研究者総覧

島 惇 (シマ ジュン)

  • 麻酔科学・集中治療医学講座(集中治療医学部門) 助教
Last Updated :2021/09/22

研究者情報

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科研費研究者番号

  • 20742860

J-Global ID

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  • その他 / その他

研究活動情報

論文

  • 敗血症性急性腎傷害に対する急性血液浄化療法後の透析離脱困難を予測する因子の解析
    島 惇, 方山 真朱, 藤内 研, 後藤 祐也, 鯉沼 俊貴, 小山 寛介, 布宮 伸
    日本集中治療医学会雑誌 26 Suppl. [P20 - 6] (一社)日本集中治療医学会 2019年02月 [査読有り][通常論文]
  • 敗血症性DICの診断に急性期DIC基準を用いるか?(vs ISTH DIC基準、日本血栓止血学会DIC基準) 敗血症性DICの診断に急性期DIC診断基準を用いない
    小山 寛介, 方山 真朱, 藤内 研, 島 惇, 鯉沼 俊貴, 布宮 伸
    日本集中治療医学会雑誌 26 Suppl. [PC5 - 2] (一社)日本集中治療医学会 2019年02月 [査読有り][通常論文]
  • Shinshu Katayama, Kansuke Koyama, Yuya Goto, Toshitaka Koinuma, Ken Tonai, Jun Shima, Masahiko Wada, Shin Nunomiya
    BMC Nephrology 19 1 101  2018年05月 [査読有り][通常論文]
     
    Background: We hypothesized that the use of actual body weight might lead to more frequent misdiagnosis of acute kidney injury (AKI) than when ideal body weight is used in underweight and/or obese patients. We examined which definition of body weight is most effective in establishing a urinary diagnosis of AKI in septic patients. Methods: Consecutive patients aged ≥ 20 years admitted to the intensive care unit of a university hospital between June 2011 and December 2016 were analyzed. Sepsis was defined in accordance with the Sepsis-3 criteria. AKI was defined as a urinary output of < 0.5 mL/kg/6h during intensive care unit stay. Patients were divided into one of four body mass index-based classes. The severity of illness and 90-day mortality were compared across the body mass index subgroups in patients diagnosed using the actual body weight or ideal body weight. Results: Of 5764 patients, 569 septic patients were analyzed. One hundred and fifty-three (26.9%) and 140 (24.6%) patients were diagnosed as having AKI using actual body weight and ideal body weight, respectively. There were no significant differences in the severity of illness among these groups. Also, 90-day mortality did not differ significantly among these groups. According to body mass index, 90-day mortality significantly differed in patients diagnosed using their actual body weights (underweight vs. normal vs. overweight vs. obese: 76.7% vs. 39.5% vs. 26.0% vs. 35.7%, P = 0.033). Conclusion: Generally, using actual body weight to calculate the weight-adjusted hourly urine output for diagnosing AKI increased the sensitivity compared to ideal body weight, irrespective of the severity of illness in septic patients. Delayed diagnosis, however, was more common among underweight patients in this situation, and clinicians should be cautious when diagnosing urinary AKI using actual body weight.
  • Kansuke Koyama, Shinshu Katayama, Tomohiro Muronoi, Ken Tonai, Yuya Goto, Toshitaka Koinuma, Jun Shima, Shin Nunomiya
    PLoS ONE 13 1 e0192064  2018年01月 [査読有り][通常論文]
     
