In cardiopulmonary support systems with a membrane oxygenation such as a percutaneous cardiopulmonary support (PCPS) or an extracorporeal membrane oxygenation (ECMO), blood pumps need to generate the ...pressure rise of approximately 200mmHg or higher, due to the high hydraulic resistances of the membrane oxygenation and of the cannula tubing. In order to realize the blood pump with higher pressure rise, higher anti-hemolysis and thrombosis performances, the development of novel centrifugal blood pump composed of two-stage has been conducted by the authors. In the present paper, effective attempts to decrease the wall shear stress and to suppress the stagnation are introduced for the prevention of hemolysis and thrombosis in blood pumps. The hemolysis test was also carried out and it was clarified that the decrease of wall shear stress is effective as a guideline of design of blood pumps for improving the anti-hemolysis performance.
The swirling flow in the draft tube of a Francis turbine can cause the flow instability and the cavitation surge and has a larger influence on hydraulic power operating system. In this paper, the ...cavitating flow with swirling flow in the diffuser was studied by the draft tube component experiment, the model Francis turbine experiment and the numerical simulation. In the component experiment, several types of fluctuations were observed, including the cavitation surge and the vortex rope behaviour by the swirling flow. While the cavitation surge and the vortex rope behaviour were suppressed by the aeration into the diffuser, the loss coefficient in the diffuser increased by the aeration. In the model turbine test the aeration decreased the efficiency of the model turbine by several percent. In the numerical simulation, the cavitating flow was studied using Scale-Adaptive Simulation (SAS) with particular emphasis on understanding the unsteady characteristics of the vortex rope structure. The generation and evolution of the vortex rope structures have been investigated throughout the diffuser using the iso-surface of vapor volume fraction. The pressure fluctuation in the diffuser by numerical simulation confirmed the cavitation surge observed in the experiment. Finally, this pressure fluctuation of the cavitation surge was examined and interpreted by CFD.
Antiseizure prophylaxis is required during busulfan administration for hematopoietic stem cell transplantation. However, antiseizure agents such as benzodiazepines and phenytoin may produce adverse ...effects through interaction with other drugs. We retrospectively assessed the prophylactic efficacy and safety of levetiracetam and clonazepam against busulfan-induced seizures between 2013 and 2018. Thirty patients (after 2015) received levetiracetam, and 13 patients (before 2015) received clonazepam in this study. Levetiracetam was well-tolerated and had a significantly lower frequency of adverse effects, such as somnolence, compared with clonazepam, although two patients in the levetiracetam group experienced seizures. Levetiracetam is a feasible option for preventing busulfan-induced seizures.
Pulse pressure may be potentially useful for selecting effective cardiac treatment strategies. This study aimed to assess the association between the cardiac treatment strategies and risk of major ...adverse cardiovascular events (MACE) in patients with type 2 diabetes and coronary artery disease (CAD), based on low or high levels of pulse pressure.
We analyzed data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial and calculated hazard ratios (HRs) for MACE with 95% confidence intervals (95%CIs) using the Cox proportional hazard model. The risk of MACE in patients with type 2 diabetes and CAD was compared between the early revascularization and medical therapy groups separately in patients with pulse pressures < 60 mmHg (n = 1378) and ≥ 60 mmHg (n = 916).
During a maximal follow-up of 6 years, 389 patients experienced MACE. In patients with pulse pressure < 60 mmHg, the risk of MACE was significantly higher in the early revascularization group (HR: 1.37, 95%CI: 1.04–1.81, P = 0.02) and was specifically and significantly higher in the percutaneous coronary intervention group (HR: 1.66, 95%CI: 1.17–2.34, P = 0.004) than in the medical therapy group. In contrast, the risk of MACE in patients with pulse pressure ≥ 60 mmHg was significantly lower in the early revascularization group (HR: 0.72, 95%CI: 0.53–0.96, P = 0.02) and was specifically lower in the coronary artery bypass graft surgery group (HR: 0.49, 95%CI: 0.30–0.82, P = 0.006) than in the medical therapy group.
Pulse pressure may be used to determine optimal cardiac treatment strategies in patients with type 2 diabetes and CAD.
