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Yoshida T, Iwata H, Fujino Y. Reply to Morais et al.: Electrical Impedance Tomography-based Ventilation Patterns for Evaluating Proper Ventilator Settings and to Classifying Lung Morphofunction. Am J Respir Crit Care Med 2024. [PMID: 38669685 DOI: 10.1164/rccm.202404-0673le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/24/2024] [Indexed: 04/28/2024] Open
Affiliation(s)
- Takeshi Yoshida
- Osaka University Hospital, Intensive Care Unit, Suita, Japan
- Hospital for Sick Children, 7979, Physiology and Experimental Medicine, Departments of Critical Care Medicine and Anesthesia, Toronto, Ontario, Canada;
| | - Hirofumi Iwata
- Osaka University Hospital, Intensive Care Unit, Suita, Japan
| | - Yuji Fujino
- Osaka University Hospital, Intensive Care Unit, Suita, Osaka, Japan
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Matsuda T, Fujino Y, Makabe H, Morisawa T, Takahashi T, Kakegawa K, Matsumoto T, Kiyohara T, Torimoto Y, Miwa M, Fujiwara T, Daida H. Validity Verification of Human Pose-Tracking Algorithms for Gait Analysis Capability. Sensors (Basel) 2024; 24:2516. [PMID: 38676133 PMCID: PMC11054247 DOI: 10.3390/s24082516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Two-dimensional (2D) clinical gait analysis systems are more affordable and portable than contemporary three-dimensional (3D) clinical models. Using the Vicon 3D motion capture system as the standard, we evaluated the internal statistics of the Imasen and open-source OpenPose gait measurement systems, both designed for 2D input, to validate their output based on the similarity of results and the legitimacy of their inner statistical processes. We measured time factors, distance factors, and joint angles of the hip and knee joints in the sagittal plane while varying speeds and gaits during level walking in three in-person walking experiments under normal, maximum-speed, and tandem scenarios. The intraclass correlation coefficients of the 2D models were greater than 0.769 for all gait parameters compared with those of Vicon, except for some knee joint angles. The relative agreement was excellent for the time-distance gait parameter and moderate-to-excellent for each gait motion contraction range, except for hip joint angles. The time-distance gait parameter was high for Cronbach's alpha coefficients of 0.899-0.993 but low for 0.298-0.971. Correlation coefficients were greater than 0.571 for time-distance gait parameters but lower for joint angle parameters, particularly hip joint angles. Our study elucidates areas in which to improve 2D models for their widespread clinical application.
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Affiliation(s)
- Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo 113-0033, Japan
| | - Yuji Fujino
- Global Development Center, Development Department, Development Section, IMASEN Electric Industrial Co., Ltd., Nagoya-shi 484-0083, Japan
| | - Hitoshi Makabe
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo 113-0033, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo 113-0033, Japan
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo 113-0033, Japan
| | - Kei Kakegawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo 113-0033, Japan
| | - Takanari Matsumoto
- Global Development Center, Development Department, Development Section, IMASEN Electric Industrial Co., Ltd., Nagoya-shi 484-0083, Japan
| | - Takehiko Kiyohara
- Global Development Center, Development Department, Development Section, IMASEN Electric Industrial Co., Ltd., Nagoya-shi 484-0083, Japan
| | - Yasuo Torimoto
- Global Development Center, Development Department, Development Section, IMASEN Electric Industrial Co., Ltd., Nagoya-shi 484-0083, Japan
| | - Masaki Miwa
- Global Development Center, Development Department, Development Section, IMASEN Electric Industrial Co., Ltd., Nagoya-shi 484-0083, Japan
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Hiroyuki Daida
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo 113-0033, Japan
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Kurokami Y, Yamashita C, Yokoi K, Tonomura K, Ishitsuka Y, Yoshida T, Koyama Y, Fujino Y, Fujimoto M, Tanemura A. A rare case of metastatic extramammary Paget disease developing transfusion-related acute lung injury during chemotherapy. J Dermatol 2024. [PMID: 38605433 DOI: 10.1111/1346-8138.17223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Yu Kurokami
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Chigusa Yamashita
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazunori Yokoi
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kyoko Tonomura
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yosuke Ishitsuka
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takeshi Yoshida
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yukiko Koyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Atsushi Tanemura
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Matsuda T, Miyamori T, Fujino Y, Nozu S, Kajiwara Y. Reliability and validity of muscle activity analysis using wearable electromyographs. J Phys Ther Sci 2024; 36:123-127. [PMID: 38434994 PMCID: PMC10904218 DOI: 10.1589/jpts.36.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/30/2023] [Indexed: 03/05/2024] Open
Abstract
[Purpose] The aim of this study was to develop a novel wearable surface electromyograph called NOK, and compare its reliability and validity to an existing electromyograph. [Participants and Methods] The study participants were 23 healthy university students (Seven males and 16 females; age 20.3 ± 1.1 years [mean ± standard deviation]; height 162.0 ± 6.7 cm; weight 58.4 ± 10.1 kg) who all gave informed written consent. The newly developed electromyograph (NOK) features a rubberized skin contact surface that requires no electrodes and allows the acquisition of up to 10 channels of muscle waveforms on a portable personal computer. After measuring maximal isometric elbow extension and flexion, we examined muscle waveforms during isometric contractions of elbow joint flexion and extension at approximately 50% of maximal voluntary contraction using both NOK and Delsys electromyographs and compared the results of the two devices. [Results] We found a significant moderate correlation between the measurements by the two devices for biceps and triceps. The measurements by the two devices also showed strong measure-retest reliability. Systematic errors were observed for elbow flexion and extension in the two measurements, indicating limited agreement between the two measurement methods. [Conclusion] Although the new device also has high repeatability and reliability, it is unsuitable for analyzing detailed muscle activity. However, since it can measure up to 10 channels of muscle activity, it is expected to be used in the rehabilitation and sports field in the future.
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Affiliation(s)
- Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Science,
Juntendo University: 3-2-12 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Takayuki Miyamori
- Department of Physical Therapy, Faculty of Health Science,
Juntendo University: 3-2-12 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Science,
Juntendo University: 3-2-12 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Shojiro Nozu
- Faculty of Health and Sports Science, Juntendo University,
Japan
| | - Yuma Kajiwara
- NTT DATA INSTITUTE OF MANAGEMENT CONSULTING, Inc.,
Japan
- Graduate School of Comprehensive Human Sciences, University
of Tsukuba, Japan
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Yamashita T, Uchiyama A, Enokidani Y, Yoshida T, Fujino Y. Combined Use of Alkaline Agents With Low-Flow Extracorporeal Carbon Dioxide Removal in Carbon Dioxide Inhalation Models Preserving Inspiratory Efforts. J Acute Med 2024; 14:28-38. [PMID: 38487759 PMCID: PMC10933589 DOI: 10.6705/j.jacme.202403_14(1).0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/23/2022] [Accepted: 01/03/2023] [Indexed: 03/17/2024]
Abstract
Background Low-flow extracorporeal CO 2 removal (ECCO 2 R), managed using a renal replacement platform, is useful in achieving lung-protective ventilation with low tidal volume. However, its capacity for CO 2 elimination is limited. Whether this system is valuable in reducing strong inspiratory efforts in respiratory failure is unclear. The combined use of alkaline agents with low-flow ECCO 2 R might be useful in hypercapnic subjects preserving inspiratory efforts. Methods This study examined the effects of low-flow ECCO 2 R on respiratory status and investigated the effects of NaHCO 3 , trometamol, and saline on respiratory status during low-flow ECCO 2 R in CO 2 inhalation models. Results Although low-flow ECCO 2 R did not significantly change the respiratory rate (92.2% ± 24.3% [mean ± standard deviation] of that before ECCO 2 R), it reduced minute ventilation (MV) (78.9% ± 13.5% of that before ECCO 2 R). The addition of NaHCO 3 improved acidemia but did not change MV compared with that of the saline group (0.451 ± 0.026 L/min/kg body weight [BW] vs. 0.556 ± 0.138 L/min/kg BW, respectively). The addition of trometamol improved acidemia and reduced MV compared with that of the saline group (0.381 ± 0.050 L/min/kg BW vs. 0.556 ± 0.138 L/min/kg BW, respectively). The total amounts of CO 2 removed during ECCO 2 R in the NaHCO 3 group were lower than those in the saline and trometamol groups. Conclusion The low-flow ECCO 2 R reduced MV in subjects preserving spontaneous breathing efforts with CO 2 overload. The addition of NaHCO 3 improved acidemia but did not change MV, whereas the addition of trometamol improved acidemia and reduced MV.
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Affiliation(s)
- Tomonori Yamashita
- Osaka University Graduate School of Medicine Department of Anesthesiology and Intensive Care Medicine Suita Japan
| | - Akinori Uchiyama
- Osaka University Graduate School of Medicine Department of Anesthesiology and Intensive Care Medicine Suita Japan
| | - Yusuke Enokidani
- Osaka University Graduate School of Medicine Department of Anesthesiology and Intensive Care Medicine Suita Japan
| | - Takeshi Yoshida
- Osaka University Graduate School of Medicine Department of Anesthesiology and Intensive Care Medicine Suita Japan
| | - Yuji Fujino
- Osaka University Graduate School of Medicine Department of Anesthesiology and Intensive Care Medicine Suita Japan
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Tanaka A, Kitamura T, Uchiyama A, Enokidani Y, Koyama Y, Yoshida T, Fujino Y. Response to: the association between time definition of reintubation and patient outcomes in critically ill patients-several topics should be noticed. Crit Care 2024; 28:37. [PMID: 38303064 PMCID: PMC10832126 DOI: 10.1186/s13054-024-04817-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Affiliation(s)
- Aiko Tanaka
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Department of Intensive Care, University of Fukui Hospital, Yoshida, Fukui, Japan.
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Akinori Uchiyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yusuke Enokidani
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yukiko Koyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takeshi Yoshida
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
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7
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Arashiro T, Miwa M, Nakagawa H, Takamatsu J, Oba K, Fujimi S, Kikuchi H, Iwasawa T, Kanbe F, Oyama K, Kanai M, Ogata Y, Asakura T, Asami T, Mizuno K, Sugita M, Jinta T, Nishida Y, Kato H, Atagi K, Higaki T, Nakano Y, Tsutsumi T, Doi K, Okugawa S, Ueda A, Nakamura A, Yoshida T, Shimada-Sammori K, Shimizu K, Fujita Y, Okochi Y, Tochitani K, Nakanishi A, Rinka H, Taniyama D, Yamaguchi A, Uchikura T, Matsunaga M, Aono H, Hamaguchi M, Motoda K, Nakayama S, Yamamoto K, Oka H, Tanaka K, Inoue T, Kobayashi M, Fujitani S, Tsukahara M, Takeda S, Stucky A, Suzuki T, Smith C, Hibberd M, Ariyoshi K, Fujino Y, Arima Y, Takeda S, Hashimoto S, Suzuki M. COVID-19 vaccine effectiveness against severe COVID-19 requiring oxygen therapy, invasive mechanical ventilation, and death in Japan: A multicenter case-control study (MOTIVATE study). Vaccine 2024; 42:677-688. [PMID: 38114409 DOI: 10.1016/j.vaccine.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/03/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Since the SARS-CoV-2 Omicron variant became dominant, assessing COVID-19 vaccine effectiveness (VE) against severe disease using hospitalization as an outcome became more challenging due to incidental infections via admission screening and variable admission criteria, resulting in a wide range of estimates. To address this, the World Health Organization (WHO) guidance recommends the use of outcomes that are more specific to severe pneumonia such as oxygen use and mechanical ventilation. METHODS A case-control study was conducted in 24 hospitals in Japan for the Delta-dominant period (August-November 2021; "Delta") and early Omicron (BA.1/BA.2)-dominant period (January-June 2022; "Omicron"). Detailed chart review/interviews were conducted in January-May 2023. VE was measured using various outcomes including disease requiring oxygen therapy, disease requiring invasive mechanical ventilation (IMV), death, outcome restricting to "true" severe COVID-19 (where oxygen requirement is due to COVID-19 rather than another condition(s)), and progression from oxygen use to IMV or death among COVID-19 patients. RESULTS The analysis included 2125 individuals with respiratory failure (1608 cases [75.7%]; 99.2% of vaccinees received mRNA vaccines). During Delta, 2 doses provided high protection for up to 6 months (oxygen requirement: 95.2% [95% CI:88.7-98.0%] [restricted to "true" severe COVID-19: 95.5% {89.3-98.1%}]; IMV: 99.6% [97.3-99.9%]; fatal: 98.6% [92.3-99.7%]). During Omicron, 3 doses provided high protection for up to 6 months (oxygen requirement: 85.5% [68.8-93.3%] ["true" severe COVID-19: 88.1% {73.6-94.7%}]; IMV: 97.9% [85.9-99.7%]; fatal: 99.6% [95.2-99.97]). There was a trend towards higher VE for more severe and specific outcomes. CONCLUSION Multiple outcomes pointed towards high protection of 2 doses during Delta and 3 doses during Omicron. These results demonstrate the importance of using severe and specific outcomes to accurately measure VE against severe COVID-19, as recommended in WHO guidance in settings of intense transmission as seen during Omicron.