    Introduction The pathogenesis of thrombocytopenia in patients with sepsis is not fully understood. The aims of this study were to investigate changes in thrombopoietic activity over time by using absolute immature platelet counts (AIPC) and to examine the impact of platelet production on thrombocytopenia and mortality in patients with sepsis. Methods This retrospective observational study included adult patients with sepsis admitted to the intensive care unit at a university hospital. Two hundred five consecutive sepsis patients were stratified into four groups according to nadir platelet count: severe (nadir 40×103/μL), moderate (41–80×103/μL), or mild thrombocytopenia (81–120×103/μL), or normal-increased platelet count (> 120×103/μL). The development of thrombocytopenia was assessed during the first week mortality was assessed at day 28. Result Of the 205 patients included, 61 (29.8%) developed severe thrombocytopenia. On admission, AIPC did not differ among the four groups. In patients with severe thrombocytopenia, AIPC decreased significantly from days 2 to 7, but remained within or above the normal range in the other three groups (overall group comparison, P< 0.0001). Multivariate analysis including coagulation biomarkers revealed that AIPC was independently associated with the development of severe thrombocytopenia (day 3 AIPC, odds ratio 0.49 [95% confidence interval (CI) 0.35–0.66], P< 0.0001 day 5 AIPC, 0.59 [95% CI 0.45–0.75], P< 0.0001). AIPC was a significant predictor of 28-day mortality in Cox hazard models adjusted for Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores (day 3 AIPC, hazard ratio 0.70 [95% CI 0.52–0.89], P = 0.0029 day 5 AIPC, 0.68 [95% CI 0.49–0.87], P = 0.0012). Conclusions Thrombopoietic activity was generally maintained in the acute phase of sepsis. However, a decrease in AIPC after admission was independently associated with the development of severe thrombocytopenia and mortality, suggesting the importance of suppressed thrombopoiesis in the pathophysiology of sepsis-induced thrombocytopenia.
  • Shinshu Katayama, Ken Tonai, Yuya Goto, Kansuke Koyama, Toshitaka Koinuma, Jun Shima, Masahiko Wada, Shin Nunomiya
    Journal of intensive care 6 55 - 55 2018年 [査読有り][通常論文]
     
    Background: Intravenous glycerol treatment, usually administered in the form of a 5% fructose solution, can be used to reduce intracranial pressure. The administered fructose theoretically influences blood lactate levels, although little is known regarding whether intravenous glycerol treatment causes transient hyperlactatemia. This study aimed to evaluate blood lactate levels in patients who received intravenous glycerol or mannitol. Methods: This single-center prospective observational study was performed at a 14-bed general intensive care unit between August 2016 and January 2018. Patients were excluded if they were < 20 years old or had pre-existing hyperlactatemia (blood lactate > 2.0 mmol/L). The included patients received intravenous glycerol or mannitol to reduce intracranial pressure and provided blood samples for lactate testing before and after the drug infusion (before the infusion and after 15 min, 30 min, 45 min, 60 min, 90 min, 120 min, and 150 min). Results: Among the 33 included patients, 13 patients received 200 mL of glycerol over 30 min, 13 patients received 200 mL of glycerol over 60 min, and 7 patients received 300 mL of mannitol over 60 min. Both groups of patients who received glycerol had significantly higher lactate levels than the mannitol group (2.8 mmol/L vs. 2.2 mmol/L vs. 1.6 mmol/L, P < 0.0001), with the magnitude of the increase in lactate levels corresponding to the glycerol infusion time. There were no significant inter-group differences in cardiac index, stroke volume, or stroke volume variation. In the group that received the 30-min glycerol infusion, blood lactate levels did not return to the normal range until after 120 min. Conclusions: Intravenous administration of glycerol leads to higher blood lactate levels that persist for up to 120 min. Although hyperlactatemia is an essential indicator of sepsis and/or impaired tissue perfusion, physicians should be aware of this phenomenon when assessing the blood lactate levels.
  • Shinshu Katayama, Shin Nunomiya, Kansuke Koyama, Masahiko Wada, Toshitaka Koinuma, Yuya Goto, Ken Tonai, Jun Shima
    Critical Care 21 1 229  2017年08月 [査読有り][通常論文]
     
