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Suzuki T, Shiraishi A, Ito K, Otomo Y. Comparative effectiveness of angioembolization versus open surgery in patients with blunt splenic injury. Sci Rep 2024; 14:8800. [PMID: 38627581 PMCID: PMC11021531 DOI: 10.1038/s41598-024-59420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
The effectiveness and safety of transcatheter splenic artery embolization (SAE) compared to those of open surgery in patients with blunt splenic injury (BSI) remain unclear. This retrospective cohort-matched study utilized data from the Japan Trauma Data Bank recorded between 2004 and 2019. Patients with BSI who underwent SAE or open surgery were selected. A propensity score matching analysis was used to balance the baseline covariates and compare outcomes, including all-cause in-hospital mortality and spleen salvage. From 361,706 patients recorded in the data source, this study included 2,192 patients with BSI who underwent SAE or open surgery. A propensity score matching analysis was used to extract 377 matched pairs of patients. The in-hospital mortality rates (SAE, 11.6% vs. open surgery, 11.2%, adjusted relative risk (aRR): 0.64; 95% confidence interval [CI]: 0.38-1.09, p = 0.10) were similar in both the groups. However, spleen salvage was significantly less achieved in the open surgery group than in the SAE group (SAE, 87.1% vs. open surgery, 32.1%; aRR: 2.84, 95%CI: 2.29-3.51, p < 0.001). Survival rates did not significantly differ between BSI patients undergoing SAE and those undergoing open surgery. Nonetheless, SAE was notably associated with a higher likelihood of successful spleen salvage.
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Affiliation(s)
- Toshinao Suzuki
- Department of Anesthesiology, Kimitsu Chuo Hospital, Chiba, Japan
- Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, 296-8602, Japan
- Interventional Radiology Center, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Atsushi Shiraishi
- Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, 296-8602, Japan.
| | - Kensuke Ito
- Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, 296-8602, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
- National Disaster Medical Center, Tokyo, Japan
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Sakanashi S, Tanaka H, Yokota H, Otomo Y, Masuno T, Nakano K, Inoue J, Sugita M, Tokunaga T, Kato N, Kinoshi T, Inoue H, Numata H, Nakagawa K, Sagisaka R, Tanaka S, Miyamoto T, Akama T. Injuries and illness of athletes at the Tokyo 2020 Olympic and Paralympic summer games visiting outside facilities. Sports Med Health Sci 2024; 6:48-53. [PMID: 38463667 PMCID: PMC10918355 DOI: 10.1016/j.smhs.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 12/27/2023] [Accepted: 01/10/2024] [Indexed: 03/12/2024] Open
Abstract
This study aimed to identify the reasons for transferring athletes to local medical facilities during the Olympic and Paralympic Games. Data on 567 injuries and other illnesses of athletes treated at the on-site clinics were collected from the Tokyo 2020 Organizing Committee. Of these, 84 athletes who required outpatient care during the Games were registered for this survey. During the Olympic and Paralympic Games, 66 (8.3/1 000) and 18 (7.2/1 000) athletes, respectively, consulted external medical facilities. In the Olympic Games, the reasons for these visits included 48 cases (72.7%) of injuries, 13 (19.7%) cases of illnesses, and 5 (7.6%) cases of heat stroke illness (HSI). Of these patients, 56 (84.9%) were treated as outpatients and 10 (15.1%) were hospitalized, while three of these patients required hospitalization for > 7 days. On the other hand, in the Paralympics Games, there were 7 (38.8%) cases of injuries, 9 (50.0%) other illnesses, 1 (5.6%) case of HSI, and 1 (5.6%) other cases, of which 11 (61.1%) were treated as outpatients and 7 (38.9%) were hospitalized, but none was hospitalized for > 7 days. Injuries accounted for 70% of the total cases at the 2021 Olympic Games, but only three (0.05%) were severe cases that required hospitalization for more than 1 week. In contrast, in the Paralympic Games, other illnesses accounted for approximately half of the total cases. This study provides details on the extent of injuries and other illnesses that were transferred to outside facilities, which has not been documented in previous games.
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Affiliation(s)
- Shuji Sakanashi
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Department of Sports Medicine Kokushikan University, Tokyo, Japan
| | - Hideharu Tanaka
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Department of Sports Medicine Kokushikan University, Tokyo, Japan
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
- Research Institute of Disaster Management and EMS Kokushikan University, Tokyo, Japan
| | - Hiroyuki Yokota
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Health and Medical Science, Nippon Sports Science University, Japan
| | - Yasuhiro Otomo
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Tomohiko Masuno
- Graduate School of Medicine, Nippon Medical University, Tokyo, Japan
| | - Kousuke Nakano
- Saitama City Hospital, Emergency Department, Saitama, Japan
| | - Junichi Inoue
- Nippon Medical School Musashikosugi Hospital, Emergency and Critical Care Center, Knagawa, Japan
| | - Manabu Sugita
- Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Takahiko Tokunaga
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
- Emergency Lifesaving Academy Tokyo, Tokyo, Japan
| | - Nagisa Kato
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Tokyo Medical and Dental University Hospital, Trauma and Acute Critical Care Center, Tokyo, Japan
| | - Tomoya Kinoshi
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Department of Sports Medicine Kokushikan University, Tokyo, Japan
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
- Research Institute of Disaster Management and EMS Kokushikan University, Tokyo, Japan
| | - Hironori Inoue
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
| | - Hiroto Numata
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Health and Medical Science, Nippon Sports Science University, Japan
| | - Koshi Nakagawa
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
| | - Ryo Sagisaka
- Department of Integrated Science and Engineering for Sustaiable Society, Chuo University, Japan
| | - Shota Tanaka
- Research Institute of Disaster Management and EMS Kokushikan University, Tokyo, Japan
| | - Tetsuya Miyamoto
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Takao Akama
- The Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Sugimoto M, Takayama W, Inoue A, Hifumi T, Sakamoto T, Kuroda Y, Otomo Y. Impact of Lactate Clearance on Clinical and Neurological Outcomes of Patients With Out-of-Hospital Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation: A Secondary Data Analysis. Crit Care Med 2024:00003246-990000000-00300. [PMID: 38411442 DOI: 10.1097/ccm.0000000000006245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVES Serial evaluations of lactate concentration may be more useful in predicting outcomes in patients with out-of-hospital cardiac arrest (OHCA) than a single measurement. This study aimed to evaluate the impact of lactate clearance (LC) on clinical and neurologic outcomes in patients with OHCA who underwent extracorporeal cardiopulmonary resuscitation (ECPR). DESIGN Retrospective multicenter observational study. SETTING Patients with OHCA receiving ECPR at 36 hospitals in Japan between January 1, 2013, and December 31, 2018. PATIENTS This study evaluated 1227 patients, with lactateinitial assessed upon emergency department admission and lactatesecond measured subsequently. To adjust for the disparity in the time between lactate measurements, the modified 6-hour LC was defined as follows: ([lactateinitial-lactatesecond]/lactateinitial) × 100 × (6/the duration between the initial and second measurements [hr]). The patients were divided into four groups according to the modified 6-hour LC with an equivalent number of patients among LC quartiles: Q1 (LC < 18.8), Q2 (18.8 < LC < 59.9), Q3 (60.0 < LC < 101.2), and Q4 (101.2 < LC). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The 30-day survival rates increased as the 6-hour LC increased (Q1, 21.2%; Q2, 36.8%; Q3, 41.4%; Q4, 53.6%; p for trend < 0.001). In the multivariate analysis, the modified 6-hour LC was significantly associated with a 30-day survival rate (adjusted odds ratio [AOR], 1.003; 95% CI, 1.001-1.005; p < 0.001) and favorable neurologic outcome (AOR, 1.002; 95% CI, 1.000-1.004; p = 0.027). CONCLUSIONS In patients with OHCA who underwent ECPR, an increase in the modified 6-hour LC was associated with favorable clinical and neurologic outcome. Thus, LC can be a criterion to assess whether ECPR should be continued.
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Affiliation(s)
- Momoko Sugimoto
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Wataru Takayama
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Yushima, Bunkyo-ku, Tokyo, Japan
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Suzuki K, Morishita K, Adachi T, Suekane A, Nakatsutsumi K, Teeratakulpisarn P, Kojima M, Coimbra R, Otomo Y. PROSTAGLANDIN E-MAJOR URINARY METABOLITES AS A NEW BIOMARKER FOR ACUTE MESENTERIC ISCHEMIA. J Trauma Acute Care Surg 2024:01586154-990000000-00633. [PMID: 38315046 DOI: 10.1097/ta.0000000000004267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is an emergent vascular disease caused by cessation of the blood supply to the small intestine. Despite advances in the diagnosis, intervention, and surgical procedures, AMI remains a life-threatening condition. Prostaglandin E2 Major Urinary Metabolite (PGE-MUM), the urinary metabolite of Prostaglandin E2, is known to be stable in urine and has been suggested to be a valuable biomarker for intestinal mucosal inflammation, such as ulcerative colitis. We therefore investigated whether or not PGE-MUM levels reflect the degree of ischemia in an intestinal ischemia-reperfusion (IR) model. METHODS Male rats were used to establish a superior mesenteric artery occlusion (SMAO) group, in which the superior mesenteric artery was clamped, and a sham group. The clamping times in the SMAO group were either 30 or 60 min, and reperfusion times were either 3 or 6 h, after which PGE-MUM values were measured. RESULTS The histological injury score of the SMAO (30-min ischemia and 6-h reperfusion group: 1.8 ± 0.4 and 60-min ischemia and 6-h reperfusion group: 4.7 ± 0.5) and were significantly greater than that of the sham group (0.4 ± 0.7, p < 0.05). The PGE-MUM levels in the SMAO group (30-min ischemia and 6-h reperfusion group:483 ± 256 and 60-min ischemia and 6-h reperfusion group:889 ± 402 ng/mL) were significantly higher than in the sham group (30-min and 6-h observation group:51 ± 20, and 60-min and 6-h observation group:73 ± 32 ng/mL p < 0.05). Furthermore, the PGE-MUM value was corrected by the concentration of urinary creatinine (Cr). The PGE-MUM/urinary Cr levels in the SMAO group were also significantly higher than in the sham group (p < 0.05). CONCLUSIONS We found that intestinal IR increased urinary PGE-MUM levels depending on the ischemic time. This suggests the potential utility of PGE-MUM as a noninvasive marker of intestinal ischemia.
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Picetti E, Demetriades AK, Catena F, Aarabi B, Abu-Zidan FM, Alves OL, Ansaloni L, Armonda RA, Badenes R, Bala M, Balogh ZJ, Barbanera A, Bertuccio A, Biffl WL, Bouzat P, Buki A, Castano-Leon AM, Cerasti D, Citerio G, Coccolini F, Coimbra R, Coniglio C, Costa F, De Iure F, Depreitere B, Fainardi E, Fehlings MJ, Gabrovsky N, Godoy DA, Gruen P, Gupta D, Hawryluk GWJ, Helbok R, Hossain I, Hutchinson PJ, Iaccarino C, Inaba K, Ivanov M, Kaprovoy S, Kirkpatrick AW, Klein S, Kolias A, Konovalov NA, Lagares A, Lippa L, Loza-Gomez A, Luoto TM, Maas AIR, Maciejczak A, Maier RV, Marklund N, Martin MJ, Melloni I, Mendoza-Lattes S, Meyfroidt G, Munari M, Napolitano LM, Okonkwo DO, Otomo Y, Papadopoulos MC, Petr O, Peul WC, Pudkrong AK, Qasim Z, Rasulo F, Reizinho C, Ringel F, Rizoli S, Rostami E, Rubiano AM, Russo E, Sarwal A, Schwab JM, Servadei F, Sharma D, Sharif S, Shiban E, Shutter L, Stahel PF, Taccone FS, Terpolilli NA, Thomé C, Toth P, Tsitsopoulos PP, Udy A, Vaccaro AR, Varon AJ, Vavilala MS, Younsi A, Zackova M, Zoerle T, Robba C. Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS). World J Emerg Surg 2024; 19:4. [PMID: 38238783 PMCID: PMC10795357 DOI: 10.1186/s13017-023-00525-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 11/25/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies. METHODS A multidisciplinary consensus panel of physicians selected for their established clinical and scientific expertise in the acute management of tSCI polytrauma patients with different specializations was established. The World Society of Emergency Surgery (WSES) and the European Association of Neurosurgical Societies (EANS) endorsed the consensus, and a modified Delphi approach was adopted. RESULTS A total of 17 statements were proposed and discussed. A consensus was reached generating 17 recommendations (16 strong and 1 weak). CONCLUSIONS This consensus provides practical recommendations to support a clinician's decision making in the management of tSCI polytrauma patients.
