研究実績、海外留学
循環器救急疾患に関する臨床研究を行い、国内外に配信しています。主なテーマは、急性冠症候群(急性心筋梗塞、不安定狭心症)の診断と治療、うっ血性心不全の診断、治療、ならびに合併症対策(腎障害)と予後の関係、急性大動脈解離の診断、治療と合併症の評価、肺血栓塞栓症の評価、心肺停止後の脳保護を目的とした低体温療法などであります。また、循環器疾患に限らず、珍しい症例については症例報告を配信しています。
現在実施中の医学研究(患者さんへの説明と同意取得のないもの)
日本医科大学千葉北総病院集中治療室では、多くの医学研究を実施していますが、その中には通常の診療で得たデータのみを使用する研究もあります。これらの研究では患者さんの個人情報を用いることはありませんし、当院の倫理審査(倫理委員会または薬物治験審査委員会)の承認を得て実施していますが、対象となる患者さん全てに研究内容の説明と同意を取得することが困難なため、下記に研究課題を記載しますので、もし研究への参加を辞退される場合はお申し出ください。なお、ご辞退されても今後の診療に不利益になることはございません。
研究課題(研究責任者)
1.急性心不全に対する長期予後の検討(白壁章宏)
2.急性心不全におけるキサンチン酸化還元酵素活性値の検討(白壁章宏)
3.高尿酸血症が集中治療室入院症例の予後に与える影響(白壁章宏)
4.心不全におけるミトコンドリアオートファジーの検討(白壁章宏)
5.急性心不全症例における葉酸レセプターβ測定の意義(白壁章宏)
6.慢性心不全急性憎悪に対するアンギオテンシン受容体ネプリライシン阻害薬(ARNI)
導入が心保護及び予後に与える影響(白壁章宏)
問い合わせ窓口:
日本医科大学千葉北総病院
集中治療室 部長 白壁章宏
電話 0476-99-1111(病院代表)
対応可能時間
原則として月曜、金曜(祝祭日を除く)の10時~18時
最近の誌上発表
- Shigihara S et al. Successful treatment of a patient with hype-A acute aortic dissection with emergent percutaneous coronary intervention and thoracic endovascular aortic repair under percutaneous cardiopulmonary support: a case report. Eur Heart J Case Rep. 2022 Aug 16;6(9):ytac344. doi: 10.1093/ehjcr/ytac344. eCollection 2022 Sep. PMID: 37065856 Free PMC article.
- Shirakabe A et al. Effect of sacubitril/valsartan on natriuretic peptide in patients with compensated heart failure. Heart Vessels. 2023 Jun;38(6):773-784. doi: 10.1007/s00380-022-02230-9. Epub 2023 Jan 19. PMID: 3665635
- Shibata Y et al. Evaluation of Plasma Xanthine Oxidoreductase(XOR)Activity in Patients with Cardiopulmonary Arrest. Int Heart J. 2023;64(2):237-245. doi: 10.1536/ihj.22-584. PMID: 37005317
- Shirakabe A et al. Organ dysfunction, injury, and failure in cardiogenic shock. Circ J. 2023 Sep 25;87(10):1392-1402. doi: 10.1253/circj.CJ-23-0320. Epub 2023 Aug 29. PMID: 37648518
- Shibata Y et al. Reply to Letter by Kataoka, et al. Regarding Article, ”Evaluation of Plasma Xanthine Oxidoreductase(XOR)Activity in Patients with Cardiopulmonary Arrest”. Int Heart J. 2024;65(1):166-167. doi: 10.1536/ihj.23-564. PMID: 38296572 No abstract available
- Sawatani T et al. Time-Dependent Changes in N-Terminal Pro-Brain Natriuretic Peptide and B-Type Natriuretic Peptide Ratio During Hospitalization for Acute Hert Failure. Int Heart J. 2023;64(2):213-222. doi: 10.1536/ihj.22-350. PMID: 37005316
- Shirakabe A et al. Timing and Degree of Acute Kidney Injury in Patients Requiring Non-Surgical Intensive Care. Circ J. 2023 Sep 25;87(10):1392-1402. doi: 10.1253/circj.CJ-23-0320. Epub 2023 Aug 29. PMID: 3764851
- Nishigoori S et al. Trends in Sudden Death Following Admission for Acute Heart Failure.Am J Cardiol. 2022 Sep 1;178:89-96. doi:10.1016/j.amjcard.2022.05.024. Epub 2022 Jul 10. PMID: 35831216
- Nishigoori S et al. Helicopter emergency medical service for patients with acute coronary syndrome: selection validity and impact on clinical outcomes. Heart Vessels. 2022 Jul;37(7):1125-1135. doi:10.1007/s00380-022-02022-1. Epub 2022 Jan 15.PMID: 35032206
- Shirakabe A et al. Type III procollagen peptide level can indicate liver dysfunction associated with volume overload in acute heart failure. ESC Heart Fail. 2022 Jun;9(3):1832-1843.doi: 10.1002/ehf2.13878. Epub 2022 Mar 14.PMID: 35289118 Free PMC article.
