Real-World Preventive Effects of Suvorexant in Intensive Care Delirium: A Retrospective Cohort Study.

OBJECTIVE: This study aimed to examine the effects of suvorexant on delirium prevention in a real-world setting. Previous studies have demonstrated the efficacy of suvorexant for delirium prevention in limited randomized clinical trial settings; however, its effectiveness in everyday clinical settings remains unknown. METHODS: A single-center, retrospective cohort study was conducted in the intensive care unit of an academic hospital. Patients (aged ≥ 3 years) admitted from January 2016 to December 2018 were eligible if they stayed in the intensive care unit for at least 72 hours. Suvorexant was prescribed by the attending physician for insomnia as part of everyday clinical practice. A Cox proportional hazards regression analysis was conducted on delirium-free survival for suvorexant users, adjusting for delirium-related covariates. As part of routine clinical practice, the Confusion Assessment Method for the Intensive Care Unit was used to detect the existence of delirium at least twice daily throughout the intensive care unit stay. RESULTS: There were 699 patients-84 suvorexant users and 615 suvorexant nonusers. Delirium was detected in 214 patients. Delirium prevalence was significantly lower in suvorexant users than in nonusers (17.9% vs 32.4%, respectively; P = .007). Cox regression analysis revealed a significantly lower hazard ratio (0.472; 95% CI, 0.268-0.832; P = .009) of delirium in suvorexant users than in nonusers. Trazodone also had a preventive effect on delirium (hazard ratio 0.345; 95% CI, 0.149-0.802; P = .013). CONCLUSIONS: The present study extends to real-world settings previous findings that suvorexant is effective for delirium prevention.

In vivo tomographic visualization of intracochlear vibration using a supercontinuum multifrequency-swept optical coherence microscope.

This study combined a previously developed optical system with two additional key elements: a supercontinuum light source characterized by high output power and an analytical technique that effectively extracts interference signals required for improving the detection limit of vibration amplitude. Our system visualized 3D tomographic images and nanometer scale vibrations in the cochlear sensory epithelium of a live guinea pig. The transverse- and axial-depth resolution was 3.6 and 2.7 µm, respectively. After exposure to acoustic stimuli of 21-25 kHz at a sound pressure level of 70-85 dB, spatial amplitude and phase distributions were quantified on a targeted surface, whose area was 522 × 522 µm2.

Metastatic liposarcoma in the jejunum causing intussusception: report of a case.

We report a case of metastatic liposarcoma in the jejunum manifesting as intestinal intussusception. A 75-year-old man underwent wide excision of a dedifferentiated liposarcoma in his left thigh, followed by adjuvant radiation therapy. He was referred to our department 7 months later with colicky abdominal pain and vomiting. Abdominal radiography showed an intussusception of the small intestine. Laparotomy revealed an antegrade jejunojejunal intussusception, and we resected the jejunum containing the tumor without attempting manual reduction. Histological examination confirmed that the tumor was a metastasis of the liposarcoma. The patient died of pulmonary metastasis 3 months later.

Alpha-fetoprotein-producing early gastric cancer of the remnant stomach: report of a case.

A 67-year-old man initially underwent a distal gastrectomy for early gastric cancer (T1, N0, M0; Stage IA) in March 1995. During the follow-up period, an elevation of the serum alpha-fetoprotein (AFP) level (98.8 ng/ml) and a liver tumor (S4) were detected. A left hepatectomy was performed in December 1996. Immunohistochemically, AFP-positive cells were present in both the primary gastric tumor and metastasized liver tumor. The serum AFP level normalized immediately, but it elevated again to 22.4 ng/ml. An endoscopic examination revealed a protruding lesion in the remnant stomach. A total resection of the remnant stomach was performed in February 2005. The tumor was evaluated T1, N0, M0; Stage IA, with positive staining for AFP. The patient has survived without any sign of recurrence for more than 11 years after the first diagnosis of cancer. To the best of our knowledge, this is the first case of a long-term survival of AFP-producing gastric cancer with successfully resected metachronous liver metastasis and gastric remnant carcinoma.