京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13050号 / 論医博第2116号 / 新制||医||1017(附属図書館) / 33140 / (主査)教授 柳田 素子, 教授 長船 健二, 教授 福原 俊一 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

If unaccounted for, differences in human anatomy can lead to adverse clinical outcomes for patients. The literature describes numerous variations of branches of the brachial artery; the most common anomaly is found as high as 25% of the time, in which the brachial artery passes over the median nerve, splitting the brachial artery into superficial and deep branches. Another common variation of the forearm arterial supply includes branching of the radial artery from the brachial artery proximal to the antecubital fossa (12.5%). Herein, we report a unique variation found in a 96-year-old white whole-body formalin-fixed male donor, dissected with typical dissection techniques. Although predictably bifurcating at the cubital fossa, the relative calibers and distribution of the ulnar and radial arteries in the forearm were notably atypical. The common interosseous artery branched from the radial artery rather than the ulnar artery, and distally branched into the anterior and posterior interosseous arteries. This morphology resulted in the deep anterior forearm and entirety of the posterior forearm relying on the radial artery for perfusion. There was also a notable size difference between the ulnar and radial arteries in which the radial artery was much larger. A review of the literature revealed two articles reporting this unique anomaly. It is important clinically to understand this abnormal branching pattern, as various medical procedures involve the radial artery. The radial artery is commonly used to gain access to circulation for cardiac catheterization and stent placement and can also be accessed for cannulation for a variety of medical procedures. Awareness of radial artery dominance reduces the possibility of iatrogenic injury and increases positive clinical outcomes. This protocol was reviewed by the VCOM IRB (#2022-050).

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23807号 / 医博第4853号 / 新制||医||1058(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 湊谷 謙司, 教授 YOUSSEFIAN Shohab, 教授 石見 拓 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Yes / Coronary artery bypass graft (CABG) using autologous saphenous vein continues to be a gold standard procedure to restore the supply of oxygen-rich blood to the heart muscles in coronary artery disease (CAD) patients with or without type 2 diabetes mellitus (T2DM). However, CAD patients with T2DM are at higher risk of graft failure. While failure rates have been reduced through improvements in procedure-related factors, much less is known about the molecular and cellular mechanisms by which T2DM initiates vein graft failure. This review gives novel insights into these cellular and molecular mechanisms and identifies potential therapeutic targets for development of new medicines to improve vein graft patency. One important cellular process that has been implicated in the pathogenesis of T2DM is protein O-GlcNAcylation, a dynamic, reversible post-translational modification of serine and threonine residues on target proteins that is controlled by two enzymes: O-GlcNAc transferase (OGT) and O-GlcNAcase (OGA). Protein O-GlcNAcylation impacts a range of cellular processes, including trafficking, metabolism, inflammation and cytoskeletal organisation. Altered O-GlcNAcylation homeostasis have, therefore, been linked to a range of human pathologies with a metabolic component, including T2DM. We propose that protein O-GlcNAcylation alters vascular smooth muscle and endothelial cell function through modification of specific protein targets which contribute to the vascular re-modelling responsible for saphenous vein graft failure in T2DM.

A quantitative research design for a descriptive and contextual study to determine the critical care nurses knowledge and data preferences regarding the central venous and pulmonary artery catheters management and decision making after coronary arte.y bypass graft operations and the utmzation period of the pulmonary artery catheter after coronary artery bypass graft operations. The data was collected through a questionnaire completed by critical care nurses and retrospective analysis of patient records through a structured checklist. Data analysis indicated the following: critical care nurses have a knowledge deficit in the management of the central venous and pulmonary artery catheters and felt more competent and confident in the central venous measurements. The utilization period of the pulmonary artery catheter was 48% compared to the 100% of the central venous catheter. / Advanced Nursing Science / M.A. (Advanced Nursing Science)

