 (p value 3.98 × 10(-4); OR 1.32) showed significant association with NOA, however, these loci are in linkage disequilibrium with each other. The conditional logistic regression tests showed that DPB1*04:01 is independently associated with NOA, confirming the involvement of the HLA region in the etiology of NOA in Japanese patients.
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18F-FDG PET/CT imaging of extensive systemic sarcoidosis with epididymal involvement.
Clin Nucl Med
PUBLISHED: 05-23-2013
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Sarcoidosis rarely involves the male reproductive tract. We present an unusual case of extensive systemic sarcoidosis with epididymal involvement. The ¹?F-FDG PET/CT demonstrated extensive foci of hypermetabolic activity involving multiple lymph nodes, liver, epididymides, muscles, and subcutaneous tissues. After immunosuppressive therapy, a follow-up PET scan showed almost complete disappearance of the FDG accumulation except for in the hilar lymph nodes.
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Blood pressure elevation in hemodialysis patients after the Great East Japan Earthquake.
Hypertens. Res.
PUBLISHED: 05-21-2013
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A major earthquake measuring 9.0 on the Richter scale struck northeastern Japan at 2:46 pm on 11 March 2011. Several reports have described transient increases in blood pressure after major earthquakes, but the impact of such increases on hemodialysis patients has not been reported. We retrospectively investigated changes in blood pressure and influencing factors in 205 patients (mean age 66.6±13.0 years; male 51.7%; median dialysis vintage 6.0 (2.0-11.0) years) on chronic dialysis at three dialysis centers in the affected area (Fukushima City) for 8 weeks after the earthquake. Pre-dialysis blood pressure was significantly elevated at 1 week after the earthquake compared with baseline (systolic vs. diastolic blood pressure: 153.1±20.2/80.1±13.5 vs. 148.6±20.0/77.5±12.8?mm?Hg, P<0.001), similarly post-dialysis blood pressure was elevated for up to 8 weeks. Independent factors influencing changes in blood pressure after the earthquake comprised baseline blood pressure and ?-blockers. The earthquake induced a significant elevation in blood pressure among patients on chronic dialysis, and activation of the sympathetic nervous system might at least in part be associated with the mechanism underlying this increase.Hypertension Research advance online publication, 3 October 2013; doi:10.1038/hr.2013.116.
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[A case of gallbladder metastasis from a malignant perivascular epithelioid cell tumor of the bladder].
Nihon Shokakibyo Gakkai Zasshi
PUBLISHED: 05-08-2013
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The perivascular epithelioid cell family of tumors (PEComas) includes common lesions such as angiomyolipomas, lymphangioleiomyomas, and clear cell "sugar" tumors of the lung. Less frequently, PEComas arise in various other locations throughout the body, including the soft tissue, bone, and the visceral organs. We report the case of a 64-year-old man who underwent total cystectomy because of a primary malignant PEComa of the bladder in August 2010. The patient was treated with the mammalian target of rapamycin inhibitor for lung and bone metastasis from April 2011 and showed stable disease. Computed tomography showed a growing mass in the neck of the gallbladder 5 months later, which was suspected to be gallbladder cancer. Cholecystectomy and lymphadenectomy was performed in February 2012, and histopathological examination indicated gallbladder metastasis from the primary malignant PEComa of the bladder. This is, to our knowledge, the first report of malignant PEComa metastasis to the gallbladder.
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Respiratory-gated ¹?F-FDG PET/CT for the diagnosis of liver metastasis.
Eur J Radiol
PUBLISHED: 04-04-2013
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To ascertain the role of respiratory-gated PET/CT with (18)F-fluorodeoxyglucose ((18)F-FDG) for accurate diagnosis of liver metastasis.
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A nonsynonymous variant of IL1A is associated with endometriosis in Japanese population.
J. Hum. Genet.
PUBLISHED: 03-17-2013
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Our previous genome-wide association study has demonstrated that single-nucleotide polymorphisms (SNPs) located in intronic and downstream regions of IL1A (interleukin 1?) were associated with the risk of endometriosis. These SNPs on the genome-wide association study platform could be only surrogates for the true causal variant. Thus, we resequenced all the exons of IL1A in 377 patients with endometriosis and 457 healthy controls. We detected seven rare variants (minor allele frequency <0.01) and four common variants. All the rare variants were not associated with endometriosis. The four common variants (rs17561, rs1304037, rs2856836 and rs3783553) in IL1A were significantly associated with endometriosis (P=0.0024, 0.0024, 0.0014 and 0.0061, respectively). All the four SNPs were within a linkage disequilibrium block. Among them, only rs17561 was nonsynonymous (p.A114S), which has been reported to be associated with susceptibility to ovarian cancer. Taken together, we examined association between rs17561 and endometriosis in an independent validation data set (524 patients and 533 healthy controls) replicating significant association (P=4.0 × 10(-5); odds ratio (OR), 1.91; 95% confidence interval (CI), 1.41-2.61). Meta-analysis by combining results from the two stages strengthened the evidence of association (P=2.5 × 10(-7); OR, 1.90; 95% CI, 1.49-2.43). Our findings demonstrated that the nonsynonymous variant of IL1A might confer genetic susceptibility to endometriosis in Japanese population.
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In vitro effects of recombinant activated factor VII on thrombin generation and coagulation following inhibition of platelet procoagulant activity by prasugrel.
Thromb. Res.
PUBLISHED: 03-13-2013
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Prasugrel is a thienopyridyl P2Y12 antagonist with potent antiplatelet effects. At present, little is known about its effects on thrombin generation or what strategies may emergently reverse its anticoagulant effects. In the current study we evaluated whether recombinant activated factor VII may reverse prasugrel induced effects and increase thrombin generation in an in vitro model.
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Severity of non-alcoholic steatohepatitis is associated with substitution of adipose tissue in skeletal muscle.
J. Gastroenterol. Hepatol.
PUBLISHED: 03-13-2013
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The pathogenesis of non-alcoholic fatty liver disease (NAFLD) is now focusing on its organ cross-talk with not only adipose tissue but also systemic skeletal muscle. Cross-sectional and longitudinal studies were conducted to determine the role of intramuscular adipose tissue content (IMAC) measured by computed tomography on the severity of NAFLD/non-alcoholic steatohepatitis (NASH).
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Effect of Japanese cedar specific immunotherapy on allergen-specific T(H)2 cells in peripheral blood.
Ann. Allergy Asthma Immunol.
PUBLISHED: 02-16-2013
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The involvement of a shift from TH2 to TH1 responses in peripheral blood in pollen subcutaneous immunotherapy (SCIT) has been contentious, partly because of difficulties analyzing antigen-specific TH cells.
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The clinical applicability of albuminuria testing in Japanese hypertensive patients: the AVA-E study.
Intern. Med.
PUBLISHED: 02-15-2013
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Albuminuria is thought to reflect generalized endothelial dysfunction. In hypertensive patients, albuminuria increases the risk of cardiovascular disease (CVD) events. Therefore, screening for albuminuria is critical for stratifying risks in hypertensive patients. However, a limited number of Japanese studies have performed quantitative examinations of albuminuria. The objective of this study was to examine the utility of the CLINITEK MICROALB CREATININE TEST for albuminuria screening.
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Emerging haemostatic agents and patient blood management.
Best Pract Res Clin Anaesthesiol
PUBLISHED: 02-11-2013
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The transfusion of allogeneic blood products has been considered as a life-saving procedure for patients suffering from major traumatic injury and those who are undergoing major surgery. The safety of blood products has improved in terms of infectious complications over the last three decades due to advanced donor screening procedures and tests. Nevertheless, non-infectious complications including a blood-type mismatch, volume overload and immunologic and non-immunologic reactions to blood products can adversely affect clinical outcomes. It is thus important to implement a patient-specific strategy in diagnosing bleeding cause(s) and optimising haemostatic therapy. This strategy is an integral part of patient blood management applicable to many perioperative patients. Recent advances in the haemostatic management and transfusion include better understanding of the pathomechanisms of coagulopathy, availability of point-of-care coagulation monitoring and introductions of pathogen-inactivated plasma and factor concentrates as well as recombinant coagulation factors. Understanding the indications and limitations of conventional haemostatic therapy, and potential indications and complications relating to emerging haemostatic agents, is important for perioperative physicians. In this article, we discuss current issues related to allogeneic plasma products and emerging biological haemostatic agents and techniques. Further, we review the mechanisms of action and available preclinical or clinical data for each therapeutic agent.
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Promoter methylation of DAPK1, FHIT, MGMT, and CDKN2A genes in cervical carcinoma.
Int. J. Clin. Oncol.
PUBLISHED: 01-26-2013
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BACKGROUND AND OBJECTIVES: Aberrant DNA methylation contributes to the malignant phenotype in virtually all types of human cancer. This study explored the relationship between promoter methylation and inactivation of the DAPK1, FHIT, MGMT, and CDKN2A genes in cervical cancer. METHODS: The promoter methylation of DAPK1, FHIT, MGMT, and CDKN2A was investigated by using a methylation-specific polymerase chain reaction in 53 specimens of cervical cancer (42 squamous cell carcinoma, 11 adenocarcinoma), 22 specimens of intraepithelial neoplasia tissues, and 24 control normal cervical tissue specimens. The correlation of promoter methylation with the clinicopathological features of cervical cancer was analyzed. The expressions of DAPK1, FHIT, MGMT, and CDKN2A were detected by measuring relative mRNA levels. RESULTS: The promoter methylation of DAPK1, FHIT, MGMT, and CDKN2A in cervical cancer vs. intraepithelial neoplasia vs. normal cervical tissue was 75.5 vs. 31.8 vs. 4.2 % (p < 0.0001), 66.0 vs. 59.1 vs. 25.0 % (p = 0.0033), 34.0 vs. 27.3 vs. 20.8 % (p = 0.76), and 17.0 vs. 31.8 vs. 8.3 % (p = 0.11), respectively. The methylation of the promoter region significantly decreased the expression of only DAPK1 (p = 0.03). The methylation rate of the DAPK1 gene promoter was significantly higher in cervical cancer tissues than in cervical intraepithelial neoplasia and normal cervical tissues. CONCLUSION: Promoter methylation may therefore lead to the inactivation of the DAPK1 gene, and may be related to the progression of cervical oncogenesis.
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Outcomes of fertility-sparing surgery for women of reproductive age with FIGO stage IC epithelial ovarian cancer.
Int J Gynaecol Obstet
PUBLISHED: 01-23-2013
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To report the clinical outcomes of patients with FIGO stage IC epithelial ovarian cancer (EOC) treated by fertility-sparing surgery (FSS).
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Development of collimator for in-situ measurement of 90Sr specific activity by ?-ray survey meter and Monte Carlo calculation.
Appl Radiat Isot
PUBLISHED: 01-08-2013
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For the in-situ measurement of (90)Sr contamination, the collimators to be combined with the ?-ray survey meter were designed with MCNP-4C calculations. The designed collimators were manufactured and its characteristics were measured in accordance with the calculations. The calculated energy deposition in the survey meter agreed within 27% to its counting rate measured in terms of their dependencies on the collimator dimension. This supports the usability of the manufactured collimators and numerical correction of the sensitivity of the survey meter depending on the geometry.
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Transfusion and hematologic variables after fibrinogen or platelet transfusion in valve replacement surgery: preliminary data of purified lyophilized human fibrinogen concentrate versus conventional transfusion.
