Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 118
Filtrar
1.
J Hosp Infect ; 131: 89-98, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36424696

RESUMO

BACKGROUND: The Japanese government introduced financial incentives to reduce nationwide antibiotic use in hospital settings. AIM: This study aimed to determine whether the nationwide financial incentives for creating infection prevention and control (IPC) teams introduced in 2012 and antimicrobial stewardship (ASP) teams introduced in 2018 were associated with changes in antibiotic use and health resource utilization at a national level. METHODS: We conducted time-series analyses and a difference-in-differences study consisting of 3,057,517 inpatients with infectious diseases from 472 medical facilities during fiscal years 2011-2018 using a nationally representative inpatient database in Japan. The primary outcome was the days of therapy (DOT) of antibiotic use per 100 patient-days (PDs). The secondary outcomes consisted of types of antibiotic used, health resource utilization, and mortality. RESULTS: A total of 5,201,304 financial incentives were observed during 2012-2018, which resulted in a total of 12.1 billion JPY (≈110 million USD). Time-series analyses found decreasing trends in total antibiotic use (79.3-72.5 DOTs/100 PDs (8.6% reduction)) and carbapenem use (9.0-7.0 DOTs/100 PDs (7.8% reduction)) from 2011 to 2018 without adversely affecting other healthcare outcomes (e.g., mortality). In the difference-in-differences analyses, we did not observe meaningful changes in total antibiotic use between the incentivized and unincentivized hospitals for ASP teams, except for the northern part of Japan. No dose-response relationships were observed between the amount of financial incentives and reductions in antibiotic use during 2011-2019. CONCLUSIONS: Further research and efforts are needed to accelerate antimicrobial stewardship in hospital settings in Japan.


Assuntos
Antibacterianos , Gestão de Antimicrobianos , Humanos , Antibacterianos/uso terapêutico , Motivação , Japão , Controle de Infecções/métodos
2.
Hernia ; 26(1): 217-223, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34138368

RESUMO

PURPOSE: Synthetic non-absorbable mesh is used for elective inguinal hernia repair but is not commonly used for incarcerated or strangulated inguinal hernia requiring enterectomy to reduce the risk of surgical-site infection. This study aimed to evaluate the safety of synthetic non-absorbable mesh repair in patients with incarcerated or strangulated inguinal hernia requiring enterectomy versus non-mesh repair. METHODS: We analyzed patients with incarcerated or strangulated inguinal hernia with enterectomy from April 2012 to March 2017 using a nationwide inpatient database in Japan. We conducted overlap propensity score-weighted analyses to compare surgical-site infection (SSI), duration of anesthesia, antibiotic use at > 3 days after surgery, postoperative hospital stay, and 30 day readmission. Two sensitivity analyses were performed. First, we compared the proportions of patients requiring wound culture at ≥ 3 days after surgery. Second, we performed overlap propensity score-weighted logistic regression analyses for surgical-site infection. RESULTS: We identified 668 eligible patients, comprising 223 patients with mesh repair and 445 with non-mesh repair. Overlap propensity score-weighted analyses showed no significant differences between the mesh repair and non-mesh repair groups for SSI (2.5 vs. 2.8%, P = 0.79). Secondary outcomes did not differ significantly between the groups. Proportion of wound culture at ≥ 3 days after surgery was similar in the two groups (11.1 vs. 14.6%, P = 0.18). Logistic regression analysis showed no significant association between mesh repair and SSI (odds ratio, 0.93; 95% confidence interval, 0.34-2.57). CONCLUSION: Synthetic non-absorbable mesh use may be safe for incarcerated or strangulated inguinal hernia requiring enterectomy.


Assuntos
Hérnia Inguinal , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Humanos , Tempo de Internação , Telas Cirúrgicas/efeitos adversos , Infecção da Ferida Cirúrgica/cirurgia
3.
BJOG ; 129(5): 805-811, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34545675

