Sustaining improvement of dispatcher-assisted cardiopulmonary resuscitation for out-of-hospital cardiac arrest patients in Japan: An observational study

Objectives

We aimed to estimate the relationship between the promotion of bystander cardiopulmonary resuscitation (CPR) with dispatcher-assistance over time and good cerebral function after out-of-hospital cardiac arrests (OHCAs).

Methods

This was a retrospective observational study, using a nationwide OHCA database in Japan. The eligible 267,193 witnessed cardiogenic OHCA patients between 2005 and 2016 were analysed. Multivariable logistic regression models were performed to estimate the effect of dispatcher-assisted bystander CPR per year. In addition, we calculated the number of patients with good cerebral function, which was attributed to dispatcher-assisted bystander CPR.

Results

Dispatcher-assisted bystander CPR was performed to 84,076 (31.5%), those without dispatcher-assistance were 48,389 (18.1%), and non-bystander CPR were 134,728 (50.4%). The adjusted odds ratio (AOR) of dispatcher-assisted bystander CPR vs. non-bystander CPR was significantly related to good cerebral function, regardless of the year (AOR, 1.47, 1.62; 95%CI, 1.19-1.80, 1.42-1.85, 2005 and 2016, respectively). The association of dispatcher-assisted bystander CPR with good cerebral function tended to increase (AOR, 1.11, 2.97; 95%CI, 0.99-1.24, 2.69-3.28, 2006 and 2016, based on 2005, respectively). Estimating the number of patients with good cerebral function who attributed to dispatcher-assisted bystander CPR was a significant increase from 41 in 2005 to 580 in 2016 (p < .0001, r = 0.98). Furthermore, chest compression consistently contributed to higher number of patients with good cerebral function than that with a combination of chest compression and shock with public-access-defibrillation.

Conclusion

We found that the increased dispatcher-assisted bystander CPR rate was related to good cerebral function at 1-month post OHCA. Chest compression without public-access-defibrillation was most helpful to that number, explaining the effects of dispatcher-assistance and sustaining improvement.

Detection of Antioxidant Phytochemicals Isolated from Camellia japonica Seeds Using HPLC and EPR Imaging

In this study, we investigated the formation of stable radicals and compounds related to antioxidants in Camellia japonica seeds using high performance liquid chromatography (HPLC) and X-band electron paramagnetic resonance imaging (EPRI). The C. japonica seed coat extracts exhibited antioxidant activity in both in vitro and cell-based studies. The extracts inhibited reactive oxygen and reactive nitrogen species production in cell-based studies. HPLC chromatograms indicated that hydrophilic antioxidant compounds—namely, gallic acid, gallocatechin, epigallocatechin, caffeine, catechin, epicatechin, and epicatechin gallate—were found in the methanolic extract. Lipophilic antioxidant compounds—including α-tocopherol, γ-tocopherol, β-tocopherol, δ-tocopherol, α-tocotrienol, γ-tocotrienol, and δ-tocotrienol—were found in the hexane extract. EPRI primarily detected paramagnetic species in seed coats. These radical species were stable organic radicals based on the peak-to-peak line width and g-values. The signals from these stable radicals were strong and stable with a g-value of 2.002. Noninvasive EPRI of the radicals present in C. japonica seeds indicated that the stable radicals were essentially located in the seed coats. The EPRI of the cotyledon demonstrated that additional radicals were localized at an apex of the cotyledon. The results indicated that the stable radicals detected by EPRI and the hydrophilic and lipophilic antioxidant compounds analyzed by HPLC were related to antioxidant reactants and products.

Free Radical Scavenging Capability of Various Defatted Sesame Seed Cakes and Hulls Using EPR Compared with In Vitro Testing and HPLC Analysis

The free radical scavenging activities of black and white sesame seed hulls and the powder of black and white sesame seed cakes were investigated using noninvasive continuous wave electron paramagnetic resonance (EPR) and antioxidant assays. With black sesame seed hulls and the powder of black sesame seed cakes, EPR detected the very strong single-line signal intensities that correspond to the stable organic radicals, while the spectrum of the white sesame seed hulls and the white sesame seed cakes showed no signal. The in vitro antioxidant activities of black and white sesame seed cake extract were evaluated by DPPH free radical scavenging activity, hydrogen peroxide scavenging activity, and ferric reducing antioxidant power (FRAP) assay. The results indicated that the extract from black sesame seed cake possessed a greater DPPH radical inhibitory activity and hydrogen peroxide inhibitory activity than white sesame seed cake extract, with IC₅₀ values of 0.847 ± 0.011 mg/mL and 0.338 ± 0.007 mg/mL, respectively. Black sesame seed cake extract also showed a strong reducing power with a FRAP value of 1.307 ± 0.037 mM Fe (II)/g of extract weight and an EC₁ value of 0.683 ± 0.002 mg/mL. The main compounds from the black and white sesame seed cake extracts were analysed using high-performance liquid chromatography (HPLC). The results revealed that the main compounds in black and white sesame seed cake extracts were in a group of water-soluble lignans, mainly sesaminol triglucoside and sesaminol diglucoside. However, sesaminol diglucoside was found in large amounts in the black sesame seed cake extract, while it was found in a very small amount in the white sesame seed cake extract. Therefore, these results demonstrated considerable antioxidant capacity of the sesame seed, especially in the black strain.

