Glycemic control in acute illness

Moritoki Egi,Nana Furushima,Shohei Makino,Satoshi Mizobuchi 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.6

Hyperglycemia is commonly observed in critical illness. A landmark large randomized controlled trial (RCT) reported that the incidence of hyperglycemia (blood glucose concentration > 108 mg/dl) was as high as 97.2% in critically ill patients. During the past two decades, a number of RCTs and several meta-analyses and network meta-analyses have been conducted to determine the optimal target for acute glycemic control. The results of those studies suggest that serum glucose concentration would be better to be maintained between 144 and 180 mg/dl. Although there have been studies showing an association of hypoglycemia with worsened clinical outcomes, a causal link has yet to be confirmed. Nonetheless, some researchers are of the view that the data suggest even mild hypoglycemia should be avoided in critically ill patients. Since acutely ill patients who receive insulin infusion are at a higher risk of hypoglycemia, a reliable devices for measuring blood glucose concentrations, such as an arterial blood gas analyzer, should be used frequently. Acute glycemic control in patients with premorbid hyperglycemia is a novel issue. Available literature suggests that blood glucose concentrations considered to be desirable and/or safe in non-diabetic critically ill patients might not be desirable in patients with diabetes. Moreover, the optimal target for acute blood glucose control may be higher in critically ill patients with premorbid hyperglycemia. Further study is required to assess optimal blood glucose control in acutely ill patients with premorbid hyperglycemia.

A Method for Measuring the Position of Quadrotors Using a Tether Winder

Nao Moritoki,Keigo Watanabe,Isaku Nagai 제어로봇시스템학회 2016 제어로봇시스템학회 국제학술대회 논문집 Vol.2016 No.10

Use of a Quadrotor is considered as one of the methods to inspect infrastructures such as a tunnel or a bridge. In such a case, it needs to control the position of the airframe. Note, however, that it is difficult to realize the position control using GPS in environments, such as in a tunnel or under a bridge, because there is a problem, such as the weakness of the GPS signal or the incomplete reaching. Therefore, the present research is aimed at developing position control not using GPS, and proposes a method for detecting the airframe position of a tethered Quadrotor, from the length and tension of the tether. Especially, a tether winder is produced so that the length and tension of the tether are measured. This paper describes how to detect the position of a Quadrotor, and presents some operation experiments of the produced tether winder.

The Association of Fever with Total Mechanical Ventilation Time in Critically Ill Patients

박동원,Moritoki Egi,Masaji Nishimura,장유진,서기영,임채만,김재열,Keiichi Tada,Koichi Matsuo,Shinhiro Takeda,Ryosuke Tsuruta,Takeshi Yokoyama,김선옥,고윤석 대한의학회 2016 Journal of Korean medical science Vol.31 No.12

This research aims to investigate the impact of fever on total mechanical ventilation time (TVT) in critically ill patients. Subgroup analysis was conducted using a previous prospective, multicenter observational study. We included mechanically ventilated patients for more than 24 hours from 10 Korean and 15 Japanese intensive care units (ICU), and recorded maximal body temperature under the support of mechanical ventilation (MAXMV). To assess the independent association of MAXMV with TVT, we used propensity-matched analysis in a total of 769 survived patients with medical or surgical admission, separately. Together with multiple linear regression analysis to evaluate the association between the severity of fever and TVT, the effect of MAXMV on ventilator-free days was also observed by quantile regression analysis in all subjects including non-survivors. After propensity score matching, a MAXMV ≥ 37.5°C was significantly associated with longer mean TVT by 5.4 days in medical admission, and by 1.2 days in surgical admission, compared to those with MAXMV of 36.5°C to 37.4°C. In multivariate linear regression analysis, patients with three categories of fever (MAXMV of 37.5°C to 38.4°C, 38.5°C to 39.4°C, and ≥ 39.5°C) sustained a significantly longer duration of TVT than those with normal range of MAXMV in both categories of ICU admission. A significant association between MAXMV and mechanical ventilator-free days was also observed in all enrolled subjects. Fever may be a detrimental factor to prolong TVT in mechanically ventilated patients. These findings suggest that fever in mechanically ventilated patients might be associated with worse mechanical ventilation outcome.

