Nagoya Journal of Medical Science最新文献

{"title":"Myonectin stimulates endothelial angiogenic activity in vitro and in vivo.","authors":"Tomohiro Masutomi, Noriyuki Ouchi, Shukuro Yamaguchi, Koji Ohashi, Naoya Otaka, Zhongyue Pu, Yuuki Shimizu, Toyoaki Murohara, Rei Shibata","doi":"10.18999/nagjms.87.2.285","DOIUrl":"10.18999/nagjms.87.2.285","url":null,"abstract":"<p><p>Endurance exercise is known to reduce the risk of cardiovascular disease. Myonectin, a myokine, is increased by endurance exercise and affects remote organs such as the heart. However, the role of myonectin in the blood vessels is unknown. In this study, we investigated the role of myonectin in angiogenesis. Human umbilical vein endothelial cells (HUVECs) were treated with recombinant myonectin to assess tube formation, proliferation, and migration. An in vivo Matrigel plug assay was performed by transplanting Matrigel containing myonectin into myonectin-knockout (Myo-KO) mice, and angiogenic response was evaluated. Mouse models of hindlimb ischemia were developed by ligating and removing the femoral arteries of wild-type (WT), Myo-KO, and myonectin-overexpressing transgenic (Myo-TG) mice, and blood flow was evaluated over time by laser Doppler imaging. In vitro, treatment with myonectin increased the differentiation of HUVECs into vascular-like structures. Myonectin significantly stimulated HUVEC migration, as assessed using a modified Boyden chamber assay. Treatment with myonectin also increased HUVEC proliferation, as assessed by the MTS assay. In the Matrigel plug assay, plugs containing myonectin displayed a significantly higher-degree of endothelial cell infiltration than plugs containing vehicle. Angiogenic repair of ischemic hindlimbs was impaired in Myo-KO mice compared to that in WT mice. However, Myo-TG mice had significantly increased limb perfusion after ischemic surgery compared to that in WT mice. This study showed that myonectin acts directly on vascular endothelial cells and promotes angiogenesis. Treatment aimed at increasing myonectin production may be useful in the treatment of cardiovascular diseases with vascular dysfunction.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"87 2","pages":"285-294"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal changes in transcutaneous hemoglobin levels and their influencing factors in postpartum women: a longitudinal study.","authors":"Mikiko Shimizu, Shigemi Iriyama","doi":"10.18999/nagjms.87.2.339","DOIUrl":"10.18999/nagjms.87.2.339","url":null,"abstract":"<p><p>This study aimed to clarify the temporal changes in transcutaneous hemoglobin levels up to 1 month postpartum and the influencing factors in postpartum women using a noninvasive transcutaneous hemoglobin measuring device. The study participants were pregnant women recruited at an outpatient clinic. We collected information on their dietary history using a concise self-administered questionnaire and an agreement document when they were hospitalized for delivery. Transcutaneous hemoglobin levels of the mothers were measured using Pronto (Masimo) at 1 day, 4 days, 2 weeks, and 1 month postpartum. We included 135 mothers (mean age, 31.7 years) who delivered at full term. The mean transcutaneous hemoglobin levels decreased slightly from day 1 (11.9 ± 1.6 g/dL) to day 4 postpartum (11.8 ± 1.7 g/dL), followed by a significant increase from day 4 to 2 weeks postpartum (13.8 ± 1.0 g/dL; p < 0.01), and no change from 2 weeks to 1 month postpartum (13.8 ± 0.9 g/dL). Iron intake in the third trimester of pregnancy affected transcutaneous hemoglobin levels from day 4 postpartum to recovery by 2 weeks postpartum. The rapid increase in hemoglobin levels from day 4 to 2 weeks postpartum was a novel finding. Evaluation of hemoglobin levels in women at 2 weeks postpartum is important for postpartum recovery. Furthermore, health guidance regarding iron intake in the third trimester of pregnancy has been suggested to be effective in restoring postpartum hemoglobin levels.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"87 2","pages":"339-350"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comprehensive analysis of the acromial morphology and etiological factors for rotator cuff tears in Fosbury flop tears: bursal-sided partial-thickness tears versus full-thickness tears.","authors":"Yukihiro Kajita, Yohei Harada, Ryosuke Takahashi, Ryosuke Sagami, Yusuke Iwahori","doi":"10.18999/nagjms.87.2.320","DOIUrl":"10.18999/nagjms.87.2.320","url":null,"abstract":"<p><p>Fosbury flop tears (FFTs) are a type of rotator cuff tear characterized by the tendon flipping upon itself and adhering medially. These tears have been observed arthroscopically as either bursal-sided partial-thickness tears (BSPTTs) or full-thickness tears (FTTs), though the mechanism leading to FFTs in these tear types remains unclear. This study aimed to investigate the clinical features, acromial morphology, and treatment outcomes of