Nutrition in aneurysm clipping

Aneurysmal subarachnoid hemorrhage (SAH) is a serious clinical event associated with high mortality and, among survivors, serious morbidity. Maintaining the muscle volume in SAH patients is essential, as rehabilitation is often required after intensive care. In this study, we investigated whether proper nutritional administration improved clinical outcomes based on patients laboratory data and level of activities of daily living. This retrospective study was carried out on 250 consecutive SAH patients who underwent craniotomy within 72 hours of onset from February 2005 to June 2018. Finally, 75 patients with a BMI < 22 kg / m2 were included. We compared postoperative energy and protein intake in relation to measures of biochemical parameters and modified Rankin Scale at discharge. Serum Alb concentrations at 25-35 hospital days was significantly improved by postoperative energy intake of ≥ 25 kcal / kg and protein intake of ≥ 0.8 g / kg per day beginning 3 days. High serum Alb concentrations at 25-35 hospital days following the start of this intake were independent factors for good prognosis. This study suggests that the minimum postoperative nutritional intake per day for SAH patients undergoing aneurysmal clipping is 25 kcal / kg of energy and 0.8 g / kg of protein. Higher serum Alb concentrations corresponded to improved long-term functional outcome

Comparative Efficacy and Safety of Linezolid and Quinupristin-Dalfopristin in the Treatment of Vancomycin-Resistant Enterococcus Infections: A Meta-Analysis

Introduction: Vancomycin-resistant Enterococcus (VRE) is one of the most important causative organisms of nosocomial infections. Once VRE outbreaks occur in hospitals, enormous efforts must be made to control them, especially in wards housing neutropenic or transplant patients. The purpose of this meta-analysis was to investigate the efficacy and adverse event profile of linezolid versus that of Quinupristin-Dalfopristin for the treatment of VRE infections.Methodology: Literature searches of PubMed, MEDLINE, and EMBASE databases were performed on April 5, 2017 using combined text words with the following MeSH/EMTREE terms: “linezolid” and “Quinupristin-Dalfopristin” and “Enterococcus” and “human.” The odds ratios (ORs) with 95% confidence intervals (CIs) for individual studies were calculated and pooled separately. The pooled estimates were combined using the inverse variance weighting scheme and random effect method.Results: A systematic search identified 674 articles, and five involving 333 patients were included in the final analysis. One study was a prospective randomized controlled trial, and four were retrospective studies. The mortality rate in the groups of patients treated with linezolid was significantly lower than that in patients treated with Quinupristin-Dalfopristin (OR: 0.47; 95% CI: 0.23 to 0.97; heterogeneity P=0.13, Z=2.05, P=0.04; I2=44%; Begg’s test: P=0.33; Egger’s test: P=0.78). The clinical and microbiological responses indicated no significant differences between the linezolid and Quinupristin-Dalfopristin groups (58% and 43%, respectively, P=0.6; OR: 1.51; 95% CI: 0.75 to 3.04; heterogeneity P=0.32; Z=1.15, P=0.25; I2=0%). The adverse event proiles differed between the Linezolid and quinupristin-dalfopristin groups.Conclusion: Our results suggest a significantly lower mortality rate in patients treated with linezolid than in those treated with Quinupristin-Dalfopristin for VRE infections; however, this was limited by a variety of factors (mostly retrospective)

