Cluster analysis identifies a pathophysiologically distinct subpopulation with increased serum leptin levels and severe obstructive sleep apnea

Sleep and Breathing - To investigate the different pathophysiologies of obstructive sleep apnea (OSA) phenotypes using cluster analysis. Differences between leptin/adiponectin levels in the...     

Therapeutic strategy using extracorporeal life support,including appropriate indication,management, limitation and timing of switch to ventricular assist device in patients with acute myocardial infarction

The appropriate indication for, management of and limitations to extracorporeal life support (ECLS) and the timing of a switch to a ventricular assist device (VAD) remain controversial issues in patients with acute myocardial infarction (AMI) complicated with cardiogenic shock or cardiopulmonary arrest. To evaluate and discuss these issues, we studied patients with AMI treated with ECLS and compared deceased and discharged patients. Thirty-eight patients with AMI who needed ECLS [35 men (92.1 %), aged 59.9 ± 13.5 years] were enrolled in this study. Of these 38 patients, 34 subsequently underwent percutaneous coronary intervention (PCI), and four subsequently received coronary artery bypass grafting (CABG). Fourteen patients (36.8 %) were discharged from the hospital. The outcome was not favorable for those patients with deteriorating low output syndrome (LOS) and the development of leg ischemia, hemolysis and multiple organ failure during ECLS. Levels of creatine kinase, creatine kinase-MB (CK-MB), lactate dehydrogenase, serum creatinine (Cr) and amylase after the patient had been put on ECLS and fluctuation of the cardiac index, blood pressure, arterial blood gas analysis and CK-MB and Cr levels during ECLS were indicators to switch from the ECLS to VAD. In the case of patients with no complication associated with ECLS, 4.6–5.6 days after initiation of ECLS was assumed to be the threshold to decide whether to switch from ECLS to VAD. Patients with AMI who suddenly developed refractory pulseless ventricular tachycardia or ventricular fibrillation without deteriorating LOS and who underwent successful PCI or CABG, and who prevented the complications associated with ECLS, showed a high probability of recovering with ECLS.     

Long‐term effectiveness of HPV vaccination against HPV infection in young Japanese women: Real‐world data

In Japan, public funding for HPV vaccination began in 2010 for girls aged 13–16 years (birth cohort years 1994–1997) and women born in 1994 who turned 25 in 2019. We aimed to verify the long‐term effectiveness of the bivalent HPV vaccine in women aged 25 years. Subjects were women aged 25–26 years who underwent cervical cancer screening and HPV testing in Niigata from 2019 to 2020 (birth cohort years 1993–1994). Information on vaccination status and sexual behavior was obtained from a questionnaire and municipal records. We compared the HPV infection rates of the vaccinated and unvaccinated groups. Of the 429 registrants, 150 (35.0%) and 279 (65.0%) were vaccinated and unvaccinated, respectively. The average period from HPV vaccination to HPV testing was 102.7 months (8.6 years), with a median of 103 months (range 92–109 months). The HPV high‐risk infection rate was 21.3% (32/150) in the vaccinated group and 23.7% (66/279) in the unvaccinated group (P = 0.63). The HPV16/18 infection rate was 0% (0/150) in the vaccinated group and 5.4% (15/279) in the unvaccinated group, showing a significant difference (P = 0.0018), and the vaccine effectiveness was 100%. The cross‐protective type HPV31/45/52 infection rate in the vaccinated group was significantly lower than that in the unvaccinated group (3.3% vs. 10.0%, P = 0.013). There was no significant difference in the mean age at sexual debut and the number of previous sexual partners between the two groups. We have demonstrated the long‐term 9‐year effectiveness of the bivalent vaccine against HPV infection for the first time in Japan.     

Effects of indigo carmine intravenous injection on oxygen reserve index (ORi™) measurement

To retrospectively investigate the effects of indigo carmine intravenous injection on oxygen reserve index (ORi?) in 20 patients who underwent elective gynecologic surgery under general anesthesia. The study subjects were patients who underwent elective gynecologic surgery under general anesthesia between April 2016 and January 2017, and were administered a 5-ml intravenous injection of 0.4% indigo carmine for clinical purposes during surgery with ORi monitoring. Changes in ORi within 20 min after indigo carmine injection were observed. A relevant decrease in ORi was defined as ≥?10% reduction in ORi from pre-injection level. ORi rapidly decreased after indigo carmine intravenous injection in all patients. In 10 of 19 patients, ORi decreased to 0 after indigo carmine injection. The median lowest value of ORi was 0 (range 0–0.16) and the median time to reach the lowest value of ORi was 2 min (range 1–4 min) after injection. ORi values returned to pre-injection levels within 20 min in 13 of 19 patients, and the median time to return to pre-injection levels was 10 min (range 6–16 min) after injection. During ORi monitoring it is necessary to consider the rapid reduction in ORi after intravenous injection of indigo carmine.     

Obstruction of the central pulmonary artery after shunt operations in patients with pulmonary atresia

The central pulmonary artery was studied angiographically 1-10 years after a palliative operation in 56 patients (mean age 6 years, range 1-20) with congenital heart disease and pulmonary atresia. All of them had originally had a central pulmonary artery that was common to both the right and left pulmonary arteries. Juxtaductal obstruction of the left pulmonary artery had developed in 70% of the patients; in 40% the obstruction was atretic unilaterally. Atresia developed at the right junction to the ductus where there was a shunt to the right pulmonary artery and at the left junction where there was a shunt to the left pulmonary artery. Stenosis causing a reduction of more than 50% of the inner diameter developed at the anastomotic site in 10% of 30 patients with a functioning Blalock shunt. In contrast, there was occlusion of the pulmonary artery or its upper branch in 73% of 11 patients with a non-functioning anastomosis.     

Novel organosilicon-containing polymers for an oxygen permselective membrane

Synthesis and gas permeation measurements of several types of polymers from methylstyrene derivatives containing mono-and bis(trialkylsilyl) group(s) were carried out. Upon radical homo-and co-polymerization of silicon-containing monomers high-molecular-weight polymers were obtained. Results from gas permeation measurements showed that these types of silicon-containing polymers exhibit fairly high oxygen permselectivity (ratio of oxygen and nitrogen permeation coefficients P/P = 3,1 ? 4,6), keeping the oxygen permeation coefficients (P) in the range of between 1,4 · 10^?9 and 4,5·10^?9 cm³ (STP) · cm · cm^?2 · s^?1 · cmHg^?1. From time lag measurements, it was found that permeation coefficients are dependent on the solubility of gases in the membranes rather than on diffusivity. Actually, the oxygen solubility coefficients increase with increasing silicon content in the polymers. Permselectivity of oxygen against nitrogen is governed by polymer constitution rather than by silicon content.