記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(一社)日本救急医学会  

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Tranexamic acid is one component of a complex management algorithm for postpartum hemorrhage. In Japan, the 2010 obstetric hemorrhage management guidelines was revised in 2017, adding the recommendation for the administration of tranexamic acid for postpartum hemorrhage. This research aims to delineate the temporal trends in tranexamic acid administration in patients undergoing cesarean deliveries and to examine the impact of the obstetric hemorrhage management guidelines implementation. METHODS: An interrupted time series analysis was conducted on data from patients who underwent cesarean deliveries from April 2012 to August 2021, sourced from Japan's nationwide health insurance claims database. We examined the trends of tranexamic acid usage and blood transfusion use before and after the implementation of the revised guidelines in 2017. RESULTS: The study cohort comprised 91 166 cesarean deliveries. Prior to the guideline implementation, the rate of tranexamic acid usage decreased. Post-guidelines implementation, there was a statistically significant increase in the rate of tranexamic acid use, with a quarterly percentage change of 0.48% (95% confidence interval: 0.36 to 0.60; P < 0.001). The guidelines implementation in 2017 was not significantly associated with a change in the rate of transfusions. CONCLUSIONS: This interrupted time series analysis demonstrated a significant increase in the rate of tranexamic acid administration following the implementation of the revised guidelines, reversing the previously observed downward trend. Our findings could reflect the impact of the revised guideline on the use of tranexamic acid for postpartum hemorrhage, but this did not translate to fewer blood transfusions.

DOI： 10.1016/j.ijoa.2024.104258

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担当区分：筆頭著者,　最終著者,　責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.62463/surgery.80

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/bjs/znae164

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/s2589-7500(24)00065-7

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/s2214-109x(24)00142-6

PubMed

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: General anesthesia for Cesarean delivery affects maternal and neonatal outcomes. We aimed to evaluate temporal trends in anesthesia management for Cesarean deliveries over 16 years and analyze interinstitutional variations in general anesthesia use in Japan. METHODS: In this retrospective cohort study, we obtained patient data from the nationwide health insurance claims database containing data for ten million individuals. We included patients who underwent Cesarean delivery between 1 January 2005 and 31 August 2021. The primary outcome was the use of general anesthesia. We evaluated institutional variations in general anesthesia use in medical facilities using two-level hierarchical logistic regression analyses with median odds ratios and intraclass correlation coefficients. RESULTS: The cohort included 86,793 patients who underwent 102,617 Cesarean deliveries at 2,496 institutions. General anesthesia was used in 3.7% (95% confidence interval [CI], 3.6 to 3.9) of all Cesarean deliveries. The temporal trend in the use of general anesthesia decreased gradually from 10.8% in 2005 to 2.9% in 2021 (P for trend < 0.001). The adjusted median odds ratio for medical facilities was 6.1 (95% CI, 5.9 to 6.7), and the intraclass correlation coefficient was 0.52 (95% CI, 0.51 to 0.55). CONCLUSION: Although the rate of general anesthesia use for Cesarean delivery in Japan decreased gradually from 2005 to 2021, general anesthesia was used in 3.7% of all Cesarean deliveries. The use of general anesthesia varied significantly across institutions, and 52% of the overall variations in general anesthesia practice can be explained by differences between facilities.

DOI： 10.1007/s12630-023-02633-w

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担当区分：筆頭著者,　責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(株)シービーアール  

J-GLOBAL

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Various basic and clinical studies have investigated the association between the types of anesthetic agents and prognosis. However, the results have varied among studies and remain controversial. In the present study, we aimed to investigate whether the risk of all-cause mortality differs between inhaled or intravenous anesthetics in patients with gastric cancer undergoing gastrectomy. METHODS: Using a Japanese nationwide insurance claims database, we analyzed patients who underwent gastrectomy under general anesthesia for gastric cancer between January 2005 and September 2019. Postoperative outcomes were compared between two groups: those who received inhaled anesthetics (Sevoflurane, Isoflurane, or Desflurane) and those who received intravenous anesthetics (propofol), using a multivariable Cox proportional hazards model. The primary outcome was overall survival. RESULTS: Among 2671 eligible patients, 2105 were in the inhaled anesthetic group, and 566 were in the intravenous anesthetic group. The median (interquartile range) age was 58 (51-63) years, and 1979 (74.1%) were men. The median follow-up period was 795 days. We identified 56 (2.7%) and 16 (2.8%) deaths during the follow-up period in the inhaled and intravenous anesthetic use groups, respectively. There was no difference in postoperative overall survival between the two groups (hazard ratio, 0.97; 95% confidence interval, 0.56-1.70; P = 0.93). CONCLUSIONS: We found no significant difference in the postoperative risks of overall survival between inhaled and intravenous anesthesia in patients with gastric cancer undergoing gastrectomy.

DOI： 10.1007/s00540-023-03288-z

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &amp;lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).</jats:p>
</jats:sec>

DOI： 10.1093/bjs/znad370

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記述言語：英語   出版者・発行元：(一社)日本集中治療医学会  

Providing standardized, high-quality rehabilitation for critically ill patients is a crucial issue. In 2017, the Japanese Society of Intensive Care Medicine (JSICM) promulgated the “Evidence-Based Expert Consensus for Early Rehabilitation in the Intensive Care Unit” to advocate for the early initiation of rehabilitations in Japanese intensive care settings. Building upon this seminal work, JSICM has recently conducted a rigorous systematic review utilizing the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. This endeavor resulted in the formulation of Clinical Practice Guidelines (CPGs), designed to elucidate best practices in early ICU rehabilitation. The primary objective of this guideline is to augment clinical understanding and thereby facilitate evidence-based decision-making, ultimately contributing to the enhancement of patient outcomes in critical care settings. No previous CPGs in the world has focused specifically on rehabilitation of critically ill patients, using the GRADE approach. Multidisciplinary collaboration is extremely important in rehabilitation. Thus, the CPGs were developed by 73 members of a Guideline Development Group consisting of a working group, a systematic review group, and an academic guideline promotion group, with the Committee for the Clinical Practice Guidelines of Early Mobilization and Rehabilitation in Intensive Care of the JSICM at its core. Many members contributed to the development of the guideline, including physicians and healthcare professionals with multiple and diverse specialties, as well as a person who had been patients in ICU. Based on discussions among the group members, eight important clinical areas of focus for this CPG were identified. Fourteen important clinical questions (CQs) were then developed for each area. The public was invited to comment twice, and the answers to the CQs were presented in the form of 10 GRADE recommendations and commentary on the four background questions. In addition, information for each CQ has been created as a visual clinical flow to ensure that the positioning of each CQ can be easily understood. We hope that the CPGs will be a useful tool in the rehabilitation of critically ill patients for multiple professions. Graphical Abstract: [Figure not available: see fulltext.]

