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Biomedical subjects

Hiroyuki Yoshihara

Publications and source records attributed to Hiroyuki Yoshihara.

At least 19 recordsLinked to original sources

Paralysis elicited by spinal cord injury evokes selective disassembly of neuromuscular synapses with and without terminal sprouting in ankle flexors of the adult rat.

Neuromuscular junctions (NMJs) innervated by motor neurons below spinal cord injury (SCI) have been reported to remain intact despite the interruption of supraspinal pathways and the resultant loss of activity. Here we report notably heterogeneous NMJ responses to SCI that include overt synapse disassembly. Complete transection of the thoracic spinal cord of adult rats evoked massive sprouting of nerve terminals in a subset of NMJs in ankle flexors, extensor digitorum longus, and tibialis anterior. Many of these synapses were extensively disassembled 2 weeks after spinal transection but by 2 months had reestablished synaptic organization despite continuous sprouting of their nerve terminals. In contrast, uniform and persistent loss of acetylcholine receptors (AChRs) was evident in another subset of NMJs in the same flexors, which apparently lacked terminal sprouting and largely maintained terminal arbors. Other synapses in the flexors, and almost all the synapses in the ankle extensors, medial gastrocnemius, and soleus, remained intact, with little pre- or postsynaptic alteration. Additional deafferentation of the transected animals did not alter the incidence or regional distribution of either type of the unstable synapses, whereas cycling exercise diminished their incidence. The muscle- and synapse-specific responses of NMJs therefore reflected differential sensitivity of the NMJs to inactivity rather than to differences in residual activity. These observations demonstrate the existence of multiple subpopulations of NMJs that differ distinctly in pre- and postsynaptic vulnerability to the loss of activity and highlight the anatomical instability of NMJs caudal to SCI, which may influence motor deficit and recovery after SCI.

Analysis of Variance↗

Combining motor training with transplantation of rat bone marrow stromal cells does not improve repair or recovery in rats with thoracic contusion injuries.

Previous studies have demonstrated that either transplantation of bone marrow stromal cells (MSC) or physical exercise regimens can elicit limited functional recovery following spinal cord injury, presumably through different mechanisms. The present study examined whether transplantation of MSC derived from transgenic Fischer alkaline phosphatase (AP) rats, in combination with exercise, would have synergistic effects leading to recovery of function that is greater than either alone. Adult female Sprague-Dawley rats received a moderate thoracic contusion injury and were divided into three groups: operated controls (Op-Control), MSC transplant recipients (MSC), and MSC transplant recipients plus exercise (MSC+Ex). Nine days after contusion, a Vitrogen matrix +/-one million MSC was injected into the lesion site in all animals. Immunosuppression with high doses of Cyclosporine A, required for MSC survival, was provided for all animals. Passive hindlimb exercise on motorized bicycles was applied 1 h/day, 3 days/week to the MSC+Ex group. A battery of behavioral tests was performed weekly to assess motor and sensory functions in all 3 groups for 12 weeks. Morphological evaluation included MSC survival, evidence of axonal growth into grafts, phenotypic analysis of MSC, and lesion/transplant size. The weight of the medial gastrocnemius muscle, a hindlimb muscle activated during stance, was used to identify extent of atrophy. No differences in motor recovery were found among the three groups. MSC survived 3 months after transplantation, indicating that the immunosuppression treatment was successful. The extent of survival was variable, and there was no correlation between MSC survival and behavioral scores. The matrix persisted, filling the lesion cavity, and some axons grew into the lesion/matrix but to a similar extent in all groups. There was no difference in lesion/matrix size among groups, indicating no neuroprotective effect on the host provided by the treatments. Immunocytochemical analysis provided no evidence that MSC differentiated into neurons, astrocytes or oligodendrocytes. Muscle mass of the medial gastrocnemius was diminished in the Op-Control group indicating significant atrophy, but was partially preserved in both the MSC and MSC+Ex groups. Our results indicate that combining the beneficial effects of rat MSC and this exercise protocol was not sufficient to enhance behavioral recovery.