- Shigihara S et al. Clinical Significance of Low-Triiodothyronine Syndrome in Patients Requiring Non-Surgical Intensive Care - Triiodothyronine Is a Comprehensive Prognostic Marker for Critical Patients With Cardiovascular Disease.Circ Rep. 2021 Sep 30;3(10):578-588.doi: 10.1253/circrep.CR-21-0040. eCollection 2021 Oct 8.PMID: 34703935 Free PMC article.
- Kiuchi K et al. The Prognostic Impact of Hospital Transfer after Admission due to Acute Heart Failure. Int Heart J. 2021;62(6):1310-1319. doi:10.1536/ihj.21-126.PMID: 34853224
- Sawatani T et al. Clinical significance of the N-terminal pro-brain natriuretic peptide and B-type natriuretic peptide ratio in the acute phase of acute heart failure.Eur Heart J Acute Cardiovasc Care. 2021 Dec 6;10(9):1016-1026. doi:10.1093/ ehjacc /zuab068.PMID: 34432003
- Shirakabe A et al. Clinical Significance of the Fibrosis-4 Index in Patients with Acute Heart Failure Requiring Intensive Care. Int Heart J. 2021 Jul 30;62(4):858-865. Doi:10.1536/ihj.20-793. Epub 2021 Jul 17.PMID: 34276014
- Matsushita M et al. Mechanisms of Urgently Presenting Acute Heart Failure. Int Heart J. 2020 Mar 28;61(2):316-324. Doi:10.1536/ihj.19-523. Epub 2020 Mar 14.PMID: 32173711
- Okazaki H et al. Time-dependent changes in plasma xanthine oxidoreductase during hospitalization of acute heart failure.ESC Heart Fail. 2021 Feb;8(1):595-604. doi : 10.1002/ehf2.13129. Epub 2020 Dec 9. PMID: 33300276 Free PMC article.
- Shirakabe A et al. Importance of the Corrected Calcium Level in Patients with Acute Heart Failure Requiring Intensive Care. Circ Rep. 2020 Dec 23;3(1):44-54. doi: 10.1253/circrep.CR-20-0068.PMID: 33693289 Free PMC article.
- Shibata Y et al. Plasma xanthine oxidoreductase (XOR) activity in patients who require cardiovascular intensive care. Heart Vessels. 2020 Oct;35(10):1390-1400. doi: 10.1007/s00380-020-01608-x. Epub 2020 Apr 27. PMID: 32342210
- Shirakabe A et al. Empagliflozin Administration Can Decrease the Dose of Loop Diuretics and Prevent the Exacerbation of Renal Tubular Injury in Patients with Compensated Heart Failure Complicated by Diabetes. Circ Rep. 2020 Sep 15;2(10):565-575. doi: 10.1253/circrep.CR-20-0041.PMID: 33693182 Free PMC article.
- Asai K et al. The effect of gonadectomy and angiotensin II receptor blockade in a mouse model of isoproterenol-induced cardiac diastolic dysfunction. J Nippon Med Sch. 2020 May 30. doi: 10.1272/jnms.JNMS.2021_88-303. Online ahead of print. PMID: 32475904 Free article.
