Background: Supraglottic airway devices (SGA) are often used for out-of-hospital cardiac arrest (OHCA) patients. However it remains unclear whether a use of SGA improves survival outcomes of OHCA compared with bag-valve-mask (BVM) alone.1Morimura N. Comparison of arterial blood gases of laryngeal mask airway and bag-valve-mask ventilation in out-of-hospital cardiac arrests.Circ J. 2009; 73: 490-562Crossref PubMed Scopus (36) Google Scholar, 2Rumball C.J. MacDonald D. The PTL, Combitube, laryngeal mask, and oral airway: a randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest.Prehos Emerg Care. 1997; 1: 1-10Crossref PubMed Scopus (191) Google Scholar Material and method: Data of OHCA patients from January 1, 2007 through December 31, 2008 were extracted from the nationwide Utstein-style registry of Japan. We excluded patients younger than 18 and older than 75 of age. Also excluded are cardiac arrest witnessed by EMS personnel, trauma- or malignancy-related cardiac arrest and patients for whom resuscitation was not attempted. The primary outcome measure was 1-month survival with minimal neurologic impairment (CPC 1 or 2) and secondary outcome was return of spontaneous circulation (ROSC) before arriving at hospital. One to one matching based on a propensity score and conditional logistic regression modeling technique were used to calculate the relative risk (RR) of SGA over BVM, adjusting for potential confounders including witness status of the arrest, bystander cardiopulmonary resuscitation, AED use, initial ECG rhythm, and call-response interval. Results: Out of a total of 21,582 eligible patients, the propensity score matching yielded 6816 matched pairs.. A RR (95%CI) of SGA for the CPC score at 1-month post-arrest was 0.38 (0.31–0.47) and a RR (95%CI) of SGA for the ROSC was 0.40 (0.34–0.47). There was not significant dose-response relationship between the ambulance call to hospital arrival at hospital interval and those two Relative Risks. Conclusion: Our large-scale database analysis has revealed that a use of SGA is negatively associated with both the immediate outcome and neurological outcome. The results appear to warrant prospective, interventional trial concerning the effectiveness of the use of SGA over BVM.

Background: Public access defibrillation now plays an important role in the treatment of sudden cardiac arrest. In July 2004, a law came into force allowing lay people to use automated external defibrillators (AED) in Japan, and thereafter, number of public access AED placement reached more than 200,000 in the year of 2010.

Recently washable wool is strongly requested in order to avoid dry cleaning with chlorinated solvents such as perchloroethylene. So far wool top has been chlorinated for shrink proofing. However chlorination will be prohibited for AOX zero emission in the near future.In this article wool fibers and fabrics were treated by pulse corona discharge, followed by two kinds of enzymes, protease and keratinase. The effects of pulse corona discharge pretreatment and enzyme concentrations on the shrinkage, strength, weigh loss, surface property, and handle of the fibers were investigated. It was found that the treatment of enzyme, in particular the keratinase, after the pulse corona discharge is very effective for shrinkage, weight loss, and strength compared to the enzyme treatment alone.Scanning electron micrographs of wool surface after the treatment showed that the wool surface is treated uniformly with the enzymes, in particular the keratinase, after the pulse corona discharge, and the fibrillation of the fabrics reduces significantly. The dual treatment improves the shrinkage with little change of the strength and handle of the wool fabrics.

This study investigated the comparative effects of losartan and amlodipine on the activation of the sympathetic nervous system, renin-angiotensin-aldosterone system (R-A-A system) and brain natriuretic peptide (BNP) in patients with essential hypertension. Twenty-four elderly patients who had received more than 12 months of antihypertensive treatment with amlodipine participated in this study. The treatment regimen of 5 mg/day amlodipine was changed to 50 mg/day losartan. Plasma catecholamines (norepinephrine, epinephrine and dopamine), active renin, aldosterone and BNP concentration were measured before and after an average of 5 months of losartan treatment. After losartan treatment, blood pressures were not changed, suggesting the comparable effect of 50 mg losartan and 5 mg amlodipine on elevated blood pressure. Losartan significantly reduced norepinephrine (799 +/- 277 pg/mL vs. 692 +/- 268 pg/mL, p < 0.05) and aldosterone concentration (81.2 +/- 35.3 pg/mL vs. 55.2 +/- 17.7 pg/mL, p < 0.01), whereas there were not any changes in BNP concentrations. These findings suggested that losartan might be superior to amlodipine in prevention of chronic or intermittent sympathetic hyperactivity and enhanced R-A-A system.