DOI： 10.1186/s40560-023-00697-w

Open Access

Web of Science

Scopus

PubMed

J-GLOBAL

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/bjs/znad092

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本集中治療医学会  

<p>重症患者に対する標準化された質の高いリハビリテーションの提供は，取り組むべき重要課題である。日本集中治療医学会では，2017年に「集中治療における早期リハビリテーション ―根拠に基づくエキスパートコンセンサス―」を発行したが，系統的にエビデンスを評価したものではなく，あくまでも専門家のコンセンサスに基づくものであった。そこで，日本集中治療医学会では，質が高く，かつ，医療従事者が理解しやすく，その意思決定に資することを目的に，システマティックレビューおよびGRADE（grading of recommendations, assessment, development and evaluation）アプローチを用いた診療ガイドラインを作成した。 重症患者に対するリハビリテーションに特化し，かつ，GRADEアプローチを用いた診療ガイドラインとしては，世界初の試みである。本ガイドラインは日本集中治療医学会集中治療早期リハビリテーション委員会を核に，ワーキンググループ，システマティックレビュー班，アカデミックガイドライン推進班から構成された診療ガイドライン作成グループの合計73名からなるメンバーで作成した。リハビリテーションでは多職種連携が非常に重要であることはいうまでもない。本ガイドラインも多職種，かつ多様な専門分野を持つ医師や医療従事者，ICU患者経験者を含む多くのメンバーが作成に寄与した。 本ガイドラインでは，グループメンバーによる議論に基づいて，8領域を注目すべき臨床重要領域とした。その上で，各領域から重要な14の臨床疑問（clinical question, CQ）を作成した。 パブリックコメントの募集を計2回行い，CQに対する回答としては，10のGRADEによる推奨，4つの背景疑問の解説が示された。また，CQごとに情報を視覚的診療フローとして作成し，各CQの位置付けがわかりやすいように配慮した。多職種が関与する重症患者に対するリハビリテーションにおいて，本ガイドラインが活用されることを期待する。</p>

DOI： 10.3918/jsicm.30_s905

CiNii Research

掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.bjao.2022.100092

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Optimal energy and protein delivery goals for critically ill patients remain unknown. The purpose of this systematic review and meta-analysis was to compare the impact of energy and protein delivery during the first 4 to 10 days of an ICU stay on physical impairments. We performed a systematic literature search of MEDLINE, CENTRAL, and ICHUSHI to identify randomized controlled trials (RCTs) that compared energy delivery at a cut-off of 20 kcal/kg/day or 70% of estimated energy expenditure or protein delivery at 1 g/kg/day achieved within 4 to 10 days after admission to the ICU. The primary outcome was activities of daily living (ADL). Secondary outcomes were physical functions, changes in muscle mass, quality of life, mortality, length of hospital stay, and adverse events. Fifteen RCTs on energy delivery and 14 on protein were included in the analysis. No significant differences were observed in any of the outcomes included for energy delivery. However, regarding protein delivery, there was a slight improvement in ADL (odds ratio 21.55, 95% confidence interval (CI) -1.30 to 44.40, p = 0.06) and significantly attenuated muscle loss (mean difference 0.47, 95% CI 0.24 to 0.71, p &lt; 0.0001). Limited numbers of RCTs were available to analyze the effects of physical impairments. In contrast to energy delivery, protein delivery ≥1 g/kg/day achieved within 4 to 10 days after admission to the ICU significantly attenuated muscle loss and slightly improved ADL in critically ill patients. Further RCTs are needed to investigate their effects on physical impairments.

DOI： 10.3390/nu14224849

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：学位論文（博士）  

The increasing rate of cesarean deliveries warrants obstetric anesthesiologists to deliver high-quality post-cesarean delivery analgesia. The aim of this study was to evaluate the temporal trends in the use of neuraxial morphine for cesarean deliveries and to describe the current postoperative analgesia practices. A retrospective cohort study using nationwide health insurance claims databases was conducted from 2005 to 2020 in Japan. Pregnant women who had undergone cesarean deliveries were included. The annual rate of neuraxial morphine use was extracted and analyzed. Additionally, we explored the patient- and facility-level factors associated with neuraxial morphine use through a multilevel logistic regression analysis. The cohort included 65,208 cesarean delivery cases from 2275 institutions. The prevalence of neuraxial morphine use was 16.0% (95% confidence interval [CI], 15.8-16.3) in the overall cohort. Intrathecal morphine was used in 20.6% (95% CI, 20.2-21.0) of spinal anesthesia cases. The trend in neuraxial morphine use steadily increased from 2005 to 2020. The significant predictors of neuraxial morphine use included spinal anesthesia, recent surgery, large medical facilities, and academic hospitals. Variations in the utilization of postoperative analgesia were observed. Our study described the current trend of neuraxial morphine use and the variation in postoperative analgesia practice in Japan.

DOI： 10.1038/s41598-022-22165-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00540-022-03097-w

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/jcm11164808

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The perioperative management of patients who are smokers presents anesthesiologists with various challenges related to respiratory, circulatory, and other clinical problems. Regarding 30-day postoperative outcomes, smokers have higher risks of mortality and complications than non-smokers, including death, pneumonia, unplanned tracheal intubation, mechanical ventilation, cardiac arrest, myocardial infarction, and stroke. Given the benefits of smoking cessation and the adverse effects of smoking on perioperative patient management, patients should quit smoking long before surgery. However, anesthesiologists cannot address these issues alone. The Japanese Society of Anesthesiologists established guidelines in 2015 (published in a medical journal in 2017) to enlighten surgical staff members and patients regarding perioperative tobacco cessation. The primary objective of perioperative smoking cessation is to reduce the risks of adverse cardiovascular and respiratory events, wound infection, and other perioperative complications. Perioperative preparations constitute a powerful teachable moment, a "golden opportunity" for smoking cessation to achieve improved primary disease outcomes and prevent the occurrence of tobacco-related conditions. This review updates the aforementioned guidelines as a practical guide to cover the nuts and bolts of perioperative smoking cessation. Its goal is to assist surgeons, anesthesiologists, and other medical professionals and to increase patients' awareness of smoking risks before elective surgery.

DOI： 10.1007/s00540-022-03080-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Background

The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021.

Methods

The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. We also conducted systematic reviews that used meta-analyses of diagnostic accuracy and network meta-analyses as a new method.

Results

Recommendations for adult patients with ARDS are described: we suggest against using serum C-reactive protein and procalcitonin levels to identify bacterial pneumonia as the underlying disease (GRADE 2D); we recommend limiting tidal volume to 4–8 mL/kg for mechanical ventilation (GRADE 1D); we recommend against managements targeting an excessively low SpO₂ (PaO₂) (GRADE 2D); we suggest against using transpulmonary pressure as a routine basis in positive end-expiratory pressure settings (GRADE 2B); we suggest implementing extracorporeal membrane oxygenation for those with severe ARDS (GRADE 2B); we suggest against using high-dose steroids (GRADE 2C); and we recommend using low-dose steroids (GRADE 1B). The recommendations for pediatric patients with ARDS are as follows: we suggest against using non-invasive respiratory support (non-invasive positive pressure ventilation/high-flow nasal cannula oxygen therapy) (GRADE 2D), we suggest placing pediatric patients with moderate ARDS in the prone position (GRADE 2D), we suggest against routinely implementing NO inhalation therapy (GRADE 2C), and we suggest against implementing daily sedation interruption for pediatric patients with respiratory failure (GRADE 2D).