RESUMO

OBJECTIVE: Pregnant women may develop disseminated intravascular coagulation (DIC), possibly resulting in massive maternal haemorrhage and perinatal death. The Japan guideline recommends use of antithrombin III (ATIII) for DIC in obstetrics; however, its effect remains uncertain. The present study aimed to investigate the effect of ATIII for DIC in obstetrics, using a national inpatient database in Japan. DESIGN: Nationwide observational study. SETTING: Japan. POPULATION: We used the Diagnosis Procedure Combination inpatient database to identify patients who delivered at hospital and were diagnosed with DIC from July 2010 to March 2018. METHODS: Propensity score matching analyses were performed to compare in-hospital maternal mortality and hysterectomy during hospitalisation between users and non-users of ATIII on the day of delivery. MAIN OUTCOME MEASURES: In-hospital mortality, hysterectomy. RESULTS: A total of 9920 patients were enrolled, including 4329 patients (44%) who used ATIII and 5511 patients (56%) who did not use ATIII. One-to-one propensity score matching created 3290 pairs. In-hospital maternal mortality did not differ significantly between the propensity-matched groups (0.3% in the ATIII group versus 0.5% in the control group; odds ratio 0.73; 95% CI 0.35-1.54). A significantly lower proportion of patients in the ATIII group, compared with those in the control group, underwent hysterectomy during hospitalisation (5.3% versus 8.7%; absolute risk difference -2.9%; 95% CI -4.2 to -1.6%). CONCLUSIONS: Although the present study did not show a mortality-reducing effect of ATIII for patients with DIC in obstetrics, it may have clinical benefit in terms of reducing the number of patients undergoing hysterectomy. TWEETABLE ABSTRACT: This study did not show mortality-reducing effect of antithrombin III for patients with DIC in obstetrics.


Assuntos
Coagulação Intravascular Disseminada , Obstetrícia , Antitrombina III/uso terapêutico , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/tratamento farmacológico , Feminino , Humanos , Japão/epidemiologia , Gravidez , Pontuação de Propensão , Resultado do Tratamento
4.
Br J Surg ; 108(2): 168-173, 2021 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-33711128

RESUMO

BACKGROUND: Although patients with schizophrenia have a higher risk of developing breast cancer than the general population, studies that have investigated postoperative complications after breast cancer surgery in patients with schizophrenia are scarce. This study examined associations between schizophrenia and short-term outcomes following breast cancer surgery. METHODS: Patients who underwent surgery for stage 0-III breast cancer between July 2010 and March 2017 were identified from a Japanese nationwide inpatient database. Multivariable analyses were conducted to compare postoperative complications and hospitalization costs between patients with schizophrenia and those without any psychiatric disorder. Three sensitivity analyses were performed: a 1 : 4 matched-pair cohort analysis with matching for age, institution, and fiscal year at admission; analyses excluding patients with schizophrenia who were not taking antipsychotic medication; and analyses excluding patients with schizophrenia who were admitted to hospital involuntarily. RESULTS: The study included 3660 patients with schizophrenia and 350 860 without any psychiatric disorder. Patients with schizophrenia had a higher in-hospital morbidity (odds ratio (OR) 1.37, 95 per cent c.i. 1.21 to 1.55), with more postoperative bleeding (OR 1.34, 1.05 to 1.71) surgical-site infections (OR 1.22, 1.04 to 1.43), and sepsis (OR 1.20, 1.03 to 1.41). The total cost of hospitalization (coefficient €743, 95 per cent c.i. 680 to 806) was higher than that for patients without any psychiatric disorder. All sensitivity analyses showed similar results to the main analyses. CONCLUSION: Although causal inferences remain premature, multivariable regression analyses showed that schizophrenia was associated with greater in-hospital morbidity and higher total cost of hospitalization after breast cancer surgery than in the general population.


Assuntos
Neoplasias da Mama/complicações , Esquizofrenia/complicações , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Feminino , Humanos , Japão , Pessoa de Meia-Idade , Análise Multivariada , Resultado do Tratamento , Adulto Jovem
5.
Br J Surg ; 107(10): 1354-1362, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32277767

RESUMO

BACKGROUND: The aim of this study was to compare perioperative outcomes of urgent colectomy and placement of a self-expanding metallic stent followed by colectomy for patients with malignant right colonic obstruction. Right-sided malignant obstruction is less common than left-sided. Stenting for malignant left colonic obstruction has been reported to reduce postoperative complications. However, the impact of stenting for malignant right colonic obstruction remains undefined. METHODS: The study included patients with right-sided malignant obstruction or stenosis undergoing colectomy between April 2012 and March 2017 identified from a nationwide database. Propensity score matching analysis was used to compare mortality and morbidity rates, proportion receiving a stoma and postoperative stay between urgent colectomy and stent groups. RESULTS: From 9572 patients, 1500 pairs were generated by propensity score matching. There was no significant difference in in-hospital mortality between the urgent colostomy and stent groups (1·6 versus 0·9 per cent respectively; P = 0·069). Complications were more common after urgent colectomy than stenting (22·1 versus 19·1 per cent; P = 0·042). Surgical-site infection was more likely with urgent colectomy (7·1 versus 4·4 per cent; P = 0·001). There was no significant difference between the two groups in anastomotic leakage (3·8 versus 2·6 per cent; P = 0·062). The proportion of patients needing a stoma was higher with urgent colectomy than primary treatment with stents (5·1 versus 1·7 per cent; P < 0·001). Postoperative stay was longer after urgent colectomy (15 versus 13 days; P < 0·001). CONCLUSION: Stenting followed by colectomy in patients with malignant right colonic obstruction may provide more favourable perioperative outcomes than urgent colectomy.