Transfusion
PUBLISHED: 01-02-2013
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BACKGROUND: Platelet (PLT) and plasma transfusion remain the mainstay hemostatic therapy for perioperative bleeding. Several studies have indicated that acquired fibrinogen (FIB) deficiency can be the primary cause of bleeding after cardiac surgery. The aim of this study was to compare hematologic and transfusion profiles between the first-line FIB replacement and PLT transfusion in post-cardiac surgical bleeding. STUDY DESIGN AND METHODS: In this prospective, randomized, open-label study, 20 adult patients who underwent valve replacement or repair and fulfilled preset visual bleeding scale were randomized to 4?g of FIB or 1 unit of apheresis PLTs. Primary endpoints included hemostatic condition in the surgical field and 24-hour hemostatic product usage. Hematologic data, clinical outcome, and safety data were collected up to the 28th day postoperative visit. RESULTS: In patients who received the first-line FIB concentrate (n?=?10), the visual bleeding scale improved after intervention, and the incidence of PLT transfusion and total plasma donor exposure were lower compared to the PLT group (n?=?10). Postintervention FIB level was statistically higher (209?mg/dL vs. 165?mg/dL) in the FIB group than in the PLT group, but PLT count and prothrombin were lower. There were no statistical differences in the postoperative blood loss and red blood cell transfusion between two groups. CONCLUSIONS: Our preliminary data indicate that the primary FIB replacement may potentially reduce the incidence of PLT transfusion and the number of donor exposures. Plasma FIB level of 200?mg/dL is attainable with a single dose of 4?g, and this level seems to mitigate bleeding despite moderately decreased thrombin generation.
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Skin autofluorescence is associated with the progression of chronic kidney disease: a prospective observational study.
PLoS ONE
PUBLISHED: 01-01-2013
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Advanced glycation end product (AGE) accumulation is thought to be a measure of cumulative metabolic stress that has been reported to independently predict cardiovascular disease in diabetes and renal failure. The aim of this study was to evaluate the association between AGE accumulation, measured as skin autofluorescence, and the progression of renal disease in pre-dialysis patients with chronic kidney disease (CKD).
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Estimation of beta-ray skin dose from exposure to fission fallout from the Hiroshima atomic bomb.
Radiat Prot Dosimetry
PUBLISHED: 10-31-2011
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Beta-ray skin dose due to the fission fallout from the Hiroshima atomic bomb is potentially related to the epilation in the black rain area. The absorbed dose to the skin from beta-rays emitted by fission fallout has been estimated for an initial ¹³?Cs deposition of 1 kBq m?² on the ground at 0.5 h after the explosion. The estimated skin dose takes into account both external exposure from fission fallout radionuclides uniformly distributed in 1 mm of soil on the surface of the ground and from a 26 ?m thickness of contaminated soil on the skin, using the Monte Carlo radiation transport code MCNP-4C. The cumulative skin dose for 1 month after the explosion is taken as the representative value. The estimated skin dose for an initial ¹³?Cs deposition of 1 kBq m?² was determined to be about 500 mSv.
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[A case of accessory papilla of duodenum causing intestinal bleeding].
Nihon Shokakibyo Gakkai Zasshi
PUBLISHED: 10-06-2011
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A 50-year-old man was admitted to our hospital with a chief complaint of melena. An emergency upper gastrointestinal endoscopic study revealed arterial bleeding from a duodenal submucosal tumor, 1.5cm in diameter and about 2cm in an oral direction from the papilla of Vater. Because it was not possible to stop the bleeding, an emergency resection of the tumor was performed. Macroscopically, the ulcerated tumor was approximately 1.5cm in diameter. Histopathologically, the tumor was determined to be located in the accessory papilla of the duodenum. We report here a rare case of bleeding from the accessory duodenal papilla and discuss the literature.
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Fibrinogen and hemostasis: a primary hemostatic target for the management of acquired bleeding.
Anesth. Analg.
PUBLISHED: 09-29-2011
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Fibrinogen plays several key roles in the maintenance of hemostasis. Its cleavage by thrombin and subsequent polymerization to form fibrin strands provides the structural network required for effective clot formation. During cases of acute blood loss, attempts to maintain circulating volume and tissue perfusion often involve the infusion of crystalloids, colloids, and red blood cells. Intravascular volume resuscitation, although vital, frequently results in dilution of the remaining clotting factors and onset of dilutional coagulopathy. In such cases, fibrinogen is the first coagulation factor to decrease to critically low levels. There currently is a lack of awareness among physicians regarding the significance of fibrinogen during acute bleeding and, at many centers, fibrinogen is not monitored routinely during treatment. We reviewed current studies that demonstrate the importance of considering fibrinogen replacement during the treatment of acquired bleeding across clinical settings. If depleted, the supplementation of fibrinogen is key for the rescue and maintenance of hemostatic function; however, the threshold at which such intervention should be triggered is currently poorly defined. Although traditionally performed via administration of fresh frozen plasma or cryoprecipitate, the use of lyophilized fibrinogen (concentrate) is becoming more prevalent in some countries. Recent reports relating to the efficacy of fibrinogen concentrate suggest that it is a viable alternative to traditional hemostatic approaches, which should be considered. The prospective study of fibrinogen supplementation in acquired bleeding is needed to accurately assess the range of clinical settings in which this management strategy is appropriate, the most effective method of supplementation and a comprehensive safety profile of fibrinogen concentrate used for such an approach.
