ObjectivesTo investigate the association between the difficulty in hospital acceptance at the scene by emergency medical service (EMS) personnel and prehospital demographic factors and reasons for EMS calls.DesignA retrospective, observational study.SettingOsaka City, Japan.ParticipantsA total of 100 649 patients transported to medical institutions by EMS from January 2013 to December 2013.Primary outcome measurementsThe definition of difficulty in hospital acceptance at the scene was EMS personnel making ≥5 phone calls to medical institutions until a decision to transport was determined. Multivariable analysis was used to assess the relationship between difficulty in hospital acceptance and prehospital factors and reasons for EMS calls.ResultsMultivariable analysis showed the elderly, foreigners, loss of consciousness, holiday/weekend, and night-time to be positively associated with difficulty in hospital acceptance at the scene. As reasons for EMS calls, gas poisoning (adjusted OR 3.281, 95% CI 1.201 to 8.965), trauma by assault (adjusted OR 2.662, 95% CI 2.390 to 2.966), self-induced drug abuse/gas poisoning (adjusted OR 4.527, 95% CI 3.921 to 5.228) and self-induced trauma (adjusted OR 1.708, 95% CI 1.369 to 2.130) were positively associated with the difficulty in hospital acceptance at the scene.ConclusionsAmbulance records in Osaka City showed that certain prehospital factors such as night-time were positively associated with difficulty in hospital acceptance at the scene, and reasons for EMS calls, such as self-induced drug abuse/gas poisoning, were also positive predictors for difficulty in hospital acceptance at the scene.

Aim: Novel coronavirus infection (COVID-19) was confirmed in Wuhan, China in December 2019, and the COVID-19 pandemic has spread around the world. However, no clinical studies on the impact of the COVID-19 pandemic on emergency medical service (EMS) systems have been carried out. Methods: This was a retrospective study with a study period from 1 January 2020 to 14 April 2020. We included the patients transported by ambulance for acute diseases and traffic accidents in Osaka city, Japan. The main outcome of this study was the difficulty in hospital acceptance. We calculated the rate of difficulty of hospital acceptance for each month for acute diseases and traffic accidents. Results: Between 1 January and 14 April 2020, 36,981 patients were transported to hospitals by ambulance for acute diseases and 3,096 patients for traffic accidents. There was no difference in the proportion of the difficulty in hospital acceptance due to traffic accidents between 2019 and 2020, but there was an increase in the proportion of the difficulty in hospital acceptance due to acute disease after the 13th week (25-31 March) of 2020 compared to that of 2019. The odds ratio in April was 2.17 (95% confidence interval, 1.84-2.58) for acute disease. Conclusion: We assessed the impact of the COVID-19 pandemic on the EMS system in Osaka City, Japan and found that, since April 2020, the EMS system in Osaka City has been facing difficulty in terms of hospital acceptance of patients transported to hospital for acute diseases.

The ATP-sensitive K(+) (K(ATP)) channels are composed of the pore-forming K(+) channel Kir6.0 and different sulfonylurea receptors (SURs). SUR1, SUR2A, and SUR2B are sulfonylurea receptors that are characteristic for pancreatic, cardiac, and vascular smooth muscle-type K(ATP) channels, respectively. The structural elements of SURs that are responsible for their different characteristics have not been entirely determined. Here we report that the 42 amino acid segment at the C-terminal tail of SURs plays a critical role in the differential activation of different SUR-K(ATP) channels by ADP and diazoxide. In inside-out patches of human embryonic kidney 293T cells coexpressing distinct SURs and Kir6.2, much higher concentrations of ADP were needed to activate channels that contained SUR2A than SUR1 or SUR2B. In all types of K(ATP) channels, diazoxide increased potency but not efficacy of ADP to evoke channel activation. Replacement of the C-terminal segment of SUR1 with that of SUR2A inhibited ADP-mediated channel activation and reduced diazoxide modulation. Point mutations of the second nucleotide-binding domains (NBD2) of SUR1 and SUR2B, which would prevent ADP binding or ATP hydrolysis, showed similar effects. It is therefore suggested that the C-terminal segment of SUR2A possesses an inhibitory effect on NBD2-mediated ADP-induced channel activation, which underlies the differential effects of ADP and diazoxide on K(ATP) channels containing different SURs.

ObjectivesTo evaluate epidemiological characteristics of out-of-hospital cardiac arrests (OHCAs) by detailed non-cardiac cause and factors associated with the outcomes after OHCAs of non-cardiac origin.DesignA prospective, population-based observational study.SettingThe Utstein Osaka Project.Participants14 164 adult patients aged ≥20 years old with OHCAs due to non-cardiac origin who were resuscitated by emergency-medical-service personnel or bystanders, and then were transported to medical institutions from January 2005 to December 2011.Primary outcome measuresOne-month survival after OHCA. Multiple logistic regression analysis was used to assess factors that were potentially associated with the outcome.ResultsDuring the study period, the 1-month survival rate was 5.3% (755/14 164). The proportion of 1-month survival was 6.2% (510/8239) in external causes, 6.5% (94/1148) in respiratory diseases, 0.8% (11/1309) in malignant tumours, 4.9% (55/1114) in strokes and 4.1% (85/2054) in others. As for external causes, the proportion of 1-month survival was 14.3% (382/2670) in asphyxia, 4.2% (84/1999) in hanging, 0.7% (9/1300) in fall, 1.1% (12/1062) in drowning, 1.6% (12/765) in traffic injury, 3.7% (7/187) in drug overuse and 1.6% (4/256) in unclassified external causes. In a multivariate analysis, adults aged <65 years old with arrests witnessed by bystanders, with normal activities of daily living before the arrests, having ventricular fibrillation arrests, having arrests in public places, intravenous fluid levels and early Emergency Medical Service response time were significant predictors for 1-month outcome after OHCAs of non-cardiac origin. The proportion of 1-month survival of all OHCAs of non-cardiac origin did not significantly increase (from 4.3% (86/2023) in 2005 to 4.9% (105/2126) in 2011) and the adjusted OR for one-increment of year was 1.01 (95% CI 0.97 to 1.06).ConclusionsFrom a large OHCA registry in Osaka, we demonstrated that 1-month survival after OHCAs of non-cardiac origin was poor and stable.

