Clinical effects of polymyxin B-immobilized fiber column direct hemoperfusion for severe bacterial meningitis: A series of 10 cases.

Our results suggest a possible role for Polymyxin B-immobilized fiber column direct hemoperfusion in combination with standard therapy in the rapid improvement of impaired consciousness in patients with severe bacterial meningitis.

Effects of the oriental herbal medicine Bofu-tsusho-san in obesity hypertension: a multicenter, randomized, parallel-group controlled trial (ATH-D-14-01021.R2).

OBJECTIVE: There is no clinical evidence that supports the benefit of integrative medicine, defined as combination therapy of oriental and western medicine, on obesity-related hypertension. This study evaluates the efficacy of Bofu-tsusho-san (BOF), an oriental herbal medicine, on the ambulatory blood pressure (BP) profile in hypertensive patients with obesity. METHODS: The study design was a multicenter, randomized, open-label, parallel-group controlled trial in 107 hypertensive patients with obesity. Participants were randomly assigned to receive either the conventional control therapy or BOF add-on therapy. In both groups antihypertensive therapy was aimed at achieving the target clinic BP. The primary outcome was change in the ambulatory BP profile from baseline to 24 weeks after randomization. RESULTS: Daytime systolic BP variability, an important parameter of ambulatory BP profile, was decreased in the BOF group, and the difference in the changes in daytime systolic BP variability was significant between the BOF and control group (Control vs BOF; the change from baseline in daytime systolic BP variability, 1.0±3.3 vs -1.0±3.3%; p=0.006). CONCLUSION: The BOF add-on therapy effectively improved the ambulatory BP variability. This is the first report suggesting that an integrative medicine approach may exert favorable effects on obesity-related hypertension compared with conventional pharmaceutical treatment. CLINICAL TRIAL REGISTRATION: UMIN000003878.

Long-term efficacy and safety of the small-sized ß2-microglobulin adsorption column for dialysis-related amyloidosis.

Dialysis-related amyloidosis (DRA) is one of the major complications often seen in long-term dialysis patients, and is one of the factors that decreases quality of life. ß2-microglobulin (ß2-m) is considered to be a major pathogenic factor in dialysis-related amyloidosis. The Lixelle adsorbent column, with various capacities, has been developed to adsorb ß2-m from the circulating blood of patients with dialysis-related amyloidosis. Using a minimum type of ß2-m-adsorbing column (Lixelle S-15), we evaluated its therapeutic efficacy and safety in dialysis patients. Seventeen hemodialysis patients with DRA were treated with the S-15 column for one year. Treatment was performed three times a week in this study. During the study period, pinch strength, visual analog scale for joint pain, and activities of daily living were evaluated every three months, and blood sampling was performed every six months. After one year's treatment with the S-15 column, the ß2-m level decreased from 29.3±9.6mg/L to 24.7±5.1mg/L (P<0.05), and the high sensitive C-reactive protein level decreased from 2996±4380ng/mL to 1292±1774ng/mL. After one year of S-15 column use, pinch strength increased from 5.9±3.0pounds to 7.2±3.2pounds (P<0.05), and the visual analog scale for joint pain and activities of daily living score also improved. Long-term use of the Lixelle S-15 column is safe and effective for improvement of quality of life in chronic dialysis patients. Improvement of chronic inflammation may be one of the mechanisms through which the beneficial effects of the column is effected.

The effect of maximal finger tapping on cerebral activation.

The purpose of the present study was to investigate the effect of the repetition rate of a simple movement on the magnitude of neuronal recruitment at maximal effort in humans. Nine right-handed healthy subjects [age: 27.4 +/- 4.8 yr, stature: 174.5 +/- 12.2 cm, body-weight 74.3 +/- 16.6 kg (Mean +/- SD)] participated in this study. We measured the regional cerebral hemodynamics using 24-channel near infrared spectroscopy (NIRS). An auditory-cued, repetitive flexion movement of the right index finger against a button was performed as the finger-tapping task at maximal effort (ME), at 25% of maximal effort (25% ME) and at 50% of maximal effort (50% ME). The increase of the left primary motor cortex hemodynamics during movement relative to the hemodynamics under the resting condition was calculated for each pair of movement conditions. The frequency of finger-tapping was 1.61 +/- 0.18 Hz (25% ME trial), 3.23 +/- 0.36 Hz (50% ME trial), and 6.46 +/- 0.72 Hz (ME trial). The left primary motor cortex showed significant activation under all conditions. The change in total hemoglobin ([tHb]) between the ME trial and the resting value (1.19 +/- 0.93 mmol.mm) was significantly higher than those between the resting value and the 25% ME trial (0.04 +/- 0.04 mmol.mm) or the 50% ME trial (0.08 +/- 0.11 mmol x mm) (p < 0.05). There was a 29.8-fold increase of the [tHb] value between the 50% ME trial and the ME trial, but only a 2-fold increase of the [tHb] value between the 25% ME trial and the 50% ME trial. These results demonstrated that the rate of change in regional cerebral hemoglobin at a maximal effort finger-tapping task was much higher than that at a low frequency finger-tapping task.

Cerebral oxygenation during intermittent supramaximal exercise.