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Radiation exposure and disease questionnaires of early entrants after the Hiroshima bombing.
Radiat Prot Dosimetry
PUBLISHED: 09-12-2011
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It is popularly known that people who entered into the ground-zero area shortly after the atomic bombings in Hiroshima and Nagasaki suffered from various syndromes similar to acute radiation effects. External exposures from neutron-induced radionuclides in soil have recently been reassessed based on DS02 calculations as functions of both distance from the hypocentres and elapsed time after the explosions. Significant exposure due to induced radiation can be determined for those who entered the area within 1000 m from the hypocentres shortly after the bombing. Although it was impossible to track the action of each of the survivors over the days or weeks following the bombings in order to make reliable dose estimates for their exposures to soil activation or fallout, four individuals among those early entrants were investigated here to describe useful information of what happened shortly after the bombing.
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Staphylococcal scalded skin syndrome in an extremely low-birth-weight neonate: molecular characterization and rapid detection by multiplex and real-time PCR of methicillin-resistant Staphylococcus aureus.
Pediatr Int
PUBLISHED: 09-02-2011
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? Staphylococcal scalded skin syndrome (SSSS), caused by methicillin-resistant Staphylococcus aureus (MRSA) producing exfoliative toxin (ET), is a life-threatening infection for neonates in neonatal intensive care units (NICUs). SSSS in extremely low-birth-weight (ELBW) neonates is rare. A new class of MRSA (community-acquired MRSA, CA-MRSA) has been emerging in the community. The aim of this study was to characterize MRSA from an ELBW neonate with SSSS, and to develop rapid detection methods for SSSS-associated and emerging pediatric MRSA.
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Principles and practice of thromboelastography in clinical coagulation management and transfusion practice.
Transfus Med Rev
PUBLISHED: 08-26-2011
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In the recent years, thromboelastography has become a popular monitoring device for hemostasis and transfusion management in major surgery, trauma, and hemophilia. Thromboelastography is performed in whole blood and assesses the viscoelastic property of clot formation under low shear condition. Thromboelastography can be performed with a variety of activator and inhibitors at different concentrations representing the most important factors for different intervals and clot formation variables reported in multiple studies and algorithms. Furthermore, fibrinogen levels and platelet counts have a major influence on thromboelastographic variables. In addition, differences in patient populations, devices, and preanalytical conditions contribute to some conflicting findings in different studies.
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A dosimetry study of the Oncoseed 6711 using glass rod dosimeters and EGS5 Monte Carlo code in a geometry lacking radiation equilibrium scatter conditions.
Med Phys
PUBLISHED: 08-06-2011
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The aim of this study was to develop a dose calculation method which is applicable to the interseed attenuation and the geometry lacking the equilibrium radiation scatter conditions in brachytherapy.
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A comparative evaluation of rotation thromboelastometry and standard coagulation tests in hemodilution-induced coagulation changes after cardiac surgery.
Transfusion
PUBLISHED: 07-14-2011
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Coagulopathy after cardiopulmonary bypass (CPB) is caused by multiple perturbations in cellular and humoral elements of coagulation. A timely and comprehensive method to evaluate hemostasis would be helpful in the management of bleeding patients after CPB. The assessment of whole blood coagulation using rotation thromboelastometry (ROTEM) was compared to coagulation tests routinely performed during cardiac surgery.
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A microchip flow-chamber system for quantitative assessment of the platelet thrombus formation process.
Microvasc. Res.