    Background: Endothelial activation and damage occur early during sepsis, with activated coagulopathy and playing a major role in the pathophysiology of sepsis-induced acute kidney injury (AKI). The aim of this study was to compare the various biomarkers of endothelial injury with the biomarkers of coagulation and inflammation and to determine a significant predictor of AKI in patients with sepsis. Methods: We conducted a single-center, retrospective, observational study on patients with sepsis fulfilling the Third International Consensus Definitions for Sepsis and Septic Shock criteria admitted to an adult intensive care unit (ICU) at a university hospital from June 2011 to December 2016. Levels of 13 biomarkers were measured on ICU admission, including markers of endothelial injury (soluble thrombomodulin [sTM], E-selectin, protein C, and plasminogen activator inhibitor-1 [PAI-1]) and markers of coagulation derangement (platelet count, fibrin degradation product [FDP], prothrombin time [PT], fibrinogen, α2-plasminogen inhibitor [α2-PI], antithrombin III [AT III], plasminogen, thrombin-antithrombin complex, and plasmin-α2-plasmin inhibitor complex). All patients with sepsis were reviewed, and the development of AKI was evaluated. Multivariate logistic regression analysis was performed to identify significant independent predictive factors for AKI. Results: Of the 514 patients admitted with sepsis, 351 (68.3%) developed AKI. Compared with the non-AKI group, all the endothelial biomarkers were significantly different in the AKI group (sTM [23.6 vs. 15.6 U/ml, P < 0.0001], E-selectin [65.5 vs. 46.2 ng/ml, P = 0.0497], PAI-1 [180.4 vs. 75.3 ng/ml, P = 0.018], and protein C [45.9 vs. 58.7 ng/ml, P < 0.0001]). Biomarkers of coagulopathy and inflammation, platelet counts, FDP, PT, α2-PI, AT III, plasminogen, and C-reactive protein were significantly different between the two groups. Multivariable logistic regression analysis showed that sTM was an independent predictive factor of AKI, with an AUROC of 0.758 (P < 0.0001). Conclusions: Endothelial biomarkers were significantly changed in the sepsis patients with AKI. Particularly, sTM was an independent predictive biomarker for the development of AKI that outperformed other coagulation and inflammation biomarkers as well as organ function in patients with sepsis.
  • Shinshu Katayama, Shin Nunomiya, Kansuke Koyama, Masahiko Wada, Toshitaka Koinuma, Yuya Goto, Ken Tonai, Jun Shima
    CRITICAL CARE 21 2017年08月 [査読有り][通常論文]
     
    Background: Endothelial activation and damage occur early during sepsis, with activated coagulopathy and playing a major role in the pathophysiology of sepsis-induced acute kidney injury (AKI). The aim of this study was to compare the various biomarkers of endothelial injury with the biomarkers of coagulation and inflammation and to determine a significant predictor of AKI in patients with sepsis. Methods: We conducted a single-center, retrospective, observational study on patients with sepsis fulfilling the Third International Consensus Definitions for Sepsis and Septic Shock criteria admitted to an adult intensive care unit (ICU) at a university hospital from June 2011 to December 2016. Levels of 13 biomarkers were measured on ICU admission, including markers of endothelial injury (soluble thrombomodulin [sTM], E-selectin, protein C, and plasminogen activator inhibitor-1 [PAI-1]) and markers of coagulation derangement (platelet count, fibrin degradation product [FDP], prothrombin time [PT], fibrinogen, alpha(2)-plasminogen inhibitor [alpha(2)-PI], antithrombin III [AT III], plasminogen, thrombin-antithrombin complex, and plasmin-alpha(2)-plasmin inhibitor complex). All patients with sepsis were reviewed, and the development of AKI was evaluated. Multivariate logistic regression analysis was performed to identify significant independent predictive factors for AKI. Results: Of the 514 patients admitted with sepsis, 351 (68.3%) developed AKI. Compared with the non-AKI group, all the endothelial biomarkers were significantly different in the AKI group (sTM [23.6 vs. 15.6 U/ml, P < 0.0001], E-selectin [65.5 vs. 46.2 ng/ml, P = 0.0497], PAI-1 [180.4 vs. 75.3 ng/ml, P = 0.018], and protein C [45.9 vs. 58.7 ng/ml, P < 0.0001]). Biomarkers of coagulopathy and inflammation, platelet counts, FDP, PT, alpha(2)-PI, AT III, plasminogen, and C-reactive protein were significantly different between the two groups. Multivariable logistic regression analysis showed that sTM was an independent predictive factor of AKI, with an AUROC of 0.758 (P < 0.0001). Conclusions: Endothelial biomarkers were significantly changed in the sepsis patients with AKI. Particularly, sTM was an independent predictive biomarker for the development of AKI that outperformed other coagulation and inflammation biomarkers as well as organ function in patients with sepsis.
  • Tomohiro Muronoi, Kansuke Koyama, Shin Nunomiya, Alan Kawarai Lefor, Masahiko Wada, Toshitaka Koinuma, Jun Shima, Masayuki Suzukawa
    THROMBOSIS RESEARCH 144 169 - 175 2016年08月 [査読有り][通常論文]
     
    Introduction: The diagnostic and prognostic value of immature platelet fraction (IPF) in sepsis has not been determined. This study aimed to assess whether IPF is an early predictor of platelet decline due to coagulopathy and is associated with mortality in patients with sepsis. Materials and methods: In total, 149 patients with a platelet count of > 80 x 10(3)/mu L on intensive care unit admission (101 with sepsis, 48 controls without sepsis) were prospectively evaluated. We measured IPF on admission and observed for development of subsequent platelet count decline (defined as a >30% decrease or <80 x 10(3)/mu L) in 5 days, and mortality at 28 days. The absolute immature platelet count (AIPC) was calculated to evaluate thrombopoiesis. Results: Forty-seven patients with sepsis subsequently developed a decrease in platelet count. The IPF was highest in patients whose platelet count decreased, followed by patients without a decrease in platelet count and controls (median, 4.3% [3.1%-8.1%] vs. 3.7% [2.6%-4.6%] vs. 2.1% [1.6%-3.5%], respectively; P < 0.0001). The AIPC was similar in patients with and without a decrease in platelet count (7.6 [4.2-10.0] vs. 5.9 [4.2-8.7] x 10(3)/mu L, respectively; P = 0.32). Coagulation derangement was more severe in patients who did than did not subsequently develop a decreased platelet count. Cox regression and receiver operator characteristic curve analysis revealed that IPF was a strong independent predictor of mortality, with accuracy similar to a standard prognostic scoring system. Conclusions: The admission IPF in septic patients predicts a subsequent decrease in platelet count, indicating platelet consumption with ongoing coagulopathy and risk of poor prognosis. (C) 2016 Elsevier Ltd. All rights reserved.

MISC

  • Shinshu Katayama, Ken Tonai, Jun Shima, Kansuke Koyama, Shin Nunomiya BMC anesthesiology 20 (1) 94 -94 2020年04月 [査読無し][通常論文]
     
