Endothelium-Derived Extracellular Vesicles Expressing Intercellular Adhesion Molecules Reflect Endothelial Permeability and Sepsis Severity.

BACKGROUND: Currently, clinical indicators for evaluating endothelial permeability in sepsis are unavailable. Endothelium-derived extracellular vesicles (EDEVs) are emerging as biomarkers of endothelial injury. Platelet endothelial cell adhesion molecule (PECAM) and vascular endothelial (VE)-cadherin are constitutively expressed endothelial intercellular adhesion molecules that regulate intercellular adhesion and permeability. Herein, we investigated the possible association between EDEVs expressing intercellular adhesion molecules (PECAM+ or VE-cadherin+ EDEVs) and endothelial permeability and sepsis severity. METHODS: Human umbilical vein endothelial cells (HUVECs) were stimulated with tumor necrosis factor alpha (TNF-α) directly or after pretreatment with permeability-modifying reagents such as angiopoietin-1, prostacyclin, or vascular endothelial growth factor (VEGF) to alter TNF-α-induced endothelial hyperpermeability. Endothelial permeability was measured using the dextran assay or transendothelial electrical resistance. Additionally, a prospective cross-sectional observational study was conducted to analyze circulating EDEV levels in patients with sepsis. EDEVs were examined in HUVEC culture supernatants or patient plasma (nonsepsis, n = 30; sepsis, n = 30; septic shock, n = 42) using flow cytometry. The Wilcoxon rank-sum test was used for comparisons between 2 groups. Comparisons among 3 or more groups were performed using the Steel-Dwass test. Spearman's test was used for correlation analysis. Statistical significance was set at P < .05. RESULTS: TNF-α stimulation of HUVECs significantly increased EDEV release and endothelial permeability. Pretreatment with angiopoietin-1 or prostacyclin suppressed the TNF-α-induced increase in endothelial permeability and inhibited the release of PECAM+ and VE-cadherin+ EDEVs. In contrast, pretreatment with VEGF increased TNF-α-induced endothelial permeability and the release of PECAM+ and VE-cadherin+ EDEVs. However, pretreatment with permeability-modifying reagents did not affect the release of EDEVs expressing inflammatory stimulus-inducible endothelial adhesion molecules such as E-selectin, intracellular adhesion molecule-1, or vascular cell adhesion molecule-1. The number of PECAM+ EDEVs on admission in the septic-shock group (232 [124, 590]/µL) was significantly higher (P = .043) than that in the sepsis group (138 [77,267]/µL), with an average treatment effect of 98/µL (95% confidence interval [CI], 2-270/µL), and the number of VE-cadherin+ EDEVs in the septic-shock group (173 [76,339]/µL) was also significantly higher (P = .004) than that in the sepsis group (81 [42,159]/µL), with an average treatment effect (ATE) of 79/µL (95% CI, 19-171/µL); these EDEV levels remained elevated until day 5. CONCLUSIONS: EDEVs expressing intercellular adhesion molecules (PECAM+ or VE-cadherin+ EDEVs) may reflect increased endothelial permeability and could be valuable diagnostic and prognostic markers for sepsis.

Impact of intraoperative fluid management on postoperative complications in patients undergoing minimally invasive esophagectomy for esophageal cancer: a retrospective single-center study.

