Nobuto Nakanishi, Isao Miyajima, Takeshi Saijo, Takahiro Kudo, Kohei Tanaka, Yuta Arai, Manabu Ishihara, Kensuke Nakamura and Joji Kotani : Cut-off values for an ultrasound-based muscle mass assessment at intensive care unit admission: A retrospective study, Clinical Nutrition Open Science, 55, 263-273, 2024.
Miharu Arase, Nobuto Nakanishi, Rie Tsutsumi, Ayuka Kawakami, Yuta Arai, Hiroshi Sakaue and Jun Oto : The Utility of Urinary Titin to Diagnose and Predict the Prognosis of Acute Myocardial Infarction., International Journal of Molecular Sciences, 25, 1, 573, 2024.
(Summary)
= 0.023). Urinary N-fragment titin can be used as non-invasive early diagnostic biomarker in AMI. Furthermore, it associates with hospital discharge disposition, providing prognostic utility.
Nobuto Nakanishi, Shigeaki Inoue, Yuko Ono, Jun Sugiyama, Kazushi Takayama, Yuta Arai, Kensuke Nakamura, Jun Oto and Joji Kotani : Ultrasound-based upper limb muscle thickness is useful for screening low muscularity during intensive care unit admission: A retrospective study, Clinical Nutrition ESPEN, 57, 569-574, 2023.
(Summary)
Malnutrition is associated with poor outcomes. Muscle mass is an important malnutrition indicator included in Global Leadership Initiative on Malnutrition (GLIM) criteria. Although bioelectrical impedance analysis and dual-energy X-ray absorptiometry are common muscle mass assessment methods, they are unreliable during intensive care unit (ICU) admission due to the influence of dynamic fluid changes. We hypothesized that ultrasound-based upper limb muscle assessment would be useful for assessing muscularity at ICU admission. We retrospectively analyzed prospectively obtained ultrasound data from patients admitted to an ICU. We excluded patients without computed tomography (CT) imaging of the third lumbar vertebra within 2 days of ICU admission. Primary outcomes were the diagnostic utility of ultrasound-based upper limb muscle thickness for assessing low muscularity by CT. Low muscularity was defined as a skeletal muscle index of 36.0 cm2/m2 for males and 29.0 cm2/m2 for females at the cross-sectional area of the third lumbar vertebrae. Secondary outcomes of this study included the relationships between upper limb muscle thickness and biceps brachii muscle cross-sectional area, quadriceps femoris thickness, rectus femoris cross-sectional area. Among 64 patients assessed by ultrasound, 52 had CT examination records and were included in the analysis. The mean age was 70 ± 13 years, and the mean body mass index was 23.3 ± 4.2 kg/m2. Upper limb muscle thickness had the discriminative power to assess low muscularity at an area under the curve of 0.77 (95% CI [confidence interval], 0.63-0.91); the cutoff value (26.8 cm) had 84.6% sensitivity and 66.7% specificity. The upper limb muscle index had the discriminative power to assess low muscularity at an area under the curve of 0.80 (95% CI, 0.68-0.93); the cutoff value (9.9 mm/m2) had 76.9% sensitivity and 71.8% specificity. Upper limb muscle thickness was correlated with upper limb muscle cross-sectional area, quadriceps femoris muscle thickness, rectus femoris muscle cross-sectional area (r = 0.39-0.76, p < 0.01, n = 52). Ultrasound-based upper limb muscle thickness assessments can screen for low muscularity upon ICU admission.
Yuki Nakano, Koji Sato, Hiroki Sato, Kazuki Momota, Yusuke Akimoto, Toshiyuki Nunomura, Yuta Arai, Manabu Ishihara, Yoshitoyo Ueno, Natsuki Tane, Taiga Itagaki and Jun Oto : 経肺圧を指標としたPEEP設定により，致死的低酸素血症から改善した神経芽細胞腫に伴う腹部コンパートメント症候群の一乳児症例, Shikoku Acta Medica, 2022;78, 3,4, 115-120, 2022.
