Dataset for Shojima_BMJ open-Final

Dataset for Shojima_BMJ open-Fina

Data from: Voluntary home and car smoke-free rules in Japan: a cross-sectional study in 2015

Objectives: Recently, the Tokyo Metropolitan Assembly passed an ordinance prohibiting smoking in private homes and cars if children are present. However, no previous study has investigated existing, voluntary home and car smoke-free rules in Japan. Therefore, we examined prevalence and determinants of comprehensive home and car smoke-free rules. Design: A cross-sectional study. Setting: Internet survey data with adjustments using inverse probability weighting for ‘being a respondent in an internet survey’. Participants: 5600 respondents aged 15-69 years in 2015 were analyzed to estimate weighted percentages and prevalence ratios (PRs) with 95% confidence intervals (CIs) of having comprehensive home and car smoke-free rules. Main outcome measures: Respondents who answered ‘smoking is never allowed’ in their home or car were defined as having home and car smoke-free rules. Results: Overall, 47.0% (95% CI = 45.8–48.3) of respondents implemented comprehensive home and car smoke-free rules. People who agreed with ‘smoking relieves stress’ were less likely to have comprehensive smoke-free rules (PR=0.76 [0.71–0.82]), especially among ever-users of electronic nicotine delivery systems (PR=0.49 [0.30–0.81]). Higher education was significantly associated with higher PR for comprehensive smoke-free rules (PR=1.30 [1.19–1.41]). Living with children was significantly associated with higher PR for smoke-free rules among current smokers than not living with children. Among never and former smokers, electronic device ever-users were less likely to have smoke-free rules than non-users (PR=2.91 [1.99–4.27]). Conclusions: In Japan, about 50% of respondents had voluntary smoke-free rules in the home and car. Information on current voluntary smoke-free rules will be useful as baseline information on home and car smoke-free status before enforcement of the 2018 Tokyo home and car smoke-free legislation

Preoperative management using Impella support for acute aortic dissection with left coronary malperfusion: a case report

Abstract Background Acute aortic dissection (AAD) with impaired perfusion of the left coronary artery has a poor prognosis, even after urgent radical aortic surgery, due to extensive myocardial damage. Although Impella, a microaxial-flow catheter pump, is useful in managing acute myocardial infarction, it is generally contraindicated in patients with AAD because it is an intra-aortic device and the aortic structure is compromised in these cases. Here, we introduce a novel intervention that allowed a planned aortic repair after managing circulation using Impella and venoarterial extracorporeal membrane oxygenation in a case of AAD with left main trunk malperfusion. Case presentation A 40-year-old man presented with cardiogenic shock. Percutaneous coronary intervention was performed to address left main trunk obstruction using an intra-aortic balloon pump; however, circulatory instability persisted. The patient was transferred to our hospital after venoarterial extracorporeal membrane oxygenation. Impella CP™ was used to improve his circulatory status. However, a subsequent CT scan confirmed an AAD diagnosis. After 5 days of stable circulatory support, the patient underwent aortic root replacement and coronary artery bypass grafting. Conclusions In patients with AAD and coronary malperfusion, adjunctive circulatory management with Impella may be a valuable therapeutic option

Long‐Term Stability of Patients Undergoing Endovascular Parent Artery Occlusion of Their Intracranial Artery

Background Although endovascular parent artery occlusion (PAO) of the intracranial artery is a well‐established treatment option, the long‐term stability of cerebral blood flow remains a concern. This study aimed to evaluate the long‐term clinical and radiological outcomes of patients who underwent PAO. Methods The patients who underwent endovascular PAO of their internal carotid or vertebral artery (VA) between April 2011 and March 2022 were included in this observational study. Information about patient characteristics, details of the endovascular treatment, and clinical and radiological follow‐up were collected. Results The study included a total of 104 cases (average age, 52.9±12.6 years old; men, 73 [70.2%] cases; 95 [91.3%] VA PAO cases) from 8 centers. Most cases were performed in an emergency condition, such as ruptured VA dissecting aneurysm (73 cases [70.2%]). PAO was successful in all cases. Early stroke (within 30 days) occurred in 33 (31.7%) cases (31 cases in VA PAO and 2 cases in internal carotid PAO) with ischemic stroke (29 cases) comprising the largest group. Clinical follow‐up over 1 month was available in 85 cases. During an average follow‐up period of 45.8±25.8 months, 1 case of VA PAO experienced a stroke without functional deterioration. Imaging follow‐up was performed in 75 cases. Recanalization of the occluded VA was observed in 2 cases. The remaining image change was contralateral VA stenosis after VA PAO. The incidence of clinical and radiological events was 1.2% and 1.1% per patient‐year, respectively. Conclusion Once the patients surpass the acute phase after PAO, their mid‐ to long‐term course was stable. The risk of late stroke or de novo aneurysm formation was lower than expected in the literature, and the direct comparison to novel reconstructive techniques is warranted in future studies. Clinical Trial Registration information: https://www.umin.ac.jp/ctr/index.html, trial ID: UMIN000045160

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo