Naoki Matsumaru

Effect of enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with sepsis-induced acute respiratory distress syndrome

BackgroundIn this study, the effects of an enteral diet enriched with eicosapentaenoic acid (EPA), γ-linolenic acid (GLA), and antioxidants were compared with a standard enteral diet in critically ill patients with sepsis-induced acute respiratory distress syndrome (ARDS).MethodsThis study was a single-center, prospective, randomized, single-blind, controlled trial in our Advanced Critical Care Center. Patients were randomized to receive a continuous EPA, GLA, and antioxidant-enriched diet (study group), or an isocaloric standard diet (control group).ResultsTwenty-three of 46 patients were in the study group, and the other 23 were in the control group. Duration of mechanical ventilation, incidence of new nosocomial infections, changes over time in Sequential Organ Failure Assessment (SOFA) scores, and 60-day mortality were not significantly different between the two groups. The ratio of partial pressure of oxygen to fraction of inspired oxygen on day 7 was significantly higher in the study group (233.0 [185.5–282.8] vs. 274.0 [225.5–310.8], p = 0.021). Duration of ICU stay was significantly shorter in the study group than in the control group (24.0 [20.0–30.0] vs. 15.0 [11.0–24.0], p = 0.008).ConclusionsAn enteral diet enriched with EPA, GLA, and antioxidants did not improve duration of mechanical ventilation, SOFA score, incidence of new nosocomial infections, or mortality but did favorably influence duration of ICU stay in critically ill patients with sepsis-induced ARDS.

Premonitory Symptom of Septic Shock in Heart Rate Variability

Delay of administering therapy increases the mortality of septic patients. Diagnosing sepsis, however, depends on the decision of an experienced specialist of whether to perform a blood test. Therefore, we believe that a real-time, non-invasive monitoring system for sepsis is useful to promote early intervention. Heart rate variability (HRV), a measure of autonomic nervous system (ANS) activity, has been suggested as an indicator of septic shock. When analyzing electrocardiograms of patients admitted in the intensive care unit (ICU), an important challenge is to distinguish HRV originating in the ANS from other factors such as arrhythmia. A stochastic model is used in this study to extract HRV caused by ANS automatically. Applying the proposed process before HRV estimation, we identified a distinctive V-shaped temporal pattern in HRV as a signal of sepsis. Our investigation continues to explain how that temporal pattern is useful to develop a real-time sepsis monitoring system for sepsis occurrence.

Septic Shock Prediction by Real Time Monitoring of Heart Rate Variability

We propose a method for septic shock prediction by real time monitoring of heart rate variability (HRV) for patients in intensive care unit (ICU). An objective criterion that is related to septic occurrence and can be measured automatically in real time is required to detect septic occurrence. Although HRV is a candidate of such criteria, an automatic estimation of HRV has been difficult because there are many arrhythmias in ICU patients. In this study, we employed a stochastic model on R-R interval series, namely heartbeat interval series, in order to detect abnormal heartbeats in normal R-R interval series automatically. Abnormal heartbeats and very low frequency components are eliminated from R-R series by using the stochastic model. Applying the elimination process before HRV estimation, we identified a distinctive V-shaped temporal pattern in HRV series before septic shock was occurred. The V-shaped pattern is applicable as a signal of septic occurrence. We finally propose a real-time monitoring for sepsis occurrence by using the V-shaped pattern in HRV.

New quantitative method for evaluation of motor functions applicable to spinal muscular atrophy

OBJECTIVE The aim of this study was to develop and introduce new method to quantify motor functions of the upper extremity. METHODS The movement was recorded using a three-dimensional motion capture system, and the movement trajectory was analyzed using newly developed two indices, which measure precise repeatability and directional smoothness. Our target task was shoulder flexion repeated ten times. We applied our method to a healthy adult without and with a weight, simulating muscle impairment. We also applied our method to assess the efficacy of a drug therapy for amelioration of motor functions in a non-ambulatory patient with spinal muscular atrophy. Movement trajectories before and after thyrotropin-releasing hormone therapy were analyzed. RESULTS In the healthy adult, we found the values of both indices increased significantly when holding a weight so that the weight-induced deterioration in motor function was successfully detected. From the efficacy assessment of drug therapy in the patient, the directional smoothness index successfully detected improvements in motor function, which were also clinically observed by the patients doctors. CONCLUSION We have developed a new quantitative evaluation method of motor functions of the upper extremity. Clinical usability of this method is also greatly enhanced by reducing the required number of body-attached markers to only one. This simple but universal approach to quantify motor functions will provide additional insights into the clinical phenotypes of various neuromuscular diseases and developmental disorders.