Final overall survival results of WJTOG3405, a randomized phase III trial comparing gefitinib versus cisplatin with docetaxel as the first-line treatment for patients with stage IIIB/IV or postoperative recurrent EGFR mutation-positive non-small-cell lung cancer

BACKGROUND

Primary analysis of the phase III study WJTOG 3405 demonstrated superiority of progression-free survival (PFS) for gefitinib (G) in patients treated with the epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) gefitinib compared with cisplatin plus docetaxel (CD) as the first-line treatment of stage IIIB/IV or postoperative recurrent EGFR mutation-positive non-small-cell lung cancer. This report presents final overall survival (OS) data.

PATIENTS AND METHODS

Patients were randomized between G (250 mg/day orally) and cisplatin (80 mg/m2 intravenously) plus docetaxel (60 mg/m2 i.v.), administered every 21 days for three to six cycles. After the exclusion of 5 patients, 172 patients (86 in each group, modified intention-to-treat population) were included in the survival analysis. OS was re-evaluated using updated data (data cutoff, 30 September 2013; median follow-up time 59.1 months). The Kaplan-Meier method and the log-rank test were used for analysis, and hazard ratios (HRs) for death were calculated using the Cox proportional hazards model.

RESULTS

OS events in the G group and CD group were 68 (79.1%) out of 86 and 59 (68.6%) out of 86, respectively. Median survival time for G and CD were 34.9 and 37.3 months, respectively, with an HR of 1.252 [95% confidence interval (CI): 0.883-1.775, P = 0.2070]. Multivariate analysis identified postoperative recurrence and stage IIIB/IV disease as independent prognostic factors, with an HR of 0.459 (95% CI: 0.312-0.673, P < 0.001). Median survival time (postoperative recurrence versus stage IIIB/IV disease) were 44.5 and 27.5 months in the G group and 45.5 and 32.8 months in the CD group, respectively.

CONCLUSION

G did not show OS benefits over CD as the first-line treatment. OS of patients with postoperative recurrence was better than that of stage IIIB/IV disease, even though both groups had metastatic disease.This study was registered with UMIN (University Hospital Medical Information Network in Japan), number 000000539.

Results of a multi-institutional, randomized, non-inferiority, phase III trial of accelerated fractionation versus standard fractionation in radiation therapy for T1-2N0M0 glottic cancer: Japan Clinical Oncology Group Study (JCOG0701)

Background

We assessed the non-inferiority of accelerated fractionation (AF) (2.4 Gy/fraction) compared with standard fractionation (SF) (2 Gy/fraction) regarding progression-free survival (PFS) in patients with T1-2N0M0 glottic cancer (GC).

Patients and methods

In this multi-institutional, randomized, phase III trial, patients were enrolled from 32 Japanese institutions. Key inclusion criteria were GC T1-2N0M0, age 20-80, Eastern Cooperative Oncology Group performance status of 0-1, and adequate organ function. Patients were randomly assigned to receive either SF of 66-70 Gy (33-35 fractions), or AF of 60-64.8 Gy (25-27 fractions). The primary end point was the proportion of 3-year PFS. The planned sample size was 360 with a non-inferiority margin of 5%.

Results

Between 2007 and 2013, 370 patients were randomized (184/186 to SF/AF). Three-year PFS was 79.9% (95% confidence interval [CI] 73.4-85.4) for SF and 81.7% (95% CI 75.4-87.0) for AF (difference 1.8%, 91% CI-5.1% to 8.8%; one-sided P = 0.047 > 0.045). The cumulative incidences of local failure at 3 years for SF/AF were 15.9%/10.3%. No significant difference was observed in 3-year overall survival (OS) between SF and AF. Grade 3 or 4 acute and late toxicities developed in 22 (12.4%)/21 (11.5%) and 2 (1.1%)/1 (0.5%) in the SF/AF arms.

Conclusion

Although the non-inferiority of AF was not confirmed statistically, the similar efficacy and toxicity of AF compared with SF, as well as the practical convenience of its fewer treatment sessions, suggest the potential of AF as a treatment option for early GC.

Clinical trials registration

UMIN Clinical Trial Registry, number UMIN000000819.

Investigation of Pigments in Thai Purple Rice Using Electron Paramagnetic Resonance Imaging and HPLC

Paramagnetic species (radicals) related pigments in Thai purple rice were investigated by electron paramagnetic resonance (EPR), X-band (9 GHz) EPR imaging (EPRI), and HPLC. The location and distribution of the paramagnetic species in purple and white rice were determined by EPR and EPRI. EPR primarily detected three paramagnetic species in purple rice, which were identified as organic radicals, Mn²⁺, and Fe³⁺ based on the g-values and hyperfine components of the EPR signals. Noninvasive two-dimensional (2D) EPRI revealed that these stable radicals are primarily located in the pigmented region of purple rice, while very few radicals were observed in the interior of the rice. HPLC revealed that the major compounds were cyanidin-3-O-glucoside and peonidin-3-O-glucoside. EPR, EPR imaging, and HPLC results indicate that the stable radicals contain the radical state of anthocyanins and are mostly found within the pigmented embryo region of purple rice. They could be either associated with antioxidant activities or could be one of the products of their oxidative decomposition.