Analysis of actual pressure point using the power flexible capacitive sensor during chest compression.

In chest compression for cardiopulmonary resuscitation (CPR), the lower half of the sternum is pressed according to the American Heart Association (AHA) guidelines 2010. These have been no studies which identify the exact location of the applied by individual chest compressions. We developed a rubber power-flexible capacitive sensor that could measure the actual pressure point of chest compression in real time. Here, we examined the pressure point of chest compression by ambulance crews during CPR using a mannequin. We included 179 ambulance crews. Chest compression was performed for 2 min. The pressure position was monitored, and the quality of chest compression was analyzed by using a flexible pressure sensor (Shinnosukekun™). Of the ambulance crews, 58 (32.4 %) pressed the center and 121 (67.6 %) pressed outside the proper area of chest compression. Many of them pressed outside the center; 8, 7, 41, and 90 pressed on the caudal, left, right, and cranial side, respectively. Average compression rate, average recoil, average depth, and average duty cycle were 108.6 counts per minute, 0.089, 4.5 cm, and 48.27 %, respectively. Many of the ambulance crews did not press on the sternal lower half definitely. This new device has the potential to improve the quality of CPR during training or in clinical practice.

A flexible pressure sensor could correctly measure the depth of chest compression on a mattress.

BACKGROUND: Feedback devices are used to improve the quality of chest compression (CC). However, reports have noted that accelerometers substantially overestimate depth when cardiopulmonary resuscitation (CPR) is performed on a soft surface. Here, we determined whether a flexible pressure sensor could correctly evaluate the depth CC performed on a mannequin placed on a mattress. METHODS: Chest compression was performed 100 times/min by a compression machine on the floor or a mattress, and the depth of CC was monitored using a flexible pressure sensor (Shinnosukekun) and CPRmeter(™). The depth of machine-performed CC was consistently 5cm. We compared data from the feedback sensor with the true depth of CC using dual real-time auto feedback system that incorporated an infrared camera (CPR evolution(™)). RESULTS: On the floor, the true depth of CC was 5.0±0.0cm (n=100), or identical to the depth of CC performed by the machine. The Shinnosukekun(™) measured a mean (±SD) CC depth of 5.0±0.1cm (n=100), and the CPRmeter(™) measured a depth of 5.0±0.2cm (n=100). On the mattress, the true depth of CC was 4.4±0.0cm (n=100). The Shinnosukekun(™) measured a mean CC depth of 4.4±0.0cm (n=100), and the CPRmeter(™) measured a depth of 4.7±0.1cm (n=100). The data of CPRmeter(™) were overestimated (P<.0001 between the true depth and the CPRmeter(™)-measured depth). CONCLUSION: The Shinnosukekun(™) could correctly measure the depth of CC on a mattress. According to our present results, the flexible pressure sensor could be a useful feedback system for CC performed on a soft surface.

Visceral fat predominance is associated with non-alcoholic fatty liver disease in Japanese women with metabolic syndrome.

AIM: Metabolic syndrome (MS) is likely to be associated with non-alcoholic fatty liver disease (NAFLD). The prevalence of NAFLD in visceral fat type MS (V-type MS) is known to be higher than in subcutaneous fat type MS (S-type MS) in men with MS, and a larger subcutaneous fat area is reported to be not associated with NAFLD in women. We elucidated differences between V-type S-type MS in Japanese women with MS. METHODS: The subjects were 276 women with MS who underwent a medical checkup including abdominal ultrasonography. We examined for the prevalence of fatty liver and investigated biochemical parameters, and we also made a distinction between V-type and S-type MS. RESULTS: Triglyceride, uric acid, alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase, the frequency of fatty liver and impaired glucose tolerance (IGT) were significantly higher in V-type MS than in S-type MS. On logistic regression analysis with NAFLD (in our study, fatty liver with ALT ≥31 IU/L was defined as NAFLD) as a dependent variable, body mass index, dyslipidemia, AST and V-type MS were significant predictors of an increased prevalence of NAFLD (odds ratios [OR] = 18.85, 3.119, 59.77 and 3.205; 95% confidence intervals [CI] = 3.585-99.15, 1.195-8.142, 18.03-198.2 and 1.198-8.573; P < 0.001, <0.05, <0.001 and <0.05, respectively). CONCLUSION: Women with V-type MS are more likely to have fatty liver, IGT and liver dysfunction than those with S-type MS. V-type MS is one of the significant predictors for NAFLD in Japanese women with MS.

Twig tea impaction in the colon causing abdominal pain.

We describe a case of lower abdominal pain caused by a twig tea impaction at the rectosigmoid junction after inadvertent ingestion. The foreign body was detected and successfully dislodged from the colonic wall with grasping forceps during colonoscopy. The post-procedural course was uneventful, and the patient was discharged 10 days after the removal. Colonic injury, including perforation due to foreign body ingestion, must be considered in patients presenting with unexplained symptoms and findings, even when they do not recall any foreign body ingestion.

Visceral fat predominance is associated with erosive esophagitis in Japanese men with metabolic syndrome.