PUBLISHED: 06-30-2011
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As the pathogenesis of arterial thrombosis often includes platelet thrombus formation (PTF), antiplatelet agents are commonly used for the prevention of thromboembolic events. Here, using a novel microchip flow-chamber system we developed to quantitatively analyze the PTF process, we evaluated the pharmacological efficacies of antiplatelet agents under different arterial shear rates. Hirudin-anticoagulated whole blood was perfused over a collagen-coated microchip at shear rates of 1000, 1500, and 2000s(-1), and PTF in the absence and presence of various antiplatelet agents was observed microscopically and quantified by measuring flow-pressure changes. The onset of PTF was measured as T(10) (time to reach 10 kPa), and AUC(10) (area under the flow pressure curve for the first 10 min) was calculated to quantify the overall stability of the formed thrombus. Aspirin and AR-C66096 (P2Y(12)-antagonist) at high concentrations (50 ?M and 1000 nM, respectively) prolonged T(10) only modestly (AR-C66096>aspirin), but effectively decreased AUC(10), resulting in unstable PTF at all examined shear rates. With dual inhibition using both aspirin (25 ?M) and ARC-66096 (250 nM), AUC(10) was drastically reduced. Nearly complete suppression of AUC(10) was also observed with abciximab (2 ?g ml(-1)) and beraprost (PGI(2)-analog; 4 nM). Although OS-1 (GPIb?-antagonist; 100 nM) prevented complete capillary occlusion, significant amounts of microscopic thrombi were observed on the collagen surface. In contrast to abciximab and beraprost, OS-1 differentially affected PTF under higher shear conditions. Our novel analytical system is capable of distinguishing the pharmacological effects of various antiplatelet agents under physiological shear rates, suggesting that this system may aid in the determination of the appropriate type and dose of antiplatelet agent in the clinical setting.
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Changes in fetal circulation associated with congenital heart disease and their effects on fetal growth.
Fetal. Diagn. Ther.
PUBLISHED: 06-13-2011
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Our aim was to investigate the association between fetal growth and cerebrovascular resistance in fetuses with congenital heart disease (CHD).
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High mortality associated with intracardiac and intrapulmonary thromboses after cardiopulmonary bypass.
J Anesth
PUBLISHED: 05-26-2011
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Intrapulmonary or intracardiac thrombosis is a rare but catastrophic event following complex cardiothoracic surgery. Although there have been multiple cases reported in the literature, the causes of these events are largely unknown. In this retrospective review, we attempt to identify risk factors and propose possible mechanisms of thromboses after cardiopulmonary bypass (CPB).
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[A case of gastric carcinoma with peritoneal metastasis successfully treated by combination chemotherapy of S-1 and cisplatin].
Gan To Kagaku Ryoho
PUBLISHED: 05-14-2011
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This case is a 69-year-old woman. We diagnosed gastric cancer and cholecystolithiasis by close inspection of abdominal pain. Because preoperative diagnosis was T2N0M0, Stage I B, we performed an operation. Many lesser tubercles were shown, and were diagnosed as peritoneal metastases pathologically. The tumor in corpus ventriculi infiltrated out of gastric serosa. We judged that curative resection was impossible and finished the operation after giving an intra-abdominal dosage of cisplatin(CDDP)at 85mg. After operation, 3 courses of performed S-1/CDDP combination chemotherapy were performed. Because we observed contraction of the main lesion and could not point out the peritoneal metastases and ascitis, we performed a second look operation. All the nodules found with peritoneal and rectouterine excavation had disappeared and we performed distal gastrectomy. The postoperative diagnosis was pT2(MP), pN0CY0, Stage I B, Cur A, therapy grade 1a. Chemotherapy does succeed, and this is a valuable case in which a radical operation could be performed.
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Analysis of the polymorphisms of genes coding biotransformation enzymes in recurrent miscarriage in the Japanese population.
J. Obstet. Gynaecol. Res.
PUBLISHED: 05-12-2011
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To investigate the relationship between the genotype of enzymes for detoxification and recurrent miscarriage.
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A comparative study of prothrombin complex concentrates and fresh-frozen plasma for warfarin reversal under static and flow conditions.
Thromb. Haemost.
