BACKGROUND: We investigated the relationship between serum total carbon dioxide (CO₂) and bicarbonate ion (HCO₃⁻) concentrations in pre-dialysis chronic kidney disease (CKD) patients and devised a formula for predicting low bicarbonate (HCO₃⁻< 24 mmol/L) and high bicarbonate (HCO₃⁻ ≥ 24 mmol/L) using clinical parameters. METHODS: In total, 305 samples of venous blood collected from 207 pre-dialysis patients assessed by CKD stage (G1 + G2, 46; G3, 50; G4, 51; G5, 60) were investigated. The relationship between serum total CO₂ and HCO₃⁻ concentrations was analyzed using Pearson’s correlation coefficient. An approximation formula was developed using clinical parameters correlated independently with HCO₃⁻ concentration. Diagnostic accuracy of serum total CO₂ and the approximation formula was evaluated by receiver operating characteristic curve analysis and a 2 × 2 table. RESULTS: Serum total CO₂ correlated strongly with HCO₃⁻ concentration (r = 0.91; P < 0.001). The following approximation formula was obtained by a multiple linear regression analysis: HCO₃⁻ (mmol/L) = total CO₂ − 0.5 × albumin − 0.1 × chloride − 0.01 × (estimated glomerular filtration rate + blood glucose) + 15. The areas under the curves of serum total CO₂ and the approximation formula for detection of low bicarbonate and high bicarbonate were 0.981, 0.996, 0.993, and 1.000, respectively. This formula had superior diagnostic accuracy compared with that of serum total CO₂ (86.6% vs. 81.3%). CONCLUSION: Serum total CO₂ correlated strongly with HCO₃⁻ concentration in pre-dialysis CKD patients. An approximation formula including serum total CO₂ showed superior diagnostic accuracy for low and high bicarbonate compared with serum total CO₂.
Acid-Base Equilibrium ; Bicarbonates ; Carbon Dioxide ; Carbon ; Glomerular Filtration Rate ; Humans ; Linear Models ; Renal Insufficiency, Chronic ; ROC Curve

Background: Few studies have investigated the relationship between serum total carbon dioxide (CO2) concentration and bicarbonate ion (HCO3-) concentration in patients undergoing hemodialysis. We determined the agreement and discrepancy between serum total CO2and HCO3- concentrations and the diagnostic accuracy of serum total CO2 for the prediction of low (HCO3- < 24 mEq/L) and high (HCO3- ≥ 24 mEq/L) bicarbonate concentrations in hemodialysis patients. Methods: One hundred forty-nine arteriovenous blood samples from 84 hemodialysis patients were studied. Multiple linear regression analysis was used to determine factors correlated with HCO3- concentration. Diagnostic accuracy of serum total CO2 was evaluated using receiver operating characteristic curve analysis and a 2 × 2 table. Agreement between serum total CO2 and HCO3- concentrations was assessed using Bland-Altman analysis. Results: Serum total CO2 concentration was closely correlated with HCO3- concentration (β = 0.858, P < 0.001). Area under the curve of serum total CO2 for the identification of low and high bicarbonate concentrations was 0.989. Use of serum total CO2 to predict low and high bicarbonate concentrations had a sensitivity of 100%, specificity of 50.0%, positive predictive value of 96.5%, negative predictive value of 100%, and accuracy of 96.6%. Bland-Altman analysis showed moderate agreement between serum total CO2 and HCO3- concentrations. Discrepancies between HCO3- and serum total CO2 concentrations (serum total CO2 - HCO3- ≤ -1) were observed in 89 samples. Conclusion Serum total CO2 concentration is closely correlated with HCO3- concentration in hemodialysis patients. However, there is a non-negligible discrepancy between serum total CO2 and HCO3- concentrations.

Background: Few studies have investigated the relationship between serum total carbon dioxide (CO2) concentration and bicarbonate ion (HCO3-) concentration in patients undergoing hemodialysis. We determined the agreement and discrepancy between serum total CO2and HCO3- concentrations and the diagnostic accuracy of serum total CO2 for the prediction of low (HCO3- < 24 mEq/L) and high (HCO3- ≥ 24 mEq/L) bicarbonate concentrations in hemodialysis patients. Methods: One hundred forty-nine arteriovenous blood samples from 84 hemodialysis patients were studied. Multiple linear regression analysis was used to determine factors correlated with HCO3- concentration. Diagnostic accuracy of serum total CO2 was evaluated using receiver operating characteristic curve analysis and a 2 × 2 table. Agreement between serum total CO2 and HCO3- concentrations was assessed using Bland-Altman analysis. Results: Serum total CO2 concentration was closely correlated with HCO3- concentration (β = 0.858, P < 0.001). Area under the curve of serum total CO2 for the identification of low and high bicarbonate concentrations was 0.989. Use of serum total CO2 to predict low and high bicarbonate concentrations had a sensitivity of 100%, specificity of 50.0%, positive predictive value of 96.5%, negative predictive value of 100%, and accuracy of 96.6%. Bland-Altman analysis showed moderate agreement between serum total CO2 and HCO3- concentrations. Discrepancies between HCO3- and serum total CO2 concentrations (serum total CO2 - HCO3- ≤ -1) were observed in 89 samples. Conclusion Serum total CO2 concentration is closely correlated with HCO3- concentration in hemodialysis patients. However, there is a non-negligible discrepancy between serum total CO2 and HCO3- concentrations.

