Hidaka Hospital

Abstract Background While the thresholds of fractional flow reserve (FFR) and non-pressure hyperaemic ratios (NHPR) for identifying myocardial ischemia (≤0.75 for FFR, ≤0.89 for NHPR) and guiding coronary revascularization (≤0.80 for FFR, ≤0.89 for NHPR) are well established, the values associated with anginal symptoms and impaired exercise capacity in patients with chronic coronary syndrome (CCS) remain unknown. Purpose To identify the FFR and diastolic pressure ratio (dPR) thresholds associated with anginal symptoms and impaired exercise capacity in patients with CCS. Methods This prospective multicentre registry enrolled 208 patients with suspected CCS undergoing coronary angiography with invasive intracoronary pressure measurements at five institutions in our city, Japan. Patients with normal coronary arteries (n=12), coronary anatomies unsuitable for intracoronary pressure assessments (n=21), and one patient who did not undergo intracoronary pressure measurements were excluded, leaving 174 patients for analysis. All patients underwent a 6-minute walk test before cardiac catheterization, meaning that the test results were not influenced by prior knowledge of the severities of their disease. Anginal symptoms and 6-minute walk distance were assessed, with impaired exercise capacity defined as a walk distance below the expected distance based on age, sex, height, and body weight. The Youden index with receiver operating characteristic (ROC) curve analysis was used to determine the FFR and dPR thresholds associated with anginal symptoms and impaired exercise capacity. Results The median age of the patients was 73 [67, 77], and 78% were male. The median 6-minute walk distance was 395 m [325, 447]. Anginal symptoms were reproduced in 40 (23%) patients during the 6-minute walk test, and 39 (22%) had impaired exercise capacity. The median FFR was 0.73 [0.55, 0.85], and the median dPR was 0.85 [0.56, 0.93]. In ROC curve analyses, the area under the curve (AUC) for FFR in identifying anginal symptoms during 6-minute walk test was 0.68 [0.58, 0.79] (P<0.001), while that for dPR was 0.69 [0.59, 0.79] (P<0.001) [Fig.1]. The FFR threshold associated with anginal symptom was 0.53, with a sensitivity of 46% and specificity of 91%, while dPR threshold was 0.63, with a sensitivity of 51% and specificity of 85%. The AUC for FFR in identifying impaired exercise capacity was 0.55 [0.44, 0.66], and that for dPR was 0.56 [0.45, 0.67], indicating that neither FFR nor dPR was significantly associated with impaired exercise capacity (P=0.301 for FFR, P=0.257 for dPR, respectively) [Fig.2]. Conclusion The hemodynamic severity of coronary stenoses, as assessed by FFR and dPR, was associated with anginal symptoms but not with impaired exercise capacity. The FFR and dPR thresholds associated with anginal symptoms were lower than those typically used for ischaemia detection and revascularization decisions.

IntroductionLactic acid bacteria (LAB) are well known for their beneficial effects on the regulation of immune responses and host protection against microbial infections. We previously reported that heat-killed Enterococcus faecalis strain KH2 (heat-killed KH2), a species of LAB, enhances inflammatory responses at wound sites and accelerates the skin wound healing process. In this study, we aimed to clarify the pathway underlying the wound-healing effects of heat-killed KH2. We focused on CARD9, a common adaptor molecule for C-type lectin receptors and Dectin-2, the upstream receptor for this adaptor molecule.MethodsFour full-thickness dermal wounds were created on the backs of wild-type (WT) mice, CARD9 KO mice, and Dectin-2 KO mice, and the effects of heat-killed KH2 administration were examined. We analyzed the percent wound closure, re-epithelialization, granulation tissue formation, and the production of inflammatory cytokines and chemokines.ResultsHeat-killed KH2 administration enhanced wound closure, granulation tissue formation, and re-epithelialization in WT mice. However, these effects were absent in heat-killed KH2-treated CARD9 KO mice. Similar results were observed in the migration of neutrophils and the production of TNF-α, IL-6, KC, and MIP-2 in heat-killed KH2-treated CARD9 KO mice. Furthermore, heat-killed KH-2 induced activation of reporter cells expressing Dectin-2. Finally, heat-killed KH-2 treatment in Dectin-2 KO mice did not promote skin wound healing.ConclusionThese results suggest that recognition of heat-killed KH2 by Dectin-2 may activate CARD9-mediated signaling, which may contribute to the promotion of skin wound healing through KH2 treatment.