BACKGROUND: Esophagectomy is a high-risk procedure that can involve serious postoperative complications. There has been an increase in the number of minimally invasive esophagectomies (MIEs) being performed. However, the relationship between intraoperative management and postoperative complications in MIE remains unclear. METHODS: After the institutional review board approval, we enrolled 300 patients who underwent MIE at Tohoku University Hospital between April 2016 and March 2021. The relationships among patient characteristics, intraoperative and perioperative factors, and postoperative complications were retrospectively analyzed. The primary outcome was the relationship between intraoperative fluid volume and anastomotic leakage, and the secondary outcomes included the associations between other perioperative factors and postoperative complications. RESULTS: Among 300 patients, 28 were excluded because of missing data; accordingly, 272 patients were included in the final analysis. The median [interquartile range] operative duration was 599 [545-682] minutes; total intraoperative infusion volume was 3,747 [3,038-4,399] mL; total infusion volume per body weight per hour was 5.48 [4.42-6.73] mL/kg/h; and fluid balance was + 2,648 [2,015-3,263] mL. The postoperative complications included anastomotic leakage in 68 (25%) patients, recurrent nerve palsy in 91 (33%) patients, pneumonia in 62 (23%) patients, cardiac arrhythmia in 13 (5%) patients, acute kidney injury in 5 (2%) patients, and heart failure in 5 (2%) patients. The Cochrane-Armitage trend test indicated significantly increased anastomotic leakage among patients with a relatively high total infusion volume (P = 0.0085). Moreover, anastomotic leakage was associated with male sex but not with peak serum lactate levels. Patients with a longer anesthesia duration or recurrent nerve palsy had a significantly higher incidence of postoperative pneumonia than those without. Further, the incidence of postoperative pneumonia was not associated with the operative duration, total infusion volume, or fluid balance. The operative duration and blood loss were related to the total infusion volume. Acute kidney injury was not associated with the total infusion volume or serum lactate levels. CONCLUSIONS: Among patients who underwent MIE, the total infusion volume was positively correlated with the incidence of anastomotic leakage. Further, postoperative pneumonia was associated with recurrent nerve palsy but not total infusion volume or fluid balance.

Intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a Japanese nationwide observational study.

BACKGROUND: Japan has four types of intensive care units (ICUs) that are divided into two categories according to the management fee charged per day: ICU management fees 1 and 2 (ICU1/2) (equivalent to high-intensity staffing) and 3 and 4 (ICU3/4) (equivalent to low-intensity staffing). Although ICU1/2 charges a higher rate than ICU3/4, no cost-effectiveness analysis has been performed for ICU1/2. This study evaluated the clinical outcomes and cost-effectiveness of ICU1/2 compared with those of ICU3/4. METHODS: This retrospective observational study used a nationwide Japanese administrative database to identify patients admitted to ICUs between April 2020 and March 2021 and divided them into the ICU1/2 and ICU3/4 groups. The ICU mortality rates and in-hospital mortality rates were determined, and the incremental cost-effectiveness ratio (ICER) (Japanese Yen (JPY)/QALY), defined as the difference between quality-adjusted life year (QALY) and medical costs, was compared between ICU1/2 and ICU3/4. Data analysis was performed using the Chi-squared test; an ICER of < 5 million JPY/QALY was considered cost-effective. RESULTS: The ICU1/2 group (n = 71,412; 60.7%) had lower ICU mortality rates (ICU 1/2: 2.6% vs. ICU 3/4: 4.3%, p < 0.001) and lower in-hospital mortality rates (ICU 1/2: 6.1% vs. ICU 3/4: 8.9%, p < 0.001) than the ICU3/4 group (n = 46,330; 39.3%). The average cost per patient of ICU1/2 and ICU3/4 was 2,249,270 ± 1,955,953 JPY and 1,682,546 ± 1,588,928 JPY, respectively, with a difference of 566,724. The ICER was 718,659 JPY/QALY, which was below the cost-effectiveness threshold. CONCLUSIONS: ICU1/2 is associated with lower ICU patient mortality than ICU3/4. Treatments under ICU1/2 are more cost-effective than those under ICU3/4, with an ICER of < 5 million JPY/QALY.

Association Between Intraoperative Landiolol Use and In-Hospital Mortality After Coronary Artery Bypass Grafting: A Nationwide Observational Study in Japan.

BACKGROUND: Ischemic heart disease is a leading cause of death worldwide, and coronary artery bypass grafting (CABG) is a major treatment. Landiolol is an ultra-short-acting beta-antagonist known to prevent postoperative atrial fibrillation. However, the effectiveness of intraoperative landiolol on mortality remains unknown. This study aimed to evaluate the association between intraoperative landiolol use and the in-hospital mortality in patients undergoing CABG. METHODS: To conduct this retrospective cohort study, we used data from the Japanese Diagnosis Procedure Combination inpatient database. All patients who underwent CABG during hospitalization between July 1, 2010, and March 31, 2020, were included. Patients who received intraoperative landiolol were defined as the landiolol group, whereas the other patients were defined as the control group. The primary outcome was in-hospital mortality. Propensity score matching was used to compare the landiolol and control groups. RESULTS: In total, 118,506 patients were eligible for this study, including 25,219 (21%) in the landiolol group and 93,287 (79%) in the control group. One-to-one propensity score matching created 24,893 pairs. After propensity score matching, the in-hospital mortality was significantly lower in the landiolol group than that in the control group (3.7% vs 4.3%; odds ratio 0.85; 95% confidence interval 0.78 to 0.94; P = .010). CONCLUSIONS: Intraoperative landiolol use was associated with decreased in-hospital mortality in patients undergoing CABG. Further randomized controlled trials are required to confirm these findings.

