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  • Ovid Technologies (Wolters Kluwer Health)  (9)
  • 1
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    Online Resource
    Abstract 111: Analysis of Successful Resuscitation for an Emergency in School Demonstrates Contribution of Teachers and Proposes Issue for Location of Automated External Defibrillator
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 130, No. suppl_2 ( 2014-11-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 130, No. suppl_2 ( 2014-11-25)
    Abstract: BACKGROUND: Considerable numbers of cardiac emergencies have been resuscitated without neurological sequel by public action of resuscitation and defibrillation. Since resuscitated cases are increasing also in Japanese schools, it is necessary to investigate factors for successful resuscitation. METHODS: Students resuscitated with AED were picked up from all issues in Mutual Aid Insurance System for Schools from 2005 to 2011. A total of 128 students were listed and classified to victims and survivors. Victims consisted of 62 cases that died or had brain sequel, and survivors consisted of 66 cases that recovered without sequel. Demography, causative disease, AED user, and the location of resuscitation in both groups were compared. RESULTS: Number of enrolled cases increased from 4 to 35 annually. School grade distribution is similar between two groups. Male to female ratio was 4.6 in victims and 2.1 in survivors (p=0.07). The most causative disease was cardiomyopathy (HCM) (22.6%) in victims, and ventricular fibrillation (VF) (28.8%) in survivors. They are the second in each other group. The third was congenital disease (8.1%) in victims, and long QT syndrome (LQT) in survivors (10.6%). In survivors, 6 cases were previously implanted ICD and 11 cases were implanted ICD after resuscitation and returned to school. Ambulance crew operated AED in 35.8% and 12.2% cases, and schoolteachers did in 64.2% and 87.8% of victims and survivors, respectively. Rate of successful resuscitation was significantly higher in cases operated by schoolteachers than that by ambulance crew (p 〈 0.01). Concerning location of resuscitation, 62.9% of victims and 71.2% of survivors were resuscitated at athletic field or gymnasium. Prevalence of resuscitation at swimming pool in victims was 2/62(3.2%) and was significantly less than that in survivors, which was 9/66(13.6%) (p 〈 0.05). Prevalence at classroom was 6/62(9.7%) in victims was significantly more than that in survivors, which was 1/66(1.5%) (p 〈 0.05). CONCLUSIONS: AED operation by teachers improve prognosis of cardiac emergencies in Japanese schools. AED should be placed near athletic field, gymnasium, pool, and ideally on the way to school for possible student.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.130.suppl_2.111
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1466401-X
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  • 2
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    Abstract 327: Basic Life Support and Defibrillation Are Changing the Prognosis of Hypertrophic Cardiomyopathy in School Students
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 130, No. suppl_2 ( 2014-11-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 130, No. suppl_2 ( 2014-11-25)
    Abstract: OBJECTIVES: Hypertrophic cardiomyopathy (HCM) has been one of the leading causes of sudden cardiac death in school students. However, recent spread of basic life support combined with public access defibrillation and implantable cardioverter-defibrillator (ICD) has a possibility of a paradigm shift for prognosis of HCM in young. METHODS: In Japan, more than 98% of all students in primary, middle, and high schools subscribe in the mutual aid system, and a school that experienced event relating sudden death is obliged to submit all health checking documents to refund for the affected student. Submitted reports were investigated for 8 years between 2004 and 2011. All victims or survivors diagnosed as HCM were extracted from those reports. Demographic data, presence of diagnosis before event, and intensity of physical activity at event were compared between them. RESULTS: Though data in 2011 is still tentative, annual numbers of victims with HCM from 2004 to 2011 were 4, 4, 5, 6, 3, 2, 4, 1, respectively. The first resuscitated survivor with HCM was reported in 2007, thereafter from 2008 until 2011, those were 6, 2, 4, 2, respectively. Therefore, totals of 29 victims and 15 survivors were enrolled in this study. All survivors were middle or high school students. Three primary school students were all victims. The male-to-female ratio was 4.8 and 2.0, respectively (NS). Ratio of students who were previously diagnosed as HCM was 48% and 20%, respectively (p=0.06). Concerning exercise intensity at cardiac event, 24% and 6.7% were occurred without exercise, respectively (p=0.08). ICD insertion after successful resuscitation was reported in 80% of survivors. CONCLUSIONS: Induction of basic life support and defibrillator has a certain impact for increasing survivors with HCM in school students. After 2008, survivors become equal or more than victims. Majority of survivors were disclosed by initial cardiac event by strenuous exercise, and cardioverter-defibrillator was implanted after resuscitation. Strategy for survival of HCM students with previously diagnosed should be reviewed. School caregivers including general physicians should acquire the management of students with ICD.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.130.suppl_2.327
