Cardiogenic shock has a high mortality rate. Even with the use of the Impella device, there are certain number of cases require further escalation therapy, although the predictive factors have not been fully elucidated. In this study, we aimed to estimate the acute mortality rate and the rate of requiring escalation therapy, as well as evaluate the predictors of the need for escalation therapy, including electrocardiographic parameters. In this retrospective study, we analyzed the patients with cardiogenic shock on Impella support between April 2018 and June 2021. Electrocardiogram, serum lactate levels, and pulmonary artery catheterization parameters were assessed 12 h after Impella implantation. Patients who died or required escalation therapy within 30 days of Impella implantation were defined as the deteriorated group and the remaining as the recovered group. A total of 67 patients with cardiogenic shock (66 ± 16 years; 46 men) with Impella were evaluated. The 30-day mortality rate and rate of requiring escalation therapy were 24
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of December 2020 was searched in PubMed, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution Service (Minds) technique. A total of 38 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, pathological diagnosis deciding the diagnosis, and causal genes of vascular anomalies. Thus, the Japanese clinical practice guidelines for vascular tumors, vascular malformations, lymphatic malformations, and lymphangiomatosis 2022 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
BACKGROUND:Postoperative delirium (POD) is a common complication that is associated with adverse outcomes. However, differences between surgical patients in intensive care unit (ICUs) and non-ICUs are unclear. This study investigated POD incidence, prognostic significance, and risk factors in ICU and non-ICU settings. METHODS:We retrospectively analyzed data from 20,338 adults who underwent general anesthesia at Nippon Medical School Hospital between July 2021 and March 2025. Patients were classified as ICU (n=2,451) and non-ICU patients (n=17,887). POD was defined by an Intensive Care Delirium Screening Checklist score of ≥4 or prescription of antipsychotics. Logistic regression was used to identify risk factors, and Kaplan-Meier analysis assessed 180-day mortality. Subgroup analysis evaluated differences between early (≤2 days) and late (3-7 days) POD. RESULTS:The overall incidence of POD was 4.4% (889/20,338) and was higher in ICU patients (19.1%) than in non-ICU patients (2.3%; p<0.001). POD was positively associated with 180-day mortality in both groups (p<0.001). Among non-ICU patients, survival was worse among patients with late POD than among those with early POD (p<0.001), whereas onset timing had no impact in ICU patients. Risk profiles differed: advanced age, higher American Society of Anesthesiologists class, and cerebrovascular disease were associated with POD in non-ICU patients, while male sex and dialysis were significant factors for ICU patients. Excessive positive fluid balance and prolonged operative time increased POD risk in both groups, but gradients were steeper in non-ICU patients. CONCLUSIONS:POD was independently positively associated with excess mortality across settings, but the risk factors and prognostic implications varied. These findings highlight the need for ward-specific preventive strategies and tailored perioperative management.
Breast reconstruction using autologous fat grafting offers a less invasive alternative with shorter surgical times compared to traditional flap procedures. Although adipose-derived stem cells (ASCs) have improved fat graft survival rates, the variability in mesenchymal stem cells (MSCs) quality due to donor health and medication intake poses challenges. MSCs derived from induced pluripotent stem cells (iPSC-MSCs) demonstrate enhanced proliferative and immunomodulatory properties that may further enhance outcomes. We harvested human adipose tissue from surgical specimens and isolated ASCs. We used human iPSC-MSCs generated through a neural crest cell lineage under xeno-free conditions (iMSCs), to assess the improvement in survival and integration of autologous human adipose tissue grafts in BALB/c-nu/ + mice. We compared outcomes in groups treated with phosphate-buffered saline (PBS), ASCs, and iMSCs over 28 days, focusing on fat graft retention, fibrosis, and neovascularization, and adipogenic differentiation using vimentin/perilipin immunofluorescence staining. iMSC treatment significantly preserved graft area (82.3 ± 20.5
