Preventive Hyperbaric Oxygen Therapy for Asymptomatic Left Ventricular Air During CT-Guided Lung Needle Biopsy.

Lung needle biopsy can cause air to enter the vessels due to the traffic between the vessels and the trachea. Hyperbaric oxygen therapy (HBOT) according to the U.S. Navy Treatment Table (USNTT) 6 or 6A protocol is used for arterial gas embolism (AGE). However, no treatment or HBOT protocol for asymptomatic intra-arterial air has been established. Here we report two cases of asymptomatic intra-arterial air during lung needle biopsy that were preventively treated with HBOT according to the USNTT 5 protocol. In case 1, a 72-year-old man with malignant lymphoma in remission underwent computed tomography (CT)-guided lung needle biopsy of a nodule in his right lung. During the biopsy, the patient developed a cough, followed by chest pain and dyspnea. Chest CT revealed a right pneumothorax and air in the left ventricle and aorta. The patient did not present with symptoms suggestive of AGE. After thoracic drainage, 4.5 hours after onset, the patient underwent HBOT according to the USNTT 5 protocol. After one session in the hyperbaric chamber, follow-up whole-body CT showed disappearance of intravascular air. In case 2, a 69-year-old man with chronic obstructive pulmonary disease underwent CT-guided lung needle biopsy of a nodule in his right lung. Post-examination CT showed intravascular air in the aorta, pulmonary artery and vein, and left ventricle. However, the patient had no symptoms. One hour after onset, the patient underwent HBOT according to the USNTT 5 protocol. A whole-body CT the next day confirmed the disappearance of intravascular air. Both patients were discharged without sequelae. HBOT is an effective treatment to flush out intra-arterial air and inhibit the expression of adhesion molecules. Asymptomatic intra-arterial air may be adequately treated with HBOT according to a short protocol such as USNTT 5.

Causes of Death in Elderly Patients With Non-Valvular Atrial Fibrillation　- Results From the ANAFIE Registry.

BACKGROUND: Previous studies on mortality in atrial fibrillation (AF) included a limited number of elderly patients receiving direct oral anticoagulants (DOACs). This subanalysis of the ANAFIE Registry evaluated 2-year mortality according to causes of death of elderly non-valvular AF (NVAF) patients in the DOAC era.Methods and Results: The ANAFIE Registry was a multicenter prospective observational study. Mean patient age was 81.5 years and 57.3% of patients were male. Of the 32,275 patients completing the study, 2,242 died. The most frequent causes of death were cardiovascular (CV) death (32.4%), followed by infection (17.1%) and malignancy (16.1%). Incidence rates of CV-, malignancy-, and infection-related death were 1.20, 0.60, and 0.63 per 100 person-years, respectively. Patients aged ≥85 years showed increased proportions of non-CV and non-malignancy deaths and a decreased proportion of malignancy deaths compared with patients aged <85 years. The incidence of death due to congestive heart failure/cardiogenic shock, infection, and renal disease was higher in patients aged ≥85 than those aged <85 years. Compared with warfarin, DOACs were associated with a significantly lower risk of death by intracranial hemorrhage, ischemic stroke, and renal disease. CONCLUSIONS: This subanalysis described the mortality according to causes of death of Japanese elderly NVAF patients in the DOAC era. Our results imply that a more holistic approach to comorbid conditions and stroke prevention are required in these patients.

Decompression Illness Treated with the Hart-Kindwall Protocol in a Monoplace Chamber.

BACKGROUND Hyperbaric oxygen (HBO2) therapy in a multiplace chamber is the standard treatment for severe altitude decompression illness (DCI). However, some hospitals may only have a monoplace chamber. Herein, we present the case of a patient with severe altitude DCI caused by rapid decompression during an actual flight operation that was successfully treated through emergency HBO2 therapy with the Hart-Kindwall protocol, a no-air-break tables with the minimal-pressure oxygen approach in a monoplace chamber due to unavailability of rapid access to a multiplace chamber. CASE REPORT A 34-year-old male aviator presented with chest pain, paresthesia, and mild cognitive impairment following rapid decompression 20 minutes after take-off, which comprised 10 minutes of reaching a height of 10 058 m (33 000 feet) and 10 minutes of cruising at that altitude. He then initiated flight descent and landing. He visited a primary clinic, and severe DCI was suggested clinically. However, since the closest hospital with a multiplace chamber was a 3-hour drive away, we provided emergency HBO2 therapy with the Hart-Kindwall protocol in a monoplace chamber at a nearby hospital 4 hours after the initial decompression. He recovered fully and returned to flight duty 2 weeks later. CONCLUSIONS Emergency HBO2 therapy with the Hart-Kindwall protocol in a monoplace chamber may be a suitable option for severe DCI, especially in remote locations with no access to facilities with a multiplace chamber. However, prior logistical coordination must be established to transfer patients to hospitals with multiplace chambers if their symptoms do not resolve.

