論文

© 2016 the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. Background: Depending on upper airway patency during anesthesia induction, tidal volume achieved by mask ventilation may vary. In 80 adult patients undergoing general anesthesia, the authors tested a hypothesis that tidal volume during mask ventilation is smaller in patients with sleep-disordered breathing priorly defined as apnea hypopnea index greater than 5 per hour. Methods: One-hand mask ventilation with a constant ventilator setting (pressure-controlled ventilation) was started 20 s after injection of rocuronium and maintained for 1 min during anesthesia induction. Mask ventilation efficiency was assessed by the breath number needed to initially exceed 5 ml/kg ideal body weight of expiratory tidal volume (primary outcome) and tidal volumes (secondary outcomes) during initial 15 breaths (UMIN000012494). Results: Tidal volume progressively increased by more than 70% in 1 min and did not differ between sleep-disordered breathing (n = 42) and non-sleep-disordered breathing (n = 38) patients. In post hoc subgroup analyses, the primary outcome breath number (mean [95% CI], 5.7 [4.1 to 7.3] vs. 1.7 [0.2 to 3.2] breath; P = 0.001) and mean tidal volume (6.5 [4.6 to 8.3] vs. 9.6 [7.7 to 11.4] ml/kg ideal body weight; P = 0.032) were significantly smaller in 20 sleep-disordered breathing patients with higher apnea hypopnea index (median [25th to 75th percentile]: 21.7 [17.6 to 31] per hour) than in 20 non-sleep disordered breathing subjects with lower apnea hypopnea index (1.0 [0.3 to 1.5] per hour). Obesity and occurrence of expiratory flow limitation during one-hand mask ventilation independently explained the reduction of efficiency of mask ventilation, while the use of two hands effectively normalized inefficient mask ventilation during one-hand mask ventilation. Conclusions: One-hand mask ventilation is difficult in patients with obesity and severe sleep-disordered breathing particularly when expiratory flow limitation occurs during mask ventilation.

© 2016 The Authors. Allergy Published by John Wiley & Sons Ltd. Background: Specific IgE (sIgE) is often used to predict oral food challenge (OFC) outcomes in food allergy, but interpretation of the results may vary depending on the assay method employed and the patient population tested. The aim of this study was to use two commercial assay systems to determine egg-sIgE values predictive of allergy within the most common populations treated at pediatric clinics. Methods: In a multicenter prospective study, 433 children with suspected or confirmed egg allergy underwent oral challenge (OFC) using cooked egg (CE) and raw egg (RE) powders to diagnose either true allergy in 1-year-old (group A, n = 220) or tolerance in 2- to 6-year-old (group B, n = 213). Egg white (EW)- and ovomucoid (OM)-sIgE values were measured using the ImmunoCAP® sIgE (ImmunoCAP) and the IMMULITE® 2000 3 gAllergy™ (3gAllergy) systems. Children were recruited from six primary care clinics and 18 hospitals in Japan. Results: Receiver-operating characteristic (ROC) curve analysis yielded similar areas under the curve (AUC) for the two assays (0.7–0.8). The optimal cutoff values and the probability curves (PCs) of the sIgE by the two assays to predict CE and RE OFC outcomes were determined for both groups. Values for 3gAllergy were higher than for ImmunoCAP; however, correlation of sIgE and predicted probability calculated by PCs were strong between the two methods. Conclusions: Cutoff values and PCs for egg-sIgE established using both ImmunoCAP and 3gAllergy may be useful for predicting egg allergy in early childhood patient populations.

Purpose: Pharmacological treatments with some anticonvulsants, including valproate, and lithium should be avoided where possible in childbearing-aged and pregnant women with epilepsy and bipolar disorder because they increase the risk of major congenital malformations. We surveilled real-world prescriptions of anticonvulsants and lithium in childbearing-aged female and male outpatients in Japan, using the first public National Insurance Claims Database of Japan.Methods: We performed a summary statistical analysis of the numbers of the most prescribed 11 anticonvulsants and lithium tablets in female and male outpatients aged 15-29 (younger childbearing age), 30-49 (older childbearing age), and >50 (non-childbearing age) years from April 2014 to March 2015. We determined the association between anticonvulsant or lithium use and sex at childbearing age, and the odds ratio (OR) and 95% confidence intervals (CIs) were estimated using logistic regression analysis.Results: Valproate (number of tablets = 273,135,937) was the most prescribed among the 12 investigated drugs, and 125,451,907 tablets were prescribed for women (younger, older, and non-childbearing ages, 19,296,528, 47,826,746, and 58,328,63, respectively), compared to 147,684,031 tablets for men (24,534,648, 57,229,981, and 65,919,402, respectively). Valproate prescription was only slightly lower in childbearing-aged women than in the same-aged men (i.e., 15-29 years of age, OR = 0.889 [95% CI, 0.888-0.890]; 30-49 years of age, OR = 0.944 [95% CI, 0.944-0.945]).Discussion: This study demonstrated valproate was highly prescribed for childbearing-aged women in Japan in 2014-2015. Physicians should prescribe valproate with considerable caution in girls and childbearing-aged women.

Genomic DNA is exposed to a constant insult from sources that are both endogenous and exogenous to the cell. REV1 protein, a eukaryotic member of Y family of DNA polymerases, is involved in the tolerance to such DNA damages by providing a translesion DNA synthesis. Here, we examined possible association between REV1 polymorphisms and breast cancer risk in Thai women. Five single nucleotide polymorphisms (SNPs) REV1 (rs3792152, rs3087395, rs3792137, rs959929, rs3087386) were genotyped. The study population consists of 570 patients with histopathologically confirmed breast cancer and 497 controls. Association of genotypes with breast cancer risk was evaluated using multivariate logistic regression to estimate odds ratios (OR) and their 95z confidence intervals (95zCI). Our results revealed that the heterozygote carrier of REV1 SNP (rs3087395) was associated with breast cancer risk with OR=1.59 (95 zCI: 1.11-2.29). In addition, an increased risk was observed for homozygotes at the REV1 SNP (rs 959929) with the OR=1.52 (95zCI: 1.01-2.29). A stratified analysis suggested that the association between the REV1 SNPs and breast cancer is different by the menopausal status. The present results suggest thatREV1 polymorphisms are likely to play a modifying role in the individual susceptibility to breast cancer among Thai women. © The Japanese Environmental Mutagen Society.