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 3
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    Abstract 170: Re-evaluation of Carotid Intima-Media Thickness by Z-score in Children and Adolescents After Kawasaki Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 131, No. suppl_2 ( 2015-04-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 131, No. suppl_2 ( 2015-04-28)
    Abstract: Objectives: The carotid intima-media thickness (CIMT) is a reliable screening method for vascular alterations even in a pediatric cohort; however, reference values of CIMT established recently by LMS methods for childhood and adolescence are limited when comparing patients after Kawasaki disease (KD) and controls. We tested the hypothesis that there are significant differences between the values of CIMT expressed as absolute values and z-scores in children and adolescents after KD and controls. Methods: We reviewed 12 published articles regarding CIMT on patients after KD and controls. Absolute values (Ab) of the mean±1 SD of CIMT in patients after KD and controls were transformed to z-scores (Zs) using age-specific reference values established by Jourdan et al. (J: 247 Caucasian subjects aged 10-20 years) and our own data (O: 175 Asian subjects aged 6-20 years), and the results were compared between the two references. In this study, the mean age of the study population derived from each article was designated the representative age for transformation. Results: In either reference (J) or (O), there was no significant sex difference in CIMT at any given age. The mean CIMT of (Ab) and (Zs) transformed by (J) or (O) were significantly different between patients after KD and controls, at 41.6% (Ab), 66.6% (Zs) by (J), and 83.3% (Zs) by (O) among 12 articles, respectively. Therefore, patients after KD had significantly higher (Zs) by (O) than those of controls (0.66±0.71 vs. 0.03±0.68, p=0.006, respectively). Compared with reference values, the controls of (O) were within the normal range. However, there were no significant differences in (Zs) by (J) between the two groups (1.72±0.77 vs. 1.23±0.83, p=0.116, respectively). When we assessed 9 articles dealing with Asian subjects, the difference of (Zs) between the two groups remained significant only by (O) (p=0.015). In contrast, when we assessed 3 articles dealing with mainly Caucasian subjects, there was no significant difference in (Zs) between the two groups with both (J) and (O). Conclusions: These results indicate that age and race-specific reference values for CIMT are mandatory for performing an accurate assessment of the vascular status in healthy children and adolescents and particularly in those after KD.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.131.suppl_2.170
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1466401-X
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  • 4
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    Online Resource
    Abstract WP140: Functional Independence Scores of Acute Stroke Patients is Associated With Discharge Directly to Home
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Background and purpose: Functional Independence Measure (FIM) is a valid tool to estimate the level of ADL. However, there were few studies whether FIM score in acute stroke patients is associated with the short-term outcome. Our aim is to reveal whether FIM scores within 3 days from admission to a stroke unit can predict the short-term good outcome (discharge directly to home). Method: We used data from a prospectively collected observational registry in a single stroke center between January 2016 and March 2017. Baseline NIHSS score, acute FIM score (= within 3 days from admission to the stroke unit), discharge FIM score (= at discharge from the stroke unit) were collected. FIM efficiency was calculated from (discharge FIM - acute FIM)/ the length of hospital stay. Logistic regression analysis was used to determine the independent predictors of discharge directly to home. Results: Of 678 patients were admitted to our stroke center due to acute stroke, 410 patients whose clinical data could be obtained (60%; mean age, 74±13 years; male, 57%; the median of length of hospital stay, 21 days; 75% with ischemic stroke) were enrolled. The median of the baseline NIHSS score, acute FIM score, and FIM efficiency were 5 (interquartile range [IQR], 2-16), 53 (IQR 22-83), and 0.88 (IQR 0.10-1.73), respectively. In univariate logistic regression analysis, male sex, acute ischemic stroke, baseline NIHSS score, acute FIM score, discharge FIM score, the length of hospital stay, and FIM efficiency were associated with discharge directly to home. In multivariate logistic regression analysis, acute FIM score (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.03-1.06; p 〈 0.01) and FIM efficiency (OR 1.63; 95% CI 1.32-2.08; p 〈 0.01) were independent predictors of discharge directly to home. Discharge FIM score was excluded from the multivariate model because discharge FIM strongly correlated with FIM efficiency (ρ=0.71; p 〈 0.01). The optimal cut-off point of acute FIM score to predict discharge to home was 〉 71, with a sensitivity of 72%, specificity of 88%, and an area under the curve of 0.86 (p 〈 0.01). Conclusions: FIM scores within 3 days from admission to a stroke unit can predict discharge directly to home, which can help stroke physicians to expect the short-term outcomes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.WP140
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 5
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    Online Resource
    Surgical Microanatomy of the Posterior Condylar Emissary Vein and its Anatomical Variations for the Transcondylar Fossa Approach
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Operative Neurosurgery Vol. 13, No. 3 ( 2017-06), p. 382-391
    Details
    In: Operative Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 13, No. 3 ( 2017-06), p. 382-391
    Type of Medium: Online Resource
    ISSN: 2332-4252 , 2332-4260
    URL: Article
    DOI: 10.1093/ons/opw038
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2886024-X
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  • 6
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    Abstract 120: A Case With Left Ventricular Failure And Unconsciousness Treated With Plasma Exchange
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 131, No. suppl_2 ( 2015-04-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 131, No. suppl_2 ( 2015-04-28)
    Abstract: Background: Either encephalopathy or left ventricular (LV) failure complicated with Kawasaki disease (KD) is rare but occasionally fatal. We experienced a critical case simultaneously complicated with both of them and successfully rescued by plasma exchange (PE). Case report: A 4-year-old girl was hospitalized with a high fever lasting 7 days, conjunctival injection, reddened and swollen lips, cervical lymphadenopathy and erythema of the palms and soles. Laboratory tests revealed that her white blood cells count 35,400/μl, C-reactive protein was 35 mg/dl, N-terminal pro-brain natriuretic peptide was 15,317 pg/ml, and interleukin-6 reported afterward was 354 pg/ml. Echocardiography showed that LV ejection fraction was 40%. She was diagnosed as KD and was treated with 2g/kg of intravenous immunoglobulin (IVIG) and oral aspirin on the 7th day of illness. On the following day, however, her blood pressure declined to 80/40mmHg and LV function was becoming gradually poorer despite of intravenous injection of dobutamine. As her consciousness was unclear and electroencephalogram (EEG) indicated slow waves, she was additionally treated with D-mannitol. Infliximab is not indicated because of heart failure. Therefore, repetitive PE was started immediately after deep sedation with mechanical respiratory assist. Her fever, EEG and LV function began improving by PE consecutive 3 days, however, those findings recurrently worsened at every interval of PE. IVIG and steroid pulse therapy were added on the 12th day after PE. On the 13th day, she became defervescent and her consciousness became clear and EEG normalized. She returned to daily life without cardiac or neurologic abnormalities after discharge. Conclusions: PE is a rapid and sufficiently effective strategy for a critical KD case when infliximab is not indicated or immediate effectiveness of steroid including pulse therapy is not expected.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.131.suppl_2.120
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 7
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    Abstract 182: Proposal of Strategy for Threatened Rupture of Super-giant Coronary Aneurysm; Rare and Fatal Complication with Kawasaki disease
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 131, No. suppl_2 ( 2015-04-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 131, No. suppl_2 ( 2015-04-28)
    Abstract: Background: Prognosis of Kawasaki disease and its main complications, coronary artery aneurysm (CAA) and myocardial ischemia were remarkably improved by intravenous immunoglobulin (IVIG) and other additional anti-inflammatory and anti-coagulation therapy. In contrast, rupture of coronary artery aneurysm is a rare, and still definitely fatal complication. Though approximately 10 cases were reported with sporadic occurrence in every three to four years in Japan, there is no patient whose life was saved. Case report: We experienced a 5-year-old boy who had already developed left CAA of 9 mm in diameter on the 7th day from onset of fever. Despite of repeated IVIG, left CAA was rapidly expanding day by day and finally the diameter became 18mm on the 12th day. Early in the next morning, sudden cardiac arrest was noted, but resuscitation was not effective. Autopsy revealed cardiac tamponade caused by rupture of very fragile wall of huge left CAA. Discussions: After this experience, we have tried to carry patients into the intensive care unit with deep sedation, if patient’s CAA is expanding more than 10mm within 2 weeks in acute stage of Kawasaki disease. Furthermore, we also recommend use of antihypertensive drugs such as calcium channel blocker and/or beta-blockers. We also have advised to colleagues in other hospitals to try in the same way when they asked for the management of similar cases. At least three patients with huge aneurysm were survived with this method in recent reports. If patient has strong inflammation sustaining with expanding huge aneurysm, plasma exchange and all possible anti-inflammatory agents including steroid or infliximab under the percutaneous cardiopulmonary support and surgeons' stand-by until inflammation will disappear. Following repair or platy of coronary aneurysm and coronary artery bypass surgery may be considered, but possibility and results are unknown. Conclusions: Because of its rarity, it is difficult to detect exact indication of deep sedation or intensive care, however, earlier and more cautious management will be safer for ‘super-giant’ aneurysm. Concerning to the sustaining inflammation with huge aneurysm, we would like to hear advices for this strategy from cardiac surgeons and pediatric intensivists.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.131.suppl_2.182