Use of hyperbaric oxygen therapy for preventing delayed neurological sequelae in patients with carbon monoxide poisoning: A multicenter, prospective, observational study in Japan.

BACKGROUND: The purpose of this study was to clarify the practical clinical treatment for acute carbon monoxide (CO) poisoning in Japan and to investigate the efficacy of hyperbaric oxygen (HBO2) therapy in preventing delayed neurological sequelae (DNS) in the acute phase of CO poisoning. METHODS: We conducted a multicenter, prospective, observational study of acute CO poisoning in Japan. Patients with acute CO poisoning were enrolled and their treatment details were recorded. The primary endpoint was the onset of DNS within 2 months of CO exposure. Factors associated with DNS were assessed with logistic regression analysis. RESULTS: A total of 311 patients from 57 institutions were registered and 255 were analyzed: 171 received HBO2 therapy (HBO2 group) and 84 did not (normobaric oxygen [NBO2] group). HBO2 therapy was performed zero, once, twice, or three times within the first 24 h in 1.8%, 55.9%, 30.9%, and 11.3% of the HBO2 group, respectively. The treatment pressure in the first HBO2 session was 2.8 ATA (47.9% of the HBO2 group), 2.0 ATA (41.8%), 2.5 ATA (7.9%), or another pressure (2.4%). The incidence of DNS was 13/171 (7.6%) in the HBO2 group and 3/84 (3.6%) in the NBO2 group (P = 0.212). The number of HBO2 sessions in the first 24 h was one of the factors associated with the incidence of DNS (odds ratio, 2.082; 95% confidence interval, 1.101-3.937; P = 0.024). CONCLUSIONS: The practical clinical treatment for acute CO poisoning, including HBO2 therapy, varied among the institutions participating in Japan. HBO2 therapy with inconsistent protocols showed no advantage over NBO2 therapy in preventing DNS. Multiple HBO2 sessions was associated with the incidence of DNS.

Analysis of bioMARKer Distribution and Individual Reproducibility Under Rivaroxaban Treatment in Japanese Patients with Non-Valvular Atrial Fibrillation (R-MARK Study, CVI ARO2).

The "on-therapy range" of direct oral anticoagulants is the 90% interval of drug concentration. Previously, we reported the on-therapy range of rivaroxaban in a single-center cohort. The present study aimed to confirm the range and intraindividual reproducibility in a multicenter cohort.Eligible patients with non-valvular atrial fibrillation under rivaroxaban treatment for prevention of ischemic stroke were enrolled from nine institutes in Tokyo, Japan, between June 2016 and May 2017 (n = 324). The first and second (three months later) blood samples both taken within 1-5 hours after rivaroxaban intake were analyzed (n = 219). Plasma concentration of rivaroxaban (PC-Riv) and prothrombin time (PT) with five reagents were measured.The 90% interval of PC-Riv was 47.3-532.9 ng/mL. The 90% interval of PT measured with RecombiPlasTin 2G was 11.8-22.3 seconds, the widest range among the five reagents examined. PC-Riv reproducibility within a 90% interval was evaluated bidirectionally (first-to-second and second-to-first), and 92.4% of samples were reproducible. The change rate (CR) of PC-Riv between two samplings ranged widely, and high CR (≥54.3%, cutoff for predicting non-reproducibility) was predicted by concomitant drugs (non-dihydropyridine calcium antagonist and thiazide) and mitral regurgitation.We reported the on-therapy range of rivaroxaban in a multicenter cohort. This range was consistent with that of a single-center cohort and was highly reproducible within three months in daily clinical practice. However, caution is necessary regarding several factors that may affect the intraindividual variation of PC-Riv.

A diver with immersion pulmonary oedema and prolonged respiratory symptoms.

