著者
Takahiro Nakashima Katsutaka Hashiba Migaku Kikuchi Junichi Yamaguchi Sunao Kojima Hiroyuki Hanada Toshiaki Mano Takeshi Yamamoto Akihito Tanaka Kunihiro Matsuo Naoki Nakayama Osamu Nomura Tetsuya Matoba Yoshio Tahara Hiroshi Nonogi for the Japan Resuscitation Council (JRC) Acute Coronary Syndrome (ACS) Task Force and the Guideline Editorial Committee on behalf of the Japanese Circulation Society (JCS) Emergency and Critical Care Committee
出版者
The Japanese Circulation Society
雑誌
Circulation Reports (ISSN:24340790)
巻号頁・発行日
vol.4, no.5, pp.187-193, 2022-05-10 (Released:2022-05-10)
参考文献数
30
被引用文献数
4

Background: To achieve early reperfusion therapy for ST-elevation myocardial infarction (STEMI), proper and prompt patient transportation and activation of the catheterization laboratory are required. We investigated the efficacy of prehospital 12-lead electrocardiogram (ECG) acquisition and destination hospital notification in patients with STEMI.Methods and Results: This is a systematic review of observational studies. We searched the PubMed database from inception to March 2020. Two reviewers independently performed literature selection. The critical outcome was short-term mortality. The important outcome was door-to-balloon (D2B) time. We used the GRADE approach to assess the certainty of the evidence. For the critical outcome, 14 studies with 29,365 patients were included in the meta-analysis. Short-term mortality was significantly lower in the group with prehospital 12-lead ECG acquisition and destination hospital notification than in the control group (odds ratio 0.72; 95% confidence interval [CI] 0.61–0.85; P<0.0001). For the important outcome, 10 studies with 2,947 patients were included in the meta-analysis. D2B time was significantly shorter in the group with prehospital 12-lead ECG acquisition and destination hospital notification than in the control group (mean difference −26.24; 95% CI −33.46, −19.02; P<0.0001).Conclusions: Prehospital 12-lead ECG acquisition and destination hospital notification is associated with lower short-term mortality and shorter D2B time than no ECG acquisition or no notification among patients with suspected STEMI outside of a hospital.
著者
Junya Matsuda Hitoshi Takano Masaki Morooka Yoichi Imori Jun Nakata Mitsunobu Kitamura Shuhei Tara Yukichi Tokita Takeshi Yamamoto Morimasa Takayama Wataru Shimizu
出版者
The Japanese Circulation Society
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
pp.CJ-20-1191, (Released:2021-04-24)
参考文献数
28
被引用文献数
3

Background:Alcohol septal ablation (ASA) is a treatment option in patients with drug-refractory symptomatic hypertrophic obstructive cardiomyopathy (HOCM). In many patients, right bundle branch block (RBBB) develops during ASA because septal branches supply the right bundle branch. However, the clinical significance of procedural RBBB is uncertain.Methods and Results:We retrospectively reviewed 184 consecutive patients with HOCM who underwent ASA. We excluded 40 patients with pre-existing RBBB (n=10), prior pacemaker implantation (n=15), mid-ventricular obstruction type (n=10), and those lost to follow-up (n=5), leaving 144 patients for analysis. Patients were divided into 2 groups according to the development (n=95) or not (n=49) of procedural RBBB. ASA conferred significant decreases in the left ventricular pressure gradient (LVPG) in both the RBBB and no-RBBB group (from 74±48 to 27±27 mmHg [P<0.001] and from 75±45 to 31±33 mmHg [P<0.001], respectively). None of the RBBB patients developed further conduction system disturbances. The percentage reduction in LVPG at 1 year after the procedure was significantly greater in the RBBB than no-RBBB group (66±24% vs. 49±45%; P=0.035). Procedural RBBB was not associated with pacemaker implantation after ASA, but was associated with reduction in repeat ASA (odds ratio 0.34; 95% confidence interval 0.13–0.92; P=0.045).Conclusions:Although RBBB frequently occurs during the ASA procedure, it does not adversely affect clinical outcomes.
著者
Mashio Nakamura Satoshi Tamaru Shigeki Hirooka Atsushi Hirayama Akihiro Tsuji Mitsuhiro Hirata Mitsuru Munemasa Izumi Nakagawa Masahiro Toshima Hiroaki Shimokawa Yuki Nishimura Toru Ogura Takeshi Yamamoto Hirono Satokawa Toru Obayashi Norikazu Yamada on behalf of the AKAFUJI Study Investigators
出版者
The Japanese Circulation Society
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
pp.CJ-23-0158, (Released:2023-06-30)
参考文献数
16
被引用文献数
1