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Affiliation(s)
- Takeshi Arashiro
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan; Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
| | - Maki Miwa
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Hidenori Nakagawa
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
| | - Junpei Takamatsu
- Department of Emergency Medicine, Kansai Rosai Hospital, Hyogo, Japan
| | - Kunihiro Oba
- Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Hitoshi Kikuchi
- Department of Emergency Medicine, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Takamasa Iwasawa
- Department of Cardiology, Yokosuka General Hospital Uwamachi, Kanagawa, Japan
| | - Fumiko Kanbe
- Intensive Care Unit, Ageo Central General Hospital, Saitama, Japan
| | - Keisuke Oyama
- Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan
| | - Masayuki Kanai
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Yoshitaka Ogata
- Department of Critical Care Medicine, Yao Tokushukai General Hospital, Osaka, Japan
| | - Takanori Asakura
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Takahiro Asami
- Department of Internal Medicine, Sano Kosei General Hospital, Tochigi, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Torahiko Jinta
- Department of Pulmonary Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Yusuke Nishida
- Department of General Internal Medicine and Infectious Diseases, Saitama Medical Center, Saitama, Japan
| | - Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan
| | - Kazuaki Atagi
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Nara, Japan
| | - Taiki Higaki
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Nara, Japan
| | - Yoshio Nakano
- Department of Internal Medicine, Kinan Hospital, Wakayama, Japan
| | - Takeya Tsutsumi
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Shu Okugawa
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihiro Ueda
- Department of Infectious Diseases, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Akira Nakamura
- Department of Internal Medicine, Asahi General Hospital, Chiba, Japan
| | - Toru Yoshida
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kaoru Shimada-Sammori
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan TAMA Medical Center, Tokyo, Japan
| | - Keiki Shimizu
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan TAMA Medical Center, Tokyo, Japan
| | - Yasuo Fujita
- Department of Emergency, Akita Red Cross Hospital, Akita, Japan
| | - Yasumi Okochi
- Department of Respiratory Medicine, Japan Community Health Care Organization Tokyo Yamate Medical Center, Tokyo, Japan
| | - Kentaro Tochitani
- Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan
| | - Asuka Nakanishi
- Department of Pulmonary Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Hiroshi Rinka
- Department of Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Daisuke Taniyama
- Department of Infectious Diseases, Showa General Hospital, Tokyo, Japan
| | - Asase Yamaguchi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Toshio Uchikura
- Department of Emergency and General Internal Medicine, Yokosuka General Hospital Uwamachi, Kanagawa, Japan
| | - Maiko Matsunaga
- Department of Pharmacy, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Hiromi Aono
- Department of Respiratory Medicine, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Masanari Hamaguchi
- Department of Critical Care Medicine, Yao Tokushukai General Hospital, Osaka, Japan
| | - Kentaro Motoda
- Department of Clinical Research, Yao Tokushukai General Hospital, Osaka, Japan
| | - Sohei Nakayama
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Kei Yamamoto
- Department of General Internal Medicine and Infectious Diseases, Saitama Medical Center, Saitama, Japan
| | - Hideaki Oka
- Department of General Internal Medicine and Infectious Diseases, Saitama Medical Center, Saitama, Japan
| | - Katsushi Tanaka
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan
| | - Takeshi Inoue
- Clinical Research Support Center, Asahi General Hospital, Chiba, Japan
| | - Mieko Kobayashi
- Clinical Research Support Center, Asahi General Hospital, Chiba, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Maki Tsukahara
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Saki Takeda
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ashley Stucky
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Chris Smith
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Martin Hibberd
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Koya Ariyoshi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Yuji Fujino
- Non-Profit Organization Japan ECMO Network, Tokyo, Japan; Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuzo Arima
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shinhiro Takeda
- Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan; Non-Profit Organization Japan ECMO Network, Tokyo, Japan; Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan
| | - Satoru Hashimoto
- Non-Profit Organization Japan ECMO Network, Tokyo, Japan; Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan
| | - Motoi Suzuki
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
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Kyogoku M, Mizuguchi S, Miyasho T, Endo Y, Inata Y, Tachibana K, Fujino Y, Yamashita K, Takeuchi M. Estimating the change in pleural pressure using the change in central venous pressure in various clinical scenarios: a pig model study. Intensive Care Med Exp 2024; 12:4. [PMID: 38224398 PMCID: PMC10789683 DOI: 10.1186/s40635-023-00590-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND We have previously reported a simple correction method for estimating pleural pressure (Ppl) using central venous pressure (CVP). However, it remains unclear whether this method is applicable to patients with varying levels of intravascular volumes and/or chest wall compliance. This study aimed to investigate the accuracy of our method under different conditions of intravascular volume and chest wall compliance. RESULTS Ten anesthetized and paralyzed pigs (43.2 ± 1.8 kg) were mechanically ventilated and subjected to lung injury by saline lung lavage. Each pig was subjected to three different intravascular volumes and two different intraabdominal pressures. For each condition, the changes in the esophageal pressure (ΔPes) and the estimated ΔPpl using ΔCVP (cΔCVP-derived ΔPpl) were compared to the directly measured change in pleural pressure (Δd-Ppl), which was the gold standard estimate in this study. The cΔCVP-derived ΔPpl was calculated as κ × ΔCVP, where "κ" was the ratio of the change in airway pressure to the change in CVP during the occlusion test. The means and standard deviations of the Δd-Ppl, ΔPes, and cΔCVP-derived ΔPpl for all pigs under all conditions were 7.6 ± 4.5, 7.2 ± 3.6, and 8.0 ± 4.8 cmH2O, respectively. The repeated measures correlations showed that both the ΔPes and cΔCVP-derived ΔPpl showed a strong correlation with the Δd-Ppl (ΔPes: r = 0.95, p < 0.0001; cΔCVP-derived ΔPpl: r = 0.97, p < 0.0001, respectively). In the Bland-Altman analysis to test the performance of the cΔCVP-derived ΔPpl to predict the Δd-Ppl, the ΔPes and cΔCVP-derived ΔPpl showed almost the same bias and precision (ΔPes: 0.5 and 1.7 cmH2O; cΔCVP-derived ΔPpl: - 0.3 and 1.9 cmH2O, respectively). No significant difference was found in the bias and precision depending on the intravascular volume and intraabdominal pressure in both comparisons between the ΔPes and Δd-Ppl, and cΔCVP-derived ΔPpl and Δd-Ppl. CONCLUSIONS The CVP method can estimate the ΔPpl with reasonable accuracy, similar to Pes measurement. The accuracy was not affected by the intravascular volume or chest wall compliance.
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Affiliation(s)
- Miyako Kyogoku
- Department of Intensive Care, Osaka Women's and Children's Hospital, 840 Murodo-Cho, Izumi, Osaka, 594-1101, Japan
| | - Soichi Mizuguchi
- Department of Emergency and Critical Care Center, Kyushu University, Fukuoka, Japan
| | - Taku Miyasho
- Laboratory of Animal Biological Responses, Department of Veterinary Science School of Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan
| | - Yusuke Endo
- Laboratory of Animal Biological Responses, Department of Veterinary Science School of Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan
- Laboratory for Critical Care, Department of Emergency Medicine-Cardio Pulmonary, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Yu Inata
- Department of Intensive Care, Osaka Women's and Children's Hospital, 840 Murodo-Cho, Izumi, Osaka, 594-1101, Japan
| | - Kazuya Tachibana
- Department of Anesthesiology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuto Yamashita
- Department of Anesthesiology, Rakuno Gakuen University, Hokkaido, Japan
| | - Muneyuki Takeuchi
- Department of Intensive Care, Osaka Women's and Children's Hospital, 840 Murodo-Cho, Izumi, Osaka, 594-1101, Japan.
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9
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Sato K, Yamazaki Y, Kameyama Y, Watanabe K, Kitahara E, Haruyama K, Takahashi Y, Fujino Y, Yamaguchi T, Matsuda T, Makabe H, Isayama R, Murakami Y, Tani M, Honaga K, Hatori K, Oji Y, Tomizawa Y, Hatano T, Hattori N, Fujiwara T. Factor analysis for construct validity of a trunk impairment scale in Parkinson's disease: a cross-sectional study. Front Neurol 2024; 14:1303215. [PMID: 38234977 PMCID: PMC10791816 DOI: 10.3389/fneur.2023.1303215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 01/19/2024] Open
Abstract
Objectives To investigate the construct validity of the Trunk Impairment Scale (TIS), which was developed to assess trunk impairment in patients with stroke, in patients with Parkinson's disease (PD). Design This retrospective, cross-sectional study enrolled consecutive PD inpatients. Correlation analysis was performed to clarify whether the TIS assessment was related to other balance functions, lower extremity muscle strength, or walking ability. Factor analysis was performed to see how the background factors of TIS differ from balance function, lower limb muscle strength, and walking ability. Results Examining the data of 471 patients with PD, there were relationships between TIS and the Mini-Balance Evaluation Systems Test (r = 0.67), Barthel Index (r = 0.57), general lower limb extension torque (r = 0.51), two-minute walk test (r = 0.54), Hoehn and Yahr stage (r = -0.61), and Movement Disorder Society Unified Parkinson's Disease Rating Scale part III total points (r = -0.59). Factor analysis showed that TIS items were divided into three factors (an abdominal muscles and righting reflex component; a perception and verticality component; and a rotational component), differing from other scales that included clinical assessment items. Conclusion The TIS can be useful for assessing the underlying trunk impairment as a basis for activities of daily living, gait function, and balance ability in patients with PD.
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Affiliation(s)
- Kazunori Sato
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuta Yamazaki
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshihiro Kameyama
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koji Watanabe
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Eriko Kitahara
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koshiro Haruyama
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Yoko Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Tomofumi Yamaguchi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Hitoshi Makabe
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Reina Isayama
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuhei Murakami
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mami Tani
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kozo Hatori
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yutaka Oji
- Department of Neurology, Juntendo University Hospital, Tokyo, Japan
| | - Yuji Tomizawa
- Department of Neurology, Juntendo University Hospital, Tokyo, Japan
| | - Taku Hatano
- Department of Neurology, Juntendo University Hospital, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Hospital, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
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10
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Hashimoto H, Yoshida T, Firstiogusran AMF, Taenaka H, Nukiwa R, Koyama Y, Uchiyama A, Fujino Y. Asynchrony Injures Lung and Diaphragm in Acute Respiratory Distress Syndrome. Crit Care Med 2023; 51:e234-e242. [PMID: 37459198 DOI: 10.1097/ccm.0000000000005988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVES Patient-ventilator asynchrony is often observed during mechanical ventilation and is associated with higher mortality. We hypothesized that patient-ventilator asynchrony causes lung and diaphragm injury and dysfunction. DESIGN Prospective randomized animal study. SETTING University research laboratory. SUBJECTS Eighteen New Zealand White rabbits. INTERVENTIONS Acute respiratory distress syndrome (ARDS) model was established by depleting surfactants. Each group (assist control, breath stacking, and reverse triggering) was simulated by phrenic nerve stimulation. The effects of each group on lung function, lung injury (wet-to-dry lung weight ratio, total protein, and interleukin-6 in bronchoalveolar lavage), diaphragm function (diaphragm force generation curve), and diaphragm injury (cross-sectional area of diaphragm muscle fibers, histology) were measured. Diaphragm RNA sequencing was performed using breath stacking and assist control ( n = 2 each). MEASUREMENTS AND MAIN RESULTS Inspiratory effort generated by phrenic nerve stimulation was small and similar among groups (esophageal pressure swing ≈ -2.5 cm H 2 O). Breath stacking resulted in the largest tidal volume (>10 mL/kg) and highest inspiratory transpulmonary pressure, leading to worse oxygenation, worse lung compliance, and lung injury. Reverse triggering did not cause lung injury. No asynchrony events were observed in assist control, whereas eccentric contractions occurred in breath stacking and reverse triggering, but more frequently in breath stacking. Breath stacking and reverse triggering significantly reduced diaphragm force generation. Diaphragmatic histology revealed that the area fraction of abnormal muscle was ×2.5 higher in breath stacking (vs assist control) and ×2.1 higher in reverse triggering (vs assist control). Diaphragm RNA sequencing analysis revealed that genes associated with muscle differentiation and contraction were suppressed, whereas cytokine- and chemokine-mediated proinflammatory responses were activated in breath stacking versus assist control. CONCLUSIONS Breath stacking caused lung and diaphragm injury, whereas reverse triggering caused diaphragm injury. Thus, careful monitoring and management of patient-ventilator asynchrony may be important to minimize lung and diaphragm injury from spontaneous breathing in ARDS.
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Affiliation(s)
- Haruka Hashimoto
- All authors: Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
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11
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Ishimaru T, Okawara M, Tateishi S, Yasui T, Horie S, Fujino Y. Impact of menopausal symptoms on presenteeism in Japanese women. Occup Med (Lond) 2023; 73:404-409. [PMID: 37494697 DOI: 10.1093/occmed/kqad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Menopausal symptoms are common among middle-aged women. Working women with severe menopausal symptoms are more likely to experience presenteeism-a condition where employees continue to work despite feeling unwell. However, it remains unclear as to which specific symptoms women experience during the menopausal transition and postmenopausal periods that primarily contribute to presenteeism. AIMS To evaluate the associations between types of menopausal symptoms and presenteeism among Japanese women. METHODS A cross-sectional study of 4000 women aged 40-59 years who were currently working was conducted in Japan in September 2022. We used an online self-administered questionnaire that included items on demographic characteristics, the Menopause Rating Scale for measuring menopausal symptoms and the Work Functioning Impairment Scale for measuring presenteeism. Logistic regression analysis was performed. RESULTS Women with severe overall menopausal symptoms had 12.18-fold (95% confidence interval [CI] 9.09-16.33, P < 0.001) increased odds of presenteeism compared with those without symptoms. Participants with psychological symptoms also had significantly higher presenteeism (severe: odds ratio: 9.18, 95% CI 6.60-12.78, P < 0.001). However, after controlling for psychological symptoms, there were no significant associations between somatic and urogenital symptoms and presenteeism. CONCLUSIONS The results indicate that menopausal symptoms, especially psychological symptoms, have a significant impact on presenteeism among Japanese women. Organizations need to address menopausal symptoms in the workplace, with an emphasis on reducing work-related stress for women with menopausal symptoms.