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 8
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    Neuroplasticity Caused by Peripheral Proprioceptive Deficits
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Medicine & Science in Sports & Exercise Vol. 54, No. 1 ( 2022-1), p. 28-37
    Details
    In: Medicine & Science in Sports & Exercise, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. 1 ( 2022-1), p. 28-37
    Abstract: Proprioceptive feedback is crucial for motor control and stabilization of the shoulder joint in everyday life and sports. Shoulder dislocation causes anatomical and proprioceptive feedback damage that contributes to subsequent dislocations. Previous recurrent anterior shoulder instability (RSI) studies did not investigate functional neuroplasticity related to proprioception of the injured shoulder. Thus, we aimed to study the differences in neuroplasticity related to motor control between patients with RSI and healthy individuals, using functional magnetic resonance imaging, and assess the effects of peripheral proprioceptive deficits due to RSI on CNS activity. Methods Using passive shoulder motion and voluntary shoulder muscles contraction tasks, we compared the CNS correlates of proprioceptive activity between patients having RSI ( n = 13) and healthy controls ( n = 12) to clarify RSI pathophysiology and the effects of RSI-related peripheral proprioceptive deficits on CNS activity. Results Decreased proprioception-related brain activity indicated a deficient passive proprioception in patients with RSI ( P 〈 0.05 family-wise error, cluster level). Proprioceptive afferent-related right cerebellar activity significantly negatively correlated with the extent of shoulder damage ( P = 0.001, r = −0.79). Functional magnetic resonance imaging demonstrated abnormal motor control in the CNS during voluntary shoulder muscles contraction. Conclusion Our integrated analysis of peripheral anatomical information and brain activity during motion tasks can be used to investigate other orthopedic diseases.
    Type of Medium: Online Resource
    ISSN: 1530-0315 , 0195-9131
    URL: Article
    DOI: 10.1249/MSS.0000000000002775
    RVK:
    ZX 1000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2031167-9
    SSG: 31
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  • 9
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    Abstract WP148: Functional Independence Score of Acute Stroke Patients Can Predict Favorable Clinical Outcome at 3 Months After Stroke Onset
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Background and Purpose: Modified Rankin scale (mRS) score at 3-month after onset is widely used as clinical outcomes in stroke patients. Functional Independence Measure (FIM) is a valid tool to estimate the level of ADL. However, there were few studies whether FIM score in acute stroke patients can predict clinical outcomes at 3-month. Our aim is to reveal that FIM scores of acute stroke patients can predict favorable outcome (mRS 0-1 at 3-month). Method: We used data from a prospectively collected observational registry in single stroke center between January 2016 and March 2017. Baseline NIHSS score, acute FIM score (=within 3 days from admission to the stroke unit), discharge FIM score (=at discharge from the stroke unit), and mRS score (before stroke, at 3-month) were collected. The relationship between discharge FIM score and mRS score at 3-month were examined using Spearman’s rank correlation test. Logistic regression analyses were used to reveal the predictors of favorable outcome. Results: Of 678 patients were admitted to our stroke center due to acute stroke, 410 patients whose clinical data could be obtained (60%; mean age, 74±13 years; male, 57%; the median of length of hospital stay, 21 days; 75% with ischemic stroke) were enrolled. The median of the baseline NIHSS score, acute and discharge FIM scores were 5 (interquartile range [IQR], 2-16), 53 (IQR 22-83), and 86 (IQR 32-119), respectively. Discharge FIM score strongly correlated with mRS score at 3 month (ρ=-0.86; p 〈 0.01). In univariate logistic regression analysis, male sex, acute ischemic stroke, premorbid mRS score, baseline NIHSS score, acute FIM score, the length of hospital stay, and discharge FIM score were associated with favorable outcome. In multivariate logistic regression analysis, male sex (odds ratio [OR] 2.28; 95% confidence interval [CI] 1.21-4.36; p=0.01), premorbid mRS score (OR 0.45; 95% CI, 0.26-0.74; p=0.01), length of hospital stay (OR 0.96; 95% CI 0.93-0.99; p=0.02), and discharge FIM score (OR 1.07; 95% CI 1.05-1.09; p 〈 0.01) were independent predictors of favorable outcome. Conclusions: FIM score at discharge from the stroke unit can predict favorable clinical outcome at three months. Our results can help stroke physicians to expect stroke patients’ status in the chronic phase.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.WP148
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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