低インスリン血症は、非糖尿病急性非代償性心不全患者において、全死亡、心血管死の独立した予後予測因子である

Background Insulin beneficially affects myocardial functions during myocardial ischemia. It increases glucose-derived ATP production, decreases oxygen consumption, suppresses apoptosis of cardiomyocytes, and promotes the survival of cardiomyocytes. Patients with chronic heart failure generally have high insulin resistance, which is correlated with poor outcomes. The role of insulin in acute decompensated heart failure (ADHF) remains unclear. This study aimed to investigate the prognostic value of serum insulin level at the time of admission for long-term outcomes in patients with ADHF. Methods and Results We enrolled 1074 consecutive patients who were admitted to our department for ADHF. Of these 1074 patients, we studied the impact of insulin on the prognosis of ADHF in 241 patients without diabetes mellitus. The patients were divided into groups according to low, intermediate, and high tertiles of serum insulin levels. Primary end points were all-cause death and cardiovascular death. During a mean follow-up of 21.8 months, 71 all-cause deaths and 38 cardiovascular deaths occurred. Kaplan-Meier analysis showed that all-cause and cardiovascular mortality was significantly higher in the low-insulin group than those in the intermediate- and high-insulin groups (log-rank P=0.0046 and P=0.038, respectively). Moreover, according to the multivariable analysis, low serum insulin was an independent predictor of all-cause and cardiovascular mortality (hazard ratio, 2.37 [95% CI, 1.24-4.65; P=0.009] and 2.94 [95% CI, 1.12-8.19; P=0.028], respectively). Conclusions Low serum insulin levels were associated with increased risk of all-cause and cardiovascular death in ADHF patients without diabetes mellitus.博士（医学）・甲第808号・令和4年3月15日© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License(https://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes

Improvement of the target sensitivity in DECIGO by optimizing its parameters for quantum noise including the effect of diffraction loss

DECIGO is the future Japanese gravitational wave detector in outer space. We previously set the default design parameters to provide a good target sensitivity to detect the primordial gravitational waves (GWs). However, the updated upper limit of the primordial GWs by the Planck observations motivated us for further optimization of the target sensitivity. Previously, we had not considered optical diffraction loss due to the very long cavity length. In this paper, we optimize various DECIGO parameters by maximizing the signal-to-noise ratio (SNR), for the primordial GWs to quantum noise including the effects of diffraction loss. We evaluated the power spectrum density for one cluster in DECIGO utilizing the quantum noise of one differential Fabry-Perot interferometer. Then we calculated the SNR by correlating two clusters in the same position. We performed the optimization for two cases: the constant mirror-thickness case and the constant mirror-mass case. As a result, we obtained the SNR dependence on the mirror radius, which also determines various DECIGO parameters. This result is the first step toward optimizing the DECIGO design by considering the practical constraints on the mirror dimension and implementing other noise sources.Comment: 13 pages, 12 figure

日本における非代償性急性心不全患者の30日および90日以内の心不全再入院の発生率と臨床的意義 : NARA-HF研究より

Background: Countermeasure development for early rehospitalization for heart failure (re-HHF) is an urgent and important issue in Western countries and Japan.Methods and Results:Of 1,074 consecutive NARA-HF study participants with acute decompensated HF admitted to hospital as an emergency between January 2007 and December 2016, we excluded 291 without follow-up data, who died in hospital, or who had previous HF-related hospitalizations, leaving 783 in the analysis. During the median follow-up period of 895 days, 241 patients were re-admitted for HF. The incidence of re-HHF was the highest within the first 30 days of discharge (3.3% [26 patients]) and remained high until 90 days, after which it decreased sharply. Within 90 days of discharge, 63 (8.0%) patients were re-admitted. Kaplan-Meier analysis revealed that patients with 90-day re-HHF had worse prognoses than those without 90-day re-HHF in terms of all-cause death (hazard ratio [HR] 2.321, 95% confidence interval [CI] 1.654-3.174; P<0.001) and cardiovascular death (HR 3.396, 95% CI 2.153-5.145; P<0.001). Multivariate analysis indicated that only male sex was an independent predictor of 90-day re-HHF. Conclusions: The incidence of early re-HHF was lower in Japan than in Western countries. Its predictors are not related to the clinical factors of HF, indicating that a new comprehensive approach might be needed to prevent early re-HHF.博士（医学）・甲第735号・令和2年3月16日日本循環器学会の許諾を得て登録（2020年9月2日付）ジャーナル公式サイト（日本循環器学会HP内）：https://www.j-circ.or.jp/journal/公開サイト（J-STAGE）：https://www.jstage.jst.go.jp/browse/circj