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Affiliation(s)
- T Ishimaru
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - M Okawara
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - S Tateishi
- Disaster Occupational Health Center, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - T Yasui
- Department of Reproductive and Menopausal Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - S Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Y Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
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12
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Tanaka A, Shimomura Y, Uchiyama A, Tokuhira N, Kitamura T, Iwata H, Hashimoto H, Ishigaki S, Enokidani Y, Yamashita T, Koyama Y, Iguchi N, Yoshida T, Fujino Y. Time definition of reintubation most relevant to patient outcomes in critically ill patients: a multicenter cohort study. Crit Care 2023; 27:378. [PMID: 37777790 PMCID: PMC10544149 DOI: 10.1186/s13054-023-04668-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/27/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Reintubation is a common complication in critically ill patients requiring mechanical ventilation. Although reintubation has been demonstrated to be associated with patient outcomes, its time definition varies widely among guidelines and in the literature. This study aimed to determine the association between reintubation and patient outcomes as well as the consequences of the time elapsed between extubation and reintubation on patient outcomes. METHODS This was a multicenter retrospective cohort study of critically ill patients conducted between April 2015 and March 2021. Adult patients who underwent mechanical ventilation and extubation in intensive care units (ICUs) were investigated utilizing the Japanese Intensive Care PAtient Database. The primary and secondary outcomes were in-hospital and ICU mortality. The association between reintubation and clinical outcomes was studied using Cox proportional hazards analysis. Among the patients who underwent reintubation, a Cox proportional hazard analysis was conducted to evaluate patient outcomes according to the number of days from extubation to reintubation. RESULTS Overall, 184,705 patients in 75 ICUs were screened, and 1849 patients underwent reintubation among 48,082 extubated patients. After adjustment for potential confounders, multivariable analysis revealed a significant association between reintubation and increased in-hospital and ICU mortality (adjusted hazard ratio [HR] 1.520, 95% confidence interval [CI] 1.359-1.700, and adjusted HR 1.325, 95% CI 1.076-1.633, respectively). Among the reintubated patients, 1037 (56.1%) were reintubated within 24 h after extubation, 418 (22.6%) at 24-48 h, 198 (10.7%) at 48-72 h, 111 (6.0%) at 72-96 h, and 85 (4.6%) at 96-120 h. Multivariable Cox proportional hazard analysis showed that in-hospital and ICU mortality was highest in patients reintubated at 72-96 h (adjusted HR 1.528, 95% CI 1.062-2.197, and adjusted HR 1.334, 95% CI 0.756-2.352, respectively; referenced to reintubation within 24 h). CONCLUSIONS Reintubation was associated with a significant increase in in-hospital and ICU mortality. The highest mortality rates were observed in patients who were reintubated between 72 and 96 h after extubation. Further studies are warranted for the optimal observation of extubated patients in clinical practice and to strengthen the evidence for mechanical ventilation.
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Affiliation(s)
- Aiko Tanaka
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Department of Intensive Care, University of Fukui Hospital, Yoshida, Fukui, Japan.
| | - Yoshimitsu Shimomura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Hematology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Akinori Uchiyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Natsuko Tokuhira
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hirofumi Iwata
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Haruka Hashimoto
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Suguru Ishigaki
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yusuke Enokidani
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tomonori Yamashita
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yukiko Koyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Naoya Iguchi
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takeshi Yoshida
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
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13
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Hoshino T, Uchiyama A, Tokuhira N, Ishigaki S, Koide M, Kubo N, Enokidani Y, Sakaguchi R, Koyama Y, Yoshida T, Hirata H, Fujino Y. Factors Associated With Prolonged Ventilation in Patients Receiving Prone Positioning Protocol With Muscle Relaxants for Severe COVID-19 Pneumonia. Respir Care 2023:respcare.10567. [PMID: 37221085 PMCID: PMC10353171 DOI: 10.4187/respcare.10567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Prone positioning and neuromuscular blocking agents (NMBAs) are frequently used to treat severe respiratory failure from COVID-19 pneumonia. Prone positioning has shown to improve mortality, whereas NMBAs are used to prevent ventilator asynchrony and reduce patient self-inflicted lung injury. However, despite the use of lung-protective strategies, high death rates in this patient population have been reported. METHODS We retrospectively examined the factors affecting prolonged mechanical ventilation in patients receiving prone positioning plus muscle relaxants. The medical records of 170 patients were reviewed. Subjects were divided into 2 groups according to ventilator-free days (VFDs) at day 28. Whereas subjects with VFDs < 18 d were defined as prolonged mechanical ventilation, subjects with VFDs ≥18 d were defined as short-term mechanical ventilation. Subjects' baseline status, status at ICU admission, therapy before ICU admission, and treatment in the ICU were studied. RESULTS Under the proning protocol for COVID-19, the mortality rate in our facility was 11.2%. The prognosis may be improved by avoiding lung injury in the early stages of mechanical ventilation. According to multifactorial logistic regression analysis, persistent SARS-CoV-2 viral shedding in blood (P = .027), higher daily corticosteroid use before ICU admission (P = .007), delayed recovery of lymphocyte count (P < .001), and higher maximal fibrinogen degradation products (P = .039) were associated with prolonged mechanical ventilation. A significant relationship was found between daily corticosteroid use before admission and VFDs by squared regression analysis (y = -0.00008522x2 + 0.01338x + 12.8; x: daily corticosteroids dosage before admission [prednisolone mg/d]; y: VFDs/28 d, R2 = 0.047, P = .02). The peak point of the regression curve was 13.4 d at 78.5 mg/d of the equivalent prednisolone dose, which corresponded to the longest VFDs. CONCLUSIONS Persistent SARS-CoV-2 viral shedding in blood, high corticosteroid dose from the onset of symptoms to ICU admission, slow recovery of lymphocyte counts, and high levels of fibrinogen degradation products after admission were associated with prolonged mechanical ventilation in subjects with severe COVID-19 pneumonia.
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Affiliation(s)
- Taiki Hoshino
- Department of Anesthesia and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akinori Uchiyama
- Department of Anesthesia and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Natsuko Tokuhira
- Department of Anesthesia and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Suguru Ishigaki
- Department of Anesthesia and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Moe Koide
- Department of Anesthesia and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoko Kubo
- Department of Anesthesia, Rinku General Medical Center, Osaka, Japan
| | - Yusuke Enokidani
- Department of Anesthesia and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryota Sakaguchi
- Department of Anesthesia and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukiko Koyama
- Department of Anesthesia and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Yoshida
- Department of Anesthesia and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Haruhiko Hirata
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuji Fujino
- Department of Anesthesia and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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14
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Taenaka H, Yoshida T, Hashimoto H, Firstiogusran AMF, Ishigaki S, Iwata H, Enokidani Y, Ebishima H, Kubo N, Koide M, Koyama Y, Sakaguchi R, Tokuhira N, Horiguchi Y, Uchiyama A, Fujino Y. Personalized ventilatory strategy based on lung recruitablity in COVID-19-associated acute respiratory distress syndrome: a prospective clinical study. Crit Care 2023; 27:152. [PMID: 37076900 PMCID: PMC10116825 DOI: 10.1186/s13054-023-04360-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/14/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Heterogeneity is an inherent nature of ARDS. Recruitment-to-inflation ratio has been developed to identify the patients who has lung recruitablity. This technique might be useful to identify the patients that match specific interventions, such as higher positive end-expiratory pressure (PEEP) or prone position or both. We aimed to evaluate the physiological effects of PEEP and body position on lung mechanics and regional lung inflation in COVID-19-associated ARDS and to propose the optimal ventilatory strategy based on recruitment-to-inflation ratio. METHODS Patients with COVID-19-associated ARDS were consecutively enrolled. Lung recruitablity (recruitment-to-inflation ratio) and regional lung inflation (electrical impedance tomography [EIT]) were measured with a combination of body position (supine or prone) and PEEP (low 5 cmH2O or high 15 cmH2O). The utility of recruitment-to-inflation ratio to predict responses to PEEP were examined with EIT. RESULTS Forty-three patients were included. Recruitment-to-inflation ratio was 0.68 (IQR 0.52-0.84), separating high recruiter versus low recruiter. Oxygenation was the same between two groups. In high recruiter, a combination of high PEEP with prone position achieved the highest oxygenation and less dependent silent spaces in EIT (vs. low PEEP in both positions) without increasing non-dependent silent spaces in EIT. In low recruiter, low PEEP in prone position resulted in better oxygenation (vs. both PEEPs in supine position), less dependent silent spaces (vs. low PEEP in supine position) and less non-dependent silent spaces (vs. high PEEP in both positions). Recruitment-to-inflation ratio was positively correlated with the improvement in oxygenation and respiratory system compliance, the decrease in dependent silent spaces, and was inversely correlated with the increase in non-dependent silent spaces, when applying high PEEP. CONCLUSIONS Recruitment-to-inflation ratio may be useful to personalize PEEP in COVID-19-associated ARDS. Higher PEEP in prone position and lower PEEP in prone position decreased the amount of dependent silent spaces (suggesting lung collapse) without increasing the amount of non-dependent silent spaces (suggesting overinflation) in high recruiter and in low recruiter, respectively.
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Affiliation(s)
- Hiroki Taenaka
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takeshi Yoshida
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Haruka Hashimoto
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Andi Muhammad Fadlillah Firstiogusran
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Suguru Ishigaki
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hirofumi Iwata
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yusuke Enokidani
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hironori Ebishima
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Naoko Kubo
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Moe Koide
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yukiko Koyama
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ryota Sakaguchi
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Natsuko Tokuhira
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yu Horiguchi
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Akinori Uchiyama
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuji Fujino
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
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15
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Tanaka A, Uchiyama A, Kitamura T, Sakaguchi R, Komukai S, Enokidani Y, Koyama Y, Yoshida T, Iguchi N, Sobue T, Fujino Y. Association between tracheostomy and survival in patients with coronavirus disease 2019 who require prolonged mechanical ventilation for more than 14 days: A multicenter cohort study. Auris Nasus Larynx 2023; 50:276-284. [PMID: 35764477 PMCID: PMC9189113 DOI: 10.1016/j.anl.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Tracheostomy is a common procedure with potential prognostic advantages for patients who require prolonged mechanical ventilation (PMV). Early recommendations for patients with coronavirus disease 2019 (COVID-19) suggested delayed or limited tracheostomy considering the risk for viral transmission to clinicians. However, updated guidelines for tracheostomy with appropriate personal protective equipment have revised its indications. This study aimed to evaluate the association between tracheostomy and prognosis in patients with COVID-19 requiring PMV. METHODS This was a multicenter, retrospective cohort study using data from the nationwide Japanese Intensive Care PAtient Database. We included adult patients aged ≥16 years who were admitted to the intensive care unit (ICU) due to COVID-19 and who required PMV (for >14 days or until performance of tracheostomy). The primary outcome was hospital mortality, and the association between implementation of tracheostomy and patient prognosis was assessed using weighted Cox proportional hazards regression analysis with inverse probability of treatment weighting (IPTW) using the propensity score to address confounders. RESULTS Between January 2020 and February 2021, 453 patients with COVID-19 were observed. Data from 109 patients who required PMV were analyzed: 66 (60.6%) underwent tracheostomy and 38 (34.9%) died. After adjusting for potential confounders using IPTW, tracheostomy implementation was found to significantly reduce hospital mortality (hazard ratio [HR]: 0.316, 95% confidence interval [CI]: 0.163-0.612). Patients who underwent tracheostomy had a similarly decreased ICU and 28-day mortality (HR: 0.269, 95% CI: 0.124-0.581; HR 0.281, 95% CI: 0.094-0.839, respectively). A sensitivity analysis using different definitions of PMV duration consistently showed reduced mortality in patients who underwent tracheostomy. CONCLUSION The implementation of tracheostomy was associated with favorable patient prognosis among patients with COVID-19 requiring PMV. Our findings support proactive tracheostomy in critically ill patients with COVID-19 requiring mechanical ventilation for >14 days.
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Affiliation(s)
- Aiko Tanaka
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Akinori Uchiyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Ryota Sakaguchi
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yusuke Enokidani
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yukiko Koyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takeshi Yoshida
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Naoya Iguchi
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
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16
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Shida K, Fukata K, Fujino Y, Inoue M, Inoue M, Sekine D, Miki H, Sato H, Kobayashi Y, Hasegawa K, Amimoto K, Makita S, Takahashi H. Predictive factors for walking in acute stroke patients: a multicenter study using classification and regression tree analysis. J Phys Ther Sci 2023; 35:217-222. [PMID: 36866009 PMCID: PMC9974313 DOI: 10.1589/jpts.35.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/09/2022] [Indexed: 03/04/2023] Open
Abstract
[Purpose] Walking ability should be predicted as early as possible in acute stroke patients. The purpose is to construct a prediction model for independent walking from bedside assessments using classification and regression tree analysis. [Participants and Methods] We conducted a multicenter case-control study with 240 stroke patients. Survey items included age, gender, injured hemisphere, the National Institute of Health Stroke Scale, the Brunnstrom Recovery Stage for lower extremities, and "turn over from a supine position" from the Ability for Basic Movement Scale. The National Institute of Health Stroke Scale items, such as language, extinction, and inattention, were grouped under higher brain dysfunction. We used the Functional Ambulation Categories to classify patients into independent (four or more the Functional Ambulation Categories; n=120) and dependent (three or fewer the Functional Ambulation Categories; n=120) walking groups. A classification and regression tree analysis was used to create a model to predict independent walking. [Results] The Brunnstrom Recovery Stage for lower extremities, "turn over from a supine position" from the Ability for Basic Movement Scale, and higher brain dysfunction were the splitting criteria for classifying patients into four categories: Category 1 (0%), severe motor paresis; Category 2 (10.0%), mild motor paresis and could not turn over; Category 3 (52.5%), with mild motor paresis, could turn over, and had higher brain dysfunction; and Category 4 (82.5%), with mild motor paresis, could turn over, and no higher brain dysfunction. [Conclusion] We constructed a useful prediction model for independent walking based on the three criteria.
