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Risk of coronary arterial lesions in immunoglobulin resistant Kawasaki disease

Open Journal of Pediatrics 2012年第1期2卷 38-41页

作者： Hirotaro Ogino Kazunari Kaneko Takamichi Uchiyama ken yoshimura Masayuki Teraguchi Yosikazu Nakamura Department of Pediatrics Kansai Medical University Osaka Japan Department of Public Health Jichi Medical University Tochigi Japan

Objective: High-dose intravenous immunoglobulin (IVIG) decreases the risk for development of coronary arterial lesions (CAL) in Kawasaki disease (KD) while patients resistant to IVIG have higher risk. This study is aimed to investigate an additional therapy affects the risk for CAL in IVIG resistant KD. Design: The information from 11,510 children with KD was collected by the nationwide survey (2003-2004) in Japan. The secondary therapeutic strategies for IVIG resistant KD were an additional IVIG dose, steroids or both. The incidence of CAL was compared among 4 groups: G1, children responded to initial IVIG;G2, IVIG resistant patients receiving an additional IVIG dose;G3, IVIG resistant patients receiving additional steroids;G4, IVIG resistant patients receiving an additional IVIG dose plus steroids. CAL was assessed at 30th day of illness using ultrasound echocardiography. Results: 2229 patients (19.4%) were resistant to initial IVIG. Incidence of CAL was significantly lower in children responding to initial IVIG than in IVIG resistant patients (1.9% and 11.0%, respectively;odd’s ratio 6.3). The incidences of CAL in an each additional therapy group were as follows: G2: 6.7%, G3: 9.7%, G4: 22.2%. The risk for CAL was significantly higher in G4 as compared with G2 and G3. Giant aneurysmal formation (GA) was more frequently developed in G3 and G4 consisting of the patients receiving steroids (G1: 0.03%, G2: 0.63%, G3: 4.3%, G4: 3.7%). Conclusion: The incidence of CAL was considerably high in IVIG resistant KD and an additional therapy by steroids may increase the risk for GA.

关键词： Kawasaki Disease Immunoglobulin Resistance Additional Treatment Coronary Arterial Lesions Steroids

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Prevention of hospital-acquired hypokalemia in children receiving maintenance fluid therapy

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Open Journal of Pediatrics 2012年第2期2卷 138-142页

作者： Kazunari Kaneko ken yoshimura Takahisa Kimata Kohsuke Ishii Tetsuya Kitao Sachiyo Tanaka Shoji Tsuji Department of Pediatrics Kansai Medical University Osaka Japan

Objective: It has been suggested that the use of hypotonic intravenous fluid (IVF) puts hospitalized children at a greater risk of developing hyponatremia in children with increased arginine vasopressin (AVP) production. To reduce its risk, the National Patient Safety Agency in UK issued alert 22 in 2007, of which recommendations were to use isotonic solutions for these children at risk of hyponatremia, instead of the previously most commonly used IVF (0.18% saline/ 4% dextrose) for maintenance fluid therapy. Recent observations, however, revealed that hypokalemia are also common in hospitalized patients who do not receive potassium in their IVF. This study was conducted to validate the potassium added IVF for the prevention of hospital-acquired hypokalemia in maintenance fluid therapy. Design: For maintenance fluid therapy, a commercially available IVF solution in Japan named as Solita-T2R (Na 84 mmol/L, K 20 mmol/L, Cl 66 mmol/L, glucose 3.2%) was infused for 41 sick children with a median age of 3.01 years. Its composition is close equivalent to 0.45% saline/5% dextrose (Na 77 mmol/L, K 0 mmol/L, Cl 77 mmol/L, dextrose 5%) except K content. The patients in states of AVP excess were excluded from the analysis. Results: Median serum potassium value did not drop significantly at a median interval of 48 hours (before IVF: 4.30 mmol/L, after IVF: 4.10 mmol/L, p > 0.05), whereas median serum sodium level significantly increased from 136.0 mmol/L to 139.0 mmol/L (p < 0.001). Conclusion: Potassium added (20 mmol/L) IVF solution reduces the risk of developing “hospital-acquired hypokalemia” in children who are not in states of AVP excess in maintenance fluid therapy. It is worthwhile to study prospectively in a larger number of sick children.

关键词： Hyponatremia Hypokalemia Hypotonic Intravenous Fluid Maintenance Fluid Therapy Potassium Content

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Multi-objective Human-like Optimization for Computational Engineering Design

Multi-objective Human-like Optimization for Computational En...

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The Sixth World Congress on Computational Mechanics in Conjunction with the Second Asian-Pacific Congress on Computational MechanicsⅠ

作者： Chen Jian ken Lee Tomonari Furukawa Shinobu yoshimura ARC Centre of Excellency in Autonomous Systems University of New South Wales School of Mechanical and Manufacturing Engineering J17 Sydney NSW 2052 Australia Graduate School of Frontier Sciences University of Tokyo 7-3-1 Hongo Bunkyo-ku Tokyo 113-8656 Japan

In recent times, there has been extensive research and development into the design phase of engineering systems such as aircrafts, vehicles and large-scale structures. In view of the mission and requirements of such engineering systems, various design criteria are contemplated owing to the system’s complexity. Recent years have also seen the rise of technological innovations particularly that of computers, involved in the evaluation and improvement of such engineering systems design. Examples of which include CAD (Computer-aided Design), CAE (Computer-aided Engineering) [1, 2] etc. These lead into the field of computational design. The objective of which is to find optimal design parameters that suit design criteria. This paper presents a multi-objective human-like optimization technique for computational engineering design. The optimization process is human-like because they are developed to mimic the human design process [3]. The human designer specifies multiple design criteria that are to be realized, propose possible designs and then later refines them in regard to his/her capability. The final design selection is then inclined towards the designer’s intuition and experience. In comparison, the presented optimization method develops multiple Pareto-optimal solutions from the feasible design space by evaluating the design’s multiple objectives. The Pareto solutions are then refined through the search algorithm, thus satisfying both design objectives and constraints. The final design is later selected by the center of gravity method proposed by the authors. Although extensive research has gone into the applications of Genetic Algorithms to multi-objective optimization [3], they are still inefficient in optimizing parameters as the nature of the algorithms is probabilistic. The search algorithms proposed are of a deterministic nature and are weightless gradient-based for efficient computation. Since the process required no prior knowledge, biasness is not involved

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隆突下积气/主支气管憩室的特征与CT表现

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国际医学放射学杂志 2010年第2期 191-191页

作者： T.Higuchi N.Takahashi M.Shiotani H.Maeda N.yoshimura 金涵弢 Department of Radiology Niigata City General Hospital463-7 Chuo-kuShumokuNiigata CityNiigata-ken950-1197Japan

本研究的目的在于评价隆突下积气在多层螺旋CT(MDCT)薄层影像上的特征及CT表现。200名无肺部疾病史且无症状的成人行MDCT检查。病灶为隆突下区域邻近主支气管的腔外气体,本文回顾性地分析其CT表现及特征。其中81人有隆突下积气,

关键词：支气管憩室隆突 CT 积气

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