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

Introduction The long-term patency of the grafts used during the coronary artery bypass grafting (CABG) is one of the most significant predictors of the clinical outcomes. The gold standard graft used during CABG with the best long-term patency rate and the better clinical outcomes is left internal thoracic artery (LITA) grafted to the left coronary artery (LCA). The controversy lies in choosing the second-best conduit for the non-left coronary artery (NLCA) with similar patency rate as LITA. This meta-analysis examines the long-term patency and clinical outcomes of all arterial grafts versus all venous grafts used during the CABG. Methods A comprehensive literature search of all published randomized control trials (RCTs) assessing long-term patency and clinical outcomes of grafts used in CABG was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (1966-2018). Keywords searched included combinations of "CABG", "venous grafts in CABG", "arterial grafts in CABG", "radial artery grafts in CABG", "gastroepiploic artery grafts in CABG", "patency and clinical outcomes". Inclusion criteria included: RCTs comparing the long-term patency, and clinical outcomes of radial artery, right internal thoracic artery, gastroduodenal artery, and saphenous vein grafts used in CABG. Long-term patency of the grafts and clinical outcomes were analyzed. Results Eight RCTs involving 2,091 patients with 1,164 patients receiving arterial grafts and 927 patients receiving venous grafts were included. There was no difference between the long-term patency rate (relative risk (RR) = 1.050, 95% confidence interval (CI) = 0.949 to 1.162, and p = 0.344), overall mortality rate (RR = 1.095, 95% CI = 0.561 to 2.136, and p = 0.790), rate of myocardial infarction (MI) (RR = 0.860, 95% CI = 0.409 to 1.812, and P = 0.692), and re-intervention rate (RR = 0.0768, 95% CI = 0.419 to 1.406, and P = 0.392) between arterial and venous grafts. Conclusion The use of arterial conduits over the venous conduits has no significant superiority regarding the long-term graft patency, the rate of MI, overall mortality, and the rate of revascularization following CABG. Additional adequately powered studies are needed to further evaluate the long-term outcomes of arterial and venous grafts following the CABG.

No description available.

<p> Meta-analysis is a statistical method to summarize the overall evidence of effects on intervention by systematically combining outcomes from available studies in the literature which are homogeneous in research methodology and research interest. The objective of this project is to evaluate the treatment effects of preoperative aspirin on bleeding and other cardiovascular outcomes from 11 randomized control trials (RCT) and 19 observational (non-RCT) studies. Both Bayesian meta-analysis and classical (frequentist) meta-analysis were applied to continuous and binary outcomes, and the results were compared.</p> <p> The robustness of the Bayesian approach is assessed by examining the performances of different likelihood functions and priors. We also discuss strategies on dealing with zero-event studies for binary outcomes, and the implementation of multiple imputation (MI) technique to missing data for continuous outcomes.</p> <p> Most results of primary analysis agree between the Bayesian and classical approaches. We suggest that the final conclusion of a meta-analysis should be based on the comparison of the results from both Bayesian and classical approaches.</p> / Thesis / Master of Science (MSc)

Health-related quality of life (HRQL) measures taken before and after coronary artery bypass grafting (CABG) aid in determining meaningful patient-perceived outcomes associated with alternative clinical interventions. This study compared performance of the Medical Outcomes Study Short Form-36 (MOS SF-36) subscales for Physical Functioning (PF), Role Physical (RP), Mental Health (MH), and Role Emotional (RE) against two other questionnaires, i.e. the Veteran's Specific Activity Questionnaire (VSAQ: self-efficacy for vigorous physical activity) and the Beck Depression Inventory (BDI-II: mental-emotional functioning). Seventy-one patients (59-M; 12-F; age, Mean + SD = 63 ± 8.6 years) were administered these three questionnaires just before and 3 months following CABG surgery. Score distributions were evaluated for the pre- and post-surgery measurements, as were change scores after CABG. All measures except the MOS SF-36 subscales for RP and RE showed statistically significant change after CABG (p<0.01). Only the subscales of RP and RE demonstrated substantial ceiling (21.0% and 56.3%) and floor effects (49.3% and 16.9%). Evaluation of individual change scores after CABG indicated that 59% and 62% of the patients, respectively, had clinically meaningful increases in the two measures of physical capability, i.e. PF and VSAQ. In contrast, 60% and 72% of patients, respectively, showed no clinically meaningful changes in the two measures of emotional functioning, i.e. RE and BDI-II scores. Chi-square analyses revealed that use of scales with similar definitional constructs resulted in significantly different surgical outcomes for the following: PF vs VSAQ (p<0.001), RP vs VSAQ (p<0.02); and MH vs BDI-II (p<0.0001). These findings illustrate the limitations in performance of the MOS SF-36 for assessing changes of importance in HRQL after CABG. The VSAQ and BDI-II, two simple measures of physical and emotional functioning that are fundamentally similar to those contained in the MOS SF-36, appear to be sensitive markers for detecting changes in these important outcomes after CABG surgery. / Master of Science