Accuracy of Cardiac Output Measured by Fourth-Generation FloTrac and LiDCOrapid, and Their Characteristics Regarding Systemic Vascular Resistance in Patients Undergoing Cardiac Surgery.

OBJECTIVES: The clinical use of less-invasive devices that calculate the cardiac output from arterial pressure waveform is increasing. The authors aimed to evaluate the accuracy and characteristics of the systemic vascular resistance index (SVRI) of the cardiac index measured by 2 less-invasive devices, fourth-generation FloTrac (CIFT) and LiDCOrapid (CILR), compared with the intermittent thermodilution technique, using a pulmonary artery catheter (CITD). DESIGN: This was a prospective observational study. SETTING: This study was conducted at a single university hospital. PARTICIPANTS: Twenty-nine adult patients undergoing elective cardiac surgery. INTERVENTIONS: Elective cardiac surgery was used as an intervention. MEASUREMENTS AND MAIN RESULTS: Hemodynamic parameters, CIFT, CILR, and CITD, were measured after the induction of general anesthesia, at the start of cardiopulmonary bypass, after completion of weaning from cardiopulmonary bypass, 30 minutes after weaning, and at sternal closure (135 measurements in total). The CIFT and CILR had moderate correlations with CITD (r = 0.62 and 0.58, respectively). Compared with CITD, CIFT, and CILR had a bias of -0.73 and -0.61 L/min/m2, limit of agreement of -2.14-to-0.68 L/min/m2 and -2.42-to-1.20 L/min/m2, and percentage error of 39.9% and 51.2%, respectively. Subgroup analysis for evaluating SVRI characteristics showed that the percentage errors of CIFT and CILR were 33.9% and 54.5% in low SVRI (<1,200 dyne×s/cm5/m), 37.6% and 47.9% in moderate SVRI (1,200-1,800 dyne×s/cm5/m), 49.3% and 50.6% in high SVRI (>1,800 dyne·s/cm5/m2), respectively. CONCLUSIONS: The accuracy of CIFT or CILR was not clinically acceptable for cardiac surgery. Fourth-generation FloTrac was unreliable in high SVRI. LiDCOrapid was inaccurate across a broad range of SVRI, and minimally affected by SVRI.

Epidemiology of adverse events attributed to airway management in paediatric anaesthesia: protocol for the prospective, multicentre, registry-based, cross-sectional Japan Pediatric Difficult Airway in Anesthesia study (J-PEDIA).

INTRODUCTION: Failure to secure an airway during general anaesthesia is a major cause of adverse events (AEs) in children. The safety of paediatric anaesthesia may be improved by identifying the incidence of AEs and their attributed risk factors. The aim of the current study is to obtain real-world data on the incidence of adverse peri-intubation events and assess their association with patient characteristics (including the prevalence of difficult airway features) and choice of anaesthesia management. These data can be used to develop a targeted education programme for anaesthesia providers towards quality improvement activities. METHODS AND ANALYSIS: This prospective, multicentre, registry-based, cross-sectional study will be conducted in four tertiary care hospitals in Japan from June 2022 to May 2025. Children <18 years of age undergoing surgical and/or diagnostic test procedures under general anaesthesia or sedation by anaesthesiologists will be enrolled in this study. Data on patient characteristics, discipline of anaesthesia providers and methodology of airway management will be collected through a standardised verification system. The exposure of interest is the presence of difficult airway features defined based on the craniofacial appearance. The primary and secondary endpoints are all AEs associated with airway management and reduced peripheral capillary oxygen saturation values. Potential confounders are related to the failure to secure the airway and variations in the anaesthesia providers' levels, adjusted using hierarchical multivariable regression models with mixed effects. The sample size was calculated to be approximately 16 000 assuming a 99% probability of obtaining a 95% Wilson CI with±0.3% of the half-width for the 2.0% of the incidence of critical AEs. ETHICS AND DISSEMINATION: The study protocol was approved by the Institutional Review Board at Aichi Children's Health and Medical Center (2021051). The results will be reported in a peer-reviewed journal and a relevant academic conference. TRIAL REGISTRATION NUMBER: UMIN000047351.