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Affiliation(s)
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
| | - Andreas K Demetriades
- Department of Neurosurgery, Royal Infirmary Edinburgh, Edinburgh, UK
- Leiden University Neurosurgical Centre Holland, HMC-HAGA The Hague & LUMC Leiden, Leiden, The Netherlands
| | - Fausto Catena
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland, Baltimore, MD, USA
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Oscar L Alves
- Hospital Lusíadas Porto, Centro Hospitalar de Gaia/Espinho, Porto, Portugal
| | - Luca Ansaloni
- Department of Surgery, Pavia University Hospital, Pavia, Italy
| | - Rocco A Armonda
- Department of Neurosurgery, Georgetown University School of Medicine and MedStar Washington Hospital Center, Washington, DC, USA
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, University of Valencia, Valencia, Spain
| | - Miklosh Bala
- Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital, Hunter Medical Research Institute and University of Newcastle, Newcastle, Australia
| | - Andrea Barbanera
- Department of Neurosurgery, SS Antonio e Biagio e Cesare Arrigo Alessandria Hospital, Alessandria, Italy
| | - Alessandro Bertuccio
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Walter L Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Pierre Bouzat
- Universite Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Andras Buki
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Davide Cerasti
- Neuroradiology Unit, Parma University Hospital, Parma, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Neuroscience, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Riverside, CA, USA
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Francesco Costa
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy
| | - Federico De Iure
- Department of Spine Surgery, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Bart Depreitere
- Department of Neurosurgery, University Hospital KU Leuven, Louvain, Belgium
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Michael J Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Nikolay Gabrovsky
- Clinic of Neurosurgery, University Hospital Pirogov, Sofia, Bulgaria
| | | | - Peter Gruen
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, USA
| | - Deepak Gupta
- Department of Neurosurgery, Neurosciences Centre and JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Gregory W J Hawryluk
- Neurological Institute, Cleveland Clinic, Akron General Hospital, Fairlawn, OH, USA
| | - Raimund Helbok
- Department of Neurology, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Iftakher Hossain
- Neurocenter, Department of Neurosurgery, Turku University Hospital, Turku, Finland
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Corrado Iaccarino
- Neurosurgery Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Kenji Inaba
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Marcel Ivanov
- Neurosurgery Department, Royal Hallamshire Hospital, Sheffield, UK
| | - Stanislav Kaprovoy
- Department of Spinal and Peripheral Nerve Surgery Burdenko Neurosurgical Center, Moscow, Russia
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Sam Klein
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
| | - Angelos Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- ANAPLASI Rehabilitation Centre, Athens, Greece
- 1St Neurosurgery Department, Henry Dunant Hospital Center, Athens, Greece
| | - Nikolay A Konovalov
- Department of Spinal and Peripheral Nerve Surgery Burdenko Neurosurgical Center, Moscow, Russia
| | - Alfonso Lagares
- Neurosurgery Department, University Hospital "12 de Octubre", Madrid, Spain
| | - Laura Lippa
- Department of Neurosurgery, Ospedale Niguarda, Milan, Italy
| | - Angelica Loza-Gomez
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Andrzej Maciejczak
- Department of Neurosurgery, St Luke Hospital, University of Rzeszow, Tarnow, Poland
| | - Ronald V Maier
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, Sweden
- Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
| | | | - Ilaria Melloni
- Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Louvain, Belgium
| | - Marina Munari
- Neuro-Intensive Care Unit, University Hospital of Padova, Padua, Italy
| | - Lena M Napolitano
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Wilco C Peul
- Leiden University Neurosurgical Centre Holland, HMC-HAGA The Hague & LUMC Leiden, Leiden, The Netherlands
| | - Aichholz K Pudkrong
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Zaffer Qasim
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Frank Rasulo
- Department of Neuroanesthesia and Neurocritical Care, Spedali Civili University Affiliated Hospital of Brescia, Brescia, Italy
| | - Carla Reizinho
- Departamento de Neurocirurgia, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Florian Ringel
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | - Sandro Rizoli
- Trauma Surgery Department, Hamad General Hospital, HMC, Doha, Qatar
| | - Elham Rostami
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Emanuele Russo
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy
| | - Aarti Sarwal
- Department of Neurology, Atrium Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Jan M Schwab
- Belford Center for Spinal Cord Injury and Departments of Neurology and Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Franco Servadei
- Humanitas Research Hospital-IRCCS & Humanitas University, Rozzano, Milan, Italy
| | - Deepak Sharma
- Neuroanesthesia & Perioperative Neuroscience, University of Washington, Seattle, WA, USA
| | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan
| | - Ehab Shiban
- Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
| | - Lori Shutter
- Department of Critical Care Medicine, Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Philip F Stahel
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Fabio S Taccone
- Department of Intensive Care, Hopital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicole A Terpolilli
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Toth
- Department of Neurosurgery, Medical School, University of Pecs, Pecs, Hungary
| | - Parmenion P Tsitsopoulos
- Department of Neurosurgery, Hippokration General Hospital, Aristotle University School of Medicine, Thessaloníki, Greece
| | - Andrew Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, 3004, Australia
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Delaware Valley Spinal Cord Injury Center, Rothman Orthopedics, Sidney Kimmel Medical Center of Thomas Jefferson University, Philadelphia, PA, USA
| | - Albert J Varon
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine/Ryder Trauma Center, Miami, FL, USA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Alexander Younsi
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Monika Zackova
- Division of Intensive Care and Neurology Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Tommaso Zoerle
- Department of Pathophysiology and Transplantation, University of Milan, Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Robba
- IRCCS Policlinico San Martino, Dipartimento di Scienze Chirurgiche Diagnostiche e Integrate, Università di Genova, Genoa, Italy
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Ide Y, Urushibata N, Takayama W, Hondo K, Aiboshi J, Otomo Y. Clinical characteristics of pneumothorax and pneumomediastinum in mechanical ventilated patients with coronavirus disease 2019: a case series. J Med Case Rep 2024; 18:7. [PMID: 38166996 PMCID: PMC10759624 DOI: 10.1186/s13256-023-04281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Pneumothorax (PTX) and pneumomediastinum (PM) have been reported as potential complications in patients with coronavirus disease 2019 (COVID-19); however, their risk factors and etiology remain unknown. Herein, we investigated the clinical characteristics of mechanically ventilated patients with COVID-19 with PTX or PM. METHODS We examined patients with severe COVID-19 requiring mechanical ventilation who were admitted to the intensive care unit of a tertiary-level emergency medical center in Tokyo, Japan between April 1, 2020. and October 31, 2021. We collected and analyzed the clinical characteristics of the patients who presented with either PTX or PM during mechanical ventilation. RESULTS During the study period, a total of 165 patients required mechanical ventilation, and 15 patients with PTX/PM during mechanical ventilation were selected. Three patients with obvious causes were excluded, and the remaining 12 patients were analyzed (7.3%). The mortality rate in these patients was as high as 50%, demonstrating the difficulty of treatment in the presence of PTX/PM. PTX/PM occurred 14.5 days after intubation. A peak pressure of > 30 cmH2O was only apparent in one patient, suggesting that high positive pressure ventilation may be less involved than mentioned in the literature. In addition, the inspiratory effort was not strong in our group of patients. (P0.1 was 2.1 cm H2O [1.0-3.8]). CONCLUSION Various factors are associated with the development of PTX/PM in patients on mechanical ventilation for COVID-19. We did not find a strong correlation between PTM/PM and barotrauma or strong inspiratory efforts, which have been identified as potential causes in previous studies.
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Affiliation(s)
- Yohei Ide
- Trauma and Acute Critical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Nao Urushibata
- Trauma and Acute Critical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan.
| | - Wataru Takayama
- Trauma and Acute Critical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Kenichi Hondo
- Trauma and Acute Critical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Junichi Aiboshi
- Trauma and Acute Critical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
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Matsuoka T, Fujishima S, Sasaki J, Gando S, Saitoh D, Kushimoto S, Ogura H, Abe T, Shiraishi A, Mayumi T, Kotani J, Takeyama N, Tsuruta R, Takuma K, Yamashita N, Shiraishi SI, Ikeda H, Shiino Y, Tarui T, Nakada TA, Hifumi T, Otomo Y, Okamoto K, Sakamoto Y, Hagiwara A, Masuno T, Ueyama M, Fujimi S, Yamakawa K, Umemura Y. COAGULOPATHY PARAMETERS PREDICTIVE OF OUTCOMES IN SEPSIS-INDUCED ACUTE RESPIRATORY DISTRESS SYNDROME: A SUBANALYSIS OF THE TWO PROSPECTIVE MULTICENTER COHORT STUDIES. Shock 2024; 61:89-96. [PMID: 38010069 DOI: 10.1097/shk.0000000000002269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT Background: Although coagulopathy is often observed in acute respiratory distress syndrome (ARDS), its clinical impact remains poorly understood. Objectives: This study aimed to clarify the coagulopathy parameters that are clinically applicable for prognostication and to determine anticoagulant indications in sepsis-induced ARDS. Method: This study enrolled patients with sepsis-derived ARDS from two nationwide multicenter, prospective observational studies. We explored coagulopathy parameters that could predict outcomes in the Focused Outcome Research on Emergency Care for Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) cohort, and the defined coagulopathy criteria were validated in the Sepsis Prognostication in Intensive Care Unit and Emergency Room-Intensive Care Unit (SPICE-ICU) cohort. The correlation between anticoagulant use and outcomes was also evaluated. Results: A total of 181 patients with sepsis-derived ARDS in the FORECAST study and 61 patients in the SPICE-ICU study were included. In a preliminary study, we found the set of prothrombin time-international normalized ratio ≥1.4 and platelet count ≤12 × 10 4 /μL, and thrombocytopenia and elongated prothrombin time (TEP) coagulopathy as the best coagulopathy parameters and used it for further analysis; the odds ratio (OR) of TEP coagulopathy for in-hospital mortality adjusted for confounding was 3.84 (95% confidence interval [CI], 1.66-8.87; P = 0.005). In the validation cohort, the adjusted OR for in-hospital mortality was 32.99 (95% CI, 2.60-418.72; P = 0.002). Although patients without TEP coagulopathy showed significant improvements in oxygenation over the first 4 days, patients with TEP coagulopathy showed no significant improvement (ΔPaO 2 /FiO 2 ratio, 24 ± 20 vs. 90 ± 9; P = 0.026). Furthermore, anticoagulant use was significantly correlated with mortality and oxygenation recovery in patients with TEP coagulopathy but not in patients without TEP coagulopathy. Conclusion: Thrombocytopenia and elongated prothrombin time coagulopathy is closely associated with better outcomes and responses to anticoagulant therapy in sepsis-induced ARDS, and our coagulopathy criteria may be clinically useful.
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Affiliation(s)
- Tadashi Matsuoka
- Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Seitaro Fujishima
- Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Junchi Sasaki
- Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan
| | | | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan
| | | | | | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Joji Kotani
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Japan
| | - Naoshi Takeyama
- Advanced Critical Care Center, Aichi Medical University Hospital, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Kiyotsugu Takuma
- Emergency and Critical Care Center, Kawasaki Municipal Hospital, Japan
| | - Norio Yamashita
- Department of Emergency and Critical Care Medicine, School of Medicine, Kurume University, Japan
| | | | - Hiroto Ikeda
- Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine
| | - Yasukazu Shiino
- Department of Acute Medicine, Kawasaki Medical School, Japan
| | - Takehiko Tarui
- Department of Emergency Medical Care, Kyorin University Faculty Health Sciences, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Japan
| | - Yuichiro Sakamoto
- Emergency and Critical Care Medicine, Saga University Hospital, Japan
| | - Akiyoshi Hagiwara
- Center Hospital of the National Center for Global Health and Medicine, Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Japan
| | - Masashi Ueyama
- Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Japan
| | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Japan
| | - Yutaka Umemura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan
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8
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Suekane A, Takayama W, Hashimoto R, Morishita K, Otomo Y. Risk factors for recurrence of suicide attempt via overdose: A prospective observational study. Am J Emerg Med 2024; 75:1-6. [PMID: 37890336 DOI: 10.1016/j.ajem.2023.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Although the prevalence of drug overdose has gradually increased worldwide, the risk factors associated with the recurrence of suicide attempts via drug overdose have not been well elucidated. In this study, we investigated the clinical course of patients with drug overdose and whether or not patients reattempted suicide via overdose, using telephone interviews, to evaluate the risk factors associated with overdose recurrence. METHODS This prospective observational study enrolled patients who attempted suicide by drug overdose and were transferred to a tertiary emergency hospital in Japan between January 1, 2015 and July 30, 2021. Recurrence of overdose within 1 year of admission for overdose was designated as the primary outcome. Multivariable logistic regression analysis was performed to assess the independent risk factors for the recurrence of overdose. Furthermore, we compared the difference in the recurrence interval between patients with and without cohabitants using the log-rank test. RESULTS A total of 94 patients were identified, and recurrence of overdose was observed in 28 patients (29.8%). The median recurrence interval was 6.0 months [IQR (interquartile range), 4.0-7.0 months]. The recurrence rate was significantly higher in patients with a history of schizophrenia than that in patients without a history of schizophrenia (58.3% vs 25.6%, p = 0.048), and significantly lower in patients with cohabitants than that in patients without cohabitants (22.6% vs 43.8%, p = 0.015). The presence of a cohabitant was significantly associated with a longer recurrence interval (p = 0.049). The effect of psychiatric intervention during hospitalization and psychiatric visits after discharge could not be found in this study. CONCLUSIONS A history of schizophrenia was an independent risk factor for the recurrence of overdose, and the presence of a cohabitant was significantly associated with a lower risk of recurrence. Large-scale, long-term studies are required to confirm the results of this study.
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Affiliation(s)
- Akira Suekane
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Wataru Takayama
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan; Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan.
| | - Rio Hashimoto
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Koji Morishita
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan; Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
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9
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Ochiai K, Otomo Y. Factors influencing deviation from target temperature during targeted temperature management in postcardiac arrest patients. Open Heart 2023; 10:e002459. [PMID: 38101858 PMCID: PMC10729178 DOI: 10.1136/openhrt-2023-002459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Targeted temperature management (TTM) is a recommended therapy for postcardiac arrest patients. Hyperthermia worsened the patient outcome, and overcooling increased the incidence of complications; therefore, a high-quality TTM is required. The target temperature tended to be modified worldwide after the TTM trial in 2013. Our institute modified the target temperature to 35°C in 2017. This study aimed to compare the conventional and modified protocols, assess the relationship between target temperature deviation and patient outcomes, and identify the factors influencing temperature deviation. METHODS This single-centre, retrospective, observational study included adult out-of-hospital cardiac arrest patients who underwent TTM between April 2013 and October 2019. We compared the conventional and modified protocol groups to evaluate the difference in the background characteristics and details on TTM. Subsequently, we assessed the relationship of deviation (>±0.5°C, >37°C, or<33°C) rates from the target temperature with mortality and neurological outcomes. We assessed the factors that influenced the deviation from the target temperature. RESULTS Temperature deviation was frequently observed in the conventional protocol group (p=0.012), and the modified protocol group required higher doses of neuromuscular blocking agents (NMBAs) during TTM (p=0.016). Other background data, completion of protocol, incidence of complications, mortality and rate of favourable neurological outcomes were not significantly different. The performance rate of TTM was significantly higher in the modified group than in the conventional protocol group (p<0.001). Temperature deviation did not have an impact on the outcomes. Age, sex, body surface area, NMBA doses and type of cooling device were the factors influencing temperature deviation. CONCLUSIONS A target temperature of 35°C might be acceptable and easily attainable if shivering of the patients was well controlled using NMBAs. Temperature deviation did not have an impact on outcomes. The identified factors influencing deviation from target temperature might be useful for ensuring a high-quality TTM.
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Affiliation(s)
- Kanae Ochiai
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Chiba, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan
- National Disaster Medical Center, Tachikawa, Tokyo, Japan
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10
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Hida K, Hirano S, Poudel S, Kurashima Y, Stefanidis D, Hashimoto D, Akiyama H, Eguchi S, Fukui T, Hagiwara M, Izaki T, Kawamoto S, Otomo Y, Nagai E, Takami H, Takeda Y, Toi M, Yamaue H, Yoshida M, Yoshida S, Kodera Y, Saito M. The degree of satisfaction and level of learning in male and female surgical residents: a nationwide questionnaire survey of graduating residents in Japan. Surg Today 2023; 53:1275-1285. [PMID: 37162584 DOI: 10.1007/s00595-023-02683-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 03/14/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Since 2002, the Japan Surgical Society has established a board certification system for surgeons to be certified for a specialty. Surgery remains a male-dominated field in Japan. This study aimed to clarify if the Japanese surgical residency training system is equally suitable for female and male residents. METHODS The Japan Surgical Society conducted the first questionnaire survey regarding the system of surgical training for the residents in 2016. The questionnaire included the degree of satisfaction with 7 aspects of the training system, including the number and variety of cases experienced and duration and quality of instruction, and the learning level for 31 procedures. The degree of satisfaction and level of learning were compared between female and male residents. RESULTS The degree of satisfaction was similar for all items between female and male residents. Female residents chose breast surgery as their subspecialty more frequently than male residents and were more confident in breast surgery procedures than male residents. Conversely, fewer female residents chose gastrointestinal surgery and were less confident in gastrointestinal surgery procedures than male residents. CONCLUSION Female residents were as satisfied with the current surgical training system as male residents. However, there may be room for improvement in the surgical system, considering that fewer applications for gastrointestinal surgery come from female residents than from males.