This study examined cerebral deoxygenation during intermittent supramaximal exercise in six healthy male subjects (age: 27.2 +/- 0.6 years (mean +/- S.E.). The subjects performed seven times exercise at an intensity corresponding to 150% of maximal oxygen uptake (VO2max) on cycle ergometer (30 s exercise/15 s rest). Cerebral oxygenation was measured by near-infrared spectroscopy (NIRS). The peak blood lactate concentration after exercise was 15.3 +/- 0.2 mmol/l. Cerebral oxygenation increased in first repetition compared with at rest (+ 5.7 +/- 0.6 microM; P < 0.05), but then decreased with time. Thus, in the last repetition cerebral oxygenation was - 8.5 +/- 0.4 microM (P < 0.05). There was no significant change in arterial oxygen saturation (99.6 +/- at rest, 98.4 +/- 0.2 at the final set of intermittent exercise), and there was no correlated change in end-tidal CO2 concentration with cerebral oxygenation (P > 0.05). These findings suggest that the fatigue resulting from dynamic severe exercise related to a decrease in the cerebral oxygenation level.

Muscle oxygenation kinetics at the onset of exercise do not depend on exercise intensity.

The purpose of this study was to determine whether the onset kinetics of muscle oxygenation in localized working muscle (mOxy) was affected by differences in exercise intensity. Five healthy male subjects exercised for 6 min at 125 W, 150 W, and 175 W, and 1 min at 300 W on a cycle ergometer. mOxy was estimated by near-infrared spectroscopy (NIRS) with a continuous wave photometer. The NIRS probe was positioned on the vastus lateralis muscle of the right leg. The relative change in mOxy was calculated from the relative change of the oxygenated hemoglobin (OxyHb) and deoxygenated hemoglobin (DeoxyHb) concentration from their resting values ([mOxy]=Delta[OxyHb]-Delta[DeoxyHb]). Assuming an exponential time course with time delay, the time constants of the mOxy were 5.7 (SD 2.2) s at 125 W, 5.6 (SD 1.9) s at 150 W, 6.0 (SD 2.2) s at 175 W, and 5.6 (SD 2.1) s at 300 W. The time delays of the mOxy were 6.7 (SD 4.2) s at 125 W, 8.6 (SD 1.6) s at 150 W, 6.4 (SD 3.0) s at 175 W, and 5.4 (SD 2.9) s at 300 W. The mean response times of the mOxy were 12.5 (SD 2.7) s at 125 W, 14.2 (SD 2.4) s at 150 W, 12.4 (SD 4.4) s at 175 W, and 11.0 (SD 3.1) s at 300 W. These results indicate that the kinetics of mOxy were not affected by differences in exercise intensity.

Does the regional oxygen uptake measured by near infrared spectroscopy reflect the phase II pulmonary oxygen uptake at the onset of exercise?

It has been hypothesized that the signals of near infrared spectroscopy (NIRS) would reflect muscle O(2) uptake (mVO(2)). Although it is not definite that NIRS signals accurately reflect mVO(2), there is every possibility that NIRS signals at least reflect regional O(2) uptake (rVO(2)). The phase II kinetics of pulmonary oxygen uptake (pVO(2)) is regarded as reflecting mVO(2) at the onset of exercise. To examine whether the rVO(2) on-kinetics measured by NIRS reflects the mVO(2) on-kinetics at the onset of exercise, we compared the rVO(2) as measured by NIRS with the phase II kinetics of pVO(2) at the onset of exercise. Twelve healthy male subjects cycled a Monark ergometer at three different intensities: below the ventilatory threshold (VT) level (below-VT), on the VT level (on-VT), and above the VT level (above-VT), for 6 minutes on three separate occasions. The rVO(2) was calculated from the concentration of oxyhemoglobin and deoxyhemoglobin, as measured by NIRS every 3 seconds. The pVO(2) was determined by the breath-by-breath method. A significant relationship between the amount of increases of pVO(2) and rVO(2) from rest to the end of exercise among all levels of exercise intensity was found (r=0.935, P<0.001). The time constants of rVO(2) (rVO(2)-Tc: below-VT: 6.514+/-2.159 s, on-VT: 7.760+/-2.035 s, above-VT: 9.532+/-2.342 s) were significantly faster than the time constants of pVO(2) (pVO(2)-Tc: below-VT: 23.8+/-4.4 s, on-VT: 25.9+/-5.1 s, above-VT: 26.3+/-5.7 s) (P<0.001). There was no significant relationship between rVO(2)-Tc and pVO(2)-Tc for each intensity (P>0.05). We conclude that the rVO(2) on-kinetics measured by NIRS does not necessarily reflect the mVO(2) kinetics at the onset of exercise.

Skeletal muscle oxygenation during incremental exercise.

The purpose of this study was to investigate the relationship between muscle oxygenation level at exhaustion and maximal oxygen uptake (VO2max) in an incremental cycling exercise. Nine male subjects took part in an incremental exhaustive cycling exercise, and then cuff occlusion was performed. Changes in oxy-(deltaHbO2) and deoxy-(deltaHb) hemoglobin concentrations in the vastus lateralis muscle were measured with a near infrared spectroscopy (NIRS). Muscle oxygenation during incremental exercise was expressed as a percentage (%Moxy) of the maximal range observed during an arterial occlusion as the lower reference point. A systematic decrease was observed in %Moxy with increasing intensity. A significant relationship was observed between %Moxy at exhaustion and VO2max (p < 0.01). We concluded that the one of the limiting factor of VO2max is the muscle oxygen diffusion capacity, and %Moxy during exercise could be one of the indexes of muscle oxygen diffusion capacity.