Continuous venovenous hemodiafiltration is the modality of choice for acute blood purification therapy at almost all medical institutions in Japan. Nafamostat mesilate, an ultrashort-acting anticoagulant, is widely used for anticoagulation. Due to restrictions imposed by national health insurance, Japanese institutions use an effluent flow rate of 15 mL/kg/h, which is lower than the standard effluent flow rate used in the West. In addition, hemofilters are believed to adsorb cytokines, and thus some institutions also proactively perform continuous renal replacement therapy with a hemofilter at an early stage for cytokine modulation in patients with sepsis. Although some aspects of these Japanese practices differ greatly from Western practices, there has not been much evidence to support current standard methods. Therefore, Japanese researchers must continue working to produce evidence for those methods, at least those that are widely used in Japan.
CaseA 42‐year‐old Peruvian woman residing in Japan for 11 years with a family history of neurocysticercosis presented to our intensive care unit with fever and intense headache.Computed tomography indicated multiple micronodular lesions in the brain parenchyma, and cerebral tuberculoma and neurocysticercosis were considered in the differential diagnosis. Neurocysticercosis was initially suspected, and oral praziquantel was initiated. However, because of a high adenosine deaminase level in the cerebrospinal fluid and positive peripheral blood interferon gamma release test result, cerebral tuberculoma was subsequently considered.OutcomeAntituberculous drugs with steroids were initiated on day 10, after which the symptoms gradually resolved; the patient was discharged on day 29. Gadolinium‐contrast magnetic resonance imaging 8 months later showed reduced nodular shadows, confirming cerebral tuberculoma.ConclusionImmediate diagnosis and treatment are imperative for cerebral tuberculoma, a lethal infection. Considering the recent increases in immigration worldwide, increased cases of tuberculoma mimicking neurocysticercosis are expected.
A simple and novel method -in the form of solution spraying -was developed to fabricate biodegradable, porous poly (Llactic acid) (PLLA) particulates for scaffold. PLLA pellets were dissolved in an organic solvent. Then, 5 % PLLA-dioxane solution was sprayed using an air-assisted atomizer with a nozzle diameter of 2.5 mm at an air flow rate of 15 L/min. After the sprayed solution solidified in liquid nitrogen, spherical particulates with median diameter of 225 pm were obtained. Morphology of sprayed products could be altered by varying the fabrication conditions.When nozzle diameter was reduced to 1.5 mm, sprayed products became fibrous. When the concentration of PLLA-dioxane solution was increased, the diameter of particulates increased too. On the other hand, when air flow rate was increased, the diameter of particulates decreased. Likewise, solidification conditions also affected the morphology of sprayed products, such that they were either thin film-like or in particulate form.Based on the results of the present study, we concluded that PLLA particulates of varying morphologies could be obtained by adjusting the fabrication conditions.
In order to investigate the collisional merging process of field-reversed configurations (FRCs), the FAT device has recently been upgraded to FAT-CM, consisting of two field-reversed theta-pinch (FRTP) formation sections and the confinement section. Collisional merging of the two FRCs causes a conversion of the kinetic energy to mostly thermal ion energy, resulting in an increase of the ion pressure that greatly expands the FRC size/volume. This increase of the FRC size is observed by magnetic diagnostics in the confinement region, leading to an increase in the excluded flux; on a side note, these characteristics/phenomena have also been observed in C-2/C-2U experiments at TAE Technologies. The process of FRC formation, translation and collisional merging in FAT-CM has been simulated by Lamy Ridge, 2D resistive magnetohydrodynamics code, in which the same phenomenon of the excluded-flux increase via FRC collisional merging has been observed. Simulation results also indicate that there is an importance of the external magnetic field structure/profile in the confinement region, clearly affecting the FRC merging. Steeper magnetic field gradient by a strong mirror field appears to suppress the axial expansion of collided FRCs and lead a merged FRC to higher temperature.
Phenobarbital overdose can cause coma and even death. The consciousness disturbance is often prolonged due to its long half-life. In this study, we investigated the efficacy of direct hemoperfusion (DHP) for the removal of phenobarbital by measuring the blood levels of phenobarbital. Methods: Study subjects included five patients with phenobarbital poisoning who were transferred to our hospital. Direct hemoperfusion was carried out in three of the five patients (six times in total), and the elimination rate was calculated by measuring the blood levels before and after DHP. Furthermore, the disappearance rate of phenobarbital without DHP was calculated in all five patients (seven times in total) for comparison with the elimination rate. Results: The elimination rate of phenobarbital with DHP was significantly higher than the disappearance rate without DHP. Conclusion: This study suggests that early introduction of DHP should be considered as a treatment option for phenobarbital poisoning.
Background In continuous renal replacement therapy (CRRT), administration of anticoagulants is necessary for achieving a certain level of filter lifetime. Generally, anticoagulant doses are controlled to keep activated partial thromboplastin time and other indicators within a certain target range, regardless of the membrane materials used for the filter. However, in actual clinical practice, the filter lifetime varies significantly depending on the membrane material used. The objective of this study was to demonstrate that the minimum anticoagulant dose necessary for prolonging the filter lifetime while reducing the risk of hemorrhagic complications varies depending on the type of membrane. Methods In three beagles, hemodiafiltration was performed with hemofilters using polysulfone (PS), polymethylmethacrylate (PMMA), and AN69ST membranes separately. The minimum dose of nafamostat mesylate (NM) that would allow for 6 h of hemodiafiltration (required dose) was investigated for each membrane material. Results The NM doses required for 6 h of hemodiafiltration were 2 mg/kg/h for the PS membrane, 6 mg/kg/h for the PMMA membrane, and 6 mg/kg/h for the AN69ST membrane. Conclusion For hemodiafiltration performed in beagles, the required NM dose varied for each filter membrane material. Using the optimal anticoagulant dose for each membrane material would allow for safer CRRT performance.
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