Background: A large-scale prospective study of the efficacy and safety of warfarin for the treatment of venous thromboembolism (VTE) has not been conducted in Japan. Therefore, we conducted a real-world prospective multicenter observational cohort study (AKAFUJI Study; UMIN000014132) to investigate the efficacy and safety of warfarin for VTE.Methods and Results: Between May 2014 and March 2017, 352 patients (mean [±SD] age 67.7±14.8 years; 57% female) with acute symptomatic/asymptomatic VTE were enrolled; 284 were treated with warfarin. The cumulative incidence of recurrent symptomatic VTE was higher in patients without warfarin than in those treated with warfarin (8.7 vs. 2.2 per 100 person-years, respectively; P=0.018). The cumulative incidence of bleeding complications was not significantly different between the 2 groups. The mean prothrombin time-international normalized ratio (PT-INR) during warfarin on-treatment was <1.5 in 180 patients, 1.5–2.5 in 97 patients, and >2.5 in 6 patients. The incidence of bleeding complications was significantly higher in patients with PT-INR >2.5, whereas the incidence of recurrent VTE was not significantly different between the 3 PT-INR groups. The cumulative incidence of recurrent VTE and bleeding complications did not differ significantly among those in whom VTE was provoked by a transient risk factor, was unprovoked, or was associated with cancer.Conclusions: Warfarin therapy with an appropriate PT-INR according to Japanese guidelines is effective without increasing bleeding complications, regardless of patient characteristics.
著者
Katsuhiko SANDO Takeshi YAMAMOTO Kenji SAWADA Tomoyuki TANIGUCHI Nobuyuki SOWA Hiroki MORI Takahiro KONDO
出版者
The Japan Society of Mechanical Engineers
雑誌
Mechanical Engineering Journal (ISSN:21879745)
巻号頁・発行日
vol.8, no.2, pp.20-00497, 2021 (Released:2021-04-15)
参考文献数
11
被引用文献数
1

This paper describes a design method of a friction reducer device using a loading cam to suppress unstable vibration. Nonlinear simulation and energy analysis of numerical solutions demonstrates that destabilization is caused by the large phase difference between the slipping velocity in the translation direction and that in the rotation direction. It was found that similarly unstable vibration occurs in various structures using wedge rollers with translational and rotational motion. The analytical equation could be simplified by focusing on the motion factor that affects the slip velocity of the power transmission surface, which is the factor of vibration. Consequently, the design method for suppressing vibration could be expressed by a mathematical formula. This equation is validated by using the results of experiments conducted in the previous work of the current authors. Furthermore, from this equation, we proposed that vibration could be suppressed by the parameter balance of the power transmission device without using damping. The power transmission surface slips when a quick torque is input and damping is used. The proposed design can handle a quick torque response and reduce the weight of the reducer. Specifically, the shape of the wedge roller is made lighter, so that the moment of inertia of the roller is not lowered, or the wedge roller is set as a small roller.
著者
Takahiro Tokuhisa Masafumi Yano Masakazu Obayashi Toshiyuki Noma Mamoru Mochizuki Tetsuro Oda Shinichi Okuda Masahiro Doi Jinyao Liu Yasuhiro Ikeda Takeshi Yamamoto Tomoko Ohkusa Masunori Matsuzaki
出版者
The Japanese Circulation Society
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
vol.70, no.6, pp.777-786, 2006 (Released:2006-05-25)
参考文献数
42
被引用文献数
18 20