Immersion pulmonary oedema (IPE) is particularly associated with an excessive reaction to exercise and/or cold stress. IPE usually resolves without recompression therapy within a day or two. Herein we report a diver diagnosed with IPE, in whom symptoms persisted for five days. A 58-year-old man presented with sudden onset of dyspnoea, cough and haemoptysis after surfacing. He was an experienced diving instructor with a history of moderate mitral valve regurgitation. While IPE was diagnosed and oxygen administered, respiratory symptoms deteriorated, and serum C-reactive protein elevated. No evidence of infection was seen. Three hyperbaric oxygen treatments were given on the basis of suspected decompression sickness, and symptoms subsequently resolved. The recently diagnosed mitral valve regurgitation and inflammatory response were considered to have contributed to the prolongation of symptoms.

Cadmium reduces adipocyte size and expression levels of adiponectin and Peg1/Mest in adipose tissue.

Adipose tissue dysfunction has been associated with diabetogenic effects. The effects of repeated Cd exposure on adipocytes remain largely unknown. We administered Cd at doses of 0, 5, 10, and 20 micromol/kgbw sc for 2 weeks (3.5 times/week) to mice and assessed the possible alteration of epididymal white adipose tissue (WAT), including histological difference, adipocyte differentiation and functional capacity. Whereas hepatic weight did not differ between the control and Cd-exposed groups, WAT weight, as well as adipose cell mass, significantly decreased in a dose-dependent manner in Cd-treated mice. The Cd concentration in WAT significantly increased in Cd-treated groups after 2 weeks of exposure. Next, we examined the effects of Cd on adipocyte differentiation and hypertrophy. Cd exposure significantly decreased the paternally expressed gene 1/Mesoderm-specific transcript mRNA expression levels. Both peroxisome proliferator-activated receptor gamma2 and CCAAT/enhancer-binding protein alpha mRNA expression levels in WAT tended to decrease in the Cd-treated groups. Next, we determined the effects of Cd exposure on the mRNA expression levels of adipose-derived hormones, such as adiponectin and resistin. The adiponectin mRNA expression level in WAT decreased after both 6h and 2 weeks of exposure to a high dose of Cd, and the reduction in resistin mRNA expression levels was observed after 2 weeks of exposure. These results suggest that Cd exposure causes abnormal adipocyte differentiation, expansion, and function, which might lead to development of insulin resistance, hypertension, and cardiovascular disease.

Influence of soil properties on the biodegradation of 1,3,6,8-tetrachlorodibenzo-p-dioxin and fungal treatment of contaminated paddy soil by white rot fungus Phlebia brevispora.

To examine the bioremediation potential of Phlebia brevispora in dioxin-contaminated soil, the fungus was inoculated into autoclaved soil that was contaminated with 2,7-dichlorodibenzo-p-dioxin (2,7-DCDD) or 1,3,6,8-tetrachlorodibenzo-p-dioxin (1,3,6,8-TCDD). Three types of soils, organic-rich soil (Andosol), organic-poor soil (Granitic Regosols), and paddy soil, were used for the construction of artificially contaminated soil to understand the influence of the soil property on fungal growth and dioxin degradation ability. Under a solid-state condition, although the growth of the fungus improved in organic-rich soil, the degradation of 2,7-DCDD was inhibited. Although the degradation of 1,3,6,8-TCDD under a solid-state condition was inhibited severely, 1,3,6,8-TCDD degradation was observed under a slurry-state condition in organic-poor soil. In the case of organic-rich soil, an increase in water content improved the 1,3,6,8-TCDD degradation efficiency. When the historically contaminated paddy soil was treated with P. brevispora under a slurry-state condition, 1,3,6,8-TCDD as the main contaminant degraded 50% after 90d incubation.

A norbergenin derivative inhibits neuronal cell damage induced by tunicamycin.

Several chemically synthesized compounds were examined for protective effects against the cell damage in tunicamycin-treated human neuroblastoma IMR-32 cells. Among the compounds tested, an antioxidant, Norbergenin-11-caproate (10 microM), exhibited complete protection against the cell growth inhibitory effect of tunicamycin but did not inhibit the induction of Bip/GRP78 mRNA by tunicamycin. Both norbergenin-11-caproate and alpha-tocopherol completely inhibited the production of reactive oxygen species induced by tunicamycin, however, alpha-tocopherol inhibited tunicamycin-induced cell damage only partially, even at 100 microM. These findings suggest the potential of Norbergenin-11-caproate for therapeutic application in endoplasmic reticulum (ER) stress-dependent diseases implicating a specific mechanism other than anti-oxidative one.