- Shirakabe A et al. Characteristics of Patients with an Abnormally Decreased Plasma Xanthine Oxidoreductase Activity in Acute Heart Failure Who Visited the Emergency Department. Cardiology. 2020;145(8):473-480. doi: 10.1159/000508037. Epub 2020 Jul 2. PMID: 32615578
- Shirakabe A et al. Clinical Approach to Shortening Length of Hospital Stay in Elderly Patients with Acute Heart Failure Requiring Intensive Care. Circ Rep. 2020 Jan 29;2(2):95-103. doi: 10.1253/circrep.CR-19-0132.PMID: 33693214 Free PMC article.
- Shirakabe A et al. Prognostic Value of Both Plasma Volume Status and Nutritional Status in Patients with Severely Decompensated Acute Heart Failure. CJC Open. 2019 Oct 21;1(6):305-315. doi: 10.1016/j.cjco.2019.10.001. eCollection 2019 Nov.
- Shirakabe A et al. Prognostic impact of new-onset atrial fibrillation associated with worsening heart failure in aging patients with severely decompensated acute heart failure. Int J Cardiol. 2020 Mar 1;302:88-94. doi: 10.1016/j.ijcard.2019.09.020. Epub 2019 Sep 13.
- Shirakabe A et al. Relation of Low Triiodothyronine Syndorome Associated with Aging and Malnutrition to Adverse Outcome in Patients with Acute Heart Failure. Am J Cardiol. 2020 Feb 1;125(3):427-435. doi: 10.1016/j.amjcard.2019.10.051. Epub 2019 Nov 7.
- Shirakabe A et al. Scoring system in patients with acute heart failure.Int J Cardiol. 2019 Aug 6. pii: S0167-5273(19)33473-4. doi: 10.1016/j.ijcard.2019.08.012. [Epub ahead of print] No abstract available.
- Shirakabe A et al. Trends in the Management of Acute Heart Failure Requiring Intensive Care.Am J Cardiol. 2019 Jul 24. pii: S0002-9149(19)30772-6. doi: 10.1016/j.amjcard.2019.06.025. [Epub ahead of print]
- Shirakabe A et al. Hyperuricemia complicated with acute kidney injury is associated with adverse outcomes in patients with severely decompensated acute heart failure. J Cardiol Heart Vasc. 2019 Mar 21;23:100345. doi: 10.1016/j.ijcha.2019.03.005. eCollection 2019 Jun.
- Matsushita M et al. Gender Differences in the Social Determinants of the Long-term Prognosis for severely Decompensated Acute Heart Failure in Patients over 75 Years of Age.Intern Med. 2019 Jun 27. doi: 10.2169/internalmedicine.2757-19. [Epub ahead of print]
- Shibuya J et al. Comparison of Coronary Culprit Lesion Morphology Determined by Optical Coherence Tomography and Relation to Outcomes in Patients Diagnosed with Acute Coronary Syndrome During Winter -vs- Other Seasons. Int Am J Cardiol. 2019 Jul 1;124(1):31-38. doi: 10.1016/j.amjcard.2019.03.045. Epub 2019 Apr 8.
- Shirakabe A et al. Worsening renal failure in patients with acute heart failure: the importance of cardiac biomarkers.ESC Heart Fail. 2019 Apr;6(2):416-427. doi: 10.1002/ehf2.12414. Epub 2019 Feb 23.
- Kobayashi N et al. Impact of Accumulated Serum Uric Acid on Coronary Culprit Lesion Morphology Determined by Optical Coherence Tomography and Cardiac Outcomes in Patients with Acute Coronary Syndrome.Cardiology. 2018;141(4):190-198. doi: 10.1159/000496053. Epub 2019 Feb 13.