Preventive effect of low-dose landiolol on postoperative atrial fibrillation study (PELTA study).

OBJECTIVE: To investigate the efficacy of prophylactic administration of low-dose landiolol on postoperative atrial fibrillation (POAF) in patients after cardiovascular surgery. METHODS: Consecutive 150 patients over 70 years of age who underwent cardiovascular surgery for valvular, ischemic heart, and aortic diseases were enrolled in this single-center prospective randomized control study from 2010 to 2014. They were assigned to three treatment groups: 1γ group (landiolol at 1 µg/kg/min), 2γ group (landiolol at 2 µg/kg/min), or control group (no landiolol). In the two landiolol groups, landiolol hydrochloride was intravenously administered for a period of 4 days postoperatively. Electrocardiography was continuously monitored during the study period, and cardiologists eventually assessed whether POAF occurred or not. RESULTS: POAF occurred in 24.4% of patients in the control group, 18.2% in 1γ group, and 11.1% in 2γ group (p = 0.256). Multivariate logistic regression analysis showed that the incidence of POAF tended to decrease depending on the dose of landiolol (trend-p = 0.120; 1γ group: OR = 0.786, 95% CI 0.257-2.404; 2γ group: OR = 0.379, 95% CI 0.112-1.287). Subgroup analysis showed a significant dose-dependent reduction in POAF among categories of female sex, non-use of angiotensin II receptor blockers (ARBs) before surgery, and valve surgery (each trend-p = 0.02, 0.03, and 0.004). CONCLUSIONS: These findings indicate that prophylactic administration of low-dose landiolol may not be effective for preventing the occurrence of POAF in overall patients after cardiovascular surgery, but the administration could be beneficial to female patients, patients not using ARBs preoperatively, and those after valvular surgery.

Intraoperative hemorrhage in revision total hip arthroplasty: a retrospective single-center study.

PURPOSE: The amount of intraoperative hemorrhages and factors associated with hemorrhages and transfusions during revision total hip arthroplasty (reTHA) have not been identified for Japanese patients. We aimed to clarify the amount of intraoperative hemorrhages, and to elucidate the factors associated with hemorrhages and transfusions during reTHA in Japanese patients. METHODS: We retrospectively reviewed patients who underwent reTHA (n = 48) and primary total hip arthroplasty (pTHA) (n = 615) in a single hospital and extracted data regarding hemorrhage, transfusion, patient comorbidities, and surgical anesthesia. We defined massive blood loss (MBL) as a hemorrhage comprising more than half of the circulating blood volume within 3 h. The odds ratio (OR) and 95% confidence interval (CI) were estimated using a multivariate logistic regression analysis. RESULTS: There was a significant difference in hemorrhages between reTHA and pTHA patients (1790 g versus 625 g; p < 0.001). Among patients with reTHA, MBL was significantly associated with younger age (OR 0.91; 95% CI 0.84-1.00; p = 0.04) and lower body mass index (BMI) (OR 0.69; 95% CI 0.53-0.91; p = 0.01). Although not significant, the incidence of MBL tended to be higher for patients with hyperlipidemia (OR 4.88; 95% CI 0.99-24.1; p = 0.051). Furthermore, the need for allogeneic transfusion was significantly associated with the number of prepared autologous blood packs (OR 0.15; 95% CI 0.07-0.55; p = 0.002). CONCLUSION: Although this study was limited by its small population and a possibility of underestimating the hemorrhage, hemorrhages in reTHA patients was two times greater than that in pTHA patients. Younger age and lower BMI increased the risk of MBL in reTHA. Preparing autologous blood decreased the risk of intraoperative allogeneic transfusion.

