Kitasato University Hospital

Bronchoscopy frequently precipitates intraprocedural hypoxemia. Although several recent randomized controlled trials suggest that high-flow nasal cannula oxygen (HFNO) reduces intraprocedural hypoxemia during bronchoscopy, the overall certainty of this evidence remains insufficient. Hence, we performed a systematic review and meta-analysis to compare the efficacy of HFNO with that of conventional low-flow oxygen therapy (COT) during adult bronchoscopy. MEDLINE, Embase, and trial registries were searched for randomized controlled trials (RCTs) involving adults (18y or older) undergoing bronchoscopy that compared HFNO with COT. The primary outcome was the incidence of hypoxemia during the procedure. The key secondary outcomes were total procedure time, bronchoscopy interruption, and lowest intraprocedural peripheral oxygen saturation. The pooled risk ratios (RRs) or mean differences (MDs) were calculated, and the certainty of evidence was assessed. The protocol was registered with PROSPERO (CRD420251071548). Eleven RCTs (12 study arms) comprising 1714 participants met the inclusion criteria. HFNO was found to significantly reduce the incidence of hypoxemic events compared with COT (RR: 0.39, 95% CI: 0.26-0.59) and lowered the likelihood of procedure interruption (RR: 0.39, 95% CI: 0.27-0.55). HFNO also maintained a higher nadir SpO2 (MD=4.5%, 95% CI: 3.02-5.99). No statistically significant difference was observed in the total procedure time (MD: -0.87min, 95% CI: -1.99 to 0.25). This meta-analysis showed HFNO reduces the incidence of intraprocedural hypoxemia and interruptions during bronchoscopy. Our findings support a selective approach, suggesting the benefits of HFNO are greater in high-risk patients.

Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and updated in 2022 (Ozaki et al. in Cardiovasc Interv Ther 33:178-203, 2018), (Ozaki et al. in Cardiovasc Interv Ther 37:1-34, 2022). Following the publication of the 2023 European Society of Cardiology (ESC) Guidelines for the management of acute coronary syndromes, the CVIT Task Force released another revised version in 2024 (Ozaki et al. in Cardiovasc Interv Ther 39:335-375, 2024). In light of new clinical evidence and technological advances that have emerged since then, the Task Force now proposes an updated expert consensus document for the management of ACS focusing on procedural aspects of primary PCI in 2026 version.

BACKGROUND: Postoperative shoulder stiffness after arthroscopic rotator cuff repair (ARCR) is a frequent complication limiting recovery. Flossing therapy, applying circumferential compression with an elastic band, has shown promise in sports medicine but has not been reported in postoperative shoulder rehabilitation. CASE PRESENTATION: Two patients in their 50s developed stiffness after ARCR despite standard rehabilitation. Flossing was applied by wrapping an elastic band from the upper arm to the shoulder, followed by passive and active movements under compression, and then active motion after decompression. Flossing therapy was performed as an adjunct to routine postoperative rehabilitation. OUTCOME AND FOLLOW-UP: Case 1 improved flexion from 160° to 180°, abduction from 150° to 180°, and internal rotation from T12 to T7. Case 2 improved flexion from 110° to 170°, abduction from 80° to 170°, and internal rotation from L2 to T10. Both patients experienced reductions in pain and improvements in strength and satisfaction. DISCUSSION: These cases suggest that flossing therapy may help improve shoulder mobility when progress plateaus with standard rehabilitation. Possible mechanisms include enhanced fascial gliding and proprioceptive modulation; however, no causal conclusions can be drawn from two cases. Further controlled studies are needed to evaluate safety, efficacy, and optimal treatment parameters.

Background/Objectives: This study aimed to describe the population pharmacokinetics of cefazolin (CFZ) using unbound serum and periprostatic adipose tissue concentrations and to optimize dosing regimens for patients undergoing robotic-assisted radical prostatectomy (RARP). Methods: We investigated the population pharmacokinetics of CFZ using 295 unbound serum and 67 periprostatic adipose tissue samples from 67 individuals. CFZ concentrations were determined in all samples. A nonlinear mixed-effects model was developed. The pharmacodynamic target was defined as maintaining unbound trough and periprostatic adipose tissue concentrations exceeding the minimum inhibitory concentration (MIC) against methicillin-susceptible Staphylococcus aureus (MSSA) for over 90% of the dosing interval (MIC90; 0.5 mg/L). Results: Systemic clearance of unbound CFZ was significantly associated with creatinine clearance (CLcr). In patients with normal renal function, simulations showed that a 1 g CFZ infusion over 15 min maintained unbound concentrations exceeding the MSSA MIC90 for >90% of the 3 h interval after the initial dose. Notably, in patients with mild renal impairment (CLcr ≤ 80 mL/min), a 5 h dosing interval also achieved a >90% probability of maintaining the target CFZ concentration. Conclusions: The simulations demonstrated that the probability of target attainment of >90% was maintained for up to 5 h in patients with mild renal impairment (CLcr ≤ 80 mL/min). These findings provide a pharmacokinetic rationale suggesting that the standard additional dose may not be necessary for this subgroup; however, future clinical studies are needed to validate safety and efficacy.

We investigated the impact of operating room pharmacists on the appropriate use of antimicrobial prophylaxis (AMP) in otorhinolaryngology-head and neck surgery. Patients without intervention by operating room pharmacists (April 1, 2017, to March 31, 2019) and those who underwent intervention by operating room pharmacists (October 1, 2019, to March 31, 2021) were compared. Additionally, an interrupted time-series (ITS) analysis was conducted as a sensitivity analysis to assess temporal trends. Overall, 1697 patients (999 in the non-intervention group and 698 in the intervention group) were included, and 213 matched pairs were analyzed after 1 : 1 propensity score matching. The compliance rate of AMP administered within 1 h prior to incision was significantly higher in the intervention group than in the non-intervention group (98.1 vs. 93.4%; p = 0.027). In the subgroup analysis, the compliance rate of the guideline-recommended initial dose in patients weighing ≥80 kg was significantly higher in the intervention group than in the non-intervention group (93.1 vs. 70.7%; p < 0.001). The compliance rate of additional doses administered at the guideline-recommended intervals in patients with an estimated glomerular filtration rate individualized body surface area (eGFRind) <50 mL/min was significantly higher in the intervention group than in the non-intervention group (89.8 vs. 80.4%; p = 0.041). ITS analysis showed that the improvement trend in AMP compliance stabilized after the intervention, indicating sustained intraoperative management. No significant differences were observed in the postoperative or total hospital stay between the two groups. In conclusion, interventions by operating room pharmacists significantly improved the appropriate use of intraoperative AMP.

Progress in intensive care for cardiovascular disease, including catheter-based therapies and mechanical circulatory support, has improved patient survival. Conversely, the numbers of patients with severe disease and older patients with multimorbidities have increased, resulting in complications during management in the intensive care unit (ICU). In addition to ICU-acquired weakness and delirium, postintensive care syndrome (PICS) has recently been recognized, defined as a prolonged impairment in physical, cognitive, and mental status. Physiotherapy is an important treatment option to prevent and ameliorate PICS. Recently, the goals of early-phase physiotherapy have shifted beyond short-term outcomes, such as reducing the length of ICU and hospital stays and recovery of physical function, to include long-term outcomes, such as return to social activity and reduced rehospitalization. Thus, appropriate physiotherapy management and intervention during the ICU are potentially crucial, because high-quality phase I cardiovascular rehabilitation leads to a seamless approach to the next phase of rehabilitation. This review summarizes current clinical issues, the implementation of assessment and treatment strategies in acute-phase physiotherapy, and future perspectives and challenges in cardiovascular intensive care.

The patient was a 56-year-old woman who had previously undergone living-donor kidney transplantation, followed by urinary diversion surgery due to recurrent pyelonephritis. Nine years after the urinary diversion, abdominal computed tomography performed for evaluation of lower abdominal pain revealed a renal calculus in the transplanted kidney. Percutaneous nephrolithotomy resulted in satisfactory stone fragmentation, but had to be performed again 14 months later to remove a residual stone that had increased in size.