•A lower pulse pressure was found to be associated with a greater MACE risk during early revascularization.•A higher pulse pressure was found to be associated with a lower MACE risk, especially for CABG.•Pulse pressure may be used to determine optimal cardiac treatment strategies in patients with type 2 diabetes and CAD.
Background
Human gut microbiota is involved in host health and disease development. Investigations of age-related and sex-related alterations in gut microbiota are limited, and the association ...between stool consistency and gut microbiota has not been fully investigated. We investigated gut microbiota differences related to age, sex, and stool consistency in healthy Japanese subjects.
Methods
Two-hundred and seventy-seven healthy Japanese subjects aged 20–89 years were enrolled. Fecal samples were obtained to analyze the gut microbiome. We evaluated the association between stool consistency Bristol stool scale (BSS) and gut microbiota.
Results
Although there were significant differences in the microbial structure between males and females, the α-diversity of gut microbiota showed no difference between males and females or among age groups. There were significant increases in genera
Prevotella
,
Megamonas
,
Fusobacterium
, and
Megasphaera
and
Bifidobacterium
,
Ruminococcus
, and
Akkermansia
in males and females, respectively. The ratio of hard stools (BSS types 1 and 2) was higher in females; the ratio of loose stools (BSS type 6) was higher in males. No younger male had BSS type 1 or type 2.
Fusobacterium
in males was significantly higher in the loose consistency group, and
Oscillospira
was significantly higher in the hard consistency group in males;
Campylobacter
,
SMB53
, and
Turicibacter
were significantly higher in the hard consistency group in females.
Conclusions
Several changes in gut microbiota were associated with age and sex. Stool consistency and gut microbiota associations emphasized the importance of stool consistency assessments to understand intestinal function.
Background
Acute kidney injury (AKI) is a major comorbidity in hospitalised patients. Patients with severe AKI require continuous renal replacement therapy (CRRT) when they are haemodynamically ...unstable. CRRT is prescribed assuming it is delivered over 24 hours. However, it is interrupted when the extracorporeal circuits clot and the replacement is required. The interruption may impair the solute clearance as it causes under dosing of CRRT. To prevent the circuit clotting, anticoagulation drugs are frequently used.
Objectives
To assess the benefits and harms of pharmacological interventions for preventing clotting in the extracorporeal circuits during CRRT.
Search methods
We searched the Cochrane Kidney and Transplant Register of Studies up to 12 September 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.
Selection criteria
We selected randomised controlled trials (RCTs or cluster RCTs) and quasi‐RCTs of pharmacological interventions to prevent clotting of extracorporeal circuits during CRRT.
Data collection and analysis
Data were ed and assessed independently by two authors. Dichotomous outcomes were calculated as risk ratio (RR) with 95% confidence intervals (CI). The primary review outcomes were major bleeding, successful prevention of clotting (no need of circuit change in the first 24 hours for any reason), and death. Evidence certainty was determined using the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach.
Main results
A total of 34 completed studies (1960 participants) were included in this review. We identified seven ongoing studies which we plan to assess in a future update of this review. No included studies were free from risk of bias. We rated 30 studies for performance bias and detection bias as high risk of bias. We rated 18 studies for random sequence generation,Ã, Ã, six studies for the allocation concealment, three studies for performance bias, three studies for detection bias,Ã, nine studies for attrition bias,Ã, 14 studies for selective reporting and nine studies for the other potential source of bias, as having low risk of bias.
We identified eight studies (581 participants) that compared citrate with unfractionated heparin (UFH). Compared to UFH, citrate probably reduces major bleeding (RR 0.22, 95% CI 0.08 to 0.62; moderate certainty evidence) and probably increases successful prevention of clotting (RR 1.44, 95% CI 1.10 to 1.87; moderate certainty evidence). Citrate may have little or no effect on death at 28 days (RR 1.06, 95% CI 0.86 to 1.30, moderate certainty evidence). Citrate versus UFH may reduce the number of participants who drop out of treatment due to adverse events (RR 0.47, 95% CI 0.15 to 1.49; low certainty evidence). Compared to UFH, citrate may make little or no difference to the recovery of kidney function (RR 1.04, 95% CI 0.89 to 1.21; low certainty evidence). Compared to UFH, citrate may reduceÃ, thrombocytopenia (RR 0.39, 95% CI 0.14 to 1.03; low certainty evidence). It was uncertain whether citrate reduces a cost to health care services because of inadequate data.