ANTECEDENTES: El objetivo de este estudio fue comparar los resultados perioperatorios entre la colectomía urgente y la colocación de una endoprótesis (stent) metálica autoexpandible seguida de colectomía en pacientes con obstrucción maligna del colon derecho. La obstrucción maligna del colon derecho es menos frecuente que la del colon izquierdo. Se ha demostrado que la colocación de una endoprótesis en la obstrucción maligna del colon izquierdo reduce las complicaciones postoperatorias. Sin embargo, el impacto de la colocación de una endoprótesis en la obstrucción maligna del colon derecho no está definido. MÉTODOS: Los pacientes con obstrucción o estenosis maligna del colon derecho sometidos a colectomía desde abril de 2012 hasta marzo de 2017 se analizaron a partir de una base de datos nacional. Se realizó un análisis mediante emparejamiento por puntaje de propensión para comparar la mortalidad, la morbilidad, el porcentaje de pacientes en los que se realizó un estoma y la estancia postoperatoria entre los grupos de colectomía urgente y endoprótesis. RESULTADOS: A partir de 9.572 pacientes, se generaron 1.500 parejas mediante emparejamiento por puntaje de propensión. No hubo diferencias significativas en la mortalidad hospitalaria entre los dos grupos (1,6% versus 0,9%, P = 0,07). Las complicaciones fueron más frecuentes después de la colectomía urgente en comparación con las endoprótesis (22,1% versus 19,1%, P = 0,04). La infección del sitio quirúrgico ocurrió con mayor frecuencia en el grupo de la colectomía urgente en comparación con el grupo de endoprótesis (7,1% versus 4,4%, P = 0,001). No se observaron diferencias significativas en la fuga anastomótica entre los dos grupos (3,8% versus 2,6%, P = 0,06). La proporción de pacientes que precisaron estomas fue mayor con la colectomía urgente en comparación con aquellos tratados inicialmente con endoprótesis (5,1% versus 1,7%, P < 0,001). La estancia postoperatoria fue más larga después de la colectomía urgente que tras la colocación de una endoprótesis (15 días versus 13 días, P < 0,001) CONCLUSIÓN: En pacientes con obstrucción maligna del colon derecho, la colocación de una endoprótesis seguida de colectomía puede proporcionar resultados perioperatorios más favorables en comparación con la colectomía urgente.


Assuntos
Colectomia , Neoplasias do Colo/complicações , Obstrução Intestinal/cirurgia , Stents Metálicos Autoexpansíveis , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Bases de Dados Factuais , Feminino , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Obstrução Intestinal/etiologia , Japão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Estomas Cirúrgicos/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia
6.
Phys Rev Lett ; 122(19): 192501, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31144924

RESUMO

We present a precision analysis of the ^{136}Xe two-neutrino ßß electron spectrum above 0.8 MeV, based on high-statistics data obtained with the KamLAND-Zen experiment. An improved formalism for the two-neutrino ßß rate allows us to measure the ratio of the leading and subleading 2νßß nuclear matrix elements (NMEs), ξ_{31}^{2ν}=-0.26_{-0.25}^{+0.31}. Theoretical predictions from the nuclear shell model and the majority of the quasiparticle random-phase approximation (QRPA) calculations are consistent with the experimental limit. However, part of the ξ_{31}^{2ν} range allowed by the QRPA is excluded by the present measurement at the 90% confidence level. Our analysis reveals that predicted ξ_{31}^{2ν} values are sensitive to the quenching of NMEs and the competing contributions from low- and high-energy states in the intermediate nucleus. Because these aspects are also at play in neutrinoless ßß decay, ξ_{31}^{2ν} provides new insights toward reliable neutrinoless ßß NMEs.

7.
Br J Surg ; 106(5): 606-615, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30883708

RESUMO

BACKGROUND: The benefit of taking intra-abdominal cultures during source control procedures in patients with complicated intra-abdominal infection (CIAI) is unknown. The aim of this study was to evaluate whether intra-abdominal cultures reduce the mortality rate of CIAI. METHODS: The Japanese Diagnosis Procedure Combination database was used to identify adult patients with CIAI who had undergone source control procedures on the first day of admission to hospital between April 2014 and March 2016. In-hospital mortality was compared between patients who did and those who did not have intra-abdominal cultures taken. A generalized linear mixed-effect logistic regression model and a random intercept per hospital were used to adjust for baseline confounders and institutional differences. Subgroup analyses were also performed according to disease cause, site of onset and severity of CIAI. RESULTS: Intra-abdominal cultures were taken from 16 303 of 41 495 included patients. Multivariable logistic regression analysis showed that patients with intra-abdominal cultures had a significantly lower mortality than those without (odds ratio 0·85, 95 per cent c.i. 0·77 to 0·95). Subgroup analyses revealed statistically significant differences in mortality between patients with and without cultures among those with lower intestinal perforation, biliary tract infection/perforation, healthcare-associated CIAI and high-risk community-acquired CIAI. CONCLUSIONS: Intra-abdominal cultures obtained during source control procedures may reduce in-hospital mortality, especially in patients with lower intestinal perforation, biliary tract infection/perforation, or healthcare-associated or high-risk community-acquired CIAI.


Assuntos
Técnicas Bacteriológicas/estatística & dados numéricos , Infecções Intra-Abdominais/microbiologia , Infecções Intra-Abdominais/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos/uso terapêutico , Doenças Biliares/complicações , Doenças Biliares/microbiologia , Feminino , Mortalidade Hospitalar , Humanos , Perfuração Intestinal/complicações , Perfuração Intestinal/microbiologia , Infecções Intra-Abdominais/complicações , Infecções Intra-Abdominais/tratamento farmacológico , Japão , Masculino , Pessoa de Meia-Idade , Utilização de Procedimentos e Técnicas , Perfuração Espontânea/complicações , Perfuração Espontânea/microbiologia
8.
Br J Surg ; 105(11): 1426-1434, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29999518

RESUMO

BACKGROUND: The benefits of high transfusion ratios (plasma to red blood cells and platelets to red blood cells) on survival in injured patients who receive massive transfusions remain uncertain. This study aimed to assess the association between transfusion ratios and adverse events and survival in patients undergoing massive transfusion for major trauma. METHODS: A retrospective observational study was conducted on patients who had major trauma using a Japanese national administrative database. The associations between transfusion ratios and outcomes (in-hospital mortality and incidence of adverse events) were analysed using a non-linear logistic generalized additive model (GAM). In a logistic generalized estimating equation model, adjusted for patient and hospital-level confounders, transfusion ratios were included as continuous or categorical variables (low, transfusion ratio 0·75 or less; intermediate, over 0·75 to 1·25; high, over 1·25). RESULTS: Some 1777 patients were included in the analysis, of whom 602 died in hospital. GAM plots of the transfusion ratios for in-hospital mortality demonstrated a downward convex unimodal curve. In-hospital mortality was similar with increasing transfusion ratios for plasma (adjusted odds ratio (OR) 1·13, 95 per cent c.i. 0·82 to 1·55; P = 0·446) and platelets (adjusted OR 0·84, 0·66 to 1·08; P = 0·171). Both plasma to red blood cell ratio (adjusted OR 1·77, 1·32 to 2·37; P < 0·001) and platelet to red blood cell ratio (adjusted OR 1·71, 1·35 to 2·15; P < 0·001) were significantly associated with a higher incidence of adverse events. No significant differences in in-hospital mortality were observed between the three transfusion categories (low, medium and high). CONCLUSION: In this study, transfusion strategies with high plasma to red blood cell and platelet to red blood cell ratios did not have survival benefits, but were associated with an increase in adverse events.