Conclusions

This article is a translated summary of the full version of the ARDS Clinical Practice Guideline 2021 published in Japanese (URL: https://www.jsicm.org/publication/guideline.html). The original text, which was written for Japanese healthcare professionals, may include different perspectives from healthcare professionals of other countries.

DOI： 10.1186/s40560-022-00615-6

PubMed

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

Background: The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021. Methods: The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. We also conducted systematic reviews that used meta-analyses of diagnostic accuracy and network meta-analyses as a new method. Results: Recommendations for adult patients with ARDS are described: we suggest against using serum C-reactive protein and procalcitonin levels to identify bacterial pneumonia as the underlying disease (GRADE 2D); we recommend limiting tidal volume to 4–8 mL/kg for mechanical ventilation (GRADE 1D); we recommend against managements targeting an excessively low SpO2 (PaO2) (GRADE 2D); we suggest against using transpulmonary pressure as a routine basis in positive end-expiratory pressure settings (GRADE 2B); we suggest implementing extracorporeal membrane oxygenation for those with severe ARDS (GRADE 2B); we suggest against using high-dose steroids (GRADE 2C); and we recommend using low-dose steroids (GRADE 1B). The recommendations for pediatric patients with ARDS are as follows: we suggest against using non-invasive respiratory support (non-invasive positive pressure ventilation/high-flow nasal cannula oxygen therapy) (GRADE 2D); we suggest placing pediatric patients with moderate ARDS in the prone position (GRADE 2D); we suggest against routinely implementing NO inhalation therapy (GRADE 2C); and we suggest against implementing daily sedation interruption for pediatric patients with respiratory failure (GRADE 2D). Conclusions: This article is a translated summary of the full version of the ARDS Clinical Practice Guideline 2021 published in Japanese (URL: https://www.jrs.or.jp/publication/jrs_guidelines/). The original text, which was written for Japanese healthcare professionals, may include different perspectives from healthcare professionals of other countries.

DOI： 10.1016/j.resinv.2022.05.003

Open Access

Scopus

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The purpose of this study was to evaluate the incidence, clinical characteristics and prognosis of postoperative symptomatic venous thromboembolism (VTE) in Japan. DESIGN: Retrospective observational study. Two data sets, Contemporary ManageMent AND outcomes in patients with Venous ThromboEmbolism (COMMAND VTE) Registry and Japanese Society of Anesthesiologists (JSA) annual report, were used for current analyses. SETTING: Eighteen of 29 centres participated in the COMMAND VTE Registry. PARTICIPANTS: Acute symptomatic patients with VTE who had undergone surgery 2 months prior to the diagnosis at 18 centres from January 2010 to December 2013 were identified in the COMMAND VTE Registry. From each centre's JSA annual report, the overall population that had received anaesthetic management during this period was retrieved. INTERVENTIONS: None. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the incidences and clinical characteristics of postoperative symptomatic VTE. The secondary outcomes were recurrent VTE, major bleeding and all-cause death. RESULTS: We identified 137 patients with postoperative symptomatic VTE, including 57 patients with pulmonary embolism. The incidences of postoperative symptomatic VTE and pulmonary embolism were 0.067% and 0.028%, respectively, based on data from 2 03 943 patients who underwent surgery, managed by anaesthesiologists, during the study period. The incidences of postoperative symptomatic VTE varied widely, depending on surgical and anaesthetic characteristics. Postoperative symptomatic VTE occurred at a median of 8 days after surgery, with 58 patients (42%) diagnosed within 7 days. The cumulative incidence, 30 days after VTE, of recurrent VTE, major bleeding, and all-cause death was 3.0%, 5.2%, and 3.7%, respectively. CONCLUSION: This study, combining the large real-world VTE and anaesthesiology databases in Japan revealed the incidence, clinical features and prognosis of postoperative symptomatic VTE, providing useful insights for all healthcare providers involved in various surgeries. TRIAL REGISTRATION: Not applicable.

DOI： 10.1136/bmjopen-2021-055090

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Society for Clinical Epidemiology  

DOI： 10.37737/ace.22011

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担当区分：筆頭著者,　最終著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Circulation Society  

DOI： 10.1253/circrep.cr-21-0137

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Intensive Care  

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

DOI： 10.1186/s40560-021-00555-7

Open Access

Scopus

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：克誠堂出版(株)  

肺動脈血栓内膜摘除術(PEA)適用のある重症慢性血栓塞栓性肺高血圧症(CTEPH)患者に対する子宮全摘術の麻酔を経験した。"右室-肺動脈(RV-PA)カップリングによるエネルギー効率を最適化する"という治療概念を背景に周術期循環管理を安全に施行することができた。システム生理学の観点から、その循環管理法について報告する。(著者抄録)

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担当区分：筆頭著者,　責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：克誠堂出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Society for Clinical Epidemiology  

DOI： 10.37737/ace.3.4_101

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担当区分：筆頭著者,　責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本臨床麻酔学会  

新型コロナウイルス感染症(COVID-19)によるパンデミック,それによる医療現場の逼迫の影響は,麻酔科医を含むあらゆる医師に,基礎研究のみならず臨床研究・公衆衛生学の重要性を再認識させた.従来の医学研究は基礎研究に偏重していたため,今後の麻酔科医には未曾有の危機にも対応できるようなバランスのとれた医学知識を涵養する必要があると考える.本稿は,COVID-19に関連する周術期のトピックに関して,麻酔科医にとって特に重要と考えられる最新の論文とその知見の概要を提示する.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J01620&link_issn=&doc_id=20210917200014&doc_link_id=%2Fci4jjsca%2F2021%2F004105%2F015%2F0502-0508%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2021%2F004105%2F015%2F0502-0508%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s40560-021-00555-7

Web of Science

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s40560-021-00555-7

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

DOI： 10.1186/s40560-021-00555-7

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

Summary

We aimed to determine the impact of pre‐operative isolation on postoperative pulmonary complications after elective surgery during the global SARS‐CoV‐2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre‐defined sub‐group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS‐CoV‐2 infection. Patients who isolated pre‐operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS‐CoV‐2 incidence and high‐income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre‐operative testing; use of COVID‐19‐free pathways; or community SARS‐CoV‐2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.

DOI： 10.1111/anae.15560

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/anae.15563

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/anae.15563

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

Abstract

Background

Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.

Methods

The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.

Results

NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.

Conclusion

As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.

