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Background: Suitable tracheostomy timing after cardiac operation remains controversial; hence, this study compared the effectiveness of early and late tracheostomy after cardiac operation. Methods: By using the nationwide administrative claims database in Japan, patients who underwent cardiac operation between April 2010 and March 2020 were identified and included in this study. In-hospital mortality, incidence of deep sternal wound infection, and ventilator-free days were analyzed and compared by dividing patients into 2 groups: an early group (patients who underwent tracheostomy 1-14 days postoperatively) and a late group (patients who underwent tracheostomy 15-30 days postoperatively). Baseline characteristics were adjusted by propensity score weighting. Results: Of 1240 patients who underwent cardiac operation and postoperative tracheostomy, 784 were included in the main analysis cohort. As the number of days between the operation and tracheostomy increased, in-hospital mortality increased, whereas ventilator-free days decreased. The early and late groups comprised 284 and 326 patients, respectively. After adjustment of baseline characteristics, the in-hospital mortality (odds ratio, 0.65; 95% CI, 0.46-0.91; P = .01) was lower in the early group than in the late group, the incidence of deep sternal wound infection (odds ratio, 0.59; 95% CI, 0.23-1.52; P = .27) was not significantly different between the 2 groups, and the early group had more ventilator-free days compared with the late group (mean difference, 5.1; 95% CI, 3.6-6.5; P < .001). Conclusions: Early tracheostomy may be considered in patients expected to require prolonged ventilation.

Objective: This study aimed to determine the maximum safe dose of intranasal insulin administration during cardiac surgery. Methods: This open-label, Phase 1, single-center, dose-escalation clinical trial recruited patients scheduled to undergo elective cardiac surgery or major vascular surgery requiring cardiopulmonary bypass between February and September 2021. They were grouped into 5 dose-escalation cohorts and administered 0, 40, 80, 160, and 240 IU insulin (n = 6 in each group) via a metered nasal dispenser after the induction of general anesthesia. Blood samples were collected at 10-minute intervals for the first 60 minutes and at 30-minute intervals thereafter. Hypoglycemia was defined as a blood glucose level

Spontaneous coronary artery dissection occurs predominantly in women and is associated with fibromuscular dysplasia. We illustrate a rare case of sudden coronary death as a result of cardiac rupture from spontaneous coronary artery dissection in a 54-year-old man without fibromuscular dysplasia. Cardiac rupture has been previously reported in 6 cases, mostly in women.

Plasmacytoid urothelial carcinomas of the bladder are rare, aggressive variants with a poor prognosis. Few reports have described the correlation of histopathological features with multiparametric magnetic resonance imaging findings in the local staging of plasmacytoid urothelial carcinoma. An 82-year-old woman with hematuria was referred to our hospital. Magnetic resonance imaging showed diffuse bladder wall thickening, with different signal intensities in the 2 layers—inner and outer. This case suggests that the presence of diffuse bladder wall thickening and varying signal intensities in the 2 layers could aid in the local staging of plasmacytoid urothelial carcinoma. A thickened bladder wall with restricted diffusion suggests tumor invasion, indicating that the tumor can invade the organ in contact with the thickened bladder wall.

Plaque rupture, plaque erosion, and COVID-19 infection can cause acute coronary syndromes (ACS). We illustrate case examples demonstrating the distinctive and characteristic pathologic findings underlying each of these various causes of acute myocardial infarction. A deeper understanding of the pathophysiology of ACS is necessary for the development of newer agents and techniques to improve outcomes after ACS. (Level of Difficulty: Advanced.)

Purpose: To elucidate the incidence and treatment pattern of active exudative age-related macular degeneration (AMD). Design: A population-based cohort study conducted using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), a national claims database managed by the Japanese Ministry of Health, Labour, and Welfare (MHLW). Participants: The entire Japanese population aged 40 years or older (76 million people). Methods: With the permission of the MHLW, we accessed the complete NDB dataset and identified patients with newly diagnosed active exudative AMD between 2011 and 2018. The incidence of active exudative AMD was categorized by age and sex per year between 2011 and 2018; moreover, details regarding first-line therapy and number of anti-vascular endothelial growth factor (VEGF) injections per elapsed year since initial treatment were obtained and changes in treatment pattern were investigated. Main Outcome Measures: Incidence rate of active exudative AMD. Results: During the specified 8-year period, 246 064 incident cases of active exudative AMD were identified; 61.4% of these patients were men. The overall incidence rate was 40.66 per 100 000 person-years (95% confidence interval [CI], 40.49–40.82) in the general population aged 40 years or older, 53.22 (95% CI, 52.95–53.49) in men, and 29.78 (95% CI, 29.60–29.98) in women. Mean age of onset was lower in men than in women (72.51 ± 10.50 years vs. 73.90 ± 10.46 years). Among patients with newly diagnosed active exudative AMD, 92.9% received anti-VEGF injections for initial treatments, whereas 1.8% underwent combination therapy with photodynamic therapy. The number of anti-VEGF injections in the first year (0–12 months), second year (13–24 months), and third year (25–36 months) after the initial injection was 3.66 ± 2.30, 1.39 ± 2.20, and 1.23 ± 2.19, respectively. Patients who received fewer injections in the first year received fewer injections in subsequent years and vice versa. Conclusions: This is a relatively large population-based study on the detailed epidemiology and actual treatment patterns of active exudative AMD in clinical practice. Our results can be a fundamental information source to ensure healthy eyes and promote well-being for all at all ages.