- Shibata Y et al. The prognostic impact of the uric acid level in patients who require cardiovascular intensive care - is serum uric acid a surrogate biomarker for critical patients in the non-surgical intensive care unit? Eur Heart J Acute Cardiovasc Care. 2019 Jan 17:2048872618822473. doi: 10.1177/2048872618822473. [Epub ahead of print]
- Okazaki H et al. Plasma xanthine oxidoreductase activity in patients with decompensated acute heart failure requiring intensive care.ESC Heart Fail. 2019 Apr;6(2):336-343. doi: 10.1002/ehf2.12390. Epub 2019 Jan 8.
- Kobayashi N et al. Relation of coronary culprit lesion morphology determined by optical coherence tomography and cardiac outcomes to serum uric acid levels in patients with acute coronary syndrome. Am J Cardiol (in print)
- Shirakabe A et al. Decreased Blood Glucose at Admission has a Prognostic Impact in Patients with Severely Decompensated Acute Heart Failure Complicated with Diabetes Mellitus. Heart Vessels (in print)
- Matsushita M et al. Social Determinants are Crucial Factors in the Long-term Prognosis of Severely Decompensated Acute Heart Failure in Patients over 75 Years of Age. J Cardiology (in print)
- Shirakabe A et al. Worsening renal function definition is insufficient for evaluating acute renal failure in acute heart failure. ESC Heart Failure (Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/ehf2.12264)
- Kobayashi N et al. Features and Outcomes in Patients with Calcified Nodules at Culprit Lesions of Acute Coronary Syndrome: An Optical Coherence Tomography Study. Cardiology 139(2):90-100:2018
- Shirakabe A et al. Prognostic benefit of maintaining the hemoglobin level during the acute phase in patients with severely decompensated acute heart failure. Heart Vessels (in print)
- Shirakabe A et al. The Prognostic Impact of Malnutrition in Patients with Severely Decompensated Acute Heart Failure, as Assessed Using the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) Score. Heart Vessels 2018 Feb;33(2):134-144
- Shirakabe A et al. Clinical Usefulness of Urinary Liver-Fatty Acid-Binding Protein (LFABP) Excretion for Predicting the Acute Kidney Injury and Short-term Prognosis in Acute Heart Failure Patients with non-Chronic Kidney Disease. CardioRenal Medicine 301-315:2017 (online journal)
- Shibata Y et al. A Unique 8 Fr Angled Sheath Thrombectomy System for Treating Proximal Inferior Vena Cava Thrombosis. Annals of Clinical Case Reports (online journal)
- Kobayashi N et al. Formation of Infectious Coronary Artery Aneurysms After Percutaneous Coronary Intervention in a Patient With Acute Myocardial Infarction Due to Septic Embolism. JACC: CARDIOVASCULAR INTERVENTIONS 10(3):e21-22:2017
- Nozaki A et al. The Prognostic Impact of Gender in Patients with Acute Heart Failure - An evaluation of the Age of Female Patients with Severely Decompensated Acute Heart Failure. J Cardiology 70(3):255-262:2017
- Matsushita M et al. Association between the Body Mass Index and the Clinical Findings in Patients with Acute Heart Failure - Evaluation of the Obesity Paradox in Patients with Severely Decompensated Acute Heart Failure. Heart Vessel 32:600-608:2017
- Okazaki H et al. Are Atherosclerotic Risk Factors Associated with a Poor Prognosis in Patients with Hyperuricemic Acute Heart Failure? - The Evaluation of the Causal Dependence of Acute Heart Failure and Hyperuricemia. Heart Vessel 32:436-445:2017