STUDY OBJECTIVES We evaluated whether interleukin (IL)-6 is produced in the pulmonary circulation and investigated the relationship between IL-6 spillover in the lung and pulmonary vascular resistance (PVR) in patients with congestive heart failure (CHF). PATIENTS AND INTERVENTIONS Blood samples were obtained from the main pulmonary artery and pulmonary capillary wedge region in 50 patients with symptomatic left ventricular dysfunction, who had undergone cardiac catheterization, and 9 age-matched control subjects. Plasma IL-6, tumor necrosis factor-alpha, norepinephrine (NE), endothelin-1, atrial and brain natriuretic peptide, and cyclic guanosine monophosphate (cGMP) levels were determined. MEASUREMENTS AND RESULTS Plasma IL-6 concentrations were significantly higher in the pulmonary capillary wedge region than in the main pulmonary artery in both control subjects and patients with CHF. IL-6 production in the lung increased markedly in patients with severe CHF compared with control subjects and patients with mild CHF. Among hemodynamic variables, neurohumoral factors, and medications, plasma NE levels (p < 0.0001) showed an independent and significant positive relationship with IL-6 production in the lung, and treatment with beta-blockers (p = 0.004) showed an independent and significant negative relationship with IL-6 production in the lung. There was a significant positive correlation between IL-6 production in the lung and both PVR (r = 0.43; p = 0.001) and cGMP production in the lung (r = 0.498; p < 0.0001). CONCLUSION IL-6 production in the pulmonary circulation increases with the severity of CHF and is mainly associated with the activation of the sympathetic nervous system. The local production of IL-6 in the lung may modify PVR in patients with CHF.

OBJECTIVES The aim of this study was to evaluate the relationship between plasma oxidized low-density lipoprotein (oxLDL), a marker of oxidative stress, and the prognosis of patients with chronic congestive heart failure (CHF).BACKGROUND Oxidative stress appears to play a role in the pathophysiology of CHF. We have recently reported the usefulness of plasma oxLDL as a marker of oxidative stress in CHF patients with dilated cardiomyopathy.METHODS We measured the plasma level of oxLDL by sandwich enzyme-linked immunosorbent assay using a specific monoclonal antibody against oxLDL in 18 age-matched normal subjects and in 84 patients with chronic CHF (New York Heart Association functional class II to IV) and monitored them prospectively for a mean follow-up period of 780 days.RESULTS Plasma oxLDL level was significantly higher in severe CHF patients than in control subjects and mild CHF patients. A significant negative correlation existed between the plasma level of oxLDL and left ventricular ejection fraction (LVEF) and a significant positive correlation between the plasma level of oxLDL and plasma norepinephrine level. Twenty-six patients had cardiac events; 14 had cardiac death and 12 were hospitalized for heart failure or other cardiovascular events. Among 10 variables including LVEF and neurohumoral factors, only high plasma levels of brain natriuretic peptide and oxLDL were shown to be independent predictors of mortality.CONCLUSIONS These results indicate that the plasma level of oxLDL is a useful predictor of mortality in patients with CHF, suggesting that oxidative stress plays an important role in the pathophysiology of CHF. (J Am Coll Cardiol 2002;39:957-62) (C) 2002 by the American College of Cardiology Foundation.