DOI： 10.1093/bjs/znab101

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

Summary

Peri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3–4.8), 3.9 (2.6–5.1) and 3.6 (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS‐CoV‐2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9–2.1)). After a ≥ 7 week delay in undertaking surgery following SARS‐CoV‐2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS‐CoV‐2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

DOI： 10.1111/anae.15458

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1097/ALN.0000000000003591

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/ams2.659

Web of Science

PubMed

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

DOI： 10.1002/ams2.659

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/ams2.659

PubMed

担当区分：筆頭著者,　最終著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1097/aln.0000000000003450

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担当区分：最終著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.bja.2020.06.032

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media {LLC}  

DOI： 10.1007/s00134-020-05998-4

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担当区分：筆頭著者,　最終著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.bja.2020.05.044

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Perioperative goal-directed fluid therapy is used for haemodynamic optimization in high-risk surgeries. Cardiac output monitoring can be performed by a specialized pressure transducer for arterial pulse waveform analysis (S-APWA). No study has assessed whether real-world use of S-APWA is associated with post-operative outcomes; therefore, using a Japanese administrative claims database, we retrospectively investigated whether S-APWA use is associated with in-hospital mortality among patients undergoing high-risk surgery under general anaesthesia. METHODS: Adult patients who underwent high-risk surgery under general anaesthesia and arterial catheterization between 2014 and 2016 were divided into S-APWA and conventional arterial pressure transducer groups, then compared regarding baseline factors and outcomes. Logistic regression analysis was performed to compare in-hospital mortality. Subgroup analyses evaluated S-APWA efficacy and outcomes based on the type of surgery and patients' comorbidity. RESULTS: S-APWA was used in 6859 of 23 655 (29.0%) patients; the crude in-hospital mortality rate was 3.5%. Adjusted analysis showed no significant association between S-APWA use and in-hospital mortality rate (adjusted odds ratio [aOR] = 0.91; 95% confidence interval [CI]: 0.76-1.07; P = .25). S-APWA use was associated with significantly lower in-hospital mortality in patients undergoing vascular surgery (aOR = 0.67; 95% CI: 0.49-0.94), and significantly higher in-hospital mortality in patients undergoing lower limb amputation (aOR = 2.63; 95% CI: 1.32-5.22). S-APWA use and in-hospital mortality were not significantly associated with other subgroups. CONCLUSION: S-APWA use was not associated with in-hospital mortality in the entire study population. However, S-APWA was associated with decreased in-hospital mortality among vascular surgery and increased in-hospital mortality among lower limb amputation.

DOI： 10.1111/aas.13584

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/CCM.0000000000004111

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.bja.2020.01.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In the original version of the article, the Tables 2 and 3 was published incorrectly. The correct version of Tables 2 and 3 are given below.

DOI： 10.1007/s00540-019-02726-1

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/SLA.0000000000003783

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本集中治療医学会  

<p>日本集中治療医学会と日本救急医学会は，合同の特別委員会を組織し，2016 年に発表した日本版敗血症診療ガイドライン（J-SSCG） 2016 の改訂を行った。本ガイドライン（J-SSCG 2020）の目的は，J-SSCG 2016 と同様に，敗血症・敗血症性ショックの診療において，医療従事者が患者の予後改善のために適切な判断を下す支援を行うことである。改訂に際し，一般臨床家だけでなく多職種医療者にも理解しやすく，かつ質の高いガイドラインとすることによって，広い普及を目指した。J-SSCG 2016 ではSSCG 2016 にない新しい領域［ICU-acquired weakness（ ICU-AW）と post-intensive care syndrome（PICS），体温管理など］を取り上げたが，J-SSCG 2020 では新たに注目すべき4 領域（Patient-and Family-Centered Care，sepsis treatment system，神経集中治療，ストレス潰瘍）を追加し，計22 領域とした。重要な118 の臨床課題（clinical question：CQ）をエビデンスの有無にかかわらず抽出した。これらのCQ には，本邦で特に注目されているCQ も含まれる。多領域にわたる大規模ガイドラインであることから，委員25 名を中心に，多職種（看護師，理学療法士，臨床工学技士，薬剤師）および患者経験者も含めたワーキンググループメンバー，両学会の公募によるシステマティックレビューメンバーによる総勢226 名の参加・協力を得た。また，中立的な立場で横断的に活躍するアカデミックガイドライン推進班をJ-SSCG 2016 に引き続き組織した。将来への橋渡しとなることを企図して，多くの若手医師をシステマティックレビューチーム・ワーキンググループに登用し，学会や施設の垣根を越えたネットワーク構築も進めた。作成工程においては，質の担保と作業過程の透明化を図るために様々な工夫を行い，パブリックコメント募集は計2 回行った。推奨作成にはGRADE方式を取り入れ，修正Delphi 法を用いて全委員の投票により推奨を決定した。結果，118CQ に対する回答として，79 個のGRADE による推奨，5 個のGPS（good practice statement），18 個のエキスパートコンセンサス，27 個のBQ（background question）の解説，および敗血症の定義と診断を示した。新たな試みとして，CQ ごとに診療フローなど時間軸に沿った視覚的情報を取り入れた。J-SSCG 2020 は，多職種が関わる国内外の敗血症診療の現場において，ベッドサイドで役立つガイドラインとして広く活用されることが期待される。なお，本ガイドラインは，日本集中治療医学会と日本救急医学会の両機関誌のガイドライン増刊号として同時掲載するものである。</p>

DOI： 10.3918/jsicm.27s0001

CiNii Research

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：克誠堂出版  

CiNii Books

J-GLOBAL

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To describe the prevalence and factors associated with preoperative haemostasis and ABO blood typing tests for children because these tests might represent low-value care. DESIGN: A retrospective observational study. SETTING: Nationwide insurance claims database in Japan. PARTICIPANTS: Patients aged 1-17 years who underwent common non-cardiac surgeries between April 2012 and March 2018 were included. Patients with high-risk comorbidities for bleeding (n=175) and those with multiple eligible surgeries were excluded (n=2121). MAIN OUTCOME MEASURES: We described the proportions of each preoperative test performed within 60 days before an index surgery, including platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and ABO blood typing tests. We also explored the associations between patient-level and institutional-level factors and any preoperative tests, using multilevel logistic regression analysis. RESULTS: We included 13 018 patients (median (IQR) age, 5.2 (2.9-7.7) years; 8276 (63.6%) boys) from 1499 institutions. The overall proportion of each test was as follows: platelet count, 78.6%; PT, 54.4%; aPTT, 56.4% and ABO blood typing tests, 50.4%. The proportion of patients undergoing any preoperative tests in the overall sample was 79.3%. Multilevel logistic regression analysis indicated that preoperative tests were associated with type of anaesthesia (general anaesthesia: adjusted OR 7.06; 95% CI 4.94 to 10.11), type of surgery (tonsillectomy: adjusted OR 3.45; 95% CI 2.75 to 4.33) and surgical setting (inpatient procedure: adjusted OR 5.41; 95% CI 3.83 to 7.66). There was one postoperative transfusion event (0.008%) in the entire cohort and 37 postoperative reoperation events for surgical bleeding after tonsillectomy (0.90%). CONCLUSIONS: In the largest Japanese cohort reported to date, preoperative haemostasis and ABO blood typing tests were performed in a majority of children prior to common paediatric surgeries. Preoperative tests were associated with anaesthesia, surgical type and surgical setting.

