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Abstract Background Although the angiotensin receptor-neprilysin inhibitor sacubitril-valsartan has demonstrated a valuable effect on cardiac function in patients with heart failure with a reduced ejection fraction, the effect of this agent in hemodialysis patients is not well known. Case presentation Sacubitril-valsartan was administered to two anuric hemodialysis patients, an 81-year-old woman and a 79-year-old man, after aortic valve replacement for aortic stenosis. Following sacubitril-valsartan administration, the two patients’ N-terminal pro-brain natriuretic peptide levels decreased from 110,373 to 47,742 and 22,723 to 7692 pg/mL within one month, respectively, and were sustained within the lower levels thereafter. Although the patients’ left ventricular ejection fractions were 40.0% and 28.4%, respectively, these values did not change at seven and four months after sacubitril-valsartan administration (41.0% and 30.0%, respectively) but increased gradually to 56.6% and 54.9% at 11 and 13 months, respectively, and were sustained at the same levels thereafter. Conclusions Long-term sacubitril-valsartan administration can improve cardiac function in hemodialysis patients with a reduced ejection fraction.

The objective of this study is to elucidate the issue of dropping during the flushing of closed suction catheters and to improve awareness of dropping prevention. Simulating a subject equipped with a ventilator, a comparative study on the causes of dropping during flushing was conducted using three different closed catheters widely used in the medical field. The results indicated significant differences in adult catheters based on ventilation volume and mode, with some cases showing significant differences according to PEEP (positive end-expiratory pressure) and angle. In comparisons involving only pediatric catheters and combined comparisons of adult and pediatric catheters, significant differences were observed in the amount of secretions dropped based on ventilation volume and ventilation mode. These differences revealed structural issues with the catheters. Specifically, it was suggested that flow from the ventilator directly affects the catheter tip and that saline buildup in the anti-drop valve can cause dropping. Furthermore, dropping issues were observed depending on the technique of the individual performing the suction. Based on the novel insights gained from this study, there is consideration to form a research team for the development of an improved device in the future. [ABSTRACT FROM AUTHOR]

The introduction of home mechanical ventilation (HMV) or home oxygen therapy (HOT) for chronic obstructive pulmonary disease (COPD) has been shown to improve patient outcomes and shorten hospital stays. Despite this, COPD deaths continue to increase worldwide, and there is room for improvement in the treatment of COPD at home. Maintaining fraction of inspiratory oxygen (FiO2) may increase the effectiveness of treatment. However, previous studies have shown when HOT was used in combination with HMV, FiO2 decreased due to leakage from the gap between the patient’s face and non-invasive positive pressure ventilation (NPPV) mask. The latest HMV model, VOCSN (Ventec Life Systems, Inc.), is now being used in clinical practice as the newest ventilator model with HOT in HMV. In this study, experiments were conducted using the two types of ventilator circuits used in the VOCSN, but no statistically significant differences were found between them. We report on basic experiments conducted to investigate whether the VOCSN can maintain FiO2 without being affected by leaks or ventilation volume compared to previous studies [ABSTRACT FROM AUTHOR]

Iodine capsule therapy was used to prevent recurrence of thyroid cancer. Hemodialysis patients receiving iodine capsule therapy require blood purification therapy in an RI room, but the method of administration has not been established, and there are few reports of such therapy in Japan. In this study, radiation dose before and after admission to the RI room was investigated in two maintenance hemodialysis patients who received iodine therapy after total thyroidectomy; both patients met the criteria for radiation dose exit after two hemodialysis treatments. Radiation contamination of the staff was also low, indicating that the treatment was performed safely. We report the results of the survey and some points to keep in mind when performing blood purification therapy in a radiation area. [ABSTRACT FROM AUTHOR]

Choline and carnitine, which are essential nutrients for living organisms, produce trimethylamine in the intestine and are metabolized in the liver to the oxidized form trimethylamine. This trimethylamine-N-oxide is said to cause arteriosclerosis. A patient diagnosed with trimethylaminuria was used as an opportunity to measure plasma trimethylamine and trimethylamine-N-oxide in hemodialysis patients and examine their association with arteriosclerosis. Plasma TMA decreased from 68.9 µM pre-dialysis to 51.5 µM post-dialysis, and TMAO decreased from 170.4 µM pre-dialysis to 150.7 µM post-dialysis. The FMD levels were 3.36% with CVD and 5.75% without CVD, a significant difference. However, 45.1% of patients had elevated plasma TMAO post dialysis, which strongly suggests that plasma TMA and TMAO are related to intestinal bacteria, since dietary influences and TMAU patients had a significant improvement in fish odor after colonoscopy. [ABSTRACT FROM AUTHOR]

The hypothalamus plays an important role in the regulation of sleep/wakefulness states. While the ventrolateral preoptic nucleus (VLPO) plays a critical role in the initiation and maintenance of sleep, the lateral posterior part of the hypothalamus contains neuronal populations implicated in maintenance of arousal, including orexin-producing neurons (orexin neurons) in the lateral hypothalamic area (LHA) and histaminergic neurons in the tuberomammillary nucleus (TMN). During a search for neurons that make direct synaptic contact with histidine decarboxylase-positive (HDC+), histaminergic neurons (HDC neurons) in the TMN and orexin neurons in the LHA of male mice, we found that these arousal-related neurons are heavily innervated by GABAergic neurons in the preoptic area including the VLPO. We further characterized GABAergic neurons electrophysiologically in the VLPO (GABAVLPO neurons) that make direct synaptic contact with these hypothalamic arousal-related neurons. These neurons (GABAVLPO→HDC or GABAVLPO→orexin neurons) were both potently inhibited by noradrenaline and serotonin, showing typical electrophysiological characteristics of sleep-promoting neurons in the VLPO. This work provides direct evidence of monosynaptic connectivity between GABAVLPO neurons and hypothalamic arousal neurons and identifies the effects of monoamines on these neuronal pathways. [ABSTRACT FROM AUTHOR]