- Shirakabe A et al. The serum heart-type fatty acid-binding protein (HFABP) levels can be used to detect the presence of acute kidney injury on admission in patients admitted to the non-surgical intensive care unit. BMC Cardiovascular Disorders 16(1):174:2016
- Okazaki H et al. The prognostic impact of uric acid in patients with severely decompensated acute heart failure. J Cardiol 68(5): 384-391:2016
- Shibuya J et al. Intravascular Ultrasound and Optical Coherence Tomography Images for Direct Right Coronary Artery Injury after Tricuspid Valve Annuloplasty. Eurointervention 12(16):1969:2017
- Shiomura R et al. Rapid Growth of Giant Coronary Artery Aneurysm following Treatment of Stent Edge Dissection. JACC Cardiovascular Interventions 9(13): e127-128:2016
- Kobayashi N et al. Matrix Metalloproteinase-9 as a Marker for Plaque Rupture and a Predictor of Adverse Clinical Outcome in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study. Cardiology 135:56-65:2016
- Shirakabe A et al. Preventive effects of bere-metal stent on restenosis after everolimus-eluting stent deployment. Heart Vessel 31(3):434-437:2016
- Kobayashi N et al. Longitudinal stent deformation as a cause of very late stent thrombosis: Opitical coherence tomography images. Int J Cardiol 202:601-603:2016
- Kobayashi N et al. Flow-limiting thrombosis after intracoronary coil embolisation: optical coherence tomography during acute myocardial infarction. Eurointevention 11(9):1028:2016
- Kobayashi N et al. Extravasation from an accessory renal artery. A critical complication associated with percutaneous coronary intervention. JACC 8(3):e45-47:2015
- Okazaki H et al. Early effects of oral pulmonary vasodilators in an elderly patient with critical thromboembolic pulmonary hypertension: A case report. J Nippon Medical School 82(4):206-210:2015
- Yamamoto Y et al. Seasonal variation in patients with acute heart failure: Prognostic impact of admission in the summer. Heart and Vessel 30:193-203:2015
- Shirakabe A et al. Serum Heart-Type Fatty Acid-Binding Protein Level Can Be Used to Detect Acute Kidney Injury on Admission and Predict an Adverse Outcome in Patients With Acute Heart Failure. Circ J 79(1):119-128:2015
- Okazaki H et al. New scoring system (APACHE-HF) for predicting adverse outcomes in patients with acute heart failure: Evaluation of the APCHEII and modified APACHEII scoring systems. J Cardiology 64(6):441-449:2014
- Shirakabe A et al. Prognostic impact of the serum heart-type fatty acid-binding protein (H-FABP) levels in patients admitted to the non-surgical intensive care unit. Clin Res Cardiol 103(10):791-804:2014
- Shirakabe A et al. Immediate administration of Tolvaptan prevents the exacerbation of acute kidney injury and improves the mid-term prognosis in patients with severely decompensated acute heart failure. Circ J 78(4):911-921:2014
- Tomita K et al. Predicting the occurrence of oxygenation impairment in patients with type-B acute aortic dissection. Int J Angiology 23:53-60:2014
- Shinada T et al. Usefulness of a surface cooling device (Arctic Sun®) for therapeutic hypothermia following cardiac arrest. J Cardiology 63(1):46-52:2014
- Kobayashi N et al. Soluble lectin-like oxidized LDL receptor-1 (sLOX-1) as a valuable diagnostic marker for rupture of thin-cap fibroatheroma: Verification by optical coherence tomography. Int J Cardiol 168(4):3217-3223:2013
- Tsurumi M et al. Airway pressure release ventilation as a therapeutic approach in a patient with severe obesity hypoventilation syndrome and restrictive lung impairment. Int J Cardiol 168(1):e6-8:2013