PUBLISHED: 04-15-2011
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Prothrombin complex concentrates (PCCs) and fresh-frozen plasma (FFP) have been clinically used for acute warfarin reversal. The recovery of prothrombin time (PT) or international normalised ratio (INR) is often reported as an endpoint, but haemostatic efficacies of PCCs and FFP may not be fully reflected in static clotting test in platelet-poor plasma. Using various in vitro assays, we compared the effects of two PCC preparations (3-factor PCC; Bebulin and 4-factor PCC; Beriplex) and FFP on warfarin reversal under static and flow conditions. First, we added an aliquot of either PCC (0.3 or 0.72 U/ml) or 20% FFP (v/v) to commercial warfarin plasma (INR 3.2, or 10.3), and then measured PT, factor II, factor VII, and thrombin generation. Subsequently, we collected whole blood samples from six consented warfarin-treated patients with mean INR 3.0 ± 0.5 (range 2.5-3.7), and compared clot formation under flow conditions at 280 s-1 before and after addition of either PCC preparation (0.3 and 0.6 U/ml) or 20% of FFP (v/v). PT/INR were restored by either PCC in plasma with INR 3.0, but they were more effectively corrected by 4-factor PCC than 3-factor PCC in plasma with INR 10.3. Effects of FFP were similar to 0.3 U/ml of PCCs in terms of PT, but FFP was less efficacious than PCCs in recovering thrombin generation or factor II levels. In flow experiments, the onset of thrombus formation was shortened by either PCC, but not by FFP, contrary to shortened PT values. For warfarin reversal 20% volume replacement with FFP is inferior to PCCs.
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A case report of fatal tumor lysis syndrome after chemotherapy in a pregnant patient with Burkitts lymphoma.
J. Obstet. Gynaecol. Res.
PUBLISHED: 04-12-2011
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A 35-year-old Japanese woman in the 24th week of gestation with bilateral breast enlargement was referred to hospital. She was diagnosed with Burkitts lymphoma and admitted for detailed evaluation and treatment. Early delivery and subsequent chemotherapy was chosen after considering the gestational week, her general condition and the wishes of the patient and her husband. She gave birth to a male infant by cesarean section in the 25(th) week of gestation. It had been planned to begin high-dose chemotherapy, such as CODOX-M/IVAC, on day 7 of the puerperium; however, her general condition worsened and chemotherapy was therefore begun on day 2 after the birth. Eight hours after chemotherapy (cyclophosphamide, vincristine and doxorubicin), she developed cardiac arrest due to tumor lysis syndrome. Despite medical treatment, her bleeding tendency did not improve and she died of respiratory failure with alveolar bleeding five days after chemotherapy.
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Successful twin pregnancy in a patient with parkin-associated autosomal recessive juvenile parkinsonism.
BMC Neurol
PUBLISHED: 03-25-2011
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Pregnancy in patients with Parkinson disease is a rare occurrence. To the best of our knowledge, the effect of pregnancy as well as treatment in genetically confirmed autosomal recessive juvenile parkinsonism (ARJP) has never been reported. Here, we report the first case of pregnancy in a patient with ARJP associated with a parkin gene mutation, ARJP/PARK2.
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Development of monitoring method of spatial neutron distribution in neutrons-gamma rays mixed field using imaging plate for NCT--depression of the field.
Appl Radiat Isot
PUBLISHED: 02-25-2011
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The degree of depression in the neutron field caused by neutron absorption in the materials of an imaging plate (IP) was investigated using MCNP-4C. Consequently, the IP doped with Gd, which reproduced the distribution of (157)Gd(n,?)(158)Gd reaction rate in the previous study, depresses the relative distribution by about 50%. The depression for the IP in which Gd is replaced with similar amount of B atoms was estimated to be about 10%. The signal intensity for this IP is estimated to be at a similar level with that for Gd-doped IP.
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Resolution of uterine arteriovenous malformation and successful pregnancy after treatment with a gonadotropin-releasing hormone agonist.
Obstet Gynecol
PUBLISHED: 01-22-2011
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Uterine arteriovenous malformations are a rare and potentially life-threatening condition. Medical therapy has not been popular because of the propensity for excessive bleeding in the patient. As a result, the effect of gonadotropin-releasing hormone (Gn-RH) agonists on uterine arteriovenous malformations has not been established.