急性心不全における退院時の尿素窒素分画排泄率の予後判定への有用性

Background Maintaining euvolemia is crucial for improving prognosis in acute decompensated heart failure (ADHF). Although fractional excretion of urea nitrogen (FEUN) is used as a body fluid volume index in patients with acute kidney injury, the clinical impact of FEUN in patients with ADHF remains unclear. This study aimed to investigate whether FEUN can determine the long-term prognosis in patients with ADHF. Methods and Results We retrospectively identified 466 patients with ADHF who had FEUN measured at discharge between April 2011 and December 2018. The primary endpoint was post-discharge all-cause death. Patients were divided into two groups according to a FEUN cut-off value of 35%, commonly used in pre-renal failure. The FEUN <35% (low-FEUN) group included 224 patients (48.1%), and the all-cause mortality rate for the total cohort was 37.1%. The log-rank test revealed that the low-FEUN group had a significantly higher rate of all-cause death compared to the FEUN equal to or greater than 35% (high-FEUN) group (P<0.001). Multivariate Cox proportional hazards model analysis revealed that low-FEUN was associated with post-discharge all-cause death, independently of other heart failure risk factors (hazard ratio, 1.467; 95% CI, 1.030-2.088, P=0.033). The risk of low-FEUN compared to high-FEUN in post-discharge all-cause death was consistent across all subgroups; however, the effects tended to be modified by renal function (threshold: 60 mL/min/1.73 m2, interaction P=0.069). Conclusions Our study suggests that FEUN may be a novel surrogate marker of volume status in patients with ADHF requiring diuretics.博士（医学）・甲第814号・令和4年3月15日Copyright © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License(https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made

Patterns of Movement Performance Among Japanese Children and Effects of Parenting Practices: Latent class analysis

Objectives: The study aimed to examine the long-term effects of parenting practice during preschool years on children’s movement performance in primary school. Methods: This study involved a three-year longitudinal study including 225 children aged 3–6 years old. Parents reported baseline parenting practice and evaluated children’s movement performance three years later. Latent class analysis was used to explore latent classes of movement performance. A post hoc test was used to identify the characteristics of different patterns. Finally, adjusted multinomial logistic regression models were used to test the influence of parenting practice on identified patterns of movement performance. Results: Children in this study were grouped into three movement performance pattens, labelled as ‘least difficulties’ (58.2%, n = 131), ‘low back pain’ (30.2%, n = 68), and ‘most difficulties’ (11.6%, n = 26). After controlling for age, gender, having siblings or not, family structure, BMI SDS, sleep condition and dietary habits, we found that if parents played games with children frequently, the children would have a 0.287 times lower probability of being in the ‘low back pain’ class, 95%CI [0.105, 0.783], and if parents take children to meet peers of a similar age frequently, the children would have a 0.339 times lower probability of being in ‘most difficulties’ class, 95%CI [0.139, 0.825]. Conclusions: Primary healthcare providers should pay careful attention to children with movement difficulties. The study provides longitudinal evidence to support the applicability of positive parenting practice in early childhood to prevent children’s movement difficulties. Keywords: Movement performance; Parenting practice; Latent class analysis; Child; Longitudinal study; Japan

僧帽弁閉鎖不全症を伴うまたは伴わない非代償性急性心不全患者の予後に心房細動が与える影響

Background: Atrial fibrillation (AF) and mitral regurgitation (MR) are frequently combined in patients with heart failure (HF). However, the effect of AF on the prognosis of patients with HF and MR remains unknown. Methods and Results: We studied 867 patients (mean age 73 years; 42.7% female) with acute decompensated HF (ADHF) in the NARA-HF registry. Patients were divided into 4 groups based on the presence or absence of AF and MR at discharge. Patients with severe MR were excluded. The primary endpoint was the composite of cardiovascular (CV) death and HF-related readmission. During the median follow-up of 621 days, 398 patients (45.9%) reached the primary endpoint. In patients with MR, AF was associated with a higher incidence of the primary endpoint regardless of left ventricular function; however, in patients without MR, AF was not associated with CV events. Cox multivariate analyses showed that the incidence of CV events was significantly higher in patients with AF and MR than in patients with MR but without AF (hazard ratio 1.381, P=0.036). Similar findings were obtained in subgroup analysis of patients with AF and only mild MR. Conclusions: The present study demonstrated that AF is associated with poor prognosis in patients with ADHF with mild to moderate MR, but not in those without MR.博士（医学）・甲第799号・令和3年9月29日© 2021, THE JAPANESE CIRCULATION SOCIETY This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license. https://creativecommons.org/licenses/by-nc-nd/4.0