(Summary)
Background : Neuroblastoma is the most common extracranial solid tumor of childhood. Although the prognosis of neuroblastoma is relatively good, newborns less than two months of age with stage 4S neuroblastoma may present with aggressive hypoxia and restrictive respiratory impairment due to abdominal compartment syndrome. Case presentation : Two-month-old girl, height of 63 cm and body weight of 10 kg. She was diagnosed as neuroblastoma with Stage 4S. Because she was suffered from refractory hypoxemia and restrictive respiratory impairment due to abdominal compartment syndrome induced by multiple liver metastasis and massive ascites, she was transferred to our ICU. Her trachea was intubated and ventilated with assist/controlled mode, driving pressure 22 cmH2O, positive end-expiratory pressure(PEEP)8 cmH2O, fraction of inspiratory oxygen(FIO2)1.0, but tidal volume was obtained only 3.2 mL/kg and PaO2/FIO2 ratio of 55 mmHg. Therefore, we insert esophageal sensor and monitored esophageal pressure to performed transpulmonary pressure guided PEEP titration. When we changed PEEP from 8 to 15 cmH2O so that the end-expiratory transpulmonary pressure achieving 0 to 5 cmH2O, her oxygenation(PaO2/FIO2 ratio : 55 to 178 mmHg)and respiratory compliance(1.4 to 3.0 mL/cmH2O)were dramatically improved. Her respiratory condition was further stabilized by ascites puncture and radiotherapy, and the patient was extubated successfully on the 25th ICU day. Conclusions : Although pediatric neuroblastoma with stage 4S may induce severe respiratory efficiency, the responsiveness of treatment for neuroblastoma is promising. Multimodal treatments including optimal ventilator management such as transpulmonary pressure -guided PEEP titration contributes to improved patient's prognosis.
Yoshitoyo Ueno, Saki Harada, Koji Sato, Kazuki Momota, Hiroki Sato, Yusuke Akimoto, Yuta Arai, Toshiyuki Nunomura, Manabu Ishihara, Natsuki Tane, Taiga Itagaki, Yasuhiko Nishioka and Jun Oto : Independent lung ventilation for the management of acute allograft rejection after single-lung transplantation for end-stage emphysema., The Journal of Medical Investigation : JMI, 69, 3.4, 323-327, 2022.
(Summary)
Background : We herein report the use of independent lung ventilation (ILV) for managing acute allograft rejection after single-lung transplantation (SLT) for end-stage emphysema. Case presentation : A 54-year-old woman was transferred to our hospital with severe hypoxemia and respiratory distress due to unilateral lung disease with diffuse alveolar damage in the right donor lung associated with acute allograft rejection and with hyperinflation of the left native lung due to emphysema. She was unresponsive to immunosuppressive medications and conventional ventilation strategies, so different ventilator settings for each lung were required. A double-lumen endotracheal tube (DLT) was inserted, and ILV was initiated. The right lung was ventilated with high positive end-expiratory pressure (PEEP), intended for lung recruitment, and the left lung was ventilated with lung protective strategies using a low tidal volume and low levels of PEEP to avoid hyperinflation. Two days later, her lung function was dramatically improved, and the DLT was replaced with a single-lumen endotracheal tube. Gas exchange was maintained, and she was successfully weaned from mechanical ventilation on intensive-care unit day 15. Conclusions : ILV appears to be effective and safe for managing acute allograft rejection after SLT for emphysema. J. Med. Invest. 69 : 323-327, August, 2022.
Youichi Otomi, Yuta Arai, Maki Ohtomo, Saho Irahara, Kaori Terazawa, Michiko Kubo, Takashi Abe, Takayoshi Shinya, Hideki Otsuka and Masafumi Harada : Increased physiological [18F] FDG uptake in the liver and blood pool among patients with impaired renal function, Nuclear Medicine Review. Central & Eastern Europe, 25, 2, 95-100, 2022.
(Summary)
In the daily clinical course, the liver uptake may seem to be increased in patients with renal failure. The purpose of this study was to investigate whether or not the FDG uptake of the liver, and the FDG uptake of blood pool which is generally used as a reference site as well as liver, is increased in patients with renal failure. We retrospectively analyzed 233 patients who underwent FDG positron emission tomography/computed tomography (PET/CT). Renal failure is defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. We compared the FDG uptake in the liver and mediastinal blood pool of 67 patients with impaired renal function to that in 166 patients with a normal renal function (eGFR ≥ 60 mL/min/1.73 m2). Correlations between the liver or mediastinal blood pool FDG uptake and the eGFR were also analyzed by Spearman's correlation test. Maximum and mean standardized uptake values (SUVmax and SUVmean, respectively) of the liver and the SUVmean of the mediastinal blood pool were 3.48 ± 0.57, 2.56 ± 0.37, and 1.90 ± 0.28 in the impaired renal function group, respectively, and 3.13 ± 0.45, 2.29 ± 0.33, and 1.66 ± 0.23, in the normal group, respectively. The SUVmax and SUVmean of the liver and SUVmean of the mediastinal blood pool in the impaired renal function group were significantly higher than those in the normal group (p < 0.001, < 0.001, and < 0.001, respectively). The SUVmax and SUVmean of the liver and SUVmean of the mediastinal blood pool of patients showed a significant negative correlation with the eGFR (Spearman's p = -0.25, -0.30, and -0.40, respectively, each p < 0.001). FDG uptake in both the liver and mediastinal blood pool was higher in patients with impaired renal function.