Assuntos
Transfusão de Sangue/métodos , Ferimentos e Lesões/terapia , Adulto , Idoso , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Escala de Gravidade do Ferimento , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade
9.
Br J Anaesth ; 120(4): 779-789, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29576118

RESUMO

BACKGROUND: Although the incidence of maternal mortality during Caesarean delivery remains very low, the rate of severe maternal morbidity is increasing. Improvements in obstetric anaesthetic practice have resulted in a dramatic reduction in the risk of maternal death from general anaesthesia. Less clear is whether the risk of severe maternal morbidity differs according to mode of anaesthesia for women undergoing Caesarean delivery. We analysed the association between the mode of anaesthesia and severe maternal morbidity during Caesarean delivery using a nationally representative inpatient database. METHODS: We identified 89 225 women undergoing scheduled Caesarean delivery from the Diagnosis Procedure Combination database in Japan, 2010-2013. We defined severe maternal morbidity as the presence of any life-threatening complications and identified women with severe maternal morbidity from the database. Propensity score-matched analysis was carried out to compare the odds of severe maternal morbidity between women who underwent general vs neuraxial anaesthesia. RESULTS: Of 89 225 women, 10 058 received general anaesthesia and 79 167 received neuraxial anaesthesia. In the propensity score-matched analysis with 10 046 pairs, a higher incidence of severe maternal morbidity was observed among patients receiving general (2.00%) rather than neuraxial anaesthesia (0.76%). The odds ratio of severe maternal morbidity was 2.68 (95% CI, 1.97-3.64) among women receiving general compared with neuraxial anaesthesia. CONCLUSIONS: For scheduled Caesarean delivery, general anaesthesia compared with neuraxial anaesthesia is associated with greater odds for severe maternal morbidity. However, we should be cautious with interpretation of these findings because they may be explained by confounding indications.


Assuntos
Anestesia Epidural/efeitos adversos , Anestesia Geral/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Cesárea , Transtornos Puerperais/induzido quimicamente , Adulto , Bases de Dados Factuais , Feminino , Humanos , Japão , Gravidez , Adulto Jovem
10.
Acta Gastroenterol Belg ; 80(3): 381-384, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29560667

RESUMO

BACKGROUNDS AND AIMS: Epidural analgesia is an option for pain control in patients with acute pancreatitis. The aim of this study is to describe characteristics, morbidity and mortality of patients with acute pancreatitis treated with epidural analgesia. PATIENTS AND METHODS: Data was extracted from a national inpatient database in Japan on patients hospitalized with acute pancreatitis between July 2010 and March 2013. A total of 44,146 patients discharged from acute care hospitals were included in this retrospective cohort study. The patient background, timing and duration of epidural analgesia, complications (epidural hematoma or abscess), surgery (for cholelithiasis / cholecystitis or complications) and mortality were verified. RESULTS: Epidural analgesia was used in 307 patients (0.70 %). The mean age was 64.0 years (standard deviation, 15.4 years) and 116 (37.8%) of the patients were female. The median duration of epidural analgesia was four days (interquartile range, 3-5 days). No patient underwent surgery for epidural hematoma or abscess. Six (2.0%) patients died during hospitalization. Most likely causes of death were pulmonary embolism, multiple organ failure, sepsis, and methicillin-resistant staphylococcus aureus enterocolitis. The responsible physician for 250 of the patients (81.4%) was a gastroenterological surgeon. Epidural analgesia was started on the day of surgery in 278 (90.6%) patients. CONCLUSION: Epidural analgesia is rarely used in patients with acute pancreatitis. None of the patients included in the study required surgery for epidural hematoma or abscess. Further research to evaluate the efficacy and safety of epidural analgesia in patients with acute pancreatitis is warranted.


Assuntos
Analgesia Epidural , Manejo da Dor , Dor , Pancreatite , Doença Aguda , Idoso , Analgesia Epidural/efeitos adversos , Analgesia Epidural/métodos , Abscesso Epidural/epidemiologia , Abscesso Epidural/etiologia , Feminino , Hematoma Epidural Espinal/epidemiologia , Hematoma Epidural Espinal/etiologia , Hospitalização/estatística & dados numéricos , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Pancreatite/complicações , Pancreatite/diagnóstico , Pancreatite/mortalidade , Pancreatite/terapia , Estudos Retrospectivos , Resultado do Tratamento
11.
BJS Open ; 1(2): 50-54, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29951606

