The purpose of this study was to identify a relationship between the background environment, bystander and emergency medical services intervention, and favourable neurological outcomes (CPC1-2) ...one-month after out-of-hospital cardiac arrest (OHCA) occurred at Tokyo train and subway stations.
This retrospective observational study used OHCA data between 2014 and 2018 that occurred at train stations in Tokyo. The eligible 954 patients were analysed for correlation between background, time frame, and location. Multivariable logistic regression models were used to estimate factors associated with CPC1-2 in patients with cardiogenic OHCA.
A total of 886 OHCA cases, cardiogenic (n=562) and non-cardiogenic (n=324), met the inclusion criteria. Of the cardiogenic cases, 71.9% occurred at the platform and on-a-train. One-month CPC1-2 was achieved in 32.0% of cardiogenic OHCAs, which included 47.3% during morning rush hour, 24.7% during daytime hours, 40.2% during evening rush hour, and 20.5% during night-time/early morning hours. CPC1-2 had significant correlation with morning rush hour (adjusted odds ratio AOR,4.52; 95% confidence interval CI, 1.09–18.78), evening rush hour (AOR, 6.85; 95% CI, 1.51–31.15), public access defibrillation (AOR, 5.19; 95% CI, 1.38–19.51), and ventricular fibrillation or pulseless ventricular tachycardia (AOR, 7.56; 95% CI, 1.35–42.43).
A total of 71.9% of cardiogenic OHCAs occurred at platforms and on trains. To improve neurological outcomes of OHCAs at stations, AED installations on train platforms are necessary. Additionally, using artificial intelligence-based platform monitoring for early detection of OHCAs and offering CPR training are required.
In the therapeutic management of eosinophilic disorder, it is important to prevent hypereosinophilia (HE)-related organ damage even in the process of diagnosis. We describe here a unique clinical and ...histopathological findings of the patient with HE accompanied with digital ischaemia. Treatment with intravenous prostaglandin E
was essential for digital ischaemia in our case while benralizumab, humanized monoclonal antibody against interleukin-5 receptorα, did not affect. Our case suggests an earlier intervention for digital ischaemia in the therapeutic management of eosiniphilic disorder.
Recurrent laryngeal nerve paralysis (RLNP) is a frequent and serious complication following esophageal cancer surgery. Therefore, this study aims to evaluate the correlation between recurrent ...laryngeal nerve (RLN) size and RLNP. This was a retrospective study of esophageal cancer patients who underwent thoracoscopic esophagectomy from January 2012 to December 2014. Eighty-four patients were included in the primary analysis. Diameter of the RLN was measured using the digital video recording of surgical procedures by the ratio between scissor and RLN. For evaluation of vocal cord paralysis or paresis, indirect laryngoscopy was performed. Because RLNP more frequently occurs on the left side than the right, we evaluated the correlation between size of the left RLN and left RLNP. The median size of the left RLN was 1.51 mm. We found that the incidence of postoperative left RLNP (Clavien-Dindo classification ≥1) was significantly higher (71% vs. 24%; P < 0.001) in thin RLNs (≤1.5 mm) than in thick RLNs (>1.5 mm). Thin RLN (P < 0.001), female sex (P = 0.025), and being overweight (P = 0.034) were identified as significant independent risk factors for postoperative RLNP. RLNP more easily occurred when the RLN was thin. It is difficult to confirm occurrence of postoperative RLNP before and at extubation. Therefore, it is helpful to know its risk factors including size of RLN.
MOSFETs with gate length down to 17 nm are reported. To suppress the short channel effect, a novel self-aligned double-gate MOSFET, FinFET, is proposed. By using boron-doped Si/sub 0.4/Ge/sub 0.6/ as ...a gate material, the desired threshold voltage was achieved for the ultrathin body device. The quasiplanar nature of this new variant of the vertical double-gate MOSFETs can be fabricated relatively easily using the conventional planar MOSFET process technologies.
In endoscopic cricopharyngeal myotomy, surgeons sometimes have concerns about performing an adequate incision with only a narrow intra-cavital view from one direction. In order to overcome these ...issues, fluoroscopic radiography was used during endoscopic cricopharyngeal myotomy.
