86 research outputs found
Transarterial embolization to treat a massive hemothorax during mechanical circulatory support via puncturing of the extracorporeal membrane oxygenation circuit
No full textAbstract Background Current guidelines recommend the use of mechanical circulatory support (MCS) for patients with cardiogenic shock that is refractory to medical therapy. Bleeding is the most common complication of MCS. Transarterial embolization (TAE) is often performed to treat this complication, because it is a less invasive hemostatic procedure. However, the TAE option needs to be carefully considered during MCS, as the access route may be limited during MCS. Case presentation A man in his 70 s was diagnosed with acute myocardial infarction and underwent percutaneous coronary intervention via venoarterial extracorporeal membrane oxygenation (VA-ECMO) and Impella. During treatment in the intensive care unit, he suffered damage to a branch of the internal thoracic artery during a cardiac drainage procedure, which was subsequently treated via emergency TAE. An ECMO return cannula and an Impella sheath were inserted into the patient’s right and left femoral arteries, respectively. An approach from the left brachial artery was selected, and the left internal thoracic artery was embolized. Subsequently, the patient required re-intervention to treat re-bleeding from another artery. Because it was difficult to target the target artery from the brachial one, owing to interference from the Impella catheter, the ECMO circuit near the return cannula was punctured and a guiding sheath was inserted. The ECMO flow and the patient’s blood pressure decreased following placement of this guiding sheath. We were thus able to maintain the patient’s blood pressure by increasing the infusion fluids and Impella flow, and embolize the target artery using a gelatin sponge to achieve hemostasis. Conclusion When TAE is difficult to perform during MCS using an approach from the upper extremities, a lower extremity approach with a sheath inserted into the ECMO circuit may represent a viable alternative
Eosinophilic Myocarditis With Hypersegmented Granulocytes and Neutrophilia Without Eosinophilia: A Case Mimicking Neutrophilic Myocarditis
No full text We report a case of a 78-year-old woman with neutrophilia without eosinophilia who was pathologically diagnosed with eosinophilic myocarditis by myocardial biopsy. The biopsy specimen showed infiltrating granulocytes with hypersegmentation, mimicking neutrophils; however, they were confirmed to be eosinophils by Giemsa staining. </jats:p
High Radial Artery Puncture Reduces CRPS Risk for Women: A Retrospective Case Series
No full textBackground/Objectives: Radial artery access (RAA) is widely used for catheter-based procedures due to its safety and convenience, but complex regional pain syndrome (CRPS) remains a rare, underrecognized complication—particularly in women. CRPS manifests as prolonged, severe pain and autonomic symptoms, often associated with nerve irritation near the carpal tunnel. This study aimed to evaluate whether modifying the puncture site to a high radial artery puncture (HRAP) reduces the risk of CRPS in patients undergoing transarterial micro-embolization (TAME) for frozen shoulder. Methods: We retrospectively reviewed 97 patients (47 women and 50 men) who underwent transarterial micro-embolization (TAME) via conventional RAA for frozen shoulder between February and June 2019. The occurrence of CRPS and vascular complications was recorded. All punctures were ultrasound-guided. Results: Among women treated via conventional RAA, five developed CRPS and one had radial artery occlusion. CRPS symptoms included intense puncture site pain (mean duration was 47 days), which severely impaired daily function. No complications occurred in men. Following the adoption of HRAP, no cases of CRPS, prolonged pain, or vascular complications were observed in the consecutive 101 women treated. Conclusions: Our findings suggest HRAP reduces CRPS risk by avoiding superficial nerve branches and targeting deeper arterial segments with fewer sensory structures. This ultrasound-guided modification is simple, does not require additional training, and may be widely applicable in both musculoskeletal and cardiovascular interventions. HRAP may help minimize neuropathic complications in broader patient populations
The Clarification of the Situation of Early Modern Education in Bhutan: 50 Years' History of Modern Education
No full text特集4: 雲南懇話会からの寄稿 = Special Issue 4: Contribution from the Yunnan ForumThis study aims to clarify the situation of early modern education in the Kingdom of Bhutan during the 1910-1950s by analysing reliable documents like annual reports on the relations between the British Government and Bhutan written by successive political officers in Sikkim. The origins of modern education in Bhutan can be traced back approximately 100 years. According to a history textbook there, 1914 saw the inception of modern education when 46 boys travelled to study at Dr. Graham's Homes in Kalimpong, India. In the same year, Ugyen Dorji established Bhutan's first modern school in Haa District. Then in the following year, another school was established in Bumthang District for educating the Crown Prince and children of the people serving in the King's court. In the first half of this paper, the author tried to examine the various aspects of these schools and proposed some facts of them and their students. Instead of the elite education institutions for the selected few, schools for the general public were established in Bhutan in the 1940-1950s. These schools can be classifying into 'private schools for Nepali immigrants' which were privately established in response to the strong demands of local residents in Southern area and 'public schools for Bhutanese' which were established under the initiative of local government officials. In the second half of this paper, it mentioned representative examples of these contrasting schools and took up educational development plan and ambition by policy makers such as the Third King Ugyen Dorji Wangchuck and the first Prime Minister Jigme Palden Dorji
