Poorer prognosis with ethylenediaminetetraacetic acid-dependent pseudothrombocytopenia: a single-center case-control study.

In ethylenediaminetetraacetic acid (EDTA)-dependent pseudothrombocytopenia (PTCP), automated platelet counts are lower than actual counts because of EDTA-induced aggregation. Factors contributing to the incidence of EDTA-PTCP are unknown, and no study has assessed the prognosis of EDTA-PTCP patients. This retrospective study assessed characteristics in EDTA-PTCP patients and matched controls to determine differences in prognosis. A retrospective case-control study was designed. From the University of Tokyo Hospital database, we identified patients diagnosed with EDTA-PTCP between 2009 and 2012, and performed 1:2 case:control matching for age and sex. A control group of sex- and age-matched patients was selected at random from the same database. We investigated differences in the frequency of complications, medication history, and blood transfusion history between the groups at the time of blood collection. Prognosis was evaluated using multivariate Cox regression analysis adjusting for age, sex, autoimmune disease, liver disease, and malignant tumor. We identified 104 EDTA-PTCP patients and 208 matched controls. The median age was 69.0 years (interquartile range: 54-76), with men comprising 51%. EDTA-PTCP patients had a higher frequency of malignant tumor and a lower frequency of hypertension and diabetes than controls. After adjustment for background factors, prognosis of EDTA-PTCP patients was significantly poorer than controls (hazard ratio, 11.8; 95% confidence intervals, 2.62-53.54). In conclusion, EDTA-PTCP patients had higher mortality, and EDTA-PTCP may need to be recognized as an indicator of worse prognosis

Impact of a New Medical Record System for Emergency Departments Designed to Accelerate Clinical Documentation: A Crossover Study.

Recording information in emergency departments (EDs) constitutes a major obstacle to efficient treatment. A new electronic medical records (EMR) system focusing on clinical documentation was developed to accelerate patient flow. The aim of this study was to examine the impact of a new EMR system on ED length of stay and physician satisfaction.We integrated a new EMR system at a hospital already using a standard system. A crossover design was adopted whereby residents were randomized into 2 groups. Group A used the existing EMR system first, followed by the newly developed system, for 2 weeks each. Group B followed the opposite sequence. The time required to provide overall medical care, length of stay in ED, and degree of physician satisfaction were compared between the 2 EMR systems.The study involved 6 residents and 526 patients (277 assessed using the standard system and 249 assessed with the new system). Mean time for clinical documentation decreased from 133.7 ± 5.1 minutes to 107.5 ± 5.4 minutes with the new EMR system (P < 0.001). The time for overall medical care was significantly reduced in all patient groups except triage level 5 (nonurgent). The new EMR system significantly reduced the length of stay in ED for triage level 2 (emergency) patients (145.4 ± 13.6 minutes vs 184.3 ± 13.6 minutes for standard system; P = 0.047). As for the degree of physician satisfaction, there was a high degree of satisfaction in terms of the physical findings support system and the ability to capture images and enter negative findings.The new EMR system shortened the time for overall medical care and was associated with a high degree of resident satisfaction

ヨソクテキ ガイラン フカ ニ トモナウ ウンドウ チョウセツ キコウ ノ オウトウセイ

Normal human subjects (n=6), sitting on a chair, were required to maintain stable elbow flexion angle (90 degrees) against loadings of 0.5 kg or 2 kg. Loading was affected either \u27without anticipation (without-A)\u27 by the experimenter or \u27with anticipation (with-A)\u27 by the subejct\u27s own contra-lateral hand. Acceleration of the forearm movement by the loading (extension) and EMG of biceps (BB) and triceps (TB) brachii muscles were recorded. Under \u27with-A\u27 condition, preceding EMG activities of BB and TB before onset time of loading (perturbation on BB) were clearly observed. Furthermore, amount of those preceding EMG activities was larger in 2 kg loading than that in 0.5kg. Under \u27without-A\u27 condition, however, those preceding EMG activities were not observed. On behalf of those preceding EMG activities, EMG burst (latency; 20 ms) of presumed stretch reflex induced by loading were early observed. Thus, anticipatory adjustment of elbow angle, observed when loading was performed by the subject, appears to optimize limb stability during the mechanical perturbation

Ettects of muscle vibration on distortion of kinetic sensation

Voluntary contraction is widely accepted as being under continuous reflex control by a variety of sensory receptors, including those in both agonists and antagonists. The questions arise as to how the spinal reflex adjustments may be modified by the application of vibration to antagonist muscles and how this may induce psychophysical errors in the attainment of intended final position. Recent psychophysical investigations have suggested that in man, the central nervous system (CNS) may concomitantly process all the information conveyed by a pair of antagonist muscles moving the same joint. Therefore, the present study was undertaken to examine effects of muscle vibration on distortion of kinesthetic sensasion. Particularly, aftereffects (influences after the vibration was stopped) was investigated. For this purpose, the muscle vibration was applied during the repetitive elbow extention-flextion in nomal human subjects. The vibration was applied over the biceps brachii muscle. After a period of practice, subjects were assigned the target movements required at non-visually guided (eye closed). Thus, after-effects of vibration produced an overshoot of the extension target that was dependent on intensity of vibration. However, after-effects of vibration disappeared after the several trials. Taken together present results and previous reports, it was suggested that distortion of kinesthetic sensation after the vibration occurred from discharge of muscle spindles and length of the post-vibrationed muscle was perceived as shorter than it really was, but it was modified by the CNS after motor learning

An Application of Motor Evoked Potential (MEP) Method to Analyzing Human Motor Learning