    BACKGROUND: INTELLiVENT-ASV® (I-ASV) is a closed-loop ventilation mode that automatically controls the ventilation settings. Although a number of studies have reported the usefulness of I-ASV, the clinical situations in which it may be useful have not yet been clarified. We aimed to report our initial 3 years of experience using I-ASV, particularly the clinical conditions and the technical and organizational factors associated with its use. Furthermore, we evaluated the usefulness of I-ASV and determined the predictive factors for successful management with I-ASV. METHODS: This single-center, retrospective observational study included patients who were ventilated using the Hamilton G5® ventilator (Hamilton Medical AG, Rhäzüns, Switzerland) from January 2016 to December 2018. The patients were categorized into the "I-ASV success" group and "I-ASV failure" group (those receiving mechanical ventilation with I-ASV along with any other mode). Multivariate analysis was performed to identify factors associated with successful I-ASV management. RESULTS: Of the 189 patients, 135 (71.4%) were categorized into the I-ASV success group. In the I-ASV success group, the reasons for ICU admission included post-elective surgery (94.1%), post-emergent surgery (81.5%), and other medical reasons (55.6%). I-ASV failure was associated with a low P/F ratio (278 vs. 167, P = 0.0003) and high Acute Physiology and Chronic Health Evaluation (APACHE) II score (21 vs. 26, P < 0.0001). The main reasons for not using I-ASV included strong inspiratory effort and asynchrony. The APACHE II score was an independent predictive factor for successful management with I-ASV, with an odds ratio of 0.92 (95% confidential interval 0.87-0.96, P = 0.0006). The area under the receiver operating curve for the APACHE II score was 0.722 (cut-off: 24). CONCLUSIONS: In this study, we found that 71.4% of the fully mechanically ventilated patients could be managed successfully with I-ASV. The APACHE II score was an independent factor that could help predict the successful management of I-ASV. To improve I-ASV management, it is necessary to focus on patient-ventilator interactions.
  • Kansuke Koyama, Shinshu Katayama, Ken Tonai, Jun Shima, Toshitaka Koinuma, Shin Nunomiya Critical care (London, England) 23 (1) 283 -283 2019年08月 [査読無し][通常論文]
     
    BACKGROUND: Altered coagulation and alveolar injury are the hallmarks of acute respiratory distress syndrome (ARDS). However, whether the biomarkers that reflect pathophysiology differ depending on the etiology of ARDS has not been examined. This study aimed to investigate the biomarker profiles of coagulopathy and alveolar epithelial injury in two subtypes of ARDS: patients with direct common risk factors (dARDS) and those with idiopathic or immune-related diseases (iARDS), which are classified as "ARDS without common risk factors" based on the Berlin definition. METHODS: This retrospective, observational study included adult patients who were admitted to the intensive care unit (ICU) at a university hospital with a diagnosis of ARDS with no indirect risk factors. Plasma biomarkers (thrombin-antithrombin complex [TAT], plasminogen activator inhibitor [PAI]-1, protein C [PC] activity, procalcitonin [PCT], surfactant protein [SP]-D, and KL-6) were routinely measured during the first 5 days of the patient's ICU stay. RESULTS: Among 138 eligible patients with ARDS, 51 were excluded based on the exclusion criteria (n = 41) or other causes of ARDS (n = 10). Of the remaining 87 patients, 56 were identified as having dARDS and 31 as having iARDS. Among the iARDS patients, TAT (marker of thrombin generation) and PAI-1 (marker of inhibited fibrinolysis) were increased, and PC activity was above normal. In contrast, PC activity was significantly decreased, and TAT or PAI-1 was present at much higher levels in dARDS compared with iARDS patients. Significant differences were also observed in PCT, SP-D, and KL-6 between patients with dARDS and iARDS. The receiver operating characteristic (ROC) analysis showed that areas under the ROC curve for PC activity, PAI-1, PCT, SP-D, and KL-6 were similarly high for distinguishing between dARDS and iARDS (PC 0.86, P = 0.33; PAI-1 0.89, P = 0.95; PCT 0.89, P = 0.66; and SP-D 0.88, P = 0.16 vs. KL-6 0.90, respectively). CONCLUSIONS: Coagulopathy and alveolar epithelial injury were observed in both patients with dARDS and with iARDS. However, their biomarker profiles were significantly different between the two groups. The different patterns of PAI-1, PC activity, SP-D, and KL-6 may help in differentiating between these ARDS subtypes.
  • Yuya Goto, Kansuke Koyama, Shinshu Katayama, Ken Tonai, Jun Shima, Toshitaka Koinuma, Shin Nunomiya Critical care (London, England) 23 (1) 249 -249 2019年07月 [査読無し][通常論文]
     