Yuta Arai, Nobuto Nakanishi, Yuko Ono, Shigeaki Inoue, Joji Kotani, Masafumi Harada and Jun Oto : Ultrasound assessment of muscle mass has potential to identify patients with low muscularity at intensive care unit admission: A retrospective study, Clinical Nutrition ESPEN, 45, 177-183, 2021.
(Summary)
Muscle mass is an important biomarker of survival from a critical illness; however, there is no widely accepted method for routine assessment of low muscularity at intensive care unit (ICU) admission. We hypothesize that ultrasound-based partial muscle mass assessments can reflect the trunk muscle mass. Therefore, we aimed to investigate whether ultrasound muscle mass measurements could reflect trunk muscle mass and identify patients with low muscularity. We performed a retrospective analysis of prospectively obtained ultrasound data at ICU admission. We included patients who underwent computed tomography (CT) imaging at the third lumbar vertebra (L3) within 2 days before and 2 days after ICU admission. Primary outcomes included the correlation between the femoral muscle mass measurements using ultrasound and the cross-sectional area (CSA) at L3 obtained by CT. Low muscularity was defined as a skeletal muscle index of 36.0 cm2/m2 for males and 29.0 cm2/m2 for females. Secondary outcomes included the correlation with the ultrasound measurements of the biceps brachii muscle mass and diaphragm thickness. Among 133 patients, 89 underwent CT imaging, which included the L3. The patient mean age was 72 ± 13 years, and 60 patients (67%) were male. The correlation between the femoral muscle ultrasound and CT was ϱ = 0.57 (p < 0.01, n = 89) and ϱ = 0.48 (p < 0.01, n = 89) for quadriceps muscle layer thickness and rectus femoris muscle CSA, and these had the discriminative power to assess low muscularity, with the areas under the curve of 0.84 and 0.76, respectively. The ultrasound measurements of the biceps brachii muscle mass and diaphragm thickness were correlated with CT imaging [ϱ = 0.57-0.60 (p < 0.01, n = 52) and ϱ = 0.35 (p < 0.01, n = 79)]. Ultrasound measurements of muscle mass were correlated with CT measurements, and the measurements of femoral muscle mass were useful to assess low muscularity at ICU admission. UMIN000044032 (retrospectively registered on April 25, 2021).
(Keyword)
Computed tomography / Intensive care unit / Muscle mass / Rectus femoris muscle / Ultrasound
Takuya Takashima, Nobuto Nakanishi, Yuta Arai and Jun Oto : The effect of high-flow nasal cannula on diaphragm dysfunction including paradoxical diaphragmatic contraction in the intensive care unit., The Journal of Medical Investigation : JMI, 68, 1.2, 159-164, 2021.
(Summary)
Background : Diaphragm dysfunction is a serious problem. However, a few management techniques exist for diaphragm dysfunction. Methods : Adult patients treated with high-flow nasal cannula (HFNC) in the intensive care unit were included in this study. The diaphragm function was evaluated using ultrasound measurement of thickening fraction before and after HFNC liberation. Normal diaphragm contraction was defined as thickening fraction ≥ 15% without HFNC, whereas decreased or paradoxical diaphragm contractions were 0%-15% or < 0%, respectively. Results : Forty patients were enrolled, and 16 (40%) had normal diaphragm contraction, whereas 19 (48%) or 5 (13%) had decreased or paradoxical diaphragm contractions, respectively. Thickening fraction increased after HFNC liberation (27.0% ± 25.7% vs. 38.8% ± 34.5%, p = 0.03 in HFNC vs. no HFNC) in patients without diaphragm dysfunction. In patients with decreased diaphragm contraction, thickening fraction did not change with or without HFNC (8.9% ± 11.7% vs. 6.7% ± 5.2%, p = 0.35), whereas paradoxical contraction decreased with HFNC (1.0% ± 10.2% vs. -10.3% ± 2.7%, p = 0.04) in patients with paradoxical diaphragm contraction. Conclusions : The work of breathing decreased with HFNC in patients without diaphragm dysfunction, but did not decrease in patients with decreased diaphragm contraction. Paradoxical diaphragm contraction decreased with HFNC. J. Med. Invest. 68 : 159-164, February, 2021.