Animals↗

Beef extract supplementation increases leg muscle mass and modifies skeletal muscle fiber types in rats.

The objective of this research was to investigate the effects of beef extract on fat metabolism, muscle mass and muscle fiber types in rats. We also investigated the synergetic effect of endurance exercise. Twenty-four male rats weighing about 270 g were assigned to two diets containing 0 or 6% beef extract (BE). Half the rats fed each diet were subjected to compulsory exercise (CE) for 30 min every other day. After 4 weeks feeding, the blood was collected and various organs were dissected. The muscle fiber type of the soleus and extensor digitorum longus (EDL) muscles were evaluated by histochemical and electrophoretical analyses. Rats supplemented with BE showed a decrease in fat content in liver and abdomen and an increase in the activity of carnitine palmitoyl transferase II in liver. BE as well as exercise increased the relative weights of both soleus and EDL. BE alone and BE plus CE did not affect the distribution of muscle fiber types in soleus. BE without exercise decreased in type IIb of EDL from 54% to 44% with compensatory increase in type IIa from 41% to 49% and type I from 5% to 7% compared with the nonsupplemented, nonexercised control group. No synergetic effect on a fast to slow fiber conversion due to the combination of BE and CE was detected. Thus, BE supplement increased muscle mass and slow type fiber in EDL. The effects of BE supplement on muscle characteristics were similar to those of exercise. beef extract, fat metabolism, muscle fiber type, muscle mass, L-carnitine

Abdomen↗

Transfusion checkup system using mobile terminals.

Kyoto University Hospital introduces a new hospital information system on January 2005. The system introduces ubiquitous information system using mobile terminals for nursing information support and implements a transfusion checkup system, as a single error in the transfusion process may result in a serious accident. The developed system carefully designed to suit real workflow and to make full use of the benefits of mobile terminals increases efficiency and the safety of transfusion.

Blood Transfusion↗

Electronic clinical path system based on semistructured data model using personal digital assistant for onsite access.

Clinical Paths (Paths) have been introduced by different hospitals for patient care management. An Electronic Clinical Path (ECP) with onsite access provision seems to improve the efficiency of medical staffs because they can share vast medical information about patients at a time and also can reuse accumulated data easily, which is impossible with paper-based Path. Data model is the basis for implementing ECP. However, there is no established model for ECP. The purpose of this study is to introduce a model for ECP and implement an ECP with onsite access system. We introduced a Semistructured Data Model (SSDM) for ECP, and implemented a Web application system based on this model using Personal Digital Assistant (PDA) as inputting device. Our system functioned as expected with wireless LAN, and users handled the data on bedside using PDA. By introducing SSDM, we showed the correspondence between schema of Paths and implementation of ECP.

Access to Information↗

Dolphin project--cooperative regional clinical system centered on clinical information center.

In 2001, a system was created to improve patient service, improve the quality of medical care, and achieve efficient medical care. A Data Center was established to accumulate and manage clinical information in the regions and share clinical information safely and appropriately. The system has already been in operation for 3 years. Even though a patient may have been examined at multiple hospitals, his medical record information will be integrated at the Center. This ensures medical care continuity and enables the patient to view his own medical records at home. Its usefulness in obtaining informed consent has been demonstrated as well. XML instances established in the MML standards (MML (Medical Markup Language): http.//www.medxml.net/E_mml30/mmlv3_E_index.htm Accessed July 2004; Jpn. J. Med. Informatics (JJMI) 17(3):203-207, 1997; J. Med. Syst. 24(3):195-211, 2000; J. Med. Syst. 27(4):357-366, 2003; J. Med. Syst. 28(6):523-533, 2004) are used for Electronic Medical Record System data exchange between the Data Center and each medical institution. The openness provided by XML makes it possible to connect diverse electronic medical records to the Center. As of the year 2004, over 10 types of electronic medical records have an MML interface, enabling connection to the Center.