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Affiliation(s)
- Koya Hida
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Saseem Poudel
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Dimitrios Stefanidis
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, USA
| | | | - Hirotoshi Akiyama
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University, Kumamoto, Japan
| | - Masaru Hagiwara
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tomoko Izaki
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Eishi Nagai
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideki Takami
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Takeda
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Motofumi Yoshida
- Department of Medical Education, Graduate School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Shigetoshi Yoshida
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsue Saito
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
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11
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Tanaka H, Tanaka S, Yokota H, Otomo Y, Masuno T, Nakano K, Sugita M, Tokunaga T, Sugimoto K, Inoue J, Kato N, Kinoshi T, Sakanashi S, Inoue H, Numata H, Nakagawa K, Miyamoto T, Akama T. Acute in-competition medical care at the Tokyo 2020 Olympics: a retrospective analysis. Br J Sports Med 2023; 57:1361-1370. [PMID: 37055080 DOI: 10.1136/bjsports-2022-105778] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE To analyse injuries and illnesses during the 2020 Tokyo Olympic Summer Games. METHODS This retrospective descriptive study included 11 420 athletes from 206 National Olympic Committees and 312 883 non-athletes. Incidences of injuries and illnesses during the competition period from 21 July to 8 August 2021 were analysed. RESULTS A total of 567 athletes (416 injuries, 51 non-heat-related illnesses and 100 heat-related illnesses) and 541 non-athletes (255 injuries, 161 non-heat-related illnesses and 125 heat-related illnesses) were treated at the competition venue clinic. Patient presentation and hospital transportation rates per 1000 athletes were 50 and 5.8, respectively. Marathons and race walking had the highest incidence of injury and illness overall (17.9%; n=66). The highest incidence of injury (per participant) was noted in boxing (13.8%; n=40), sport climbing (12.5%; n=5) and skateboarding (11.3%; n=9), excluding golf, with the highest incidence of minor injuries. Fewer infectious illnesses than previous Summer Olympics were reported among the participants. Of the 100 heat-related illnesses in athletes, 50 occurred in the marathon and race walking events. Only six individuals were transported to a hospital due to heat-related illness, and none required hospital admission. CONCLUSION Injuries and heat-related illnesses were lower than expected at the 2020 Tokyo Olympic Summer Games. No catastrophic events occurred. Appropriate preparation including illness prevention protocols, and treatment and transport decisions at each venue by participating medical personnel may have contributed to these positive results.
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Affiliation(s)
- Hideharu Tanaka
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Japan
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Shota Tanaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Tama, Japan
| | - Hiroyuki Yokota
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Health and Medical Science, Nippon Sport Science University, Setagaya-ku, Japan
| | - Yasuhiro Otomo
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Tomohiko Masuno
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Japan
| | - Kousuke Nakano
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Emergency Department, Saitama City Hospital, Saitama, Japan
| | - Manabu Sugita
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Graduate School of Medicine, Juntendo University, Bunkyo-ku, Japan
| | - Takahiko Tokunaga
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Emergency Life Saving Academy Tokyo, Tokyo, Japan
| | - Katsuhiko Sugimoto
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Department of Sports Medicine, Kokushikan University, Tama, Japan
| | - Junichi Inoue
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Emergency and Critical Care Center, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | - Nagisa Kato
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Emergency and Critical Care Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Japan
| | - Tomoya Kinoshi
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Japan
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Syuji Sakanashi
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Japan
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Hironori Inoue
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Japan
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Hiroto Numata
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Department of Sports Medicine, Kokushikan University, Tama, Japan
| | - Koshi Nakagawa
- Graduate School of Emergency Medical System, Kokushikan University, Tama, Japan
| | - Tetsuya Miyamoto
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Takao Akama
- Medical Services Department, The Tokyo Organizing Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
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12
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Oba S, Hosoya T, Kaneshige R, Kawata D, Yamaguchi T, Mitsumura T, Shimada S, Shibata S, Tateishi T, Koike R, Tohda S, Hirakawa A, Yoko N, Otomo Y, Nojima J, Miyazaki Y, Yasuda S. Thrombosis and antiphospholipid antibodies in Japanese COVID-19: based on propensity score matching. Front Immunol 2023; 14:1227547. [PMID: 37908357 PMCID: PMC10614020 DOI: 10.3389/fimmu.2023.1227547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
Background Thrombosis is a unique complication of coronavirus disease 2019 (COVID-19). Although antiphospholipid antibodies (aPL) are detected in COVID-19 patients, their clinical significance remains elusive. We evaluated the prevalence of aPL and serum concentrations of beta-2 glycoprotein I (β2GPI), a major self-antigen for aPL, in Japanese COVID-19 patients with and without thrombosis. Methods This retrospective single-center nested case-control study included 594 hospitalized patients with COVID-19 between January 2020 and August 2021. Thrombotic complications were collected from medical records. Propensity score-matching method (PSM) (1:2 matching including age, sex, severity on admission, and prior history of thrombosis) was performed to compare the prevalence and titer of aPL (anti-cardiolipin (aCL) IgG/IgM, anti-β2GPI IgG/IgM/IgA, and anti-phosphatidylserine/prothrombin antibody (aPS/PT) IgG/IgM) and serum β2GPI concentration. In addition, PSM (1:1 matching including age and sex) was performed to compare the serum β2GPI concentration between COVID-19 patients and healthy donors. Results Among the patients, 31 patients with thrombosis and 62 patients without were compared. The prevalence of any aPLs was indifferent regardless of the thrombosis (41.9% in those with thrombosis vs. 38.7% in those without, p =0.82). The positive rates of individual aPL were as follows: anti-CL IgG (9.7% vs. 1.6%, p =0.11)/IgM (0% vs. 3.2%, p =0.55), anti-β2GP1 IgG (22.6% vs. 9.7%, p =0.12)/IgA (9.7% vs. 9.7%, p =1.0)/IgM (0% vs. 0%, p =1.0), and anti-PS/PT IgG (0% vs. 1.6%, p =1.0)/IgM (12.9% vs. 21.0%, p =0.41), respectively. The aPL titers were also similar regardless of thrombosis. The levels of β2GPI in COVID-19 patients were lower than those in the healthy donors. Conclusion Although aPLs were frequently detected in Japanese COVID-19 patients, their prevalence and titer were irrelevant to thrombotic complications. While COVID-19 patients have lower levels of serum β2GPI than healthy blood donors, β2GPI levels were indifferent regardless of thrombosis. Although most of the titers were below cut-offs, positive correlations were observed among aPLs, suggesting that the immune reactions against aPL antigens were induced by COVID-19. We should focus on the long-term thromboembolic risk and the development of APS in the aPL-positive patients with high titer or multiple aPLs.
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Affiliation(s)
- Seiya Oba
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tadashi Hosoya
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Risa Kaneshige
- Department of Laboratory Science, Faculty of Health Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Daisuke Kawata
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Taiki Yamaguchi
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takahiro Mitsumura
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | - Sho Shimada
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Sho Shibata
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Ryuji Koike
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shuji Tohda
- Clinical Laboratory, Tokyo Medical and Dental University (TMDU) Hospital, Tokyo, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Nukui Yoko
- Department of Infectious Diseases, Division of Comprehensive Patient Care, Medical and Dental Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Medical Center, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Junzo Nojima
- Department of Laboratory Science, Faculty of Health Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shinsuke Yasuda
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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13
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Senda A, Endo A, Fushimi K, Otomo Y. Effectiveness of intravenous immunoglobulin therapy for invasive group A Streptococcus infection: A Japanese nationwide observational study. Int J Infect Dis 2023; 135:84-90. [PMID: 37586661 DOI: 10.1016/j.ijid.2023.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES Invasive group A Streptococcus infection (iGAS) is a rare but fatal condition. We aimed to evaluate the effectiveness of intravenous immunoglobulin (IVIG) in the treatment of iGAS. METHODS Patients' data were extracted from a Japanese nationwide database between April 2018 and March 2021. The primary outcome was in-hospital mortality rate, whereas the secondary outcomes were 30-day and 7-day mortality rates. RESULTS Overall, 481 patients (median age, 65 years; female, 49.7%) were included in the analysis. The overall mortality rate was 31.0%. After adjusting for background factors, we found that IVIG treatment had no effect on in-hospital mortality (adjusted odds ratio [OR]: 0.99, 95% confidence interval [CI]: 0.93-1.04, P = 0.92). Similar results were obtained after propensity score matching (OR: 1.00, 95% CI: 0.62-1.61, P >0.99). The 7-day and 30-day mortality rates were not associated with IVIG treatment. CONCLUSION IVIG administration had no survival benefit in iGAS patients. However, these overall findings should not be extrapolated to streptococcal toxic shock syndrome as the effect of IVIG therapy in this condition remains uncertain. Considering the rarity of iGAS, conducting a randomized controlled trial may be impractical. Therefore, an equivalent or more extensive observational study is warranted to validate these findings.
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Affiliation(s)
- Atsushi Senda
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Akira Endo
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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14
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Nakatsutsumi K, Endo A, Costantini TW, Takayama W, Morishita K, Otomo Y, Inoue A, Hifumi T, Sakamoto T, Kuroda Y. Time-saving effect of real-time ultrasound-guided cannulation for extracorporeal cardiopulmonary resuscitation: A multicenter retrospective cohort study. Resuscitation 2023; 191:109927. [PMID: 37544499 DOI: 10.1016/j.resuscitation.2023.109927] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR), a bridge to treatments for cardiac arrest patients, can be technically challenging and requires expertise. While ultrasound guidance is frequently used for vascular access, its effects on cannulation time in patients treated with ECPR are poorly defined. We hypothesized that real-time ultrasound guidance would contribute to faster and safer cannulation for ECPR. METHODS This nationwide, multicenter, retrospective study analyzed data from 36 Japanese institutions. Patients who were over age 18 years and underwent ECPR between January 1, 2013, and December 31, 2018, were included. Patients who underwent open surgical vascular access were excluded. Cannulation time and outcomes of patients who underwent real-time ultrasound-guided cannulation (i.e., ultrasound-guided group) were compared to those cannulated without the use of real-time ultrasound guidance (control group) using propensity score matching analysis. RESULTS The ultrasound-guided group comprised 510 cases, whereas the control group comprised 941 cases. Of those, 443 propensity score-matched pairs were evaluated. Cannulation time in the ultrasound-guided group was 2.5 minutes shorter than in the control group [difference, -2.5 minutes; 95% Confidence interval (CI), -3.7 to -1.3, p < 0.001]. The incidence of catheter-related complications and the incidence of the poor neurological outcomes (Cerebral Performance Category ≥3) did not differ between groups [Odds ratio (OR), 1.51; 95% CI, 0.64-3.74; OR, 1.08; 95% CI, 0.83-1.59]. CONCLUSION Real-time ultrasound-guided cannulation was associated with shorter cannulation time of ECPR.
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Affiliation(s)
- Keita Nakatsutsumi
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan; Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of California, San Diego, CA, USA.
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan; Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, Japan
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Wataru Takayama
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Koji Morishita
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan; National Hospital Organization Disaster Medical Center, 3256 Tachikawa-shi Midorimachi, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Chuo-ku Kobe, Hyogo, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Chuo-ku, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Itabashi-ku, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
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15
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Ito K, Nakatutumi K, Oofuti Y, Otomo Y. Colon perforation due to collagenous colitis: A case report. Clin Case Rep 2023; 11:e7862. [PMID: 37720705 PMCID: PMC10500050 DOI: 10.1002/ccr3.7862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/29/2023] [Accepted: 08/11/2023] [Indexed: 09/19/2023] Open
Abstract
Collagenous colitis (CC) is generally benign, and serious complications are rare. It is important to note that spontaneous perforation of CC is a possible complication. In the case of colon perforation of unknown origin, CC should be considered.
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Affiliation(s)
- Kei Ito
- Trauma and Acute Critical Care CenterTokyo Medical and Dental University Hospital of MedicineTokyoJapan
| | - Keita Nakatutumi
- Trauma and Acute Critical Care CenterTokyo Medical and Dental University Hospital of MedicineTokyoJapan
| | - Yuko Oofuti
- Trauma and Acute Critical Care CenterTokyo Medical and Dental University Hospital of MedicineTokyoJapan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care CenterTokyo Medical and Dental University Hospital of MedicineTokyoJapan
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
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16
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Hatakeyama T, Kiguchi T, Sera T, Nachi S, Urushibata N, Ochiai K, Kitamura T, Ogura S, Otomo Y, Iwami T. Pre-hospital airway management and neurological status of patients with out-of-hospital cardiac arrest: A retrospective cohort study. Resusc Plus 2023; 15:100422. [PMID: 37457630 PMCID: PMC10339239 DOI: 10.1016/j.resplu.2023.100422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/04/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Little is known about whether pre-hospital advanced airway management (AAM) under the presence of a physician could improve outcome of patients with cardiac arrest, compared with pre-hospital AAM under the absence of a physician. Methods This retrospective multicentre-cohort study enrolled consecutive patients who were transported to participating hospitals after out-of-hospital cardiac arrest in Japan between 1 June 2014 and 31 December 2019. We included patients who underwent pre-hospital AAM and resuscitation after arrival at hospital, and who were ≥18 years of age, with medical aetiologies. The primary outcome was favourable neurological survival (Cerebral Performance Category score of 1 or 2) one month after cardiac arrest. The primary outcome was called one-month favourable neurological survival. The first confirmed cardiac rhythm was defined using 3-lead electrocardiogram monitor or an automated external defibrillator and by determining whether the carotid artery was pulsating. Previous research found that the presence of a pre-hospital physician was associated with improved patients' outcomes, after the type of first confirmed cardiac rhythm was considered. Therefore, the first confirmed cardiac rhythm in current study was subdivided into non-shockable or shockable groups. A multivariable logistic regression analysis was performed on propensity score-matched patients. Results We analysed 16,703 patients. Among the 2,346 patients in the non-shockable group, 1.2% (N = 29) achieved the primary outcome. The adjusted odds ratio of pre-hospital AAM with or without a physician for the primary outcome in the results of the non-shockable group was 4.64 (95% confidence interval: 1.81-14.4). Among the 826 patients in the shockable group, 16.9% (N = 140) achieved the primary outcome and the adjusted odds ratio of pre-hospital AAM with or without a physician for the primary outcome in the results of the shockable group was 1.05 (95% confidence interval: 0.67-1.63). Conclusions This retrospective multicentre-cohort study found that pre-hospital AAM under the presence of a physician was significantly associated with increased neurological outcome in specific patients with cardiac arrest, compared with pre-hospital AAM under the absence of a physician.