The impact of suture materials on surgical site infections (SSIs) has been well documented in various surgical fields; however, it has not been thoroughly examined in oral oncological surgery with free-flap reconstruction. This study aimed to evaluate the incidence of oral SSIs associated with the use of monofilament and braided sutures for flap fixation. A retrospective chart review of patients who underwent oral oncological resection with free-flap reconstruction was conducted between May 2020 and April 2024. Either monofilament (4-0 PDS® II or Monodiox®) or braided (3-0 Vicryl®) suture was used for flap suturing. The primary outcome was the incidence of oral SSIs, defined according to the guidelines of the United States Centers for Disease Control and Prevention. Multivariable logistic regression and inverse probability of treatment weighting based on propensity scores were used to estimate the risk differences. Of 209 eligible patients, 58 experienced oral SSIs, resulting in an incidence of 27.8%. Monofilament sutures were used in 174 patients and braided sutures in 35. The incidence of oral SSIs was higher in the braided suture group (42.9%) than in the monofilament suture group (24.7%). Analysis using propensity scores revealed a significantly higher risk of oral SSIs associated with braided sutures than with monofilament sutures, with a 18.5% risk difference (95% confidence interval, 2.1%-34.9%; P = 0.027). Braided sutures may pose an increased risk of SSIs in oral oncological surgeries with free-flap reconstructions. Monofilament sutures are recommended for reconstructions, especially of the floor of the mouth.

Mycobacteriummalmoenseis a rare species ofnon-tuberculosis mycobacteriadetected in Japan that causes pulmonary infection and cervical lymphadenitis. Here, we report a case of pulmonary infection caused byM. malmoense, which was difficult to distinguish fromMycobacterium tuberculosis(Mtb) infection. A 64-year-old Japanese woman with a history of pulmonarytuberculosishad bloody phlegm, a cough, and discomfort in her chest. Chest computed tomography revealed a cavity, infiltration, and a nodule. A smear test for acid-fast bacilli was positive, aMycobacteriumaviumcomplex transcription reverse-transcription concerted (TRC) test was negative, and an Mtb TRC test was withheld because the internal control was negative. After diluting the specimens, the internal control tested positive, and the sample tested negative. We diagnosed pulmonaryM. malmoenseinfection based on a culture test. In conclusion, attention should be paid to the concentration of bacteria in Mtb TRC test samples, ensuring that the internal control provides expected results.

Post-hip-fracture knee pain (PHFKP) occurs in ∼28%-37% of patients and contributes to a prolonged length of hospital stay (LOS). Analyses of LOS prolongation due to PHFKP have been limited to univariate analyses that do not consider important confounding factors. After adjusting for important confounding factors, we investigated whether the presence or absence of PHFKP makes a difference in LOS in patients with hip fractures. We conducted a retrospective review of the medical records of patients who had undergone postoperative rehabilitation after surgery for a hip fracture. Demographic and clinical information, discharge parameters, and PHFKP development information were collected from the medical records. Using propensity score matching, we performed a two-group comparison of LOS, the functional independence measure (FIM) motor score (FIMm), FIMm gain, and FIMm effectiveness in patients with and without PHFKP. Six variables were included in the calculation of propensity scores: age, sex, body mass index, fracture type, American Society of Anesthesiologists physical status, and independence in activities of daily living at discharge. One-way analysis of variance was used to examine the details of the relationships between LOS and (i) the time of PHFKP development and (ii) pain intensity. We analyzed the cases of 261 patients, of whom 87 (33.3%) developed PHFKP. In propensity score matching, 80 patients were each matched to a patient in the PHFKP or non-PHFKP group. After propensity score matching, a between-group comparison revealed that the PHFKP group had a longer LOS (+11days) than the non-PHFKP group, and there were no differences in FIMm gain or FIMm effectiveness. The timing of PHFKP development and pain intensity were not related to the LOS. Even after adjusting for confounders, the development of PHFKP was found to prolong LOS. Clinicians should be aware of possible LOS prolongation in hip fracture patients with PHFKP.