FFTs, stratifying patients into BSPTT and FTT groups. We included patients with small-to-medium-sized supraspinatus tendon tears who underwent arthroscopic rotator cuff repair (ARCR). Those with BSPTTs were categorized as Group P, and those with FTTs as Group F. Variables such as age, sex, diabetes mellitus status, critical shoulder angle (CSA), lateral acromial angle (LAA), sagittal and coronal acromion morphologies, Japanese Orthopaedic Association (JOA) score, and retear rate were evaluated. Group P consisted of 13 patients, primarily younger males with traumatic tears, while Group F included 40 patients, with a higher proportion of females. There were no significant differences between the groups in CSA, LAA, JOA scores, or retear rates. Both groups had a high prevalence of double-floor type osteophytes in coronal acromial morphology. FFTs were frequently observed in both BSPTTs and FTTs, particularly in patients with double-floor osteophytes. BSPTTs with FFTs may be more common in younger patients with trauma. Overall, ARCR outcomes for FFTs were similar between BSPTTs and FTTs, suggesting similar efficacy in treatment across these tear types.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"87 2","pages":"320-328"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calcineurin in cancer signaling networks.","authors":"Honoka Haba, Shoma Tsubota, Midori Shimada","doi":"10.18999/nagjms.87.2.182","DOIUrl":"10.18999/nagjms.87.2.182","url":null,"abstract":"<p><p>Calcium/calcineurin/nuclear factor of activated T-cell signaling is a vital regulator of the development and function of immune, nervous, cardiovascular, and musculoskeletal systems. The dysregulation of calcineurin activity has been implicated in various pathological conditions, including certain cancers, cardiac hypertrophy, and neurodegenerative disorders. Calcineurin is highly expressed in certain cancers and stabilizes and activates factors that promote cancer cell proliferation. Research has shown that protein dephosphorylation by calcineurin contributes to tumor formation and progression. Thus, elucidating molecular mechanisms of calcineurin-mediated tumorigenesis and tumor cell growth and targeting signaling pathways downstream of calcineurin may lead to new cancer therapies. This study reviewed the multiple roles of calcineurin in cell cycle progression and its potential as a target for cancer treatment.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"87 2","pages":"182-195"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Durvalumab-combined chemotherapy for biliary tract cancer in a Japanese expert center: initial 50 cases in daily practice.","authors":"Yoshikuni Inokawa, Shunsuke Onoe, Shoji Kawakatsu, Masamichi Hayashi, Nobuyuki Watanabe, Osamu Maeda, Takashi Mizuno, Hideki Takami, Hiroki Kawashima, Yuichi Ando, Tomoki Ebata","doi":"10.18999/nagjms.87.2.254","DOIUrl":"10.18999/nagjms.87.2.254","url":null,"abstract":"<p><p>Combination regimen consisting of gemcitabine, cisplatin, and durvalumab (GCD) has been employed for unresectable biliary tract cancer (BTC) since the end of 2022 in Japan. Here, we summarize our experience with GCD to demonstrate the clinical outcomes in a practical setting. Patients who underwent GCD for unresectable/recurrent BTC between January and December 2023 were investigated retrospectively. Data for maximal response rate (RR), disease control rate (DCR), and adverse events (AEs) were collected. Progression-free survival (PFS) and overall survival (OS) curves were generated using the Kaplan-Meyer method. Fifty (initially unresectable, n = 32; recurrence after surgery, n = 18) consecutive patients were enrolled, 19 of whom started GCD as second-line therapy or later. Overall RR was 24.0% including complete response in 1 (2%) patient and partial response in 11 (22%) patients; DCR was 68.0%. The median PFS and OS were 7.1 months and not reached, respectively. During a median follow-up period of 8.5 months, 8 (16%) patients underwent surgical resection. A total of 36 (72%) patients suffered Grade 3-5 AE, and 3 immune-related AE were controlled with injection of corticosteroid or observation. The efficacy of GCD for unresectable/recurrent BTC was confirmed in the practical setting, with acceptable toxicity, prolonged survival, and potential probability of resection.