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11.
Ryosuke Nakashima Masaaki Nishihara Takeshi Iyonaga Sho Iwasaka Yuzo Yamamoto Yuji Shono Jun Maki Kentaro Tokuda Tomohiko Akahoshi Taiki Higo Takanari Kitazono Hiroyuki Tsutsui 《Medicine》2021,100(23)
Rationale:In coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome refractory to optimal conventional management, we should consider the indication for veno-venous extracorporeal membrane oxygenation (V-V ECMO). Growing evidence indicates that COVID-19 frequently causes coagulopathy, presenting as hypercoagulation and incidental thrombosis. For these reasons, a multifactorial approach with several anticoagulant markers should be considered in the management of anticoagulation using heparin in COVID-19 patients on V-V ECMO.Patient concerns:A 48-year-old man was infected with COVID-19 with a worsening condition manifesting as acute respiratory distress syndrome.Diagnoses:He was refractory to conventional therapy, thus we decided to introduce V-V ECMO. We used heparin as an anticoagulant therapy for V-V ECMO and adjusted the doses of heparin by careful monitoring of the activated clotting time (ACT) and activated partial thromboplastin time (APTT) to avoid both hemorrhagic and thrombotic complications. We controlled the doses of heparin in the therapeutic ranges of ACT and APTT, but clinical hemorrhaging and profound elevation of coagulant marker became apparent.Interventions:Using thromboelastography (TEG; Haemonetics) in addition to ACT and APTT, we were able to clearly detect not only sufficient coagulability of COVID19 on V-V ECMO (citrated rapid thromboelastography-R 0.5 min, angle 75.5°, MA 64.0 mm, citrated functional fibrinogen-MA 20.7 mm) but also an excessive effect of heparin (citrated kaolin -R 42.7 min, citrated kaolin with heparinase 11.7 min).Outcomes:Given the TEG findings indicating an excessive heparin effect, the early withdrawal of ECMO was considered. After an evaluation of the patient''s respiratory capacity, withdrawal from V-V ECMO was achieved and then anticoagulation was stopped. The hemorrhagic complications and elevated thrombotic marker levels dramatically decreased.Lessons:TEG monitoring might be a useful option for managing anticoagulation in COVID-19 patients on V-V ECMO frequently showing a hypercoagulative state and requiring massive doses of heparin, to reduce both hemorrhagic and thrombotic complications. 相似文献
12.
Naoki Asayama Shinji Nagata Masanobu Yukutake Hiroki Takemoto Kenjiro Shigita Taiki Aoyama Akira Fukumoto Shinichi Mukai 《Internal medicine (Tokyo, Japan)》2021,60(9):1383
A 72-year-old man had undergone uncomplicated endoscopic submucosal dissection (ESD) with en bloc resection of a localized 20-mm IIc lesion in the anterior wall of the gastric angle. Twenty-eight days later, he was re-admitted with epigastric pain of one-week duration. Contrast-enhanced computed tomography (CT) revealed a 60-mm mass bordered by viscera; repeat endoscopy confirmed a smooth elevated submucosal tumor at the greater curvature on the oral side of the post-ESD ulcer. We diagnosed him with a perigastric abscess as a complication of ESD and performed endoscopic ultrasound-guided drainage. Subsequently, the symptoms and blood inflammatory parameters improved, and follow-up CT showed the disappearance of the abscess. 相似文献
13.
Ryohei Sumitani Taiki Hori Jumpei Murai Shiyori Kawata Masahiro Oura Kimiko Sogabe Mamiko Takahashi Takeshi Harada Shiro Fujii Hirokazu Miki Kumiko Kagawa Masahiro Abe Shingen Nakamura 《Internal medicine (Tokyo, Japan)》2021,60(11):1753
A 33-year-old man was admitted to our hospital for fever and abdominal pain. A blood analysis revealed pancytopenia and increased serum pancreatic enzymes with disseminated intravascular coagulation. A detailed examination revealed acute pancreatitis, with diffuse swelling of the pancreas and diffuse beaded dilatation of the main pancreatic duct, which mimicked autoimmune pancreatitis complicated by acute myeloid leukemia. Systemic cytotoxic chemotherapy led to the remission of leukemia and pancreatitis. We hypothesized that the etiology of acute pancreatitis was invasion of leukemia cells. Acute pancreatitis is rare as a symptom of leukemia; however, we should consider the possibility of leukemia during the differential diagnosis of acute pancreatitis. 相似文献
14.
Matsuda Hiroshi Okita Kyoji Motoi Yumiko Mizuno Toshiki Ikeda Manabu Sanjo Nobuo Murakami Koji Kambe Taiki Takayama Toshiki Yamada Kei Suehiro Takashi Matsunaga Keiko Yokota Takanori Tateishi Ukihide Shigemoto Yoko Kimura Yukio Chiba Emiko Kawashima Takahiro Tomo Yui Tachimori Hisateru Kimura Yuichi Sato Noriko 《Annals of nuclear medicine》2022,36(12):1039-1049
Annals of Nuclear Medicine - Amyloid positron emission tomography (PET) can reliably detect senile plaques and fluorinated ligands are approved for clinical use. However, the clinical impact of... 相似文献
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17.
Kodesho Taiki Taniguchi Keigo Kato Takuya Mizoguchi Shougo Yamakoshi Yoshiki Watanabe Kota Fujimiya Mineko Katayose Masaki 《Journal of Medical Ultrasonics》2021,48(2):115-121
Journal of Medical Ultrasonics - Estimation of muscle passive force from elasticity using shear wave elastography (SWE) has been reported. However, the relationship between the elasticity and... 相似文献
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19.
Yuko Kitagawa Hitoshi Idani Haruhiro Inoue Harushi Udagawa Ichiro Uyama Harushi Osugi Natsuya Katada Hiroya Takeuchi Yasunori Akutsu Shinya Asami Ken Ishikawa Akihiko Okamura Taiki Ono Fumihiko Kato Toshiki Kawabata Koichi Suda Tomoko Takesue Tsuyoshi Tanaka Mai Tsutsui Kei Hosoda Satoru Matsuda Tatsuo Matsuda Mariko Mani Tatsuya Miyazaki 《Asian journal of endoscopic surgery》2015,8(2):114-124
20.
The proteasomal subunit Rpn6 is a molecular clamp holding the core and regulatory subcomplexes together 总被引:2,自引:0,他引:2
Pathare GR Nagy I Bohn S Unverdorben P Hubert A Körner R Nickell S Lasker K Sali A Tamura T Nishioka T Förster F Baumeister W Bracher A 《Proceedings of the National Academy of Sciences of the United States of America》2012,109(1):149-154
Proteasomes execute the degradation of most cellular proteins. Although the 20S core particle (CP) has been studied in great detail, the structure of the 19S regulatory particle (RP), which prepares ubiquitylated substrates for degradation, has remained elusive. Here, we report the crystal structure of one of the RP subunits, Rpn6, and we describe its integration into the cryo-EM density map of the 26S holocomplex at 9.1?? resolution. Rpn6 consists of an α-solenoid-like fold and a proteasome COP9/signalosome eIF3 (PCI) module in a right-handed suprahelical configuration. Highly conserved surface areas of Rpn6 interact with the conserved surfaces of the Pre8 (alpha2) and Rpt6 subunits from the alpha and ATPase rings, respectively. The structure suggests that Rpn6 has a pivotal role in stabilizing the otherwise weak interaction between the CP and the RP. 相似文献