ESA 2015 発表報告

5月30—6月2日にドイツ、ベルリンで行われましたESA2015で当教室から4名の先生が発表致しました。当教室では海外の学会に参加するだけではなく、積極的に研究成果を発表しております。 以下に簡単ですが、発表要旨、質疑応答の内容を報告します。


Histidine-Rich Glycoprotein as a novel prognostic biomarker in critically ill patients

 Histidine-Rich Glycoprotein (HRG) is a protein produced in liver. In this study, we measured HRG levels in patients and assessed the HRG as a biomarker. We demonstrated that the HRG levels in SIRS patients were significantly low, and that the HRG levels in septic patients were still lower than those in non-septic SIRS patients. Moreover, HRG levels were correlated with mortality (Odd ratio 0.86; p<0.01). The ROC curve analysis of HRG levels for mortality revealed that the AUC was 0.88.
 These results suggested that the lower HRG levels might indicate the higher severities of patients, and that HRG could be a useful marker for the severity and mortality.

Questions & Answers

Q1You collected patients in ICU. What kind of patients was included in the control?
A1In this study, we collected samples from healthy volunteers as a control group.
Q2In this study, you measured HRG one time. How is the change after that?
A2We have little data about changes of HRG levels in time course. In my impression, in the non-survivor group, HRG levels tended to keep lower level.
Q3How was the mortality in septic patients?
A38 / 20cases. Over 30%.
Q4What’s the next step?
A4We are going to collect samples from only septic patients.
Comment. It’s better to study in the larger cohort, and in the same target, not in the limited small target.


The role of transcription factor Bach1 in a rat model of acute liver injury induced by experimental endotoxemia

We previously demonstrated the upregulation of HO-1 gene and the downregulation of ALAS1 gene in rat liver following intraperitoneal LPS injection. In this study, we confirmed that HO-1 gene is upregulated and ALAS1 gene is downregulated after intravenous LPS administration, suggesting that free heme may be involved in septic hepatic injury. Bach1 gene was also upregulated following LPS treatment, on the other hand, nuclear Bach1 protein showed transient decline after both LPS and hemin treatment. These results implied that Bach1 protein is exported from nucleus by binding with free heme and Bach1 mRNA is induced to compensate the decline of Bach1 protein.

Questions & Answers

Q1Is Bach1 a target of sepsis?
A1I don’t know. Bach1 is important because Bach1 is a transcripton factor which regulates the induction of cytoprotective HO-1, but I don’t think Bach1 itself as a target of sepsis.
Q2What is the message to the clinical fields?
A2We think that free heme is a key factor in enhancing septic liver injury. However,detecting free heme is very difficult. So following the change in Bach1 protein may be useful.


The impact of fluid’s choice in early stage of hemorrhagic shock resuscitation on lung injury: Experimental animal study

We examined the impact of fluid’s choice (normal saline or hyroxyethyl starch 130000) in early stage of hemorrhagic shock resuscitation on lung injury using of rat hemorrhage shock model. Saline group required more fluid volume to resuscitate. Lung wet/dry ratio was significantly lower in hydroxyethyl starch 130000 group. On the other hand, lung injury score and microscopic findings showed no difference between two groups. The fluid’s choice in early stage of hemorrhagic shock resuscitation may have an impact on respiratory status after resuscitation.

Questions & Answers

Q1Explain the ventilator setting.
A1We didn’t use ventilator. Mice breathed spontaneously in room air under intraperitoneal pentobarbital anesthesia.
Q2What do you think about clinical influence of this study?
A2In this study with 3 hour resuscitation model rat, lung injury score and microscopic findings didn’t show significant difference between saline group and hydroxyethyl starch 130000 group. Further research (e.g. 12 or 24 hour model) is required to give this study apparent clinical impact.


Relationship between post-operative pulmonary complication and intraoperative ventilator setting during one-lung ventilation; prospective observational study

This study assessed the relationship between post-operative pulmonary complication (PPC) and ventilator setting during one lung ventilation (OLV). The incidence of PPC was 26%. In preoperative baseline, any variables didn't have significant difference. About ventilator setting, FIO2 during OLV of PPC group was significantly higher than that of non-PCC group. On multivariate analysis, odd ratio per FIO2 increase of 10% was 1.23. The higher inspired oxygen concentration during OLV might cause the more PPC.

Questions & Answers

Q1How did you set PEEP of each groups?
A1It depended on anesthesiologist then.
Q2FIO2 of non-PPC was high (>80%) and didn’t greatly change throughout OLV (>70%).The difference of FIO2 between PPC group and non-PPC group was little. It is only 10%. Is this difference related with PPC?
A2It’s a possibility. This result suggested association. So we want to conduct RCT to confirm this result.
Q3How often did PPC group return back to intubation?
A3I didn’t tell the incidence of re-intubation. I have to investigate the incidence. I think that the incidence of re-intubation was few.
Q4Which is more important in the incidence of PPC, patient’s factor or clinician’s procedure?
A4I didn’t tell certainly. I adjusted by pre-SpO2, but FIO2 during OLV was significantly related with PPC.
This result suggested the propensiy and association only.