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"87 2","pages":"254-263"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meflin/Islr is a marker of fibroblasts that arise in fibrotic regions after spinal cord injury.","authors":"Yoshinori Morita, Yukihiro Shiraki, Akira Kato, Yasuhiro Nagatani, Ryota Ando, Hiroaki Nakashima, Shiro Imagama, Atsushi Enomoto","doi":"10.18999/nagjms.87.2.305","DOIUrl":"10.18999/nagjms.87.2.305","url":null,"abstract":"<p><p>Scar formation after spinal cord injury (SCI) hampers axonal regeneration and functional recovery. Previous studies have shown that scar formation is attributable to both gliosis and fibrosis, the latter requiring fibroblast proliferation and extracellular matrix deposition. In this setting, there are essentially two cell types generating new fibroblasts: pericytes and tissue-resident fibroblasts. Here, we showed that Meflin, a glycosylphosphatidylinositol-anchored protein (a specific marker of fibroblasts across multiple organs) is expressed by fibroblasts in the normal mouse spinal cord. An in situ hybridization analysis showed that Meflin⁺ cells arose from the meninges and perivascular region of the spinal parenchyma after spinal cord compression injury. That finding was corroborated by single-cell transcriptomic data from normal and injured mouse spinal cords. Interestingly, Meflin⁺ cells are positive for the fibroblast markers collagen type I and platelet-derived growth factor receptor (PDGFR) α but not for pericyte markers such as PDGFRβ and chondroitin sulfate proteoglycan 4 in the normal spinal cord. Those findings are consistent with the recent view that tissue-resident fibroblasts play a central role in many other types of fibrotic disease. A lineage-tracing experiment using a knock-in mouse line that expressed inducible Cre recombinase under the control of the Meflin promoter showed that Meflin⁺ cells yield PDGFRβ⁺ myofibroblasts but not glial cells positive for glial fibrillary acidic protein. These findings suggest that the Meflin⁺ population contains the cells of origin of myofibroblasts that are involved in scar formation after SCI.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"87 2","pages":"305-319"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of long-term systolic blood pressure variability for predicting the development of type 2 diabetes mellitus.","authors":"Zean Song, Yuanying Li, Young-Jae Hong, Chifa Chiang, Masaaki Matsunaga, Yupeng He, Atsuhiko Ota, Koji Tamakoshi, Hiroshi Yatsuya","doi":"10.18999/nagjms.87.2.220","DOIUrl":"10.18999/nagjms.87.2.220","url":null,"abstract":"<p><p>Better identification of individuals at high risk for type 2 diabetes mellitus (T2DM) requires risk-prediction models incorporating novel predictors. Accordingly, this study aimed to evaluate the merits of including long-term systolic blood pressure variability (SBPV) in predicting T2DM incidence in a Japanese cohort of 3017 participants (2446 men, 571 women; age, 36-65 years) in 2007, who were followed up until March 2019. Consecutive SBP values, recorded between 2003 and 2007, were regressed annually for each participant. The slope and root-mean-square error of the regression line were calculated for each individual to represent SBPV. The significance of SBPV was examined by adding it to a multivariate Cox model incorporating age, sex, smoking status, regular exercise, family history of diabetes, body mass index, blood levels of triglycerides, high-density lipoprotein cholesterol, and fasting blood glucose. The c-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to compare the performance of the prediction models without (Model 1) and with (Model 2) SBPV. During the 9.8-year follow-up period, 135 participants developed T2DM. Although a statistically significant difference in c-index between Model 1 (0.785) and Model 2 (0.786) was not found, the NRI (8.312% [<i>p</i> < 0.001]) and IDI (0.700% [<i>p</i> = 0.012]) demonstrated that the performance of Model 2 improved compared with Model 1. In conclusion, results suggested that long-term SBPV slightly improved predictive utility for T2DM when added to a conventional prediction model. The study was registered at University Hospital Medical Information Network Clinical Trial registry (UMIN000052544, https://www.umin.ac.jp/).</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"87 2","pages":"220-236"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early introduction of intravenous oxycodone injection followed by quick titration to oral oxycodone in outpatient cancer pain treatment in opioid-naïve patients: \"oxycodone bridge method\".","authors":"Kazuhiro Hiramatsu, Masahide Fukaya, Taro Aoba, Atsuki Arimoto, Hiromasa Yamashita, Yu Nakashima","doi":"10.18999/nagjms.87.2.272","DOIUrl":"10.18999/nagjms.87.2.272","url":null,"abstract":"<p><p>Following opioid therapy initiation in opioid-naïve outpatients, cancer-related pain does not improve immediately, and pain relief is maintained after many days. This prospective study aimed to evaluate the feasibility of quick opioid introduction with injectable oxycodone for outpatient cancer-related pain and bridge to oral persistent-release tablet. Patients with Numerical Rating Scale of ≥4 for cancer-related pain were included. Injectable oxycodone 2 mg was evaluated for efficacy and safety after 30 min of administration; in case of lower efficacy, injectable oxycodone was administered for another 30 min. For patients exhibiting improvement 30 and 60 min after injectable oxycodone administration, oral persistent-release