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Affiliation(s)
- Kohei Shida
- Department of Rehabilitation Center, Saitama Medical
University International Medical Center: 1397-1 Yamane, Hidaka-shi, Saitama 350-1298,
Japan, Department of Physical Therapy, Faculty of Human Health
Sciences, Tokyo Metropolitan University, Japan
| | - Kazuhiro Fukata
- Department of Rehabilitation Center, Saitama Medical
University International Medical Center: 1397-1 Yamane, Hidaka-shi, Saitama 350-1298,
Japan,Corresponding author. Kazuhiro Fukata (E-mail: )
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Sciences,
Juntendo University, Japan
| | - Masahide Inoue
- Department of Rehabilitation Center, Saitama Medical
University International Medical Center: 1397-1 Yamane, Hidaka-shi, Saitama 350-1298,
Japan, Department of Physical Therapy, Faculty of Human Health
Sciences, Tokyo Metropolitan University, Japan
| | - Mamiko Inoue
- Department of Rehabilitation Center, Saitama Medical
University International Medical Center: 1397-1 Yamane, Hidaka-shi, Saitama 350-1298,
Japan
| | - Daisuke Sekine
- Department of Rehabilitation Center, Saitama Medical
University International Medical Center: 1397-1 Yamane, Hidaka-shi, Saitama 350-1298,
Japan
| | - Hiroshi Miki
- Department of Rehabilitation, Tokyo Saiseikai Central
Hospital, Japan
| | - Hirofumi Sato
- Department of Rehabilitation, Saitama Citizens Medical
Center, Japan
| | - Yohei Kobayashi
- Department of Rehabilitation, Saitama Sekishinkai Hospital,
Japan
| | - Koki Hasegawa
- Department of Rehabilitation, Sainokuni Higashiomiya
Medical Center, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Faculty of Human Health
Sciences, Tokyo Metropolitan University, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University
International Medical Center, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University
International Medical Center, Japan
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17
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Inoue M, Amimoto K, Chiba Y, Sekine D, Fukata K, Fujino Y, Takahashi H, Makita S. Analyses of weight-bearing asymmetry pattern for standing in the early phase after stroke: a cross-sectional study. Physiother Theory Pract 2023:1-8. [PMID: 36593735 DOI: 10.1080/09593985.2022.2163860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND How the weight-bearing asymmetry pattern and related maximum lateral weight-bearing capacity, physical functions, balance, and mobility involved in weight-bearing asymmetry and lesions are related to weight-bearing asymmetry in patients with early-onset stroke remains unclear. OBJECTIVE To investigate the difference between weight-bearing in the early phase after stroke categorized as symmetrical or nonsymmetrical regarding impairments, balance, walking, and independence, and any lesion location difference. METHODS This cross-sectional study included 46 persons with hemiparetic stroke within 3 weeks from onset undergoing inpatient rehabilitation and classified into symmetrical, paretic, and non-paretic groups. We performed posturographic, functional, mobility, and lesion location assessments on participants once the evaluation was possible. RESULTS The symmetrical, paretic, and non-paretic groups included 14, 11, and 21 patients, respectively. The non-paretic group had lesser mean % body weight in maximum lateral weight-bearing to the paretic direction (79% versus 55%, p < .001), motor function of the hip lower limb (64 versus 58, p = .003) per the Stroke Impairment Assessment Set, Trunk Impairment Scale (18 versus 15, p = .020), and Berg Balance Scale (42 versus 32, p = .047) than the paretic group with more lesions in the insula (55% versus 0%, p < .001) and parietal cortex (36% versus 0%, p = .009) than the non-paretic group. CONCLUSION The non-paretic group had low dynamic balance, severe motor paresis, and trunk dysfunction. The paretic group had lesions in the insula or parietal cortex.
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Affiliation(s)
- Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, Japan
| | - Yuya Chiba
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Daisuke Sekine
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, Japan
| | - Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Juntendo University, 3-2-12, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
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18
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Nukiwa R, Uchiyama A, Tanaka A, Kitamura T, Sakaguchi R, Shimomura Y, Ishigaki S, Enokidani Y, Yamashita T, Koyama Y, Yoshida T, Tokuhira N, Iguchi N, Shintani Y, Miyagawa S, Fujino Y. Timing of tracheostomy and patient outcomes in critically ill patients requiring extracorporeal membrane oxygenation: a single-center retrospective observational study. J Intensive Care 2022; 10:56. [PMID: 36585705 PMCID: PMC9802016 DOI: 10.1186/s40560-022-00649-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is an integral method of life support in critically ill patients with severe cardiopulmonary failure; however, such patients generally require prolonged mechanical ventilation and exhibit high mortality rates. Tracheostomy is commonly performed in patients on mechanical ventilation, and its early implementation has potential advantages for favorable patient outcomes. This study aimed to investigate the association between tracheostomy timing and patient outcomes, including mortality, in patients requiring ECMO. METHODS We conducted a single-center retrospective observational study of consecutively admitted patients who were supported by ECMO and underwent tracheostomy during intensive care unit (ICU) admission at a tertiary care center from April 2014 until December 2021. The primary outcome was hospital mortality. Using the quartiles of tracheostomy timing, the patients were classified into four groups for comparison. The association between the quartiles of tracheostomy timing and mortality was explored using multivariable logistic regression models. RESULTS Of the 293 patients treated with ECMO, 98 eligible patients were divided into quartiles 1 (≤ 15 days), quartile 2:16-19 days, quartile 3:20-26 days, and 4 (> 26 days). All patients underwent surgical tracheostomy and 35 patients underwent tracheostomy during ECMO. The complications of tracheostomy were comparable between the groups, whereas the duration of ECMO and ICU length of stay increased significantly as the quartiles of tracheostomy timing increased. Patients in quartile 1 had the lowest hospital mortality rate (19.2%), whereas those in quartile 4 had the highest mortality rate (50.0%). Multivariate logistic regression analysis showed a significant association between the increment of the quartiles of tracheostomy timing and hospital mortality (adjusted odds ratio for quartile increment:1.55, 95% confidence interval 1.03-2.35, p for trend = 0.037). CONCLUSIONS The timing of tracheostomy in patients requiring ECMO was significantly associated with patient outcomes in a time-dependent manner. Further investigation is warranted to determine the optimal timing of tracheostomy in terms of mortality.
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Affiliation(s)
- Ryota Nukiwa
- grid.136593.b0000 0004 0373 3971Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Akinori Uchiyama
- grid.136593.b0000 0004 0373 3971Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Aiko Tanaka
- grid.136593.b0000 0004 0373 3971Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan ,grid.413114.2Department of Intensive Care, University of Fukui Hospital, Yoshida, Fukui, Japan
| | - Tetsuhisa Kitamura
- grid.136593.b0000 0004 0373 3971Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka Japan
| | - Ryota Sakaguchi
- grid.136593.b0000 0004 0373 3971Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Yoshimitsu Shimomura
- grid.136593.b0000 0004 0373 3971Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka Japan ,grid.410843.a0000 0004 0466 8016Department of Hematology, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Suguru Ishigaki
- grid.136593.b0000 0004 0373 3971Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan ,grid.136593.b0000 0004 0373 3971Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka Japan
| | - Yusuke Enokidani
- grid.136593.b0000 0004 0373 3971Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Tomonori Yamashita
- grid.136593.b0000 0004 0373 3971Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Yukiko Koyama
- grid.136593.b0000 0004 0373 3971Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Takeshi Yoshida
- grid.136593.b0000 0004 0373 3971Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Natsuko Tokuhira
- grid.136593.b0000 0004 0373 3971Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Naoya Iguchi
- grid.136593.b0000 0004 0373 3971Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Yasushi Shintani
- grid.136593.b0000 0004 0373 3971Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka Japan
| | - Shigeru Miyagawa
- grid.136593.b0000 0004 0373 3971Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka Japan
| | - Yuji Fujino
- grid.136593.b0000 0004 0373 3971Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan
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19
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Tokuhira N, Uchiyama A, Hoshino T, Kubo N, Ishigaki S, Enokidani Y, Sakaguchi R, Koyama Y, Fujino Y. Control of blood glucose levels by an artificial pancreas in patients with severe coronavirus disease 2019 pneumonia. Artif Organs 2022:10.1111/aor.14472. [PMID: 36440971 PMCID: PMC9877914 DOI: 10.1111/aor.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/02/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many patients with severe coronavirus disease 2019 (COVID-19) pneumonia experience hyperglycemia. It is often difficult to control blood glucose (BG) levels in such patients using standard intravenous insulin infusion therapy. Therefore, we used an artificial pancreas. This study aimed to compare the BG status of the artificial pancreas with that of standard therapy. METHODS Fifteen patients were included in the study. BG values and the infusion speed of insulin and glucose by the artificial pancreas were collected. Arterial BG and administration rates of insulin, parenteral sugar, and enteral sugar were recorded during the artificial pancreas and standard therapy. The target BG level was 200 mg/dl. RESULTS Arterial BG was highly correlated with BG data from the artificial pancreas. A higher BG slightly increased the difference between the BG data from the artificial pancreas and arterial BS. No significant difference in arterial BG was observed between the artificial pancreas and standard therapy. However, the standard deviation with the artificial pancreas was smaller than that under standard therapy (p < 0.0001). More points within the target BG range were achieved with the artificial pancreas (180-220 mg/dl) than under standard therapy. The hyperglycemic index of the artificial pancreas (8.7 ± 15.6 mg/dl) was lower than that of standard therapy (16.0 ± 21.5 mg/dl) (p = 0.0387). No incidence of hypoglycemia occurred under the artificial pancreas. CONCLUSIONS The rate of achieving target BG was higher using artificial pancreas than with standard therapy. An artificial pancreas helps to control BG in critically ill patients.
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Affiliation(s)
- Natsuko Tokuhira
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Akinori Uchiyama
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Taiki Hoshino
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Naoko Kubo
- Department of AnesthesiaRinku General Medical CenterOsakaJapan
| | - Suguru Ishigaki
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yusuke Enokidani
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Ryota Sakaguchi
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yukiko Koyama
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yuji Fujino
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
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20
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Firstiogusran AMF, Yoshida T, Hashimoto H, Iwata H, Fujino Y. Positive end-expiratory pressure and prone position alter the capacity of force generation from diaphragm in acute respiratory distress syndrome: an animal experiment. BMC Anesthesiol 2022; 22:373. [PMID: 36460946 PMCID: PMC9716689 DOI: 10.1186/s12871-022-01921-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Spontaneous breathing potentially injures lungs and diaphragm when spontaneous effort is vigorous in acute respiratory distress syndrome (ARDS) while immobility also has risks of Intensive Care Unit (ICU) acquired weakness and diaphragm atrophy. Thus, ventilatory strategy to mitigate strong spontaneous effort should be promptly established without a systemic use of neuromuscular blocking agent. Here, we investigated the impacts of positive end-expiratory pressure (PEEP) and body position on the capacity of force generation from diaphragm following bilateral phrenic nerve stimulations in a rabbit ARDS model. METHODS Using lung-injured rabbits, we measured 1) transdiaphragmatic pressure by bilateral phrenic nerve stimulation and 2) end-expiratory lung volume using computed tomography, under two different levels of PEEP (high, low) and body positions (supine, prone). RESULTS Overall, transdiaphragmatic pressure was the highest at low PEEP in supine position and the lowest at high PEEP in prone position. Compared to values in low PEEP + supine, transdiaphragmatic pressure was significantly reduced by either prone alone (the same PEEP) or increasing PEEP alone (the same position) or both combinations. End-expiratory lung volume was significantly increased with increasing PEEP in both positions, but it was not altered by body position. INTERPRETATION The capacity of force generation from diaphragm was modulated by PEEP and body position during mechanical ventilation in ARDS. Higher PEEP or prone position per se or both was effective to decrease the force generation from diaphragm.
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Affiliation(s)
- Andi Muhammad Fadlillah Firstiogusran
- grid.136593.b0000 0004 0373 3971The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Yoshida
- grid.136593.b0000 0004 0373 3971The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan ,Osaka, Japan
| | - Haruka Hashimoto
- grid.136593.b0000 0004 0373 3971The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirofumi Iwata
- grid.136593.b0000 0004 0373 3971The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuji Fujino
- grid.136593.b0000 0004 0373 3971The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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21
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Fukata K, Amimoto K, Shida K, Fujino Y, Osaki S, Makita S, Takahashi H. Effects of standing and walking training using a laser pointer based on stimulus-driven attention for behavioural outcome in spatial neglect: A single-case study. Neuropsychol Rehabil 2022; 32:2519-2533. [PMID: 34309494 DOI: 10.1080/09602011.2021.1956548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The therapy for unilateral spatial neglect (USN) is unclear. This case report investigated the effect of standing and walking training using a laser pointer based on stimulus-driven attention for USN. The patient was a right-handed 79-year-old man with cardiogenic cerebral embolism in the right middle and posterior cerebral arteries. Initially, we evaluated the absence of hemiparalysis in the lower limb and sensory disorder; almost all daily activities were performed independently. Intervention effects were verified using the BABA method. The course of the four phases (B1, A1, B2, A2) was conducted for 5 days. In the B1 and B2 phases, standing and walking training using a laser pointer was performed additionally to conventional physical therapy. Outcomes were measured using the Behavioural Inattention Test conventional subtest (BIT-c), Catherine Bergego Scale (CBS), and modified Posner task (MPT). The BIT-c remained unchanged in each phase. CBS scores improved after B1 and B2. In the MPT, the reaction time in the left space reduced after B1 and B2 compared with those in the A1 and A2 control phases. In this case, training may have contributed to the improvement in the response to the neglected space and behavioural assessment of USN.
