Takahiro Hirayama

AN69ST membranes adsorb nafamostat mesylate and affect the management of anticoagulant therapy: a retrospective study

BackgroundIn Japan, nafamostat mesylate (NM) is frequently used as an anticoagulant during continuous renal replacement therapy (CRRT). The dialyzer membrane AN69ST has been reported to adsorb NM and affect the management of anticoagulant therapy. However, the adsorbed amount has not yet been quantitatively assessed. Therefore, in this study, we evaluated the pre- and post-hemofilter prolongation of the activated clotting time (ACT) in patients with AN69ST and PS membranes. We also measured the adsorption of NM in three types of CRRT membranes using an experimental model.MethodsIn a study of patients who underwent CRRT using AN69ST or PS membranes in 2015 at the Advanced Emergency and Critical Care Center, Okayama University Hospital, pre- and post-hemofilter ACT measurements were extracted retrospectively, and the difference was calculated. In addition, AN69ST (sepXiris100), PS (HEMOFEEL SHG-1.0), and PMMA membranes (HEMOFEEL CH-1.0N) were used in an in vitro model of a dialysis circuit, and the concentrations of NM were measured in pre- and post-hemofilter membranes and filtrates.ResultsThe ACT difference was significantly lower in the group using AN69ST membranes (p < 0.01). In the in vitro model (n = 4) with adsorption and filtration, the post-hemofilter and filtrate concentrations of NM in AN69ST membranes were significantly lower than those in the PS and PMMA membranes (p < 0.01). The NM adsorption clearance of the AN69ST membrane was significantly higher than that of the PS and PMMA membranes.ConclusionsThe AN69ST membrane had higher NM adsorption than the PS and PMMA membranes. This may have resulted in the lower ACT difference in patients undergoing CRRT using the AN69ST membrane than in patients undergoing CRRT using PS or PMMA membranes.

Tetanus in a 19-year-old Japanese Woman

A 19-year-old Japanese woman presented with a suddenonset of difficulty in opening her mouth (Picture A). Trismus and cervicofacial involuntary movements in the patient were easily triggered by stimulation. Although there was no recent history of trauma, minor skin disorders were seen on her foot (Picture B). The patient’s medical history revealed that she had never been vaccinated with tetanus toxoid. We diagnosed the patient with tetanus and administered tetanus immune globulin (5,000 units), toxoid vaccination, and intravenous penicillin G (2,400 million units per day). The patient’s neuromuscular manifestations gradually improved and she was discharged on day 10. Tetanus is a fatal disease in developing countries where vaccination is unavailable. In Japan, with the introduction of preventive immunization in 1968, the incidence of tetanus has dramatically declined. Presently, almost all Japanese cases are in patients over forty years of age who had been born before the implementation of routine vaccination; teenagers are scarcely reported as having this disease (1). For cases in which tetanus is suspected, urgent treatment is necessary (2).

Predicting the return of spontaneous circulation after out-of-hospital cardiac arrest through blood gas analysis

Intr Several studies have investigated the factors associated with the return of spontaneous circulation (ROSC) in outof-hospital cardiac arrest (OHCA) cases. The most analyzed factor is pre-hospital resuscitation, such as an early phone call for the ambulance, bystander cardiopulmonary resuscitation (CPR), presentation with ventricular fibrillation, and medication. The blood gas parameters have not yet been reported as a predictive factor for ROSC.