Background: The purpose of this study was to determine the association between glenohumeral osteoarthritis (GHOA) and three-dimensional acromial and glenoid morphology. Methods: In this retrospective study, we compared computed tomographic studies of three groups of scapulae: normal healthy, mild GHOA (Samilson-Prieto grade 1), and severe GHOA (Samilson-Prieto grade 3). All scans were segmented to create three-dimensional reconstructions. From these models, critical shoulder angle and acromial offset were measured, as normalized to scapular height. The coronal plane inclination of the glenoid was measured using a glenoid sphere-fit method. Reliability was confirmed via intraclass correlation coefficients > 0.75. Results: Eighty scapulae were included: 30 normal, 20 mild GHOA, and 30 severe GHOA. There were no differences in acromial offset between the normal group and either the mild-GHOA group or the severe-GHOA group. The severe-GHOA group had a smaller critical shoulder angle than either the normal (30 ± 5° vs. 34 ± 4°, P = .003) or mild-GHOA groups (34 ± 4°, P = .020), but the normal and mild-GHOA groups did not differ (P = .965). The severe-GHOA group had more inferiorly inclined glenoids than either the normal (7 ± 6° vs. 12 ± 5°, P = .002) or mild-GHOA groups (14 ± 5°, P ≤ .001), but the normal and mild-GHOA groups did not differ (P = .281). Conclusion: Normal and severe-GHOA shoulders differ in critical shoulder angle and glenoid inclination but not acromial offset. The lack of a difference in critical shoulder angle or inferior inclination between mild-GHOA and normal groups calls into question whether inclination and critical shoulder angle differences predate severe GHOA.

Background: The purpose of this study was to determine whether greater tuberosity morphology (1) could be measured reliably on magnetic resonance imaging (MRI), (2) differed between patients with rotator cuff tears (RCTs) compared with those without tears or glenohumeral osteoarthritis, or (3) differed between patients with rotator cuff repairs (RCR) who healed and those that did not. Methods: This is a retrospective comparative study. (1) We measured greater tuberosity width (coronal and sagittal), lateral offset, and angle on MRI corrected into the plane of the humerus. To determine reliability, these measurements were made by two observers and intraclass correlation coefficients were calculated. (2) We compared these measurements between patients with a full-thickness RCT and patients aged >50 years without evidence of a RCT or glenohumeral osteoarthritis. (3) We then compared these measurements between those patients with healed RCRs and those with evidence of retear on MRI. In this portion, we only included patients with both a preoperative and postoperative MRI at least 1 year from RCR. Postoperative MRIs were obtained to assess healing rates, not because of concern for failure. Those without tendon defects were considered healed. Results: (1) In a validation cohort of 50 patients with MRI, all inter-rater intraclass correlation coefficients were greater than 0.75. (2) There were no differences between our RCT group of 110 patients and our comparison group of 100 patients in tuberosity coronal width, sagittal width, or lateral offset. The RCT group had a significantly smaller greater tuberosity angle (63 ± 4° vs 65 ± 5°, P = .003). (3) In our group of 110 RCRs, postoperative MRI scans were obtained at a mean follow-up of 23.6 ± 15.7 months showing 84 (76%) patients had healed RCRs. Larger coronal tuberosity width was associated with healing (1.3 ± 0.2 vs 1.2 ± 0.2 cm, P = .032), as was smaller tear width (P

Background: The etiologies of glenohumeral osteoarthritis (GHOA) and eccentric glenoid wear within GHOA are unknown, but muscular imbalance may play a role. The purpose of the present study was to determine the relationship between deltoid muscle area, GHOA, and eccentric glenoid wear. We hypothesized that patients with GHOA would have overall deltoid atrophy as compared with controls and that increasing posterior deltoid areas would associate with glenoid retroversion in the Walch B-type (eccentric) GHOA group. Methods: The study was a retrospective review of computed tomography imaging studies. We included a control group of subjects without GHOA and a group of individuals with GHOA before undergoing total shoulder arthroplasty. We assigned Walch types via consensus. Cross-sectional area was measured for the anterior and posterior deltoid musculature demarcated via the scapular line, normalized to the total deltoid area. Absolute and normalized total, anterior, and posterior deltoid areas were compared between controls and the entire GHOA group. Normalized anterior and posterior deltoid areas were compared between Walch A-type and B-type GHOA patients within the GHOA group. Univariate linear regression was used to evaluate for an association between glenoid retroversion and normalized posterior deltoid areas in controls, Walch A-type, and Walch B-type patients. Multivariate linear regression analysis was used to evaluate the effects of normalized posterior deltoid area, age, sex, and height on glenoid retroversion within the Walch B-type subgroup. Results: We included 99 patients with GHOA and 47 controls. The control and GHOA patients did not differ in absolute deltoid areas (21.8 ± 8.8cm2 vs. 20.6 ± 7.9cm2; P = .488). Patients with GHOA had a statistically significant increase in normalized posterior deltoid area (0.50 ± 0.10 vs. 0.46 ± 0.10; P = .032) and a reciprocal decrease in normalized anterior deltoid area (0.50 ± 0.10 vs. 0.54 ± 0.10; P = .040) compared with controls. Walch A-type and B-type patients did not differ in normalized posterior deltoid areas (0.50 ± 0.11 vs. 0.50 ± 0.10; P = .780). Normalized posterior deltoid area positively associated with glenohumeral retroversion in Walch B-type GHOA (R2 = 0.102; P = .020), a relationship maintained in multivariate linear regression, using gender, age, and height as covariates (standardized beta = 0.309, P = .027). Conclusion: GHOA is not associated with deltoid atrophy, calling into question the suggestion that periarticular muscular atrophy in GHOA is secondary to disuse. Increasing normalized posterior deltoid area associates with increased glenoid retroversion in patients with Walch B-type glenoid morphology. Muscular imbalance may play a role in the etiology or progression of the glenoid deformity observed in eccentric GHOA.