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Affiliation(s)
- Toshihiro Hatakeyama
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-koshigaya, Koshigaya, Saitama 343-8555, Japan
| | - Takeyuki Kiguchi
- Department of Preventive Services, School of Public Health, Graduate School of Medicine, Kyoto University, Yoshida-Konoemachi, Sakyo-ku, Kyoto 606-8501, Japan
- Department of Critical Care and Trauma Center, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan
| | - Toshiki Sera
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Advanced Emergency and Critical Care Center, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Sho Nachi
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagito, Gifu, Gifu 501-1194, Japan
- Emergency Medical Center, Chuno Kosei Hospital, 5-1, Wakakusa-dori, Seki, Gifu 501-3802, Japan
| | - Nao Urushibata
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kanae Ochiai
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Shinji Ogura
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagito, Gifu, Gifu 501-1194, Japan
| | - Yasuhiro Otomo
- National Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo 190-0014, Japan
| | - Taku Iwami
- Department of Preventive Services, School of Public Health, Graduate School of Medicine, Kyoto University, Yoshida-Konoemachi, Sakyo-ku, Kyoto 606-8501, Japan
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Akutsu T, Endo A, Sonobe H, Suzuki K, Murata K, Otomo Y. A case of fulminant myocarditis with full recovery after a 38-h sustained asystole. Clin Case Rep 2023; 11:e7722. [PMID: 37529125 PMCID: PMC10387519 DOI: 10.1002/ccr3.7722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/20/2023] [Accepted: 07/09/2023] [Indexed: 08/03/2023] Open
Abstract
Key Clinical Message Even if cardiac rhythm deteriorated to asystole in the clinical course of fulminant myocarditis, cardiac function may recover, and the patient may be discharged without brain damage, if circulation could be maintained by appropriate mechanical cardiac supports. Abstract A 69-year-old man was diagnosed with fulminant myocarditis with circulatory collapse. His cardiac rhythm deteriorated to asystole on the second day; however, circulatory status was maintained through extracorporeal membrane oxygenation and intra-aortic balloon pumping. After 38 h-lasting asystole, his heart resumed beating. He was discharged without neurological deficits on Day 25.
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Affiliation(s)
- Tomohiro Akutsu
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
- Department of Acute Critical Care MedicineMatsudo General HospitalMatsudoJapan
| | - Akira Endo
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
- Department of Acute Critical Care and Disaster MedicineTokyo Medical and Dental University Graduate School of MedicineBunkyo‐kuJapan
| | - Hiroyuki Sonobe
- Department of Acute Critical Care MedicineMatsudo General HospitalMatsudoJapan
| | - Keisuke Suzuki
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Kiyoshi Murata
- Department of Acute Critical Care MedicineMatsudo General HospitalMatsudoJapan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster MedicineTokyo Medical and Dental University Graduate School of MedicineBunkyo‐kuJapan
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18
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Morishita K, Coimbra R, Ito K, Otomo Y. The American Association for the Surgery of Trauma-European Society of Trauma and Emergency Surgery Emergency Surgery Course: Initial experience in Japan. J Trauma Acute Care Surg 2023; 95:e3-e5. [PMID: 37125818 DOI: 10.1097/ta.0000000000003995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Acute care surgery has recently been recognized as a field of surgery in Japan, but no well-organized nontrauma emergency surgery education system exists. The American Association for the Surgery of Trauma-European Society of Trauma and Emergency Surgery Emergency Surgery Course (AAST-ESTES ESC) course gives surgeons the knowledge and skills to make daily decisions about nontrauma emergency surgery. We held an AAST-ESTES ESC course in Japan from October 2 to 3, 2022. METHODS Thirty-two Japanese participants were asked to rate the following items using a 5-point Likert scale from 1 to 5: overall assessment, program subjects, content, instructional style, and activity. In addition, we also inquired about topics that participants intended to change as a result of what they had learned in the course. RESULTS All items were rated highly (4.1-4.7) by the participants. Participants reported intending to implement changes concerning mesenteric ischemia, colorectal crises, and acute pancreatitis after taking the course. CONCLUSION Japanese surgeons gave the AAST-ESTES ESC course excellent ratings, suggesting its crucial role in Japan, where there has been no development of nontrauma emergency surgery education courses.
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Affiliation(s)
- Koji Morishita
- From the Department of Acute Critical Care and Disaster Medicine (K.M., Y.O.), Tokyo Medical and Dental University, Tokyo, Japan; Riverside University Health System (R.C.), Comparative Effectiveness and Clinical Outcomes Research Center, Moreno Valley, California; and Department of Emergency Medicine (K.I.), Division of Acute Care Surgery, Teikyo University School of Medicine, Tokyo, Japan
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19
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Takayama W, Endo A, Morishita K, Otomo Y. Manual Chest Compression versus Automated Chest Compression Device during Day-Time and Night-Time Resuscitation Following Out-of-Hospital Cardiac Arrest: A Retrospective Historical Control Study. J Pers Med 2023; 13:1202. [PMID: 37623453 PMCID: PMC10455266 DOI: 10.3390/jpm13081202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE We assessed the effectiveness of automated chest compression devices depending on the time of admission based on the frequency of iatrogenic chest injuries, the duration of in-hospital resuscitation efforts, and clinical outcomes among out-of-hospital cardiac arrest (OHCA) patients. METHODS We conducted a retrospective historical control study of OHCA patients in Japan between 2015-2022. The patients were divided according to time of admission, where day-time was considered 07:00-22:59 and night-time 23:00-06:59. These patients were then divided into two categories based on the in-hospital cardiopulmonary resuscitation (IHCPR) device: manual chest compression (mCC) group and automatic chest compression devices (ACCD) group. We used univariate and multivariate ordered logistic regression models adjusted for pre-hospital confounders to evaluate the impact of ACCD use during IHCPR on outcomes (IHCPR duration, CPR-related chest injuries, and clinical outcomes) in the day-time and night-time groups. RESULTS Among 1101 patients with OHCA (day-time, 809; night-time, 292), including 215 patients who underwent ACCD during IHCPR in day-time (26.6%) and 104 patients in night-time group (35.6%), the multivariate model showed a significant association of ACCD use with the outcomes of in-hospital resuscitation and higher rates of return in spontaneous circulation, lower incidence of CPR-related chest injuries, longer in-hospital resuscitation durations, greater survival to Emergency Department and hospital discharge, and greater survival with good neurological outcome to hospital discharge, though only in the night-time group. CONCLUSIONS Patients who underwent ACCD during in-hospital resuscitation at night had a significantly longer duration of in-hospital resuscitation, a lower incidence of CPR-related chest injuries, and better outcomes.
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Affiliation(s)
- Wataru Takayama
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan; (K.M.); (Y.O.)
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan;
| | - Akira Endo
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan;
- Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura 300-0028, Ibaraki, Japan
| | - Koji Morishita
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan; (K.M.); (Y.O.)
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan;
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan; (K.M.); (Y.O.)
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan;
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20
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Hosoya T, Oba S, Komiya Y, Kawata D, Kamiya M, Iwai H, Miyamoto S, Kataoka M, Tobiume M, Kanno T, Ainai A, Sato H, Hirakawa A, Mitsui Y, Satoh T, Wakabayashi K, Yamada T, Otomo Y, Miyazaki Y, Hasegawa H, Suzuki T, Yasuda S. Apple-shaped obesity: A risky soil for cytokine-accelerated severity in COVID-19. Proc Natl Acad Sci U S A 2023; 120:e2300155120. [PMID: 37216518 DOI: 10.1073/pnas.2300155120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Obesity has been recognized as one of the most significant risk factors for the deterioration and mortality associated with COVID-19, but the significance of obesity itself differs among ethnicity. Multifactored analysis of our single institute-based retrospective cohort revealed that high visceral adipose tissue (VAT) burden, but not other obesity-associated markers, was related to accelerated inflammatory responses and the mortality of Japanese COVID-19 patients. To elucidate the mechanisms how VAT-dominant obesity induces severe inflammation after severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, we infected two different strains of obese mice, C57BL/6JHamSlc-ob/ob (ob/ob), C57BLKS/J-db/db (db/db), genetically impaired in the leptin ligand and receptor, respectively, and control C57BL/6 mice with mouse-adapted SARS-CoV-2. Here, we revealed that VAT-dominant ob/ob mice were extremely more vulnerable to SARS-CoV-2 due to excessive inflammatory responses when compared to SAT-dominant db/db mice. In fact, SARS-CoV-2 genome and proteins were more abundant in the lungs of ob/ob mice, engulfed in macrophages, resulting in increased cytokine production including interleukin (IL)-6. Both an anti-IL-6 receptor antibody treatment and the prevention of obesity by leptin replenishment improved the survival of SARS-CoV-2-infected ob/ob mice by reducing the viral protein burden and excessive immune responses. Our results have proposed unique insights and clues on how obesity increases the risk of cytokine storm and death in patients with COVID-19. Moreover, earlier administration of antiinflammatory therapeutics including anti-IL-6R antibody to VAT-dominant patients might improve clinical outcome and stratification of the treatment for COVID-19, at least in Japanese patients.
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Affiliation(s)
- Tadashi Hosoya
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Seiya Oba
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Yoji Komiya
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Daisuke Kawata
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Mari Kamiya
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Hideyuki Iwai
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Sho Miyamoto
- Department of Pathology, National Institute of Infectious Diseases, Tokyo 208-0011, Japan
| | - Michiyo Kataoka
- Department of Pathology, National Institute of Infectious Diseases, Tokyo 208-0011, Japan
| | - Minoru Tobiume
- Department of Pathology, National Institute of Infectious Diseases, Tokyo 208-0011, Japan
| | - Takayuki Kanno
- Department of Pathology, National Institute of Infectious Diseases, Tokyo 208-0011, Japan
| | - Akira Ainai
- Department of Pathology, National Institute of Infectious Diseases, Tokyo 208-0011, Japan
| | - Hiroyuki Sato
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Yuichi Mitsui
- Department of Immune Regulation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Takashi Satoh
- Department of Immune Regulation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Kenji Wakabayashi
- Department of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Tetsuya Yamada
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Medical Center, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
| | - Hideki Hasegawa
- Center for Influenza and Respiratory Virus Research, National Institute of Infectious Diseases, Tokyo 208-0011, Japan
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Tokyo 208-0011, Japan
| | - Shinsuke Yasuda
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo 113-8510, Japan
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Wada T, Yamakawa K, Kabata D, Abe T, Fujishima S, Kushimoto S, Mayumi T, Ogura H, Saitoh D, Shiraishi A, Otomo Y, Gando S. Sepsis-related coagulopathy treatment based on the disseminated intravascular coagulation diagnostic criteria: a post-hoc analysis of a prospective multicenter observational study. J Intensive Care 2023; 11:8. [PMID: 36872342 PMCID: PMC9985865 DOI: 10.1186/s40560-023-00656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/23/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND The development of disseminated intravascular coagulation (DIC) in patients with sepsis has been repeatedly confirmed as a factor associated with poor prognosis. Anticoagulant therapy has been expected to improve sepsis patient outcomes, whereas no randomized controlled trials have demonstrated the survival benefit of anticoagulant therapies in non-specific overall sepsis. Patient selection based on the component of "high disease severity" in addition to "sepsis with DIC" has recently proved important in identifying appropriate targets for anticoagulant therapy. The aims of this study were to characterize "severe" sepsis DIC patients and to identify the patient population benefiting from anticoagulant therapy. METHODS This retrospective sub-analysis of a prospective multicenter study included 1,178 adult patients with severe sepsis from 59 intensive care units in Japan from January 2016 to March 2017. We examined the association of patient outcomes, including organ dysfunction and in-hospital mortality, with the DIC score and prothrombin time-international normalized ratio (PT-INR), one of the components of the DIC score, using multivariable regression models including the cross-product term between these indicators. Multivariate Cox proportional hazard regression analysis with non-linear restricted cubic spline including a three-way interaction term (anticoagulant therapy × the DIC score × PT-INR) was also performed. Anticoagulant therapy was defined as the administration of antithrombin, recombinant human thrombomodulin, or their combination. RESULTS In total, we analyzed 1013 patients. The regression model showed that organ dysfunction and in-hospital mortality deteriorated with higher PT-INR values in the range of < 1.5 and that this trend was more pronounced with higher DIC scores. Three-way interaction analysis demonstrated that anticoagulant therapy was associated with better survival outcome in patients with a high DIC score and high PT-INR. Furthermore, we identified a DIC score ≥ 5 and PT-INR ≥ 1.5 as the clinical threshold for identification of optimal targets for anticoagulant therapy. CONCLUSIONS The combined use of the DIC score and PT-INR helps in selecting the optimal patient population for anticoagulant therapy in sepsis-induced DIC. The results obtained from this study will provide valuable information regarding the study design of randomized controlled trials examining the effects of anticoagulant therapy for sepsis. TRIAL REGISTRATION UMIN-CTR, UMIN000019742. Registered on November 16, 2015.
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Affiliation(s)
- Takeshi Wada
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, N15, W7, Kita-Ku, Sapporo, Japan.
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan.,Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshihiko Mayumi
- Department of Trauma, Critical Care Medicine and Burn Center, Community Healthcare Organization, Chukyo Hospital, Nagoya, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan
| | | | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoshi Gando
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, N15, W7, Kita-Ku, Sapporo, Japan.,Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
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22
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Mori S, Ai T, Taguchi T, Negi M, Otomo Y. Aggressive diffuse large B-cell lymphoma manifested by splenic rupture progressed 2 months after transverse myelitis: an autopsy case report. Acute Med Surg 2023; 10:e822. [PMID: 36844678 PMCID: PMC9949603 DOI: 10.1002/ams2.822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
Background Splenic rupture by diffuse large B-cell lymphoma (DLBCL), which usually progresses insidiously, is extremely rare. Case Presentation A 60-year-old man presented with paralysis in his lower left extremity. A magnetic resonance imaging suggested transverse myelitis. No lymphadenopathy or organomegaly was noted. Two months after remission, he was referred to the emergency department complaining of presyncope. He was in preshock due to splenic rupture, and underwent laparotomy after attempts of transcatheter arterial embolization. Splenomegaly, hepatomegaly, and disseminated enlarged lymph nodes were observed. Histological examinations of the resected spleen showed DLBCL. He died of multiple organ failure associated with intractable bleeding. His autopsy revealed diffuse systemic invasions of lymphoma cells except for the brain and spinal cord. Microscopically, the spinal cord showed macular incomplete necrosis and histiocytic infiltration, suggestive of hemophagocytic syndrome. Conclusion The progression of DLBCL in our case is drastically rapid. Undiagnosed transverse myelitis preceded the onset.
