Non-traumatic hemorrhage is controlled with REBOA in acute phase then mortality increases gradually by non-hemorrhagic causes: DIRECT-IABO registry in Japan.

PURPOSE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is now a feasible and less invasive resuscitation procedure. This study aimed to compare the clinical course of trauma and non-trauma patients undergoing REBOA. METHODS: Patient demographics, etiology, bleeding sites, hemodynamic response, length of critical care, and cause of death were recorded. Characteristics and outcomes were compared between non-trauma and trauma patients. Kaplan-Meier survival analysis was then conducted. RESULTS: Between August 2011 and December 2015, 142 (36 non-trauma; 106 trauma) cases were analyzed. Non-traumatic etiologies included gastrointestinal bleeding, obstetrics and gynecology-derived events, visceral aneurysm, abdominal aortic aneurysm, and post-abdominal surgery. The abdomen was a common bleeding site (69%), followed by the pelvis or extra-pelvic retroperitoneum. None of the non-trauma patients had multiple bleeding sites, whereas 45% of trauma patients did (P < 0.001). No non-trauma patients required resuscitative thoracotomy compared with 28% of the trauma patients (P < 0.001). Non-trauma patients presented a lower 24-h mortality than trauma patients (19 vs. 51%, P = 0.001). The non-trauma cases demonstrated a gradual but prolonged increased mortality, whereas survival in trauma cases rapidly declined (P = 0.009) with similar hospital mortality (68 vs. 64%). Non-trauma patients who survived for 24 h had 0 ventilator-free days and 0 ICU-free days vs. a median of 19 and 12, respectively, for trauma patients (P = 0.33 and 0.39, respectively). Non-hemorrhagic death was more common in non-trauma vs. trauma patients (83 vs. 33%, P < 0.001). CONCLUSIONS: Non-traumatic hemorrhagic shock often resulted from a single bleeding site, and resulted in better 24-h survival than traumatic hemorrhage among Japanese patients who underwent REBOA. However, hospital mortality increased steadily in non-trauma patients affected by non-hemorrhagic causes after a longer period of critical care.

Geophysics. Migrating tremor off southern Kyushu as evidence for slow slip of a shallow subduction interface.

Detection of shallow slow earthquakes offers insight into the near-trench part of the subduction interface, an important region in the development of great earthquake ruptures and tsunami generation. Ocean-bottom monitoring of offshore seismicity off southern Kyushu, Japan, recorded a complete episode of low-frequency tremor, lasting for 1 month, that was associated with very-low-frequency earthquake (VLFE) activity in the shallow plate interface. The shallow tremor episode exhibited two migration modes reminiscent of deep tremor down-dip of the seismogenic zone in some other subduction zones: a large-scale slower propagation mode and a rapid reversal mode. These similarities in migration properties and the association with VLFEs strongly suggest that both the shallow and deep tremor and VLFE may be triggered by the migration of episodic slow slip events.

Emission and metal- and ligand-centered-redox characteristics of the hexarhenium(III) clusters trans- and cis-[Re6(mu 3-S)8Cl4(L)2]2-, where L is a pyridine derivative or pyrazine.

Preparations of a series of face-capped octahedral hexarhenium(III) clusters having two N-heterocyclic ligands, [Bu4N]2[trans-[Re6(mu 3-S)8Cl4(L)2]] (Bu4N+ = tetra-n-butylammonium cation; L = pyrazine (1a), 4,4'-bipyridine (3a), 4-methylpyridine (5a), 4-(dimethylamino)pyridine (6a)) and their cis analogues (1b, 3b, 5b, and 6b, respectively), and their electrochemical and photophysical properties have been reported. An X-ray crystal structure determination has been carried out for 1a to confirm the trans configuration (C40H80N6S8Cl4Re6, orthorhombic, space group Cmca (No. 64), a = 19.560(5) A, b = 19.494(4) A, c = 18.592(4) A, beta = 115.76(2) degrees, Z = 4). The redox potential of the reversible ReIII6/ReIII5ReIV process of these complexes and previously reported [Bu4N]2[trans- and cis-[Re6(mu 3-S)8Cl4(4-cyanopyridine)2]] (2a and 2b, respectively) and [Bu4N]2[trans- and cis-[Re6(mu 3-S)8Cl4(pyridine)2]] (4a and 4b, respectively) in acetonitrile depends linearly on the pKa of the N-heterocyclic ligands, with the potentials being more negative with basic ligands. The ligand-centered-redox waves for 1a, 1b, 2a, and 2b were observed as split waves (delta E1/2 = 90-140 mV), the extent of the splitting being larger for the cis isomer and largest for the pyrazine complexes. Electronic interaction between the two ligands through the [Re6(mu 3-S)8]2+ core has been suggested. The second ligand-reduction wave was also observed for 3a and 3b, the potential being shifted positively to coalesce with the first reduction wave on addition of the weak proton donor imidazole. This is accounted for by the proton-coupled redox reaction at the free pyridyl site of the 4,4'-bipyridine ligands. All of the complexes show luminescence in acetonitrile at room temperature. While the complexes of pyridine and 4-methylpyridine show photophysical characteristics (lambda em 740-750 nm, phi em 0.031-0.057, tau em 4.2-6.2 microseconds) similar to those (770 nm, 0.039, and 6.3 microseconds, respectively) of [Re6(mu 3-S)8Cl6]4-, emissions of other complexes are significantly weak with lambda em, phi em, and tau em values in the ranges 763-785 nm, 0.0010-0.0017, and 0.013-0.029 microsecond, respectively. Suggestions are given for the excited states localized on the cluster core and the ligand pi* orbitals.

Effects of histamine H1 receptor antagonists on compound 48/80-induced scratching behavior in mice.

The effects of histamine H1 receptor antagonists on compound 48/80-induced scratching behavior were studied in mice. Classical histamine H1 receptor antagonists such as diphenhydramine and chlorpheniramine caused a potent depressant effect on compound 48/80-induced scratching behavior. Histamine H1 receptor antagonists having antiallergic activity (an inhibition of mast cell degranulation), such as azelastine and oxatomide and nonsedative histamine H receptor antagonists such as terfenadine, epinastine and astemizole, also showed a relatively potent effect. On the other hand, the effects of tranilast and cromolyn sodium--antiallergic drugs without histamine H1 receptor antagonistic activity--were extremely weak. Diazepam had weak or no depressant effects on compound 48/80-induced scratching behavior. These results suggest that inhibition of compound 48/80-induced scratching behavior is mainly due to histamine H1 receptor antagonistic activity and not to the sedative action of the drugs.