Background: The purpose of this study was to determine factors associated with early symptomatic acromial and scapular spine fractures in patients who underwent reverse total shoulder arthroplasty (RTSA). Methods: We retrospectively evaluated all RTSAs performed by the senior author between 1/1/2013 and 6/1/2019. We evaluated patient demographics including gender, age, prevalence of comorbidities including osteoporosis, inflammatory arthritis, diabetes, and endocrine disorders such as hypothyroidism. We also evaluated preoperative and 2-week postoperative radiographs for center of rotation medialization (CORM) as distance between the center of the humeral head or glenosphere and the line of the deltoid, and distalization via the acromial-greater tuberosity distance (AGT). We evaluated inter- and intra-rater reliability via intraclass correlation coefficients. Results: We included 335 RTSAs with a minimum of 3 months of follow-up in the analysis. Reliability was acceptable with all intraclass correlation coefficients> 0.75. Symptomatic acromial and scapular spine stress fractures were significantly more common in those with inflammatory arthritis than those without (18% vs. 5%, P = 0.016). The rate of fracture was highest in patients with rheumatoid arthritis (24% vs. 5.2%, P = 0.003). There was no statistically significant association between symptomatic fractures and preoperative CORM or AGT (P = 0.557, P = 0.528) or postoperative CORM or AGT (P = 0.56, P = 0.102). There also was no statistically significant correlation between symptomatic stress fracture and patient age, gender, BMI, smoking, osteoporosis, gout, medical comorbidity, or previous shoulder surgery. Conclusion: In this retrospective analysis of postoperative RTSA, symptomatic acromial and scapular stress fractures were significantly more common in patients with rheumatoid arthritis and thus precautions should be taken in these patients.

IMPORTANCE:. Despite various reports on the incidence of adverse events related to the in-hospital transport of critically ill patients, there is little verification of the correlation between the occurrence of adverse events and the use of checklists. The risk factors for the occurrence of adverse events during transport based on the use of checklists have not been well studied. Understanding them can contribute to making patient transport safer. OBJECTIVES:. We aimed to investigate the frequency of adverse events and risk factors related to the in-hospital transport of critically ill patients in a hospital that uses a checklist for transporting patients. DESIGN, SETTING, AND PARTICIPANTS:. This single-center, prospective, observational study was conducted between February 1, 2020, and July 31, 2020, at Kobe City Medical Center General Hospital, Japan. Patients greater than or equal to 18 years old who were admitted to the ICU and were transported for examination or procedures were included. MAIN OUTCOMES AND MEASURES:. The transport member recorded patient information and any adverse events that occurred and filled out an information collection form. We then applied multivariate analysis to identify risk factors. RESULTS:. A total of 117 transports for 117 patients were evaluated in this study. Twenty-two adverse events occurred in 20 transports (17.1%). There were nine transports (7.7%) in which the patients required treatment, all of which were related to patient instability. Multivariate logistic regression analysis showed that the use of sedative drugs was related to adverse events (odds ratio, 2.9; 95% CI, 1.0–8.5; p = 0.04). We were not able to show a relationship of either the severity of the illness or body mass index with the occurrence of adverse events. CONCLUSIONS AND RELEVANCE:. This study revealed that the frequency of adverse events related to the in-hospital transportation of critically ill patients based on the use of a checklist was 17.1% and that the use of sedatives was associated with adverse events.

We report a case of bulky cardiac metastasis of intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC). A 72-year-old woman developed a chief complaint of chest pain. Contrast-enhanced computed tomography revealed multiple enhanced masses in the heart, retroperitoneum, and femur. Initially, multiple metastases of cardiac primary angiosarcoma were suspected because the cardiac mass was the largest. However, it was diagnosed as SFT/HPC on the basis of biopsy and immunostaining for the retroperitoneal lesion. She had a history of resected brain tumor surgery for a meningioma 11 years earlier, and pathological reconfirmation revealed this was not a meningioma but rather a SFT/HPC. Thus, we found that the enhanced masses were extracranial metastases of an intracranial primary SFT/HPC. She died approximately 3 years after the onset of chest pain. Autopsy confirmed metastasis in the retroperitoneum, liver, lung, mesentery, skeletal muscle, and bone in addition to the heart. SFT/HPC has been reported to easily recur locally and to show systemic metastasis over the long term. Given that SFT/HPC has been recognized as a subtype of meningioma, the differential diagnosis for patients with a history of intracranial tumors, such as meningioma, should include SFT/HPC. Keywords: Solitary fibrous tumor, Hemangiopericytoma, Meningioma, STAT6, Cardiac metastasis, Delayed metastasis

Hypothesis: The purpose of this study was to determine the clinical outcomes of arthroscopic labral repair for anteroinferior glenohumeral instability with the use of double-loaded suture anchors. Methods: This study evaluated a series of consecutive patients treated after the senior author changed from single- to double-loaded suture anchors for the treatment of anteroinferior glenohumeral instability with a minimum follow-up period of 2 years. We collected the following outcomes at final follow-up: visual analog scale pain score, Simple Shoulder Test score, American Shoulder and Elbow Surgeons score, and instability recurrence data. Results: A total of 41 consecutive patients underwent arthroscopic labral repair with double-loaded anchors, of whom 30 (71%) were able to be contacted at a minimum of 2 years postoperatively. These patients included 4 contact or collision athletes (13%). The patients had an average of 12 ± 13 prior dislocations over an average period of 56 ± 57 months preoperatively. Mean glenoid bone loss measured 16% ± 10%, and 67% (18 of 27 patients) had glenoid bone loss ≥ 13.5%. Intraoperatively, 3.2 ± 0.4 anchors were used. No posterior repairs or remplissage procedures were performed. At an average of 6.7 ± 2.7 years' follow-up, the visual analog scale pain score was 0.8 ± 1.4; Simple Shoulder Test score, 11 ± 2; and American Shoulder and Elbow Surgeons score, 90 ± 14. Patients with bone loss < 13.5% had a 0% redislocation rate and 11% subluxation rate, whereas those with bone loss ≥ 13.5% had a 6% reoperation rate, 22% redislocation rate, and 22% subluxation rate. Conclusion: Arthroscopic labral repair with double-loaded anchors provides satisfactory clinical results at early to mid-term outcome assessment when glenoid bone loss is

