D-dimer trends predict recurrent stroke in patients with cancer-related hypercoagulability

Abstract Introduction: In patients with cancer-associated hypercoagulability (CAH)-related stroke, D-dimer trends after anticoagulant therapy may offer a biomarker of treatment efficacy. The purpose of this study was to clarify the association between D-dimer trends and recurrent stroke after anticoagulant therapy in patients with CAH-related stroke. Methods: We performed retrospective cohort study of consecutive patients with CAH-related stroke at two stroke centers from 2011 through 2020. The ratio of post-treatment to pre-treatment D-dimer levels (post/pre ratio) was used as an indicator of D-dimer trends after anticoagulant therapy. Fine–Gray models were used to evaluate the association between post/pre ratio and recurrent stroke. Results: Among 360 acute ischemic stroke patients with active cancer, 73 patients with CAH-related stroke were included in this study. Recurrent stroke occurred in 13 patients (18%) during a median follow-up time of 28 days (interquartile range, 11–65 days). Multivariate analysis revealed that high post/pre ratio was independently associated with recurrent stroke (per 0.1 increase: hazard ratio 2.20, 95% confidence interval 1.61–3.01, p=0.012). Discussion and Conclusion: D-dimer levels after anticoagulant therapy were associated with recurrent stroke in CAH-related stroke patients. Patients with neutral trends in high D-dimer levels after anticoagulant therapy were at high risk of recurrent stroke

AsiaPEX:Challenges and Prospects in Asian Precipitation Research

The Asian Precipitation Experiment (AsiaPEX) was initiated in 2019 to understand terrestrial precipitation over diverse hydroclimatological conditions for improved predictions, disaster reduction, and sustainable development across Asia under the framework of the Global Hydroclimatology Panel (GHP)/Global Energy and Water Exchanges (GEWEX). AsiaPEX is the successor to GEWEX Asian Monsoon Experiment (GAME; 1995-2005) and Monsoon Asian Hydro-Atmosphere Scientific Research and Prediction Initiative (MAHASRI; 2006-16). While retaining the key objectives of the aforementioned projects, the scientific targets of AsiaPEX focus on land-atmosphere coupling and improvements to the predictability of the Asian hydroclimatological system. AsiaPEX was designed for both fine-scale hydroclimatological processes occurring at the land surface and the integrated Asian hydroclimatological system characterized by multiscale interactions. We adopt six approaches including observation, process studies, scale interactions, high-resolution hydrological modeling, field campaigns, and climate projection, which bridge gaps in research activities conducted in different regions. Collaboration with mesoscale and global modeling researchers is one of the core methods in AsiaPEX. We review these strategies based on the literature and our initial outcomes. These include the estimation and validation of highresolution satellite precipitation, investigations of extreme rainfall mechanisms, field campaigns over the Maritime Continent and Tibetan Plateau, areas of significant impact on the entire AsiaPEX region, process studies on diurnal- to interdecadal-scale interactions, and evaluation of the predictabilities of climate models for long-term variabilities. We will conduct integrated observational and modeling initiative, the Asian Monsoon Year (AMY)-II around 2025-28, whose strategies are the subregional observation platforms and integrated global analysis.</p

The influence of duodenally-delivered Shakuyakukanzoto (Shao Yao Gan Cao Tang) on duodenal peristalsis during endoscopic retrograde cholangiopancreatography: a randomised controlled trial

Abstract Background Anti-cholinergic agents may be used to inhibit duodenal peristalsis, but they may have adverse effects. Shakuyakukanzoto ( Shao Yao Gan Cao Tang ) has an anti-spasmodic effect and has been used before for oesophagogastroduodenoscopy and colonoscopy. This randomised clinical trial aimed to evaluate the inhibitory effect of Shakuyakukanzoto on duodenal peristalsis, and its usefulness when administered into the duodenum just before endoscopic retrograde cholangiopancreatography (ERCP). Methods Participants were recruited between June 2008 and December 2010. All were aged\ua0\u226518\ua0years and provided written informed consent. Exclusion criteria were: acute pancreatitis, a history of ischemic heart disease, prostatic hypertrophy or glaucoma, and altered/postsurgical upper gastrointestinal anatomy. The recruited participants were randomly assigned to the Shakuyakukanzoto group and control group. Shakuyakukanzoto 100\ua0mg/mL solution or placebo (warm water) was administered directly as a spray into the duodenum during endoscopy. Efficacy was evaluated by observing the extent of duodenal peristalsis and assessing the difficulty of cannulating the common bile duct, the required time (RT) from administration to inhibition of duodenal peristalsis and the stop duration time (DT, the duration for which peristalsis was inhibited). Side effects were evaluated by measuring serum potassium concentration after ERCP. Results Of 28 participants, 15 were assigned to the Shakuyakukanzoto group and 13 to the control group. Duodenal peristalsis was inhibited in eight of the 10 eligible participants (80.0%) in the Shakuyakukanzoto group and none (0%) of the nine eligible participants in the control group ( P \ua0=\ua00.026). In the Shakuyakukanzoto group, mean RT (\ub1standard deviation) was 76.0\ua0\ub1\ua023.9\ua0s and DT was 11.3\ua0\ub1\ua04.2\ua0min. No adverse effects were observed in the Shakuyakukanzoto group during or after ERCP. Conclusion Duodenal peristalsis can be inhibited by spraying Shakuyakukanzoto solution directly into the duodenum. Trial registration UMIN Clinical Trials Registry (UMIN-CTR) UMIN00001146

Prevalence and Long-Term Prognosis of Post-Intensive Care Syndrome after Sepsis: A Single-Center Prospective Observational Study

Post-intensive care syndrome (PICS) comprises physical, mental, and cognitive disorders following a severe illness. The impact of PICS on long-term prognosis has not been fully investigated. This study aimed to: (1) clarify the frequency and clinical characteristics of PICS in sepsis patients and (2) explore the relationship between PICS occurrence and 2-year survival. Patients with sepsis admitted to intensive care unit were enrolled. Data on patient background; clinical information since admission; physical, mental, and cognitive impairments at 3-, 6-, and 12-months post-sepsis onset; 2-year survival; and cause of death were obtained from electronic medical records and telephonic interviews with patients and their families. At 3 months, comparisons of variables were undertaken in the PICS group and the non-PICS group. Among the 77 participants, the in-hospital mortality rate was 11% and the 2-year mortality rate was 52%. The frequencies of PICS at 3, 6, and 12 months were 70%, 60%, and 35%, respectively. The 2-year survival was lower in the PICS group than in the non-PICS group (54% vs. 94%, p < 0.01). More than half of the survivors had PICS at 3 and 6 months after sepsis. Among survivors with sepsis, those who developed PICS after 3 months had a lower 2-year survival