Takami Komatsu

Molecular Cloning, mRNA Expression and Chromosomal Localization of Mouse Angiotensin-converting Enzyme-related Carboxypeptidase (mACE2)

We isolated two mouse cDNA clones which show significant similarities with human angiotensin-converting enzyme-related carboxypeptidase (ACE2). The cDNAs were 2746 and 1995 bp in length and seemed to arise from the same gene by alternative splicing. The longer cDNA encoded a 798-amino acid protein containing the sequence motif conserved among zinc metallopeptidases. Mouse ACE2 showed 83% identity with human ACE2. Northern blot analysis revealed that 2.8- and 2.0-kb transcripts were expressed mainly in the kidney and the lungs. The mouse ACE2 gene was mapped to chromosome X 70.5 cM.

Prevention of medical accidents caused by defective surgical instruments

BACKGROUND The malfunctioning of surgical instruments may lead to serious medical accidents. Limited information is available on the risk of defective instruments. The purpose of these study is to demonstrate the features of defective surgical instruments, to establish a strategy to reduce the risk of medical accidents. METHODS We studied 19,474 consecutive operations during 2007 to 2009 at our hospital. The data on defective instruments were collected based on the orders for repair of broken instruments and reports of near-miss incidents. Adverse events caused by defective instruments were also identified from reports of near-miss incidents. RESULTS A total of 1,775 nonfunctioning instruments were identified during the study period. Of these, 112 were found during operation. More than half of the defective instruments were tissue-grasping instruments, bone-boring/gnawing instruments, and instruments for endoscopic surgery. Wearing out and inappropriate use of instruments were 2 major causes of defects. The rest of the causes consisted of inadequate inspection and factory defects. Two near-miss incidents (incidence 10 per 100,000 operations) in endoscopic surgery were potentially critical, but the postoperative course was uneventful in each patient. The incidence of defects adjusted by the number of operations demonstrated that bone-boring/gnawing instruments and instruments for endoscopic surgery tend to be broken during surgery. Without inspection by the manufacturer, the incidence would be much higher for endoscopic instruments. CONCLUSION Our data suggest that the appropriate use and adequate inspection of particular types of instruments are key for reducing the risk of medical accidents caused by defective surgical instruments.

Challenging Residual Contamination of Instruments for Robotic Surgery in Japan

BACKGROUND Recently, robotic surgery has been introduced in many hospitals. The structure of robotic instruments is so complex that updating their cleaning methods is a challenge for healthcare professionals. However, there is limited information on the effectiveness of cleaning for instruments for robotic surgery. OBJECTIVE To determine the level of residual contamination of instruments for robotic surgery and to develop a method to evaluate the cleaning efficacy for complex surgical devices. METHODS Surgical instruments were collected immediately after operations and/or after in-house cleaning, and the level of residual protein was measured. Three serial measurements were performed on instruments after cleaning to determine the changes in the level of contamination and the total amount of residual protein. The study took place from September 1, 2013, through June 30, 2015, in Japan. RESULTS The amount of protein released from robotic instruments declined exponentially. The amount after in-house cleaning was 650, 550, and 530 µg/instrument in the 3 serial measurements. The overall level of residual protein in each measurement was much higher for robotic instruments than for ordinary instruments (P<.0001). CONCLUSIONS Our data demonstrated that complete removal of residual protein from surgical instruments is virtually impossible. The pattern of decline differed depending on the instrument type, which reflected the complex structure of the instruments. It might be necessary to establish a new standard for cleaning using a novel classification according to the structural complexity of instruments, especially for those for robotic surgery. Infect Control Hosp Epidemiol 2017;38:143-146.

Novel concept of cleanliness of instruments for robotic surgery

Robotic systems for surgeryhavebeendevelopedover the last 30 years, and currently use of the da Vinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) predominates in many countries. Robotic systems provide surgeons with many benefits such as refinedmanipulation of surgical instruments. On the other hand, they bring about difficulty for personnel in central sterile supply departments, because these instruments may be difficult or impossible to clean adequately. This article discussesconcernsabout thecleanlinessof robotic instruments.

Epidural block during general anesthesia attenuates urinary trypsin inhibitor excretion in lower abdominal surgery

AbstractPurpose. The aim of this study was to elucidate whether urinary trypsin inhibitor excretion differs between general anesthesia (GA) and epidural block during general anesthesia (EPI) in lower abdominal surgery. Methods. Sixteen women undergoing abdominal total hysterectomy were assigned to the GA and EPI groups. The GA group received propofol induction and maintenance with isoflurane, nitrous oxide, and vecuronium. The EPI group received epidural block, followed by propofol induction and maintenance with isoflurane and nitrous oxide. The levels of adrenocorticotropic hormone and cortisol during anesthesia and on postoperative days 1, 2, and 3, and the levels of urinary trypsin inhibitor in 12-h urine from the day of surgery to postoperative day 3, were measured. Results. As compared with the EPI group, the GA group had a higher level of adrenocorticotropic hormone at the completion of anesthesia, higher levels of cortisol at the completion of anesthesia and postoperative day 2, and higher excretion of urinary trypsin inhibitor on the day of surgery and postoperative days 1 and 2. Conclusion. The present results suggest that excretion of urinary trypsin inhibitor into the urine under epidural block during general anesthesia is lower than that under general anesthesia alone in lower abdominal surgery. This is probably due to the difference in endocrine response to surgery between the two types of anesthesia.

Concerns Associated With Cleaning Robotic Surgical Instruments—Response to Wallace

Affiliations: 1. Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2. Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran; 3. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Address correspondence to Saeid Safiri, Assistant Professor of Epidemiology, Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran (saeidsafiri@gmail.com). Infect Control Hosp Epidemiol 2017;38:1013–1014

The effect of linear polarized near-infrared irradiation around the stellate ganglia on hormonal secretions

AbstractLinear polarized near-infrared irradiation around the stellate ganglia (Lizer-SGB) is thought to have a similar effect to stellate ganglion block (SGB), namely, a reduced effect on stress. The effect of Lizer-SGB on various hormone levels was examined. Six adult male volunteers received bilateral Lizer-SGB, and blood was collected before and after this treatment, followed by measurements of plasma adrenocorticotropic hormone (ACTH) and serum cortisol (CS), luteinizing hormone (LH), testosterone (TS), thyroid stimulating hormone (TSH), triiodothyronine (T3) and thyroxine (T4). On a different day, the same measurements were taken from volunteers in the absence of irradiation. The results showed that ACTH, LH, TS and T4 levels were similar in treated and non-treated groups, whilst CS levels decreased after Lizer-SGB. Although TSH and T3 levels decreased, their values were not changed as a specific effect of Lizer-SGB. The results obtained showed that Lizer-SGB has an effect similar to SGB, regarding ...