Disseminated intravascular coagulation (DIC) and multiple organ failure often occur via the crosstalk between inflammation and coagulation, which is mediated by High Mobility Group Box 1 (HMGB1). In septic shock, Polymyxin-B direct hemoperfusion (PMX-DHP) ameliorates hemodynamics by endogenous cannabinoid adsorption and improves pulmonary oxygenation by indirect cytokine reduction through the adsorption of activated mononuclear cells. However, PMX-DHP has no direct effect on HMGB1 circulating in the plasma. In cases with DIC, recombinant thrombomodulin (rTM), an effective drug for DIC, exerts not only anticoagulation but also antiinflammatory properties via direct anti-HMGB1 activity. Therefore, a combination of PMX-DHP and rTM is expected to block the vicious cycle of a cytokine storm ending up with multiple organ failure in DIC. The aim of this study was to investigate the efficacy of combination therapy for septic shock associated with DIC. This study comprised 22 consecutive patients with sepsis-induced DIC who received PMX-DHP. The initial eight patients were treated without rTM (historical control group), and the following 14 patients were given rTM (rTM group). The baseline Sequential Organ Failure Assessment (SOFA) score or age was not different between both groups. Sixtyday survival rate in the rTM group was significantly higher than that in the control group (85.7% vs. 37.5%, P = 0.015). A combination of PMX-DHP and rTM may be effective in septic shock accompanied by DIC and is expected to improve survival rates.

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Our results suggest that AN69ST-CHDF can be a novel FGF-23 lowering therapy for acute illnesses requiring acute blood purification.

The micro-strains of a ngernail and toenail caused by pulse wave were measured by a conventional strain measuring method using a biaxial strain gauge. The strain uctuations of nails were larger in the lateral direction than in the longitudinal direction. In a previous study, pulse wave measurement by a polyvinylidene di uoride (PVDF) lm, which is a piezo lm, attached to the nail surface was proposed as a new pulse wave measuring method with lower electrical power consumption. The piezo lm can transform a nail surface micro-strain caused by pulse wave into an electrical signal. However, the optimal orientation of the piezo lm on nails remains unclear. The experimental results of the present study showed that a larger displacement was generated from the nails to the piezo lms by aligning the longitudinal direction of the piezo lm with the lateral direction of the nails.