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ObjectiveStatus epilepticus (SE) is an emergency condition for which rapid and secured cessation is crucial. Although fosphenytoin (FPHT) is recommended as a second-line treatment, levetiracetam (LEV) reportedly has similar efficacy, but higher safety. Therefore, we herein compared LEV with FPHT in adult SE.MethodsWe initiated a multicentre randomised control trial in emergency departments with adult patients with convulsive SE. Diazepam was initially administered, followed intravenously by FPHT at 22.5 mg/kg or LEV at 1000–3000 mg. The primary outcome was assigned as the seizure cessation rate within 30 min of the administration of the study drug.ResultsA total of 176 adult patients with SE were enrolled (82 FPHT and 94 LEV), and 3 were excluded from the full analysis set. Seizure cessation rates within 30 min were 83.8% (67/80) in the FPHT group and 89.2% (83/93) in the LEV group. The difference in these rates was 5.5% (95% CI −4.7 to 15.7, p=0.29). The non-inferiority of LEV to FPHT was confirmed with pConclusionThe efficacy of LEV was similar to that of FPHT for adult SE following the administration of diazepam. LEV may be recommended as a second-line treatment for SE along with phenytoin/FPHT.Trial registration numberjRCTs031190160.

A non-invasive method for assessment of intravascular volume for optimal fluid administration is needed. We here conducted a preliminary study to confirm whether cardiac variation in the internal jugular vein (IJV), evaluated by ultrasound, predicts fluid responsiveness in patients in the emergency department. Patients who presented to the emergency department between August 2019 and March 2020 and required infusions were enrolled. We recorded a short-axis video of the IJV, respiratory variability in the inferior vena cava and stroke volume variations using the ClearSight System (Edwards Lifesciences, Irvine, CA, USA) before infusion of 500 mL of crystalloid fluid. Cardiac variations in the cross-sectional area of the IJV were measured by speckle tracking. Among the 148 patients enrolled, 105 were included in the final analysis. Fluid responsiveness did not correlate with the cardiac collapse index (13.6% vs. 16.8%, p = 0.24), but correlated with stroke volume variations (12.5% vs. 15.6%, p = 0.026). Although it is a simple correction, the cardiac collapse index correlated with stroke volume corrected by age (r = 0.25, p = 0.01), body surface area (r = 0.33, p = 0.002) and both (r = 0.35, p = 0.001). Cardiac variations in the IJV did not predict fluid responsiveness in the emergency department, but may reflect stroke volume.

Diarrhea is one of the most common complications associated with enteral nutrition in hospitalized patients. Oligomeric enteral nutrition has been considered to reduce the incidence of diarrhea. We herein introduced and examined the effects of a specific oligomeric enteral nutrition with the low-molecular-weight whey peptides, Peptino‍

We hypothesized that coagulopathy independently contributes to muscle injury focusing to titin fragmentation, and investigated their correlations.We conducted a post-hoc analysis of an observational study, in which we evaluated muscle injury with the biomarker titin. Coagulopathy was assessed on the first day using the Japanese diagnostic criteria of acute-phase disseminated intravascular coagulopathy (JAAM-DIC). Mean N-titin/Cre measured on days 1, 3, 5, and 7 was assigned as the primary outcome.Overall, 111 eligible patients were included. Mean N-titin/Cre were significantly higher in the JAAM-DIC group. A multivariable analysis identified JAAM-DIC as independent risk factors for mean N-titin/Cre while other severity scores were not.Coagulopathy correlated with muscle titin fragmentation, as an independent risk factor.The present study is registered at the University Hospital Medical Information Network-clinical trials registry (UMIN000040290, Registration date: May 7, 2020).

ObjectivesPost-intensive care syndrome (PICS) is a recognised sequela after critical care. The development of an index that predicts PICS mental disorders will be of significance for the selection of subsequent interventions. The purpose of this study was to find factors associated with PICS mental disorders. We hypothesised that grip strength during hospitalisation may be associated with the PICS mental status after discharge.DesignA post-hoc analysis of a multicentre prospective observational study.SettingNine hospitals in Japan.ParticipantsPatients who were newly admitted to intensive care unit and stayed for at least 48 hours were included. Exclusion criteria were patients younger than 18 years, those who required assistance with ambulation prior to admission, those with concomitant central nervous system disorders and those with terminal conditions.Primary and secondary outcome measuresPsychiatric symptoms 3 months after discharge were assessed using the Hospital Anxiety and Depression Scale (HADS). The HADS total score (HADS-total) was assigned as the primary outcome.Results98 patients were included into this study. Grip strength at discharge negatively correlated with HADS-total 3 months after discharge (r=−0.37, pConclusionsGrip strength at discharge correlated with mental disorders 3 months after discharge. Therefore, it may be useful for predicting postdischarge mental disorders.Trial registration numberUMIN000036503.

The risk of acute functional decline increases with age, and concepts including frailty and post-acute care syndrome have been proposed, however, the effects of the nutritional status currently remain unclear. Patients admitted to the emergency department of Hitachi General Hospital for infectious diseases between April 2018 and May 2019 were included. To identify risk factors for functional decline at discharge, defined as Barthel Index &lt, 60, we investigated basic characteristics, such as age, sex, disease severity, the pre-morbid care status, and cognitive impairment, as well as laboratory data on admission, including albumin as a nutritional assessment indicator. In total, 460 surviving patients out of 610 hospitalized for infection were analyzed. In a multivariable logistic regression analysis, factors independently associated with Barthel Index &lt, 60 at discharge were age (adjusted OR 1.03, 95%CI 1.01&ndash, 1.06, p = 0.022), serum albumin (adjusted OR: 0.63, 95%CI: 0.41&ndash, 0.99, p = 0.043), and the need for care prior to admission (adjusted OR: 5.92, 95%CI: 3.15&ndash, 11.15, p &lt, 0.001). Hypoalbuminemia on admission in addition to age and the need for care prior to admission were identified as risk factors for functional decline in patients hospitalized for infection. Functional decline did not correlate with the severity of illness.