Background: Revision reverse total shoulder arthroplasty (RTSA) reliably improves shoulder pain and function in patients with failed shoulder arthroplasty, although it can lead to significant postoperative complications. The purpose of this study was to determine the effect of postoperative complications on shoulder pain and function after revision RTSA. Methods: We evaluated 36 patients at an average of 4.3 years (range, 2-8.6 years) after revision of a shoulder arthroplasty to RTSA. Of these patients, 9 had a failed anatomic total shoulder arthroplasty, 23 had a failed hemiarthroplasty, and 4 had a failed RTSA. The American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) pain score were evaluated postoperatively, and patients with and without postoperative complications were compared. Results: The final ASES score and VAS pain score were 61 ± 23 and 2.4 ± 2.3, respectively. A major postoperative complication occurred in 7 patients (19%) (infection in 3, hematoma in 1, instability in 1, and acromial and/or scapular spine fracture in 2). Further surgical treatment was required in 5 patients (14%) (irrigation and débridement and component exchange for infection in 3, irrigation and débridement for hematoma in 1, and open reduction–internal fixation of scapular spine fracture in 1). On comparison of clinical outcomes between patients with and patients without complications, the ASES score and VAS pain score were significantly worse in patients with complications vs. those without them (ASES score, 43 ± 24 vs. 66 ± 21 [P = .04]; VAS pain score, 4.3 ± 2 vs. 2 ± 2.2 [P = .03]). Conclusion: Revision RTSA resulted in postoperative pain and shoulder function comparable to primary RTSA reported in the literature, although postoperative complications led to clinically significant declines in function and increases in pain.

Background: The purpose of this study was to determine the short-term outcomes for patients who underwent revision surgery for shoulder instability, including both revision arthroscopic repair and Latarjet. Methods: This study included patients who underwent revision of a prior arthroscopic labral repair to arthroscopic labral repair or Latarjet at our institution from 2012 to 2017. After collection of preoperative demographic data, preoperative 3-dimensional imaging was reviewed to determine percent glenoid bone loss (%GBL) and to determine whether each shoulder was on-track or off-track. Patients were contacted to obtain postoperative patient-reported outcome metrics including visual analog scale pain, Simple Shoulder Test, American Shoulder and Elbow Surgeons scores, and instability recurrence (full dislocation, subluxation, or subjective apprehension) data at a minimum of 2 years postoperatively. Results: Of 62 patients who met criteria, 45 patients were able to be contacted. Of them, 21 underwent revision arthroscopy and 24 underwent a Latarjet procedure. In the revision arthroscopy group, 5 of 15 had %GBL >20% and 4 of 21 were contact athletes. In the Latarjet group, 11 of 22 had %GBL >20% and 5 of 24 were contact athletes. Of 21 revision arthroscopy patients, 8 underwent concomitant remplissage. Eight of 21 patients in the revision arthroscopy group and 7 of 21 patients in the Latarjet group reported instability postoperatively. Three of 21 patients in the revision arthroscopy group and 2 of 21 patients in the Latarjet group reported full dislocations postoperatively. Zero patients in the revision arthroscopy group and 1 of 21 patients in the Latarjet group underwent reoperation. Conclusion: Our results suggest that both revision Latarjet and arthroscopic stabilization can be of benefit in select circumstances. However, in revision settings, postoperative instability symptoms are common with both procedures.

Objectives: To investigate the physical, cognitive, and psychological factors related to daily step count in patients with subacute stroke. Design: Prospective cohort study. Setting: A subacute rehabilitation ward with 160 beds. Participants: Patients with subacute stroke who could walk independently (N=101). Among the 101 participants enrolled in this study (mean age, 64.5±13.5y), 64.4% (n=65) were men and 69.3% (n=70) were patients with cerebral infarction. Interventions: We assessed ambulatory activity using a pedometer placed in the pants pocket on the nonparalyzed side continuously for 7 consecutive days. We also obtained demographic and clinical information and recorded the following measurement scores: Stroke Impairment Assessment Set, FIM, Mini-Mental State Examination (MMSE), Self-Rating Depression Scale, and Apathy Scale. All measurements were collected at admission and discharge. Main Outcome Measures: The outcomes assessed were ambulatory activity, motor and sensory functions, functional disability, cognitive function, depressive symptoms, and motivation. Results: The median daily steps ambulated at admission and discharge were 5584 steps (interquartile range, 3763-7096 steps) and 5991 steps (interquartile range, 4329-8204 steps), respectively. In the univariate regression analysis, age, sex, serum albumin level, affected side of the brain, and MMSE score at admission were significantly associated with the daily step count at discharge. Multiple regression analysis using these 5 items as independent variables revealed that the MMSE score at admission (reference, 28-30 points; B, −2.07; 95% confidence interval, −3.89 to −0.35; β, −0.22; P=.027) was significantly associated with the daily step count at discharge. Conclusions: Cognitive function at admission had a significant association with the daily step count at discharge in patients with subacute stroke who could walk independently.