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Affiliation(s)
- Shusuke Mori
- Trauma and Acute Critical Care CenterTokyo Medical and Dental UniversityTokyoJapan
| | - Tomohiko Ai
- Trauma and Acute Critical Care CenterTokyo Medical and Dental UniversityTokyoJapan
| | - Towako Taguchi
- Department of PathologyTokyo Medical and Dental UniversityTokyoJapan
| | - Mariko Negi
- Department of PathologyTokyo Medical and Dental UniversityTokyoJapan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care CenterTokyo Medical and Dental UniversityTokyoJapan
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23
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Akutsu T, Endo A, Sonobe H, Saida F, Miyakawa K, Takedatsu F, Suzuki K, Murata K, Otomo Y. Surgical strategy for airway management and bleeding control in penetrating neck injury in zone II: A case report. Clin Case Rep 2023; 11:e6862. [PMID: 36703764 PMCID: PMC9871397 DOI: 10.1002/ccr3.6862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
We report the case of a 33-year-old man with a self-inflicted neck wound with severe hypopharynx injury, and hemorrhagic shock, which was well managed by a trauma surgeon trained in esophageal surgery. Training in cervical lymph node dissection for esophageal cancer could be useful in the management of penetrating neck injuries.
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Affiliation(s)
- Tomohiro Akutsu
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan,Department of Acute Critical Care MedicineMatsudeo General HospitalMatsudeoJapan
| | - Akira Endo
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Hiroyuki Sonobe
- Department of Acute Critical Care MedicineMatsudeo General HospitalMatsudeoJapan
| | - Fumitaka Saida
- Department of Surgery, Section of Trauma and Acute Care SurgeryUniversity of ChicagoChicagoIllinoisUSA
| | - Kyuhei Miyakawa
- Trauma and Acute Critical Care CenterTokyo Medical and Dental University HospitalBunkyo‐kuJapan
| | - Fumino Takedatsu
- Department of Acute Critical Care MedicineMatsudeo General HospitalMatsudeoJapan
| | - Keisuke Suzuki
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Kiyoshi Murata
- Department of Acute Critical Care MedicineMatsudeo General HospitalMatsudeoJapan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care CenterTokyo Medical and Dental University HospitalBunkyo‐kuJapan
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24
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Inoue H, Tanaka H, Sakanashi S, Kinoshi T, Numata H, Yokota H, Otomo Y, Masuno T, Nakano K, Sugita M, Tokunaga T, Sugimoto K, Inoue J, Kato N, Nakagawa K, Tanaka S, Sagisaka R, Miyamoto T, Akama T. Incidence and factor analysis for the heat-related illness on the Tokyo 2020 Olympic and Paralympic Games. BMJ Open Sport Exerc Med 2023; 9:e001467. [PMID: 37051574 PMCID: PMC10083866 DOI: 10.1136/bmjsem-2022-001467] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 04/14/2023] Open
Abstract
Introduction Among the 43 venues of Tokyo 2020 Olympic Games (OG) and 33 venues of Paralympic Games (PG) were held, the heat island effect was highly expected to cause heat-related illnesses in the outdoor venues with maximum temperatures exceeding 35°C. However, the actual number of heat-related illness cases during the competition was lower than that was initially expected, and it was unclear under what conditions or environment-related heat illnesses occurred among athletes. Object To clarify the cause and factors contributing to the occurrence of heat-related illness among athletes participating in the Tokyo 2020 Olympic and Paralympic Games. Method This retrospective descriptive study included 15 820 athletes from 206 countries. From 21 July 2021 to 8 August 2021 for the Olympics, and from 24 August 2021 to 5 September 2021 for the Paralympics. The number of heat-related illness cases at each venue, the incidence rate for each event, gender, home continent, as well as the type of competition, environmental factors (such as venue, time, location and wet-bulb globe temperature (WBGT)), treatment factor and the type of competition were analysed. Results More number of heat-related illnesses among athletes occurred at the OG (n=110, 76.3%) than at the PG (n=36, 23.7%). A total of 100 cases (100%) at the OG and 31 cases (86.1%) at the PG occurred at the outdoors venues. In the OG, a total of 50 cases (57.9%) occurred during the competition of marathon running and race walking at Sapporo Odori Park. Six of those, were diagnosed with exertional heat illness and treated with cold water immersion (CWI) at OG and one case at PG. Another 20 cases occurred in athletics (track and field) competitions at Tokyo National Olympic Stadium. In total, 10 cases (10.0%) were diagnosed with severe heat illness in the OG and 3 cases (8.3%) in the PG. Ten cases were transferred to outside medical facilities for further treatment, but no case has been hospitalised due to severe condition. In the factor analysis, venue zone, outdoor game, high WBGT (<28°C) and endurance sports have been found to have a higher risk of moderate and severe heat-related illness (p<0.05). The incidence rate and severity could be attenuated by proper heat-related illness treatment (CWI, ice towel, cold IV transfusion and oral hydration) reduced the severity of the illness, providing summer hot environment sports. Conclusion The Tokyo 2020 Olympic and Paralympic summer games were held. Contrary to expectations, we calculated that about 1 in 100 Olympic athletes suffered heat-related illness. We believe this was due to the risk reduction of heat-related illness, such as adequate prevention and proper treatment. Our experience in avoiding heat-related illness will provide valuable data for future Olympic summer Games.
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Affiliation(s)
- Hironori Inoue
- Emergency Medical System, Kokushikan University Graduate School, Tama, Tokyo, Japan
| | - Hideharu Tanaka
- Department of EMS System, Kokushikan University, Setagaya-ku, Japan
| | - Shuji Sakanashi
- Emergency Medical System, Kokushikan University Graduate School, Tama, Tokyo, Japan
| | - Tomoya Kinoshi
- Emergency Medical System, Kokushikan University Graduate School, Tama, Tokyo, Japan
| | - Hiroto Numata
- Nippon Medical School Tama Nagayama Hospital, Tama, Tokyo, Japan
| | - Hiroyuki Yokota
- Graduate School of Health and Medical Science, Nippon Sports Science University, Yokohama, Kanagawa, Japan
| | - Yasuhiro Otomo
- Tokyo Medical and Dental University Graduate School of Medicine and Dentistry, Bunnkyouku, Japan
| | | | - Kousuke Nakano
- Saitama City Hospital, Emergency Department, Saitama, Japan, Saitama, Japan
| | | | | | - Katsuhiko Sugimoto
- Emergency Medical System, Kokushikan University Graduate School, Tama, Tokyo, Japan
| | - Junichi Inoue
- Emergency and Critical Care Center, Yamanashi, Japan
| | - Nagisa Kato
- Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
- Trauma and Acute Critical Care Center, Tokyo, Japan
| | - Koshi Nakagawa
- Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Shota Tanaka
- Research Institute of Disaster and EMS, Kokushikan University, Tama City, Tokyo, Japan
| | - Ryo Sagisaka
- Department of EMS System, Kokushikan University, Tama City, Tokyo, Japan
| | - Tetsuya Miyamoto
- Tokyo Organising Committee of the Olympic and Paralympic Games, Tokyo, Japan
| | - Takao Akama
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
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25
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Asada S, Mori S, Takemoto A, Tamura K, Ito G, Otomo Y. Spontaneous splenic rupture due to occult signet-ring cell gastric cancer accompanied by a bulky splenic vein thrombosis and postoperative brain infarction: A case report. Acute Med Surg 2023; 10:e879. [PMID: 37533436 PMCID: PMC10392777 DOI: 10.1002/ams2.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/02/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
Background Splenic rupture because of metastasis from a distant organ is extremely rare. Case Presentation An 80-year-old man presented with left flank pain. A computed tomography (CT) demonstrated a poorly enhanced enlarged spleen with bulky thrombus in the splenic vein without extravasations. A CT on the following day showed increased intraperitoneal hemorrhage; therefore, an emergency laparotomy was performed. The spleen was enlarged and ruptured with lacerations on its surface. Macroscopic examination showed congestion with a thrombus in the splenic vein around the hilum. Pathology revealed signet-ring cell carcinoma. On the third postoperative day, a massive cerebral infarction in the left middle cerebral artery was revealed. Endoscopic examination demonstrated normal gastric mucosa except for some erosions, for which biopsies were performed, and two of five specimens encompassed signet-ring cell carcinoma in the lamina propria. Conclusion Occult cancer could result in a drastic manifestation of its metastasis accompanying systemic thrombotic events.
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Affiliation(s)
- Shimpei Asada
- Trauma and Acute Critical Care CenterTokyo Medical and Dental UniversityTokyoJapan
| | - Shusuke Mori
- Trauma and Acute Critical Care CenterTokyo Medical and Dental UniversityTokyoJapan
| | - Akira Takemoto
- Department of PathologyTokyo Medical and Dental UniversityTokyoJapan
| | - Kazuhiro Tamura
- Department of PathologyTokyo Medical and Dental UniversityTokyoJapan
| | - Go Ito
- Department of Gastroenterology and HepatologyTokyo Medical and Dental UniversityTokyoJapan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care CenterTokyo Medical and Dental UniversityTokyoJapan
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26
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Akutsu T, Endo A, Okuzawa H, Suzuki K, Yonekawa C, Hoshi H, Otomo Y. Gastric tube perforation penetrating the pericardium after esophagectomy that needed surgical repair. Acute Med Surg 2023; 10:e861. [PMID: 37346083 PMCID: PMC10280607 DOI: 10.1002/ams2.861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/08/2023] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
Background As the prognosis of esophageal cancer surgery has improved, reports on postoperative complications of gastric tubes have increased. Among them, gastric tube ulcer perforation is infrequent but often severe and difficult to treat. Case Presentation A 73-year-old man had undergone thoracoscopic subtotal esophagectomy and laparoscopic-assisted gastric tube reconstruction via the retrosternal route for thoracic esophageal cancer 8 years previously. He was transferred to our hospital with a diagnosis of gastric tube ulcer perforation, penetrating the pericardium. Emergency surgery was performed to remove the gastric tube, followed by immediate reconstruction by right colon interposition. The patient was discharged on postoperative day 142. Conclusion We report a rare complication of gastric tube ulcer perforation, penetrating the pericardium, after esophagectomy for esophageal cancer. It was successfully treated with appropriate surgical management.
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Affiliation(s)
- Tomohiro Akutsu
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Akira Endo
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
- Department of Acute Critical Care and Disaster MedicineTokyo Medical and Dental University Graduate School of Medicine and Dental SciencesTokyoJapan
| | - Hiraaki Okuzawa
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Keisuke Suzuki
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
- Department of Acute Critical Care and Disaster MedicineTokyo Medical and Dental University Graduate School of Medicine and Dental SciencesTokyoJapan
| | - Chisato Yonekawa
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Hiromasa Hoshi
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster MedicineTokyo Medical and Dental University Graduate School of Medicine and Dental SciencesTokyoJapan
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27
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Senda A, Kojima M, Watanabe A, Kobayashi T, Morishita K, Aiboshi J, Otomo Y. Profiles of lipid, protein and microRNA expression in exosomes derived from intestinal epithelial cells after ischemia-reperfusion injury in a cellular hypoxia model. PLoS One 2023; 18:e0283702. [PMID: 36989330 PMCID: PMC10058167 DOI: 10.1371/journal.pone.0283702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Intestinal ischemia-reperfusion injury leads to proinflammatory responses via gut-derived mediators, and accumulating evidence suggests that exosomes secreted by intestinal epithelial cells are involved in the development of systemic inflammation. Studies have reported changes in protein, lipid, and microRNA (miRNA) expression; however, considering the different experimental conditions, information on the relationships among these biomolecules remains insufficient. The aim of this study was to elucidate the multiple changes that simultaneously occur in exosomes after ischemic stimulation. Here, differentiated human intestinal Caco-2 cells were exposed to 95% air (normoxia group) or 5% O2 (hypoxia group) for 6 h. Cells in each group were subsequently incubated for 24 h in an atmosphere of 5% CO2 plus 95% air. The conditioned medium of each group was collected for isolating intestinal epithelial cell-derived exosomes. Together with proteome analyses, lipid analyses, and miRNA quantification, biological functional assays were performed using monocytic NF-κB reporter cells. Lipid metabolism-related protein expression was upregulated, miRNA levels were slightly altered, and unsaturated fatty acid-containing lysophosphatidylcholine concentration increased after hypoxia and reoxygenation injury; this suggested that the changes in exosomal components associated with ischemia-reperfusion injury activates inflammation, including the NF-κB pathway. This study elucidated the multiple changes that co-occur in exosomes after ischemic stimulation and partially clarified the mechanism underlying exosome-mediated inflammation after intestinal ischemic recanalization.
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Affiliation(s)
- Atsushi Senda
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Mitsuaki Kojima
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
- Emergency and Critical Care Center, Tokyo Women's Medical University Adachi Medical Center, Adachi-ku, Tokyo, Japan
| | - Arisa Watanabe
- Department of Biological Sciences, Graduate School of Humanities and Sciences, Ochanomizu University, Bunkyo-ku, Tokyo, Japan
| | - Tetsuyuki Kobayashi
- Department of Biological Sciences, Graduate School of Humanities and Sciences, Ochanomizu University, Bunkyo-ku, Tokyo, Japan
| | - Koji Morishita
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Junichi Aiboshi
- Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Chiba, Japan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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28
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Haruta K, Endo A, Shiraishi A, Otomo Y. Usefulness of resuscitative endovascular balloon occlusion of the aorta compared to aortic cross-clamping in severely injured trauma patients: Analysis from the Japan Trauma Data Bank. Acute Med Surg 2023; 10:e830. [PMID: 36936741 PMCID: PMC10014424 DOI: 10.1002/ams2.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/12/2023] [Indexed: 03/16/2023] Open
Abstract
Aim To compare in-hospital mortality of severely injured trauma patients who underwent resuscitative endovascular balloon occlusion of the aorta (REBOA) or aortic cross-clamping (ACC). Methods In this multicenter, retrospective cohort study using data from a nationwide trauma registry of tertiary emergency medical centers in Japan (n = 280), trauma patients who underwent aortic occlusion at the emergency department from 2004 to 2019 were divided into two groups according to the treatment they received: patients treated with ACC and patients who underwent placement of a REBOA catheter. Multiple imputations were used to handle the missing data. In-hospital mortality of the patients who underwent REBOA or ACC was compared using a mixed-effect logistic regression analysis and a propensity score-matching analysis, in which the confounders, including baseline patient demographics and severity, were adjusted. Results Of 1,670 patients (1,137 with REBOA and 533 with ACC), 66% were male. The median age was 56 years, and the mortality rate was 55.2% in the REBOA group and 81.6% in the ACC group. The mixed-effect model regression analysis showed a significantly lower odds ratio for in-hospital mortality rate in the REBOA group (odds ratio 0.17; 95% confidence interval, 0.12-0.26). A similar odds ratio was observed in the propensity score matching analysis (odds ratio 0.27; 95% confidence interval, 0.18-0.40). Conclusion Compared with ACC, REBOA use was associated with decreased mortality in severely injured trauma patients.