RESUMO

BACKGROUND: Radiofrequency ablation (RFA) is a minimally invasive treatment for hepatocellular carcinoma (HCC). There is increasing evidence of an association between increasing hospital volume and lower postoperative mortality for many surgical procedures, but this is difficult to establish with minimally invasive treatments, where postoperative mortality is low. The aim of this study was to investigate the relationship between hospital volume and in-hospital mortality following RFA using a Japanese nationwide database. METHODS: Data from the Diagnostic Procedure Combination database were analysed from 1 July 2010 to 31 March 2012. Multivariable logistic regression was used to analyse the relationship between hospital volume and in-hospital mortality following RFA, with adjustment for patient background. RESULTS: Some 36 675 patients with HCC were identified in the database. The overall in-hospital mortality rate from RFA was 0·31 per cent. In-hospital mortality was significantly higher in low-volume than high-volume hospitals (odds ratio 2·57, 95 per cent c.i. 1·61 to 4·09; P < 0·001). Higher in-hospital mortality was significantly associated with older age and a higher Charlson Co-morbidity Index score. CONCLUSION: RFA for HCC was associated with acceptably low mortality in Japan, but in-hospital mortality following RFA was affected by hospital procedural volume.

12.
Phys Chem Chem Phys ; 18(45): 31012-31016, 2016 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-27805205

RESUMO

Visible luminescence europium(iii) complexes with large π-conjugated systems were theoretically and experimentally studied. A strategy for extending the π-conjugation of a ligand for use with europium(iii) ions was found on the basis of fragment molecular orbital and density functional theory calculations. Using this method, a novel europium complex was designed and synthesized. Its excited state properties were assessed from the luminescence spectrum, excitation spectrum, luminescence lifetime, and luminescence quantum yield. In this study, the novel photophysics induced by the combination of visible luminescent europium(iii) ions and large π-conjugated systems are described.

14.
Phys Rev Lett ; 117(8): 082503, 2016 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-27588852

RESUMO

We present an improved search for neutrinoless double-beta (0νßß) decay of ^{136}Xe in the KamLAND-Zen experiment. Owing to purification of the xenon-loaded liquid scintillator, we achieved a significant reduction of the ^{110m}Ag contaminant identified in previous searches. Combining the results from the first and second phase, we obtain a lower limit for the 0νßß decay half-life of T_{1/2}^{0ν}>1.07×10^{26} yr at 90% C.L., an almost sixfold improvement over previous limits. Using commonly adopted nuclear matrix element calculations, the corresponding upper limits on the effective Majorana neutrino mass are in the range 61-165 meV. For the most optimistic nuclear matrix elements, this limit reaches the bottom of the quasidegenerate neutrino mass region.

15.
Anaesthesia ; 71(4): 424-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26874247

RESUMO

We retrospectively analysed 30-day mortality and duration of intubation for 8016 children ventilated for three or more days, sedated with midazolam (n = 7716) or propofol (n = 300). We matched the propensity scores of 263 pairs of children. The propensity-matched 30-day mortality (95% CI) was similar: 17/263 (6.5%) with midazolam vs. 24/263 (9.1%) with propofol, p = 0.26. Weaning from mechanical ventilation of children sedated with midazolam was slower than weaning of children sedated with propofol, subhazard ratio (95% CI) 1.43 (1.18-1.73), p < 0.001.


Assuntos
Hipnóticos e Sedativos/administração & dosagem , Propofol/administração & dosagem , Respiração Artificial , Adolescente , Cuidados Críticos , Estado Terminal , Feminino , Humanos , Lactente , Infusões Intravenosas , Intubação Intratraqueal/estatística & dados numéricos , Masculino , Midazolam , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Desmame do Respirador/estatística & dados numéricos
16.
Allergy ; 70(5): 585-90, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25703656

RESUMO

BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic small-vessel vasculitis associated with asthma, eosinophilia, and necrotizing vasculitis. EGPA is potentially life-threatening and often involves peripheral neuropathies, peptic ulcers, cerebral vessel disease, and cardiovascular disease. However, there is limited understanding of the prognostics factors for patients with EGPA. We investigated the clinical features and factors affecting patients' in-hospital mortality, using a national inpatient database in Japan. METHODS: We retrospectively collected data of EGPA patients who required hospitalization between July 2010 and March 2013, using the Diagnosis Procedure Combination database. We evaluated EGPA patients' characteristics and performed multivariate logistic regression analyses to assess the factors associated with in-hospital mortality. RESULTS: A total of 2195 EGPA patients were identified. The mean age was 61.9 years, 42.1% (924/2195) were male, and 41.6% (914/2195) had emergent admission. In-hospital deaths occurred in 97/2195 patients (4.4%). Higher in-hospital mortality was associated with age older than 65 years, disturbance of consciousness on admission, unscheduled admission, respiratory disease, cardio-cerebrovascular disease, renal disease, sepsis, and malignant disease on admission. Lower mortality was associated with female gender and peripheral neuropathies. CONCLUSIONS: Our study revealed the clinical features of EGPA patients who required hospitalization and the factors associated with their mortality. These results may be useful for physicians when assessing disease severity or treatments for hospitalized EGPA patients.