Summary Background Appropriate protein delivery amounts during the acute phase of critical care are unknown. Along with nutrition, early mobilization and the combination are important. We conducted a randomized controlled trial during critical care to assess high-protein and medium-protein delivery under equal total energy delivery with and without active early rehabilitation. Methods ICU patients of August 2018–September 2019 were allocated to a high-protein group (target energy 20 kcal/kg/day, protein 1.8 g/kg/day) or a medium-protein group (target energy 20 kcal/kg/day, protein 0.9 g/kg/day) with the same nutrition protocol by day 10. By dividing the study period, standard rehabilitation was administered during the initial period. Rehabilitation with belt-type electrical muscle stimulation was given from day 2 in the latter as a historical comparison. Femoral muscle volume was evaluated on day 1 and day 10 using computed tomography. Results This study analyzed 117 eligible patients with similar characteristics assigned to a high-protein or medium-protein group. Total energy delivery was around 20 kcal/kg/day in both groups, but protein delivery was 1.5 g/kg/day and 0.8 g/kg/day. As a primary outcome, femoral muscle volume loss was 12.9 ± 8.5% in the high-protein group and 16.9 ± 7.0% in the medium-protein group, with significant difference (p = 0.0059). Persistent inflammation, immunosuppression, and catabolism syndrome were significantly less frequent in the high-protein group. Muscle volume loss was significantly less in the high-protein group only during the electrical muscle stimulation period. Conclusions For critical care, high protein delivery provided better muscle volume maintenance, but only with active early rehabilitation. Registration University Hospital Medical Information Network, UMIN000033783 Registered on 16 Aug 2018. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000038538 .

The effects of beta-hydroxy-beta-methylbutyrate (HMB) complex administration and the significance of titin, a biomarker of muscle injury, in elderly minor trauma patients in acute phase has not been established. In this single-center, randomized controlled study, trauma patients aged ≥ 70 years with an injury severity score &lt, 16 were included. Titin values on days 1 and 3 were measured and the intervention group received HMB complex (2.4 g of HMB + 14 g of glutamine + 14 g of arginine) and the control group received glutamine complex (7.2 g of protein including 6 g of glutamine). The cross-sectional area of the rectus femoris (RFCSA) on ultrasound, grip strength, and the Barthel Index were assessed on the first day of rehabilitation and after 2 weeks. We analyzed 24 HMB and 25 control participants. Titin values on day 3 correlated with grip strength (r = −0.34, p = 0.03) and the Barthel Index (r = −0.39, p = 0.01) at follow-up. HMB complex supplementation had no effect on the RFCSA (2.41 vs. 2.45 cm2, p = 0.887), grip strength (13.3 vs. 13.1 kg, p = 0.946), or the Barthel Index (20.0 vs. 50.0, p = 0.404) at follow-up. Titin values might associate with subsequent physical function. Short-term HMB complex supplementation from acute phase did not ameliorate muscle injury.

An ultrasonic micro-motor usually has small torque because of its small size of the transducer. If large sized transducer is used for driving small sized output part, we can expect better motor characteristics. In this research, a normal sized Langevin transducer was used to excite the driving vibration and its vibration is transmitted through the transmission line of 1 mm in diameter. A simple pipe is used for the rotor and its outer and inner diameters are 5 mm and 2 mm, respectively. Since an ultrasonic motor needs elliptic motion to drive the rotor, part of the longitudinal vibration has to be converted into the torsional vibration. A spring washer is used for mode conversion and preload is provided by this spring washer at the same time. The outer diameter of the spring washer is 4 mm. The driving frequency is about 49.6 kHz and the preload by the spring washer is about 8 N. The maximum revolution speed was 353 r.p.m. at applied voltage of 50 Vp-p, the maximum torque was 0.245 mNm at applied voltage ...

An ultrasonic micro-motor usually has small torque because of its small sized rotor. If we can use large sized transducer, such as bolt clamped Langevin transducer, we can expect an ultrasonic micro-motor with high performance. In this research, a Langevin transducer with 31.5 mm in diameter is used to drive a rotor with 5 mm in diameter. Spiral structure is used to excite both longitudinal and torsional vibration to drive the rotor. The maximum revolution speed was 147 r.p.m. at applied voltage of 60 Vp-p, the maximum torque was 0.061 mNm at applied voltage of 60 Vp-p, and the maximum driving efficiency was 0.0059 % at applied voltage of 50 Vp-p.

This paper describes an unique mastering scheme to form the Land-Pre-Pit address along with the groove. The scheme expands the resolution limit and gives other advantages in the disc manufacturing. The authors produced the disc applying it on a 351nm mastering apparatus and confirmed the realization of 20 GBytes disc capacity per the DVD size. The scheme can be inherited in the future mastering using the shortened wavelength or the electron beam.

A new modulation code and new signal reproduction processes for a high-density optical disk system are proposed. With these new techniques, the capacity of the optical disk system can be 30% higher than the present digital versatile disk (DVD) system. An evaluation in terms of the bit error rate by both simulation and hardware experiments is also shown.