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Affiliation(s)
- Koichi Haruta
- Graduate School of MedicineTokyo Medical and Dental University HospitalTokyoJapan
- Department of Emergency Medicine, Shizuoka Prefectural Hospital OrganizationShizuoka General HospitalShizuokaJapan
| | - Akira Endo
- Department of Acute Critical Care and Disaster MedicineTokyo Medical and Dental University HospitalTokyoJapan
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Atsushi Shiraishi
- Department of Acute Critical Care and Disaster MedicineTokyo Medical and Dental University HospitalTokyoJapan
- Emergency and Trauma CenterKameda Medical CenterChibaJapan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster MedicineTokyo Medical and Dental University HospitalTokyoJapan
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29
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Morishita K, Katase K, Ishikane M, Otomo Y. Motivating factors for frontline healthcare workers during the COVID-19 pandemic: A survey in Japan. Curr Psychol 2022:1-9. [PMID: 36618542 PMCID: PMC9803592 DOI: 10.1007/s12144-022-04177-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
Healthcare workers (HCWs), who are at the frontline of the COVID-19 pandemic, treated COVID-19 patients under many types of stress for over a year. As an external motivating factor, incentives could be important for HCWs dealing with COVID-19. However, there has been no research regarding the change in the consciousness of HCWs during the unrelenting waves of COVID-19. Therefore, we conducted a survey of HCWs during different waves of COVID-19 (the second and fourth waves in Japan). An open web-based survey was conducted among HCWs who wore PPE while treating COVID-19 patients. The first survey of HCWs in Japan was conducted from August 27 to September 9, 2020, while the second survey was conducted from April 7 to May 10, 2021, during the second and fourth waves, respectively. The first and second surveys had 157 and 125 participants, respectively. There were no significant differences in the characteristics of the participants in the first and second survey groups regarding the types of occupation, age, sex, or full-time status. The percentage of HCWs who required financial incentives to maintain motivation remained high (88.5% vs. 82.7%). In addition, most frontline HCWs hope for regular SARS-CoV-2 PCR testing, which will be provided free of charge, as a necessary incentive. External motivating factors, such as financial and other incentives, were important to maintain the motivation of HCWs during the second and fourth waves of the COVID-19 pandemic in Japan. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-022-04177-6.
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Affiliation(s)
- Koji Morishita
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510 Japan
| | - Kozo Katase
- Section of Research Development, Department of Public Health, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510 Japan
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30
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Wada T, Shiraishi A, Gando S, Kabata D, Yamakawa K, Fujishima S, Saitoh D, Kushimoto S, Ogura H, Abe T, Mayumi T, Otomo Y. Association of antithrombin with development of trauma-induced disseminated intravascular coagulation and outcomes. Front Immunol 2022; 13:1026163. [PMID: 36569855 PMCID: PMC9788110 DOI: 10.3389/fimmu.2022.1026163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Trauma activates the innate immune system to modulate hemostasis and minimize the damage caused by physiological bodily responses, including the activation of coagulation. Sufficiently severe trauma overwhelms physiological responses and elicits the systemic inflammatory response syndrome, which leads to the onset of disseminated intravascular coagulation (DIC), characterized by dysregulated inflammatory coagulofibrinolytic responses. Impaired anticoagulant mechanisms, including antithrombin, constitutes the pathology of DIC, while the dynamics of antithrombin and relevance to outcomes in trauma-induced coagulopathy have not been fully elucidated. This study investigated the associations of antithrombin activity with DIC onset and outcomes in severely injured patients. Methods This retrospective sub-analysis of a multicenter, prospective study included patients with an injury severity score ≥16. We characterized trauma patients with low antithrombin activity (antithrombin <80% on hospital arrival, n = 75) in comparison with those who had normal antithrombin activity (antithrombin ≥80%, n = 200). Global markers of coagulation and fibrinolysis, molecular biomarkers for thrombin generation (soluble fibrin [SF]), and markers of anticoagulation (antithrombin) were evaluated to confirm the associations of antithrombin with DIC development and outcomes, including in-hospital mortality and the multiple organ dysfunction syndrome (MODS). Results Patients with low antithrombin activity had higher prevalence of shock, transfusion requirements, and in-hospital mortality. Higher DIC scores and more severe organ dysfunction were observed in the low AT group compared to that in the normal AT group. Antithrombin activity on arrival at the hospital was an independent predictor of the development of DIC in trauma patients, and levels of SF increased with lower antithrombin values (antithrombin activity > 85%). Antithrombin activity at 3 h showed good predictive performance for in-hospital mortality, and a multivariable Cox proportional-hazard regression model with a cross-product term between the antithrombin and DIC showed that the in-hospital mortality in patients with DIC increased with decreased antithrombin activity. A multivariable logistic regression model showed that the odds for the development of MODS in patients with DIC increased with lower antithrombin values. Conclusion Decreased antithrombin activity in trauma-induced coagulopathy is associated with poor outcomes through worsening of DIC.
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Affiliation(s)
- Takeshi Wada
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan,*Correspondence: Takeshi Wada,
| | | | - Satoshi Gando
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan,Department of Acute and Critical Care Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan,Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Toshihiko Mayumi
- Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Nagoya, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
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Abe T, Umemura Y, Ogura H, Kushimoto S, Fujishima S, Saitoh D, Iriyama H, Komori A, Otomo Y, Shiraishi A, Gando S. 276 Relationship Between Fluid Administration in the First Three Hours of Sepsis Resuscitation and Mortality. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Endo A, Yamakawa K, Tagami T, Umemura Y, Takahashi K, Nagasawa H, Araki Y, Kojima M, Sera T, Yagi M, Yamamoto R, Takahashi J, Nakane M, Takeda C, Narita C, Kazuma S, Okura H, Takahashi H, Wada T, Tahara S, Matsuoka A, Masaki T, Shiraishi A, Shimoyama K, Yokokawa Y, Nakamura R, Sageshima H, Yanagida Y, Takahashi K, Otomo Y. Optimal target blood pressure in elderly with septic shock (OPTPRESS) trial: study protocol for a randomized controlled trial. Trials 2022; 23:799. [PMID: 36153530 PMCID: PMC9509562 DOI: 10.1186/s13063-022-06732-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hemodynamic stabilization is a core component in the resuscitation of septic shock. However, the optimal target blood pressure remains debatable. Previous randomized controlled trials suggested that uniformly adopting a target mean arterial pressure (MAP) higher than 65 mmHg for all adult septic shock patients would not be beneficial; however, it has also been proposed that higher target MAP may be beneficial for elderly patients, especially those with arteriosclerosis.
Methods
A multicenter, pragmatic single-blind randomized controlled trial will be conducted to compare target MAP of 80–85 mmHg (high-target) and 65–70 mmHg (control) in the resuscitation of septic shock patients admitted to 28 hospitals in Japan. Patients with septic shock aged ≥65 years are randomly assigned to the high-target or control groups. The target MAP shall be maintained for 72 h after randomization or until vasopressors are no longer needed to improve patients’ condition. To minimize the adverse effects related to catecholamines, if norepinephrine dose of ≥ 0.1 μg/kg/min is needed to maintain the target MAP, vasopressin will be initiated. Other therapeutic approaches, including fluid administration, hydrocortisone use, and antibiotic choice, will be determined by the physician in charge based on the latest clinical guidelines. The primary outcome is all-cause mortality at 90 days after randomization.
Discussion
The result of this trial will provide great insight on the resuscitation strategy for septic shock in the era of global aged society. Also, it will provide the better understanding on the importance of individualized treatment strategy in hemodynamic management in critically ill patients.
Trial registration
UMIN Clinical Trials Registry; UMIN000041775. Registered 13 September 2020.
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Gando S, Shiraishi A, Wada T, Yamakawa K, Fujishima S, Saitoh D, Kushimoto S, Ogura H, Abe T, Mayumi T, Sasaki J, Kotani J, Takeyama N, Tsuruta R, Takuma K, Shiraishi SI, Shiino Y, Nakada TA, Okamoto K, Sakamoto Y, Hagiwara A, Fujimi S, Umemura Y, Otomo Y. Effects of tranexamic acid on coagulofibrinolytic markers during the early stage of severe trauma: A propensity score-matched analysis. Medicine (Baltimore) 2022; 101:e29711. [PMID: 35960088 PMCID: PMC9371565 DOI: 10.1097/md.0000000000029711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Tranexamic acid (TXA) reduces the risk of bleeding trauma death without altering the need for blood transfusion. We examined the effects of TXA on coagulation and fibrinolysis dynamics and the volume of transfusion during the early stage of trauma. This subanalysis of a prospective multicenter study of severe trauma included 276 patients divided into propensity score-matched groups with and without TXA administration. The effects of TXA on coagulation and fibrinolysis markers immediately at (time point 0) and 3 hours after (time point 3) arrival at the emergency department were investigated. The transfusion volume was determined at 24 hours after admission. TXA was administered to the patients within 3 hours (median, 64 minutes) after injury. Significant reductions in fibrin/fibrinogen degradation products and D-dimer levels from time points 0 to 3 in the TXA group compared with the non-TXA group were confirmed, with no marked differences noted in the 24-hour transfusion volumes between the 2 groups. Continuously increased levels of soluble fibrin, a marker of thrombin generation, from time points 0 to 3 and high levels of plasminogen activator inhibitor-1, a marker of inhibition of fibrinolysis, at time point 3 were observed in both groups. TXA inhibited fibrin(ogen)olysis during the early stage of severe trauma, although this was not associated with a reduction in the transfusion volume. Other confounders affecting the dynamics of fibrinolysis and transfusion requirement need to be clarified.
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Affiliation(s)
- Satoshi Gando
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Japan
- Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Japan
- *Correspondence: Satoshi Gando, Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, N33E14, Higashi-ku 065-0033, Japan (e-mail: )
| | | | - Takeshi Wada
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical College, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
- Health Services Research and Development Center, University of Tsukuba, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Japan
| | - Joji Kotani
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Japan
| | - Naoshi Takeyama
- Advanced Critical Care Center, Aichi Medical University Hospital, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Kiyotsugu Takuma
- Emergency and Critical Care Center, Kawasaki Municipal Hospital, Japan
| | | | - Yasukazu Shiino
- Department of Acute Medicine, Kawasaki Medical School, Japan
| | - Taka-aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Japan
| | - Yuichiro Sakamoto
- Emergency and Critical Care Medicine, Saga University Hospital, Japan
| | - Akiyoshi Hagiwara
- Center Hospital of the National Center for Global Health and Medicine, Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Japan
| | - Yutaka Umemura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Japan
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Morishita K, Kudo A, Uchida T, Kurashima N, Toba M, Ito K, Otomo Y. Unexpected Mechanical Ventilation Dysfunction in a Coronavirus Disease Patient With Severe Pneumonia Due to the Oxygen Flowsensor Failure. J Patient Saf 2022; 18:e867-e868. [PMID: 35948298 DOI: 10.1097/pts.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abe D, Inaji M, Hase T, Takahashi S, Sakai R, Ayabe F, Tanaka Y, Otomo Y, Maehara T. A Prehospital Triage System to Detect Traumatic Intracranial Hemorrhage Using Machine Learning Algorithms. JAMA Netw Open 2022; 5:e2216393. [PMID: 35687335 PMCID: PMC9187955 DOI: 10.1001/jamanetworkopen.2022.16393] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE An adequate system for triaging patients with head trauma in prehospital settings and choosing optimal medical institutions is essential for improving the prognosis of these patients. To our knowledge, there has been no established way to stratify these patients based on their head trauma severity that can be used by ambulance crews at an injury site. OBJECTIVES To develop a prehospital triage system to stratify patients with head trauma according to trauma severity by using several machine learning techniques and to evaluate the predictive accuracy of these techniques. DESIGN, SETTING, AND PARTICIPANTS This single-center retrospective cohort study was conducted by reviewing the electronic medical records of consecutive patients who were transported to Tokyo Medical and Dental University Hospital in Japan from April 1, 2018, to March 31, 2021. Patients younger than 16 years with cardiopulmonary arrest on arrival or with a significant amount of missing data were excluded. MAIN OUTCOMES AND MEASURES Machine learning-based prediction models to detect the presence of traumatic intracranial hemorrhage were constructed. The predictive accuracy of the models was evaluated with the area under the receiver operating curve (ROC-AUC), area under the precision recall curve (PR-AUC), sensitivity, specificity, and other representative statistics. RESULTS A total of 2123 patients (1527 male patients [71.9%]; mean [SD] age, 57.6 [19.8] years) with head trauma were enrolled in this study. Traumatic intracranial hemorrhage was detected in 258 patients (12.2%). Among several machine learning algorithms, extreme gradient boosting (XGBoost) achieved the mean (SD) highest ROC-AUC (0.78 [0.02]) and PR-AUC (0.46 [0.01]) in cross-validation studies. In the testing set, the ROC-AUC was 0.80, the sensitivity was 74.0% (95% CI, 59.7%-85.4%), and the specificity was 74.9% (95% CI, 70.2%-79.3%). The prediction model using the National Institute for Health and Care Excellence (NICE) guidelines, which was calculated after consultation with physicians, had a sensitivity of 72.0% (95% CI, 57.5%-83.8%) and a specificity of 73.3% (95% CI, 68.7%-77.7%). The McNemar test revealed no statistically significant differences between the XGBoost algorithm and the NICE guidelines for sensitivity or specificity (P = .80 and P = .55, respectively). CONCLUSIONS AND RELEVANCE In this cohort study, the prediction model achieved a comparatively accurate performance in detecting traumatic intracranial hemorrhage using only the simple pretransportation information from the patient. Further validation with a prospective multicenter data set is needed.
