No abstract

A 90-year-old man presented with subcutaneous ecchymoses. He had been under treatment with dabigatran etexilate methanesulfonate (DEM). Prolonged APTT and decreased PT was developed 2 months after the start of DEM, more prolonged 6 months later. DEM was discontinued, the coagulopathy did not improve. Factor V activity was decreased, along with appearance of coagulation factor V inhibitor (FVI). He did not have antiphospholipid syndrome or malignancy. He was diagnosed as having acquired FVI caused by DEM. Steroid pulse therapy was effective. There have been 74 reported cases of AFVI induced by drug treatment, but none after treatment with DEM.

A 35-year-old Japanese man was emergently admitted to our hospital with chief complaints of palpitation and dyspnea. He has been treated for Basedow's disease. He was diagnosed with acute decompensated heart failure, atrial fibrillation and thyrotoxicosis. We started anti-thyroid agents and a treatment for heart failure with beta blockers and diuretics under anti-coagulation therapy. His B-type natriuretic peptide levels remained high, although the heart failure had been compensated and the heart rate was well controlled while hyperthyroidism still existed. We should bear in mind that a discrepancy can exist between the clinical course and the B-type natriuretic peptide level in heart failure patients complicated with hyperthyroidism.

To clarify developmental characteristics and sex differences in elementary school students, the approach run velocity and jumping movements during the long jump performed by second-(16 males and 15 females), fourth-(18 males and 18 females), and sixth(20 males and 16 females)-grade students were kinematically analyzed. In addition to measuring the distances achieved by the students, their movements from the start of the approach run to landing were video-recorded. Using recorded images, the mean approach run velocity in each 3-m section of the track was calculated, and factors associated with jumping movements were examined. Sixth-grade students(males：2.83±0.45 m, females：2.25±0.32 m)achieved the longest distances, followed by fourth-(males：2.41±0.41 m, female：2.07±0.29 m)and second-(males：2.15±0.27 m, females：1.64±0.26 m)graders, in this order, with significant differences. As for the approach run velocity in the last 3-m section, both male and female sixth-and fourth-graders maintained their velocities until takeoff , while those of male and female second-graders decreased. When preparing their bodies for takeoff, both male and female six-graders straightened their upper bodies more quickly than second-graders to increase their initial vertical velocities at takeoff. On the other hand, in both males and females, landing movements did not improve with age. On examining sex differences in jumping movements, decreases in the velocity during takeoff , as well as the forward force when landing, were less marked among males at all grades.

Background Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) requires a large amount of economic and human resources. The presence of bystander cardiopulmonary resuscitation (CPR) was focused on selecting appropriate V-A ECMO candidates. Result This study retrospectively enrolled 39 patients with V-A ECMO due to out-of-hospital cardiac arrest (CA) between January 2010 and March 2019. The introduction criteria of V-A ECMO included the following: (1) < 75 years old, (2) CA on arrival, (3) < 40 min from CA to hospital arrival, (4) shockable rhythm, and (5) good activity of daily living (ADL). The prescribed introduction criteria were not met by 14 patients, but they were introduced to V-A ECMO at the discretion of their attending physicians and were also included in the analysis. Neurological prognosis at discharge was defined using The Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories of Brain Function (CPC). Patients were divided into good or poor neurological prognosis (CPC ≤ 2 or ≥ 3) groups (8 vs. 31 patients). The good prognosis group had a significantly larger number of patients who received bystander CPR (p = 0.04). The mean CPC at discharge was compared based on the combination with the presence of bystander CPR and all five original criteria. Patients who received bystander CPR and met all original five criteria showed significantly better CPC than patients who did not receive bystander CPR and did not meet some of the original five criteria (p = 0.046). Conclusion Considering the presence of bystander CPR help in selecting the appropriate candidate of V-A ECMO among out-of-hospital CA cases.