A quantitative research design for a descriptive and contextual study to determine the critical care nurses knowledge and data preferences regarding the central venous and pulmonary artery catheters management and decision making after coronary arte.y bypass graft operations and the utmzation period of the pulmonary artery catheter after coronary artery bypass graft operations. The data was collected through a questionnaire completed by critical care nurses and retrospective analysis of patient records through a structured checklist. Data analysis indicated the following: critical care nurses have a knowledge deficit in the management of the central venous and pulmonary artery catheters and felt more competent and confident in the central venous measurements. The utilization period of the pulmonary artery catheter was 48% compared to the 100% of the central venous catheter. / Advanced Nursing Science / M.A. (Advanced Nursing Science)

The mechanical behavior of the arterial wall is determined by the composition and structure of its internal constituents as well as the applied traction-forces, such as pressure and axial stretch. The purpose of this work is to develop new theoretical frameworks and experimental methodologies to further the understanding of arterial mechanics and role of the various intrinsic and extrinsic mechanically motivating factors. Specifically, residual deformation, matrix organization, and perivascular support are investigated in the context of their effects on the overall and local mechanical behavior of the artery. We propose new kinematic frameworks to determine the displacement field due to residual deformations previously unknown, which include longitudinal and shearing residual deformations. This allows for improved predictions of the local, intramural stresses of the artery. We found distinct microstructural differences between the femoral and carotid arteries from non-human primates. These arteries are functionally and mechanically different, but are geometrically and compositionally similar, thereby suggesting differences in their microstructural alignments, particularly of their collagen fibers. Finally, we quantified the mechanical constraint of perivascular support on the coronary artery by mechanically testing the artery in-situ before and after surgical exposure.

The objectives of this thesis are: a) To examine racial/ethnic differences in coronary artery calcification (CAC) and CAD, between symptomatic South Asians and Caucasians, matched for age, gender and conventional cardiovascular risk factors, b) To assess, using a meta-analysis model, the natural history of and stability of measurements of coronary artery calcium scoring (CACs) based on data collected from two large published trials: St Francis and EBEAT, c) To investigate the prevalence of coronary artery calcification in individuals with CT evidence for AVC, mitral valve calcification (MAC) or of both of them (AVC+MAC), d) To assess any potential association between premature CAD (<55 years in first-degree male relatives and <65 years in first-degree female relatives) and CAC in a large cohort of asymptomatic individuals. We found that coronary artery calcification is more extensive and diffuse in symptomatic patients of South Asian ethnic origin as compared to Caucasians, despite similar conventional risk factors for CAD. This is more evident in those >50 years of age, suggesting potential genetic or other risk factors yet to be determined. The natural history of coronary artery calcification was overtime progression in the majority of subjects, irrespective of gender. The higher variability in RCA measurements could be related to the low baseline CACs or exaggerated movement of the right side atrioventricular ring, whereas those for LCA brances are influenced by the branch allocation of the CACs. Valve calcification is not isolated but involve also and the coronary arteries. The presence of calcification in the aortic valve or combined aortic and mitral valves predicted coronary artery calcification. Additionally patients in whom both valves have become calcified tend to have severe coronary artery calcification. And finally, there is no relationship between the prevalence and extent of coronary artery calcification and the presence of family history of coronary heart disease in asymptomatic individuals with none of the conventional risk factors for atherosclerosis.

The absence of a practice guideline for peripheral artery disease (PAD) in the cardiology department creates differing practice preferences among providers, leading to deviations in practice among staff. Variations in practice can affect the quality of care that is provided to patients. This project was guided by research statements indicating that there was a difference in the screening approach for PAD among health practitioners at preimplementation and postimplementation and that an 85% compliance with the guideline would signify consistency in the provision of care. Rogers' theory of diffusion of innovations was used to facilitate the adoption of the guideline. This project helped close the gap between research (adoption of a guideline) and practice (compliance in the use of evidence in clinical practice). Using random medical record reviews and pretest-posttest design, the results of the project showed that patterns of using the PAD guideline in practice at preimplementation significantly differed compared to postimplementation. The rates of screening for the compliance of the PAD guideline showed approximately an eightfold increase. The adoption of the PAD guideline has implications for policy, because adopting the PAD guideline helped standardize the care, improve effectiveness of care in nursing practice, evaluate quality through use of research, and promote social change by improving patient outcomes.