Questionnaire survey on the continuity of home oxygen therapy after a disaster with power outages

AbstractBackgroundAfter the Great East Japan Earthquake, oxygen-dependent patients in areas experiencing power outages could not continue home oxygen therapy (HOT) without oxygen cylinders. The purpose of this study was to examine use of oxygen cylinders in areas experiencing power outages and the effects of HOT interruption on patients' health.MethodsQuestionnaires were mailed to 1106 oxygen-dependent patients and HOT-prescribing physicians in Akita, near the disaster-stricken area. We investigated patients' actions when unable to use an oxygen concentrator and classified the patients based on oxygen cylinder use. Patients who experienced an interruption of or reduction in oxygen flow rate by their own judgment were assigned to the “interruption” and “reduction” groups, respectively; those who maintained their usual flow rate were assigned to the “continuation” group. Differences were tested using analysis of variance and the χ2 tests.ResultsIn total, 599 patients responded to the questionnaire. Oxygen cylinders were supplied to 574 patients (95.8%) before their oxygen cylinders were depleted. Comparison of the continuation (n=356), reduction (n=64), and interruption (n=154) groups showed significant differences in family structure (p=0.004), underlying disease (p=0.014), oxygen flow rate (p<0.001), situation regarding use (p<0.001), knowledge of HOT (p<0.001), and anxiety about oxygen supply (p<0.001). There were no differences in changes in physical condition.ConclusionsMost patients could receive oxygen cylinders after the disaster. Some patients discontinued their usual oxygen therapy, but their overall health status was not affected

CNVs in Three Psychiatric Disorders

BACKGROUND: We aimed to determine the similarities and differences in the roles of genic and regulatory copy number variations (CNVs) in bipolar disorder (BD), schizophrenia (SCZ), and autism spectrum disorder (ASD). METHODS: Based on high-resolution CNV data from 8708 Japanese samples, we performed to our knowledge the largest cross-disorder analysis of genic and regulatory CNVs in BD, SCZ, and ASD. RESULTS: In genic CNVs, we found an increased burden of smaller (500 kb) exonic CNVs in SCZ/ASD. Pathogenic CNVs linked to neurodevelopmental disorders were significantly associated with the risk for each disorder, but BD and SCZ/ASD differed in terms of the effect size (smaller in BD) and subtype distribution of CNVs linked to neurodevelopmental disorders. We identified 3 synaptic genes (DLG2, PCDH15, and ASTN2) as risk factors for BD. Whereas gene set analysis showed that BD-associated pathways were restricted to chromatin biology, SCZ and ASD involved more extensive and similar pathways. Nevertheless, a correlation analysis of gene set results indicated weak but significant pathway similarities between BD and SCZ or ASD (r = 0.25–0.31). In SCZ and ASD, but not BD, CNVs were significantly enriched in enhancers and promoters in brain tissue. CONCLUSIONS: BD and SCZ/ASD differ in terms of CNV burden, characteristics of CNVs linked to neurodevelopmental disorders, and regulatory CNVs. On the other hand, they have shared molecular mechanisms, including chromatin biology. The BD risk genes identified here could provide insight into the pathogenesis of BD

DIRECT EFFECT OF PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY ON THE HEART IN PATIENT WITH PERIPHERAL ARTERY DISEASE

Background and Purpose : The patient with peripheral artery disease (PAD) is known to have a poor prognosis for life. Recently, it has been reported that percutaneous transluminal angioplasty (PTA) for PAD improves the prognosis. However, the detailed mechanisms remain unclear.Augmentation index (AIx) or central aortic pressure (CAP) is shown to increase myocardial mechanical stress and facilitate myocardial hypertrophy. The aim of this study is to clarify the direct cardioprotective effects of PTA mediated by decreasing CAP and AIx.Methods : 28 patients with PAD were enrolled. They were divided into two groups ; control group (n=12) and PTA group (n=16). Both radial AIx and CAP were measured by using pulse waveform analysis of arterial waveform recorded non-invasively by applanation tonometry in radial artery. We used a plasma B-type natriuretic peptide (BNP) level as a marker of myocardial mechanical stress. Plasma BNP levels, radial AIx and CAP which were measured after PTA or angiography, were compared with the data on admission.Result : Although plasma BNP levels in the control group were not changed, those in the PTA group were significantly decreased from 68.44 to 42.08 pg/ml (p<0.05). Pulse waveform analysis demonstrated that radial AIx and CAP in the control group remain unchanged. On the other hand, radial AIx and CAP were significantly reduced in the PTA group. The reduction rates of radial AIx, CAP and plasma BNP levels were −11.3%, −8.9% and −34% respectively.Conclusion : These results suggest that PTA can decrease myocardial mechanical stress in patients with PAD. The mechanisms may be mediated in part by reduction of radial AIx and CAP

QUALITY OF LIFE AND HEART RATE VARIABILITY FOLLOWING ACUTE MYOCARDIAL INFARCTION

Objective : The aim of this study was to investigate whether cardiac autonomic function measuredby heart rate variability (HRV) indices are related to quality of life (QOL) improvements inpatients with acute myocardial infarction (AMI) treated by percutaneous coronary intervention.Methods : We enrolled 20 consecutive patients with AMI. Measures of HRV, obtained fromboth frequency and time domain analyses using 24-h Holter monitoring before discharge, were asfollows : low and high frequency (HF) domain measures, the square root of the mean squared differencesof successive R-R intervals (rMSSD), and the percentage of differences between adjacentnormal R-R intervals >50 ms for the whole analysis (pNN50). QOL was determined byphysical and mental component summary (PCS and MCS, respectively) scores derived from theJapanese Medical Outcomes Study 36-item Short Form Health Survey before and 6 months afterdischarge.Results : The subjects showed significant improvement in the MCS, but not the PCS score.　There were also positive correlations between the parasympathetic parameters of HF, rMSSD,and pNN50 and the change in MCS score. In a multivariate analysis, rMSSD was found to beindependently associated with the change in MCS score.Conclusions : Parasympathetic tone, as measured by HRV, is independently associated withQOL, which emphasizes the role of cardiac autonomic function on QOL in patients with AMI

RENAL TRANSPLANTATION IMPROVES CARDIAC FUNCTION

There is mounting evidence that chronic kidney disease is a major contributor to severe cardiac damage. Although renal transplantation (RT) is an effective strategy in patients with end-stage renal disease (ESRD), the effects on cardiac function remain unclear. This study determined the effects of RT on left ventricular (LV) morphology and function in a retrospective longitudinal analysis of echocardiographic data collected in RT (n=17) and maintenance hemodialysis (HD ; n=19) groups from 2003 to 2008.Echocardiographic data obtained within 6 months and at over 3 years were compared with the data before transplantation. Improved blood pressure and anemia were observed with RT, but not HD. In contrast to the HD group, the left ventricular mass index (LVMI) in the RT group was decreased from 195.2 ± 52.1 to 162.5 ± 30.8 g/m2 ( p<0.05). In addition, the LV ejection fraction was improved in the RT group from 63.0 ± 17.1% to 79.5 ± 3.3% ( p<0.01), but not in the HD group. The rate of reduction of LVMI in the RT group was greater in patients with good control of hemoglobin.In conclusion, RT has beneficial effects on LV hypertrophy and function, as well as on ESRD