The clinical efficacy of atrial natriuretic peptide (ANP) has been well investigated in several clinical conditions such as acute heart failure and perioperative period of cardiovascular surgery, no definite evidence has been yet obtained. Moreover, the role of ANP in controlling vascular permeability are not known. It has been reported that the regulation of intravascular fluid volume and cardiac preload by ANP is strongly associated with its vascular permeability-enhancing action, in addition to its diuretic action and vasodilatory action. Furthermore, ANP has been also known to inhibit the hyperpermeability of damaged vascular endothelial cells and protect the endothelial cell barrier function. Apart from these actions, ANP has recently been suspected of degrading the endothelial glycocalyx. ANP affects both vascular endothelial cells and their glycocalyx coating, and may, therefore, play an important role in modulating in vivo vascular permeability.

Well-designed survey research can provide valuable information, for example to generate a research question and for a subsequent study. The knowledge to be obtained can range from clinician reflections to patient reports and from qualitative to quantitative. Since survey research has been more widely and easily performed due to the recent advancement in technology, we are receiving more frequent invitation to conduct survey research and may be more likely to be invited to complete research surveys in our daily practice. As with other types of research design, knowing how to critically evaluate is essential, not only to interpret the result, but also to conduct sound survey research. Although survey research is generally considered to be an easy method of clinical research from a cost and methodological perspective, it can be said that conducting a high-quality study is a challenge. Therefore, clinicians need to understand the rigorous methodology of survey research as a participant, knowledge user, and investigator. In this review, we have addressed essential elements of clinical survey research to conduct a rigorous study and to interpret and critically appraise it, from how to write a protocol to how to publish a manuscript.

Breathing system filters (i.e., inspiratory filters and expiratory filter) and heat and moisture exchange filters (HMEF) can be used for blocking the release of viruses and bacteria from ventilators. Filters are divided into mechanical and electrostatic filters. Mechanical filters have a high hydrophobic capacity and can maintain high filtration efficiency, even under wet conditions. Some electrostatic filters have a low hydrophobic capacity, which may reduce filtration efficiency. Therefore, a mechanical filter is used as the expiratory filter while using a heated humidifier. Since mechanical filters have a large amount of dead space, electrostatic filters are often used for HMEFs. HMEFs with electrostatic filters should be used in combination with an expiratory filter because filtration efficiency will decrease if the moisture mixed from the HME side also enters the filter side. Furthermore, it is necessary to pay particular attention to the increase in expiratory resistance and devise ways to reduce the mixing of water into the filter housing to extend the filter replacement interval.

Background: The aim of this study was to evaluate the impact of cardio-renal syndrome type 1 (CRS-1) on hospitalacquired disability (HAD) in patients with acute decompensated heart failure (ADHF). Methods: A total of 958 adult ADHF patients (female 45%, age 77±13 years) who underwent acute-phase cardiac rehabilitation between 2013 and 2018 were enrolled in this study. Patients were assigned to HAD group with defined as a decrease in Barthel index (BI) of at least 5 points at discharge compared with pre-admission BI. CRS-1 was defined as a creatinine criteria of The Kidney Disease: Improving Global Outcomes (KDIGO) Guideline for acute kidney injury. Multivariate logistic regression analysis was used to identify the predictors of HAD in patients with ADHF. Results: The prevalence of CRS-1 was significantly higher in patients with HAD than in those without HAD (21.2 vs. 11.6%, P = 0.002). In multivariate logistic analysis, CRS-1 was associated with HAD independent of age, albumin, and completion of early mobilization (OR : 2.064, 95% CI : 1.160 - 3.675, P = 0.014) . Conclusion: CRS-1 is independently associated with HAD in patients with ADHF.

Posterior reversible encephalopathy syndrome (PRES) has been shown to have a favorable prognosis, but cases with neurological sequelae and death have also been reported. It is a disease that is not well recognized among pediatricians because there are few reports of pediatric cases, which may delay the diagnosis and timing of treatment intervention. A retrospective study was conducted to clarify the clinical features of PRES in pediatric patients. Thirteen cases were identified, with ages raging from 1 to 17 years old (median age 8 years old). All cases showed consciousness disorder, with seizure in 9 cases and hypertension in 11 cases. Immunosuppressants and anticancer agents were used in 11 cases. All had underlying diseases, mostly consisting of renal and hematological diseases. All cases demonstrated progression without any neurological sequelae. The clinical features of the cases in the present study were the same as those observed in previous studies. In children, an appropriate blood pressure evaluation may lead to an early diagnosis, timely intervention, and a consequent improvement in the prognosis of PRES in patients with consciousness disorder with seizure.

Liver injuries caused by blunt abdominal trauma are common, and bile duct injuries requiring treatment comprise 4% to 23% of liver injuries. We encountered a patient who had type IIIb (Japanese Society of Trauma classification) liver injury accompanied by bile duct injury, which was treated conservatively with endoscopic nasobiliary drainage (ENBD) and percutaneous subcapsular drainage. The advantage of ENBD is that cholangiography is a simple procedure that does not require additional endoscopic retrograde cholangiopancreatography (ERCP) because stent removal is not required. Regarding the treatment of traumatic bile leakage, there are many reports of papillotomy and biliary stent placement, and conservative treatment is possible in about 90% of patients. However, ENBD may be the first choice because it is less invasive than the above treatments. In addition, in cases of poorly controlled bile leakage, it may be possible to avoid open surgery by additionally performing percutaneous drainage under the hepatic capsule.