    BACKGROUND: Recent studies have suggested a low potential risk for contrast medium-induced kidney injury in patients with relatively normal renal function. However, whether contrast media cause additional deterioration of renal function in patients with acute kidney injury (AKI), including those with sepsis-associated AKI, remains unclear. This study aimed to evaluate the effect of contrast media on renal function and mortality in patients with sepsis who already had AKI. METHODS: We performed a propensity score-matched historical cohort study in the medico-surgical intensive care unit of Jichi Medical University Hospital. Adult patients who were diagnosed with sepsis and AKI were enrolled. Records from our sepsis database from 2011 to 2017 were examined. Septic patients with AKI who received contrast media within 24 h of admission (C group) were matched 1:1 with septic patients who did not receive contrast media (NC group). The primary outcome was deterioration of kidney function (DRF), which was defined as an elevation of serum creatinine levels (> 0.3 mg/dL or 1.5-fold from baseline) or induction of renal replacement therapy. RESULTS: A total of 339 septic patients with AKI were included. After propensity score adjustment, the DRF rate was similar between the C and NC groups (34.0% versus 35.0%; P = 1.00). The 7-day mortality (3.0% versus 6.0%; P = 0.50), 28-day mortality (9.2% versus 15.0%; P = 0.25), and 90-day mortality (25.8% versus 32.1%; P = 0.45) rates were comparable between the two groups. In propensity-adjusted subsets of a high-risk subset (AKI stages 2 and 3 on admission), the rate of DRF was also similar between the two groups. CONCLUSIONS: A single administration of contrast media was not associated with exacerbation of AKI or increased short/long-term mortality in patients with sepsis.
  • Shinshu Katayama, Kansuke Koyama, Jun Shima, Ken Tonai, Yuya Goto, Toshitaka Koinuma, Shin Nunomiya Critical care explorations 1 (5) e0013 2019年05月 [査読無し][通常論文]
     
