The Keio journal of medicine
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Anemia in chronic kidney disease (CKD) is a risk factor for cardiovascular diseases and is treated by long-acting erythropoiesis-stimulating agents (ESAs). Although the results of previous studies have shown that hemoglobin levels could not be maintained at the initiation of dialysis in CKD patients treated with recombinant human erythropoietin, it remains undetermined whether long-acting ESAs are effective in preventing the progression of anemia at the initiation of dialysis. In the present study, hemoglobin levels in 40 CKD patients treated with darbepoetin alfa (DA) and 15 CKD patients treated with a continuous erythropoietin receptor activator (CERA) were retrospectively compared during the 6 months period before the initiation of dialysis. ⋯ Although the total doses of ESAs used during the 6-month period were similar between the two groups, DA-treated CKD patients received subcutaneous injections more frequently than did patients treated with CERA. These results suggest that CKD patients require more intense ESA therapy to prevent a decline in hemoglobin levels at the initiation of dialysis, including those treated with long-acting ESAs. The results also raise the possibility that CERA is more useful than DA for reducing the number of injections during the pre-dialysis period.
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Comparative Study
Cardiopulmonary Resuscitation Training in Schools: A Comparison of Trainee Satisfaction among Different Age Groups.
Cardiopulmonary resuscitation (CPR) has recently been added to the school curriculum worldwide and is currently taught to students between the ages of 10 and 16 years. The effect of the age of trainees on their satisfaction with CPR training has yet been elucidated. The aim of this study was to compare the satisfaction of trainees of different ages who participated in CPR training in schools in Japan. ⋯ The current model suggested that the students' satisfaction with CPR training was strongly related to their age. Primary school students enjoyed CPR training more and were more confident in their ability to perform CPR than junior high and high school students were. Therefore, children aged 10-11 years may be the most appropriate candidates for the introduction of CPR training in schools.
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Few medical journals specifically instruct authors to use the active voice and avoid the passive voice, but advice to that effect is common in the large number of stylebooks and blogs aimed at medical and scientific writers. Such advice typically revolves around arguments that the passive voice is less clear, less direct, and less concise than the active voice, that it conceals the identity of the person(s) performing the action(s) described, that it obscures meaning, that it is pompous, and that the high rate of passive-voice usage in scientific writing is a result of conformity to an established and old-fashioned style of writing. ⋯ In this review, I examine the advice offered by anti-passive writers, along with some of their examples of "inappropriate" use, and argue that the key factor in voice selection is sentence word order as determined by the natural tendency in English for the topic of discourse ("old" information) to take subject position and for "new" information to come later. Authors who submit to this natural tendency will not have to worry much about voice selection, because it will usually be automatic.
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The purpose of this study was to assess the clinical usefulness of near-infrared spectroscopy (cerebral oximetry) in patients presenting to the emergency department (ED) with carbon monoxide (CO) intoxication. Eighteen patients with a diagnosis of CO intoxication who presented to our ED during 2013 were included in this prospective study. All patients were treated and monitored according to the standard recommendations for CO intoxication. ⋯ The differences in ScO2 values before and after oxygen therapy were statistically significant (P ≤ 0.005). Assessment of patients exposed to CO gas using cerebral oximetry can provide information about cerebral oxygen saturation. Blood COHb level measurement is still the best method for diagnosing CO intoxication; however, cerebral oximetry, a non-invasive technique, may be an effective method for assessing cerebral oxygen saturation.
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Penetrating neck injuries are commonly related to stab wounds and gunshot wounds in the United States. The injuries are classified by penetration site in terms of the three anatomical zones of the neck. Based on this zonal classification system, penetrating injuries to the head and neck have traditionally been evaluated by conventional angiography and/or surgical exploration. ⋯ CT angiography is a fast and minimally invasive imaging modality to evaluate penetrating injuries of the head and neck for stable patients. The spectrum of penetrating neck injuries includes vascular injury (extravasation, pseudoaneurysm, dissection, occlusion, and arteriovenous fistula), aerodigestive injury (esophageal and tracheal injuries), salivary gland injury, neurologic injury (spinal canal and cerebral injuries), and osseous injury, all of which can be evaluated using CT angiography. Familiarity with the complications and imaging characteristics of penetrating injuries of the head and neck is essential for accurate diagnosis and optimal treatment.