A retrospective review was performed on 43 patients on hemodialysis undergoing valve surgery between May 1999 and August 2004. Ages ranged from 36 to 80 years (mean, 63.8 years). Twenty aortic, 9 mitral, 8 aortic and mitral and 6 valvuloplasties were performed. Twenty-three aortic mechanical valves, 5 aortic bioprosthetic valves, 13 mitral mechanical valves and 4 mitral bioprosthetic valves were implanted. Twenty-five of the 28 aortic valve replacement were hypoplasia of the aortic valve ring. There were 3 hospital deaths (heart failure, pneumonia and sepsis). There were 10 late deaths (2 heart failure, 2 pneumonia, wound infection, cerebral infarction, 2 cancer, arteriosclerosis obliterans and unknown death). Survival at 1, 3 and 5 years was 81%, 74% and 47%. There were three documented major bleedings or thromboembolisms in the 29 patients with mechanical valves (10%) and none in the 9 patients with bioprosthetic valves (0% no significance). Three reoperations were performed for premature degeneration of bioprosthetic valve (19, 24 and 50 months) due to accelerated calcification. These results demonstrate that the prosthetic valve-related major bleedings and strokes in hemodialysis patients are similar for both mechanical and bioprosthetic valves, and that bioprosthetic valves will undergo premature degeneration. Therefore, preference should be given to mechanical valve prostheses in hemodialysis patients.

Recently, pelvic floor muscle training has become popular not only in health magazines but also in women’s magazines, on television and on social networking services. The pelvic floor muscles are difficult to visually confirm movement of in a clothed situation, making it difficult to get a sense of muscle contraction; and, thus, there are many cases of incorrect training leading to pelvic floor dysfunction, including urinary incontinence and pelvic organ prolapse, and significant reduction of quality of life and healthy life expectancy. Therefore, the ability of instructors to teach appropriate pelvic floor muscle training is an important key to the prevention and improvement of pelvic floor dysfunction. The purpose of this review is to understand the functional anatomy and motor function of the pelvic floor muscles and to disseminate evaluation and training practices for preventing and improving pelvic floor dysfunction such as urinary incontinence and pelvic organ prolapse.

Background: Choosing catecholamines, such as norepinephrine and dopamine, for perioperative blood pressure control is essential for anesthesiologists and intensivists. However, studies specific to noncardiac surgery are limited. Therefore, we aimed to evaluate the effects of postoperative norepinephrine and dopamine on clinical outcomes in adult noncardiac surgery patients by analyzing a nationwide intensive care patient database. Methods: The Japanese Intensive care PAtient Database (JIPAD) was used for this multicenter retrospective study. Adult patients in the JIPAD who received norepinephrine or dopamine within 24 h after noncardiac surgery in 2018–2020 were included. We compared the norepinephrine and dopamine groups using a one-to-one propensity score matching analysis. The primary outcome was in-hospital mortality. Secondary outcomes were intensive care unit (ICU) mortality, hospital length of stay, and ICU length of stay. Results: A total of 6,236 eligible patients from 69 ICUs were allocated to the norepinephrine (n = 4,652) or dopamine (n = 1,584) group. Propensity score matching was used to create a matched cohort of 1,230 pairs. No differences in the in-hospital mortality was found between the two propensity score matched groups (risk difference: 0.41%, 95% CI [−1.15, 1.96], P = 0.608). Among the secondary outcomes, only the ICU length of stay was significantly shorter in the norepinephrine group than in the dopamine group (median length: 3 vs. 4 days, respectively; P < 0.001). Conclusions In adult patients after noncardiac surgery, norepinephrine was not associated with decreased mortality but was associated with a shorter ICU length of stay than dopamine.

Inhaled corticosteroids should be taken continuously. As the methods of inhalation vary depending on the pharmaceutical preparations of inhaled corticosteroids, satisfactory effects cannot be expected without proper inhalation. This paper deals with the assessment of inhalational skills with the use of a manual of corticosteroid inhalation and a check sheet of patients’ performance. The effective inhalation as judge by the combination of the speed and the time needed for inhalation was assessed with the help of the training device for inhalation of each inhaled corticosteroid. The average scores of inhalational skills were increased significantly as follow ; aerosol : from 3.8 to 4.9 (p=0.035), Turbuhaler: from 2.6 to 3.0 (p=0.003), discus: from 4.9 to 6.0 (p<0.001). Among 7 in patients (38.9%) who were insufficient in inhalational ability, except for 1 patient who interrupted medication, 4 and 2 patients were improved in the speed and the time needed for inhalation, respectively. It was suggested to advise physicians to dispense alternative preparations of inhaled corticosteroids depending on the repeated evaluation of the inhalational ability.

Inhaled corticosteroids should be taken continuously. As the methods of inhalation vary depending on the pharmaceutical preparations of inhaled corticosteroids, satisfactory effects cannot be expected without proper inhalation. This paper deals with the assessment of inhalational skills with the use of a manual of corticosteroid inhalation and a check sheet of patients’ performance. The effective inhalation as judge by the combination of the speed and the time needed for inhalation was assessed with the help of the training device for inhalation of each inhaled corticosteroid. The average scores of inhalational skills were increased significantly as follow ; aerosol : from 3.8 to 4.9 (p=0.035), Turbuhaler: from 2.6 to 3.0 (p=0.003), discus: from 4.9 to 6.0 (p<0.001). Among 7 in patients (38.9%) who were insufficient in inhalational ability, except for 1 patient who interrupted medication, 4 and 2 patients were improved in the speed and the time needed for inhalation, respectively. It was suggested to advise physicians to dispense alternative preparations of inhaled corticosteroids depending on the repeated evaluation of the inhalational ability.