BACKGROUND AND AIM: Although visceral fat is strongly associated with metabolic syndrome (MS), the association between erosive esophagitis (EE) and visceral and subcutaneous fat types in individuals with MS has remained unclear. In this study, we divided individuals with MS into those with visceral and subcutaneous fat types, and determined the differences in the presence of EE between the types of MS in Japanese men. METHODS: The participants were 265 men with MS who underwent a medical checkup including upper gastrointestinal endoscopy and abdominal ultrasonography. We made a distinction between visceral and subcutaneous fat types of MS by ultrasonography, and examined for the presence of EE, and the correlation between EE and other data. RESULTS: Total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, and the frequency of EE were significantly higher in visceral fat-type MS than in subcutaneous fat-type MS. On logistic regression analysis with EE as a dependent variable and the significant background factors as the independent variables, visceral fat-type MS and hiatal hernia were significant predictors of an increased prevalence of EE (odds ratios=3.808 and 8.599; 95% confidence intervals=1.710-8.479 and 4.206-17.58; P<0.005 and <0.001, respectively). CONCLUSION: Japanese men with visceral fat-type MS are more likely to have dyslipidemia and EE than those with subcutaneous fat-type MS. Visceral fat-type MS is one of the most significant predictors of an increased prevalence of EE in Japanese men with MS.

Usefulness of differentiating metabolic syndrome into visceral fat type and subcutaneous fat type using ultrasonography in Japanese males.

BACKGROUND: Although metabolic syndrome (MS) is likely to be associated with nonalcoholic fatty liver disease (NAFLD), visceral fat type MS and subcutaneous fat type MS have not been distinguished. In this study, we divided persons with MS into those with visceral and subcutaneous fat types by ultrasonography (US), and elucidated differences between these types of MS in Japanese males. METHODS: The subjects were 628 males with MS who underwent a medical checkup including abdominal US. We examined for the presence of fatty liver and investigated biochemical parameters, and we also made a distinction between visceral and subcutaneous fat types of MS by US. RESULTS: Total cholesterol (T-CHO), low-density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and the frequency of fatty liver were significantly higher in visceral fat type MS than in subcutaneous fat type MS. On logistic regression analysis with NAFLD (in our study, fatty liver with ALT ≥31 IU/l was defined as NAFLD) as a dependent variable, the age, body mass index (BMI), AST, and visceral fat type MS were significant risk factors for NAFLD. BMI, AST, and visceral fat type MS were predictors of an increased prevalence of NAFLD [odds ratios (ORs) = 1.903, 12.06, and 2.617; 95% confidence intervals (CIs) = 1.122-3.228, 7.053-20.61, and 1.741-3.935; p = 0.017, <0.001, and <0.001, respectively). CONCLUSIONS: Japanese males with visceral fat type MS are more likely to have dyslipidemia, fatty liver, and liver dysfunction than those with subcutaneous fat type MS. Visceral fat type MS is one of the most significant risk factors for NAFLD in Japanese males with MS.

Ultrasonographic comparison of gastric motility between diabetic gastroparesis patients with and without metabolic syndrome.

BACKGROUND AND AIMS: Diabetic patients with poor glycemic control or long standing disease often have impaired gastric motility. Recently, metabolic factors such as blood glucose have been reported as influencing gastric motility independently of autonomic neuropathy. Many diabetic patients have metabolic syndrome, which is strongly associated with coronary and other diseases. We investigated whether metabolic syndrome influences diabetic gastroparesis patients. METHODS: We observed gastric motility ultrasonographically in diabetic gastroparesis patients including nine with and nine without metabolic syndrome. Both groups complained of upper abdominal symptoms when hospitalized to improve blood sugar control. All patients underwent upper gastrointestinal endoscopy to rule out gastric and duodenal lesions. All had autonomic neuropathy. Gastric motility was evaluated within 3 days after admission by transabdominal ultrasonography after a test meal. RESULTS: Gastric emptying was 45.0 +/- 13.7% in patients with and 39.1 +/- 11.9% in patients without metabolic syndrome, which was not statistically significant. Frequency of gastric contractions was 8.33 +/- 2.78 per 3 min in patients with metabolic syndrome and 7.44 +/- 2.13 per 3 min in the others, which was not statistically significant. The motility index, which involves antral contractility, was 3.21 +/- 2.18 in patients with metabolic syndrome and 2.80 +/- 1.87 in the others, which was not statistically significant. CONCLUSIONS: Metabolic syndrome did not appear to contribute to delayed gastric motility in diabetic gastroparesis.

A patient with esophageal hemangioma treated by endoscopic mucosal resection: a case report and review of the literature.

In a 58-year-old male, upper digestive endoscopy revealed a protruding lesion in the esophagus on a medical examination. The patient was referred to the Department of Surgery in our hospital to undergo surgery. On the initial consultation, upper digestive endoscopy showed a smooth, soft, black purple, type II protruding lesion measuring approximately 25 mm at 35 cm apart from the incisor. For diagnostic treatment and patient's request, endoscopic mucosal resection (EMR) was performed. The resected specimen measured 25 mm x 25 mm. The histological findings suggested cavernous hemangioma. To treat esophageal hemangioma, esohagectomy, tumor enucleation, or sclerotherapy has been performed. However, recently, thorough preoperative examination, such as endoscopic ultrasonography (EUS), has facilitated endoscopic resection, such as EMR.