Ayumi Shintani

Estimated glomerular filtration rate and the risk–benefit profile of intensive blood pressure control amongst nondiabetic patients: a post hoc analysis of a randomized clinical trial

The Systolic Blood Pressure Intervention Trial (SPRINT; ClinicalTrials.gov, NCT01206062) reported reduced cardiovascular events by intensive blood pressure (BP) control amongst hypertensive patients without diabetes. However, the risk–benefit profile of intensive BP control may differ across estimated glomerular filtration rate (eGFR) levels.

Improving Outcomes of Witnessed Out‐of‐Hospital Cardiac Arrest After Implementation of International Liaison Committee on Resuscitation 2010 Consensus: A Nationwide Prospective Observational Population‐Based Study

Background The International Liaison Committee on Resuscitation (ILCOR) periodically updates the consensus recommendations for cardiopulmonary resuscitation to improve the outcomes of out‐of‐hospital cardiac arrest (OHCA). However, little is known about the differences in outcomes of witnessed OHCA following the publication of the ILCOR 2010 and the ILCOR 2005 recommendations. Methods and Results We enrolled 241 990 adults who experienced witnessed OHCA between 2007 and 2013 from a prospective, nation‐wide, population‐based cohort database in Japan. We compared neurologically favorable 1‐month survival and 1‐month survival rates post‐OHCA by dividing the study period into 2 categories: the ILCOR 2005 period and ILCOR 2010 period. The associations between guideline periods and outcomes were estimated using multivariable logistic regression analysis and reported as adjusted odds ratio and 95% CI. Among 241 990 patients examined in this study, OHCA was witnessed in 44 706 patients (18%) by emergency medical service personnel and in 197 284 patients (82%) by citizens. Compared with the ILCOR 2005 period, the neurologically favorable 1‐month survival rate improved from 4.6% to 5.2% (adjusted odds ratio, 1.54; 95% CI, 1.42–1.67; P<0.001), and the 1‐month survival rate improved from 9.0% to 9.7% (adjusted odds ratio, 1.34; 95% CI, 1.27–1.42; P<0.001) in the ILCOR 2010 period. These improvements were also shown in patients receiving conventional versus compression‐only cardiopulmonary resuscitation. Conclusions Outcomes of witnessed OHCA were better in the ILCOR 2010 period than those in the ILCOR 2005 period. Our results can provide baseline data for many future prospective studies.

Efficacy of a concomitant elemental diet to reduce the loss of response to adalimumab in patients with intractable Crohn's disease

Secondary loss of response to adalimumab (ADA‐LOR) commonly occurs in patients with Crohns disease (CD) treated with adalimumab (ADA). We evaluated the efficacy of concomitant elemental diet (ED) therapy to reduce ADA‐LOR in adult CD patients.

Relationship between atherosclerosis and occlusal support of natural teeth with mediating effect of atheroprotective nutrients: From the SONIC study

Whereas most of studies investigating relationship between oral health and atherosclerosis have focused on periodontitis, very few of them were examined about occlusal status of natural teeth which possibly influence dietary habit. The primary aim of this cross-sectional study was to investigate the association between the occlusal support of posterior teeth and the prevalence of atherosclerosis in community-dwelling septuagenarians. Also, the second aim was to test the hypothesis that the intake of key nutrients for atherosclerosis prevention would have a mediating effect on the relationship between the occlusal status and atherosclerosis. The study population included 468 community-dwelling dentate persons aged 69–71 years recruited from the local residential registration in Japan. Participants were divided into three groups, according to the number of occlusal support zones (OSZ) in the posterior area: Complete (four OSZ), Moderate (three or two OSZ), and Collapsed (one or no OSZ). Dietary intakes were assessed using a brief-type self-administered diet history questionnaire. Atherosclerosis was defined as carotid intima-media thickness ≧1.10 mm by using carotid ultrasonography test. The logistic or linear regression model was used in multivariate analysis to assess relationship between occlusal status and atherosclerosis, and the mediating effect of key nutrients within the relationship. Multivariable analysis showed a significant association between occlusal status and atherosclerosis (odds ratio for Collapsed group to Complete group: 1.87; 95% CI: 1.45–2.41), independent of periodontal status (odds ratio: 2.01, 95%CI: 1.46–2.78). Fish and shellfish, vitamin B6 and n-3PUFAs were significantly related to both of occlusal status and atherosclerosis, and also was indicated a mediating effect on the association between occlusal status and atherosclerosis. This study implied that, within the limitation of the cross-sectional study design, the reduced posterior occlusion was related to the increased prevalence of atherosclerosis via the decline of key dietary intakes among Japanese community-dwelling dentate individuals.