Nutritional characteristics of the Japanese diet: A cross-sectional study of the correlation between Japanese Diet Index and nutrient intake among community-based elderly Japanese.

OBJECTIVES: To our knowledge, the overall nutritional quality of the Japanese diet has not been assessed previously. The aim of this study was to investigate the relationship between adhering to a Japanese diet and nutrient intake. METHODS: We conducted a cross-sectional study of 1129 Japanese persons ≥70 y of age. Dietary habits were assessed using a food frequency questionnaire. The primary outcome was nutrient intake (12 components of NRF9.3 index). The overall nutrient adequacy (ONA) score was applied for assessing the potential of nutrient density. Correlation analysis was performed to compare the Japanese Diet Index (JDI) and nutrient intake, and multiple regression analysis was used to simulate the modified JDI (MJDI). RESULTS: The JDI was positively correlated with all nine beneficial nutrients, and negatively correlated with two nutrients (saturated fat and sugar). The JDI was significantly correlated with the ONA score (Spearman's coefficient = 0.248). The MJDI, which was defined by the coefficients for seven food items, was significantly correlated with the ONA score (Spearman's coefficient = 0.515). However, the JDI and MJDI were correlated with higher sodium intake. CONCLUSIONS: The present findings suggest that adhering to a Japanese diet defined by the JDI score is associated with better nutrient intake. However, this dietary pattern also appears to be associated with high sodium intake.

Association between housing type and γ-GTP increase after the Great East Japan Earthquake.

BACKGROUND: It has been reported that alcohol consumption increases after natural disasters, with an impact on health. However, the impact of relocation upon drinking behavior has been unclear. The aim of this study was to clarify the association between housing type and the impact of alcohol consumption on health after the Great East Japan Earthquake (GEJE) of 2011. METHODS: We analyzed 569 residents living in devastated areas of Ishinomaki city, who had undergone assessment of their γ-GTP levels at health check-ups in both 2010 and 2013, and had given details of the type of housing they occupied in 2013. The housing types were categorized into five groups: "same housing as that before the GEJE", "prefabricated temporary housing", "privately rented temporary housing/rental housing", "homes of relatives", and "reconstructed housing". We used fixed-effect regression analysis to examine the association between housing type after the GEJE and changes in γ-GTP after adjustment for age, BMI, housing damage, number of people in household, smoking status, presence of illness, psychological distress, and social network. RESULTS: The mean age of the participants was 71.5 years and 46.2% of them were men. The proportion of individuals who drank heavily, and suffered from psychological distress and insomnia, was highest among those living in privately rented temporary housing/rental housing. Compared with individuals who continued to occupy the same housing as those before the GEJE, the effect of change in γ-GTP was significantly higher in individuals who had moved to privately rented temporary housing/rental housing (b = 9.5, SE = 4.4, p < 0.05). CONCLUSION: Our present findings reveal that disaster victims who have moved to privately rented temporary housing/rental housing are at highest risk of negative health effects due to alcohol drinking.

Psychological distress and the incident risk of functional disability in elderly survivors after the Great East Japan Earthquake.

BACKGROUND: We conducted a prospective cohort study to investigate whether psychological distress would have increased the incident risk of functional disability after the 2011 Great East Japan Earthquake. METHODS: First phase data pertaining to psychological distress and other lifestyle factors were collected from 1037 subjects aged ≥ 65 years, from June to December 2011, in four affected areas of Miyagi prefecture in Japan. Psychological distress was measured by the Kessler 6-item psychological distress scale (K6), and classified into three categories (K6 score ≤ 9, 10-12, ≥ 13). Outcome data on functional disability were collected from the public Long-term Care Insurance database. Participants were followed up for about 2.6 years. The Cox model was used to calculate the multivariate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: During the follow-up period, 118 participants were certified as incident disability (43.8 disability events per 1000 person-years). Compared with the lowest category (K6 score ≤ 9), participants in the highest category (K6 score ≥ 13) had a significantly higher risk of functional disability (HR = 2.65, 95% CI = 1.35-5.18, p = 0.002). In order to consider reverse causality, we conducted analysis excluding all incidents and deaths that occurred within the first year of follow-up, but our findings remained unchanged. LIMITATIONS: We did not consider all potential confounders and use of appropriate medication. CONCLUSIONS: The present study has demonstrated that psychological distress was associated with an increased risk of functional disability among elderly survivors of a natural disaster.