DOI： 10.1136/bmjopen-2019-032306

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担当区分：筆頭著者,　最終著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

添付ファイル： 2019_NDB.pdf

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Transthoracic esophagectomy is an invasive surgery, and the excessive surgical stress produces inflammatory cytokines, which provoke acute respiratory distress syndrome (ARDS). Sivelestat sodium hydrate-a selective neutrophil elastase inhibitor-is used to treat or prevent ARDS in patients undergoing esophagectomy, although clear evidence is lacking. We investigated the benefits and risk of prophylactic sivelestat. METHODS: This retrospective study used an administrative claims database in Japan. Adult patients who underwent transthoracic esophagectomy from 2010 to 2016 were identified and divided into a prophylactic sivelestat use group and a non-prophylactic use group that included both non-users and therapeutic users. The primary outcome was all-cause in-hospital mortality, and a secondary outcome included the proportion of ARDS. We used 1:1 propensity score matching. For sensitivity analyses, we conducted a 1:2 propensity score matching analysis and several analyses with various patient inclusion criteria. RESULTS: Of the 3391 patients with esophagectomy, 621 received prophylactic sivelestat. On unadjusted analysis, the sivelestat group had a higher proportion of in-hospital mortality (5.3% vs. 2.9%) compared with the control group. We created a matched cohort of 615 pairs, whose baseline characteristics were well balanced. On adjusted analysis using propensity score matching, prophylactic sivelestat administration was not associated with decreased in-hospital mortality [adjusted odds ratio (aOR) 1.65; 95% confidence interval (CI) 0.95-2.88], ARDS rate (aOR 1.25; 95% CI 0.49-3.17). The findings were also consistent with other sensitivity analyses. CONCLUSION: Because mortality and postoperative complications were similar, our findings do not support prophylactic sivelestat administration for patients undergoing esophagectomy.

DOI： 10.1007/s00540-018-2602-9

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The effect of preoperative transthoracic echocardiography on the clinical outcomes of patients with hip fractures undergoing surgical treatment remains controversial. We hypothesized that preoperative echocardiography is associated with reduced postoperative morbidity and improved patient survival after surgical repair of hip fractures. METHODS: Drawing from a nationwide administrative database, patients undergoing hip fracture surgeries between April 1, 2008 and December 31, 2016 were included. We examined the association of preoperative echocardiography with the incidence of in-hospital mortality using propensity score matching. Secondary outcomes included postoperative complications, the incidence of postoperative intensive care unit admissions, and length of hospital stay. For sensitivity analyses, we restricted the overall cohort to include only hip fracture surgeries performed within 2 days from admission. RESULTS: Overall, 34,679 (52.1%) of 66,620 surgical patients underwent preoperative echocardiography screening. The screened patients (mean [SD] age, 84.3 years [7.7 years]; 79.0% female) were propensity score matched to 31,941 nonscreened patients (mean [SD] age, 82.1 years [8.7 years]; 78.2% female). The overall in-hospital mortality, before propensity matching, was 1.8% (1227 patients). Propensity score matching created a matched cohort of 25,205 pairs of patients. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 417 [1.65%] vs 439 [1.74%]; odds ratio, 0.95; 95% confidence interval, 0.83-1.09; P = .45). Preoperative echocardiography was not associated with reduced postoperative complications and intensive care unit admissions. In sensitivity analysis, we identified 25,637 patients from the overall cohort (38.5%) with hip fracture surgeries performed within 2 days of admission. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 1.67% vs 1.80%; odds ratio, 0.93; 95% confidence interval, 0.72-1.18; P = .53). Findings were also consistent with other sensitivity analyses and subgroup analyses. CONCLUSIONS: This large, retrospective, nationwide cohort study demonstrated that preoperative echocardiography was not associated with reduced in-hospital mortality or postoperative complications.

DOI： 10.1213/ANE.0000000000003888

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Arterial pulse waveform analysis (APWA) is used for cardiac output monitoring. However, data on the frequency of and patient characteristics for specialized pressure transducer for APWA (S-APWA) use are lacking. We retrospectively identified 175,201 patients aged 18 years or older, who underwent non-cardiac surgery under general anesthesia with an arterial catheter from January 1, 2014, to December 31, 2016. We extracted data on patient demographics, comorbidities, surgical and anesthesia characteristics, and hospital characteristics. Among the full study cohort, 24,605 (14.0%) patients were monitored using S-APWA. Further, the use of S-APWA was higher in patients undergoing high-risk surgery than in those undergoing low-risk surgery [high vs low: adjusted odds ratio (aOR) 1.95; 95% confidence interval (CI) 1.76-2.15, moderate vs low: aOR 1.11; 95% CI 1.01-1.22] and those with more comorbidities than in those with less comorbidities (high vs low: aOR 1.49; 95% CI 1.42-1.56, moderate vs low: aOR 1.25; 95% CI 1.20-1.31). S-APWA use was significantly associated with both surgery risk and patients' comorbidities. In conclusion, our study may provide a benchmark for future studies related to the appropriate use of S-APWA.

DOI： 10.1007/s00540-018-02609-x

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担当区分：筆頭著者,　責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

J-GLOBAL

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Routine preoperative testing is discouraged before low-risk surgery because testing does not provide any beneficial effect in terms of patient outcome. However, few studies have assessed the utilization of hospital health care resources in terms of preoperative tests in a real-world setting. Here, we aimed to assess the prevalence and factors associated with preoperative blood tests before low-risk surgery in Japan. METHODS: In this retrospective observational study, we used the nationwide insurance claims data of Japan. Patients who underwent low-risk surgeries between April 1, 2012 and March 31, 2016, were included. Our primary outcome was the receipt of any preoperative tests within 60 days before an index procedure: complete blood count, basic metabolic panel, coagulation tests, and liver function tests. We performed a descriptive analysis to estimate the proportions of preoperative blood tests, and examined the associations between patient-level and institutional-level factors and preoperative blood tests, using multilevel logistic regression analysis. Interinstitutional variation in the utilization of preoperative tests was summarized using the median odds ratio (OR). RESULTS: The study sample included 59,818 patients (mean [standard deviation] age, 44.0 [11.3] years; 33,574 [56.1%] women) from 9746 institutions. The overall proportion of each test was: complete blood count, 58.7%; metabolic panel, 47.8%; coagulation tests, 36.6%; and liver function tests, 48.5%. The proportion receiving any preoperative tests in the overall sample was 59.5%. Multilevel logistic regression analysis indicated that preoperative blood tests were associated with the Charlson comorbidity index score (score ≥3: adjusted OR, 4.21; 95% confidence interval [CI], 3.69-4.80), anticoagulant use (adjusted OR, 4.12; 95% CI, 2.35-7.22), type of anesthesia (general anesthesia: adjusted OR, 5.69; 95% CI, 4.85-6.68; regional anesthesia: adjusted OR, 3.76; 95% CI, 3.28-4.30), surgical setting (inpatient procedure: adjusted OR, 3.64; 95% CI, 3.30-4.00), and number of beds (≥100 beds: adjusted OR, 3.61; 95% CI, 3.19-4.08). The median institutional-specific proportion of preoperative tests was 40.0% (interquartile range, 0%-100%). The median OR for interinstitutional variation in ordering preoperative tests was 4.34. These findings were consistent across a sensitivity analysis. CONCLUSIONS: Preoperative blood tests were performed before 59.5% of low-risk surgeries. Preoperative tests were associated with the type of anesthesia, patient characteristics, and medical facility status. There was a substantial interinstitutional variation in the utilization of preoperative tests.