Evaluating the Effect on Mortality of a No-Tranexamic acid (TXA) Policy for Cardiovascular Surgery

OBJECTIVESnThe authors stopped using tranexamic acid (TXA) in April 2013. The present study aimed to examine the impact of a no-TXA-use policy by comparing the adverse effects of TXA and clinical outcomes before and after the policy change in patients undergoing cardiovascular surgery.nnnDESIGNnA single center retrospective cohort study.nnnSETTINGnA single cardiovascular center.nnnPARTICIPANTSnPatients undergoing cardiovascular surgery between January 2008 and July 2015 (n = 3,535).nnnINTERVENTIONSnPatients outcomes before and after the policy change were compared to evaluate the effects of the change.nnnMEASUREMENTS AND MAIN RESULTSnThe seizure rate decreased significantly after the policy change (6.9% v 2.7%, p < 0.001). However, transfusion volumes and blood loss volumes increased significantly after the policy change (1,840 mL v 2,030 mL, p = 0.001; 1,250 mL v 1,372 mL, p < 0.001, respectively). Thirty-day mortality was not statistically different (1.6% v 1.4%, p = 0.82), nor were any of the other outcomes. Propensity-matched analysis and segmented regression analysis showed similar results.nnnCONCLUSIONSnThe mortality rate remained the same even though the seizure rate decreased after the policy change. Blood loss volume and transfusion volume both increased after the policy change. TXA use provides an advantageous benefit by reducing the need for blood transfusion.

Validation of an algorithm that determines stroke diagnostic code accuracy in a Japanese hospital-based cancer registry using electronic medical records

BackgroundThis study aimed to validate an algorithm that determines stroke diagnostic code accuracy, in a hospital-based cancer registry, using electronic medical records (EMRs) in Japan.MethodsThe subjects were 27,932 patients enrolled in the hospital-based cancer registry of Osaka University Hospital, between January 1, 2007 and December 31, 2015. The ICD-10 (international classification of diseases, 10th revision) diagnostic codes for stroke were extracted from the EMR database. Specifically, subarachnoid hemorrhage (I60); intracerebral hemorrhage (I61); cerebral infarction (I63); and other transient cerebral ischemic attacks and related syndromes and transient cerebral ischemic attack (unspecified) (G458 and G459), respectively. Diagnostic codes, both “definite” and “suspected,” and brain imaging information were extracted from the database. We set the algorithm with the combination of the diagnostic code and/or the brain imaging information, and manually reviewed the presence or absence of the acute cerebrovascular disease with medical charts.ResultsA total of 2654 diagnostic codes, 1991 “definite” and 663 “suspected,” were identified. After excluding duplicates, the numbers of “definite” and “suspected” diagnostic codes were 912 and 228, respectively. The proportion of the presence of the disease in the “definite” diagnostic code was 22%; this raised 51% with the combination of the diagnostic code and the use of brain imaging information. When adding the interval of when brain imaging was performed (within 30xa0days and within 1xa0day) to the diagnostic code, the proportion increased to 84% and 90%, respectively. In the algorithm of “definite” diagnostic code, history of stroke was the most common in the diagnostic code, but in the algorithm of “definite” diagnostic code and the use of brain imaging within 1xa0day, stroke mimics was the most frequent.ConclusionsCombining the diagnostic code and clinical examination improved the proportion of the presence of disease in the diagnostic code and achieved appropriate accuracy for research. Clinical research using EMRs require outcome validation prior to conducting a study.

Establishment of a dual-wavelength spectrophotometric method for analysing and detecting carbapenemase-producing Enterobacteriaceae

The spread of carbapenemase-producing Enterobacteriaceae (CPE) is an increasing global public health concern. The development of simple and reliable methods for CPE detection is required in the clinical setting. This study aimed to establish a dual-wavelength measurement method using an ultraviolet–visible spectrophotometer to rapidly quantify imipenem hydrolysis in bacterial cell suspensions. The hydrolytic activities of 148 strains including various CPE strains (Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Enterobacter aerogenes containing the blaIMP, blaKPC, blaNDM, blaOXA, and blaVIM genes) were measured and analysed. A cut-off value was obtained for differentiation between CPE and non-CPE strains, and the method had high sensitivity (100%) and specificity (100%) within 60u2009min. Our system has potential clinical applications in detecting CPE.