Objectives:. We conducted a pilot study using an experimental study protocol to evaluate the measurement error of arterial pulse contour analysis-derived stroke volume due to improper transducer leveling during the passive leg raising test and the impact of such error on the determination of fluid responsiveness. Design:. Prospective observational study. Setting:. A medical-surgical ICU at a tertiary referral center in Kobe, Japan. Patients:. Consecutive critically ill adult patients using the FloTrac system Version 4.0 (Edwards Lifesciences, Irvine, CA) for hemodynamic monitoring between September 1, 2018, and November 31, 2018. Interventions:. None. Measurements and Main Results:. Using 20 patients, we estimated the change in the zero-reference level of an arterial transducer during head-down tilting as the vertical distance between the zero-reference levels of the transducer in the 45° semi-recumbent and supine positions. Using the FloTrac system Version 4.0, we recorded the hemodynamic variables every 20 seconds for 180 seconds at each of the following three points: 1) baseline, 2) after the transducer was elevated by the predetermined distance, and 3) after the transducer had returned to baseline. With respect to the predetermined change in the transducer level, a mean value of 18 ± 3 cm resulted in an increase in stroke volume measurement (mean value, 11 mL/beat; 95% CI, 10–13). This value corresponded to 20% (95% CI, 18–23%) of the baseline value 20 seconds after changing the transducer level. A significant correlation was observed between the predetermined change in the transducer level and the increase in the measured stroke volume (r2 = 0.58; p < 0.001). CONCLUSIONS:. When using the FloTrac system Version 4.0, a rapid increase in stroke volume was observed after elevating the arterial transducer. Clinicians and researchers are advised that proper leveling of the arterial transducer is necessary in order to accurately assess the change in arterial pulse contour analysis-derived stroke volume during the passive leg raising test.

Objective: To clarify the activities of daily living (ADL) structure of persons with spinal cord injury (SCI) by analyzing the associations between the Spinal Cord Independence Measure III (SCIM III) total score and individual SCIM III item scores. Design: A retrospective survey. Setting: A national hospital with 2 SCI units in Japan. Participants: Inpatients (N=81) within 60 days of SCI onset were included (men, 84%). The mean age was 62 years. Of these, 63 persons had incomplete SCI (47 persons had tetraplegia). Interventions: Not applicable. Main Outcome Measure: SCIM III was used to assess the ADL independence level on a monthly basis during hospitalization. SCIM III data were analyzed with ordinal logistic analyses. Results: The analyses revealed that SCIM III total scores accounted for the probabilities of individual SCIM III item scores. Goodness-of-fit of each logistic model by Wald test was significant (P10 attained modified independence level. Conclusions: The SCIM III total score can provide information on the probability and degree of difficulty of attaining independence for each item. Therefore, the present total SCIM III scores could be the indication for ADL attainment. In addition, the higher total SCIM III score and the probability of individual items score are useful for planning efficient rehabilitative approaches, considering the degree of difficulty of attaining independence for each item. Moreover, our results show good generalizability across patients with complete and incomplete SCI. Keywords: Paraplegia, Probability, Prognosis, Rehabilitation, Tetraplegia

ABSTRACT: Objective: Exenatide once weekly (ExeOW) is one of the long-acting glucagon-like peptide 1 receptor agonists. Embedding exenatide in poly(D,L-lactide-co-glycolide) microspheres enables the once-weekly subcutaneous injection of exenatide as a treatment for diabetes. We report a case of a patient with type 2 diabetes and hypothyroidism who developed long-standing subcutaneous nodules after treatment by ExeOW injection.Methods: Case report and review of the literature. A 57-year-old Japanese man with type 2 diabetes treated with ExeOW and primary hypothyroidism.Results: We observed multiple subcutaneous nodules remaining at the ExeOW injection site for >10 weeks. As the patient's thyroid hormone levels normalized, these nodules decreased and disappeared, and his hemoglobin A1c levels improved.Conclusion: The patient's clinical course suggests that the hydrolysis of ExeOW at the site of injection may be inhibited by concomitant hypothyroidism, in which glycosaminoglycans including hyaluronic acid are known to accumulate (including in the skin). This case may indicate that hypothyroidism prolongs the existence of subcutaneous nodules from ExeOW treatment.Abbreviations: ExeOW = exenatide once weekly GLP-1 = glucagon-like peptide 1 HbA1c = hemoglobin A1c NGSP = National Glycohemoglobin Standardization Program PLG = poly(D,L-lactide-co-glycolide)

This case report describes sustained monomorphic ventricular tachycardia (VT) caused by a large epicardial scar, related to dilated-phase hypertrophic cardiomyopathy mimicking VT originating from the apical septum. VT resolved with epicardial catheter ablation. The exit of the VT circuit suggested that a 12-lead electrocardiogram can be remote with respect to the critical isthmus in this case. In patients with structural heart disease, it is difficult to identify the VT reentrant circuit by surface electrocardiography, which shows only the exit site. VT originating in the epicardium should be considered, even if the suspected origin is another ventricular site.

ABSTRACT: Objective: Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare, chronic, relapsing inflammatory osteoarticular disorder with dermatologic manifestations. SAPHO syndrome can be a rare cause of atypical symptoms including neurologic defects. We report a case with SAPHO syndrome with the endocrinologic defects most likely associated with SAPHO syndrome.Methods: Case report and review of the literature.Results: A 61-year-old Japanese female with SAPHO syndrome presented with polyuria and polydipsia. Pituitary magnetic resonance imaging (MRI) with gadolinium enhancement showed an enlarged infundibulum and pituitary with ring-enhancing masses located at the posterior pituitary and upper infundibulum. Extensive diagnostic workup excluded local and systemic infection, brain metastasis, and various secondary hypophysitis as the cause of the infundibular and pituitary lesions. There were spontaneous improvements in the MRI findings taken 4 months after her initial presentation. The patient underwent a biopsy of the anterior pituitary, which showed a sterile lymphocytic infiltration.Conclusion: There are rare cases of SAPHO syndrome patients in which transient neurologic symptoms associated with the self-limiting ring-enhancing lesions consisting of a sterile and nonspecific inflammation are described. Since cystic formation in the infundibulum caused by idiopathic lymphocytic hypophysitis has not been reported, to the best of our knowledge, we concluded that the endocrinologic defects in our patient were most likely associated with SAPHO syndrome. Thus, SAPHO syndrome should be considered as one of the causes not only for ring-enhancing lesions in the brain but also for secondary hypophysitis, especially in patients with dermatologic and osteoarticular manifestations.