Changes in time spent walking and the risk of incident dementia in older Japanese people: the Ohsaki Cohort 2006 Study.

Background: the impact of long-term changes in physical activity during adulthood in the context of primary prevention of dementia has not been addressed previously. Objective: to study the relationship between changes in time spent walking after middle age and incident dementia in older Japanese individuals. Methodology: we conducted a cohort study of 6,909 disability-free Japanese individuals aged ≥65 years who lived in Ohsaki City, Japan. In both 1994 and 2006, the individual amount of time spent walking per day was assessed using a self-reported questionnaire (<0.5 h, 0.5-1 h or ≥1 h). Based on these three categories of exposure at the two points, participants were categorised into nine groups according to changes in time spent walking. Data on incident dementia were retrieved from the public Long-term Care Insurance (LTCI) Database, in which participants were followed up for 5.7 years (between April 2007 and November 2012). The Cox model was used for estimating the multivariate-adjusted hazard ratios (HRs) of incident dementia. Results: the 5.7-year incidence of dementia was 9.2%. Compared with persons who remained in the lowest category of time spent walking (<0.5 h/day in both 1994 and 2006), persons who remained in the highest category (≥1 h/day in both 1994 and 2006) had a significantly lower risk of incident dementia: the multivariate-adjusted HR (95% confidence intervals) was 0.72 (0.53 and 0.97). Conclusions: these results suggest that maintaining a higher level of physical activity after middle age may be a key strategy for prevention of dementia in older age.

Sense of life worth living (ikigai) and incident functional disability in elderly Japanese: The Tsurugaya Project.

OBJECTIVE: To test the hypothesis that elderly persons who feel ikigai (a sense of life worth living) have a lower risk of incident functional disability than those who do not. Recent studies have suggested that ikigai impacts on mortality. However, its impact upon disability is unknown. The aim of the present study was to investigate the association between ikigai and incident functional disability among elderly persons. METHODS: We conducted a prospective cohort study of 830 Japanese elderly persons aged ≥70 years as a comprehensive geriatric assessment in 2003. Information on ikigai was collected by self-reported questionnaire. Data on functional disability were retrieved from the public Long-term Care Insurance database in which participants were followed up for 11 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) for incidence of functional disability were calculated for three groups delineated according to the presence of ikigai ("no", "uncertain" or "yes") using the Cox proportional hazards regression model. RESULTS: The 11-year incidence of functional disability was 53.3% (442 cases). As compared with the "no" group, the multiple-adjusted HR (95% CI) of incident functional disability was 0.61 (0.36­1.02) for the "uncertain" group and 0.50 (0.30­0.84) for the "yes" group. CONCLUSION: A stronger degree of ikigai is significantly associated with a lower risk of incident functional disability.

Impact of Pain on Incident Risk of Disability in Elderly Japanese: Cause-specific Analysis.

BACKGROUND: Although several cross-sectional studies have reported that pain is associated with functional disability in the elderly, data regarding a longitudinal association between pain and disability are inconsistent. This study aimed to investigate the association of pain severity with subsequent functional disability due to all causes as well as stroke, dementia, and joint disease/fracture. METHODS: The authors conducted a prospective cohort study of 13,702 Japanese individuals aged 65 yr or older. Information regarding pain severity during the previous 4 weeks and other lifestyle factors was collected via questionnaire in 2006. Data on the incidence of functional disability were retrieved from the Long-term Care Insurance database. Cox proportional hazards regression analysis was used to estimate the multivariate-adjusted hazard ratios for incident functional disability. RESULTS: The authors documented 2,686 (19.6%) cases of incident functional disability. The multivariate hazard ratio of functional disability was 1.15 (95% CI, 1.02 to 1.31) among respondents with moderate pain and 1.31 (95% CI, 1.12 to 1.54) among respondents with severe pain in comparison with those without pain (P trend < 0.001). These positive associations were particularly remarkable for disability due to joint disease/fracture: the multivariate hazard ratio was 1.88 (95% CI, 1.37 to 2.58) for moderate pain and 2.76 (95% CI, 1.93 to 3.95) for severe pain (P trend < 0.001). There was a negative association between pain severity and disability due to dementia (P trend = 0.041) and no significant association between pain severity and disability due to stroke. CONCLUSIONS: Among elderly Japanese individuals, the authors found a significant positive association between pain severity and future incident functional disability.

