Improved long-term performance of pulsatile extracorporeal left ventricular assist device

SummaryBackground and purposeThe majority of heart transplant (HTx) candidates require left ventricular assist device (LVAD) support for more than 2 years before transplantation in Japan. However, the only currently available device is the extracorporeal pulsatile LVAD. The long-term management of extracorporeal LVAD support has improved remarkably over the years. To determine which post-operative management factors are related to the long-term survival of patients on such LVAD, we retrospectively compared the incidence of complications and their management strategies between the initial and recent eras of LVAD use, classified by the year of LVAD surgery.MethodsSixty-nine consecutive patients supported by extracorporeal pulsatile LVAD as a bridge to HTx between 1994 and 2007 were reviewed retrospectively. The patients were assigned according to the time of LVAD surgery to either group A (n=30; between 1994 and 2000) or group B (n=39; between 2001 and 2007).ResultsPatients in group B survived significantly longer on LVAD support than those in group A (674.6 vs. 369.3 days; p<0.001). The 1- and 2-year survival rates were significantly higher in group B than that in group A (82% vs. 48%, p<0.0001; 68% vs. 23%, p<0.0001, respectively). The proportion of deaths due to cerebrovascular accidents was lower (17% vs. 50%, p<0.001) in group B compared with group A. The incidences of systemic infection were similar in both groups, but the proportions of patients alive and achieving transplant surgery after systemic infection were higher in group B than those in group A (55% vs. 14%, p<0.01; 14% vs. 36%, p<0.05, respectively).ConclusionsThe long-term survival of patients even on “first-generation” extracorporeal LVAD has improved significantly in the recent era. Careful management of cerebrovascular accidents and systemic infection will play important roles in the long-term LVAD management

Support for UNRWA's survival

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides life-saving humanitarian aid for 5·4 million Palestine refugees now entering their eighth decade of statelessness and conflict. About a third of Palestine refugees still live in 58 recognised camps. UNRWA operates 702 schools and 144 health centres, some of which are affected by the ongoing humanitarian disasters in Syria and the Gaza Strip. It has dramatically reduced the prevalence of infectious diseases, mortality, and illiteracy. Its social services include rebuilding infrastructure and homes that have been destroyed by conflict and providing cash assistance and micro-finance loans for Palestinians whose rights are curtailed and who are denied the right of return to their homeland

Paleoceanographic Changes of the Sea of Japan During 3.5-0.8 Ma

On the basis of fossil record from marine deposits in and around the Sea of Japan, the environment during 3.5-0.8 Ma is divided into two stages. During the old stage (3.5-1.71 Ma (stage 60/59)), cold surface water prevailed, except for the short term inflow (< 41 ky duration) of warm Tsushima Current at 3.5, 3.2, 2.9, 2.4 and 1.9 Ma. During the young stage (1.71-0.8 Ma), the Tsushima Current flowed into the sea at every interglacial highstand. This change was caused by opening of the southern channel due to crustal stretching in the northern Okinawa Trough. The onset of inflow of the Tsushima Current caused intrusion of warm-water organisms into the Sea of Japan during interglacial stages and barrier to migration of land organisms between East Asia and Japan. In summary, the environments and organisms in and around the Sea of Japan since 3.5 Ma have been strongly controlled by the development of southern channel (1.71 and 1.35 Ma) and global climate changes (glacial/interglacial cycles).International Symposium, "The Origin and Evolution of Natural Diversity". 1–5 October 2007. Sapporo, Japan

Glaucony and carbonate grains as indicators of the condensed section: Omma Formation, Japan

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Constraints on eustatic sea-level changes during the Mid-Pleistocene Climate Transition : Evidence from the Japanese shallow-marine sediment record

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