DOI： 10.1213/ANE.0000000000002734

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その他リンク： http://orcid.org/0000-0003-0523-2997

担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：真興交易(株)医書出版部  

英国国立医療技術評価機構が推奨する代表的な術前検査として、血算、血清生化学、心機能検査、肺機能検査/動脈血ガス分析について概説し、海外および日本の低リスク手術における術前検査の現状について述べた。米国やカナダのように既にガイドラインが確立している国においても、また日本においても、低リスク手術における術前検査が過剰に実施されている。周術期管理に優れた麻酔科医が中心となり、個々の患者に応じたリスク評価、術式や麻酔方法に応じた適切な術前検査を行い、アウトカムの向上を目指すべきと考えられた。

J-GLOBAL

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Nature  

PURPOSE: Routine preoperative pulmonary function tests (PFTs) are not recommended prior to low-risk surgery because their prognostic value is limited. However, only a few studies have assessed the utilization of healthcare resources regarding preoperative PFTs in a real-world setting. Here, we aimed to assess the prevalence and determinant factors of preoperative PFTs before low-risk surgery in Japan. METHODS: In this retrospective cohort study, we used the nationwide insurance claims databases. Patients who underwent low-risk surgeries under general anesthesia between April 1, 2012, and March 31, 2016, were included. The primary outcome was the receipt of PFTs within 60 days before an index surgery. We performed descriptive analyses to estimate the rates of preoperative PFTs annually starting in 2012, and examined the associations between patient- and institutional-level factors and preoperative PFTs using multilevel logistic regression analyses. RESULTS: The cohort included 9495 procedures (8866 patients) at 1487 institutions. Preoperative PFTs were conducted before 71.8% of the procedures. The temporal trend of preoperative PFTs remained constant from 72.4% in 2012 to 72.2% in 2015. Multilevel regression analysis revealed that preoperative PFTs were associated with older age, number of beds at a medical facility, and inpatient procedures. The median institutional-specific proportion of PFTs was 75.0% (interquartile range, 14.3-100%) with wide inter-institutional variation. CONCLUSIONS: Our analysis found that preoperative PFTs were performed before 72% of low-risk surgeries under general anesthesia. Apart from age, preoperative PFTs were determined primarily by non-medical factors. Additionally, we observed substantial institutional variation in the use of preoperative PFTs.

DOI： 10.1007/s00540-017-2423-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s40560-017-0270-8

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

To optimize delivery of health care services in clinical practice, the use of unnecessary interventions should be reduced. Although recommendations for this reduction have been accepted worldwide, recent studies have revealed that the use of such procedures continues to increase. We conducted a retrospective cohort study using a nationwide claim-based database to evaluate factors influencing preoperative blood testing prior to low-risk surgery, via a Bayesian generalized linear mixed approach. The study period was set from April 1, 2012, to March 31, 2016, and 69,252 surgeries performed at 9,922 institutions were included in the analysis. Mean patient age was 44.3 +/- 11.3 years (57% female). Preoperative blood tests were performed for 59.0% of procedures. Among institutional factors, the number of beds was strongly associated with preoperative blood testing (odds ratio [95% highest posterior density interval (HPD interval)], 2.64 [2.53 to 2.75]). The difference (95% credible interval) in the rate of preoperative blood testing between institutions with &lt;100 beds and &gt;= 100 beds was 0.315 [0.309 to 0.322], and the Bayesian index theta was 1.00. This indicated that preoperative blood tests are strongly influenced by institutional factors, suggesting that specific guidelines should be developed to avoid excessive preoperative testing for low-risk surgery.

DOI： 10.1155/2017/3624075

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その他リンク： http://orcid.org/0000-0003-0523-2997

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Clinical Anesthesia  

Study objective Limited data are available regarding the anesthetic management and outcome of patients undergoing pure laparoscopic radical prostatectomy (LRP) and robotic-assisted LRP (RALP). Therefore, our primary objective was to compare the anesthetic management between these 2 groups. Our secondary objective was to determine the incidence of adverse outcomes associated with RALP, which requires an extreme Trendelenburg position. Design A retrospective observational study. Setting University teaching hospital. Patients A total of 223 men, consisting of 97 LRP patients and 126 RALP patients, treated during a 3-year period (January 2010-December 2012) were retrospectively studied. Interventions None. Measurements Information on patient demographics, type of anesthesia, anesthetic/pneumoperitoneum/surgical times, intraoperative fluids and blood products, estimated blood loss, intraoperative and postoperative opioid use, postoperative analgesic consumption, length of stay in the postanesthesia care unit, postoperative complications, and hospital stays was collected and compared. Main results The estimated blood loss was higher in LRP patients than in RALP patients (median, 550 mL vs 200 mL; P < .001). Likewise, 24% of the LRP patients received intraoperative transfusions compared with 0.79% of the RALP patients (P < .001). The RALP patients had a longer anesthesia time (median, 276 vs 259 minutes; P = .032) and a greater intraoperative use of opioids (P < .001). The incidence of complications was similar in both groups with the exception of postoperative nausea and vomiting, which were observed more frequently among the RALP patients than among the LRP patients (33% vs 16%; P = .007). Conclusions This is the first report to compare the anesthetic management of RALP vs LRP. Anesthesiologists can expect RALP surgery to be associated with less blood loss and a need for fewer blood products than traditional LRP surgery. The anesthetic outcome of RALP was generally satisfactory except for a high incidence of postoperative nausea and vomiting.

DOI： 10.1016/j.jclinane.2016.08.014

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担当区分：筆頭著者,　責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Journal of Anesthesiology  

Background: Postoperative delirium (POD) is a common but serious complication after major surgery. The aim of this study was to investigate the incidence and effects on outcome of POD in esophagectomy patients, and to identify risk factors for developing POD. Methods: A retrospective medical record review was conducted for all patients who had received esophagectomy for esophageal cancer during a three-year period Results: In a total of 71 patients, the overall incidence of POD was 20%. Multivariable regression analysis identified two independent risk factors for POD: older age (≥70) and preoperative electrolyte abnormalities. Patients with delirium had a higher incidence of respiratory complications and longer hospital stays compared with the non-delirium patients. Conclusions: The incidence of POD in patients undergoing esophagectomy is 20%. The risk factors of POD are older age and preoperative electrolyte abnormalities. POD negatively impacts postoperative respiratory complications and hospital stay.

