Partial cooling of the upper body with a water-cooled vest in an environment exceeding body temperature.

OBJECTIVES: To evaluate the efficacy of water-cooled clothing that continuously cools restricted body areas to suppress body temperature increase as an anti-heatstroke measure for workers in hot environments that exceed body temperature. METHODS: Ten healthy men were placed in Room A (air temperature: 25°C, relative humidity: 50%) for 15 min. They were then transferred to Room B (air temperature: 40°C, relative humidity: 50%), where they rested for 10 min, then put on cooling clothing, and again rested for 15 min (the control group rested for 25 min). They then performed intense ergometer exercise for 40 min at 40% maximal oxygen consumption after which they rested for 10 min. The three trial conditions were CON (long-sleeved summer work clothes), VEST (cooling vest), and P-VEST (partial cooling vest). In VEST and P-VEST, water-cooled clothing continuously recirculated with 10°C water was used to cool the upper body. In P-VEST, only the neck, axillae, and heart areas were in contact with the cooled clothing. The measured indices were the rectal, esophageal, and external auditory canal temperatures; heart rate; estimated sweat volume; and subjective evaluations. RESULTS: Compared with the CON condition, the rectal, esophageal, and external auditory canal temperatures and the heart rate were significantly lower and the subjective indices were decreased in the VEST and P-VEST conditions. CONCLUSIONS: Partial cooling showed a body cooling effect similar to that of whole upper body cooling. Partial body cooling promoted the heat dissipation, suggesting that partial cooling is efficient for maintaining body cooling in hot environments.

A fan-attached jacket worn in an environment exceeding body temperature suppresses an increase in core temperature.

We examined whether blowing hot air above body temperature under work clothing may suppress core temperature. Nine Japanese men engaged in two 30-min bicycle ergometer sessions at a workload of 40% VO2max at 40 °C and 50% relative humidity. The experiment was conducted without wearing any cooling apparatus (CON), wearing a cooling vest that circulated 10.0 °C water (VEST), and wearing a fan-attached jacket that transferred ambient air underneath the jacket at a rate of 30 L/s (FAN). The VEST and FAN conditions suppressed the increases of rectal temperature (CON, VEST, FAN; 38.01 ± 0.19 °C, 37.72 ± 0.12 °C (p = 0.0076), 37.54 ± 0.19 °C (p = 0.0023), respectively), esophageal temperature (38.22 ± 0.30 °C, 37.55 ± 0.18 °C (p = 0.0039), 37.54 ± 0.21 °C (p = 0.0039), respectively), and heart rate (157.3 ± 9.8 bpm, 136.9 ± 8.9 bpm, (p = 0.0042), 137.5 ± 6.5 bpm (p = 0.0023), respectively). Two conditions also reduced the estimated amount of sweating and improved various subjective evaluations. Even in the 40 °C and 50% relative humidity environment, we may recommend wearing a fan-attached jacket because the heat dissipation through evaporation exceeded the heat convection from the hot ambient air.

Characteristics of patients who were able to switch from benzodiazepine hypnotics to lemborexant.

OBJECTIVES: There is little evidence of insomnia treatment, especially exit strategies for hypnotics. We examined on the characteristics of patients who were able to switch from benzodiazepine hypnotics to lemborexant. METHODS: Insomnia was assessed using the Athens Insomnia Scale. Efficacy outcome assessment was the Clinical Global Impressions-Improvement scale. RESULTS: Eighty patients switched from benzodiazepine hypnotic monotherapy to lemborexant and 57 patients who continued the use of benzodiazepine hypnotics. The switched group had a significantly lower benzodiazepine hypnotic diazepam equivalent and a significantly shorter dosing period than the continued group (p < 0.001 for all). The mean Athens Insomnia Scale total score of the switched group was a significant improved (5.8 ± 3.3 to 4.0 ± 3.3; p < 0.05). The mean Clinical Global Impressions-Improvement score of the switched group was 3.3 ± 0.7. CONCLUSION: Our findings suggest that when administering benzodiazepine hypnotics, shortening the administration period, as much as possible, allows a smooth switch to safe long-term maintenance therapy using lemborexant, without exacerbating insomnia.

The effect of lemborexant for insomnia disorder.

