Saitama Red Cross Hospital

(Malignant LymphomaML) 2 1, 2 ) 1-4 ) EB B (diffuse large B-cell lymphomaDLBCL)

BackgroundIntubation risk assessment in severe coronavirus disease 2019 (COVID-19) remains a key clinical challenge, especially for patients treated with high-flow nasal cannula (HFNC). We aimed to clarify whether lymphopenia at admission is associated with the subsequent need for intubation.MethodsThis retrospective study included all consecutive COVID-19 patients admitted to Saitama Red Cross Hospital in Saitama, Japan, from July to September 2021, who required HFNC therapy at presentation. Intubation was performed if the saturation of peripheral oxygen (SpO₂) remained below 90% despite HFNC with a fraction of inspired oxygen (FiO₂) of 80%. We compared clinical and laboratory characteristics between patients who required intubation and those successfully managed on HFNC to identify prognostic factors present at the time of HFNC initiation.ResultsOut of 49 analyzed patients, 15 required intubation during hospitalization and 34 did not. Age and body mass index (BMI) were similar between groups. The Mann-Whitney U tests showed significantly lower lymphocyte counts (intubation: 739.1/μL (interquartile range (IQR) 516.3) vs. non-intubation: 909.0/μL (IQR 423.4); p=0.034), lower lymphocyte percentage (8.0% (IQR 13.0) vs. 15.6% (IQR 9.6); p=0.037), and longer hospital stays (17 days (IQR 18) vs. 14 days (IQR 10); p=0.007) in the intubation group. Multivariate stepwise logistic regression identified lower lymphocyte count (OR 0.997; 95% CI: 0.995-1.000; p=0.048) and longer hospital stay (OR 1.09; 95% CI: 1.01-1.20; p=0.036) as independent indicators of intubation.ConclusionIn severe COVID-19 patients treated with HFNC, admission lymphopenia was independently associated with subsequent intubation; however, its discriminative performance as a prognostic marker was modest. Lymphocyte counts may aid prognostic risk stratification when interpreted cautiously alongside conventional clinical markers and oxygenation indices, particularly in the context of current and future respiratory viral outbreaks.

要旨 サルモネラは急性感染後に胆嚢・胆管内で胆石にバイオフィルムを形成し，慢性保菌者となることが知られている。慢性保菌者では重症化のリスクがあるため注意を要する。症例は82歳の女性で1か月前に重量物を持った後に腰痛で体動困難となり，その後経口摂取がほとんどできなくなった。前日から発熱と意識障害を認め救急搬送となった。左腸腰筋膿瘍，第2・第4腰椎圧迫骨折，敗血症性ショックの診断で入院した。入院後に髄膜炎および化膿性脊椎炎が判明し，血液・髄液・膿からは Salmonella species O4 群が検出された。膿瘍ドレナージを含む集学的治療を行ったが，意識障害は遷延し，第79病日に療養型病院へ転院となった。本症例では胆石を有しており，原因菌の慢性保菌者であった可能性がある。慢性保菌者が腰椎圧迫骨折に続発して化膿性脊椎炎を発症し，外傷や低栄養による免疫低下から腸腰筋膿瘍，髄膜炎，敗血症性ショックへ進展したことが疑われた。高齢者や免疫低下状態ではサルモネラ菌血症の発症リスクが高く，その予後は不良である。胆石を有する患者ではサルモネラの慢性保菌者である可能性を念頭に置き，感染症状があればサルモネラ菌血症も鑑別に挙げることが重要である。

要旨 症例は50歳台の男性で，既往に高血圧があり，降圧薬を内服していた。突然の胸痛で救急要請があり，救急隊が接触した際には頻脈で血圧測定不能のショック状態であり，救命救急センターに搬送された。来院後もショックが継続し，心エコーで心嚢液貯留を認め，心タンポナーデによる閉塞性ショックと判断した。エコーガイド下に経皮的心嚢穿刺を試みたが安全な穿刺部が確保不能であり，全身麻酔下に左小切開開胸による心嚢ドレナージの方針とした。エコーで心膜との最短距離を同定し左小切開開胸アプローチによる心嚢ドレナージ術を施行した。循環動態が安定した後，造影CT検査を行い急性大動脈解離Stanford A（acute type A of aortic dissection: ATAAD）の診断となり，心臓血管外科で緊急上行大動脈人工血管置換術を施行した。術後はsurgical site infectionなどの合併症なく良好に経過し，術後19日で退院した。急性大動脈解離に合併する心タンポナーデへの治療方法として心嚢穿刺や心膜開窓術が挙げられる。左小切開開胸アプローチによる心嚢ドレナージは心膜までの到達距離や出血合併症軽減を考慮し，剣状突起下アプローチが困難な場合にドレナージの選択肢の一つとなりうると考える。

Cough reflex and vagal reflex-induced bradycardia are important to predict and prevent prior to PFA to ensure procedural safety and efficacy. However, no studies have yet investigated differences in their incidence among the various PFA systems. We aimed to evaluate the incidence, predictors, and system-specific differences of cough reflex and vagal response during PFA in a large multicenter cohort. Data from 1715 patients undergoing PFA using either PulseSelect, Farapulse, or Varipulse systems at 13 centers were analyzed. Cough reflex was defined as any episode requiring procedure interruption or physical restraint, while a vagal response was defined as sinus arrest or atrioventricular block lasting ≥ 5s. Pulmonary vein isolation was achieved in all patients except for one case. Complications were rare and did not differ significantly among the PFA systems. Cough reflex occurred in 49.3% of patients, most frequently in the left superior pulmonary vein. Compared with Farapulse, the risk of cough reflex was higher with PulseSelect (odds ratio [OR] 1.648, 95% confidence interval [CI] 1.321-2.057) and Varipulse (OR 1.645, 95% CI 1.019-2.657). Patient-related factors such as male sex, asthma, heart failure, and hypertension increased the risk, whereas general anesthesia significantly reduced it (OR 0.236, 95% CI 0.174-0.318). Vagal response occurred in 15.2% of patients, with no significant differences among the PFA systems, and the sequence of pulmonary vein isolation did not affect its occurrence. Prophylactic atropine reduced the risk of vagal response. Cough reflex may vary across PFA systems, while vagal response may remain consistent.