Loss-of-function mutations in the cardiac sodium channel α-subunit gene SCN5A result in multiple inherited arrhythmic syndromes. This case report describes 2 unrelated probands carrying an identical SCN5A frameshift mutation, V1764fsX1786, who exhibited distinct clinical manifestations: progressive cardiac conduction defect (PCCD)/Brugada syndrome (patient #1) and idiopathic ventricular fibrillation (IVF) (patient #2). Using a whole-cell patch clamp technique, cells expressing V1764fsX1786 showed no observable Na+ current. Therefore, a significant phenotypic overlap was found between IVF and PCCD/Brugada syndrome in the 2 probands with the V1764fsX1786, loss-of-function frameshift mutation of the cardiac sodium channel gene SCN5A.

Recently, cardiac resynchronization therapy (CRT. has been established as an effective treatment for drug-resistant heart failure with left ventricular dyssynchrony in patients with a New York Heart Association class (NYHA. of III-IV. Many cases have already been treated with CRT in Japan, however, some challenges still remains, such as difficult placement of the left ventricular (LV. lead at the target site, high threshold values even after successful placement of the LV lead, and the need to reposition of the LV lead due to diaphragmatic stimulation regardless of an appropriate threshold value. In particular, those cases with high threshold values at a distal site or those in which the lead is placed at a proximal site because of diaphragmatic stimulation are prone to lead dislodgement, and re-operation may be required. We report on a patient in whom stabilization of the LV lead was obtained by placing a coronary stent in the coronary sinus wall which resulted in an improved clinical course.

Background. Treatment and management strategies for asthma in children are generally consistent internationally, but prescription of antiasthma drugs differs among countries. The objective of this study was to examine the prescribing patterns of antiasthma drugs, particularly controller medications, in children. Methods. A retrospective cohort study was performed in children with asthma using an administrative claims database in Japan. Results . A total of 1149 preschool-age and 3226 school-age children were identified. Leukotriene receptor antagonists were prescribed for about 80% of the children. Long-acting β-agonists were prescribed for 87.6% and 59.6% of preschool-age and school-age children, respectively, whereas prescriptions of inhaled corticosteroids had lower rates of 8.2% and 16.5%, respectively. In an examination of prescriptions at 1-month intervals, a relatively high number of children were prescribed bronchodilators without anti-inflammatory agents. Conclusion . Our findings suggest that asthma care for children in Japan can be improved through changes in drug prescriptions.

Background: The increasing incidence of damage to pacemaker leads for cardiac resynchronization therapy (CRT. is an emerging problem that should be prevented. The extrathoracic venipuncture approach has been suggested as a technique for venous access to avoid the problem. Methods and Results: 10 patients had pacemaker lead placement for CRT using the double target method. The lead was inserted in the extrathoracic portion of the subclavian and/or axillary veins without complications in all of the patients. Conclusion: This approach achieves accurate, safe, and speedy extrathoracic venipuncture and is especially suitable for multiple lead placements for CRT.

We examined the in vitro effect of Candida albicans on NO production by macrophages. Candida albicans suppressed not only NO production but also expression of inducible NO synthase (iNOS) mRNA by murine IFN-γ and bacterial LPS-stimulated peritoneal macrophages. The suppression was not associated with inhibition but rather stimulation of IL-1β production. This effect was observed when more than 1 × 103/ml of Candida albicans were added to macrophage cultures (1 × 106 cells/ml) and reached a maximal level at 1 × 106/ml. The NO inhibitory effect of Candida albicans was mediated predominantly by as yet unidentified soluble factor(s) and to a lesser extent by direct contact. In addition, heat- or paraformaldehyde-killed Candida albicans did not show this inhibitory activity. Culture supernatant of Candida albicans also inhibited NO production by activated macrophages in a dose-dependent manner, and increased IL-1β production. Finally, the inhibitory effect was not mediated by IL-10 and transforming growth factor-beta (TGF-β), since neutralizing antibodies to these cytokines did not influence Candida albicans-induced reduction in macrophage NO production. Our results suggest that Candida albicans may evade host defence mechanism(s) through a soluble factor-mediated suppression of NO production by stimulated macrophages, and that the effect is independent of production of immunosuppressive cytokines such as IL-10 and TGF-β. [ABSTRACT FROM AUTHOR]

Health care providers use several types of syringes in their daily routine to provide or safely deliver therapeutic agents to patients. Pump infusion with a syringe (PIS) are used for the rapid delivery of large amounts of fluid or blood to patients in critical conditions, such as hypovolemic shock. Patients often experience bacterial infections, such as catheter-related bloodstream infections, specifically when they are in critical condition in the intensive care unit (ICU) after surgery or undergoing resuscitation in an emergency department. A previous study has shown that PIS may cause intraluminal contamination. This study compared PIS-induced contamination among different types of available syringes, including disposable plastic syringes produced by several companies, glass syringes, and syringes with plastic covers. The authors found that plastic syringes caused approximately equivalent PIS-induced contamination and that glass syringes caused substantially more contamination than plastic syringes. However, syringes equipped with a plastic cover exhibited no contamination. Furthermore, disinfection with ethanol completely prevented PIS-induced contamination. This study supports the evidence that PIS may cause bacterial contamination and that a thorough aseptic technique is needed, especially when using glass syringes. These findings highlight the need to develop alternative devices for rapid infusion., Competing Interests: Conflict of Interest:The authors of this article have no conflicts of interest to disclose., (Copyright © 2024 Infusion Nurses Society.)

