Predictive effects of the lactate/albumin ratio on neurological outcomes in patients after out-of-hospital cardiac arrest.

Background: Predicting outcomes for out-of-hospital cardiac arrest (OHCA) patients remains challenging. We aimed to evaluate the association between the lactate/albumin ratio (LAR) upon hospital arrival and neurological outcomes in OHCA patients.

Methods: This multicenter, retrospective, nationwide observational study was based on data from the JAAM-OHCA registry, including 28,098 adults with non-traumatic OHCA from 140 emergency medical centers across Japan (June 2014 to December 2021).

Serum lactate to albumin ratio at hospital arrival and neurological outcome of out-of-hospital cardiac arrest: a nationwide multicenter observational study.

Objective: We investigated the possible association between lower serum lactate to albumin ratio upon hospital arrival and out-of-hospital cardiac arrest (OHCA) outcome.

Methods: Records from the Japanese Association for Acute Medicine-Out-of-Hospital Cardiac Arrest (JAAM-OHCA) Registry were used for this multicenter observational study. Enrolled patients were ≥18 years old with OHCA of medical etiology who were hospitalized after spontaneous circulation returned between June 1, 2014, and December 31, 2021.

Functional outcomes in older patients after Parkinson's disease diagnosis in Japan: The LIFE study.

Background: The association between care needs level (CNL) and functional outcomes after diagnosis in older patients with Parkinson's disease (PD) is unclear.

Methods: Using health insurance claims and the Japanese Long-Term Care (LTC) data from 12 municipalities in Japan, PD patients aged ≥ 65 years old were identified between April 2014 and March 2022. CNL was classified as no care needed (NCN), support level (SL), CNL1 (low level), CNL2-3, and CNL4-5 (fully dependent) based on the total estimated daily care hours as defined by the national standard criteria.

Impact of the COVID-19 pandemic on favourable neurological outcome after EMS-witnessed out-of-hospital cardiac arrest: a prospective nationwide observational study.

Aim: To evaluate the impact of the COVID-19 pandemic on favourable neurological outcome after out-of-cardiac arrest (OHCA) witnessed by emergency medical services (EMS) personnels in Japan.

Methods: We conducted an interrupted time series analysis (ITSA) using a prospective, nationwide, population-based registry in Japan to assess 30-day favourable neurological outcome (Cerebral Performance Category 1 or 2), prehospital return of spontaneous circulation (ROSC), and 30-day survival among adult patients with EMS-witnessed OHCA during the pre-pandemic (January 2016-March 2020) and pandemic (April 2020-December 2021) periods. Subgroup analyses were performed by stratifying regions based on state of emergency declaration status.

Comparison between DOACs and warfarin for left atrial thrombus in atrial fibrillation patients.

Background: Atrial fibrillation (AF) is a major risk factor for thromboembolic events, with left atrial thrombus (LAT) formation occurring despite oral anticoagulant (OAC) therapy in some patients. Direct oral anticoagulants (DOACs) have demonstrated efficacy in preventing thrombosis; however, their role in LAT resolution compared to warfarin remains unclear.

Methods: This retrospective, multicenter study analyzed 260 AF patients with transesophageal echocardiography (TEE)-confirmed LAT among 17,436 AF patients who underwent TEE.

A win ratio approach for comparing graft-versus-host disease-free, relapse-free survival among alternative donors.

The optimal alternative donor type for patients lacking human leucocyte antigen (HLA)-matched related or unrelated donors remains unclear. In comparative studies evaluating donor types, graft-versus-host disease (GVHD)-free, relapse-free survival (GRFS) represents a well-established end-point but has limitations. The win ratio approach addresses these limitations by analysing multiple end-points with varying severities to account for the relative component priorities.

Extracorporeal and Conventional Cardiopulmonary Resuscitation and Low-Flow Duration: Insights From a Nationwide Hospital-Based Registry Study in Japan (JAAM-OHCA Registry).

Background: The optimal low-flow duration (LFD) for extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) remains unclear. We evaluated the impact of LFD on neurological outcomes based on initial cardiac rhythms and compared trends between ECPR and CCPR.

Methods: This secondary analysis used data from a nationwide, prospective study of adult (≥18 years) nontraumatic patients with out-of-hospital cardiac arrest receiving cardiopulmonary resuscitation upon hospital arrival (June 2014-December 2019).

Renal Function and its Time-Sensitive Influence on Survival Rates of Acute Myocardial Infarction.

Background: Primary percutaneous coronary intervention is the preferred treatment for acute myocardial infarction. However, in patients with chronic kidney disease (CKD), the use of contrast media can exacerbate renal dysfunction, often necessitating alternative strategies. The impact of CKD on acute myocardial infarction prognosis, particularly in the context of percutaneous coronary intervention, is not fully understood.

Prognostic utility of advanced lung cancer inflammation index in heart failure with preserved ejection fraction.

Aims: Malnutrition and inflammation are associated with poor outcomes with heart failure (HF). As a marker integrating inflammation and nutritional status, the advanced lung cancer inflammation index (ALI), calculated by body mass index × serum albumin level / neutrophil-to-lymphocyte ratio, has been developed for the prognosis of several diseases including HF. The aim of this study is to investigate the prognostic value of ALI in elderly multimorbid HF patients with HF with preserved ejection fraction (HFpEF).

Clinical outcomes, safety, and potential prognostic factors of noninvasive respiratory support in patients with COVID-19: A Japanese multicenter observational study.

Background: This study aimed to explore the clinical practice of noninvasive respiratory support (NIRS) in COVID-19 patients, and assess its clinical outcomes, safety, and prognostic factors.

Methods: A multicenter, retrospective observational study was conducted with consecutive adult COVID-19 patients who underwent NIRS at nine Japanese hospitals between January 1 and September 30, 2021. NIRS modalities included high-flow nasal cannula oxygen therapy (HFNC), noninvasive ventilation (NIV), and continuous positive airway pressure (CPAP).

Factors associated with automated external defibrillator use in out-of-hospital cardiac arrest by type of lay rescuers: a Japanese nationwide, population-based descriptive study.

Background: Prompt automated external defibrillator (AED) use and shock delivery are crucial for improving outcomes in patients with out-of-hospital cardiac arrest (OHCA). This study was aimed at elucidating the current patterns of AED use by lay rescuers in Japan and exploring the associated factors by lay rescuer type.

Methods: In this observational study, data from the All-Japan Utstein Registry, a nationwide population-based registry of OHCAs, were analyzed.

Severity of mobility limitation and adverse outcomes in heart failure.

Background: Mobility limitation is prevalent in patients with heart failure (HF), but the dose-response relationship between its severity and adverse outcomes remains unquantified.

Methods: We conducted a patient-level pooled analysis of two prospective Japanese cohort studies, including 2103 hospitalised patients with HF with no exclusion criteria. Mobility limitation at discharge was categorised into four levels: category I (independent outdoor walking), category II (indoor independence but requiring outdoor assistance), category III (requiring indoor assistance) and category IV (unable to walk).

Adverse effects of progestin-primed ovarian stimulation: combination of clinical study and single-cell analysis.

Research Question: Does progestin-primed ovarian stimulation (PPOS) have a negative effect on reproductive outcomes compared with a gonadotrophin-releasing hormone (GnRH) antagonist protocol?

Design: This retrospective cohort study included 907 patients aged <40 years with normal ovarian reserves undergoing either PPOS (n = 299) or a GnRH-antagonist protocol (n = 608) in their first IVF cycle between 2018 and 2020. An additional genetic analysis, single-cell RNA sequencing (scRNA-seq), was performed on the mural granulosa cells (mGC) of metaphase II oocyte follicles retrieved from 16 patients, with the above inclusion criteria, undergoing PPOS (n = 8) or a GnRH-antagonist protocol (n = 8) between 2021 and 2022. Inverse probability of treatment weighting (IPTW) was performed on the clinical data.

Different impacts of intestinal microbiota and lifestyle factors on advanced adenoma and colorectal cancer risk.

The association between intestinal microbiota, dietary and lifestyle habits, and colorectal cancer (CRC) development is not fully understood. This study aimed to assess the association between intestinal microbiota composition and CRC risk across clinical stages, accounting for dietary and lifestyle factors. This cross-sectional study conducted in Japan included 499 participants who underwent colonoscopies.

Rationale, Design, Feasibility, and Profile of the Japanese Circulation Society Chest Pain Registry - Single-Center Pilot Study.

Background: Acute coronary syndrome (ACS) requires prompt diagnosis and treatment. Although "OPQRST" (Onset, Provocation, Quality, Region/Radiation, Symptoms, and Time) is commonly used, the evidence linking emergency department (ED) chest pain characteristics to ACS remains inconclusive. This study evaluated detailed symptoms in ED patients with and without ACS using a broad chest pain registry with symptom data.

Association Between Annual Procedural Volume and Outcomes in Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study in Japan (the JAAM-OHCA Registry).

Extracorporeal cardiopulmonary resuscitation (ECPR) requires advanced skills for induction and management. This study evaluated whether the outcomes of ECPR differ by institutional volume. Using the Japanese Association for Acute Medicine-Out-of-Hospital Cardiac Arrest (JAAM-OHCA) registry, we analyzed adult patients (aged ≥18 years) who received ECPR between 2014 and 2020, focusing on 30 day in-hospital survival and favorable neurologic prognosis at 30 days defined as Cerebral Performance Category (CPC) 1-2.

Increased risk of postoperative pancreatic fistula in patients with chronic steroid usage undergoing pancreatectomy.

Purpose: Chronic steroid use may increase the risk of postoperative complications; however, its impact on postoperative outcomes after pancreatectomy has not been fully investigated. This study investigated the impact of chronic steroid use on surgical outcomes, particularly postoperative pancreatic fistulas (POPF).

Methods: A retrospective analysis of 656 patients who underwent pancreatectomy between 2010 and 2021 was conducted.

Underlying Cause of Out-of-Hospital Cardiac Arrests in Japan in Survivors Versus Nonsurvivors.

Background: The causes underlying out-of-hospital cardiac arrest (OHCA) are rarely investigated. This study aimed to investigate causes of OHCA in CRITICAL (Comprehensive Registry of In-Hospital Intensive Care for OHCA Survival), a multicenter OHCA registry in Osaka, Japan.

Methods: Nontraumatic patients with OHCA (by CARES [Cardiac Arrest Registry to Enhance Survival] criteria) aged 18 to 90 years between July 1, 2012 and December 31, 2020 were included.

Effective transcatheter intracoronary delivery of mRNA-lipid nanoparticles targeting the heart.

Messenger RNA (mRNA) has great potential to provide innovative medical solutions in the treatment of heart failure. Although lipid nanoparticles (LNPs) are an established mRNA delivery system, effectively delivering LNPs to the heart remains a significant challenge. Here, we evaluated the efficacy of transcatheter intracoronary (IC) administration compared to intravenous (IV) and intramyocardial (IM) administration in normal and ischemia-reperfusion (I/R) model rabbit hearts using LNPs encapsulating Firefly Luciferase (FLuc) mRNA.

Impact of aortic root rotation angle on new-onset first-degree atrioventricular block following mitral valve surgery.

Objectives: This study aimed to classify anatomical variations in aortic root rotation using preoperative three-dimensional transoesophageal echocardiography (3D-TEE), validate these findings with cardiac computed tomography (CT) in patients undergoing mitral valve surgery and evaluate the clinical impact on postoperative atrioventricular conduction disorders.

Methods: A total of 126 patients with normal electrocardiograms who underwent isolated mitral valve surgery were included. Anatomical variation was diagnosed using 3D-TEE, and aortic root rotation angle was measured using cardiac CT.

Association Between No-Flow Time, Prehospital Low-Flow Time, and Conversion to Nonshockable Rhythm in Patients With Out-of-Hospital Cardiac Arrest Presenting With Initial Shockable Rhythm: A Nationwide Prospective Study in Japan.

Background: Out-of-hospital cardiac arrest (OHCA) with initial shockable rhythm generally has a favorable prognosis. However, the prognosis worsens when this rhythm transitions to nonshockable rhythm on hospital arrival. This study aimed to investigate the association between no-flow time (NFT), prehospital low-flow time (LFT), and the conversion to nonshockable rhythm on hospital arrival in patients with OHCA initially exhibiting shockable rhythm.

Electrocardiographic patterns of accidental hypothermia.

Introduction: Accidental hypothermia impacts the cardiovascular system, complicating patient management and prognosis. While previous studies have reported an association between hypothermia and ECG patterns, these findings are largely based on case reports or small-scale observational studies with limited sample sizes, underscoring the need for a more comprehensive analysis.

Methods: We conducted a retrospective analysis using the J-POINT registry, which included patients with body temperatures ≤35 °C who visited the emergency departments of 12 Japanese institutions between April 1, 2011, and March 31, 2016.

Characteristics and Outcomes of Veno-Arterial Extracorporeal Membrane Oxygenation in Accidental Hypothermia: A Multicenter Study in Japan.

Despite growing evidence supporting the efficacy of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for accidental hypothermia (AH), few studies have assessed its real-world application. We aimed to describe the use and outcomes of VA-ECMO in AH patients using data from a multicenter registry. This retrospective study included adult AH patients from the Japanese accidental hypothermia network registry (J-Point registry) between April 2011 and March 2016.