Development and validation of a prediction model for loss of physical function in elderly hemodialysis patients

Abstract Background Among aging hemodialysis patients, loss of physical function has become a major issue. We developed and validated a model of predicting loss of physical function among elderly hemodialysis patients. Methods We conducted a cohort study involving maintenance hemodialysis patients u2009≥65u2009years of age from the Dialysis Outcomes and Practice Pattern Study in Japan. The derivation cohort included 593 early phase (1996–2004) patients and the temporal validation cohort included 447 late-phase (2005–12) patients. The main outcome was the incidence of loss of physical function, defined as the 12-item Short Form Health Survey physical function score decreasing to 0 within a year. Using backward stepwise logistic regression by Akaike’s Information Criteria, six predictors (age, gender, dementia, mental health, moderate activity and ascending stairs) were selected for the final model. Points were assigned based on the regression coefficients and the total score was calculated by summing the points for each predictor. Results In total, 65 (11.0%) and 53 (11.9%) hemodialysis patients lost their physical function within 1u2009year in the derivation and validation cohorts, respectively. This model has good predictive performance quantified by both discrimination and calibration. The proportion of the loss of physical function increased sequentially through low-, middle-, and high-score categories based on the model (2.5%, 11.7% and 22.3% in the validation cohort, respectively). The loss of physical function was strongly associated with 1-year mortality [adjusted odds ratio 2.48 (95% confidence interval 1.26–4.91)]. Conclusions We developed and validated a risk prediction model with good predictive performance for loss of physical function in elderly hemodialysis patients. Our simple prediction model may help physicians and patients make more informed decisions for healthy longevity.

In response to ‘benefits and risks of intensive blood-pressure lowering in advanced chronic kidney disease’

We thank Dr. A. Cheung and his colleagues from the SPRINT Research group for their letter-to-theeditor [1] about our study [2]. Their main criticisms included the statistical power of our study (especially in the subgroups of patients with eGFR <45 mL min /1.73 m) and the issue of multiple comparisons. In our rebuttal, we take the advantage of this opportunity to clarify several core concepts of our study, highlighting the heterogeneity within the chronic kidney disease (CKD) spectrum and the statistical methods used to evaluate treatment effect modifications.

Association of prophylactic synbiotics with reduction in diarrhea and pneumonia in mechanically ventilated critically ill patients: A propensity score analysis

INTRODUCTIONnThe preventive association of synbiotics therapy has not been thoroughly clarified in mechanically ventilated patients. The purpose of this study was to evaluate whether synbiotics therapy has preventive association against septic complications in ventilated critically ill patients.nnnMETHODSnCritically ill patients who were mechanically ventilated were included in this retrospective observational study. Patients who received synbiotics (Bifidobacterium breve, Lactobacillus casei, and galactooligosaccharides) within 3 days after admission (denoted as synbiotics group) were compared with patients who did not receive synbiotics. The incidences of enteritis, pneumonia, and bacteremia were evaluated as clinical outcome. Enteritis was defined as an acute onset of diarrhea consisting of continuous liquid watery stools for more than 12xa0h. The confounding factors include APACHE II on admission, gender, the cause of admission and antibiotics.nnnRESULTSnWe included 179 patients in this study: 57 patients received synbiotics and 122 patients did not receive synbiotics. The incidences of enteritis were significantly lower in the synbiotics group compared with the control group (3.5% vs. 15.6%; pxa0<xa00.05). The odds ratios for diarrhea-free days during the first 28 days for the synbiotics group as compared with the controls were 4.354 (95% confidence interval (CI), 2.407 to 7.877; pxa0<xa00.001) in an ordinal logistic regression model with propensity scores. The odds ratios for pneumonia-free days during the first 28 days for the synbiotics group were 2.529 (95% CI, 1.715 to 3.731; pxa0<xa00.001). The incidences of bacteremia did not have significant differences.nnnCONCLUSIONnProphylactic synbiotics appeared to have preventive association on enteritis and pneumonia in mechanically ventilated critically ill patients.