Cooperative Behavior↗

CLAIM (CLinical Accounting InforMation)--an XML-based data exchange standard for connecting electronic medical record systems to patient accounting systems.

With the evolving and diverse electronic medical record (EMR) systems, there appears to be an ever greater need to link EMR systems and patient accounting systems with a standardized data exchange format. To this end, the CLinical Accounting InforMation (CLAIM) data exchange standard was developed. CLAIM is subordinate to the Medical Markup Language (MML) standard, which allows the exchange of medical data among different medical institutions. CLAIM uses eXtensible Markup Language (XML) as a meta-language. The current version, 2.1, inherited the basic structure of MML 2.x and contains two modules including information related to registration, appointment, procedure and charging. CLAIM 2.1 was implemented successfully in Japan in 2001. Consequently, it was confirmed that CLAIM could be used as an effective data exchange format between EMR systems and patient accounting systems.

Accounts Payable and Receivable↗

Enhancement of CLAIM (clinical accounting information) for a localized Chinese version.

CLinical Accounting InforMation (CLAIM) is a standard for the exchange of data between patient accounting systems and electronic medical record (EMR) systems. It uses eXtensible Markup Language (XML) as a meta-language and was developed in Japan. CLAIM is subordinate to the Medical Markup Language (MML) standard, which allows the exchange of medical data between different medical institutions. It has inherited the basic structure of MML 2.x and the current version, version 2.1, contains two modules and nine data definition tables. In China, no data exchange standard yet exists that links EMR systems to accounting systems. Taking advantage of CLAIM's flexibility, we created a localized Chinese version based on CLAIM 2.1. Since Chinese receipt systems differ from those of Japan, some information such as prescription formats, etc. are also different from those in Japan. Two CLAIM modules were re-engineered and six data definition tables were either added or redefined. The Chinese version of CLAIM takes local needs into account, and consequently it is now possible to transfer data between the patient accounting systems and EMR systems of Chinese medical institutions effectively.

Accounting↗

Clinical path modeling in XML for a web-based benchmark test system for medication.

Many hospitals have introduced the Clinical Path (Path) to improve medical procedures. A Path is a way to manage care and check lists for a certain disease, providing a useful tool for hospital management. Paths can help hospitals reduce the duration of hospitalization and variations in care of patients while increasing hospital revenue. Nowadays, Paths are made by each hospital and there is no standard format. Benchmark testing between Paths used by different hospitals is important for evaluating medical practices, in order to develop and improve more effective practices. However, as the formats used in Paths are not standardized, benchmark testing of Paths is no easy task. To start benchmark testing of Paths, we compare medication in Paths and introduce description rules of medication in XML. Based on these, we developed a prototype system that enables us to compare the difference of medications in Paths prescribed between multiple of hospitals.

Benchmarking↗

Enhancement of MML medical data exchange standard for a localized Chinese version.

Medical Markup Language (MML) is a standard for the exchange of medical data among different medical institutions. It was developed in Japan in 1995. Since version 2.21, MML has used eXtensible Markup Language (XML) as a meta-language. The latest version, 3.0, conforms to HL7 Clinical Document Architecture (CDA) and contains 14 modules and 36 data definition tables. In China, a standard which structures entire medical records in XML does not yet exist. Taking advantage of MML's flexibility, we created a localized Chinese version based on MML 3.0. Parts of the original specifications have been enhanced; these include a newly developed health insurance information module and 12 additional or redefined data definition tables. The Chinese version takes local needs into account and now makes it possible to exchange medical data among Chinese medical institutions.

China↗

[Clinical information system and regional cooperative medicine].

By sharing medical information safely and appropriately with in a region, we constracted a system which provides an increase in efficiency of patient service, and improvement in the quality and efficiency of medical treatment. Even if a patient consults two or more hospitals, medical chart information is unified in the center and the continuity of the medical records is ensured. Patients can peruse their own charts from home, which is useful for informed consent.

Access to Information↗

FEM-based soft tissue destruction model for ablation simulator.