Aim: Compare heart rate assessment methods in the delivery room on newborn clinical outcomes., Methods: A search of Medline, SCOPUS, CINAHL and Cochrane was conducted between January 1, 1946, to until August 16, 2023. (CRD 42021283438) Study Selection was based on predetermined criteria. Reviewers independently extracted data, appraised risk of bias and assessed certainty of evidence., Results: Two randomized controlled trials involving 91 newborns and 1 nonrandomized study involving 632 newborns comparing electrocardiogram (ECG) to auscultation plus pulse oximetry were included. No studies were found that compared any other heart rate measurement methods and reported clinical outcomes. There was no difference between the ECG and control group for duration of positive pressure ventilation, time to heart rate ≥ 100 beats per minute, epinephrine use or death before discharge. In the randomized studies, there was no difference in rate of tracheal intubation [RR 1.34, 95% CI (0.69-2.59)]. No participants received chest compressions. In the nonrandomized study, fewer infants were intubated in the ECG group [RR 0.75, 95% CI (0.62-0.90)]; however, for chest compressions, benefit or harm could not be excluded. [RR 2.14, 95% (CI 0.98-4.70)]., Conclusion: There is insufficient evidence to ascertain clinical benefits or harms associated with the use of ECG versus pulse oximetry plus auscultation for heart rate assessment in newborns in the delivery room., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Aim: To examine speed and accuracy of newborn heart rate measurement by various assessment methods employed at birth., Methods: A search of Medline, SCOPUS, CINAHL and Cochrane was conducted between January 1, 1946, to until August 16, 2023. (CRD 42021283364) Study selection was based on predetermined criteria. Reviewers independently extracted data, appraised risk of bias and assessed certainty of evidence., Results: Pulse oximetry is slower and less precise than ECG for heart rate assessment. Both auscultation and palpation are imprecise for heart rate assessment. Other devices such as digital stethoscope, Doppler ultrasound, an ECG device using dry electrodes incorporated in a belt, photoplethysmography and electromyography are studied in small numbers of newborns and data are not available for extremely preterm or bradycardic newborns receiving resuscitation. Digital stethoscope is fast and accurate. Doppler ultrasound and dry electrode ECG in a belt are fast, accurate and precise when compared to conventional ECG with gel adhesive electrodes., Limitations: Certainty of evidence was low or very low for most comparisons., Conclusion: If resources permit, ECG should be used for fast and accurate heart rate assessment at birth. Pulse oximetry and auscultation may be reasonable alternatives but have limitations. Digital stethoscope, doppler ultrasound and dry electrode ECG show promise but need further study., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘Dr. Kapadia is a co-author of one of the studies included in this review. Drs. Liley and Rabi are editorial board members for the Resuscitation Plus journal. The other authors have no conflicts to disclose.’., (© 2024 The Author(s).)

Objective: Behavioral performance of health professionals is essential for adequate patient care. This study aimed to assess the behavioral skills of fellows in neonatology before and after a simulation training program on neonatal resuscitation., Study Design: From March 2019 to February 2020, a prospective cohort with 12 second-year fellows in neonatology were evaluated during three training cycles (16 hours each) in manikin-based simulation of neonatal resuscitation with standardized scenarios. Each cycle lasted 1 month, followed by a 3-month interval. One video-recorded scenario of approximately 10 minutes was performed for each fellow at the beginning and at the end of each training cycle. Therefore, each fellow was recorded six times, before and after each one of three training cycles. Anxiety of the fellows was assessed by the Beck Anxiety Inventory applied before the first training cycle. The videos were independently analyzed in a random order by three trained facilitators using the Behavioral Assessment Tool. The behavioral performance was evaluated by repeated measures of analysis of variance adjusted for anxiety and for previous experience in neonatal resuscitation., Results: Fellows' overall behavioral performance improved comparing the moment before the first training and after the second training. The specific skills, such as communication with the team, delegation of tasks, allocation of attention, use of information, use of resources, and professional posture, showed a significant improvement after the second month of training. No further gains were noted with the third training cycle. Anxiety was observed in 42% of the fellows and its presence worsened their behavioral performance., Conclusion: An improvement in behavioral performance was observed, comparing the moment before the first training and after the second training, without further gains after the third training. It is worth noting the important role of anxiety as a modulator of acquisition and retention of behavioral skills in health professionals in training., Key Points: · Simulation training should improve technical and behavioral skills of providers. · Behavioral skills improve after a first cycle of training, but not after a repeat cycle. · Anxiety modulates trainees' behavioral performance., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: This article aimed to report a temporal series of respiratory distress syndrome (RDS)-associated neonatal mortality rates in preterm live births in São Paulo state, Brazil, and to identify social, maternal, and neonatal characteristics associated with these deaths., Study Design: This is a population-based study of all live births with gestational age (GA) between 22 and 36 weeks, birth weight ≥400 g, without congenital anomalies from mothers living in São Paulo state during 2004 to 2015. RDS-associated neonatal mortality was defined as death up to 27 days after birth with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality rate (annual percent change [APC] with 95% confidence intervals [95% CIs]) was analyzed by Prais-Winsten. Kaplan-Meier estimator identified the time after birth that the RDS-associated neonatal death occurred. Poisson's regression model compared social maternal and neonatal characteristics between preterm live births that survived the neonatal period and those with RDS-associated neonatal deaths, with results expressed in incidence rate ratio and 95% CI., Results: A total of 645,276 preterm live births were included in the study, of which 612,110 survived and 11,078 had RDS-associated neonatal deaths. RDS-associated neonatal mortality rate was 17.17 per thousand preterm live births, with a decreasing annual trend (APC: -6.50%; 95% CI: -9.11 to -3.82%). The median time of these deaths was 48 hours after birth. The following risk factors for RDS-associated neonatal death were identified: maternal schooling ≤7 years (1.18; 1.09-1.29), zero to three prenatal care visits (1.25; 1.18-1.32), multiple pregnancy (1.24; 1.16-1.33), vaginal delivery (1.29; 1.22-1.36), GA 22 to 27 weeks (106.35; 98.36-114.98), GA 28 to 31 weeks (20.12; 18.62-21.73), male sex (1.16; 1.10-1.22), and 5-minute Apgar scores of 0 to 3 (6.74; 6.08-7.47) and 4 to 6 (3.97; 3.72-4.23)., Conclusion: During the study period, RDS-associated neonatal mortality rates showed significant reduction. The relationship between RDS-associated neonatal deaths and social, maternal, and neonatal factors suggests the need for perinatal strategies to reduce prematurity and to improve the initial management of preterm infants., Key Points: · RDS is associated with preterm live births.. · Impact of RDS-associated neonatal mortality in middle-income countries is scarce.. · Qualified perinatal care can reduce RDS-associated neonatal mortality.., Competing Interests: None declared. Database use was possible due to FAPESP (Project number 2017/03748–7) and due to agreements numbers 23089.004297/2008–11 and 23089.000057/2014–95 between Fundação SEADE and Universidade Federal de São Paulo., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