Background The Ca2+ regulatory proteins in the sarcoplasmic reticulum (SR) play a key role in the pathogenesis of heart failure. In the present study the effect of chronic β-receptor-stimulation on cardiac and SR functions was assessed, with or without angiotensin-II receptor antagonist treatment recently reported to have anti-β-adrenergic activity. Methods and Results Rats were treated with isoproterenol with (+) or without (-) candesartan (CAN) and then SR vesicles were isolated from the left ventricular muscle. Both Ca2+-uptake and the amount of SR Ca2+-ATPase were significantly lower in the CAN (-) group than in the shams, but those were almost normally restored in the CAN (+). Although the level of the protein kinase A (PKA)-phosphorylation of the SR Ca2+ release channel, known as the ryanodine receptor (RyR2), was elevated in the CAN (-), no Ca2+-leak was detected. However, SIN-1 (O2 - donor) induced Ca2+-leak in the CAN (-) at a 10-fold lower dose than in the sham and CAN (+). In cardiomyocytes, SIN-1 decreased cell shortening and the peak Ca2+ transient and prolonged time from peak to 70% decline in CAN (-), again at 10-fold lower dose than in the sham and CAN (+). Conclusion Chronic β-receptor-stimulation did not induce any Ca2+-leak from the SR, whereas Ca2+-leak was easily induced when oxidative stress was applied to the PKA-phosphorylated RyR2. Candesartan not only improved Ca2+-uptake, but also prevented PKA-phosphorylation, rendering the SR less susceptible to Ca2+-leak. (Circ J 2006; 70: 777 - 786)
著者
Naoki Nakayama Takeshi Yamamoto Migaku Kikuchi Hiroyuki Hanada Toshiaki Mano Takahiro Nakashima Katsutaka Hashiba Akihito Tanaka Kunihiro Matsuo Osamu Nomura Sunao Kojima Junichi Yamaguchi Tetsuya Matoba Yoshio Tahara Hiroshi Nonogi for the Japan Resuscitation Council (JRC) Acute Coronary Syndrome (ACS) Task Force and the Guideline Editorial Committee on behalf of the Japanese Circulation Society (JCS) Emergency and Critical Care Committee
出版者
The Japanese Circulation Society
雑誌
Circulation Reports (ISSN:24340790)
巻号頁・発行日
vol.4, no.10, pp.449-457, 2022-10-07 (Released:2022-10-07)
参考文献数
20
被引用文献数
1 5

Background: Recent guidelines for acute coronary syndrome (ACS) recommend prehospital administration of aspirin and nitroglycerin for ACS patients. However, there is no clear evidence to support this. We investigated the benefits and harms of prehospital administration of aspirin and nitroglycerin by non-physician healthcare professionals in patients with suspected ACS.Methods and Results: We searched the PubMed database and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence. Three retrospective studies for aspirin and 1 for nitroglycerin administered in the prehospital setting to patients with acute myocardial infarction were included. Prehospital aspirin administration was associated with significantly lower 30-day and 1-year mortality compared with aspirin administration after arrival at hospital, with odds ratios (OR) of 0.59 (95% confidence interval [CI] 0.35–0.99) and 0.47 (95% CI 0.36–0.62), respectively. Prehospital nitroglycerin administration was also associated with significantly lower 30-day and 1-year mortality compared with no prehospital administration (OR 0.34 [95% CI 0.24–0.50] and 0.38 [95% CI 0.29–0.50], respectively). The certainty of evidence was very low in both systematic reviews.Conclusions: Our systematic reviews suggest that prehospital administration of aspirin and nitroglycerin by non-physician healthcare professionals is beneficial for patients with suspected ACS, although the certainty of evidence is very low. Further investigation is needed to determine the benefit of the prehospital administration of these agents.
著者
Sunao Kojima Takeshi Yamamoto Migaku Kikuchi Hiroyuki Hanada Toshiaki Mano Takahiro Nakashima Katsutaka Hashiba Akihito Tanaka Junichi Yamaguchi Kunihiro Matsuo Naoki Nakayama Osamu Nomura Tetsuya Matoba Yoshio Tahara Hiroshi Nonogi for the Japan Resuscitation Council (JRC) Acute Coronary Syndrome (ACS) Task Force and the Guideline Editorial Committee on behalf of the Japanese Circulation Society (JCS) Emergency and Critical Care Committee
出版者
The Japanese Circulation Society
雑誌
Circulation Reports (ISSN:24340790)
巻号頁・発行日
vol.4, no.8, pp.335-344, 2022-08-10 (Released:2022-08-10)
参考文献数
24
被引用文献数
2