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Development of in-situ measurement for 90 Sr specific activity by ?-ray survey meter combined with sensitivity correction by Monte Carlo calculation.
Appl Radiat Isot
PUBLISHED: 01-20-2011
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The objective of this study was to develop an in-situ measurement technique for the instant detection of the (90)Sr contamination. A numerical method to correct the detection efficiency of the ? survey meter was applied for an elk antler sample from the vicinity of the Mayak facility. The estimated (90)Sr specific activity of 0.21±0.04 Bq/g agrees within the factor of two to the value 0.11±0.06 Bq/g evaluated with the imaging plate, which was previously validated. Also, the dependence of the detection efficiency was shown to be an exponential function of the sample thickness and nearly proportional to the area of the sample.
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Complete hysteroscopic resection of a large atypical polypoid adenomyoma, followed by a successful pregnancy.
Fertil. Steril.
PUBLISHED: 01-19-2011
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To describe the hysteroscopic resection of a large atypical polypoid adenomyoma (APA) in a young patient followed by a successful pregnancy.
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Identification of Receptor Tyrosine Kinase, Discoidin Domain Receptor 1 (DDR1), as a Potential Biomarker for Serous Ovarian Cancer.
Int J Mol Sci
PUBLISHED: 01-18-2011
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Ovarian cancer, one of the most common gynecological malignancies, has an aggressive phenotype. It is necessary to develop novel and more effective treatment strategies against advanced disease. Protein tyrosine kinases (PTKs) play an important role in the signal transduction pathways involved in tumorigenesis, and represent potential targets for anticancer therapies. In this study, we performed cDNA subtraction following polymerase chain reaction (PCR) using degenerate oligonucleotide primers to identify specifically overexpressed PTKs in ovarian cancer. Three PTKs, janus kinase 1, insulin-like growth factor 1 receptor, and discoidin domain receptor 1 (DDR1), were identified and only DDR1 was overexpressed in all ovarian cancer tissues examined for the validation by quantitative real-time PCR. The DDR1 protein was expressed in 63% (42/67) of serous ovarian cancer tissue, whereas it was undetectable in normal ovarian surface epithelium. DDR1 was expressed significantly more frequently in high-grade (79%) and advanced stage (77%) tumors compared to low-grade (50%) and early stage (43%) tumors. The expression of the DDR1 protein significantly correlated with poor disease-free survival. Although its functional role and clinical utility remain to be examined in future studies, our results suggest that the expression of DDR1 may serve as both a potential biomarker and a molecular target for advanced ovarian cancer.
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Plasma and cerebral spinal fluid tranexamic acid quantitation in cardiopulmonary bypass patients.
J. Chromatogr. B Analyt. Technol. Biomed. Life Sci.
PUBLISHED: 01-03-2011
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A method for the determination of tranexamic acid (TXA) in human plasma and cerebral spinal fluid (CSF) was developed. Analyses were performed by ultra performance liquid chromatography with tandem mass spectrometry detection (UPLC-MS/MS) using ?-aminocaproic acid (ACA) as an internal standard. TXA and ACA were extracted from a 50 ?L sample of plasma or CSF using a methanol protein crash protocol, and chromatographic separation was performed on an ACQUITY™ TQD mass spectrometer using a UPLC C18 BEH 1.7 ?m column with a water and methanol gradient containing 0.1% formic acid. The detection and quantitation was performed by positive ion electrospray ionization using the multiple reaction monitoring (MRM) mode. The method was linear over the concentration range of 0.1-10.0 ?g/mL, with lower limit of quantitation of 0.1 ?g/mL for TXA. The intra- and inter-assay precision was less than 12% and 13% respectively at the plasma and CSF TXA concentrations tested. The present method provides a relatively simple and sensitive assay with short turn-around-time. The method has been successfully applied to assess the plasma and CSF concentrations of tranexamic acid achieved with only one dosing regimen of tranexamic acid in patients undergoing cardiopulmonary bypass surgery (CPB).
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