Until recently, drastic approach of motor learning in intact humans was not possible. The introduction of noninvasive techniques to stimulate the motor cortex in the present review permitted the testing and investigation of cortical motor outflow related to mechanisms in human motor learning. Human mapping studies, previously performed only during surgical procedures on patients with neurological disorders, can now be done with minimal discomfort. In the present brief review, therefore, we have attempted to introduce and review to use mapping techniques and to study the neurophysiological mechanisms of human motor learning. In particular, we surveyed modulation of cortical motor output during the acquisition of new motor skills and discussed neuronal plasticity that underlies improvement of voluntary movement in the brain

Effects of Voluntary Motor Command on Motor Evoked Potentials (MEPs) of Multifunction Muscle

Using the technique of transcranial magnetic stimulation motor evoked potentials (MEPs) were studied in the first dorsal interosseous(FDI) muscle of human subject. The question was asked how the central nervous system control a multifunction muscle for performing the aimed voluntary movement. Main findings are followings: 1) differences of MEP amplitude were observed among different directions of finger movement, 2) however, there were remarkable different FDI contributions to performing their movements, 3) then, while we retested them by control the background EMG discharge, MEP amplitudes were dependent on amount of targeted muscle activity, 4) under a certain condition there were significant differences of MEP amplitude between flexion and abduction of index finger. Taken together, present results confirmed the former principle suggested by Desmedt and Godaux (1981), i.e., the active excitatory synapses for flexion commands are larger distirubuted troughout the same motoneuron pool than those of abduction. Therefore, MEPs might be reflected on synaptic connectivities of voluntary motor commands in motoneuron pool

Soleus H-Reflex Depression Induced by Simultaneous Arm Flexion and Head Rotation in Standing Humans

A neurophysiological analysis of anticipatory postural adjustments (APAs) associated with the early phase of a simultaneous voluntary arm and head movement was carried out in normal human subjects (n=9). Simultaneous arm elevation and head rotation, performed at maximum velocity, was studied in freely standing humans. Electromyographic (EMG) activities of the anterior deltoid (AD), the sternocleidmastoideus (SM), the biceps femoris (BF) and the soleus (Sol) muscles were recorded. To examine how the simultaneous arm and head movement influences spinal reflex depressions induced by APA, Sol H-reflexes of ipsilateral side of arm movement and contralateral side of head rotation were also elicited. Prior to and during simultaneous movement, a sequence of EMG modification and Sol H-reflex depression were observed in BF and Sol muscles as similar as previously reported (Anson and Kasai, 1995; Kasai and Komiyama, 1996). Amount of EMG modification and Sol H-reflex depression, however, was larger in the simulatneous movement than those in the single movement. Those results suggest that descending motor commands related to APA would be flexible and provide for the postural adjustment according to the requirement of stability body equilibrium upon different voluntary movement conditions. That is, the central nervous system may produce the optimal response in a context involving external and internal constraints

Severe Hemorrhage from Cervical Cancer Managed with Foley Catheter Balloon Tamponade

A 67-year-old woman complaining of continuous fresh vaginal hemorrhage came to our emergency department in a pre-shock state. Examinations revealed an irregularly shaped mass in the uterus and active arterial bleeding. Emergent hysterectomy and interventional radiology were not immediately available. Foley catheter with 20mL water was inserted into the uterine cavity, then the balloon was pulled to obstruct the uterus output (Figure). Her vital signs became stabilized, and she was transferred to another hospital two days later

Severe Hemorrhage from Cervical Cancer Managed with Foley Catheter Balloon Tamponade

A 67-year-old woman complaining of continuous fresh vaginal hemorrhage came to our emergency department in a pre-shock state. Examinations revealed an irregularly shaped mass in the uterus and active arterial bleeding. Emergent hysterectomy and interventional radiology were not immediately available. Foley catheter with 20mL water was inserted into the uterine cavity, then the balloon was pulled to obstruct the uterus output (Figure). Her vital signs became stabilized, and she was transferred to another hospital two days later

Temporal modulations of agonist and antagonist muscle activities accompanying improved performance of ballistic movements

Although many studies have examined performance improvements of ballistic movement through practice, it is still unclear how performance advances while maintaining maximum velocity, and how the accompanying triphasic electromyographic (EMG) activity is modified. The present study focused on the changes in triphasic EMG activity, i.e., the first agonist burst (AG1), the second agonist burst (AG2), and the antagonist burst (ANT), that accompanied decreases in movement time and error. Twelve healthy volunteers performed 100 ballistic wrist flexion movements in ten 10-trial sessions under the instruction to ""maintain maximum velocity throughout the experiment and to stop the limb at the target as fast and accurately as possible"". Kinematic parameters (position and velocity) and triphasic EMG activities from the agonist (flexor carpi radialis) and antagonist (extensor carpi radialis) muscles were recorded. Comparison of the results obtained from the first and the last 10 trials, revealed that movement time, movement error, and variability of amplitudes reduced with practice, and that maximum velocity and time to maximum velocity remained constant. EMG activities showed that AG1 and AG2 durations were reduced, whereas ANT duration did not change. Additionally, ANT and AG2 latencies were reduced. Integrated EMG of AG1 was significantly reduced as well. Analysis of the α angle (an index of the rate of recruitment of the motoneurons) showed that there was no change in either AG1 or AG2. Correlation analysis of α angles between these two bursts further revealed that the close relationship of AG1 and AG2 was kept constant through practice. These findings led to the conclusion that performance improvement in ballistic movement is mainly due to the temporal modulations of agonist and antagonist muscle activities when maximum velocity is kept constant. Presumably, a specific strategy is consistently applied during practice