A patient monitoring system for cardiopulmonary bypass surgery has been developed. This monitoring system uses a SWAN 286-10 computer (fully IBM PC/AT compatible) and a DT280l-A Input/Output board to monitor seven surgical parameters. This system monitors six temperatures, the hemoglobin content, the arterial oxygen saturation, the venous oxygen saturation, the oxygen consumption, and the blood flow rate through the cardiopulmonary bypass circuit. Additionally, there are three individual timers available. Details and the evaluation of the hardware and software design of this monitoring system are presented. Also, recommendations for clinical use are discussed. / Master of Science / incomplete_metadata

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.

The American Heart Association (2006) has identified cardiovascular disease as the leading cause of death in the United States for every year except 1918 since 1900. Cardiac surgery is an increasingly common method of treating this problem (Contrada, Goyal, Cather, Rafalson, Idler et al. , 2004). Researchers have found that depression is associated with serious complications related to cardiac surgery (Connemey, Shapiro, McLaughlin, Bagiella, & Sloan, 2001 ). Many researchers have identified factors associated with depression in these patients. The purpose of this thesis was to identify and synthesize these current research findings. Studies included were published from 1997-2006 and focused on male and female patients 18 years of age and older, primarily undergoing Coronary Artery Bypass Grafting (CABG). The synthesis of these findings includes both the factors associated with developing depression and the complications associated with depression. Common factors associated with its development included female gender, lower socioeconomic status, pessimism, and poorer cognitive and physical functioning. Complications associated with depression included decreased physical functioning, healing, and cognitive functioning, as well as increased hospital stays, readmissions, cardiac events, and mortality. The associated factors may help to identify patients at high risk for developing depression, while the complications emphasize its importance. Limitations were acknowledged and recommendations for nursing research, education, and practice are included.

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)

Kang, Ning. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references. / Abstract also in Chinese. / Abstracts --- p.i / Abbreviations --- p.v / List of Figures and Tables --- p.vii / Contents --- p.viii / Chapter Chapter 1: --- Introduction --- p.1 / Chapter 1. --- Saphenous vein graft patency after coronary artery bypass grafting --- p.1 / Chapter 2. --- Mechanism of vein graft failure and therapeutic strategies --- p.8 / Chapter 2.1 --- Mechanism --- p.15 / Chapter 2.2 --- Therapeutic strategies --- p.18 / Chapter 3. --- Summary --- p.22 / Chapter 4. --- References --- p.23 / Chapter Chapter 2: --- Animal model and laboratory investigations --- p.34 / Chapter 1. --- Surgical procedure --- p.35 / Chapter 2. --- Postoperative management --- p.37 / Chapter 3. --- Adenoviral-mediated gene transfer ex vivo for gene therapy study --- p.38 / Chapter 4. --- Laboratory investigations --- p.39 / Chapter 5. --- Statistical analysis --- p.40 / Chapter 6. --- Summary --- p.41 / Chapter 7. --- References --- p.41 / Chapter Chapter 3: --- "Impact of osteopontin expression in vein grafts on VSMC migration, proliferation, and neointimal formation" --- p.42 / Chapter 1. --- Introduction --- p.42 / Chapter 2. --- Methods and materials --- p.43 / Chapter 3. --- Results --- p.43 / Chapter 4. --- Discussion --- p.49 / Chapter 5. --- Summary --- p.52 / Chapter 6. --- References --- p.53 / Chapter Chapter 4: --- Potential Role of gene therapy in prevention of vein graft failure --- p.56 / Chapter 1. --- Vectors --- p.56 / Chapter 2. --- "Reporter gene, timing and titer" --- p.57 / Chapter 3. --- Candidate genes --- p.58 / Chapter 4. --- Summary --- p.64 / Chapter 5. --- References --- p.66 / Chapter Chapter 5: --- Conclusions --- p.70 / Acknowledgements --- p.72