Initial experiences in management of blunt aortic injury taking associated brain injury into consideration.

BACKGROUND: Although endovascular stent-grafting (SG) has become acceptable for blunt aortic injury (BAI), open surgical repair (OR) does provide reliable, good long-term results. A current surgical strategy for BAI, taking account of associated brain injury, is presented and preferable initial management for BAI is proposed. METHODS AND RESULTS: The surgical strategy for BAI was established in 2001: SG is performed for patients with obvious brain injuries, but OR is performed for patients without brain injury, and conservative treatment should be used initially for patients with critical non-aortic injuries. Between 2001 and 2004 20 patients with BAI were admitted to hospital: 16 blunt aortic ruptures and 4 blunt aortic dissections. Of them 15 patients underwent surgery (SG, 9; OR, 6) and 5 patients were treated conservatively. One patient died from associated lung injury after SG, all patients treated conservatively died because of associated brain injuries or another rupture of BAI, and 2 elderly patients treated by OR died within 1 year from postoperative respiratory failure. CONCLUSION: This brain-injury conscious surgical strategy for BAI provided acceptable early results. OR should be chosen for young patients without brain injury, but endovascular SG seems to be a better initial treatment for elderly patients or patients with other comorbidities.     

Status of Plasmodium vivax malaria in the Republic of Korea, 2008-2009: decrease followed by resurgence

The number of Plasmodium vivax malaria cases in the Republic of Korea (ROK) in 2008 was 1009, a 54.2% decrease on the previous year. It then resurged to 1317 cases in 2009 (30.5% increase on 2008). One possible cause for the sharp decrease in 2008 might be the large-scale presumptive anti-relapse therapy with primaquine that was undertaken in the Democratic People's Republic of Korea in 2007. Of the 2326 cases of P. vivax malaria diagnosed in the ROK during 2008-2009, 599 cases (25.8%) were military personnel, 535 cases (23.0%) were veterans, and 1192 cases (51.2%) were civilians. Local transmission within the ROK appeared to increase gradually, and the length of the transmission period of P. vivax malaria extended during this period. Parasite clearance time after chloroquine treatment has increased in the late 2000s, which requires the introduction of countermeasures against the decreasing chloroquine susceptibility, including reduction of mass chemoprophylaxis with chloroquine in the ROK Army.     

Factors associated with ADL dependence: A comparative study of residential care home and community-dwelling elderly in Japan

Background:   Since the start of Long Term Nursing Insurance in Japan in April 2000, there has been much discussion about and emphasis on leading healthy and active twilight years, without ever being bedridden if possible. In an attempt to address some of these concerns, this comparative study examines the factors associated with dependence in the activities of daily living (ADL) in two samples of elderly people living in two different environments.
Methods:   In this cross-sectional, self-reported study, 262 and 968 elderly people from a residential care home and Yogo town completed a 65-item questionnaire. Questions pertaining to ADL, medical and social history, quality of life (QOL) and the 15-item Geriatric Depression Scale were included in the questionnaire. Using logistic regression model, factors associated with ADL dependence were determined.
Results:   In the residential care home group, age, female gender, instrumental ADL, communication-related ability, history of falls, stroke, and osteoarthropathy, depressive tendency and low satisfaction with life emerged as the factors associated with ADL dependence, after multivariate logistic regression. The corresponding factors in the community-dwelling elderly group were age, depressive tendency, history of osteoarthropathy, and low sense of health.
Conclusion:   Age and female gender were the two non-modifiable risk factors associated with ADL dependence. Stroke, followed by osteoarthropathy and falls were the main medical conditions predisposing to functional dependence. Dependence in instrumental ADL, independence in communication-related ADL, depressive tendency and components of QOL were factors associated with ADL dependence. Awareness of these factors not only helps to identify at-risk patients, to initiate preventive measures and to promote disability-delaying activities, but also helps in the holistic management of geriatric patients.     