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Aims Fibrosis-4 index (FIB-4 index), calculated by age, aspartate aminotransferase, alanine aminotransferase, and platelet count, is a simple marker to evaluate liver fibrosis and is associated with right-sided heart failure. However, the clinical relevance of FIB-4 in patients with heart failure with preserved ejection fraction (HFpEF) remains unclear. We investigated the prognostic implication of the FIB-4 index regarding right ventricular dysfunction in patients with HFpEF.Methods and results This prospective study included 116 consecutive HFpEF patients (mean age 79 years, 43% male) hospitalized with acute decompensated heart failure. We evaluated the association of the FIB-4 index with right ventricular function determined by tricuspid annular plane systolic excursion (TAPSE) and tricuspid lateral annular systolic velocity (S′) before discharge. Cox regression analysis was performed to evaluate the association between the FIB-4 index and major adverse cardiovascular events (MACE) defined as the composite of cardiovascular death, readmission for heart failure, nonfatal myocardial infarction, and nonfatal stroke. FIB-4 index before discharge was significantly lower than that at admission (2. 62 [1.92-3.46] and 3.03 [2.05-4.67], median [interquartile range], P < 0.001). Left ventricular ejection fraction, TAPSE, and S′ before discharge were 62.7 (55.9-68.6) %, 17.5 ± 4.6 mm (mean ± standard deviation), and 10.0 (8.0-12.0) cm/s, respectively. In multiple linear regression analysis, the FIB-4 index before discharge was inversely correlated with TAPSE (β minus;0.244, P = 0.014) and S′ (β À0.266, P = 0.009). During a median follow-up of 736 days, 37 MACE occurred. Multivariate Cox regression analysis revealed that a high FIB-4 index before discharge (per 1 point) was a significant predictor of MACE (hazard ratio 1.270, 95% confidence interval 1.052-1.532) after adjustment for male, serum creatinine, and haemoglobin. Receiver operating characteristic analysis indicated that the optimal cut-off value of FIB-4 index before discharge to predict MACE was 3.11. Kaplan-Meier survival analysis showed that patients with a FIB-4 index before discharge ≥3.11 had a significantly poorer prognosis than patients with FIB-4 index before discharge <3.11 (P = 0.029). Patients with an FIB-4 index ≥3.11 had a 2.202-fold (95% confidence interval 1.110-4.368) increased risk of MACE compared with those with an FIB-4 index <3.11 after adjustment for male, serum creatinine, and haemoglobin. Conclusions An increase in the FIB-4 index was associated with right ventricular dysfunction and a higher risk of future MACE in patients with HFpEF.

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rogression of coronary atherosclerosis and rupture of unstable plaque are key processes in acute myocardial infarction (AMI). The extent of coronary artery disease has been well documented as a major prognostic factor in patients with AMI. Prevention and evaluation of the progression of atherosclerotic plaque volume is thus essential to both reduce cardiac events and estimate prognosis after AMI.Evidence that supplementation with n-3 polyunsaturated fatty acids prevents atherosclerosis-related cardiovascular risk has been accumulating. 1,2 More recently, a large randomized study demonstrated that eicosapentaenoic acid (EPA) is effective in preventing major coronary events in patients with hyperlipidemia. 3 Dysfunction of the vascular endothelium, fatty streak formation and fibrous cap formation are processes in the formation of atherosclerotic lesions that are regulated by the action of vasoactive molecules, growth factors, cytokines, and lipid metabolites. Several studies have demonstrated that supplementation with n-3 polyunsaturated fatty acids attenuates the exaggerated platelet aggregation induced by various stimuli, 4,5 attenuates the action of growth factors and cytokines, 5-7 reduces the serum triglyceride concentration, 8,9 and increases high-density lipoprotein levels. 8 There are several methods of evaluating coronary atherosclerotic lesions. Coronary angiography is widely used as the gold-standard to determine coronary stenosis, but it can only detect a luminal reduction in stenosis, collateral patterns and the presence of dense calcification of the coronary arteries, not plaque quantity. Coronary angioscopy and intravascular ultrasound (IVUS) can provide information about plaque characteristics to some extent, 10-14 but the observation areas are somewhat restricted and the methods are quite invasive. Multidetector spiral computed tomography (MDCT) with high slice numbers is now providing sufficient time and spatial resolution power to detect coronary atherosclerosis. 15,16 Its reliability in the determination of coronary plaque morphology has been recently demonstrated by studies using IVUS and histopathologic studies. 17,18 The advantages of MDCT are that it is relatively noninvasive compared with intracoronary angioscopy and IVUS, and has sufficient stability for observation of the entire coronary tree. Indeed, at present, MDCT is thought to be 1 of the best methods of evaluating coronary plaque characteristics.Based on these lines of evidence, we hypothesized that serum n-3 polyunsaturated fatty acid levels would correlate with the extent of coronary atherosclerotic lesions. The Background The relationship between serum fatty acid levels and the extent of coronary plaques and calcification was examined in patients with acute myocardial infarction (AMI). Methods and ResultsThe serum levels of the n-3 polyunsaturated fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) and the n-6 polyunsaturated fatty acids (arachidonic acid (AA) and dihomogamma-linolenic acid (DGLA)) were det...