Correction: Trends in clinical characteristics and factors associated with initial prescription of SGLT2 inhibitors in Japanese patients with type 2 diabetes mellitus.

[This corrects the article DOI: 10.1007/s13340-022-00577-y.].

Reversible Bilateral Transverse Sinus Occlusion Treated by Lumboperitoneal Shunt in Idiopathic Intracranial Hypertension: A Case Report.

We report a patient with idiopathic intracranial hypertension (IIH) with bilateral transverse sinus occlusion treated by a lumboperitoneal shunt. A 45-year-old woman presented with visual disturbance and chronic headache. Magnetic resonance (MR) venography and three-dimensional computed tomography angiography (3D-CTA) showed occlusion of both transverse sinuses. After the surgery, MR venography and 3D-CTA showed no blockages in both transverse sinuses. This phenomenon reveals that obstruction of the bilateral transverse sinus is a consequence of intracranial hypertension, not just a single cause. Since many patients have an obstruction or stenosis of the venous sinus, there are some reports of endovascular treatment. Sinus reconstruction is usually effective, but it is not effective in some cases. Reversal of sinus occlusion suggests that endovascular therapy for IIH is inadequate in some cases.

Concomitant use of VA-ECMO and Impella with inhaled nitric oxide to treat cardiogenic shock after cardiac surgery: A case report.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to treat cardiogenic shock. However, a lack of left ventricle (LV) unloading and increased systemic afterload can cause pulmonary congestion. Impella (Abiomed, Danvers, MA, USA), a catheter-mounted micro-axial rotary pump, unloads the LV and provides hemodynamic support. However, Impella cannot support the right ventricle (RV), and RV dysfunction impedes weaning from VA-ECMO. A 50-year-old man with heart failure with reduced ejection fraction due to myocardial infarction developed moderate aortic stenosis and regurgitation, moderate mitral regurgitation, and tricuspid regurgitation. Aortic valve replacement, mitral valve replacement, and tricuspid valve replacement were performed. VA-ECMO with intra-aortic balloon pump (IABP) was initiated as he could not be weaned from cardiopulmonary bypass. The patient could not be weaned from IABP and VA-ECMO; therefore, Impella 5.0 was inserted instead of IABP on day 7. However, Impella 5.0 was ineffective due to RV dysfunction. Increased inhaled nitric oxide (iNO) dose lowered pulmonary vascular resistance, decreased RV afterload, and improved RV distension. He was weaned from VA-ECMO after increasing the flow from the Impella 5.0. Combining VA-ECMO with Impella and iNO improved hemodynamics in a patient with RV dysfunction, and Impella with iNO aided weaning from VA-ECMO. Learning objective: Combining venoarterial extracorporeal membrane oxygenation (VA-ECMO) with Impella (Abiomed, Danvers, MA, USA) and inhaled nitric oxide (iNO) can improve hemodynamics in a patient with right ventricular dysfunction, and iNO may aid weaning from VA-ECMO.

Trends in clinical characteristics and factors associated with initial prescription of SGLT2 inhibitors in Japanese patients with type 2 diabetes mellitus.

Aims: To investigate the changes in patient background and treatment lines between 2016-2019 and contributing factors when sodium-glucose co-transporter 2 inhibitors (SGLT2i) are newly prescribed for type 2 diabetes mellitus patients. Methods: The subjects comprised patients who had attended outpatient clinics at the four Jikei University School of Medicine-affiliated hospitals. One-way analysis of variance was used to evaluate annual changes in patients' characteristics. Logistic regression analysis was also used to explore factors contributing to the treatment lines. Results: The age of the 1951 subjects [mean ± SD] was 59.1 ± 12.8 years; BMI 27.5 ± 4.9 kg/m2; HbA1c 8.15 ± 1.24%; eGFR 74.2 ± 25.3 ml/min/1.73m2. SGLT2i was the 2.86th (± 1.22) new prescription among antidiabetic drugs, and at increasingly earlier treatment lines between 2016 and 2019 (3.28 ± 1.16 to 2.59 ± 1.19; P < 0.001). The age of initial SGLT2i prescription significantly increased over time (P < 0.001). In contrast, the patients' BMI and eGFR values decreased over time. Again, the proportions of patients with chronic kidney disease (CKD) and cardiovascular disease-heart failure disease (CVD-HF) tended to increase over time. The patients for whom SGLT2i had been prescribed in the first line were more likely to have obesity and HF (1.64 [1.15-2.34] and 1.84 [1.12-3.02], respectively). Conclusions: SGLT2i was more likely to be newly prescribed to patients with CVD-HF and CKD, older patients, and to be prescribed in earlier treatment lines in recent years. Obesity and HF were predictor of SGLT2i prescriptions in the first line. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-022-00577-y.

The magnitude of the survival benefit of internal thoracic artery grafting: Absolute risk reduction.

The magnitude of the survival benefit of CABG with internal thoracic artery graft increases with time over decades.

A Giant Left Coronary Button Aneurysm After Aortic Root Remodeling Procedure in a Patient With Marfan Syndrome: A Case Report.

Coronary button aneurysm is a well-known complication of aortic root surgery, especially in patients with Marfan syndrome. We present a case of a giant left coronary button aneurysm that occurred 20 years after an aortic root remodeling procedure was performed. A 32-year-old man with Marfan syndrome underwent the aortic root remodeling procedure for annuloaortic ectasia. Thirteen years later, an aortic aneurysm with chronic aortic dissection was diagnosed, and partial aortic arch replacement was performed. Twenty years after the first procedure, a 73-mm left coronary button aneurysm was observed. Due to dense adhesions from repeated surgeries, we approached the aneurysm through the artificial graft lumen, and the coronary artery was successfully reconstructed using Piehler's technique. When performing aortic root surgery for Marfan syndrome, the risk of coronary artery button aneurysm formation should be considered. Once an aneurysm is formed, a surgical strategy that assumes dense adhesions is essential.