Assuntos
Síndrome de Churg-Strauss/mortalidade , Adulto , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
17.
J Thromb Haemost ; 13(1): 31-40, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25393713

RESUMO

BACKGROUND: The association between recombinant human soluble thrombomodulin (rhTM) use and mortality in patients with sepsis-associated disseminated intravascular coagulation (DIC) remains controversial. OBJECTIVES: To examine the hypothesis that rhTM could be effective in the treatment of patients with sepsis-associated DIC following severe pneumonia. METHODS: Propensity score and instrumental variable analyses using a nationwide administrative database, the Japanese Diagnosis Procedure Combination inpatient database, were used. The main outcome was 28-day in-hospital all-cause mortality. RESULTS: Eligible patients (n = 6342) from 936 hospitals were categorized into the rhTM group (n = 1280) or control group (n = 5062). Propensity score matching created a matched cohort of 1140 pairs with and without rhTM. No significant difference in 28-day mortality was documented between the two groups in the unmatched analysis (rhTM vs. control, 37.0%, 474/1280 vs. 36.9%, 1866/5062; odds ratio [OR], 1.00; 95%CI, 0.98-1.03), nor in the propensity-matched analysis (37.6%, 429/1140 vs. 37.0%, 886/1140; OR, 1.01; 95%CI, 0.93-1.10). The logistic regression analysis did not show a significant association between the use of rhTM and 28-day mortality in propensity-matched patients (OR, 1.00; 95%CI, 0.87-1.22). An analysis using the hospital rhTM-prescribing rate as an instrumental variable found that receipt of rhTM was not associated with reduction in mortality at 28 days (risk difference, 0.008; 95% CI, -0.08-0.98). CONCLUSIONS: This large retrospective nationwide study demonstrated that there might be little association between the use of rhTM and mortality in severe pneumonia patients with sepsis-associated DIC. A multinational randomized trial is required to confirm this.


Assuntos
Coagulação Intravascular Disseminada/tratamento farmacológico , Coagulação Intravascular Disseminada/mortalidade , Pneumonia/mortalidade , Sepse/mortalidade , Trombomodulina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Coagulação Intravascular Disseminada/diagnóstico , Feminino , Mortalidade Hospitalar , Humanos , Japão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pontuação de Propensão , Modelos de Riscos Proporcionais , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Sepse/diagnóstico , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
18.
Int J Tuberc Lung Dis ; 19(1): 120-6, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25519801

RESUMO

SETTING: Although standardised multidrug treatments exist, mortality among hospitalised tuberculosis (TB) patients is high. OBJECTIVE: To characterise TB patients requiring acute hospital care and identify factors associated with in-hospital mortality. DESIGN: Using a Japanese national database of acute-care hospitals, we identified patients with sputum smear-positive pulmonary TB who were discharged (both deceased and alive) between July 2010 and March 2013. Demographic characteristics, comorbidity, procedures and treatments were examined. We performed a multivariable logistic regression analysis to identify risk factors for in-hospital mortality. RESULTS: Of 877 treated patients (566 males, mean age 74.5 years) identified, 152 (17.3%) died. A standard four-drug regimen of isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and pyrazinamide was given to 279 (31.8%) patients, and INH, RMP and EMB to 335 (38.2%) patients. Multivariable analysis showed that the three-drug regimen was significantly associated with higher rates of in-hospital mortality (OR 1.87, 95%CI 1.07-3.27, P = 0.028). Other factors associated with in-hospital death were age, male sex, smoking habit, emergency admission, dementia and severe respiratory condition. CONCLUSION: The risk factors for in-hospital death identified include the use of the three-drug regimen. Treatment choice could influence the outcome of hospitalised TB patients.