The impact of liver disorders on perioperative management of reoperative cardiac surgery: a retrospective study in adult congenital heart disease patients.

PURPOSE: We evaluated the preoperative prevalence of risk factors for liver disorders and the relationship between the liver disorders and perioperative outcomes in adult congenital heart disease (ACHD) patients. METHODS: This retrospective study included 32 ACHD patients who underwent reoperative cardiac surgery. RESULTS: Preoperatively, 38% of the study patients had risk factors, including congestive liver (CL) due to right heart failure (31%), chronic hepatitis C (HC) (22%), and both CL and HC (16%). The numbers of patients with Child-Pugh scores 5, 6, 7 and 8 were 22, 7, 2 and 1. Median (range) preoperative platelet count and fibrinogen values were 155 (61-330) × 103/µl and 250 (145-367) mg/dl, respectively. The patients with higher Child-Pugh scores tended to have longer duration of anesthesia and surgery (p = 0.078, 0.078, respectively), and had significantly higher platelet transfusion (p = 0.031). Lower platelet count was associated with longer duration of anesthesia, surgery and cardio pulmonary bypass (CPB), and larger amount of blood loss and platelet transfusion (p = 0.01, 0.011, 0.024, 0.033, 0.021). Lower fibrinogen value was associated with longer duration of anesthesia, surgery and CPB, and larger amount of platelet transfusion (p = 0.015, 0.009, 0.009, 0.023). CONCLUSION: ACHD patients who underwent reoperative cardiac surgery had a high prevalence of risk factors for liver disorders preoperatively, and liver disorders aggravated some intraoperative outcomes. These findings suggest that the prevention of liver disorders is important for reducing the occurrence of poor outcomes, and that ACHD patients with liver disorders need attentive perioperative management.

Predictive ability of a simple subjective memory complaints scale for incident dementia: Evaluation of Japan's national checklist, the "Kihon Checklist".

AIM: Subjective memory complaints scales are expected to be useful for the prediction of future cognitive decline. In Japan, the "Kihon Checklist-Cognitive Function" (KCL-CF), which consists of three items, is used for primary screening of high-risk older adults. However, the predictive validity of the KCL-CF remains unknown. The aim of the present cohort study was to examine whether the KCL-CF can predict the incidence of dementia. METHODS: Information on the KCL-CF score (0-3 points) was collected from community-dwelling older adults (≥65 years) through a questionnaire. Data on incident dementia were retrieved from the Long-term Care Insurance database. The Cox model and receiver operating characteristic curve analysis were used. RESULTS: Among 13 974 participants, the 5.7-year rate of incident dementia was 8.8%. All KCL-CF items significantly predicted the risk of incident dementia even after adjustment for age and sex (P-trend < 0.0001). A higher KCL-CF score was associated with a higher risk of dementia; the age- and sex-adjusted hazard ratios (95% confidence interval) were 1.00 (reference) for a KCL-CF score of 0 points, 1.89 (1.65-2.15) for 1 point, 3.01 (2.59-3.50) for 2 points, and 6.20 (4.87-7.90) for 3 points (P-trend < 0.0001). A cut-off score of ≥1 points had a specificity of 65.1% and a sensitivity of 60.2%, and the area under the receiver operating characteristic curve was 0.65 (95% confidence interval 0.63-0.66). CONCLUSIONS: The KCL-CF was able to predict incident dementia. However, because a false-negativity rate of approximately 40% would be expected, the KCL-CF score alone might not be sufficient for screening of dementia incidence. Geriatr Gerontol Int 2017; 17: 1300-1305.