    Since endothelial function is closely related to organ dysfunction in sepsis and the relationship among endothelial injury, organ dysfunction, and other biomarkers remains unclear, we aimed to evaluate the correlation among endothelial injury, organ dysfunction, and several biomarkers in patients with sepsis. Design: This was a retrospective observational study. Setting: The study was conducted in a university hospital with 14 mixed ICU beds. Patients: ICU patients with sepsis from June 2011 to December 2017 were enrolled in this study. Interventions: Endothelial biomarkers (soluble thrombomodulin, plasminogen activator inhibitor-1, and protein C) and markers of inflammation and coagulation were evaluated during the ICU stay. Sequential Organ Failure Assessment scores were assessed for 7 days after ICU admission to determine organ dysfunction. Variables were compared among five stratified groups according to the Sequential Organ Failure Assessment score (0-2, 3-5, 6-8, 9-12, and 13-24). Regression analysis and 95% CIs were used to evaluate trends in biomarkers. Measurements and Main Results: The patients were divided into five stratified groups (Sequential Organ Failure Assessment 0-2, n = 159 [20.5%]; Sequential Organ Failure Assessment 3-5, n = 296 [38.2%]; Sequential Organ Failure Assessment 6-8, n = 182 [23.5%]; Sequential Organ Failure Assessment 9-12, n = 75 [9.7%]; Sequential Organ Failure Assessment 13-24, n = 31 [4.0%]). Protein C activity was significantly correlated with the severity of organ dysfunction. It was lower on day 1, increased upon successful treatment, and was significantly higher in groups with lower Sequential Organ Failure Assessment scores. Conclusions: Trends and activity of protein C were superior in predicting organ dysfunction compared with other endothelial biomarkers. Monitoring the level of protein C activity is an ideal tool to monitor organ dysfunctions in patients with sepsis.
  • 島惇, 芝順太郎, 藤田裕壮, 時任利奈, 佐藤正章, 竹内護 麻酔 67 (9) 1002‐1005 2018年09月 [査読無し][通常論文]
  • 方山真朱, 小山寛介, 後藤祐也, 島惇, 藤内研, 鯉沼俊貴, 布宮伸 日本集中治療医学会学術集会(Web) 45th (Suppl.) ROMBUNNO.O77‐7 (WEB ONLY) -7] 2018年02月 [査読無し][通常論文]
  • 方山真朱, 小山寛介, 後藤祐也, 島惇, 藤内研, 鯉沼俊貴, 布宮伸 日本集中治療医学会学術集会(Web) 45th (Suppl.) ROMBUNNO.O78‐2 (WEB ONLY) -2] 2018年02月 [査読無し][通常論文]
  • 石川美香, 方山真朱, 布宮伸, 小山寛介, 後藤祐也, 島惇, 藤内研, 鯉沼俊貴 日本集中治療医学会学術集会(Web) 45th (Suppl.) ROMBUNNO.P48‐5 (WEB ONLY) -5] 2018年02月 [査読無し][通常論文]
  • 島惇, 方山真朱, 小山寛介, 藤内研, 後藤祐也, 鯉沼俊貴, 布宮伸 日本集中治療医学会学術集会(Web) 45th (Suppl.) ROMBUNNO.O81‐1 (WEB ONLY) -1] 2018年02月 [査読無し][通常論文]
  • 後藤祐也, 方山真朱, 島惇, 藤内研, 鯉沼俊貴, 小山寛介, 布宮伸 日本集中治療医学会学術集会(Web) 45th (Suppl.) ROMBUNNO.O77‐4 (WEB ONLY) -4] 2018年02月 [査読無し][通常論文]
  • 藤内研, 方山真朱, 島惇, 鯉沼俊貴, 小山寛介, 布宮伸 日本呼吸療法医学会学術総会プログラム・抄録集 40th 303 2018年 [査読無し][通常論文]
  • 方山真朱, 布宮伸, 和田政彦, 小山寛介, 鯉沼俊貴, 後藤祐也, 藤内研, 島惇 日本集中治療医学会学術集会(Web) 44th ROMBUNNO.DP67‐4 (WEB ONLY) 2017年 [査読無し][通常論文]
  • 島惇, 芝順太郎, 平幸輝, 藤田裕壮, 竹内護 日本臨床麻酔学会誌 36 (6) S376 2016年10月 [査読無し][通常論文]
  • 玉井謙次, 島惇, 竹内護 日本集中治療医学会学術集会(Web) 43rd FP‐246 (WEB ONLY) 2016年01月 [査読無し][通常論文]
  • 玉井謙次, 阿野正樹, 鯉沼俊貴, 小山寛介, 和田政彦, 島惇, 室野井智博, 竹内護, 布宮伸 日本集中治療医学会学術集会(Web) 43rd FP‐231 (WEB ONLY) 2016年01月 [査読無し][通常論文]
  • 島惇, 布宮伸 Expert Nurse 31 (4) 42 -43 2015年03月 [査読無し][通常論文]
  • 島惇, 布宮伸 Expert Nurse 31 (4) 50 -51 2015年03月 [査読無し][通常論文]
  • 島惇, 布宮伸 Expert Nurse 31 (4) 46 -47 2015年03月 [査読無し][通常論文]
  • 島惇, 布宮伸 Expert Nurse 31 (4) 44 -45 2015年03月 [査読無し][通常論文]
  • 島惇, 布宮伸 Expert Nurse 31 (4) 40 -42 2015年03月 [査読無し][通常論文]
  • 島惇, 布宮伸 Expert Nurse 31 (4) 48 -49 2015年03月 [査読無し][通常論文]
  • 島惇, 布宮伸 Expert Nurse 31 (4) 52 -53 2015年03月 [査読無し][通常論文]
  • 島惇, 布宮伸 Expert Nurse 31 (4) 38 -39 2015年03月 [査読無し][通常論文]
  • 島惇, 布宮伸 Expert Nurse 31 (4) 36 -37 2015年03月 [査読無し][通常論文]


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