Introduction: Premature birth, perinatal asphyxia, and infections are the main causes of neonatal death. Growth deviations at birth also affect neonatal survival according to week of gestation at birth, particularly in developing countries. The purpose of this study was to verify the association between inappropriate birth weight and neonatal death in term live births., Methods: This is an observational follow-up study with all term live births from 2004 to 2013 in Sao Paulo State, Brazil. Data were retrieved with the deterministic linkage of death and birth certificates. The definition of very small for gestational age (VSGA) and very large for gestational age (VLGA) used the 10th percentile of 37 weeks and the 90th percentile of 41 weeks + 6 days, respectively, based on the Intergrowth-21st. We measured the outcome in terms of time to death and the status of each subject (death or censorship) in the neonatal period (0-27 days). Survival functions were calculated using the Kaplan-Meier method stratified according to the adequacy of birth weight into three groups (normal, very small, or very large). We used multivariate Cox regression to adjust for proportional hazard ratios (HRs)., Results: The neonatal death rate during the study period was 12.03/10,000 live births. We found 1.8% newborns with VSGA and 2.7% with VLGA. The adjusted analysis showed a significant increase in mortality risk for VSGA infants (HR = 4.25; 95% CI: 3.89-4.65), independent of sex, 1-min Apgar score, and five maternal factors., Discussion: The risk of neonatal death in full-term live births was approximately four times greater in those with birth weight restriction. The development of strategies to control the factors that determine fetal growth restriction through planned and structured prenatal care can substantially reduce the risk of neonatal death in full-term live births, especially in developing countries such as Brazil., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Konstantyner, Areco, Bandiera-Paiva, Marinonio, Kawakami, Balda, Miyoshi, Sanudo, Costa-Nobre, de Freitas, Morais, Teixeira, Waldvogel, Kiffer, de Almeida and Guinsburg.)

Moderate and late preterm newborns comprise around 85% of live births < 37 weeks gestation. Data on their neonatal mortality in middle-income countries is limited. This study aims to analyze the temporal trend, causes and timing of neonatal mortality of infants with 32 0/7 -36 6/7 weeks gestation without congenital anomalies from 2004-2015 in the population of São Paulo State, Brazil. A database was built by deterministic linkage of birth and death certificates. Causes of death were classified by ICD-10 codes. Among 7,317,611 live births in the period, there were 545,606 infants with 32 0/7 -36 6/7 weeks gestation without congenital anomalies, and 5782 of them died between 0 and 27 days. The neonatal mortality rate decreased from 16.4 in 2004 to 7.6 per thousand live births in 2015 (7.47% annual decrease by Prais-Winsten model). Perinatal asphyxia, respiratory disorders and infections were responsible, respectively, for 14%, 27% and 44% of the 5782 deaths. Median time to death was 24, 53 and 168 h, respectively, for perinatal asphyxia, respiratory disorders, and infections. Bottlenecks in perinatal health care are probably associated with the results that indicate the need for policies to reduce preventable neonatal deaths of moderate and late preterm infants in the most developed state of Brazil.

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed., (Copyright © 2023 by the American Academy of Pediatrics.)

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

Background: Prematurity and respiratory distress syndrome (RDS) are strongly associated. RDS continues to be an important contributor to neonatal mortality in low- and middle-income countries. This study aimed to identify clusters of preterm live births and RDS-associated neonatal deaths, and their cooccurrence pattern in São Paulo State, Brazil, between 2004 and 2015.  METHODS: Population-based study of all live births with gestational age ≥ 22 weeks, birthweight ≥ 400 g, without congenital anomalies from mothers living in São Paulo State, Brazil, during 2004-2015. RDS-associated neonatal mortality was defined as deaths < 28 days with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality and preterm live births rates per municipality were submitted to first- and second-order spatial analysis before and after smoothing using local Bayes estimates. Spearman test was applied to identify the correlation pattern between both rates., Results: Six hundred forty-five thousand two hundred seventy-six preterm live births and 11,078 RDS-associated neonatal deaths in São Paulo State, Brazil, during the study period were analyzed. After smoothing, a non-random spatial distribution of preterm live births rate (I = 0.78; p = 0.001) and RDS-associated neonatal mortality rate (I = 0.73; p = 0.001) was identified. LISA maps confirmed clusters for both, with a negative correlation (r = -0.24; p = 0.0000). Clusters of high RDS-associated neonatal mortality rates overlapping with clusters of low preterm live births rates were detected., Conclusions: Asymmetric cluster distribution of preterm live births and RDS-associated neonatal deaths may be helpful to indicate areas for perinatal healthcare improvement., (© 2022. The Author(s).)

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research., (Copyright © 2021 European Resuscitation Council, American Heart Association, Inc. and International Liaison Committee on Resuscitation. Published by Elsevier B.V. All rights reserved.)