Postprandial hyperglycemia and endothelial function in type 2 diabetes: focus on mitiglinide
No full textAbstract The risk of cardiovascular complication in a diabetes patient is similar to that in a nondiabetic patient with a history of myocardial infarction. Although intensive control of glycemia achieved by conventional antidiabetic agents decreases microvascular complications such as retinopathy and nephropathy, no marked effect has been reported on macrovascular complications or all-cause mortality. Evidence from VADT, ACCORD, and ADVANCE would suggest that glycemic control has little effect on macrovascular outcomes. Moreover, in the case of ACCORD, intensive glycemic control may be associated with an increased risk of mortality. There is sufficient evidence that suggests that postprandial hyperglycemia may be an independent risk factor for cardiovascular disease in diabetes patients. However, there are no prospective clinical trials supporting the recommendation that lowering postprandial blood glucose leads to lower risk of cardiovascular outcomes. Mitiglinide is a short-acting insulinotropic agent used in type 2 diabetes treatment. It has a rapid stimulatory effect on insulin secretion and reduces postprandial plasma glucose level in patients with type 2 diabetes. Because of its short action time, it is unlikely to exert adverse effects related to hypoglycemia early in the morning and between meals. Mitiglinide reduces excess oxidative stress and inflammation, plays a cardioprotective role, and improves postprandial metabolic disorders. Moreover, mitiglinide add-on therapy with pioglitazone favorably affects the vascular endothelial function in type 2 diabetes patients. These data suggest that mitiglinide plays a potentially beneficial role in the improvement of postprandial hyperglycemia in type 2 diabetes patients and can be used to prevent cardiovascular diseases. Although the results of long-term, randomized, placebo-controlled trials for determining the cardiovascular effects of mitiglinide on clinical outcomes are awaited, this review is aimed at summarizing substantial insights into this topic.</p
Voice Compression and Communications: Principles and Applications for Fixes and Wireless Channels
No full textUp-to-date, expert coverage of topics in wireless voice communications Voice communication is the most important facet of mobile radio service. Even when the predicted surge of wireless data and Internet services becomes a reality, voice will remain the most natural means of human communication. Voice Compression and Communications details issues in wireless voice communications and treats compression, channel coding, and wireless transmission as a joint subject. Part I covers background material, whereas Part II provides detailed information on both proprietary and standardized analysis-by-synthesis codecs, including the speech codecs of virtually all existing wireline-based and wireless systems. Parts III and IV discuss mainly research-based wideband, audio, as well as very low-rate schemes likely to find their way into future standards. Voice Compression and Communications describes fundamental concepts in a non-mathematical way early in the book for those with only a background knowledge of signal processing and communications. More advanced readers will find detailed discussions of theoretical principles, future concepts, and solutions to various specific wireless voice communications problems
Positively curved complex submanifolds immersed in a complex space form
No full textThe author gives the partial solution for the conjecture; a Kaehler submanifold in a complex space form of constant holomorphic sectional curvature 1 is totally geodesic if ever its holomorphic sectional curvature is greater than
1
2
\frac {1}{2}
.</p
Long-term warfarin therapy and biomarkers for osteoporosis and atherosclerosis
No full textAbstractBackgroundStroke prevention by warfarin, a vitamin K antagonist, has been an integral part in the management of atrial fibrillation. Vitamin K-dependent matrix Gla protein (MGP) has been known as a potent inhibitor of arterial calcification and osteoporosis. Therefore, we hypothesized that warfarin therapy affects bone mineral metabolism, vascular calcification, and vascular endothelial dysfunction.MethodsWe studied 42 atrial fibrillation patients at high-risk for atherosclerosis having one or more coronary risk factors. Twenty-four patients had been treated with warfarin for at least 12months (WF group), and 18 patients without warfarin (non-WF group). Bone alkaline phosphatase (BAP) and under carboxylated osteocalcin (ucOC) and receptor activator of nuclear factor-kappa B ligand (RANKL) were measured as bone metabolism markers. Reactive hyperemia-peripheral arterial tonometry (RH-PAT) index measured by Endo-PAT2000 was used as an indicator of vascular endothelial function.ResultsThere were no significant differences in patient background characteristics and other clinical indicators between the two groups. In WF group, the ucOC levels were significantly higher than those in the non-WF group (10.3±0.8 vs. 3.4±0.9ng/mL; P<0.01), similarly, the RANKL levels in the WF group were higher than those in the non-WF group (0.60±0.06 vs. 0.37±0.05ng/mL; P=0.007). Moreover, RH-PAT index was significantly lower in the WF group compared to those in the non-WF group (1.48±0.11 vs. 1.88±0.12; P=0.017).ConclusionsLong-term warfarin therapy may be associated with bone mineral loss and vascular calcification in 60–80year old hypertensive patients
- …