Peri-operative fluoroscopic radiography was utilised to check the position of the diverticuloscope, and to confirm the extent of the incision during surgery. A balloon catheter was used to determine whether the cricopharyngeal muscle was sufficiently resected. Blood loss, peri-operative complications, and functional oral swallowing scale and penetration aspiration scale scores were evaluated.
In 12 out of 15 patients, intra-operative fluoroscopic radiography showed the diverticuloscope positioned in the post-cricoid area, and the cricopharyngeal muscle was raised and the surgery completed without adverse effect. Swallowing functions improved following surgery.
Intra-operative fluoroscopy might improve endoscopic cricopharyngeal myotomy by allowing surgeons to confirm the extent of resection, and by reducing peri-operative morbidity and complication rates.
Background and purpose: To estimate the diagnostic accuracy of cardiac 123I‐metaiodobenzylguanidine (MIBG) scintigram for detection of Parkinson disease.
Methods: A cross‐sectional study with index ...test of MIBG scintigram and reference standard of U.K. Parkinson’s Disease Brain Bank Criteria was performed in 403 patients. Ratio of cardiac‐to‐mediastinum MIBG accumulation was determined at 20 min (early H/M) and 4 h (late H/M). Area under the receiver‐operator characteristic (ROC) curve, sensitivity and specificity in detecting Parkinson disease were analyzed. Accuracy was analyzed in a subgroup of patients with disease duration of 3 years or less.
Results: Area under the ROC curve was 0.89 using either early or late H/M as a diagnostic marker (95% CI 0.85–0.92 for early H/M and 0.86–0.93 for late H/M). Sensitivity and specificity were 81.3% (76.1–85.8%) and 85.0% (77.7–90.6%) for early H/M and 84.3% (79.3–88.4%) and 89.5% (83.01–94.1%) for late H/M. In the subgroup with duration of 3 years or less, the ROC curve area, sensitivity, and specificity were 0.86 (0.79–0.92), 76.0% (64.8–85.1%), and 83.9% (71.7–92.4%) for early H/M and 0.85 (0.78–0.92), 73.3% (61.9–82.9%), and 87.5% (75.9–94.8%) for late H/M.
Conclusion: Although diagnostic accuracy of cardiac MIBG scintigram is high, it is limited because of insufficient sensitivity in patients with short duration.
Extended-release tacrolimus (TacER), administered once daily, offers improved adherence with reduced side effects while still maintaining an immunosuppressive potency equivalent to that of ...conventional tacrolimus preparations.
The study included 83 patients who received consecutive living-donor kidney transplants at our facility from June 2013 to December 2016. Comparisons were made between 48 cases of induction with TacER and 35 cases of induction with cyclosporine (CyA). The observation period was 3 months after transplantation. Transplanted kidney function, rejection, infectious disease, lipid abnormalities, and glucose tolerance were compared.
The 2 groups showed no significant difference in donor background or transplanted kidney function. Within the 3-month observation period, an acute rejection response was observed in 2 cases in the TacER group and in 8 cases in the CyA group. After transplantation, hyperlipidemia requiring medication was observed more frequently in the CyA group. The 2 groups did not show a marked difference in systemic infection or renal calcineurin inhibitor toxicity in histopathologic examination of the transplanted kidneys 3 months after surgery.
Proactive use of TacER leads to improved adherence while yielding immunosuppressive potency equivalent to that of conventional tacrolimus preparations; however, tacrolimus has a potent blood sugar-elevating effect; thus, direct comparison with the CyA group is important for assessing the side effects.
TacER has the potential to also reduce side effects in the early stages after surgery, suggesting its potential as a drug of first choice.
•TacER effectively suppressed acute rejection in the early postoperative stages of kidney transplantation.•Diabetes and CyA administration were independent variables for acute rejection.•There is no need to worry about delayed absorption in evening for TacER.•We observed 2 cases of TacER had CNI toxicity without deterioration in serum creatinine levels.•TacER should be selected for kidney transplant recipients with diabetic nephropathy.
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