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担当区分：筆頭著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：克誠堂出版(株)  

術後せん妄は、術後合併症の発症や予後に影響を与える重大な合併症である。今回、食道手術における術後せん妄の発生頻度と周術期の関連因子を検討した。当院で2009年1月から2011年12月までに食道がんのため食道切除術が施行され、ICUへ入室した71症例を対象した。調査項目はさまざまな周術期因子と術後せん妄との関連を後方視的に診療録調査した。術後せん妄の発症頻度は20%であり、高齢(≧70歳)、術前の電解質異常が術後せん妄の独立した危険因子であった。また、術後せん妄は術後呼吸器合併症の増加や入院日数に影響を与えた。発症関連因子のうち、術前の電解質異常は介入できる可能性がある。(著者抄録)

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Korean Society of Anesthesiologists  

Unroofed coronary sinus (URCS) is a rare cardiac anomaly, in which communication occurs between the coronary sinus (CS) and the left atrium (LA) because of partial or complete absence of the CS roof. A 30-year-old woman was scheduled for surgical closure of atrial septal defect, mitral valve repair and tricuspid annuloplasty. The intraoperative transesophageal echocardiography (TEE) revealed left-to-right shunt between the CS and the LA. The three-dimensional (3D) TEE confirmed the diagnosis of partially URCS. This defect was repaired with a pericardial patch. In this case, the 3D images of URCS, which were a helpful supplement to the 2D images, providing better visualization of the wall defect and more information regarding the size and location of the defect. The combined use of 2D and 3D images provides valuable information to aid in understanding the anatomy and morphology of this rare anomaly. © the Korean Society of Anesthesiologists, 2014.

DOI： 10.4097/kjae.2014.67.1.52

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記述言語：日本語   出版者・発行元：(一社)日本呼吸療法医学会  

日本集中治療医学会/日本呼吸器学会/日本呼吸療法医学会ARDS診療ガイドライン作成委員会は、今回、合同で『ARDS診療ガイドライン2021』を作成した。2016年版の診療ガイドラインでは、成人のみを対象とした臨床課題(clinical question:CQ)を取り上げたが、今回は成人の46のCQに加えて小児を対象とした15のCQも作成した。前回と同様、GRADE(Grading of Recommendations Assessment,Development and Evaluation)システムを用いた推奨度決定の手法を用いた。また、新たな手法として診断精度のメタ解析およびネットワークメタ解析を用いたシステマティックレビュー(systematic review:SR)も行った。これらにより、より充実した信頼性の高い実用的な診療ガイドラインを作成することができた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J02315&link_issn=&doc_id=20221212340001&doc_link_id=10.50903%2Fjsrcm.39.2_81&url=https%3A%2F%2Fdoi.org%2F10.50903%2Fjsrcm.39.2_81&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本呼吸器学会  

日本集中治療医学会/日本呼吸器学会/日本呼吸療法医学会ARDS診療ガイドライン作成委員会は、今回、合同で『ARDS診療ガイドライン2021』を作成した。2016年版の診療ガイドラインでは、成人のみを対象とした臨床課題(clinical question:CQ)を取り上げたが、今回は成人の46のCQに加えて小児を対象とした15のCQも作成した。前回と同様、GRADE(Grading of Recommendations Assessment、Development and Evaluation)システムを用いた推奨度決定の手法を用いた。また、新たな手法として診断精度のメタ解析およびネットワークメタ解析を用いたシステマティックレビュー(systematic review:SR)も行った。これらにより、より充実した信頼性の高い実用的な診療ガイドラインを作成することができた。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

日本集中治療医学会/日本呼吸器学会/日本呼吸療法医学会ARDS診療ガイドライン作成委員会は,今回,合同で『ARDS診療ガイドライン2021』を作成した。2016年版の診療ガイドラインでは,成人のみを対象とした臨床課題(clinical question:CQ)を取り上げたが,今回は成人の46のCQに加えて小児を対象とした15のCQも作成した。前回と同様,GRADE(Grading of Recommendations Assessment,Development and Evaluation)システムを用いた推奨度決定の手法を用いた。また,新たな手法として診断精度のメタ解析およびネットワークメタ解析を用いたシステマティックレビュー(systematic review:SR)も行った。これらにより,より充実した信頼性の高い実用的な診療ガイドラインを作成することができた。(著者抄録)

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記述言語：英語   掲載種別：研究論文（その他学術会議資料等）   出版者・発行元：Cold Spring Harbor Laboratory  

<title>Abstract</title><sec><title>Background</title>The increasing availability of electronic health records has made it possible to construct and implement models for predicting intensive care unit (ICU) mortality using machine learning. However, the algorithms used are not clearly described, and the performance of the model remains low owing to several missing values, which is unavoidable in big databases.

</sec><sec><title>Methods</title>We developed an algorithm for subgrouping patients based on missing event patterns using the Philips eICU Research Institute (eRI) database as an example. The eRI database contains data associated with 200,859 ICU admissions from many hospitals (&gt;400) and is freely available. We then constructed a model for each subgroup using random forest classifiers and integrated the models. Finally, we compared the performance of the integrated model with the Acute Physiology and Chronic Health Evaluation (APACHE) scoring system, one of the best known predictors of patient mortality, and the imputation approach-based model.

</sec><sec><title>Results</title>Subgrouping and patient mortality prediction were separately performed on two groups: the sepsis group (the ICU admission diagnosis of which is sepsis) and the non-sepsis group (a complementary subset of the sepsis group). The subgrouping algorithm identified a unique, clinically interpretable missing event patterns and divided the sepsis and non-sepsis groups into five and seven subgroups, respectively. The integrated model, which comprises five models for the sepsis group or seven models for the non-sepsis group, greatly outperformed the APACHE IV or IVa, with an area under the receiver operating characteristic (AUROC) of 0.91 (95% confidence interval 0.89–0.92) compared with 0.79 (0.76–0.81) for the APACHE system in the sepsis group and an AUROC of 0.90 (0.89–0.91) compared with 0.86 (0.85–0.87) in the non-sepsis group. Moreover, our model outperformed the imputation approach-based model, which had an AUROC of 0.85 (0.83–0.87) and 0.87 (0.86–0.88) in the sepsis and non-sepsis groups, respectively.

</sec><sec><title>Conclusions</title>We developed a method to predict patient mortality based on missing event patterns. Our method more accurately predicts patient mortality than others. Our results indicate that subgrouping, based on missing event patterns, instead of imputation is essential and effective for machine learning against patient heterogeneity.

</sec><sec><title>Trial registration</title>Not applicable.

</sec>

DOI： 10.1101/2021.02.28.21252249

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記述言語：英語   掲載種別：論文集(書籍)内論文   出版者・発行元：100 Selected Case Reports from Anesthesia and Analgesia  

This case report describes a 71-year-old woman who experienced unusual delayed emergence from propofol, which lasted for 3 hours and resulted in admission to the intensive care unit. Because genetic variations of propofol-metabolizing enzymes are proposed to be causal factors, we explored genetic polymorphisms of cytochrome P450 2B6 (CYP2B6) and uridine 5'-diphospho-glucuronosyltransferase 1A9 (UGT1A9). Suggested high-risk factors (advanced age, CYP2B6 516 G/T, and UGT1A9 1399 C/C) were observed in this case of delayed propofol metabolism. Therefore, genetic variants involved in propofol metabolism should be considered in unexplained delayed emergence.