Assuntos
Hospitalização , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Criança , Pré-Escolar , Etambutol/uso terapêutico , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Isoniazida/uso terapêutico , Japão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Alta do Paciente , Pirazinamida/uso terapêutico , Estudos Retrospectivos , Rifampina/uso terapêutico , Fatores de Risco , Escarro/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/diagnóstico , Adulto Jovem
19.
Bone Joint J ; 96-B(11): 1530-4, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25371469

RESUMO

Necrotising soft-tissue infections (NSTIs) of the upper limb are uncommon, but potentially life-threatening. We used a national database to investigate the risk factors for amputation of the limb and death. We extracted data from the Japanese Diagnosis Procedure Combination database on 116 patients (79 men and 37 women) who had a NSTI of the upper extremity between 2007 and 2010. The overall in-hospital mortality was 15.5%. Univariate analysis of in-hospital mortality showed that the significant variables were age (p = 0.015), liver dysfunction (p = 0.005), renal dysfunction (P < 0.001), altered consciousness (p = 0.049), and sepsis (p = 0.021). Logistic regression analysis showed that the factors associated with death in hospital were age over 70 years (Odds Ratio (OR) 6.6; 95% confidence interval (CI) 1.5 to 28.2; p = 0.011) and renal dysfunction (OR 15.4; 95% CI 3.8 to 62.8; p < 0.001). Univariate analysis of limb amputation showed that the significant variables were diabetes (p = 0.017) mellitus and sepsis (p = 0.001). Multivariable logistic regression analysis showed that the factors related to limb amputation were sepsis (OR 1.8; 95% CI 1.5 to 24.0; p = 0.013) and diabetes mellitus (OR 1.6; 95% CI 1.1 to 21.1; p = 0.038). For NSTIs of the upper extremity, advanced age and renal dysfunction are both associated with a higher rate of in-hospital mortality. Sepsis and diabetes mellitus are both associated with a higher rate of amputation.


Assuntos
Amputação Cirúrgica/estatística & dados numéricos , Infecções dos Tecidos Moles/cirurgia , Extremidade Superior/cirurgia , Idoso , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Japão/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Necrose/mortalidade , Necrose/cirurgia , Razão de Chances , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Infecções dos Tecidos Moles/mortalidade , Taxa de Sobrevida/tendências , Resultado do Tratamento
20.
J Thromb Haemost ; 12(9): 1470-9, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24943516

RESUMO

BACKGROUND: The association between antithrombin use and mortality in patients with sepsis-associated disseminated intravascular coagulation (DIC) remains controversial. OBJECTIVES: To examine the hypothesis that antithrombin could be effective in the treatment of patients with sepsis-associated DIC following severe pneumonia. METHODS: Propensity score and instrumental variable analyses were performed by use of a nationwide administrative database, the Japanese Diagnosis Procedure Combination inpatient database. The main outcome was 28-day mortality. RESULTS: Severe pneumonia patients diagnosed with sepsis-associated DIC (n = 9075) were categorized into antithrombin (n = 2663) and control (n = 6412) groups. Propensity score matching created a matched cohort of 2194 pairs of patients with and without antithrombin use. Mortality differences were found between the two groups (antithrombin vs. control: unmatched, 40.8% vs. 45.7%; propensity-matched, 40.6% vs. 44.2%; inverse probability-weighted, 41.1% vs. 45.1%). Multiple logistic regression analyses showed an association between antithrombin use and 28-day mortality (unmatched with propensity score adjusted, adjusted odds ratio [OR] 0.87, 95% confidence interval [CI] 0.78-0.97; propensity-matched, adjusted OR 0.85, 95% CI 0.75-0.97; inverse probability-weighted, adjusted OR 0.85, 95% CI 0.79-0.90). An analysis with the hospital antithrombin-prescribing rate as an instrumental variable showed that receipt of antithrombin was associated with a 9.9% (95% CI 3.5-16.3) reduction in 28-day mortality. CONCLUSIONS: This retrospective, large, nationwide database study demonstrates that antithrombin administration may be associated with reduced 28-day mortality in patients with severe pneumonia and sepsis-associated DIC. A large, multinational randomized trial is required.


Assuntos
Anticoagulantes/química , Antitrombinas/uso terapêutico , Coagulação Intravascular Disseminada/tratamento farmacológico , Pneumonia/tratamento farmacológico , Sepse/tratamento farmacológico , Idoso , Algoritmos , Antitrombinas/química , Bases de Dados Factuais , Coagulação Intravascular Disseminada/complicações , Coagulação Intravascular Disseminada/mortalidade , Feminino , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pneumonia/complicações , Pneumonia/mortalidade , Probabilidade , Análise de Regressão , Estudos Retrospectivos , Sepse/complicações , Sepse/mortalidade , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA