In-hospital extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest: an analysis by time-dependent propensity score matching using a nationwide database in Japan

院外心停止患者における膜型人工肺を活用した蘇生 --膜型人工肺を活用した蘇生と生存率向上との関連--. 京都大学プレスリリース. 2023-11-21.BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) has been proposed as a rescue therapy for patients with refractory cardiac arrest. This study aimed to evaluate the association between ECPR and clinical outcomes among patients with out-of-hospital cardiac arrest (OHCA) using risk-set matching with a time-dependent propensity score. METHODS: This was a secondary analysis of the JAAM-OHCA registry data, a nationwide multicenter prospective study of patients with OHCA, from June 2014 and December 2019, that included adults (≥ 18 years) with OHCA. Initial cardiac rhythm was classified as shockable and non-shockable. Patients who received ECPR were sequentially matched with the control, within the same time (minutes) based on time-dependent propensity scores calculated from potential confounders. The odds ratios with 95% confidence intervals (CI) for 30-day survival and 30-day favorable neurological outcomes were estimated for ECPR cases using a conditional logistic model. RESULTS: Of 57, 754 patients in the JAAM-OHCA registry, we selected 1826 patients with an initial shockable rhythm (treated with ECPR, n = 913 and control, n = 913) and a cohort of 740 patients with an initial non-shockable rhythm (treated with ECPR, n = 370 and control, n = 370). In these matched cohorts, the odds ratio for 30-day survival in the ECPR group was 1.76 [95%CI 1.38-2.25] for shockable rhythm and 5.37 [95%CI 2.53-11.43] for non-shockable rhythm, compared to controls. For favorable neurological outcomes, the odds ratio in the ECPR group was 1.11 [95%CI 0.82-1.49] for shockable rhythm and 4.25 [95%CI 1.43-12.63] for non-shockable rhythm, compared to controls. CONCLUSION: ECPR was associated with increased 30-day survival in patients with OHCA with initial shockable and even non-shockable rhythms. Further research is warranted to investigate the reproducibility of the results and who is the best candidate for ECPR

Precise Isotopic Analysis of Mo in Seawater Using Multiple Collector-Inductively Coupled Mass Spectrometry Coupled with a Chelating Resin Column Preconcentration Method

It is widely recognized that the natural isotopic variation of Mo can provide crucial information about the geochemical circulation of Mo, and the ocean is an important reservoir of Mo. To obtain precise isotopic data on Mo in seawater samples using multiple collector-inductively coupled plasma mass spectrometry (MC-ICPMS), we have developed a preconcentration technique using 8-hydroxyquinoline bonded covalently to a vinyl polymer resin (TSK-8HQ). By optimizing the procedure, Mo in seawater could be effectively separated from matrix elements such as alkali, alkaline earth, and transition metals. With this technique, even with a 50-fold enrichment factor, the changes in the 98Mo/95Mo ratio during preconcentration were smaller than twice the standard deviation (SD) in this study. Mass discrimination of Mo isotopes during the measurement was externally corrected for by normalizing 86Sr/88Sr to 0.1194 using an exponential law. We evaluated δ98/95Mo to a precision of 0.08 ‰ (2 SD); this value was found to be less than one-third of previous reported values. Moreover, we were able to determine an accurate ratio

右小開胸による低侵襲心臓手術後の再膨張性肺水腫

2015(平成27)年

New endoscopic ultrasonography criteria for malignant lymphadenopathy based on inter-rater agreement.

Background and aimsVarious studies have been previously conducted on the diagnosis of lymphadenopathy as benign or malignant, but the results vary. These studies did not describe the inter-rater agreement on the EUS features of lymphadenopathy. In this study, we evaluate the inter-rater agreement on EUS features and propose EUS diagnostic norms for lymphadenopathy based on inter-rater agreement.MethodA total of 68 lymph nodes subjected to EUS-fine needle aspiration (FNA) were reviewed by five endoscopic experts. The EUS features evaluated lymph node size, shape, border, margin, echogenicity, homogeneity, and the hilum of the lymph node. Inter-rater agreement (multi-rater kappa statics) was performed. We established new criteria using results with a high degree of inter-rater agreement from EUS features and compared them with the former criteria.ResultThere was a moderate agreement on shape, kappa (K) = 0.44 (95% confidence interval [CI]: 0.34-0.54), and fair agreement on echogenicity, homogeneity, border, and hilum of the lymph node, K (95% CI) = 0.33 (0.17-0.38), 0.34 (0.26-0.35), 0.22 (0.21-0.31), and 0.22 (0.11-0.26), respectively. This resulted in the establishment of new EUS diagnostic criteria using shape, long axis > 20 mm and short axis > 10 mm. New criteria were superior to old criteria (area under the curve 0.82 vs 0.52, P ConclusionEUS diagnostic criteria for lymphadenopathy based on inter-rater agreement were more accurate than old criteria. This result will be useful for the diagnosis of lymphadenopathy

Simultaneous Gastric Metastasis From Renal Cell Carcinoma: A Case Report and Literature Review

While some reports are available regarding metachronous gastric metastasis from renal cell carcinoma after treatment, there are few reports of primary lesion detection based on the diagnosis of a gastric metastatic lesion. The patient in this case was an 80-year-old woman who underwent upper gastrointestinal endoscopy after having developed anorexia 2 months earlier. A submucosal tumor with central umbilication was found in the gastric greater curvature. Endoscopic ultrasonography revealed a solid and hypoechoic mass with hypervascularity on color Doppler imaging that proliferated mainly within the submucosal layer. There was partial exposure of the tumor on the superficial layer. Biopsy was performed, as a neuroendocrine tumor was suspected; however, histopathological findings with immunostaining revealed gastric metastasis from clear renal cell carcinoma. Subsequently, contrast enhanced computed tomography showed right renal cell carcinoma and liver metastasis. Thus, molecularly targeted drug treatment was initiated by the Department of Urology. Our findings indicate that a primary lesion can be identified and prognosis can be assumed based on biopsy of the gastric metastatic lesion. Immunostaining of biopsy samples collected endoscopically could help achieve definite diagnosis

Total Neoadjuvant Therapy for Rectal Cancer: the Case Report

We report a case of advanced rectal cancer that could be radically resected after total neoadjuvant therapy (TNT). A 65-year-old man underwent TNT for lower rectal cancer. The patient received a short course of chemoradiation therapy (CRT) at a total dose of 30 Gy to the pelvic area, including lateral lymph nodes, in fractions of 3 Gy administered five times a week over 10 days (days 1-5 and 8-12). The CRT was given in combination with S-1 at a dose of 80 mg twice daily on all days of radiotherapy. After CRT, the patient was scheduled to receive two cycles of S-1 + oxaliplatin (SOX) therapy. SOX was administered over 3 weeks (130 mg/m² oxaliplatin on days 20 and 41, and 80 mg oral S-1 on days 20-33 and 41-54). Robotically-assisted laparoscopic low anterior resection was performed on day 77. Histopathological findings showed only a small amount of residual tumor (residual tumor volume of less than 5%), and the radial margin was negative. There were no severe adverse events, postoperative complications, or functional disorders. These findings demonstrated the effectiveness and safety of TNT with short-term irradiation for rectal cancer. This regimen may be a new candidate for neoadjuvant treatment of previously untreated rectal cancer