For low molecular weight heparin (LMWH) versus UFH, six studies (250 participants) were identified. Compared to LMWH, UFH may reduce major bleeding (0.58, 95% CI 0.13 to 2.58; low certainty evidence). It is uncertain whether UFH versus LMWH reduces death at 28 days or leads to successful prevention of clotting. Compared to LMWH, UFH may reduce the number of patient dropouts from adverse events (RR 0.29, 95% CI 0.02 to 3.53; low certainty evidence). It was uncertain whether UFH versus LMWH leads to the recovery of kidney function because no included studies reported this outcome. It was uncertain whether UFH versus LMWH leads to thrombocytopenia. It was uncertain whether UFH reduces a cost to health care services because of inadequate data.
For the comparison of UFH to no anticoagulation, one study (10 participants) was identified. It is uncertain whether UFH compare to no anticoagulation leads to more major bleeding. It is uncertain whether UFH improves successful prevention of clotting in the first 24 hours, death at 28 days, the number of patient dropouts due to adverse events, recovery of kidney function, thrombocytopenia, or cost to health care services because no study reported these outcomes.
For the comparison ofÃ, citrate to no anticoagulation,Ã, no completed study was identified.
Authors' conclusions
Currently,Ã, available evidence does not support the overall superiority of any anticoagulant to another. Compared to UFH, citrate probably reduces major bleeding and prevents clotting and probably has little or no effect on death at 28 days. For other pharmacological anticoagulation methods, there is no available data showing overall superiority to citrate or no pharmacological anticoagulation. Further studies are needed to identify patient populations in which CRRT should commence with no pharmacological anticoagulation or with citrate.
Hypoxia has been reported to impair psychological functions, such as working memory and decision-making. However, few studies have examined hypoxia's effect on social cognition.
Using a ...self-referential task, the present study investigated normobaric hypoxia's effect on the self-referential process. Additionally, we measured brain activity during the task with fNIRS and performed conventional univariate analysis with the general linear model (GLM) as well as homologous cortical functional connectivity analysis.
The results revealed that normobaric hypoxia impaired recognition of adjectives in the other-reference condition but not in the self-reference. The GLM analysis did not detect differences in brain activity between the self- and other-reference conditions, suggesting that GLM analysis may not be suitable for examining self- and other-reference conditions' neural correlates. The homologous cortical connectivity analysis revealed that the connectivity's magnitude was greater in the self-reference than in the other-reference conditions in the normoxic group. However, such a decrease in connectivity in the other-reference conditions was not observed in the hypoxic group, possibly to compensate for cognitive decline induced by the hypoxia.
Considering that homologous connectivity reflects the default mode network, which is supposedly linked to continuous self-reference, stable strength of the connectivity in the self-reference condition under the hypoxia may suggest robust nature of the self-reference process under normobaric hypoxia.
L-Ornithine has recently received considerable attention as a functional amino acid in the fields of nutrition science and health science due to its potential as an anxiolytic-like and/or antifatigue ...agent. In this study, we used socially isolated mice as a high-stress animal model and investigated whether long-term oral administration of L-ornithine had antistress effects on group-housed or socially isolated mice. For this purpose, we used behavioral and pharmacological methods including the elevated plus maze test, the open field test, the stress-induced hyperthermia test, and the pentobarbital-induced sleep test. In group-housed mice, no effect of L-ornithine treatment was observed in any behavioral test. In the isolated mice, however, the treatment decreased locomotor activity and increased the time spent in the central circle in the open field test. In addition, it increased sleep duration in the pentobarbital-induced sleep test. Performance in the elevated plus maze test and stress-induced hyperthermia test was not affected by the treatment. These findings suggest that long-term oral administration of L-ornithine ameliorates antistress effects on highly stressed socially isolated mice.
It is well known that root canal treatment of maxillary molars is made difficult by root fusion and complicated root morphology. In addition, the root apices of maxillary molars are in close ...proximity to the maxillary sinus, often causing odontogenic maxillary sinusitis. Two cases of this type of molar, in which a microscope and cone-beam computed tomography (CBCT) were needed for proper root canal treatment, are reported. Satisfactory results were obtained in both cases.
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