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Affiliation(s)
- Kazuhiro Fukata
- Department of Rehabilitation Centre, Saitama Medical University International Medical Centre, Saitama, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Kohei Shida
- Department of Rehabilitation Centre, Saitama Medical University International Medical Centre, Saitama, Japan.,Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, Bunkyo-ku, Japan
| | - Shinpei Osaki
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan.,Department of Rehabilitation, Kansai Electric Power Hospital, Osaka, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Centre, Saitama, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Centre, Saitama, Japan
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22
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Fukata K, Fujino Y, Inoue M, Inoue M, Sekine D, Miki H, Sato H, Kobayashi Y, Hasegawa K, Amimoto K, Makita S, Takahashi H. Early incidence and factors affecting recovery from lateropulsion after acute hemispheric stroke. Ann Phys Rehabil Med 2022; 66:101706. [PMID: 36182061 DOI: 10.1016/j.rehab.2022.101706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan.
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 3-2-12, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Mamiko Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Daisuke Sekine
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Hiroshi Miki
- Department of Rehabilitation, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan
| | - Hirofumi Sato
- Department of Rehabilitation, Saitama Citizens Medical Center, 299-1, Shimane, Nishi-ku, Saitama, Saitama, 331-0054, Japan
| | - Yohei Kobayashi
- Department of Rehabilitation, Saitama Sekishinkai Hospital, 2-37-20, Irumagawa, Sayamashi, Saitama, 350-1305, Japan
| | - Koki Hasegawa
- Department of Rehabilitation, Sainokuni Higashiomiya Medical Center, 1522, Torocyo, kita-ku, Saitama, Saitama, 331-8577, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashi-Ogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
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23
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Ohshimo S, Liu K, Ogura T, Iwashita Y, Kushimoto S, Shime N, Hashimoto S, Fujino Y, Takeda S. Trends in survival during the pandemic in patients with critical COVID-19 receiving mechanical ventilation with or without ECMO: analysis of the Japanese national registry data. Crit Care 2022; 26:354. [PMCID: PMC9664428 DOI: 10.1186/s13054-022-04187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
The survival rate of patients with critical coronavirus disease-19 (COVID-19) over time is inconsistent in different settings. In Japan, a national database was organized to monitor and share the patient generation across the country in an immediate response to the COVID-19 pandemic. This study aimed to evaluate changes in survival over time and the prognostic factors in critical COVID-19 patients receiving mechanical ventilation with/without extracorporeal membrane oxygenation (ECMO) using the largest database in Japan.
Methods
This is a prospective observational cohort study of patients admitted to intensive care units in Japan with fatal COVID-19 pneumonia receiving mechanical ventilation and/or ECMO. We developed a prospective nationwide registry covering > 80% of intensive care units in Japan, and analyzed the association between patients’ backgrounds, institutional ECMO experience, and timing of treatment initiation and prognosis between February 2020 and November 2021. Prognostic factors were evaluated by Kaplan–Meier analysis and Cox proportional hazards analysis.
Results
A total of 9418 patients were ventilated, of whom 1214 (13%) received ECMO. The overall survival rate for ventilated patients was 79%, 65% for those receiving ECMO. There have been five outbreaks in Japan to date. The survival rate of ventilated patients increased from 76% in the first outbreak to 84% in the fifth outbreak (p < 0.001). The survival rate of ECMO patients remained unchanged at 60–68% from the first to fifth outbreaks (p = 0.084). Age of ≥ 59 (hazard ratio [HR] 2.17; 95% confidence interval [CI] 1.76–2.68), ventilator days of ≥ 3 before starting ECMO (HR 1.91; 95% CI 1.57–2.32), and institutional ECMO experiences of ≥ 11 (HR 0.70; 95% CI 0.58–0.85) were independent prognostic factors for ECMO.
Conclusions
During five COVID-19 outbreaks in Japan, the survival rate of ventilated patients tended to have gradually improved, and that of ECMO patients did not deteriorate. Older age, longer ventilator days before starting ECMO, and fewer institutional ECMO experiences may be independent prognostic factors for critical COVID-19 patients receiving ECMO.
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Inoue M, Amimoto K, Shida K, Sekine D, Hasegawa D, Fukata K, Fujino Y, Makita S, Takahashi H. Effects of Dynamic Sitting Exercise with Delayed Visual Feedback in the Early Post-Stroke Phase: A Pilot Double-Blinded Randomized Controlled Trial. Brain Sci 2022; 12:brainsci12050670. [PMID: 35625055 PMCID: PMC9139189 DOI: 10.3390/brainsci12050670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Sitting ability in the early post-stroke phase affects functional balance ability and other prognoses. We investigated whether dynamic sitting exercise with delayed visual feedback in the mediolateral and anteroposterior directions affected postural control in the early post-stroke phase. In this pilot randomized controlled trial, 27 hemiparetic stroke patients were randomized to experimental (n = 13) and control (n = 14) groups. Dynamic sitting exercise (30 times/day, 5 days/week) in the mediolateral and anteroposterior directions, with 500-ms-delayed (experimental group) or real-time (control group) visual feedback on a computer, was added to usual physical therapy. We evaluated the postural assessment scale for stroke (PASS), static and dynamic sitting balance tasks, the five-times sit-to-stand test, trunk impairment scale, functional ambulation category, and functional independence measure−motor items. In intention-to-treat analysis, the experimental group demonstrated a significant intervention effect on the PASS score (p < 0.05). The mean percentage of body weight on the moving side in the lateral sitting task and the number of successes in the five-times sit-to-stand test were significantly higher in the experimental group than those in the control group (p < 0.05). Thus, the proposed exercise improves postural control, dynamic sitting balance, and sit-to-stand ability in early post-stroke patients.
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Affiliation(s)
- Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
- Correspondence: ; Tel.: +81-3-3819-1211
| | - Kohei Shida
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Daisuke Sekine
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Daichi Hasegawa
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Yuji Fujino
- Department of Physical Therapy, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan;
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
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25
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Tanaka A, Kabata D, Hirao O, Kosaka J, Furushima N, Maki Y, Uchiyama A, Egi M, Shintani A, Morimatsu H, Mizobuchi S, Kotake Y, Fujino Y. Prediction Model of Extubation Outcomes in Critically Ill Patients: A Multicenter Prospective Cohort Study. J Clin Med 2022; 11:jcm11092520. [PMID: 35566646 PMCID: PMC9102390 DOI: 10.3390/jcm11092520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 02/05/2023] Open
Abstract
Liberation from mechanical ventilation is of great importance owing to related complications from extended ventilation time. In this prospective multicenter study, we aimed to construct a versatile model for predicting extubation outcomes in critical care settings using obtainable physiological predictors. The study included patients who had been extubated after a successful 30 min spontaneous breathing trial (SBT). A multivariable logistic regression model was constructed to predict extubation outcomes (successful extubation without reintubation and uneventful extubation without reintubation or noninvasive respiratory support) using eight parameters: age, heart failure, respiratory disease, rapid shallow breathing index (RSBI), PaO2/FIO2, Glasgow Coma Scale score, fluid balance, and endotracheal suctioning episodes. Of 499 patients, 453 (90.8%) and 328 (65.7%) achieved successful and uneventful extubation, respectively. The areas under the curve for successful and uneventful extubation in the novel prediction model were 0.69 (95% confidence interval (CI), 0.62−0.77) and 0.70 (95% CI, 0.65−0.74), respectively, which were significantly higher than those in the conventional model solely using RSBI (0.58 (95% CI, 0.50−0.66) and 0.54 (95% CI, 0.49−0.60), p = 0.004 and <0.001, respectively). The model was validated using a bootstrap method, and an online application was developed for automatic calculation. Our model, which is based on a combination of generally obtainable parameters, established an accessible method for predicting extubation outcomes after a successful SBT.
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Affiliation(s)
- Aiko Tanaka
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita 565-0871, Japan; (A.U.); (Y.F.)
- Correspondence: ; Tel.: +81-6-6879-5820; Fax: +81-6-6879-5823
| | - Daijiro Kabata
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (D.K.); (A.S.)
| | - Osamu Hirao
- Department of Anesthesiology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan;
| | - Junko Kosaka
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; (J.K.); (H.M.)
| | - Nana Furushima
- Department of Anesthesiology and Intensive Care Medicine, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan; (N.F.); (M.E.); (S.M.)
| | - Yuichi Maki
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan; (Y.M.); (Y.K.)
| | - Akinori Uchiyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita 565-0871, Japan; (A.U.); (Y.F.)
| | - Moritoki Egi
- Department of Anesthesiology and Intensive Care Medicine, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan; (N.F.); (M.E.); (S.M.)
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (D.K.); (A.S.)
| | - Hiroshi Morimatsu
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; (J.K.); (H.M.)
| | - Satoshi Mizobuchi
- Department of Anesthesiology and Intensive Care Medicine, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan; (N.F.); (M.E.); (S.M.)
| | - Yoshifumi Kotake
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan; (Y.M.); (Y.K.)
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita 565-0871, Japan; (A.U.); (Y.F.)
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Tanaka A, Uchiyama A, Kitamura T, Sakaguchi R, Komukai S, Matsuyama T, Yoshida T, Tokuhira N, Iguchi N, Fujino Y. Association between early tracheostomy and patient outcomes in critically ill patients on mechanical ventilation: a multicenter cohort study. J Intensive Care 2022; 10:19. [PMID: 35410403 PMCID: PMC8996211 DOI: 10.1186/s40560-022-00610-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/10/2022] [Indexed: 12/04/2022] Open
Abstract
Background Tracheostomy is commonly performed in critically ill patients because of its clinical advantages over prolonged translaryngeal endotracheal intubation. Early tracheostomy has been demonstrated to reduce the duration of mechanical ventilation and length of stay. However, its association with mortality remains ambiguous. This study aimed to evaluate the association between the timing of tracheostomy and mortality in patients receiving mechanical ventilation. Methods We performed a retrospective cohort analysis of adult patients who underwent tracheostomy during their intensive care unit (ICU) admission between April 2015 and March 2019. Patients who underwent tracheostomy before or after 29 days of ICU admission were excluded. Data were collected from the nationwide Japanese Intensive Care Patient Database. The primary outcome was hospital mortality. The timing of tracheostomy was stratified by quartile, and the association between patient outcomes was evaluated using regression analysis. Results Among the 85558 patients admitted to 46 ICUs during the study period, 1538 patients were included in the analysis. The quartiles for tracheostomy were as follows: quartile 1, ≤ 6 days; quartile 2, 7–10 days; quartile 3, 11–14 days; and quartile 4, > 14 days. Hospital mortality was significantly higher in quartile 2 (adjusted odds ratio [aOR]: 1.52, 95% confidence interval [CI]: 1.08–2.13), quartile 3 (aOR: 1.82, 95% CI: 1.28–2.59), and quartile 4 (aOR: 2.26, 95% CI: 1.61–3.16) (p for trend < 0.001) than in quartile 1. A similar trend was observed in the subgroup analyses of patients with impaired consciousness (Glasgow Coma Scale score < 8) and respiratory failure (PaO2:FiO2 ≤ 300) at ICU admission (p for trend = 0.081 and 0.001, respectively). Conclusions This multi-institutional observational study demonstrated that the timing of tracheostomy was significantly and independently associated with hospital mortality in a stepwise manner. Thus, early tracheostomy may be beneficial for patient outcomes, including mortality, and warrants further investigation. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-022-00610-x.
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Fukata K, Amimoto K, Inoue M, Sekine D, Fujino Y, Makita S, Takahashi H. Immediate effect of standing and sit-to-stand training on postural vertical for backward disequilibrium following stroke: a case report. Physiother Theory Pract 2022:1-9. [DOI: 10.1080/09593985.2022.2037031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kazuhiro Fukata
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Masahide Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Daisuke Sekine
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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28
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Ohshimo S, Shime N, Shimatani T, Okazaki Y, Nishikimi M, Asada M, Ota K, Fujino Y, Takeda S. Alarming of Severe Respiratory Failure Requiring ECMO Caused by the SARS-CoV-2 Omicron Variant. JMA J 2022; 5:370-371. [PMID: 35992281 PMCID: PMC9358227 DOI: 10.31662/jmaj.2022-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/30/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Non-profit Organization Japan ECMO Network, Kawaguchi, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Non-profit Organization Japan ECMO Network, Kawaguchi, Japan
| | - Tatsutoshi Shimatani
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yusuke Okazaki
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Momoko Asada
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kohei Ota
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Fujino
- Non-profit Organization Japan ECMO Network, Kawaguchi, Japan
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinhiro Takeda
- Non-profit Organization Japan ECMO Network, Kawaguchi, Japan
- Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
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29
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Shimizu K, Hirata H, Kabata D, Tokuhira N, Koide M, Ueda A, Tachino J, Shintani A, Uchiyama A, Fujino Y, Ogura H. Ivermectin administration is associated with lower gastrointestinal complications and greater ventilator-free days in ventilated patients with COVID-19: A propensity score analysis. J Infect Chemother 2021; 28:548-553. [PMID: 35016823 PMCID: PMC8718885 DOI: 10.1016/j.jiac.2021.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/11/2021] [Accepted: 12/26/2021] [Indexed: 12/15/2022]
Abstract
Introduction COVID-19 patients have been reported to have digestive symptoms with poor outcome. Ivermectin, an antiparasitic drug, has been used in COVID-19 patients. The objective of this study was to evaluate whether ivermectin has effects on gastrointestinal complications and ventilator-free days in ventilated patients with COVID-19. Methods COVID-19 patients who were mechanically ventilated in the ICU were included in this study. The ventilated patients who received ivermectin within 3 days after admission were assigned to the Ivermectin group, and the others were assigned to the Control group. Patients in the Ivermectin group received ivermectin 200 μg/kg via nasal tube. The incidence of gastrointestinal complications and ventilator-free days within 4 weeks from admission were evaluated as clinical outcomes using a propensity score with the inverse probability weighting method. Results We included 88 patients in this study, of whom 39 patients were classified into the Ivermectin group, and 49 patients were classified into the Control group. The hazard ratio for gastrointestinal complications in the Ivermectin group as compared with the Control group was 0.221 (95% confidence interval [CI], 0.057 to 0.855; p = 0.029) in a Cox proportional-hazard regression model. The odds ratio for ventilator-free days as compared with the Control group was 1.920 (95% CI, 1.076 to 3.425; p = 0.027) in a proportional odds logistic regression model. Conclusions Ivermectin improved gastrointestinal complications and the number of ventilator-free days in severe COVID-19 patients undergoing mechanical ventilation. Prevention of gastrointestinal symptoms by SARS-Cov-2 might be associated with COVID-19 outcome.