- Kitamura M et al. High-sensitivity cardiac troponin T for earlier diagnosis of acute myocardial infarction in patients with initially negative troponin T test : Comparison between cardiac markers. J Cardiology 62(6):336-342:2013
- Shinada T et al. Efficacy of therapeutic hypothermia for neurological salvage in patients with cardiogenic sudden cardiac arrest: The importance of pre-hospital return of spontaneous circulation. J Nippon Medical School 80(4):287-295:2013
- Shirakabe A et al. Predictive score for survival after percutaneous cardiopulmonary support in cardiovascular disease patients. Evaluation of pre-procedual information. Circ J 77(8):2064-2072:2013
- Hata N et al. Clinical significance of acute kidney injury in non-surgical Type-B acute aortic dissection. Gazzetta Medica Italiana 172(7-8):553-560: 2013
- Kobayashi N et al. Detection of acute aortic dissection by extremely soluble lectin-like oxidized LDL receptor-1 (sLOX-1) and low troponin T levels in blood. Int J Cardiol 165(3):557-559:2013
- Kobayashi N et al. Rapid progression of acute aortic dissection demonstrated by short-term seial computed tomography. JACC 61(15):e161:2013
- Matsushita M et al. Association between the visiting time and the clinical findings on admission in patients with acute heart failure. J Cardiology 61(3):210-215:2013
- Kobayashi N et al. Intravascular ultrasound-guided endovascular stenting for celiac artery complicated with hepatic hypoperfusion folowing acute type-B aortic dissection. JACC 59(17):1568:2013
- Kobayashi N et al. Characteristics of patients with cardiac arrest caused by coronary vasospasm. Circ J 77(3):673-678:2013
- Shirakabe A et al. Prognostic impact of acute kidney injury in patients with acute decompensated heart failure. Circ J 77(3):687-696:2013
- Kobayashi N et al. Methodological Considerations for Utilizing Plasma Matrix Metalloproteinase-9 as a Biomarker in Acute Coronary Syndromes -Reply- Circ J 76(4):1044-1045:2012
- Shirakabe A et al. Immediate administration of atorvastatin decreased the serum MMP-2 level and improved the prognosis for acute heart failure. J Cardiology 59(3):374-382:2012
- Shirakabe A et al. Clinical significance of acid-base balance in an emergency setting in patients with acute heart failure. J Cardiology 60(4):288-294:2012
- Shirakabe A et al. Long-term prognostic impact after acute kidney injury in patients with acute heart failure. Evaluation of the RIFLE criteria. Int Heart Journal 53(5):313-319:2012
- Kobayashi N et al. Soluble Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 as an Early Biomarker for ST Elevation Myocardial Infarction -Time-Dependent Comparison With Other Biomarkers– Circ J 75(6):1433-1439:2011
- Hata N et al. Severity of cardiovascular disease patients transported by air ambulance. Air Medical J 30(6):328-332:2011
- Kobayashi N et al. Matrix Metalloproteinase-9 for the Earliest Stage Acute Coronary Syndrome -Comparison With High-Sensitivity Troponin T- Circ J 75(12):2853-2861:2011
- Kobayashi N et al. Soluble Lectin-Like Oxidized LDL Receptor-1 and High Sensitivity Troponin T as Diagnostic Biomarkers for Acute Coronary Syndrome. Circ J 75(12):2862-2871:2011
- Shirakabe A et al. Predicting the success of noninvasive positive pressure ventilation in emergency room for patients wuth acute heart failure. J Cardiology 57(1):107-114:2011