TOWARD BETTER CONDUCT OF MULTINATIONAL CLINICAL TRIALS: COMPARISON OF CLINICAL ASSESSMENT SCALES BY REGIONS (NORTH AMERICA AND JAPAN)

data were obtained from the electronic medical record for all patients with a clinician’s diagnosis of Alzheimer’s disease (331.0) and Dementia with Lewy Bodies (331.82) at the UAB Memory Disorders Clinic from 4/30/2012 to 4/30/2015. ABCs and RCS data were available on 76 patients diagnosed with Alzheimer’s disease (mean age 75) and 34 patients diagnosed with Dementia with Lewy Bodies (mean age 72). The correlation between the scores on both tests was calculated. Additionally, mean ABCs scores were compared by Kruskal Wallis tests between the two groups. Results: ABCs and RCS scores showed a moderate strength correlation across all patients (Spearman Correlation Coefficient1⁄40.69). This correlation persists for each diagnosis individually, r1⁄40.68 for AD and r1⁄40.71 for DLB. Mean ABCs scores were 17.0 for subjects with AD and 20.3 for subjects with DLB (c21⁄46.1; P1⁄40.013). Mean RCS scores were 5.43 for AD and 5.76 for DLB; no statistical difference was observed between the 2 diagnoses. Conclusions: The predicted relationship between the performance on the ABCs and RCS was established. The RCS did not differentiate between groups. Mean ABCs scores were significantly higher among DLB patients suggesting the ABCs may be more sensitive to AD than DLB. Since the scoring distribution of the ABCs is similar to that of the MiniMental State Exam, our findings are consistent with prior observations that the Montreal Cognitive Assessment is better suited for identifying cognitive impairment associated with parkinsonism. These findings further support the utility of the ABCs for assessing cognitive impairment for common diagnoses among patients attending a Memory Disorders Clinic for dementia-related conditions.

Preliminary Experience with Air Transfer of Patients for Rescue Endovascular Therapy after Failure of Intravenous Tissue Plasminogen Activator

The present report describes our experience with air transfer of patients with acute ischemic stroke in whom intravenous tissue plasminogen activator (IV t-PA) failed for rescue endovascular therapy (EVT). Twenty-three consecutive patients in whom IV t-PA failed were transferred to our hospital for rescue EVT between February 2011 and April 2013. The amount of time required for transfer, distance, clinical outcomes, and complications were compared between patients transferred by ground (TG group; n = 17) and by air (TA group; n = 6). Computed tomography imaging on arrival revealed hemorrhagic transformation in 1 (5.9%) patient in the TG group, whereas none of the patients in the TA group developed any type of complication. The remaining 22 patients received rescue EVT. The elapsed time from the request call to arrival at our hospital did not significantly differ between the TG and TA groups (45.8 ± 4.9 min vs. 41.6 ± 2.3 min). However, the distance from the primary hospital to our institution was significantly longer for the TA group than for the TG group (38.8 ± 10.4 km vs. 13.5 ± 1.2 km, p = 0.001). The frequency of favorable outcomes (modified Rankin Scale 0–1 at 90 days after onset) in the TG and TA groups were 25.0% and 50.0%, respectively (p = 0.267). Air transfer for patients after IV t-PA failure allowed for more rapid delivery of patients over longer distances than ground transfer.

Monitoring of premonitories septic shock in heart-rate variability

Real time monitoring of heart rate variability (HRV) for patients in intensive care unit (ICU) is considered to be useful for predicting their septic shock occurrences. HRV is estimated from a series of heartbeat intervals (RRI). Abnormal heartbeats and very low frequency components in RRI series have to be eliminated carefully because they result in erroneous estimate of HRV. Especially, an effective method of abnormal heartbeat elimination for ICU patients is necessary because ICU patients usually have many arrhythmias. In this study, we propose an abnormal heartbeat elimination method in which a stochastic model concerning with RRI series is employed. Applying the proposed elimination method to RRI series for ICU patients before HRV estimation, we identified a distinctive V-shape temporal pattern in HRV series before septic shock was occurred. The V-shaped pattern is applicable as a signal of septic occurrence. We finally propose a real-time monitoring for sepsis occurrence by using the V-shaped pattern in HRV. It is expected that septic shock occurrence is preventable by presenting an alarm when a V-shaped pattern appears in continuous HRV monitoring.