Background: In Japan, oxygen is commonly administered during the acute phase of myocardial infarction (MI) to patients without oxygen saturation monitoring. In this study we assessed the effects of supplemental oxygen therapy, compared with ambient air, on mortality and cardiac events by synthesizing evidence from randomized controlled trials (RCTs) of patients with suspected or confirmed acute MI.Methods and Results: PubMed was systematically searched for full-text RCTs published in English before June 21, 2020. Two reviewers independently screened the search results and appraised the risk of bias. The estimates for each outcome were pooled using a random-effects model. In all, 2,086 studies retrieved from PubMed were screened. Finally, 7,322 patients from 9 studies derived from 4 RCTs were analyzed. In-hospital mortality in the oxygen and ambient air groups was 1.8% and 1.6%, respectively (risk ratio [RR] 0.90; 95% confidence interval [CI] 0.38–2.10]); 0.8% and 0.5% of patients, respectively, experienced recurrent MI (RR 0.44; 95% CI 0.12–1.54), 1.5% and 1.6% of patients, respectively, experienced cardiac shock (RR 1.10; 95% CI 0.77–1.59]), and 2.4% and 2.0% of patients, respectively, experienced cardiac arrest (RR 0.91; 95% CI 0.43–1.94).Conclusions: Routine supplemental oxygen administration may not be beneficial or harmful, and high-flow oxygen may be unnecessary in normoxic patients in the acute phase of MI.
著者
Katsutaka Hashiba Takahiro Nakashima Migaku Kikuchi Sunao Kojima Hiroyuki Hanada Toshiaki Mano Takeshi Yamamoto Akihito Tanaka Junichi Yamaguchi Kunihiro Matsuo Naoki Nakayama Osamu Nomura Tetsuya Matoba Yoshio Tahara Hiroshi Nonogi for the Japan Resuscitation Council (JRC) Acute Coronary Syndrome (ACS) Task Force and the Guideline Editorial Committee on behalf of the Japanese Circulation Society (JCS) Emergency and Critical Care Committee
出版者
The Japanese Circulation Society
雑誌
Circulation Reports (ISSN:24340790)
巻号頁・発行日
pp.CR-22-0034, (Released:2022-07-13)
参考文献数
19
被引用文献数
3

Background: In the management of patients with ST-elevation myocardial infarction (STEMI), system delays for reperfusion therapy are still a matter of concern. We investigated the impact of prehospital activation of the catheterization laboratory in the management of STEMI patients.Methods and Results: This is a systematic review of observational studies. A search was conducted of the PubMed database from inception to July 2020 to identify articles for inclusion in the study. The critical outcomes were short- and long-term mortality. The important outcome was door-to-balloon time. The GRADE approach was used to assess the certainty of the evidence. Seven studies assessed short-term mortality; 1,541 were assigned to the prehospital activation (PH) group and 1,191 were assigned to the emergency department activation (ED) group. There were 26 fewer deaths per 1,000 patients in the PH group. Three studies assessed long-term mortality; 713 patients were assigned to the PH group and 1,026 were assigned to the ED group. There were 54 fewer deaths per 1,000 patients among the PH group. Five studies assessed door-to-balloon time; 959 were assigned to the PH group and 631 to the ED group. Door-to-balloon time was 33.1 min shorter in the PH group.Conclusions: Prehospital activation of the catheterization laboratory resulted in lower mortality and shorter door-to-balloon time for patients with suspected STEMI outside of a hospital.
著者
Sunao Kojima Takeshi Yamamoto Migaku Kikuchi Hiroyuki Hanada Toshiaki Mano Takahiro Nakashima Katsutaka Hashiba Akihito Tanaka Junichi Yamaguchi Kunihiro Matsuo Naoki Nakayama Osamu Nomura Tetsuya Matoba Yoshio Tahara Hiroshi Nonogi for the Japan Resuscitation Council (JRC) Acute Coronary Syndrome (ACS) Task Force and the Guideline Editorial Committee on behalf of the Japanese Circulation Society (JCS) Emergency and Critical Care Committee
出版者
The Japanese Circulation Society
雑誌
Circulation Reports (ISSN:24340790)
巻号頁・発行日
pp.CR-22-0031, (Released:2022-07-06)
参考文献数
24
被引用文献数
2