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Affiliation(s)
- Daisu Abe
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Hase
- Institute of Education, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shota Takahashi
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryosuke Sakai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Fuga Ayabe
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
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36
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Mitsumura T, Okamoto T, Tosaka M, Yamana T, Shimada S, Iijima Y, Sakakibara R, Shibata S, Honda T, Shirai T, Ishizuka M, Aiboshi J, Furusawa H, Tateishi T, Tamaoka M, Shigemitsu H, Arai H, Otomo Y, Tohda S, Anzai T, Takahashi K, Yasuda S, Miyazaki Y. SARS-CoV-2 RNA copy number is a factor associated with the mortality of COVID-19 and improves the predictive performance of mortality in severe cases. Jpn J Infect Dis 2022; 75:504-510. [PMID: 35650037 DOI: 10.7883/yoken.jjid.2022.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Factors associated with mortality are important for the treatment of coronavirus disease 2019 (COVID-19). The polymerase chain reaction (PCR) test is the gold standard for diagnosing COVID-19 and reflects the viral load in the upper respiratory tract. This study enrolled 523 patients. Four hundred forty-one and 75 patients were performed PCR testing in nasopharyngeal swabs and sputum specimens, respectively, within 20 days from the onset. We investigated the association between RNA copy number and the severity and mortality of COVID-19, and its effect on the predictive performance for the severity and mortality. RNA copy numbers in nasopharyngeal swabs were higher in the non-survivor group than in the survivor group. Multivariate logistic regression analysis identified that the high RNA copy number (≥ 9 log10 /swab) in nasopharyngeal swabs was a factor associated with mortality (odds ratio, 4.50; 95% confidence interval, 1.510 - 13.100; p = 0.008). Furthermore, in severe cases, adding RNA copy number (≥ 9 log10 /swab), which was adjusted by duration from onset to PCR, improved mortality predictive performance based on known factors. The RNA copy number is a factor associated with the mortality of COVID-19 and can improve the predictive performance of mortality in severe cases.
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Affiliation(s)
- Takahiro Mitsumura
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tsukasa Okamoto
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan.,Department of Pulmonary Immunotherapeutics, Tokyo Medical and Dental University, Japan
| | - Mizuho Tosaka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Takashi Yamana
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Sho Shimada
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Yuki Iijima
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Rie Sakakibara
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Sho Shibata
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Takayuki Honda
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tsuyoshi Shirai
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Masahiro Ishizuka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Junichi Aiboshi
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, Japan
| | - Haruhiko Furusawa
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Meiyo Tamaoka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Hidenobu Shigemitsu
- Department of Intensive Care Medicine, Tokyo Medical and Dental University, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, Japan
| | - Shuji Tohda
- Department of Laboratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Japan
| | - Shinsuke Yasuda
- Department of Rheumatology, Tokyo Medical and Dental University, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
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37
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Inoue A, Hifumi T, Sakamoto T, Okamoto H, Kunikata J, Yokoi H, Sawano H, Egawa Y, Kato S, Sugiyama K, Bunya N, Kasai T, Ijuin S, Nakayama S, Kanda J, Kanou S, Takiguchi T, Yokobori S, Takada H, Inoue K, Takeuchi I, Honzawa H, Kobayashi M, Hamagami T, Takayama W, Otomo Y, Maekawa K, Shimizu T, Nara S, Nasu M, Takahashi K, Hagiwara Y, Kushimoto S, Fukuda R, Ogura T, Shiraishi SI, Zushi R, Otani N, Kikuchi M, Watanabe K, Nakagami T, Shoko T, Kitamura N, Otani T, Matsuoka Y, Aoki M, Sakuraya M, Arimoto H, Homma K, Naito H, Nakao S, Okazaki T, Tahara Y, Kuroda Y. Extracorporeal cardiopulmonary resuscitation in adult patients with out-of-hospital cardiac arrest: a retrospective large cohort multicenter study in Japan. Crit Care 2022; 26:129. [PMID: 35534870 DOI: 10.1186/s13054-022-03998-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/24/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The prevalence of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) has been increasing rapidly worldwide. However, guidelines or clinical studies do not provide sufficient data on ECPR practice. The aim of this study was to provide real-world data on ECPR for patients with OHCA, including details of complications. METHODS We did a retrospective database analysis of observational multicenter cohort study in Japan. Adult patients with OHCA of presumed cardiac etiology who received ECPR between 2013 and 2018 were included. The primary outcome was favorable neurological outcome at hospital discharge, defined as a cerebral performance category of 1 or 2. RESULTS A total of 1644 patients with OHCA were included in this study. The patient age was 18-93 years (median: 60 years). Shockable rhythm in the initial cardiac rhythm at the scene was 69.4%. The median estimated low flow time was 55 min (interquartile range: 45-66 min). Favorable neurological outcome at hospital discharge was observed in 14.1% of patients, and the rate of survival to hospital discharge was 27.2%. The proportions of favorable neurological outcome at hospital discharge in terms of shockable rhythm, pulseless electrical activity, and asystole were 16.7%, 9.2%, and 3.9%, respectively. Complications were observed during ECPR in 32.7% of patients, and the most common complication was bleeding, with the rates of cannulation site bleeding and other types of hemorrhage at 16.4% and 8.5%, respectively. CONCLUSIONS In this large cohort, data on the ECPR of 1644 patients with OHCA show that the proportion of favorable neurological outcomes at hospital discharge was 14.1%, survival rate at hospital discharge was 27.2%, and complications were observed during ECPR in 32.7%.
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Affiliation(s)
- Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroshi Okamoto
- Department of Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Jun Kunikata
- Clinical Research Support Center, Kagawa University Hospital, Kagawa, Japan
| | - Hideto Yokoi
- Clinical Research Support Center, Kagawa University Hospital, Kagawa, Japan
| | - Hirotaka Sawano
- Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Suita, Japan
| | - Yuko Egawa
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
| | - Shunichi Kato
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, Hokkaido, Japan
| | - Takehiko Kasai
- Department of Emergency Medicine, Sapporo Medical University, Hokkaido, Japan
| | - Shinichi Ijuin
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Shinichi Nakayama
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Jun Kanda
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Seiya Kanou
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Toru Takiguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroaki Takada
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Kazushige Inoue
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Ichiro Takeuchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroshi Honzawa
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Kobayashi
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan
| | - Tomohiro Hamagami
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan
| | - Wataru Takayama
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Kunihiko Maekawa
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Takafumi Shimizu
- Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Satoshi Nara
- Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Michitaka Nasu
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Kuniko Takahashi
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Yoshihiro Hagiwara
- Department of Emergency Medicine and Critical Care Medicine Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai, Utsunomiya Hospital, Tochigi, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Reo Fukuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai, Utsunomiya Hospital, Tochigi, Japan.,Department of Emergency Medicine and Critical Care Medicine, Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Shin-Ichiro Shiraishi
- Department of Emergency and Critical Care Medicine, Aizu Central Hospital, Fukushima, Japan
| | - Ryosuke Zushi
- Emergency Medicine, Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan
| | - Norio Otani
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Migaku Kikuchi
- Emergency and Critical Care Center, Dokkyo Medical University, Tochigi, Japan
| | | | - Takuo Nakagami
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Shiga, Japan
| | - Tomohisa Shoko
- Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Chiba, Japan
| | - Takayuki Otani
- Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yoshinori Matsuoka
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Hideki Arimoto
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Koichiro Homma
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiromichi Naito
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoya Okazaki
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
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Ochiai K, Oka T, Kato N, Kondo Y, Otomo Y, Swienton RE. Differences in the Awareness and Knowledge of Radiological and Nuclear Events Among Medical Workers in Japan. Front Public Health 2022; 10:808148. [PMID: 35433584 PMCID: PMC9006773 DOI: 10.3389/fpubh.2022.808148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Previous research revealed a lack of comfort and knowledge regarding nuclear and radiological events among medical staff. We investigated the awareness and knowledge of radiological and nuclear events among the Japanese medical staff by comparing differences by occupation (doctors, nurses, and other medical specialists). Methods We conducted a cross-sectional questionnaire survey among trainees undergoing Japanese disaster medical training courses between July 2014 and February 2016. The differences by occupation were evaluated for all questions on awareness and knowledge concerning disasters or radiological and nuclear events and demographics. Results Among the occupations, there were significant differences in the willingness to work onsite based on the types of disaster, familiarity with the national disaster medical response system, the accuracy rate of some knowledge about medical practice and the risk, and demographic characteristics such as practical experience and educational degree. The accuracy rates of responses to some questions on knowledge were very low in all occupations. Conclusion There were significant differences in awareness and knowledge of radiological and nuclear events by occupation. We believe that the results can be used to develop and modify the content of training courses on radiological and nuclear events to make such courses beneficial for each healthcare worker.
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Affiliation(s)
- Kanae Ochiai
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Tomo Oka
- Emergency Medical Center, Fujisawa City Hospital, Kanagawa, Japan
| | - Nagisa Kato
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Yuji Kondo
- Department of Emergency, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Raymond E Swienton
- University of Texas Southwestern Medical Center, Dallas, TX, United States
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Umemura Y, Abe T, Ogura H, Fujishima S, Kushimoto S, Shiraishi A, Saitoh D, Mayumi T, Otomo Y, Hifumi T, Hagiwara A, Takuma K, Yamakawa K, Shiino Y, Nakada TA, Tarui T, Okamoto K, Kotani J, Sakamoto Y, Sasaki J, Shiraishi SI, Tsuruta R, Masuno T, Takeyama N, Yamashita N, Ikeda H, Ueyama M, Gando S. Hour-1 bundle adherence was associated with reduction of in-hospital mortality among patients with sepsis in Japan. PLoS One 2022; 17:e0263936. [PMID: 35157744 PMCID: PMC8843226 DOI: 10.1371/journal.pone.0263936] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/30/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The updated Surviving Sepsis Campaign guidelines recommend a 1-hour window for completion of a sepsis care bundle; however, the effectiveness of the hour-1 bundle has not been fully evaluated. The present study aimed to evaluate the impact of hour-1 bundle completion on clinical outcomes in sepsis patients. METHODS This was a multicenter, prospective, observational study conducted in 17 intensive care units in tertiary hospitals in Japan. We included all adult patients who were diagnosed as having sepsis by Sepsis-3 and admitted to intensive care units from July 2019 to August 2020. Impacts of hour-1 bundle adherence and delay of adherence on risk-adjusted in-hospital mortality were estimated by multivariable logistic regression analyses. RESULTS The final study cohort included 178 patients with sepsis. Among them, 89 received bundle-adherent care. Completion rates of each component (measure lactate level, obtain blood cultures, administer broad-spectrum antibiotics, administer crystalloid, apply vasopressors) within 1 hour were 98.9%, 86.2%, 51.1%, 94.9%, and 69.1%, respectively. Completion rate of all components within 1 hour was 50%. In-hospital mortality was 18.0% in the patients with and 30.3% in the patients without bundle-adherent care (p = 0.054). The adjusted odds ratio of non-bundle-adherent versus bundle-adherent care for in-hospital mortality was 2.32 (95% CI 1.09-4.95) using propensity scoring. Non-adherence to obtaining blood cultures and administering broad-spectrum antibiotics within 1 hour was related to in-hospital mortality (2.65 [95% CI 1.25-5.62] and 4.81 [95% CI 1.38-16.72], respectively). The adjusted odds ratio for 1-hour delay in achieving hour-1 bundle components for in-hospital mortality was 1.28 (95% CI 1.04-1.57) by logistic regression analysis. CONCLUSION Completion of the hour-1 bundle was associated with lower in-hospital mortality. Obtaining blood cultures and administering antibiotics within 1 hour may have been the components most contributing to decreased in-hospital mortality.
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Affiliation(s)
- Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Japan
- * E-mail:
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Seitato Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Akiyoshi Hagiwara
- Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Kiyotsugu Takuma
- Emergency & Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yasukazu Shiino
- Department of Acute Medicine, Kawasaki Medical School, Okayama, Japan
| | - Taka-aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takehiko Tarui
- Department of Emergency Medical Care, Kyorin University Faculty of Health Sciences, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Kitakyushu, Japan
| | - Joji Kotani
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichiro Sakamoto
- Emergency and Critical Care Medicine, Saga University Hospital, Saga, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shin-ichiro Shiraishi
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Fukushima, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Naoshi Takeyama
- Advanced Critical Care Center, Aichi Medical University Hospital, Aichi, Japan
| | - Norio Yamashita
- Advanced Emergency Medical Service Center Kurume University Hospital, Kurume, Japan
| | - Hiroto Ikeda
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Masashi Ueyama
- Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Nagoya, Japan
- Community Healthcare Organization, Chukyo Hospital, Nagoya, Japan
| | - Satoshi Gando
- Department of Anesthesiology and Critical Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
- Department of Acute and Critical Care Medicine, Sapporo Tokushukai Hospital, Sapporo, Japan
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40
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Ito K, Endo A, Kobayashi M, Otomo Y. Severe pancreatic injury with total disruption of main pancreatic duct successfully managed by multi‐stage endoscopic therapy: a case report. Acute Med Surg 2022; 9:e735. [PMID: 35169488 PMCID: PMC8840899 DOI: 10.1002/ams2.735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 12/27/2022] Open
Abstract
Background The management of pancreatic injury is not well‐established. Recently, endoscopic therapy has been reported as a treatment option for main pancreatic duct disruption. Case Presentation A 68‐year‐old man presented to our hospital and was diagnosed with severe traumatic pancreatic injury that developed 2 days prior. Endoscopic retrograde cholangiopancreatography revealed main pancreatic duct disruption. Although initial stenting to the distal main pancreatic duct was not achieved because of the widespread intermediate fluid collection, an endoscopic naso‐pancreatic drainage tube was successfully inserted into via the main duodenal papilla. After drainage, the endoscopic naso‐pancreatic drainage tube was replaced with an endoscopic retrograde pancreatic drainage tube, and a stent was successfully placed into the distal main pancreatic duct via the minor papilla. Conclusion We report a case of severe pancreatic injury managed using multi‐stage endoscopic therapy that could be a possible treatment strategy for pancreatic injury with total main pancreatic duct disruption.
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Affiliation(s)
- Kei Ito
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Akira Endo
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Masanori Kobayashi
- Department of Gastroenterology and Hepatology Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
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Ishii E, Nawa N, Matsui H, Otomo Y, Fujiwara T. Comparison of Disease Patterns and Outcomes Between Non-Japanese and Japanese Patients at a Single Tertiary Emergency Care Center in Japan. J Epidemiol 2022; 32:80-88. [PMID: 33281150 PMCID: PMC8761568 DOI: 10.2188/jea.je20200211] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/07/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Japan's historically low immigration rate and monolingual culture makes it a particularly interesting setting for clarifying non-national medical care. Our study objective was to examine disease patterns and outcome differences between Japanese and non-Japanese patients in a rapidly globalizing nation. METHODS A secondary data analysis of 325 non-Japanese and 13,370 Japanese patients requiring tertiary care or intensive-care unit or high-care unit admission to the emergency department at the Tokyo Medical and Dental University medical hospital from 2010 through 2019 was conducted. Multivariable linear and logistic regressions models were applied to examine differences in percentage of diagnosis, mortality rates, and length of stay, stratified by Glasgow Coma Scale (GCS) scores to consider the impact of language barriers. Sex and age were adjusted. RESULTS Non-Japanese patients had more anaphylaxis, burns, and infectious disease, but less cardiovascular diagnoses prior to adjustment. After adjustment, there were significantly more anaphylaxis (adjusted odds ratio [aOR] 2.7; 95% confidence interval [CI], 1.7-4.4) and infectious disease diagnoses (aOR 2.2; 95% CI, 1.3-3.7), and marginally more burn diagnoses (aOR 2.3; 95% CI, 0.96-5.3) than Japanese patients. Regardless of GCS scores, there were no significant differences between non-Japanese and Japanese patient length of stay for anaphylaxis, burn, and infectious disease after covariate adjustment. CONCLUSION There were more non-Japanese patients diagnosed with anaphylaxis, burns, and infectious disease, but no notable patient care differences for length of stay. Further prevention efforts are needed against anaphylaxis, burns, and infectious disease for non-Japanese tourists or residents.