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Affiliation(s)
- Kentaro Shimizu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Haruhiko Hirata
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-0051, Japan.
| | - Natsuko Tokuhira
- Intensive Care Unit, Osaka University Hospital, Osaka University, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Moe Koide
- Intensive Care Unit, Osaka University Hospital, Osaka University, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Akiko Ueda
- Laboratory for Clinical Investigation, Osaka University Hospital, Osaka University, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-0051, Japan.
| | - Akinori Uchiyama
- Intensive Care Unit, Osaka University Hospital, Osaka University, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yuji Fujino
- Intensive Care Unit, Osaka University Hospital, Osaka University, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
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30
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Yamaguchi T, Hoshizaki M, Minato T, Nirasawa S, Asaka MN, Niiyama M, Imai M, Uda A, Chan JFW, Takahashi S, An J, Saku A, Nukiwa R, Utsumi D, Kiso M, Yasuhara A, Poon VKM, Chan CCS, Fujino Y, Motoyama S, Nagata S, Penninger JM, Kamada H, Yuen KY, Kamitani W, Maeda K, Kawaoka Y, Yasutomi Y, Imai Y, Kuba K. ACE2-like carboxypeptidase B38-CAP protects from SARS-CoV-2-induced lung injury. Nat Commun 2021; 12:6791. [PMID: 34815389 PMCID: PMC8610983 DOI: 10.1038/s41467-021-27097-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/04/2021] [Indexed: 01/08/2023] Open
Abstract
Angiotensin-converting enzyme 2 (ACE2) is a receptor for cell entry of SARS-CoV-2, and recombinant soluble ACE2 protein inhibits SARS-CoV-2 infection as a decoy. ACE2 is a carboxypeptidase that degrades angiotensin II, thereby improving the pathologies of cardiovascular disease or acute lung injury. Here we show that B38-CAP, an ACE2-like enzyme, is protective against SARS-CoV-2-induced lung injury. Endogenous ACE2 expression is downregulated in the lungs of SARS-CoV-2-infected hamsters, leading to elevation of angiotensin II levels. Recombinant Spike also downregulates ACE2 expression and worsens the symptoms of acid-induced lung injury. B38-CAP does not neutralize cell entry of SARS-CoV-2. However, B38-CAP treatment improves the pathologies of Spike-augmented acid-induced lung injury. In SARS-CoV-2-infected hamsters or human ACE2 transgenic mice, B38-CAP significantly improves lung edema and pathologies of lung injury. These results provide the first in vivo evidence that increasing ACE2-like enzymatic activity is a potential therapeutic strategy to alleviate lung pathologies in COVID-19 patients. Endogenous ACE2 is a receptor for SARS-CoV-2 and a recombinant soluble ACE2 protein can inhibit SARS-CoV-2 infection acting as a decoy. Here the authors show that B38-CAP, an ACE2-like enzyme but not a decoy for the virus, is protective against SARS-CoV-2-induced lung injury in animal models.
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Affiliation(s)
- Tomokazu Yamaguchi
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Midori Hoshizaki
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.,Laboratory of Regulation of Intractable Infectious Diseases, National Institute of Biomedical Innovation, Health and Nutrition (NIBIOHN), 7-6-8 Saito-Asagi, Ibaraki, Osaka, 567-0085, Japan
| | - Takafumi Minato
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Satoru Nirasawa
- Biological Resources and Post-Harvest Division, Japan International Research Center for Agricultural Sciences, 1-1 Ohwashi, Tsukuba, Ibaraki, 305-8686, Japan
| | - Masamitsu N Asaka
- Tsukuba Primate Research Center, NIBIOHN, Hachimandai 1-1, Tsukuba-shi, Ibaraki, 305-0843, Japan
| | - Mayumi Niiyama
- Laboratory of Biopharmaceutical Research, NIBIOHN, 7-6-8 Saito-Asagi, Ibaraki, Osaka, 567-0085, Japan
| | - Masaki Imai
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, 108-8639, Tokyo, Japan
| | - Akihiko Uda
- Department of Veterinary Science, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjyuku-ku, Tokyo, 162-8640, Japan
| | - Jasper Fuk-Woo Chan
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Saori Takahashi
- Akita Research Institute of Food and Brewing, 4-26 Sanuki, Arayamachi, Akita, 010-1623, Japan
| | - Jianbo An
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Akari Saku
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Ryota Nukiwa
- Laboratory of Regulation of Intractable Infectious Diseases, National Institute of Biomedical Innovation, Health and Nutrition (NIBIOHN), 7-6-8 Saito-Asagi, Ibaraki, Osaka, 567-0085, Japan.,Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Daichi Utsumi
- Tsukuba Primate Research Center, NIBIOHN, Hachimandai 1-1, Tsukuba-shi, Ibaraki, 305-0843, Japan
| | - Maki Kiso
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, 108-8639, Tokyo, Japan
| | - Atsuhiro Yasuhara
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, 108-8639, Tokyo, Japan
| | - Vincent Kwok-Man Poon
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Chris Chung-Sing Chan
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Satoru Motoyama
- Department of Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Satoshi Nagata
- Laboratory of Antibody Design, NIBIOHN, 7-6-8 Saito-Asagi, Ibaraki, Osaka, 567-0085, Japan
| | - Josef M Penninger
- Department of Medical Genetics, Life Sciences Institute, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.,IMBA, Institute of Molecular Biotechnology of the Austrian Academy of Sciences, 1030, Vienna, Austria
| | - Haruhiko Kamada
- Laboratory of Biopharmaceutical Research, NIBIOHN, 7-6-8 Saito-Asagi, Ibaraki, Osaka, 567-0085, Japan
| | - Kwok-Yung Yuen
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Wataru Kamitani
- Department of Infectious Diseases and Host Defense, Graduate School of Medicine, Gunma University, Maebashi, Gunma, 371-8511, Japan
| | - Ken Maeda
- Department of Veterinary Science, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjyuku-ku, Tokyo, 162-8640, Japan
| | - Yoshihiro Kawaoka
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, 108-8639, Tokyo, Japan
| | - Yasuhiro Yasutomi
- Tsukuba Primate Research Center, NIBIOHN, Hachimandai 1-1, Tsukuba-shi, Ibaraki, 305-0843, Japan
| | - Yumiko Imai
- Laboratory of Regulation of Intractable Infectious Diseases, National Institute of Biomedical Innovation, Health and Nutrition (NIBIOHN), 7-6-8 Saito-Asagi, Ibaraki, Osaka, 567-0085, Japan
| | - Keiji Kuba
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
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Kiriyama Y, Kinishi Y, Hiramatu D, Uchiyama A, Fujino Y, Toda K, Ootaki C. Outcomes of severe peripartum cardiomyopathy and mechanical circulatory support: a case series. JA Clin Rep 2021; 7:80. [PMID: 34725740 PMCID: PMC8560865 DOI: 10.1186/s40981-021-00484-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background We present three cases of severe peripartum cardiomyopathy (PPCM) that required mechanical circulatory supports. Case presentation Case 1: A 33-year-old woman developed acute heart failure (AHF) after normal spontaneous delivery. Intra-aortic balloon pump (IABP) was inserted on postpartum day (PD) 10 with a peripartum cardiomyopathy (PPCM), which was withdrawn on PD 30 after medical treatment including anti-prolactin drugs. Case 2: A 44-year-old woman developed AHF 1 month after vaginal delivery. IABP or extra-corporeal membrane oxygenation (ECMO) was not effective and a biventricular assist device was inserted. It was withdrawn on PD 85 after improvement of left ventricular ejection fraction (LVEF). Case3: A 37-year-old woman was transferred with a diagnosis of PPCM. Cardiac function unimproved by IABP or ECMO, and a left ventricular assist device was implanted. It was withdrawn on PD 386 after recovery of LVEF. Conclusion All the cases with PPCM recovered after mechanical circulatory supports and resumed social lives.
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Affiliation(s)
- Yuki Kiriyama
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yuki Kinishi
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Daisuke Hiramatu
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Akinori Uchiyama
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Chiyo Ootaki
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
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32
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Iwata N, Shibata SC, Yoshioka D, Uchiyama A, Toda K, Sawa Y, Fujino Y. Impact of Ventricular Assist Device-Specific Infections on Post-Heart Transplant Infections: A Retrospective Single-Center Study. Transplant Proc 2021; 53:3030-3035. [PMID: 34732298 DOI: 10.1016/j.transproceed.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with a ventricular assist device (VAD) who are awaiting heart transplant (HTx) are susceptible to infections. Such infections, especially at the site of the VAD, may increase the risk of severe post-transplant infections and mortality. Information on the characteristics of VAD-specific infections and outcomes in HTx recipients after prolonged periods of LVAD therapy is scarce. PURPOSE We aimed to assess the impact of active VAD-specific infections on the incidence of early post-transplant infections and patient survival. METHODS We conducted a retrospective review of adult HTx cases at our center between April 2011 and October 2020. Informed consent was waived due to study design. A total of 86 patients were included in this study, among whom 94.2% (n = 81) were bridged with a VAD, and the median VAD support period was 1089 days. RESULTS Patients with active VAD-specific infections were significantly more likely to develop severe acute mediastinitis [odds ratio (OR) 14.8, 95% confidence interval (CI) 4.83-45.4, P < .01]. Active VAD infections were significantly related to increased length of intensive care unit stay (22.1 days vs 13.0 days, P = .016) and longer mechanical ventilation periods (324.7 hours vs 113.2 hours, P = .03). The 30-day survival rates for patients with and without post-transplant infections were 100% and 97.1%, respectively. CONCLUSION Compared to other risk factors, the presence of active VAD-specific infections increases the risk of early post-heart transplant infections and morbidity, without affecting mortality.
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Affiliation(s)
- Naomi Iwata
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Sho C Shibata
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akihiko Uchiyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Tanaka A, Uchiyama A, Horiguchi Y, Higeno R, Sakaguchi R, Koyama Y, Ebishima H, Yoshida T, Matsumoto A, Sakai K, Hiramatsu D, Iguchi N, Ohta N, Fujino Y. Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study. Sci Rep 2021; 11:19993. [PMID: 34620954 PMCID: PMC8497593 DOI: 10.1038/s41598-021-99501-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 09/24/2021] [Indexed: 12/17/2022] Open
Abstract
The cuff leak test (CLT) has been widely accepted as a simple and noninvasive method for predicting post-extubation stridor (PES). However, its accuracy and clinical impact remain uncertain. We aimed to evaluate the reliability of CLT and to assess the impact of pre-extubation variables on the incidence of PES. A prospective observational study was performed on adult critically ill patients who required mechanical ventilation for more than 24 h. Patients were extubated after the successful spontaneous breathing trial, and CLT was conducted before extubation. Of the 191 patients studied, 26 (13.6%) were deemed positive through CLT. PES developed in 19 patients (9.9%) and resulted in a higher reintubation rate (8.1% vs. 52.6%, p < 0.001) and longer intensive care unit stay (8 [4.5-14] vs. 12 [8-30.5] days, p = 0.01) than patients without PES. The incidence of PES and post-extubation outcomes were similar in patients with both positive and negative CLT results. Compared with patients without PES, patients with PES had longer durations of endotracheal intubation and required endotracheal suctioning more frequently during the 24-h period prior to extubation. After adjusting for confounding factors, frequent endotracheal suctioning more than 15 times per day was associated with an adjusted odds ratio of 2.97 (95% confidence interval, 1.01-8.77) for PES. In conclusion, frequent endotracheal suctioning before extubation was a significant PES predictor in critically ill patients. Further investigations of its impact on the incidence of PES and patient outcomes are warranted.