Background: In Japan, oxygen is commonly administered during the acute phase of myocardial infarction (MI) to patients without oxygen saturation monitoring. In this study we assessed the effects of supplemental oxygen therapy, compared with ambient air, on mortality and cardiac events by synthesizing evidence from randomized controlled trials (RCTs) of patients with suspected or confirmed acute MI.Methods and Results: PubMed was systematically searched for full-text RCTs published in English before June 21, 2020. Two reviewers independently screened the search results and appraised the risk of bias. The estimates for each outcome were pooled using a random-effects model. In all, 2,086 studies retrieved from PubMed were screened. Finally, 7,322 patients from 9 studies derived from 4 RCTs were analyzed. In-hospital mortality in the oxygen and ambient air groups was 1.8% and 1.6%, respectively (risk ratio [RR] 0.90; 95% confidence interval [CI] 0.38–2.10]); 0.8% and 0.5% of patients, respectively, experienced recurrent MI (RR 0.44; 95% CI 0.12–1.54), 1.5% and 1.6% of patients, respectively, experienced cardiac shock (RR 1.10; 95% CI 0.77–1.59]), and 2.4% and 2.0% of patients, respectively, experienced cardiac arrest (RR 0.91; 95% CI 0.43–1.94).Conclusions: Routine supplemental oxygen administration may not be beneficial or harmful, and high-flow oxygen may be unnecessary in normoxic patients in the acute phase of MI.
著者
Katsuhiko SANDO Takeshi YAMAMOTO Kenji SAWADA Tomoyuki TANIGUCHI Nobuyuki SOWA Haruki MORI Takahiro KONDO
出版者
The Japan Society of Mechanical Engineers
雑誌
Mechanical Engineering Journal (ISSN:21879745)
巻号頁・発行日
pp.20-00497, (Released:2021-03-03)
参考文献数
11
被引用文献数
1

This paper describes a design method of a friction reducer device using a loading cam to suppress unstable vibration. Nonlinear simulation and energy analysis of numerical solutions demonstrates that destabilization is caused by the large phase difference between the slipping velocity in the translation direction and that in the rotation direction. It was found that similarly unstable vibration occurs in various structures using wedge rollers with translational and rotational motion. The analytical equation could be simplified by focusing on the motion factor that affects the slip velocity of the power transmission surface, which is the factor of vibration. Consequently, the design method for suppressing vibration could be expressed by a mathematical formula. This equation is validated by using the results of experiments conducted in the previous work of the current authors. Furthermore, from this equation, we proposed that vibration could be suppressed by the parameter balance of the power transmission device without using damping. The power transmission surface slips when a quick torque is input and damping is used. The proposed design can handle a quick torque response and reduce the weight of the reducer. Specifically, the shape of the wedge roller is made lighter, so that the moment of inertia of the roller is not lowered, or the wedge roller is set as a small roller.
著者
Mizuki Miura Masao Yamasaki Yukari Uemura Masatomo Yoshikawa Katsumi Miyauchi Hiroyuki Tanaka Hideki Miyachi Jun Yamashita Makoto Suzuki Takeshi Yamamoto Ken Nagao Issei Komuro Morimasa Takayama
出版者
The Japanese Circulation Society
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
vol.80, no.2, pp.461-468, 2016-01-25 (Released:2016-01-25)
参考文献数
22
被引用文献数
14 16

Background:Previous trials have found that low low-density lipoprotein-cholesterol (LDL-C) on admission was associated with increased mortality in patients with acute myocardial infarction (AMI). There are few reports, however, on the effect of low LDL-C with or without in-hospital statin treatment on short-term prognosis in AMI patients.Methods and Results:A total of 9,032 AMI patients underwent primary PCI in 68 centers in the Tokyo CCU Network Registry during 2009–2012, in whom LDL-C was measured in 6,486. We divided them into 4 groups: statin-treated/LDL-C <100 mg/dl (n=1,236), statin-treated/LDL-C ≥100 mg/dl (n=3,671), statin-naïve/LDL-C <100 mg/dl (n=662), and statin-naïve/LDL-C ≥100 mg/dl (n=917). We assessed hospital mortality within 30 days. In-hospital all-cause mortality was significantly lower in the statin-treated/LDL-C ≥100-mg/dl group (3.2%, P<0.001). On multivariate Cox regression analysis, adjusted for age, gender, hypertension, diabetes mellitus, dyslipidemia and other clinical factors, the combination of statin treatment and LDL-C ≥100 mg/dl was an independent predictor of lower in-hospital mortality (adjusted HR, 0.211; 95% CI: 0.096–0.462; P<0.001). In the LDL-C <100-mg/dl patients, statin treatment also independently reduced in-hospital mortality (adjusted HR, 0.467; 95% CI: 0.223–0.976; P=0.043). Spontaneously low LDL-C was associated with increased short-term mortality.Conclusions:Statin treatment was associated with better short-term outcome in patients with AMI, even in patients with low LDL-C. (Circ J 2016; 80: 461–468)