BackgroundAutoimmune pulmonary alveolar proteinosis (aPAP) is a rare disease characterized by progressive surfactant accumulation and hypoxemia caused by autoantibodies against granulocyte–macrophage colony-stimulating factor (GM-CSF), which alveolar macrophages require to clear surfactant. Molgramostim is a formulation of inhaled recombinant human GM-CSF, but its efficacy and safety in patients with aPAP have not been studied sufficiently.MethodsIn this phase 3, double-blind, placebo-controlled trial, we randomly assigned patients with aPAP to receive molgramostim at a dose of 300 μg or placebo once daily for 48 weeks. The primary end point was the change from baseline to week 24 in the diffusing capacity of the lungs for carbon monoxide (DLCO), which was adjusted for hemoglobin concentration and expressed as a percentage of the predicted value. Secondary end points adjusted for multiplicity were the change from baseline in DLCO at 48 weeks and the change from baseline in the St. George’s Respiratory Questionnaire total (SGRQ-T) and activity (SGRQ-A) scores (scores range from 0 to 100, with lower scores indicating better quality of life) and in exercise capacity at 24 and 48 weeks.ResultsA total of 164 patients underwent randomization: 81 were assigned to receive molgramostim and 83 to receive placebo. The least-squares mean change in DLCO from baseline to week 24 was 9.8 percentage points (95% confidence interval [CI], 7.3 to 12.3) with molgramostim and 3.8 percentage points (95% CI, 1.4 to 6.3) with placebo (estimated treatment difference, 6.0 percentage points; 95% CI, 2.5 to 9.4; P<0.001). The least-squares mean change in DLCO from baseline to week 48 was 11.6 percentage points (95% CI, 8.7 to 14.5) with molgramostim and 4.7 percentage points (95% CI, 1.8 to 7.6) with placebo (P<0.001), and the least-squares mean change in the SGRQ-T score at week 24 was −11.5 points (95% CI, −15.0 to −8.0) and −4.9 points (95% CI, −8.3 to −1.5), respectively (P=0.007). No significant between-group difference in the change in SGRQ-A score was observed at 24 weeks, so no statistical inference was drawn with respect to subsequent secondary end points. The percentage of patients with at least one adverse event and the percentage with at least one serious adverse event were similar in the two groups.ConclusionsOnce-daily inhaled molgramostim led to a greater increase in pulmonary gas transfer than placebo in patients with aPAP. (Funded by Savara; IMPALA-2 ClinicalTrials.gov number, NCT04544293; European Union Clinical Trials Information System number, 2024-511052-41-00.)

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

BackgroundThe widespread availability of health information online, coupled with the ease of access to the internet, has led pregnant women to rely heavily on online sources for pregnancy-related guidance. The internet-based information regarding nutrition enabled positive dietary changes for pregnant women. Although there are some important sources for pregnant women to collect their health information, some information increases maternal anxiety and difficulties based on a lack of information. Moreover, some women become confused due to conflicts on the same topics from different websites. However, concerns about the reliability and impact of this information have surfaced, contributing to heightened anxiety among expectant mothers. The importance of the quality of web-based information is increasingly recognized; however, no studies have evaluated the quality of nutrition-related information for pregnant women.ObjectiveThis study aims to bridge this research gap by assessing the quality of online health information concerning prenatal nutrition tailored to pregnant women.MethodsThis cross-sectional descriptive study was conducted through a Google keyword search on February 14, 2023. We used search terms, such as “pregnancy,” “pregnant women,” “diet,” and “nutrition” and conducted an exhaustive search on Google. Using the Quality Evaluation Scoring Tool (QUEST), we meticulously evaluated the quality of the retrieved information.ResultsThe top 20 Google-searched sites were evaluated using the QUEST tool. The average score was 11.7 points, ranging from 6 to 15, with most sites scoring between 11 and 15. Half of the websites lacked clear authorship and most gave weak or no attribution to specific scientific sources. While conflict of interest scored highest overall, with 60% showing no bias, some sites promoted products or specific interventions. Currency was inconsistent—only half were updated within 5 years. Complementarity received the lowest scores, with 70% lacking support for patient-physician relationships. The tone was generally positive, with 95% supporting their claims, though only one site used a balanced, well-reasoned tone. Discrepancies in cited guidelines on nutritional intake and inappropriate expressions about alcohol, weight management, and miscarriage raised concerns about the information’s accuracy and appropriateness.ConclusionsAlthough many websites use cautious language to mitigate commercial influence, deficiencies persist in crucial areas for empowering informed decision-making among pregnant women. From our assessment of the results, it was found that incorrect evidence information is provided at the top of search results, which is easily accessible to users. The inadequacies in attributing authorship, clarifying conflicts of interest, and ensuring the currency of information pose substantial challenges to the reliability and usefulness of online health resources in prenatal nutrition. Since internet-based information is the most accessible, reliable evidence should be provided to protect everyone from misinformation, including shallow health literacy demographics, and from potential physical and psychological harm.