OBJECTIVES The study evaluates the effect of atrial natriuretic peptide (ANP) compared with nitroglycerin (GTN) on left ventricular (LV) remodeling after first anterior acute myocardial infarction (AMI).BACKGROUND Compared with GTN, ANP suppresses the renin-angiotensin-aldosterone system and endothelin-1 (ET-1), which stimulate LV remodeling.METHODS Sixty patients with a first anterior AMI were randomly divided into the ANP (n = 30) or GTN (n = 30) groups after direct percutaneous transluminal coronary angioplasty. We evaluated LV ejection fraction (LVEF), end-diastolic volume index (LVEDVI) and endsystolic volume index (LVESVI) at the acute phase and after one month. We also measured neurohumoral factors during study drug infusion.RESULTS There nas no difference in the baseline characteristics or LVEF (46.9 +/- 1.0 vs. 46.8 +/- 1.3%) between the two groups. Although there was no difference in hemodynamics during the infusion periods, the LVEF tvas significantly improved after one month compared with the baseline value in both groups, but it was improved more in the ANP group than in the GTN group (54.6 +/- 1.1%, 50.8 +/- 1.3%, p < 0.05). Left ventricular enlargement was prevented in the ANP group (LVEDVI, 85.8 +/- 3.1 ml/m(2) to 87.3 +/- 2.7 ml/m(2); p = ns, LVESVI, 45.6 +/- 1.8 ml/m(2) to 41.0 +/- 2.1 ml/m(2), p < 0.05) but not in the GTN group (LVEDVI, 86.2 +/- 4.1 to 100.2 +/- 3.7, p < 0.01; LVESVI, 46.3 +/- 2.8 ml/m(2) to 51.1 +/- 3.0 ml/m(2), p = ns). During the infusion, ANP suppressed plasma levels of aldosterone, angiotensin II and ET-1 compared with GTN.CONCLUSIONS These findings indicate that in patients with a first anterior AMI, an ANP infusion can prevent LV remodeling better than can GTN, and effectively suppresses aldosterone, angiotensin II and ET-1. (J Am Coll Cardiol 2001;37:1820-6) (C) 2001 by the American College of Cardiology.

Objectives The purpose of this study was to evaluate whether plasma aldosterone (ALD) is extracted or produced through the heart in patients with acute myocardial infarction (AMI) and to determine the relationship between transcardiac extraction of plasma ALD and left ventricular (LV) remodeling.Background Although we demonstrated that circulating ALD was extracted through the failing heart and that transcardiac extraction of ALD correlated with LV end-diastolic volume index (LVEDVI) in patients with congestive heart failure, the existence and increase of ALD synthase in the hearts of infarct rats were reported, suggesting cardiac: production of ALD in patients with AMI.Methods We measured plasma ALD in the aortic root (Ao) and coronary sinus (CS) in 57 consecutive patients who received successful revascularization and enalapril, with first AMI at acute phase and after one month. We also measured plasma procollagen type III aminoterminal peptide (PIIINP) in the CS.Results Plasma ALD was significantly lower in the CS than it was in the Ac, at the acute phase (84.7 +/-6.3 pg/ml vs. 105.5 +/-8.0 pg/ml, p<0.0001). Significant positive correlations exist between the transcardiac gradient of ALD at the acute phase and the LVEDVI at one month. Moreover, the transcardiac gradient of plasma ALD at the acute phase has a significant correlation with plasma PIIINP, a biochemical marker of fibrosis, after one month. Stepwise multivariate analysis showed that transcardiac extraction of plasma ALD at the acute phase had an independent and significant positive relationship with a large LVEDVI after one month.Conclusions These results indicate that plasma ALD is extracted through the heart in patients with AMI at the acute phase and that the extracted ALD plays an important role in modulating post-infarct LV remodeling. (J Am Coll Cardiol 2001;38:1375-82) (C) 2001 by the American College of Cardiology.

Background: Cardiac natriuretic peptides may induce apoptosis in myocytes; however, the relationship between plasma levels of cardiac natriuretic peptides and those of soluble Fas (sFas) and tumor necrosis factor (TNF)-α remains unknown in patients with congestive heart failure (CHF). Methods and Results: We measured plasma levels of sFas and TNF-α and those of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), norepinephrine, and endothelin 1 in 96 patients with CHF (ejection fraction < 45%). The patients were monitored for 3 years. Plasma levels of sFas and TNF-α increased with the severity of CHF. There was no significant correlation between sFas plasma levels and those of ANP and BNP. Cox proportional hazard analysis showed that high levels of sFas (P =.009) and BNP (P <.0001) and a low ejection fraction (P =.019) were independent significant prognostic predictors. Conclusions: There is no significant correlation between cardiac natriuretic peptide and sFas levels in plasma. Plasma sFas is a useful prognostic marker independent of neurohumoral factors, suggesting that immune activation and/or apoptosis play a significant role in the pathogenesis of CHF.