(Keyword)
Adult / Cannula / Diaphragm / Humans / Intensive Care Units / Ultrasonography
Moriaki Yamanaka, Takayoshi Shinya, Yoichi Otomi, Michiko Kubo, Yuta Arai, Hiroaki Toba, Yoshimi Bando, Hideki Otsuka and Masafumi Harada : Semiquantitative assessment of fluorodeoxyglucose uptake in primary tumours on dynamic PET/computed tomography for lymph node metastasis evaluation in patients with lung cancer: A prospective study, Nuclear Medicine Communications, 41, 11, 1189-1198, 2020.
(Summary)
To semiquantitatively estimate fluorine-18-fluorodeoxyglucose (FDG) uptake in primary lung cancer cells using dynamic and dual-time-point (DTP) PET/computed tomography (PET/CT) to obtain a diagnostic index for lymph node metastasis. Forty-five patients with lung cancer underwent dynamic and DTP PET/CT examinations. All primary lesions and lymph node metastases were evaluated pathologically. At each time phase, we assessed the maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of the primary tumours. We investigated the relationship between semiquantitative index and the presence of lymph node metastasis for each case and for all cases satisfying indications for segmentectomy. In cases with lymph node metastasis, we assessed the SUVmax of pathologically proven metastatic lymph nodes and nonmetastatic lymph nodes in each dynamic phase for evaluating temporal change. Among 45 patients, 15 had 17 lymph node metastasis. SUVmax, MTV and TLG of primary tumours at each time phase were significantly associated with lymph node metastasis (P < 0.05). In receiver operating characteristic analysis, dynamic second and third phases showed high diagnostic ability for lymph node metastasis. The temporal change in SUVmax in the dynamic phase between primary tumours and metastatic lymph nodes were significantly different (P = 0.065). The temporal change in SUVmax was significantly lower in nonmetastatic lymph nodes than in primary tumours and metastatic lymph nodes (P < 0.0001). Semiquantitative assessment of FDG uptake in dynamic second and third phases and the assessment of temporal changes in SUVmax on dynamic PET/CT scans were important predictors in diagnosing lymph node metastasis.
Yoichi Otomi, Hideki Otsuka, Kaori Terazawa, Mihoko Kondo, Yuta Arai, Moriaki Yamanaka, Maki Otomo, Takashi Abe, Takayoshi Shinya and Masafumi Harada : A reduced liver 18F-FDG uptake may be related to hypoalbuminemia in patients with malnutrition, Annals of Nuclear Medicine, 33, 9, 689-696, 2019.
(Summary)
18F-FDG PET/CT is a hybrid imaging method widely used as a useful, noninvasive imaging modality for evaluating various neoplastic diseases. When assessing the tumor uptake, the liver and the mediastinal blood pool are often used as a reference region. In daily clinical practice, the 18F-FDG uptake in the liver sometimes appears to decrease on PET images of patients with malnutrition. The purpose of this study was to investigate whether or not the liver 18F-FDG uptake is decreased in patients with malnutrition. We retrospectively analyzed 246 patients who underwent 18F-FDG PET/CT from January 2018 to June 2018 and whose blood serum albumin was measured within 1 month of PET/CT. We compared the liver uptake and mediastinal blood uptake of patients with low serum albumin level (< 4.0 g/dl) and hypoalbuminemia (< 3.5 g/dl) with those with a normal serum albumin level (≥ 4.0 g/dl). Correlations between the liver and mediastinal blood uptake and the serum albumin level were also calculated. The maximum standardized uptake value (SUVmax) and mean standardized uptake value (SUVmean) of the liver in 117 patients with low serum albumin were 3.1 ± 0.5 and 2.3 ± 0.3, respectively, while they were 2.9 ± 0.4, 2.0 ± 0.3 in 29 patients with hypoalbuminemia; these values were all significantly lower than the respective ones (3.4 ± 0.5, 2.5 ± 0.4) in 129 patients with normal serum albumin (all p < 0.001). The SUVmean of the mediastinal blood uptake in patients with hypoalbuminemia and normal serum albumin were 1.6 ± 0.2 and 1.7 ± 0.3, respectively (p = 0.053). The serum albumin level demonstrated a significantly positive, moderate correlation with the liver SUVmean, showing a regression line of y = 0.31x + 1.1 (r = 0.41, p < 0.001). The liver 18F-FDG uptake tended to decrease in patients with hypoalbuminemia. In the patients with malnutrition, the mediastinal blood pool may be a more stable reference than the liver for evaluating the tumor activity because hypoalbuminemia is considered to less strongly influence the mediastinal blood pool than that in the liver.