- Kobayashi N et al. Optical Coherence Tomography Findings in a Case of Acute Coronary Syndrome Caused by Coronary Vasospasm. Int Heart J 51(4):291-292:2010
- Kobayashi N et al. Reccurent very late thrombosis of drug-eluting stent: Optical coherence tomography findings. J Cardiology Case (JCCASE) 2:e166-e169:2010
- Shirakabe A et al. Clinical Significance of Matrix Metaloproteinase (MMP)-2 in Patients With Acute Heart Failure. Int Heart Journal 51(6):404-410:2010
- Shirakabe A et al. Effiacy and safety of nicorandil therapy in patients with acute heart failure. J Cardiology 56(3):339-347:2010
- Hata N et al. Acute kidney injury and outcomes in acute decompensated heart failure: evaluation of RIFLE criteria in an acutely ill heart failure population. Euro JHF 12(1):32-37:2010
- Yokoyama S et al. Difference in Neointimal Proliferation between Ruptured and Non-Ruptured Segment After Bare Metal Stent Implantation. Int Heart J 51(1):7-12:2010
- Yokoyama S et al. Extended Follow-Up by Serial Angioscopic Observation for Bare-Metal Stents in Native Coronary Arteries: From Healing Response to Atherosclerotic Transformation of Neointima. Circulation:Cardiovascular Interventions 2:205-212:2009
- Akutsu K et al. Immediate Disappearance of Thrombosed False Lumen in Ascending Aorta of Retrograde Type A Aortic Dissection. Ann Thorac Surg 89:e49:2009
- Kobayashi N et al. A case of Myocardial Infarction Caused by Coronary Vasospasm: Efficacy of Soluble Lectin-Like Oxidized LDL Recptor-1 for Distinguishing between Vasospasm and Plaque Rupture. J Nippon Medical School 76(5):268-271:2009
海外留学
小林宣明 2012年8月から2014年7月
米国、コロンビア大学
白壁章宏 2014年2月から2016年1月
米国、ニュージャージー州立医科歯科大学 細胞生物学分子医学部門/心血管研究施設
留学だより
白壁章宏 留学を終えて
Rutgers University New Jersey Medical School
2014年2月から2016年1月までアメリカNew Jersey州にありますRutgers University New Jersey Medical School (旧 University of Medicine and Dentistry of New Jersey)佐渡島純一教授研究室に2年間留学させていただいておりました。教授の佐渡島純一先生は、細胞生化学の分野では世界的に権威のある方で、研究室には世界中から研究者が集まっており、とても充実した日々を過ごすことができました。
留学中は、心肥大及び心不全時に心筋細胞で実際何が起こっているのかを研究する基礎実験に没頭する日々でした。主に心筋細胞でのミトコンドリア動態、オートファジーの仕組みなどを中心に研究しました。オートファジーとは、細胞が持っている細胞内の異常なタンパク質を分解するための仕組みで、心筋細胞に虚血、圧負荷などのストレスが加わった時に細胞内で増加する異常タンパク質を除去しようとしたり、リサイクルを行おうとする自浄能力のような働きです。心不全時に心筋細胞では異常なタンパク質の自浄能力が低下しており、特に、心臓の主なエネルギー源であるATPを産生するミトコンドリアの機能が低下した際の自浄能力(ミトコンドリアオートファジー)が低下していることが解明されました。そして、この低下しているミトコンドリアオートファジーを活性化させるペプチドをマウスに投与することでマウスを心不全から回避させることができました。心不全におけるミトコンドリアオートファジーはまだまだ不明な点が多く、世界的に有名な施設でこれらの研究に携わることができたのは、非常に有意義なことでした。今後は、これらの留学での基礎研究を実際の患者様への医療に役立てられるように多方面で仕事ができればと思っています。
留学させていただいたことで、たくさんの異文化経験をすることができました。日本を離れて生活することで日本の素晴らしさを感じることもたくさんありました。留学中の時間はすべての意味でかけがえのない時間となりました。今後は、これらの経験をもとに留学前よりもさらに人間として成長した姿勢で患者様の医療に携われればと思っています。
留学を終えて 小林宣明
Columbia University Medical Center & Cardiovascular Research Foundation
このたび、アメリカ合衆国ニューヨーク州にあるColumbia University Medical Center New York Presbyterian Hospital (NYPH) およびCardiovascular Research Foundation (CRF)での2年間の留学を終え、2014年7月に帰国しました。留学中は、冠動脈造影の解析、血管内超音波(IVUS)、光干渉断層装置(OCT)、近赤外線分光解析(NIRS)等の血管内画像診断の解析、心臓MRIの解析を勉強してまいりました。NYPHは、U.S News Best Hospital 2012-13 のCardiology & Heart surgery 部門で全米4位にランキングされるなど、全米屈指の病院です。年間3000例を超える経皮的冠動脈インターベンション(PCI)に加え、Structural Heart Diseaseに対する経皮的なカテーテル治療も多く行われており、その多くに携わり勉強してきました。CRFはTranscatheter Cardiovascular Therapeutics (TCT) conference や、American College of Cardiology i 2 summit を主宰するなど、循環器、特に血管内治療に関して全米屈指の研究施設です。留学中は、多施設研究の画像解析に携わり、またTCT主催にもかかわり、多くの経験をしました。
あっという間の2年間でしたが、留学中は画像解析が主体で、臨床に深く没頭することはできず、臨床に対する欲求が募る日々でした。帰国後は念願かない、北総病院集中治療室に配属され、臨床にどっぷりつかった毎日を送っています。留学での経験を帰国後の臨床に生かして頑張っていこうと思います。