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Affiliation(s)
- Aiko Tanaka
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Akinori Uchiyama
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yu Horiguchi
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ryota Higeno
- Division of Pediatrics, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Ryota Sakaguchi
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yukiko Koyama
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hironori Ebishima
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takeshi Yoshida
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Atsuhiro Matsumoto
- Division of Anesthesiology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Kanaki Sakai
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Daisuke Hiramatsu
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Naoya Iguchi
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Noriyuki Ohta
- Department of Anesthesiology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Inoue M, Fujino Y, Sugimoto S, Amimoto K, Fukata K, Miura K, Matsuda T, Makita S, Takahashi H. Effects of dynamic supported standing training in a patient with pusher behavior: a case report. Physiother Theory Pract 2021; 38:3241-3247. [PMID: 34498984 DOI: 10.1080/09593985.2021.1978119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The effects of task-specific and voluntary exercise in upright positions for pusher behavior remain unclear. In this report, we aimed to describe the effects of dynamic supported standing training using a modified standing frame to correct the alignment in a patient with severe pusher behavior. CASE DESCRIPTION A 76-year-old man with cardioembolic ischemic stroke demonstrated pusher behavior. The patient underwent 3 days of dynamic supported standing training using a modified standing frame. The Scale for Contraversive Pushing, the Burke Lateropulsion Scale, and the Trunk Control Test were used to assess changes. OUTCOMES Immediate improvements in sitting balance were observed after the intervention, and the effects persisted to 8 days later. CONCLUSION Dynamic supported standing training using a modified standing frame may improve pusher behavior with short-term training. The collapsed posture of the patient in the present case was corrected using the modified standing frame. This neutral standing position could have a positive effect on motor learning with respect to holding one's posture.
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Affiliation(s)
- Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Juntendo University, Tokyo, Japan
| | - Satoshi Sugimoto
- Department of Physical Therapy, Tokyo International University, Saitama, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, Tokyo, Japan
| | - Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kohei Miura
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | | | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
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35
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Uematsu H, Osako S, Hakata S, Kabata D, Shintani A, Kawazoe D, Mizuno K, Fujino Y, Matsuda Y. A Double-Blind, Placebo-Controlled Study of Ultrasound-Guided Pulsed Radiofrequency Treatment of the Saphenous Nerve for Refractory Osteoarthritis-Associated Knee Pain. Pain Physician 2021; 24:E761-E769. [PMID: 34554694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND While the efficacy of pulsed radiofrequency (PRF) for shoulder pain has been demonstrated, its efficacy on the saphenous nerves for knee osteoarthritis (OA)-associated pain has only been reported in observational studies. OBJECTIVES The aim of this study was to compare saphenous nerve PRF to placebo for knee OA-associated pain. STUDY DESIGN Patients, practitioners, and outcome assessor-blinded randomized placebo-controlled trial. SETTING Pain management clinics at 2 hospitals in Japan. METHODS Patients were randomly allocated to the PRF (n = 37) or placebo group (n = 33). Patients aged 40-85 years with refractory anteromedial knee pain. PRF in the saphenous nerve under ultrasound guidance. The placebo group underwent the same procedure, but with motor stimulation. The primary endpoint was the average pain intensity measured using the visual analog scale (VAS) at the 12-week post-treatment visit; secondary outcomes included the average VAS at 1 and 4 weeks, and pain intensities at rest, in flexion, at standing, and at walking. Other secondary outcomes were knee pain, symptoms, activities of daily living, knee-related quality of life, mobility, range of motion, and adverse events. RESULTS In the PRF group, the mean VAS score was 52.41 ± 26.17 at 12 weeks, while in the sham group, the mean VAS score was 63.06 ± 27.12 (P < 0.05). There were no significant differences between the groups in any of the secondary outcomes. LIMITATIONS Patients with comorbidities were excluded from this study. The follow-up time was limited to 12 weeks. CONCLUSIONS Ultrasound-guided saphenous nerve PRF proved to be effective for at least 12 weeks in patients with knee OA and showed no adverse events.
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Affiliation(s)
- Hironobu Uematsu
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Seiichi Osako
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Saya Hakata
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoichi Matsuda
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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36
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Yoshida T, Tanaka A, Roldan R, Quispe R, Taenaka H, Uchiyama A, Fujino Y. Prone Position Reduces Spontaneous Inspiratory Effort in Patients with Acute Respiratory Distress Syndrome: A Bicenter Study. Am J Respir Crit Care Med 2021; 203:1437-1440. [PMID: 33567221 DOI: 10.1164/rccm.202012-4509le] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Aiko Tanaka
- Osaka University Graduate School of Medicine Suita, Japan
| | - Rollin Roldan
- Hospital Rebagliati Lima, Perú.,Universidad de Piura Lima, Perú
| | - Rocío Quispe
- Instituto Nacional de Enfermedades Neoplásicas Lima, Perú
| | - Hiroki Taenaka
- Osaka University Graduate School of Medicine Suita, Japan
| | | | - Yuji Fujino
- Osaka University Graduate School of Medicine Suita, Japan
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Inoue M, Amimoto K, Chiba Y, Sekine D, Fukata K, Fujino Y, Takahashi H, Makita S. Effect of Exercise Involving Standing Weight Shifting to the Nonparetic Side on an Inclined Surface in the Early Phase After a Stroke: A Randomized Controlled Trial. Phys Ther 2021; 101:6254128. [PMID: 33909896 DOI: 10.1093/ptj/pzab114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/24/2021] [Accepted: 03/18/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE This study aimed to clarify whether an exercise involving weight shifting to the nonparetic side while standing on an inclined surface improves standing balance in the early phase after stroke. METHODS This assessor-blinded, randomized controlled trial included people undergoing inpatient rehabilitation at a university hospital. Participants (N = 52) with hemiparesis caused by a stroke were randomly assigned to an experimental group (n = 26) or control group (n = 26). Participants performed a weight-shifting exercise to the nonparetic side using a goal-directed reaching strategy while standing on an inclined surface that was elevated 5 degrees to the nonparetic side in the experimental group or a flat surface in the control group. The reaching exercise was conducted 30 times per day for 5 days. Primary outcome was the Berg Balance Scale. Secondary outcomes were the posturographic examination (static standing and lateral weight shifting to the nonparetic and paretic sides), Trunk Control Test, Trunk Impairment Scale, Functional Ambulation Category, and Functional Independent Measure motor item scores. RESULTS Through intention-to-treat analysis, no significant intervention effects were observed between groups on the Berg Balance Scale. A significant intervention effect was observed, however, with the experimental group on the lateral weight shifting to the nonparetic side in the mean percentage bodyweight values and center-of-pressure moving distance and to the paretic side in center-of-pressure moving distance and Functional Ambulation Category. There were no significant interaction effects concerning other outcomes. CONCLUSION These results suggest that standing reaching exercises to the nonparetic side while standing on an inclined surface could improve lateral weight-shifting capacity and gait ability in participants in the early poststroke phase. IMPACT This intervention should be incorporated into standard treatment programs focusing on the paretic side during early stroke rehabilitation.
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Affiliation(s)
- Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Higashiogu, Arakawa-ku, Tokyo, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, Higashiogu, Arakawa-ku, Tokyo, Japan
| | - Yuya Chiba
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Daisuke Sekine
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Juntendo University, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
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38
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Fujino Y, Fukata K, Inoue M, Okawa S, Okuma K, Kunieda Y, Miki H, Matsuda T, Amimoto K, Makita S, Takahashi H, Fujiwara T. Examination of Rehabilitation Intensity According to Severity of Acute Stroke: A Retrospective Study. J Stroke Cerebrovasc Dis 2021; 30:105994. [PMID: 34284324 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/24/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate the intensity and effectiveness of rehabilitation in acute stroke patients according to the severity of functional impairments in them. MATERIALS AND METHODS This retrospective cohort study included 294 patients with acute hemispheric stroke admitted to three acute-care hospitals who subsequently underwent an inpatient rehabilitation program. Stroke severity was classified according to neurological deficits and trunk dysfunction. The following data were obtained from medical records: age, sex, stroke type, lesion side, hospitalization duration, initial functional status determined using the National Institutes of Health Stroke Scale, rehabilitation start date, first day out of bed after admission, total treatment duration, total number of treatment sessions, rehabilitation implementation rate between start of rehabilitation and discharge, trunk control test and Barthel Index score on the first day out of bed after admission and discharge, and post-discharge outcomes. Hierarchical cluster analysis was performed with clusters categorized using the National Institutes of Health Stroke Scale and trunk control test scores. Variables were compared using the Kruskal-Wallis test, and Dunn's nonparametric comparison test was performed for post-hoc analysis to determine differences between clusters. RESULTS The National Institutes of Health Stroke Scale and trunk control test showed a significant correlation (r = -0.816, p < 0.01) using which cluster analysis identified three clusters. Rehabilitation showed a ceiling effect in patients with mild stroke and a floor effect in patients with severe stroke. CONCLUSION These results may guide the determination of rehabilitation intensity with reference to the severity of neurological deficits and trunk dysfunction.
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Affiliation(s)
- Yuji Fujino
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 3-2-12, Hongo Bunkyo-ku, Tokyo, Japan.
| | - Kazuhiro Fukata
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masahide Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shinsuke Okawa
- Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan
| | - Katsunobu Okuma
- Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan
| | - Yota Kunieda
- Department of Rehabilitation, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Hiroshi Miki
- Department of Rehabilitation, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 3-2-12, Hongo Bunkyo-ku, Tokyo, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshiyuki Fujiwara
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 3-2-12, Hongo Bunkyo-ku, Tokyo, Japan; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan
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Taenaka H, Yoshida T, Hashimoto H, Iwata H, Koyama Y, Uchiyama A, Fujino Y. Individualized ventilatory management in patients with COVID-19-associated acute respiratory distress syndrome. Respir Med Case Rep 2021; 33:101433. [PMID: 34094847 PMCID: PMC8165976 DOI: 10.1016/j.rmcr.2021.101433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 04/09/2021] [Accepted: 05/27/2021] [Indexed: 01/08/2023] Open
Abstract
Due to the coronavirus disease 2019 pandemic, the number of coronavirus disease 2019-associated acute respiratory distress syndrome is rapidly increasing. The heterogeneity of coronavirus disease 2019-associated acute respiratory distress syndrome contributes to the complexity of managing patients. Here we described two patients with coronavirus disease 2019-associated acute respiratory distress syndrome showing that the bedside physiological approach including careful evaluation of respiratory system mechanics and visualization of ventilation with electrical impedance tomography was useful to individualize ventilatory management.
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Affiliation(s)
- Hiroki Taenaka
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Yoshida
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Haruka Hashimoto
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirofumi Iwata
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yukiko Koyama
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akinori Uchiyama
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuji Fujino
- The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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40
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Hayashi Y, Kuri M, Fujino Y. Anesthetic Management of a Left Ventricular Assist Device Implantation as a Bridge to Pediatric Heart Transplantation for a Patient With Fontan Circulation. J Cardiothorac Vasc Anesth 2021; 36:2518-2521. [PMID: 34130894 DOI: 10.1053/j.jvca.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/25/2021] [Accepted: 05/03/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Yuri Hayashi
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Michioki Kuri
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Takahashi Y, Fujino Y, Miura K, Toida A, Matsuda T, Makita S. Intra- and inter-rater reliability of rectus femoris muscle thickness measured using ultrasonography in healthy individuals. Ultrasound J 2021; 13:21. [PMID: 33856566 PMCID: PMC8050162 DOI: 10.1186/s13089-021-00224-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultrasonography (US) is a feasible and accessible method for the measurement of skeletal muscle mass. This technique presents acceptable intra-rater reliability; however, there are a few reports on its inter-rater reliability. Additionally, relative reliability should equally be inspected to determine the presence of systematic errors. Therefore, this study aimed to investigate the intra- and inter-rater reliabilities and absolute reliability of rectus femoris muscle thickness as measured using US. METHODS The participants included in our study comprised 12 healthy young men (26.5 ± 3.9 years. Rectus femoris muscle thickness was measured from the right side of the thigh using US by two trained physical therapists. Inter- and intra-rater reliabilities were determined using the intraclass correlation coefficient (ICC) (1, 1) and ICC (2, 1) methods, respectively. Absolute reliability was evaluated using Bland - Altman analysis. Additionally, we calculated the minimal detectable change at the 95% level of confidence (MDC95). RESULT According to the results of the Bland - Altman analysis, no fixed or proportional errors were present. The ICC (1, 1) was 0.95, and the ICC (2, 1) was 0.70. The MDC95 values of rectus femoris thickness for the intra- and inter-rater reliabilities were 2.0 mm and 4.3 mm, respectively. CONCLUSIONS In our study, intra- and inter-rater reliabilities were measured at "excellent" and "moderate" levels in the healthy individuals based on a previously defined scale. Moreover, we determined the measurement error for quantifying rectus femoris thickness. Therefore, the measurement of rectus femoris thickness using US could be considered applicable in clinical research.
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Affiliation(s)
- Yosuke Takahashi
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, 3-2-12, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Kohei Miura
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Ayumi Toida
- Department of Central Examination, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, 3-2-12, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Saitama, 1397-1 Yamane350-1298, Japan
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Higeno R, Uchiyama A, Enokidani Y, Fujino Y. Advanced cuff pressure control ventilation (ACPCV); a bench study of a new concept of mechanical ventilation. J Med Eng Technol 2021; 45:324-333. [PMID: 33843444 DOI: 10.1080/03091902.2021.1900437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The concept of advanced cuff pressure control ventilation (ACPCV) is that the endotracheal tube (ETT) cuff volume could be controlled and allowed to exhale the gas through the vocal cords. The potential advantages of ACPCV are reduction of dead space, reduction of expiratory airway resistance, and preservation of vocal cord function. We developed the ACPCV system and investigated its performance in bench studies. The ETT cuff volume was regulated via four steps, depending on airway pressure and tracheal pressure. Two ventilatory settings were examined under several rates of spontaneous breathing efforts. Imposed expiratory resistance (RE), imposed expiratory work of breathing (WOB), and auto-PEEP of ACPCV were compared with continuous mandatory ventilation (CMV). RE of ACPCV (2.6 ± 0.5 cm H2O/l/s) was significantly lower than that of CMV (11.6 ± 1.6 cm H2O/l/s) (p < 0.001). Expiratory WOB of ACPCV (0.25 ± 0.02 J/l) was significantly lower than that of CMV (0.54 ± 0.10 J/l) (p < 0.001). Auto-PEEP of ACPCV (-0.6 ± 0.2 cm H2O) was significantly lower than that of CMV (1.1 ± 0.7 cm H2O) (p < 0.001). ACPCV can significantly reduce RE and expiratory WOB by controlling the ETT cuff volume in synchronisation with mechanical ventilation.