tablet 5 and 10 mg were initiated, respectively. If side effects are acceptable, oral persistent-release tablet twice daily was prescribed. The final evaluation for its efficacy and safety was conducted at revisit. Overall satisfaction (1-5 points, higher points are better) was evaluated. The study included 23 patients (26 symptoms). The Numerical Rating Scale was improved from 6.7 ± 1.9 to 2.5 ± 2.5 and 1.3 ± 1.3 at 30 min after injectable oxycodone and revisit, respectively. Five patients with six symptoms receiving 60 min of injectable oxycodone had Numerical Rating Scale of 3.7 ± 1.7 and 1.7 ± 1.2 at revisit. No patient had Grade 3 or higher side effect during injectable oxycodone and at revisit. The overall satisfaction was 4.4 ± 0.8. In conclusion, early injectable oxycodone introduction for opioid-naïve outpatients can be feasible and useful as a quick bridge to oral persistent-release tablet.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"87 2","pages":"272-284"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep-learning reconstruction of the prostate improves image quality and acquisition time in T2-weighted imaging.","authors":"Daichi Kobayashi, Hayato Tomita, Tsuyoshi Morimoto, Yuki Deguchi, Hirofumi Fukuchi, Hikaru Ishida, Kumie Miyakawa, Yasuyuki Kobayashi, Hidefumi Mimura","doi":"10.18999/nagjms.87.2.264","DOIUrl":"10.18999/nagjms.87.2.264","url":null,"abstract":"<p><p>We compared the qualitative and quantitative quality of prostate conventional T2-weighted imaging and T2-weighted imaging with deep-learning reconstruction. Patients with suspected prostate cancer undergoing magnetic resonance imaging between April 2022 and June 2023 were included. Quantitative analysis was performed to determine the signal-to-noise and contrast ratios of the perirectal fat tissue, internal obturator muscle, and pubic tubercle. Eight periprostatic anatomical structures, overall image quality, and motion artifacts were evaluated by two radiologists using 5- or 4-point scales. Qualitative analysis results were compared to determine the agreement between the two radiologists. In total, 106 patients (mean age: 71 ± 8.3 years; 106 men) were included in this study. The acquisition time for conventional T2-weighted imaging and T2-weighted imaging with deep-learning reconstruction was 4 min and 16 s and 2 min and 12 s, respectively. The signal-to-noise ratio of the perirectal fat tissue and internal obturator muscle and contrast ratio of fat/muscle and bone/muscle determined via T2-weighted imaging with deep-learning reconstruction were significantly superior to those determined via conventional T2-weighted imaging (both <i>p</i> < 0.01). Compared with conventional T2-weighted imaging, T2-weighted imaging with deep-learning reconstruction showed significant improvement in the visualization of the periprostatic anatomy, overall image quality, and motion artifacts (both <i>p</i> < 0.05). Compared with conventional methods, T2-weighted imaging with deep-learning reconstruction facilitated the acquisition of good-quality magnetic resonance images of the prostate within a shorter acquisition time. T2-weighted imaging with deep-learning reconstruction will aid clinicians in diagnosing prostate cancer with shortened acquisition time while maintaining quantitative and qualitative image properties.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"87 2","pages":"264-271"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of anesthesiologists' non-technical skills in the management of a case of life-threatening cardiac tamponade during robot-assisted thoracic surgery.","authors":"Kochi Yamane, Toyofumi Fengshi Chen-Yoshikawa","doi":"10.18999/nagjms.87.2.368","DOIUrl":"10.18999/nagjms.87.2.368","url":null,"abstract":"<p><p>Deficiency of non-technical skills may increase the number of adverse events in the operating room. Sustained life-threatening hypotension due to intraoperative cardiac tamponade during robot-assisted thoracic surgery is rare, requiring prompt assessment and swift decision-making. A 54-year-old woman was scheduled to undergo robot-assisted thoracic surgery for an anterior mediastinal tumor. During the operation, hemodynamic instability occurred despite the administration of a high dose of vasopressor. Anesthesiologists and thoracic surgeons shared information regarding the situation, and decided to perform echocardiography and call other physicians for assistance. Cardiac tamponade was diagnosed during echocardiography, and an incision was made in the pericardium. The patient recovered from the critical situation and was extubated in the operating room. Particularly in robot-assisted surgery, non-technical skills are indispensable to enable the anesthesiologist to successfully manage critical hemodynamic instability owing to unexplained causes.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"87 2","pages":"368-373"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}