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Nagoya-shi, Japan

Shiga T.,Tokyo Womens Medical University | Tanaka K.,Nippon Medical School | Kato R.,Nagoya Ekisaikai Hospital | Amino M.,Tokai University | And 9 more authors.
Resuscitation | Year: 2010

Objective: To compare the efficacy and safety of nifekalant, a pure class III anti-arrhythmic drug, and lidocaine in patients with shock-resistant in-hospital ventricular fibrillation (VF) or ventricular tachycardia (VT). Patients and methods: Between August 2005 and March 2008, we conducted a prospective, two-arm, cluster observational study, in which participating hospitals were pre-registered either to the nifekalant arm or the lidocaine arm. Patients were enrolled if they had in-hospital VF or VT resistant to at least two defibrillation shocks. Congenital or drug-induced long QT syndrome was excluded. The primary end-point was termination of VF or VT with/without additional shock. The secondary end-points were return of spontaneous circulation (ROSC), 1-month survival and survival to hospital discharge. We also assessed the frequency of adverse events, including asystole, pulseless electrical activity and torsade de pointes. Results: In total, 55 patients were enrolled. After nifekalant, 22 of 27 patients showed termination of VF or VT, as compared with 15 of 28 patients treated with lidocaine with/without additional shock (odds ratio (OR): 3.8; 95% confidence interval (CI): 1.1-13.0; P = 0.03). Twenty-three of 27 patients given nifekalant showed ROSC, as compared with 15 of 28 patients given lidocaine (OR: 5.0; 95% CI: 1.4-18.2; P = 0.01). There was no difference in 1-month survival or survival to hospital discharge between the nifekalant and lidocaine arms. There was a higher incidence of asystole with lidocaine (7 of 28 patients) than with nifekalant (0 of 27 patients) (P = 0.005). Torsade de pointes was not observed. Conclusion: Nifekalant was more effective than lidocaine for termination of arrhythmia and for ROSC in patients with shock-resistant in-hospital VF or VT (umin-CTR No. UMIN 000001781). © 2009 Elsevier Ireland Ltd. All rights reserved. Source

Itatsu K.,Nagoya University | Yokoyama Y.,Nagoya University | Sugawara G.,Nagoya University | Kubota H.,Handa City Hospital | And 6 more authors.
British Journal of Surgery | Year: 2014

Results: A total of 4305 consecutive patients were registered. Of these, 378 were excluded because of failure to complete follow-up and 3927 patients were analysed. IH was diagnosed in 318 patients. The estimated incidence rates for IH were 5.2 per cent at 12 months and 10.3 per cent at 24 months. In multivariable analysis, wound classification III and IV (hazard ratio (HR) 2.26, 95 per cent confidence interval 1.52 to 3.35), body mass index of 25 kg/m2or higher (HR 1.76, 1.35 to 2.30), midline incision (HR 1.74, 1.28 to 2.38), incisional surgical-site infection (I-SSI) (HR 1.68, 1.24 to 2.28), preoperative chemotherapy (HR 1.61, 1.08 to 2.37), blood transfusion (HR 1.46, 1.04 to 2.05), increasing age by 10-year interval (HR 1.30, 1.16 to 1.45), female sex (HR 1.26, 1.01 to 1.59) and thickness of subcutaneous tissue for every 1-cm increase (HR 1.18, 1.03 to 1.35) were identified as independent risk factors. Compared with superficial I-SSI, deep I-SSI was more strongly associated with the development of IH.Conclusion: Although there are several risk factors for IH, reducing I-SSI is an important step in the prevention of IH. Registration number: UMIN000004723 (University Hospital Medical Information Network, http://www.umin.ac.jp/ctr/index.htm).Background: Few larger studies have estimated the incidence of incisional hernia (IH) after abdominal surgery.Methods: Patients who had abdominal surgery between November 2009 and February 2011 were included in the study. The incidence rate and risk factors for IH were monitored for at least 180 days. © 2014 BJS Society Ltd. Source

Iwata M.,Aichi University | Yamanaka K.,Aichi University | Kitagawa Y.,Nagoya Ekisaikai Hospital
International Journal of Emergency Medicine | Year: 2013

Background: Consultation is a common and important aspect of emergency medicine practice. We examined the frequency of consultations, the level of agreement and factors of disagreement with regard to the disposition of patients who visited two emergency departments (EDs) of tertiary care hospitals in Japan. Findings: We analyzed 3,503 consecutive patients who visited two EDs in Japan during a 3-month period. The initial diagnosis in the ED, the presence of consultation, and the patient disposition following the ED visit were recorded. At least one consultation was requested in 34.7% of the patients (1,215/3,503), and 88% of these patients were admitted to the hospital (1,063/1,215). Consultants and emergency physicians (EPs) agreed on patient disposition 95% of the time (1,153/1,215), with κ = 0.76 (95% CI 0.70-0.82). Opinions about disposition were discordant in 5% of the patients consulted upon. In 63% of those cases, patients were not diagnosed in the ED. Conclusion: Consultants and EPs agreed on patient disposition in most cases. In more than half of the cases in which disagreements arose between EPs and consultants, the EPs were not able to reach an initial diagnosis. Further studies are needed to examine the association between disagreements in disposition and adverse outcomes. © 2013 Iwata et al.; licensee Springer. Source

Izawa S.,Nagoya University | Enoki H.,Nagoya University | Hirakawa Y.,Nagoya University | Iwata M.,Nagoya Ekisaikai Hospital | And 3 more authors.
British Journal of Nutrition | Year: 2010

Although anthropometric parameters have been extensively studied regarding their relationship to physical function status, the association between these parameters and the activity of daily living (ADL) function remains controversial. We investigated whether BMI or mid-upper arm circumference (AC) is an indication of variation in the physical functioning of the frail elderly. The present study was a prospective cohort analysis of 543 community-dwelling frail elderly. Data included the participants' demographic characteristics, basic ADL, comorbidity and anthropometric measurements at baseline and at 2-year follow-up. Logistic regression models were used to investigate the association between ADL status and anthropometric measurements during the study period. Among the 543 participants, 418 maintained or improved their ADL status, while 125 showed an ADL decline during the study period. Multivariate logistic regression analysis showed that BMI and AC levels or ADL status at baseline were not independent predictors of the loss of ADL function or the decline in these anthropometric measurements during the study period, respectively. However, the decline in BMI and AC levels and the loss of ADL function were associated with each other during the study period. There is an association between the negative changes in anthropometric measurements during the follow-up period and the decline in ADL function during a 2-year follow-up in community-dwelling frail elderly. © 2009 The Authors. Source

Hoshino Y.,Nagoya University | Nishikawa K.,Nagoya Ekisaikai Hospital | Ito Y.,Nagoya University | Kuzushima K.,Aichi Cancer Center Research Institute | Kimura H.,Nagoya University
Journal of Clinical Virology | Year: 2011

Background: During the convalescent phase of acute infectious mononucleosis (AIM), Epstein-Barr virus (EBV) load shrinks rapidly in association with a rapid decline in the number of EBV-specific CD8+ T cells. The actual contribution of EBV-specific CD8+ T cells in reducing EBV load, however, is not known. Objectives: To clarify the impact of EBV-specific CD8+ T cells on the contraction of EBV load in AIM, we estimated half-lives of both EBV load and EBV-specific CD8+ T cells. Study design: Blood was serially taken from five pediatric patients with AIM during the convalescent period, including the very early phase, and both EBV load and EBV-specific CD8+ T cell numbers were assayed. Results: EBV load declined rapidly (half-life 1.5 d) during the first 2 weeks after onset of symptoms. This half-life was seven-fold shorter than that reported for CD27+ memory B cells. Subsequently, the EBV load declined much more slowly, with a half-life of 38.7 d. EBV-specific CD8+ T cell numbers also declined concomitantly with the decrease in EBV load. The half-life of EBV-specific CD8+ T cells during first 2 weeks was 2.9 d. The number of EBV-specific CD8+ T cells and the rate of change of viral load correlated significantly (R2≥0.8; p≤0.02). Conclusions: The short half-life of EBV load, together with the strong correlation between the number of EBV-specific CD8+ T cells and the rate of change of viral load indicates an active role for EBV-specific CD8+ T cells in elimination of EBV in AIM. © 2010 Elsevier B.V. Source

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