ABSTRACT
Objective: Poor R wave progression in right precordial leads is a relatively common electrocardiogram (ECG) finding that indicates possible prior anterior myocardial infarction (MI); however, it is observed frequently in apparently normal individuals. In contrast, reversed R wave progression (RRWP) may be more specific to cardiac disorders; however, the significance of RRWP in daily clinical practice is unknown. The purpose of this study was to clarify the significance of RRWP in clinical practice.Materials and Methods: We analyzed consecutive ECGs obtained from 12,139 patients aged ≥20 years at Mito Kyodo General Hospital in Ibaraki between November 2009 and August 2012. Our setting is a secondary emergency hospital in the community, and the study participants were inpatients or patients who visited the general or emergency outpatient departments. RRWP was defined as RV2 < RV1, RV3 < RV2, or RV4 < RV3. Regarding ECGs considered to show RRWP, we confirmed the presence or absence of an abnormal Q wave and whether ultrasound cardiography, contrast-enhanced computed tomography, coronary angiography, and/or left ventriculography were performed to obtain detailed information.Results: RRWP was identified in 34 patients (0.3%). Among these patients, 29 (85%) had undergone cardiac evaluation. The final diagnosis was previous anterior MI in 12 patients (41%) and ischemic heart disease (IHD) without MI in 5 patients (17%). All 17 patients with IHD had left anterior descending (LAD) artery stenosis. The other patients were diagnosed with dilated (two patients, 7%) and hypertrophic (one patient, 3%) cardiomyopathy, left ventricular hypertrophy (one patient, 3%), or pulmonary embolism (one patient, 3%). Only seven patients (24%) were normal.Conclusions: RRWP is rare in daily clinical practice; however, it is a highly indicative marker for cardiac disease, particularly IHD with LAD artery stenosis.
ABSTRACT
Clinical research is essential for the practice of evidence-based medicine. This study reports on our current practice of clinical research support in Mito Kyodo General Hospital and discusses future challenges. In April 2013, the University of Tsukuba hired a clinical research assistant to provide clinical research support in Mito Kyodo General Hospital. The clinical research assistant worked full-time in the hospital in collaboration with 3 university faculty members. The target population for this study comprised 450 medical personnel including doctors, nurses, and other medical staff. From April 2014, 1 of the 3 faculty members visited the hospital once a month to offer clinical research consultations and deliver a lecture on nursing research. We analyzed past records of clinical research support and conducted a questionnaire survey to explore the level of satisfaction of the medical personnel. Four-hundred and ninety records of 91 research topics proposed by 68 medical personnel were identified. Of these, 93.4% were proposed by doctors or nurses. Most studies employed an observational study design (64.8%) and were conducted in order to make a presentation at an academic conference (51.1%). The consultation sessions were held 1–5 times, for 40–405 min, and lasted from 1–84 days per research topic. Consultations mostly pertained to research design and protocol planning (57.1%). Forty-seven clients were invited to participate in the questionnaire survey, 30 of whom provided valid responses. The results showed that 96.6% of the clients were satisfied with the consultations. The number of clients who participated in the consultations comprised only 15.1% of the target population. These practice biases need to be addressed in future. However, nearly all respondents were satisfied with the consultations. These findings suggest that our clinical research support was beneficial to medical personnel.
ABSTRACT
Syncope is a common chief complaint in emergency departments, and although causes in most patients with syncope are benign, some patients have a serious disease. Here we report a 50-year-old patient with facial trauma who had past history of alcoholic liver cirrhosis. He fell down by syncope due to portopulmonary hypertension (PPHTN) accompanied by portal hypertension. Oral ambrisentan, a potent ET<sub>A</sub>-selective receptor, 2.5 mg once a day was initiated. His ECG and the results of cardiac catheterization showed improvement in hemodynamic abnormality after the treatment. Also, the patient had no significant symptoms, including syncope, for nine months after receiving ambrisentan.
ABSTRACT
<b>Background:</b> Rapid and accurate diagnosis is essential for containing the novel influenza A/H1N1 pandemic. Polymerase chain reaction (PCR) testing is an accurate diagnostic method, but it is not routinely available worldwide. We herein evaluated the usefulness of pharyngeal “influenza follicles” in diagnosing seasonal influenza and influenza A/2009 (H1N1) pdm.<br><b>Methods:</b> Between August 3 and October 29, 2009, we evaluated 87 patients with influenza-like symptoms. Twenty-three had influenza follicles (22 on initial evaluation; 1 on follow-up) while 64 did not. Considering these two groups, we then compared the positive cases using rapid diagnostic testing (confirmed by PCR). In addition, 419 cases of seasonal influenza diagnosed between 2003 and 2009 were examined for the presence of influenza follicles based on Miyamoto's 2007 definition<sup>9</sup>, and new exclusion criteria were developed.<br><b>Results:</b> Among the 23 patients with influenza follicles, 21 were diagnosed with novel influenza. Of these, follicles were present on initial evaluation in 20 and on follow-up in 1. None of the 64 patients without influenza follicles were diagnosed with influenza (sensitivity 100%, specificity 97%). Among the 419 patients diagnosed with seasonal influenza between 2003 and 2009, influenza follicles occurred in all type A/H3N2, A/H1N1, and B cases (sensitivity 95.46%, specificity 98.42%). Thus, follicles were considered a specific sign of influenza.<br><b>Conclusion:</b> Influenza follicles occur in both seasonal and novel influenza. This identification method has higher diagnostic sensitivity and specificity than rapid diagnostic testing and is a promising clinical tool for diagnosing influenza when PCR is unavailable, or in pandemic situations.
ABSTRACT
We used near-infrared spectroscopy (NIRS) to study noninvasively the effects of aging on changes in muscle oxygenation during steady bicycle exercise. For the study, 6 healthy young males and 13 healthy elderly male volunteers were recruited. To evaluate the physical fitness level and to determine exercise intensity, the ventilatory threshold (VT) was first measured. As a result, elderly subjects were divided into two groups according to O<SUB>2</SUB> uptake at VT (Elderly-H ; 936.0±26.4, Elderly-L ; 695.3±29.9, Young ; 790.0±51.19 ml) . Secondly we measured muscle oxygenation by NIRS at rest and during exercise at relative work intensities of VT ; 20%, 40%, 60%, 80% and 100%. In all cases muscle oxygenation at rest and during exercise was expressed as a relative value from 100% oxygenation (oxygen capacity) established by thigh occlusion (ischemia) . All subjects showed progressive deoxygenation with increasing intensity. There were no differences between the three groups in muscle oxygenation during exercise at relative work intensity of VT. These data suggest that aging and physical fitness level have no effect on muscle oxygenation below relative work intensity of VT.