Association of direct bilirubin level with postoperative outcome in critically ill postoperative patients

Masaharu Nagae,Moritoki Egi,Kenta Kubota,Shohei Makino,Satoshi Mizobuchi 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.1

Background: Hyperbilirubinemia is a common postoperative complication. Elevated direct bilirubin (D-Bil) and indirect bilirubin (I-Bil) levels are related to different pathophysiologies; therefore, their associations with outcomes also differ. However, there have been few comparative studies of such associations in postoperative patients. Methods: This retrospective study compared the associations of postoperative D-Bil and I-Bil with outcomes. We included adult patients requiring postoperative intensive care for more than 48 hours between 2008 and 2013, except those undergoing liver operations. The number of patients was determined using a power calculation. D-Bil and I-Bil measurements were obtained on postoperative days (POD) 1 and 2. The primary outcome was defined as hospital mortality, with the number of ICU-free survival days (IFSD) at POD 28 as the secondary outcome. Results: The study population consisted of 1,903 patients with a mortality rate of 2.2%. D-Bil at POD 1 was significantly higher in non-survivors than survivors (P = 0.001), but I-Bil at POD 1 showed no such relation (P = 0.209). Multivariate logistic analysis indicated that higher postoperative D-Bil was independently associated with increased postoperative mortality (POD 1: adjusted odds ratio [OR] = 2.32, P < 0.001; POD 2: adjusted OR = 1.95, P < 0.001), but I-Bil showed no such relation (POD 1: P = 0.913; POD 2: P = 0.209). Increased D-Bil was independently associated with decreased IFSD at POD 28 (POD 1: adjusted coefficient = –1.54, P < 0.001; POD 2: –1.84, P < 0.001). In contrast, increased I-Bil at POD 1 was independently associated with increased IFSD at POD 28 (POD 1: adjusted coefficient = +0.39, P = 0.021; POD 2: +0.33, P = 0.080). Conclusions: D-Bil indices have a higher capability than I-Bil for predicting poorer outcomes in critically ill postoperative patients.

Cocoa Flavanols and Procyanidins Can Modulate the Lipopolysaccharide Activation of Polymorphonuclear Cells In Vitro

Thomas P. Kenny,Shang-an Shu,Yuki Moritoki,Carl L. Keen,M. Eric Gershwin 한국식품영양과학회 2009 Journal of medicinal food Vol.12 No.1

Flavanols and procyanidins isolated from cocoa have been reported to possess multiple activities potentially relevant to oxidant defenses, vascular function, and immune function. In a combination of in vivo and in vitro studies, we and others have observed that cocoa can be an anti-inflammatory modulator and that compounds in cocoa are capable of modulating eicosanoid production, platelet aggregation, and the pool size of nitric oxide. The present study extends these findings by examining the in vitro effects of cocoa procyanidins on polymorphonuclear cells (PMNs). PMNs, part of the innate arm of the immune system, represent 50–60% of the total peripheral white blood cells and are the first cells to be recruited to the sites of inflammation or injury secondary to bacterial infections. Herein, we demonstrate that certain flavanols and procyanidins isolated from cocoa can moderate a subset of signaling pathways derived from lipopolysaccharide (LPS) stimulation of PMNs, mainly, PMN oxidative bursts and activation markers, and they can influence select apoptosis mechanisms. We hypothesize that flavanols and procyanidins can decrease the impact of LPS on the N-formyl-Met-Leu-Phe-primed PMN ability to generate reactive oxygen species by partially interfering in activation of the mitogen-activated protein kinase pathway.

Cocoa Flavanols and Procyanidins Can Modulate the Lipopolysaccharide Activation of Polymorphonuclear Cells In Vitro

Kenny, Thomas P.,Shu, Shang-An,Moritoki, Yuki,Keen, Carl L.,Gershwin, M. Eric The Korean Society of Food Science and Nutrition 2009 Journal of medicinal food Vol.12 No.1

Flavanols and procyanidins isolated from cocoa have been reported to possess multiple activities potentially relevant to oxidant defenses, vascular function, and immune function. In a combination of in vivo and in vitro studies, we and others have observed that cocoa can be an anti-inflammatory modulator and that compounds in cocoa are capable of modulating eicosanoid production, platelet aggregation, and the pool size of nitric oxide. The present study extends these findings by examining the in vitro effects of cocoa procyanidins on polymorphonuclear cells (PMNs). PMNs, part of the innate arm of the immune system, represent 50-60% of the total peripheral white blood cells and are the first cells to be recruited to the sites of inflammation or injury secondary to bacterial infections. Herein, we demonstrate that certain flavanols and procyanidins isolated from cocoa can moderate a subset of signaling pathways derived from lipopolysaccharide (LPS) stimulation of PMNs, mainly, PMN oxidative bursts and activation markers, and they can influence select apoptosis mechanisms. We hypothesize that flavanols and procyanidins can decrease the impact of LPS on the N-formyl-Met-Leu-Phe-primed PMN ability to generate reactive oxygen species by partially interfering in activation of the mitogen-activated protein kinase pathway.