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Affiliation(s)
- Ryota Higeno
- Department of Pediatrics, Osaka General Medical Center, Osaka, Japan
| | - Akinori Uchiyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yusuke Enokidani
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Abstract
BACKGROUND Two major definitions exist for presenteeism: sickness presenteeism and impaired work function. The evidence for comparing previous studies on presenteeism is insufficient because of the different definitions of presenteeism used. AIMS To assess the relationship between the two major definitions of presenteeism. METHODS This cross-sectional study analysed secondary data on 5334 respondents to an employee survey administered in a construction company in Japan. Impaired work function was measured using the Work Functioning Impairment Scale (WFun). Multiple logistic regression was performed. RESULTS A strong linear association was observed between the number of days of sickness presenteeism and impaired work function (all P < 0.001). In contrast, the number of days of sickness absence was only partially positively associated with impaired work function. All choices for most frequent health problem were positively associated with impaired work function, beginning with mental problems (adjusted odds ratio [OR] = 20.45, 95% confidence interval [CI]: 14.94-28.01), followed by malaise (adjusted OR = 11.91, 95% CI: 9.08-15.62) and sleeping problems (adjusted OR = 8.62, 95% CI: 6.57-11.33). CONCLUSIONS A strong relationship was observed between the two major definitions of presenteeism, even after adjusting for a variety of chronic health conditions. Although a consensus on the definition of presenteeism is yet to be reached, this study provides insight on comparing existing studies on presenteeism.
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Affiliation(s)
- T Ishimaru
- Department of Health Management, Nishinihon Occupational Health Service Center, Kitakyushu, Japan
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Y Mine
- Department of Public Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Y Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
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Sato Y, Iura A, Kawamoto Y, Yamamoto S, Iritakenishi T, Fujino Y. Successful anesthetic management of separation surgery for pygopagus conjoined twins: a case report. JA Clin Rep 2021; 7:6. [PMID: 33404797 PMCID: PMC7788156 DOI: 10.1186/s40981-020-00406-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022] Open
Abstract
Background Conjoined twins are an extremely rare congenital occurrence, and anesthetic management for surgical separation presents unique challenges for anesthesiologists. Case presentation Five-month-old male pygopagus conjoined twins underwent separation surgery. We performed anesthesia induction in the supine position and surgery in the prone position. This presented a challenge because the transition from supine to prone position reversed the positional relationship between the two babies, resulting in crossing of the respiratory circuits and monitors. To solve the problem, we used anesthesia machines and monitors on the opposite side of each baby during anesthesia induction. The positional relationship between the twins and anesthesia machines and monitors normalized after the change to the prone position. Following the separation surgery, the twins were discharged without any complications. Conclusions Our method of using opposite side anesthetic machines and monitors for anesthesia induction was useful for the safe anesthetic management of pygopagus conjoined twins.
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Affiliation(s)
- Yukari Sato
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.,Department of Anesthesiology, Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Akira Iura
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Yu Kawamoto
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Shunsuke Yamamoto
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Takeshi Iritakenishi
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
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Enokidani Y, Uchiyama A, Yoshida T, Abe R, Yamashita T, Koyama Y, Fujino Y. Effects of Ventilatory Settings on Pendelluft Phenomenon During Mechanical Ventilation. Respir Care 2021; 66:1-10. [PMID: 32900913 PMCID: PMC9993817 DOI: 10.4187/respcare.07880] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pendelluft phenomenon is defined as the displacement of gas from a more recruited nondependent (ND) lung region to a less recruited dependent (D) lung region. This phenomenon may cause lung injury. Thus, a lung model for pendelluft was established, and the effects of ventilatory settings on pendelluft were examined. METHODS Two sets of the twin-bellows-type training test lung (TTL) model were utilized. One set of bellows simulated the diaphragm, and the other simulated the lung. One TTL model represented the ND region, and the other represented the D region. The lung bellows were connected to each other and were ventilated with 1 ventilator. The diaphragm bellows were ventilated with 2 synchronized ventilators that regulated pleural pressure levels. We simulated pendelluft by applying different pleural pressure levels to the D and ND bellows. The increment of the tidal volume in the D region from the "no breathing effort" condition was defined as the pendelluft volume. The effects of ventilator settings, such as ventilatory modes, triggering sensitivity, inspiratory pressurization, and inspiratory cycling-off, were examined. The changes in tidal volumes in the D region based on the control settings were compared to assess the severity of pendelluft. RESULTS The gas flow from the D region to the ND region was found to be essential in pendelluft, but the severity of this phenomenon was not always proportional to gas flows. The severity increased with the increase in the differences in pleural pressure levels between the ND and D regions, and it was amplified by the difference in lung mechanics between the ND and D regions. However, the ventilator settings had minimal effect on the severity of pendelluft. CONCLUSIONS The pendelluft was affected by the heterogeneity of lung mechanics and pleural pressure. Furthermore, a minimal association was observed between the ventilator settings and the severity of pendelluft.
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Affiliation(s)
- Yusuke Enokidani
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akinori Uchiyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Takeshi Yoshida
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryuichiro Abe
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomonori Yamashita
- Department of Anesthesiology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Yukiko Koyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Fukata K, Amimoto K, Inoue M, Shida K, Kurosawa S, Inoue M, Fujino Y, Makita S, Takahashi H. Effects of performing a lateral-reaching exercise while seated on a tilted surface for severe post-stroke pusher behavior: A case series. Top Stroke Rehabil 2020; 28:606-613. [PMID: 33345722 DOI: 10.1080/10749357.2020.1861718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: For patients with severe post-stroke pusher behavior (PB), acquiring a vertical posture involves correcting paretic-sided body tilt to the non-paretic side. Active lateral sitting training may facilitate improvement in postural orientation for patients with PB. However, its effect on patients with severe PB remains unclear.Objective: To determine the effect of performing a lateral-reaching exercise in patients with severe PB seated on a tilted surfaceMethods: Three patients with severe PB due to right hemispheric stroke participated in our study. Using a single-case design, the intervention's effect was verified using the applied behavior analysis method. Conventional physical therapy was performed for 1 h at baseline and at follow-up. During the intervention, lateral sitting training on a tilted surface was performed 40 times per session (total, 2 sessions). PB was assessed using the Scale for Contraversive Pushing and the Burke Lateropulsion Scale, and patient-reported fear of falling. The Function in Sitting Test (FIST) and the Trunk Control Test (TCT) were administered.Results: PB improved in all patients post-intervention and persisted at follow-up. Fear of falling during the passive sitting task while moving toward the non-paretic side disappeared post-intervention and at follow-up. FIST and TCT scores improved in 2 patients.Conclusion: The lateral sitting exercise reduced severe PB in all patients; however, sitting balance and trunk performance did not improve in 1 patient. Future studies to examine the adaptability of this task and long-term effects are needed.
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Affiliation(s)
- Kazuhiro Fukata
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, Tokyo, Japan
| | - Mamiko Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kohei Shida
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Tokyo, Japan
| | - Saki Kurosawa
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masahide Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
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47
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Goto E, Ishikawa H, Okuhara T, Ueno H, Okada H, Fujino Y, Kiuchi T. Presenteeism among workers: health-related factors, work-related factors and health literacy. Occup Med (Lond) 2020; 70:564-569. [PMID: 33180107 DOI: 10.1093/occmed/kqaa168] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Presenteeism is an important factor in workers' health. However, few studies have examined how variables such as socio-economic status, health status, workplace status and health literacy correlate with and affect presenteeism. AIMS To assess the correlates of presenteeism with a focus on health-related factors, work-related factors and health literacy. METHODS We conducted a cross-sectional study of 2914 Japanese workers from one company. We used a self-administered questionnaire to assess socio-demographic characteristics, health status, work environment, presenteeism and health literacy. RESULTS Forty-one per cent of participants were under 40 years of age and 70% were male. We found that 59% of the participants were at high risk of presenteeism. Presenteeism was associated with sex, age, household income, marital status, health-related factors (i.e. self-rated health status, dietary choices, exercise habits), work-related factors (i.e. workplace support, job demands, job control) and health literacy. Logistic regression analyses indicated that presenteeism was associated with self-rated health status, overtime hours, workplace support, job demands, job control and health literacy after adjusting for sex, age and income. CONCLUSIONS Health-related factors, work-related factors and health literacy are all associated with presenteeism. Improving the workplace environment, especially factors such as overtime working hours, workplace support, job demands and job control, and increasing health literacy may reduce presenteeism among general office workers.
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Affiliation(s)
- E Goto
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - H Ishikawa
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
| | - T Okuhara
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - H Ueno
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - H Okada
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Y Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - T Kiuchi
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Fukata K, Fujino Y, Inoue M, Inoue M, Sekine D, Tsutsumi M, Okihara T, Mano M, Miki H, Sato H, Kobayashi Y, Hasegawa K, Kunieda Y, Ishihara S, Makita S, Takahashi H, Amimoto K. Factors Influencing Sitting Ability During the Acute Post-Stroke Phase: A Multicenter Prospective Cohort Study in Japan. J Stroke Cerebrovasc Dis 2020; 30:105449. [PMID: 33166768 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/23/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Sitting ability during the acute phase after stroke is a useful indicator of functional outcomes; however, factors that affect this ability have not been evaluated. Therefore, this study aimed to identify and evaluate factors that affect sitting ability in the acute phase after stroke. MATERIALS AND METHODS This multicenter prospective cohort study included hemispheric stroke patients who underwent an inpatient rehabilitation program after acute stroke from five acute care hospitals. The effect of age, sex, lesion side, etiology, consciousness disorder, stroke and dementia history, stroke-related complications, National Institutes of Health Stroke Scale score, hemiparalysis, turn-over movement from the supine position and sit-up movement, and Scale for Contraversive Pushing on the "remain sitting" item in the revised version of the Ability of Basic Movement Scale at the time of acute hospital discharge were investigated. Factors affecting sitting ability were identified using binomial logistic regression analysis. RESULTS We included 293 stroke patients. Age (odds ratio: 0.943, 95% confidence interval: 0.910-0.977, p=0.001), National Institutes of Health Stroke Scale score (odds ratio: 0.862, 95% confidence interval: 0.811-0.916, p<0.001), and Scale for Contraversive Pushing score (odds ratio: 0.543, 95% confidence interval: 0.419-0.705, p<0.001) were identified as independent predictors of sitting ability at the time of hospital discharge (median; 23.0 days). CONCLUSIONS Older patients and those with high Scale for Contraversive Pushing and National Institutes of Health Stroke Scale scores experienced difficulties in regaining sitting ability. These results may guide physical therapy for patients with impaired sitting ability due to hemispheric stroke.
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Affiliation(s)
- Kazuhiro Fukata
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, Tokyo, Japan
| | - Masahide Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan; Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Mamiko Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Daisuke Sekine
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan; Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Misato Tsutsumi
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tetsuya Okihara
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masayuki Mano
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroshi Miki
- Department of Rehabilitation, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Hirofumi Sato
- Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan
| | - Yohei Kobayashi
- Department of Rehabilitation, Saitama Sekishinkai Hospital, Saitama, Japan
| | - Koki Hasegawa
- Department of Rehabilitation, Sainokuni Higashiomiya Medical Center, Saitama, Japan
| | - Yota Kunieda
- Department of Rehabilitation, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Shunichi Ishihara
- Department of Psychology, Faculty of Human Sciences, Bunkyo University, Saitama, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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Sawamura T, Norisue Y, Mima H, Ueta I, Shigemitsu H, Ohno M, Maki J, Ito K, Uemura S, Uesawa H, Gando S, Fujino Y, Nishida O. Withholding and withdrawing of the treatment for major surge in coronavirus disease 2019 (COVID-19) pandemic, from the viewpoint of healthcare resource rationing. ACTA ACUST UNITED AC 2020. [DOI: 10.3918/jsicm.27_509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Tadashi Sawamura
- Clinical Ethics Committee, Japanese Society of Intensive Care Medicine
| | - Yasuhiro Norisue
- Clinical Ethics Committee, Japanese Society of Intensive Care Medicine
| | - Hiroyuki Mima
- Clinical Ethics Committee, Japanese Society of Intensive Care Medicine
| | - Ikuya Ueta
- Clinical Ethics Committee, Japanese Society of Intensive Care Medicine
| | | | - Mika Ohno
- Clinical Ethics Committee, Japanese Society of Intensive Care Medicine
| | - Jun Maki
- Clinical Ethics Committee, Japanese Society of Intensive Care Medicine
| | - Kaori Ito
- Clinical Ethics Committee, Japanese Society of Intensive Care Medicine
| | - Sakura Uemura
- Clinical Ethics Committee, Japanese Society of Intensive Care Medicine
| | - Hiromi Uesawa
- Clinical Ethics Committee, Japanese Society of Intensive Care Medicine
| | - Satoshi Gando
- Adviser, Clinical Ethics Committee, Japanese Society of Intensive Care Medicine
| | - Yuji Fujino
- Clinical Ethics Committee, Japanese Society of Intensive Care Medicine
| | - Osamu Nishida
- President, Japanese Society of Intensive Care Medicine
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Matsumoto Y, Fujino Y, Furue H. Anti-nociceptive and anxiolytic effects of systemic flupirtine and its direct inhibitory actions on in vivo neuronal mechanical sensory responses in the adult rat anterior cingulate cortex. Biochem Biophys Res Commun 2020; 531:528-534. [DOI: 10.1016/j.bbrc.2020.07.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022]
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