DOI： 10.1213/xaa.0000000000000397

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開催年月日： 2023年11月

記述言語：英語  

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開催年月日： 2023年6月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（指名）  

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開催年月日： 2023年

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開催年月日： 2023年

記述言語：日本語   会議種別：口頭発表（招待・特別）  

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開催年月日： 2022年11月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2022年10月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（指名）  

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開催年月日： 2022年6月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2021年11月

記述言語：日本語  

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開催年月日： 2021年9月

記述言語：日本語  

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開催年月日： 2021年9月

記述言語：日本語  

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開催年月日： 2021年2月

記述言語：日本語  

日本集中治療医学会と日本救急医学会は,合同の特別委員会を組織し,2016年に発表した日本版敗血症診療ガイドライン(J-SSCG)2016の改訂を行った。本ガイドライン(J-SSCG2020)の目的は,J-SSCG2016と同様に,敗血症・敗血症性ショックの診療において,医療従事者が患者の予後改善のために適切な判断を下す支援を行うことである。改訂に際し,一般臨床家だけでなく多職種医療者にも理解しやすく,かつ質の高いガイドラインとすることによって,広い普及を目指した。J-SSCG2016ではSSCG2016にない新しい領域[ICU-acquircd weakness(ICU-AW)とpost-intensive care syndrome(POCS),体温管理など]を取り上げたが,J-SSCG2020では新たに注目すべき4領域(Patient-and Family-Centered Care, sepsis treatment system,神経集中治療,ストレス潰瘍)を追加し,計22領域とした。重要な118の臨床課題(clinical question:CQ)をエビデンスの有無にかかわらず抽出した。これらのCQには,本邦で特に注目されているCQも含まれる。多領域にわたる大規模ガイドラインであることから,委員25名を中心に,多職種(看護師,理学療法士,臨床工学技士,薬剤師)および患者経験者も含めたワーキンググループメンバー,両学会の公募によるシステマティックレビューメンバーによる総勢226名の参加・協力を得た。また,中立的な立場で横断的に活躍するアカデミックガイドライン推進班をJ-SSCG2016に引き続き組織した。将来への橋渡しとなることを企図して,多くの若手医師をシステマティックレビューチーム・ワーキンググループに登用し,学会や施設の垣根を越えたネットワーク構築も進めた。作成工程においては,質の担保と作業過程の透明化を図るために様々な工夫を行い,パブリックコメント募集は計2回行った。推奨作成にはGRADE方式を取り入れ,修正Delphi法を用いて全委員の投票により推奨を決定した。結果,118CQに対する回答として,79個のGRADEによる推奨,5個のGPS(good practice statement),18個のエキスパートコンセンサス,27個のBQ(background question)の解説,および敗血症の定義と診断を示した。新たな試みとして,CQごとに診療フローなど時間軸に沿った視覚的情報を取り入れた。J-SSCG2020は,多職種が関わる国内外の敗血症診療の現場において,ベッドサイドで役立つガイドラインとして広く活用されることが期待される。なお,本ガイドラインは,日本集中治療医学会と日本救急医学会の両機関誌のガイドライン増刊号として同時掲載するものである。(著者抄録)

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開催年月日： 2021年

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開催年月日： 2020年12月

記述言語：英語   会議種別：ポスター発表  

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開催年月日： 2020年12月

記述言語：日本語  

<p>日本集中治療医学会と日本救急医学会は，合同の特別委員会を組織し，2016年に発表した日本版敗血症診療ガイドライン（J-SSCG2016）の改訂を行った。本ガイドライン（J－SSCG2020）の目的は，J-SSCG2016と同様に，敗血症・敗血症性ショックの診療において，医療従事者が患者の予後改善のために適切な判断を下す支援を行うことである。改訂に際し，一般臨床家だけでなく多職種医療者にも理解しやすく，かつ質の高いガイドラインとすることによって，広い普及を目指した。J-SSCG2016ではSSCG2016にない新しい領域（ICU-acquiredweakness（ICU-AW）とPost-Intensive Care Syndrome（PICS），体温管理など）を取り上げたが，J-SSCG2020では新たに注目すべき4領域（Patient-and Family-Centered Care，Sepsis Treatment System，神経集中治療，ストレス潰瘍）を追加し，計22 領域とした。重要な117の臨床課題（クリニカルクエスチョン：CQ）をエビデンスの有無にかかわらず抽出した。これらのCQには，日本国内で特に注目されているCQも含まれる。多領域にわたる大規模ガイドラインであることから，委員24名を中心に，多職種（看護師，理学療法士，臨床工学技士，薬剤師）および患者経験者も含めたワーキンググループメンバー，両学会の公募によるシステマティックレビューメンバーによる総勢226名の参加・協力を得た。また，中立的な立場で横断的に活躍するアカデミックガイドライン推進班を2016年版に引き続き組織した。将来への橋渡しとなることを企図して，多くの若手医師をシステマティックレビューチーム・ワーキンググループに登用し，学会や施設の垣根を越えたネットワーク構築も進めた。作成工程においては，質の担保と作業過程の透明化を図るために様々な工夫を行い，パブリックコメント募集は計2回行った。推奨作成にはGRADE方式を取り入れ，修正Delphi法を用いて全委員の投票により推奨を決定した。結果，117CQに対する回答として，79個のGRADEによる推奨，5個のGPS（Good Practice Statement），18個のエキスパートコンセンサス，27個のBQ（Background Question）の解説，および敗血症の定義と診断を示した。新たな試みとして，CQごとに診療フローなど時間軸に沿った視覚的情報を取り入れた。J-SSCG2020は，多職種が関わる国内外の敗血症診療の現場において，ベッドサイドで役立つガイドラインとして広く活用されることが期待される。なお，本ガイドラインは，日本集中治療医学会と日本救急医学会の両機関誌のガイドライン増刊号として同時掲載するものである。</p>

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開催年月日： 2020年11月

記述言語：日本語  

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開催年月日： 2020年10月

記述言語：日本語   会議種別：口頭発表（招待・特別）  

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記述言語：日本語  

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開催年月日： 2020年4月

記述言語：英語   会議種別：口頭発表（招待・特別）  

開催地：フロリダ   国名：アメリカ合衆国  

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開催年月日： 2020年

記述言語：日本語  

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開催年月日： 2020年

記述言語：日本語   会議種別：口頭発表（一般）  

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記述言語：日本語   会議種別：口頭発表（基調）  

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開催年月日： 2019年9月

記述言語：日本語  

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開催年月日： 2019年

記述言語：日本語  

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開催年月日： 2018年3月

記述言語：日本語  

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開催年月日： 2017年9月

記述言語：日本語   会議種別：口頭発表（一般）  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：英語   会議種別：ポスター発表  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語   会議種別：ポスター発表  

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記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（指名）  

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記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

添付ファイル： 14EBM（案内状） 2.pdf

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記述言語：日本語  

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記述言語：英語   会議種別：ポスター発表  

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記述言語：日本語   会議種別：ポスター発表  

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