BACKGROUND: Lemborexant has a low dependence potential, less muscle relaxant effect, and less effect on cognitive function. However, there have been no naturalistic reports in Japan clarifying the effect of lemborexant on insomnia disorder. We retrospectively examined the effectiveness of treatment with lemborexant. METHODS: Insomnia was assessed using the Athens Insomnia Scale (AIS). Efficacy outcome assessment was the Clinical Global Impressions-Improvement scale (CGI-I). RESULTS: We analyzed 150 patients (male/female = 57/93) in total. The mean subject age and mean duration of illness were 47.8 ± 19.9 years and 4.2 ± 7.2 years, respectively. The average dose of lemborexant was 5.9 ± 2.0 mg. The mean AIS total score was a significant improved (6.6 ± 3.7-3.9 ± 3.3) (p < 0.01). The mean CGI-I score was 3.2 ± 0.8. The 24-week continuation rates for lemborexant were 86.7%. CONCLUSION: Similar to the results obtained in previous studies, the CGI-I score, which is one of the objective indicators evaluated by the therapist, and the AIS, which is one of the subjective evaluations of patients, improved as well. The results of this study suggest that lemborexant may be safe and effective in patients with insomnia in real-world clinical practice.

Continuation rate for asenapine and brexpiprazole treatment in patients with schizophrenia.

INTRODUCTION: The current study sought to compare the treatment continuation rates of asenapine and brexpiprazole while specifically investigating the factors influencing this index and the clinical efficacy of brexpiprazole. METHODS: Retrospective study on patients with schizophrenia who were prescribed either asenapine (n = 73) or brexpiprazole (n = 136), as part of their routine medical care. RESULTS: The treatment continuation rates for asenapine and brexpiprazole were 19.0% and 38.6% at 52 weeks, with that of brexpiprazole found to be significantly higher than that of asenapine (p = .002). Moreover, age was found to be a significant factor affecting the treatment continuation rate for brexpiprazole (p = .03). Additionally, patients with a longer continuation duration had significantly lower Clinical Global Impression-Severity of Illness (CGI-S) scale scores compared to those who discontinued early (p = .04). The continuation rate was also significantly higher for those who began using the drug as outpatients compared to those first administered the drug as inpatients (p = .04). Furthermore, disease duration, CGI-S scale, and continuation duration significantly affected the clinical efficacy of brexipiprazole (p < .05 for all). CONCLUSIONS: The continuation rate for brexpiprazole increases as the age of the patient increases, as disease severity decreases, and if the patient first uses the drug as an outpatient. Shorter disease duration and longer drug administration may lead to improved clinical efficacy. These results suggest that brexpiprazole is an effective treatment option for maintenance therapy of schizophrenia.

Comparisons of the effects of second-generation antipsychotics long-acting injections on treatment retention according to severity of patient condition.

INTRODUCTION: There have been no naturalistic reports in Japan clarifying the difference of second-generation antipsychotics (SGA) long-acting injections (LAIs) on treatment retention according to severity of patient condition. METHODS: This study aimed to investigate the difference in treatment retention between SGA LAIs according to severity of patient condition. RESULTS: This study demonstrated that, although AOM patients had better rates of treatment retention compared to PP and RLAI for mild cases, the reverse was true for moderate to severe cases. CONCLUSION: Because treatment retention rates can differ for each SGA LAI based on the severity of the patient's condition.

One patient with schizophrenia showed reduced drug-induced extrapyramidal symptoms as a result of an alternative regimen of treatment with paliperidone 3 and 6 mg every other day.

BACKGROUND: Schizophrenia is a chronic disease that requires long-term management with antipsychotics. Antipsychotic drugs are given by tapering their dose, extending the dosing interval, and so on, as part of a treatment strategy to minimize the adverse effects while at the same time maintaining efficacy. METHODS: We report the case of one patient with schizophrenia in whom the clinical symptoms were alleviated after treatment with 6 mg paliperidone. However, the patient developed extrapyramidal syndrome, for which 3 and 6 mg paliperidone were administered alternately every other day. Extrapyramidal syndrome was assessed using the Drug-Induced Extrapyramidal Symptoms Scale, Abnormal Involuntary Movement Scale, or Barnes Akathisia Scale. RESULTS: There was improvement in Drug-Induced Extrapyramidal Symptoms Scale score and Abnormal Involuntary Movement Scale score. However, there was almost no change in the Positive and Negative Syndrome Scale total score, positive score, negative score, or general score. CONCLUSION: The results indicate the possibility of lessened adverse effects as a result of an alternative regimen of treatment with paliperidone 3 and 6 mg every other day in the maintenance phase.