Background: The “work style reform of physicians” is due to come into effect in April 2024. Cardiovascular surgery involves many life-saving surgeries after hours, and it is expected to be difficult to achieve the upper limit (level A) of 960 h per year and less than 100 h per month for overtime work. In 2021, there were five full-time cardiovascular surgeons, four of whom were responsible for performing emergency surgery for acute aortic dissection in our facility. The ability to provide emergency surgical care with any two-person combination increases the flexibility of staffing for routine surgery or after-hours on-call. The working environment and surgical outcomes of acute aortic dissection under this system are reported, and changes in work style in cardiovascular surgery are discussed. Methods: The surgical outcomes of 39 cases of acute aortic dissection requiring emergency open heart surgery at this hospital during the one-year period from January to December 2021 were investigated. The number of cases (and first assistants) performed by five full-time surgeons were 7(13), 9(6), 12(3), 11(7) and 0(10), respectively. In addition, there were 8 cases of acute aortic dissection requiring urgent stent graft treatment during the same period. The emergency response rate for emergency patients (including those other than acute aortic dissection) was 100% during the same period. Results: The age was 69 years (median), 48.7% were female, 92.3% were Stanford type A, of which 22.2% were DeBakey type II. Shock vital 20.5%, malperfusion 30.8%. The surgical procedures included TAR in 19 cases, PAR in 8 cases, HAR in 12 cases (including 2 Bentall). Concomitant operations were AVR in 5 cases, CABG in 2 cases, TEVAR in 1 case, lower limb arterioplasty in 2 cases and right hemispherectomy in 1 case. Operating time 400 min (median), extracorporeal circulation time 194 min (median), cardiac arrest 108 min (median), selective cerebral perfusion time 125 min (median), lower body circulation arrest 46 min (median). Hospital mortality 7.7%, stroke 12.8%, delayed paraparesis 2.6%. Ventilation time was 1 day (median), hospital stay 23 days (median), 64.1% were discharged at home. Working Environments: 12-13 on-calls per month. Maximum yearly overtime work is 480.5 h with full overtime pay. Exemptions from working after night shift were also possible. Conclusions: The surgical outcomes of acute aortic dissection at our hospital were acceptable. Not having a fixed surgeon enabled a flexible emergency response, and increased the flexibility of staffing for routine surgery and on-call, and was considered to enable both a change in working style and surgical safety while meeting the needs of the community.

This case report describes our first experience performing percutaneous epicardial catheter ablation for Burugada syndrome in our hospital. We describe the good results achieved in this case. The patient was a man in his 30s with no remarkable medical history. However, his family history was notable for the sudden death of his grandfather at age 37 years and his father at age 27 years. While asleep, the patient experienced convulsions and lost consciousness. During emergency transportation, defibrillation was performed 7 times by the ambulance crew. When the patient arrived at our hospital, sinus rhythm was observed on ECG. During resuscitation, Burugada syndrome was diagnosed based on ECG findings. On hospital day 6, an internal cardioverter defibrillator was implanted. After discharge, the defibrillator operated 10 times, so we opted for ablation treatment. Fractionated potential of over 150 ms was confirmed in the right ventricular outflow tract. A low voltage zone of <1 mV could be mapped, and the same site was cauterized a total of 46 times. As a result, ST segment amplitude decreased significantly in lead V1 on ECG. Percutaneous epicardial catheter ablation performed with reference to Nademanee’s report achieved good results in this case of Burugada syndrome.

BACKGROUND: Pyrethroid (PYR) insecticides are widely used for controlling various pests. There are two types that differ in terms of usage: agricultural-purpose PYR (agriculture-PYR) and hygiene purpose PYR (hygiene-PYRs). Few studies exist on the exposure to these chemicals in small children. In this study, we conducted biomonitoring of urinary pyrethroid metabolites in 1.5-year-old children throughout the year. METHODS: Study subjects were 1075 children participating in an Aichi regional sub-cohort of the Japan Environment and Children's Study as of 18-month health check-up. The concentrations of four specific hygiene-PYR metabolites including 2,3,5,6-tetrafluoro-1,4-benzenedimethanol (HOCH₂-FB-Al), and five common metabolites of hygiene- and agriculture-PYRs including 3-phenoxybenzoic acid (3PBA) and cis- and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (DCCA), were measured in urine samples extracted from soiled diapers using a triple quadrupole gas chromatograph-mass spectrometer. RESULTS: The highest detection frequencies were for 3PBA, followed by DCCA, 1R-trans-chrysanthemum dicarboxylic acid, and HOCH₂-FB-Al. Among the six metabolites, urinary concentrations were seasonally varied. However, this variation was not observed in the most studied PYR metabolite, 3PBA. Spearman's correlation analysis demonstrated a significant positive correlation between FB-Al and DCCA (r = 0.56) and HOCH₂-FB-Al and 4-methoxymethyl-2,3,5,6-tetrafluorobenzyl alcohol (r = 0.60). CONCLUSIONS This biomonitoring survey found widespread and seasonally specific exposure to multiple hygiene- and agriculture-PYRs in 1.5-year-old Japanese children.
Agriculture ; Child, Preschool ; Environmental Exposure/analysis* ; Humans ; Infant ; Insecticides ; Japan ; Mass Spectrometry ; Pyrethrins/urine*