In surgical procedures, ablation is one of the most difficult skills to train and acquire. For the risk of ablation failure, ablation training environments are desired. This paper proposes FEM-based deformation and destruction soft tissue model for ablation training simulator. The proposed model employs shearing stress hypothesis. The result of simulation experiments shows that the model can express different destruction progression by manipulation.

Catheter Ablation↗

MVL: medical VR simulation library.

In the last ten years, medical VR techniques have much progress and many simulators have been developed for education, planning, rehearsal and so on. On the other hand, developing a simulator takes much more labor and cost. In this paper, we propose MVL: Medical Virtual reality simulation Library, which supports simulation of several significant medical manipulations considering multiple organ interaction. The result of developing simulators using MVL confirmed validity about variety and developing cost.

Computer Simulation↗

Interactive 3D region extraction of volume data using deformable boundary object.

This study aims to establish an interactive and intuitive region extraction environment for volume data. A volume clipping method using deformable boundary object is proposed to support 3D region extraction task. Slice-based volume rendering of boundary elements enables to visualize clipped results in real time. Geometrical transformation and physics-based deformation support intuitive modification of 3D region of interest. Some extraction tasks are tested using CT data set on the developed system. All tests confirmed real-time visualization of clipped results is effective for interactive 3D region extraction in volume visualization and virtual object modeling.

Elasticity↗

Cost accounting by diagnosis in a Japanese university hospital.

Cost accounting according to diagnoses covering approximately 600 inpatients with 64 diseases in 20 departments of Kumamoto University was carried out. The reports of these results were automatically generated and used for individual departmental meetings with participating delegates. The administration of each department as well as the management of diseases was discussed at the meetings, and all departments were requested to provide a report of their discussions. We are planning to increase the number of patients in the sample group and to perform more comprehensive and accurate hospital cost accounting.

Costs and Cost Analysis↗

The development of MML (Medical Markup Language) version 3.0 as a medical document exchange format for HL7 messages.

Medical Markup Language (MML), as a set of standards, has been developed over the last 8 years to allow the exchange of medical data between different medical information providers. MML Version 2.21 used XML as a metalanguage and was announced in 1999. In 2001, MML was updated to Version 2.3, which contained 12 modules. The latest version--Version 3.0--is based on the HL7 Clinical Document Architecture (CDA). During the development of this new version, the structure of MML Version 2.3 was analyzed, subdivided into several categories, and redefined so the information defined in MML could be described in HL7 CDA Level One. As a result of this development, it has become possible to exchange MML Version 3.0 medical documents via HL7 messages.

Medical Informatics Applications↗

A simulation model of hospital management based on cost accounting analysis according to disease.

Since a little before 2000, hospital cost accounting has been increasingly performed at Japanese national university hospitals. At Kumamoto University Hospital, for instance, departmental costs have been analyzed since 2000. And, since 2003, the cost balance has been obtained according to certain diseases for the preparation of Diagnosis-Related Groups and Prospective Payment System. On the basis of these experiences, we have constructed a simulation model of hospital management. This program has worked correctly at repeated trials and with satisfactory speed. Although there has been room for improvement of detailed accounts and cost accounting engine, the basic model has proved satisfactory. We have constructed a hospital management model based on the financial data of an existing hospital. We will later improve this program from the viewpoint of construction and using more various data of hospital management. A prospective outlook may be obtained for the practical application of this hospital management model.

Accounting↗

The latest MML (Medical Markup Language) version 2.3--XML-based standard for medical data exchange/storage.

As a set of standards, Medical Markup Language (MML) has been developed over the last 8 years to allow the exchange of medical data between different medical information providers MML version 2.21 was characterized by XML as metalanguage and was announced in 1999, at which time full-scale implementation tests were carried out; subsequently, various information and functional inadequacies were discovered in this version. MML was therefore updated to version 2.3 in 2001. At present, MML contains 12 MML modules including the new referral, test result, and report modules. In version 2.3, the group ID element was added; the access right definition and health insurance module were amended.

Humans↗