(Keyword)
Albumin / FDG / Hypoalbuminemia / Liver / Malnutrition
Mitsuhiro Kinoshita, Katsuya Takechi, Yuta Arai, Ryozo Shirono, Yoshihiro Nagao, Shoichi Izumi, Takuya Akagawa, Shiori Noda, Shoichiro Takao, Chikara Ogawa, Daisuke Suwa, Katsuyoshi Tamaki, Naoto Uyama, Yoko Akagawa, Kyosuke Osaki, Norio Ohnishi and Hayato Tani : Utility of the Virtual Liver Parenchymal Perfusion Area Using a Commercially Available Workstation in Transarterial Chemoembolization for Hepatocellular Carcinoma, Cardiovascular and Interventional Radiology, 42, 1, 69-77, 2018.
(Summary)
To evaluate the accuracy of the virtual liver parenchymal perfusion area using a commercially available workstation and liver analysis software in conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC). This method was retrospectively applied to 29 treated HCCs in 23 patients. The virtual embolic area (VEA) was estimated based on cone beam computed tomography during hepatic arteriography using a commercially available workstation and liver analysis software by two observer groups (group A: experts; group B: semi-experts). The real embolic area (REA) was defined as the area where iodized oil accumulated on computed tomography at 1 week after cTACE. The REA was estimated by each of the two groups, and the mean REA between the groups (mREA) was used as a standard reference. Agreement of volume and cross-sectional area in three orthogonal planes between the VEA and mREA were analyzed using intraclass correlation coefficients (ICCs) and Bland-Altman plots. The ICCs for volume between VEA and mREA were 0.97 and 0.88 for groups A and B, respectively, and those for cross-sectional area were 0.94 and 0.88 for the axial plane, 0.95 and 0.83 for the coronal plane, and 0.87 and 0.74 for the sagittal plane, respectively. Thus, the overall agreement was excellent, except for the sagittal imaging plane in group B. This method using a commercially available workstation and liver analysis software can be useful for estimating the embolic area in cTACE.
(Keyword)
3-Dimensional workstation / Cone beam computed tomography / Hepatocellular carcinoma / Real embolic area / Transarterial chemoembolization / Virtual embolic area / Virtual liver parenchymal perfusion area
Yoichi Otomi, Takayoshi Shinya, Naoto Uyama, Yuta Arai, Kanako Miyamoto, Katsuya Takechi, Michiko Kubo, Hideki Otsuka and Masafumi Harada : The physiological accumulation of FDG in the muscles in relation to the side of intravenous administration, Japanese Journal of Radiology, 35, 2, 53-60, 2016.
(Summary)
The purpose of the study was to evaluate the physiological accumulation of 18F-FDG in the muscles in relation to the side of intravenous administration. We retrospectively investigated 3,118 18F-FDG-PET/CT examinations. We evaluated the physiological accumulation of FDG in the muscles of the shoulder and arm relative to its dependence on the side of intravenous administration. Six hundred six of the 3,118 examinations (19.4%) showed physiological accumulation of FDG in the teres minor muscle. Accumulation was seen on the side of administration in 486 examinations (80.2%), contralateral to the side of administration in 56 examinations (9.2%), and bilaterally in 64 examinations (10.6%). Five hundred seventy-seven of the 3,118 examinations (18.5%) showed accumulation of FDG in the muscles between the radioulna near the elbow. Accumulation was observed on the side of administration in 432 examinations (74.9%), contralateral to the side of the administration in 71 examinations (12.3%), and bilaterally in 74 examinations (12.8%). The present study finds that not only accumulation in the teres minor muscles but also accumulation in the muscles between the radioulna near the elbow occurs significantly more frequently on the side of intravenous administration compared to the contralateral side.
(Keyword)
Accumulation between the radioulna near the elbow / FDG / FDG injection / Physiological accumulation / Teres minor muscle