[Redo Coronary Artery Bypass Grafting].

Redo coronary artery bypass grafting( CABG) may be the most technically challenging operations in cardiac surgery. The coronary artery disease is more advanced, and the coronary targets may be suboptimal. Furthermore, the patients are typically older and sicker compared to those undergoing primary CABG. The frequency of redo CABG relative to total CABG procedures has been decreasing over time. Perioperative mortality for redo CABG is reported to be as high as three times that of primary CABG, but this risk is reduced with experience. Redo CABG is a complicated operation, and appropriate surgical strategies are essential for achieving good outcomes.

Accuracy of predicting the vancomycin concentration in Japanese cancer patients by the Sawchuk-Zaske method or Bayesian method.

BACKGROUND: In cancer patients treated with vancomycin, therapeutic drug monitoring is currently performed by the Bayesian method that involves estimating individual pharmacokinetics from population pharmacokinetic parameters and trough concentrations rather than the Sawchuk-Zaske method using peak and trough concentrations. Although the presence of malignancy influences the pharmacokinetic parameters of vancomycin, it is unclear whether cancer patients were included in the Japanese patient populations employed to estimate population pharmacokinetic parameters for this drug. The difference of predictive accuracy between the Sawchuk-Zaske and Bayesian methods in Japanese cancer patients is not completely understood. OBJECTIVE: To retrospectively compare the accuracy of predicting vancomycin concentrations between the Sawchuk-Zaske method and the Bayesian method in Japanese cancer patients. METHODS: Using data from 48 patients with various malignancies, the predictive accuracy (bias) and precision of the two methods were assessed by calculating the mean prediction error, the mean absolute prediction error, and the root mean squared prediction error. RESULTS: Prediction of the trough and peak vancomycin concentrations by the Sawchuk-Zaske method and the peak concentration by the Bayesian method showed a bias toward low values according to the mean prediction error. However, there were no significant differences between the two methods with regard to the changes of the mean prediction error, mean absolute prediction error, and root mean squared prediction error. CONCLUSION: The Sawchuk-Zaske method and Bayesian method showed similar accuracy for predicting vancomycin concentrations in Japanese cancer patients.

Previous Immune Checkpoint Inhibitor Treatment to Increase the Efficacy of Docetaxel and Ramucirumab Combination Chemotherapy.

BACKGROUND/AIM: For immune checkpoint inhibitor (ICI)-pretreated patients, docetaxel and ramucirumab (DOC+RAM) combination therapy may be more effective compared to patients not receiving ICI treatment. PATIENTS AND METHODS: From June 2013 to July 2018, 39 patients with advanced/recurrent non-small cell lung cancer underwent DOC+RAM therapy. We analyzed the efficacy and safety of DOC+RAM therapy based on the presence (pre-ICI+) or absence (pre-ICI-) of ICI pretreatment history. RESULTS: Of the 39 patients treated with DOC+RAM, we identified 18 (46%) pre-ICI+ patients. Overall response rates for DOC+RAM concerning pre-ICI+ and pre-ICI- patients were 38.9% vs. 19.0%, respectively. Median progression-free survival (PFS) was 5.7 vs. 2.3 months [hazard ratio(HR)=0.36; 95% confidence interval (CI)=0.16-0.80]. Adverse events such as fever, myalgia, arthritis, pleural effusion, and pneumonitis tended to be increased in pre-ICI+ patients. CONCLUSION: Despite increased toxicity concerns, DOC+RAM therapy in pre-ICI+ patients showed a trend for tumor regression improvement and statistically significant prolongation of PFS.

A Case of Sarcoidosis-lymphoma Syndrome: Importance of Brain Biopsy.

Sarcoidosis is occasionally associated with malignant lymphoma. Cases of sarcoidosis associated with malignant lymphoma are called sarcoidosis-lymphoma syndrome. We report a 63-year-old man with sarcoidosis associated with primary central nervous system lymphoma (PCNSL). Definitive diagnosis by clinical and radiological findings was difficult. Finally, brain biopsy could produce the correct diagnosis. We could provide appropriate treatment for PCNSL and the patient has survived over 2 years. Thus, it is very important to make an early definitive diagnosis by biopsy for intracranial lesion, because it can prolong survival in patients with sarcoidosis.

Impact of Complete Revascularization on Long-Term Outcomes After Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction.

BACKGROUND: The long-term outcomes of complete revascularization (CR) in patients with left ventricular (LV) dysfunction undergoing coronary artery bypass grafting (CABG) remain unclear. Methods and Results: We evaluated a consecutive series of 111 patients with LV ejection fraction ≤35% who underwent isolated first-time CABG: 63 underwent CR and 48 underwent incomplete revascularization (IR). At a median follow-up of 10.1 years, the rates of death from any cause, cardiac death, and major adverse cardiac and cerebrovascular events (MACCE) were significantly greater in the IR group. After adjusting for propensity score, no significant difference was found between the CR and IR groups regarding death from any cause (hazard ratio [HR], 1.45; 95% CI: 0.75-2.81; P=0.271) and cardiac death (HR, 1.45; 95% CI: 0.68-3.10; P=0.337). In contrast, IR increased the risk of MACCE (HR, 1.92; 95% CI: 1.08-3.41; P=0.027), which was principally attributed to an increased risk of repeat revascularization (HR, 3.92; 95% CI: 1.34-11.44; P=0.013). CONCLUSIONS: Although IR was not significantly associated with an increased risk of long-term mortality in patients with LV dysfunction who underwent CABG, CR might reduce the risks of repeat revascularization and subsequent MACCE.