Spatial dispersion of action potential duration restitution kinetics is associated with induction of ventricular tachycardia/fibrillation in humans

INTRODUCTION: Action potential duration restitution (APDR) plays a role in initiation and maintenance of ventricular tachycardia (VT)/ventricular fibrillation (VF). We hypothesized that the steeply sloped APDR and its spatial heterogeneity contribute to VT/VF inducibility in patients with ventricular arrhythmia. METHOD AND RESULTS: After programmed ventricular stimulation (PVS) for evaluation of clinically documented VT, patients (n = 20, 15 male, age 52.5 +/- 9.5 years) were divided into two groups: inducible sustained VT/VF (IVT, n = 10) and noninducible VT/VF (NVT, n = 10). Data were compared with the corresponding results obtained from normal controls (C, n = 10). Right ventricular (RV) monophasic action potential duration at 90% repolarization (APD90) and ventricular effective refractory period (VERP) in the right ventricular apex (RVA) and right ventricular outflow tract (RVOT) were determined. APDR was acquired by scanning diastole with premature ventricular beats during a pacing cycle length of 600 msec (S1-S2) in all patients and by rapid pacing at the cycle lengths that induced APD alternans in three patients. Maximal slopes (Smax) of the APDR curves and DeltaAPD90 (APD90 at S2 400 ms - APD90 at the shortest S2) were measured. VERP and APD90 at each RV site did not differ among the three groups. Smax obtained by S1-S2 (1.6 +/- 0.6) did not differ from Smax obtained by rapid pacing (1.2 +/- 0.7), with a significant correlation noted between these values (r = 0.92, P < 0.01). The IVT group had a higher spatial dispersion of Smax (Smax at RVOT - Smax at RVA) compared to the C group (P < 0.05), with no difference between the NVT group and the IVT or C groups. The IVT group had a higher spatial dispersion of DeltaAPD90 compared to the NVT and C groups (P < 0.01, respectively). Smax at the RVOT (2.7 +/- 1.9) was steeper than that at the RVA (1.9 +/- 1.2, P < 0.05). Inducibility of sustained VT/VF was greater at the RVOT (83.3%) than at the RVA (50.0%, P < 0.05). CONCLUSION: In patients with ventricular arrhythmia, VT/VF is highly inducible under conditions of greater spatial dispersion of ventricular refractoriness and APDR.     

Change of platelet activation markers using flow cytometry in patients with hematology/oncology disorders after transfusion

In spite of the frequent need of platelet transfusions, there is limited information on the association of platelet activation markers, in transfused patients with hematology/oncology disorders, with platelet function using flow cytometry. The goal of this study was to evaluate the changes of PAC-1 binding and CD62P expression, with or without agonists in patients after transfusions. Twenty-eight whole blood samples were obtained from 24 patients admitted to the department of Hematology & Oncology and transfused with platelets; these samples were compared to 30 healthy controls. Whole blood samples, either with or without agonists, such as 20 µM adenosine diphosphate (ADP) or 100 µM thrombin receptor activating peptide (TRAP), were stained with the fluorescein conjugated monoclonal antibodies PAC-1 or CD62P. Then, the percent expression for each marker was analysed using flow cytometry. ADP and TRAP induced an increased percentage of CD62P expression and PAC-1 binding after platelet transfusions compared to the samples studied before transfusion, and these findings were lower than those of the healthy controls. However, the expression of platelets without the agonists was not significantly changed, despite the transfusions. Therefore, agonist-induced platelet activation markers, studied by flow cytometry, appear to be more useful for the evaluation of platelet function after transfusions than platelet activation markers without agonists.     

Implantable hearing aid. Report of the first human applications

To our knowledge, this is the first report of human application of the partial implantable hearing aid. Direct driving of the stapes by an ossicular vibrator of piezoelectric ceramic bimorph is the fundamental mechanism of this device. Acoustic signals received by a microphone were transmitted to the external link coil after amplification. By means of electromagnetic induction, the internal coil placed under the retroauricular skin excited electroacoustic energy, which is transmitted to the vibrator directly coupled with the stapes. The device used in this first patient has been functioning for longer than one year. Excellent frequency response of the vibrator and highly efficient direct transmission of electroacoustic signals to the inner ear gave rise to acoustic perception of superior quality that could not be obtained by other surgical or rehabilitative measures.