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Affiliation(s)
- Euma Ishii
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobutoshi Nawa
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Medical Education Research and Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroki Matsui
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
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42
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Kojima M, Endo A, Shiraishi A, Shoko T, Otomo Y, Coimbra R. Association between the plasma-to-red blood cell ratio and survival in geriatric and non-geriatric trauma patients undergoing massive transfusion: a retrospective cohort study. J Intensive Care 2022; 10:2. [PMID: 35016735 PMCID: PMC8753889 DOI: 10.1186/s40560-022-00595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The benefits of a high plasma-to-red blood cell (RBC) ratio on the survival of injured patients who receive massive transfusions remain unclear, especially in older patients. We aimed to investigate the interaction of age with the plasma-to-RBC ratio and clinical outcomes of trauma patients. METHODS In this retrospective study conducted from 2013 to 2016, trauma patients who received massive transfusions were included. Using a generalized additive model (GAM),we assessed how the plasma-to-RBC ratio and age affected the in-hospital mortality rates. The association of the plasma-to-RBC ratio [low (< 0.5), medium (0.5-1.0), and high (≥ 1.0)] with in-hospital mortality and the incidence of adverse events were assessed for the overall cohort and for patients stratified into non-geriatric (16-64 years) and geriatric (≥ 65 years) groups using logistic regression analyses. RESULTS In total, 13,894 patients were included. The GAM plot of the plasma-to-RBC ratio for in-hospital mortality demonstrated a downward convex unimodal curve for the entire cohort. The low-transfusion ratio group was associated with increased odds of in-hospital mortality in the non-geriatric cohort [odds ratio 1.38, 95% confidence interval (CI) 1.22-1.56]; no association was observed in the geriatric group (odds ratio 0.84, 95% CI 0.62-1.12). An increase in the transfusion ratio was associated with a higher incidence of adverse events in the non-geriatric and geriatric groups. CONCLUSION The association of the non-geriatric age category and plasma-to-RBC ratio for in-hospital mortality was clearly demonstrated. However, the relationship between the plasma-to-RBC ratio with mortality among geriatric patients remains inconclusive.
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Affiliation(s)
- Mitsuaki Kojima
- Emergency and Critical Care Medicine, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kohoku, Adachi-ku, Tokyo, Japan. .,Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.
| | - Akira Endo
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Atsushi Shiraishi
- Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, Japan
| | - Tomohisa Shoko
- Emergency and Critical Care Medicine, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kohoku, Adachi-ku, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center-CECORC, Riverside University Health System Medical Center, 26520 Cactus Ave., Moreno Valley, CA, USA
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Fujita A, Nakatsutsumi K, Takahashi T, Suzuki T, Nakashima C, Ito K, Endo A, Otomo Y. Effective hemostasis by preperitoneal pelvic packing for common iliac vein injury without pelvic fracture in severe blunt trauma: a case report. Acute Med Surg 2022; 9:e771. [PMID: 35846944 PMCID: PMC9272522 DOI: 10.1002/ams2.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background A common iliac vein injury in the absence of pelvic fractures due to blunt trauma is rare, with no treatment strategy established. Case Presentation A 48‐year‐old man, who was injured in a dumbwaiter accident, presented to the hospital with hemorrhagic shock. Computed tomography (CT) revealed active bleeding from the intercostal and hepatic arteries as well as the left common iliac vein. No pelvic fracture was noted. Preperitoneal pelvic packing was performed for the left common iliac vein injury as a damage control surgery. After the operation, endovascular embolization was performed to address the arterial bleeding. The patient became hemodynamically stable, and follow‐up CT showed no signs of bleeding. The packing gauze was removed 3 days after the admission. The patient was discharged without complications. Conclusion Preperitoneal pelvic packing provided temporary hemostasis in a hemodynamically unstable patient with common iliac vein injury but with no pelvic fractures.
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Affiliation(s)
- Akihiro Fujita
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital Tokyo Japan
| | - Keita Nakatsutsumi
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital Tokyo Japan
| | - Tatsuaki Takahashi
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital Tokyo Japan
| | - Tensei Suzuki
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital Tokyo Japan
| | - Choko Nakashima
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital Tokyo Japan
| | - Kei Ito
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital Tokyo Japan
| | - Akira Endo
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital Tokyo Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital Tokyo Japan
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Yagi M, Aiboshi J, Kojima M, Yoshikawa S, Morishita K, Kaji M, Otomo Y. Life‐saving case of cardiopulmonary arrest by secondary aortoenteric fistula formed in the anastomotic site between the inferior mesenteric artery and aortic graft. Acute Med Surg 2022; 9:e2744. [PMID: 35356485 PMCID: PMC8948498 DOI: 10.1002/ams2.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/19/2022] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Secondary aortoenteric fistula is a fatal cause of gastrointestinal bleeding after aortic reconstructive surgery with a prosthesis. In most cases, the proximal suture line is involved. We herein report a rare case in which the fistula formed between the suture line of inferior mesenteric artery reimplantation and the jejunum. Case Presentation An 82‐year‐old man was transferred to our hospital due to hematemesis with severe hypovolemic shock. Although he fell into cardiopulmonary arrest, immediate resuscitation achieved return of spontaneous circulation. As his surgical history of aortic reconstruction and computed tomography findings suggested potential secondary aortoenteric fistula, emergency surgery was carried out. The anastomosis between the inferior mesenteric artery and aortic graft was communicating with the jejunum. Partial jejunal resection was undertaken, and the aortic graft was replaced. Conclusion The anastomosis between the inferior mesenteric artery and aortic graft in the previous aortic replacement can become the site of secondary aortoenteric fistula.
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Affiliation(s)
- Masayuki Yagi
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Junichi Aiboshi
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Mitsuaki Kojima
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Shunsuke Yoshikawa
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Koji Morishita
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Masahito Kaji
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
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Oba S, Hosoya T, Amamiya M, Mitsumura T, Kawata D, Sasaki H, Kamiya M, Yamamoto A, Ando T, Shimada S, Shirai T, Okamoto T, Tateishi T, Endo A, Aiboshi J, Nosaka N, Yamanouchi H, Ugawa T, Nagaoka E, Oi K, Tao S, Maejima Y, Tanaka Y, Tanimoto K, Takeuchi H, Tohda S, Hirakawa A, Sasano T, Arai H, Otomo Y, Miyazaki Y, Yasuda S. Arterial and Venous Thrombosis Complicated in COVID-19: A Retrospective Single Center Analysis in Japan. Front Cardiovasc Med 2021; 8:767074. [PMID: 34869681 PMCID: PMC8639692 DOI: 10.3389/fcvm.2021.767074] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Thrombosis is a characteristic complication in coronavirus disease 2019 (COVID-19). Since coagulopathy has been observed over the entire clinical course, thrombosis might be a clue to understanding the specific pathology in COVID-19. Currently, there is limited epidemiological data of COVID-19-associated thrombosis in the Japanese population and none regarding variant strains of SARS-CoV-2. Here, we elucidate the risk factors and the pattern of thrombosis in COVID-19 patients. Methods: The patients consecutively admitted to Tokyo Medical and Dental University Hospital with COVID-19 were retrospectively analyzed. SARS-CoV-2 variants of concern/interest (VOC/VOI) carrying the spike protein mutants E484K, N501Y, or L452R were identified by PCR-based analysis. All thrombotic events were diagnosed by clinical symptoms, ultrasonography, and/or radiological tests. Results: Among the 516 patients, 32 patients experienced 42 thromboembolic events. Advanced age, severe respiratory conditions, and several abnormal laboratory markers were associated with the development of thrombosis. While thrombotic events occurred in 13% of the patients with a severe respiratory condition, those events still occurred in 2.5% of the patients who did not require oxygen therapy. Elevated D-dimer and ferritin levels on admission were independent risk factors of thrombosis (adjusted odds ratio 9.39 and 3.11, 95% confidence interval 2.08-42.3, and 1.06-9.17, respectively). Of the thrombotic events, 22 were venous, whereas 20 were arterial. While patients with thrombosis received anticoagulation and antiinflammatory therapies with a higher proportion, the mortality rate, organ dysfunctions, and bleeding complications in these patients were higher than those without thrombosis. The incidence of thrombosis in COVID-19 became less frequent over time, such as during the replacement of the earlier strains of SARS-CoV-2 by VOC/VOI and during increased use of anticoagulatory therapeutics. Conclusion: This study elucidated that elevated D-dimer and ferritin levels are useful biomarkers of thrombosis in COVID-19 patients. The comparable incidence of arterial thrombosis with venous thrombosis and the development of thrombosis in less severe patients required further considerations for the management of Japanese patients with COVID-19. Further studies would be required to identify high-risk populations and establish appropriate interventions for thrombotic complications in COVID-19.
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Affiliation(s)
- Seiya Oba
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tadashi Hosoya
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Miki Amamiya
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takahiro Mitsumura
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Daisuke Kawata
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hirokazu Sasaki
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Mari Kamiya
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akio Yamamoto
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takahiro Ando
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Sho Shimada
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tsuyoshi Shirai
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tsukasa Okamoto
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akira Endo
- Trauma and Acute Critical Care Medical Center, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Junichi Aiboshi
- Trauma and Acute Critical Care Medical Center, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Nobuyuki Nosaka
- Department of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hideo Yamanouchi
- Department of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Toyomu Ugawa
- Department of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Eiki Nagaoka
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Keiji Oi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yukie Tanaka
- Research Core, Institute of Research, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kousuke Tanimoto
- Research Core, Institute of Research, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Genome Laboratory, Medical Research Institute, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroaki Takeuchi
- Department of Molecular Virology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shuji Tohda
- Clinical Laboratory, Tokyo Medical and Dental University (TMDU) Hospital, Tokyo, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Medical Center, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shinsuke Yasuda
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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46
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Wada T, Shiraishi A, Gando S, Yamakawa K, Fujishima S, Saitoh D, Kushimoto S, Ogura H, Abe T, Mayumi T, Sasaki J, Kotani J, Takeyama N, Tsuruta R, Takuma K, Shiraishi SI, Shiino Y, Nakada TA, Okamoto K, Sakamoto Y, Hagiwara A, Fujimi S, Umemura Y, Otomo Y. Pathophysiology of Coagulopathy Induced by Traumatic Brain Injury Is Identical to That of Disseminated Intravascular Coagulation With Hyperfibrinolysis. Front Med (Lausanne) 2021; 8:767637. [PMID: 34869481 PMCID: PMC8634586 DOI: 10.3389/fmed.2021.767637] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/20/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Traumatic brain injury (TBI)-associated coagulopathy is a widely recognized risk factor for secondary brain damage and contributes to poor clinical outcomes. Various theories, including disseminated intravascular coagulation (DIC), have been proposed regarding its pathomechanisms; no consensus has been reached thus far. This study aimed to elucidate the pathophysiology of TBI-induced coagulopathy by comparing coagulofibrinolytic changes in isolated TBI (iTBI) to those in non-TBI, to determine the associated factors, and identify the clinical significance of DIC diagnosis in patients with iTBI. Methods: This secondary multicenter, prospective study assessed patients with severe trauma. iTBI was defined as Abbreviated Injury Scale (AIS) scores ≥4 in the head and neck, and ≤2 in other body parts. Non-TBI was defined as AIS scores ≥4 in single body parts other than the head and neck, and the absence of AIS scores ≥3 in any other trauma-affected parts. Specific biomarkers for thrombin and plasmin generation, anticoagulation, and fibrinolysis inhibition were measured at the presentation to the emergency department (0 h) and 3 h after arrival. Results: We analyzed 34 iTBI and 40 non-TBI patients. Baseline characteristics, transfusion requirements and in-hospital mortality did not significantly differ between groups. The changes in coagulation/fibrinolysis-related biomarkers were similar. Lactate levels in the iTBI group positively correlated with DIC scores (rho = −0.441, p = 0.017), but not with blood pressure (rho = −0.098, p = 0.614). Multiple logistic regression analyses revealed that the injury severity score was an independent predictor of DIC development in patients with iTBI (odds ratio = 1.237, p = 0.018). Patients with iTBI were further subdivided into two groups: DIC (n = 15) and non-DIC (n = 19) groups. Marked thrombin and plasmin generation were observed in all patients with iTBI, especially those with DIC. Patients with iTBI and DIC had higher requirements for massive transfusion and emergency surgery, and higher in-hospital mortality than those without DIC. Furthermore, DIC development significantly correlated with poor hospital survival; DIC scores at 0 h were predictive of in-hospital mortality. Conclusions: Coagulofibrinolytic changes in iTBI and non-TBI patients were identical, and consistent with the pathophysiology of DIC. DIC diagnosis in the early phase of TBI is key in predicting the outcomes of severe TBI.
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Affiliation(s)
- Takeshi Wada
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | | | - Satoshi Gando
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan.,Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan.,Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Joji Kotani
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoshi Takeyama
- Advanced Critical Care Center, Aichi Medical University Hospital, Nagakute, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Ube, Japan
| | - Kiyotsugu Takuma
- Emergency & Critical Care Center, Kawasaki Municipal Hospital, Kawasaki, Japan
| | | | - Yasukazu Shiino
- Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Kitakyushu, Japan
| | - Yuichiro Sakamoto
- Emergency and Critical Care Medicine, Saga University Hospital, Saga, Japan
| | - Akiyoshi Hagiwara
- Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Sumiyoshi, Japan
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Sumiyoshi, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
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47
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Sugimoto M, Takayama W, Murata K, Otomo Y. The impact of lactate clearance on outcomes according to infection sites in patients with sepsis: a retrospective observational study. Sci Rep 2021; 11:22394. [PMID: 34789801 PMCID: PMC8599851 DOI: 10.1038/s41598-021-01856-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/01/2021] [Indexed: 01/20/2023] Open
Abstract
Whether lactate clearance (LC) influences outcomes differently depending on the infection site in sepsis cases is not fully elucidated. Herein, we analyzed LC’s clinical utility as a predictor of patient outcomes according to infection site. This retrospective study, conducted at two tertiary emergency critical care medical centers in Japan, included patients with sepsis or septic shock. The associations between infection site (lungs vs. other organs) and in-hospital mortality and ventilator-free days (VFDs) were evaluated using univariable and multivariate analyses. We assessed LC’s ability to predict in-hospital mortality using the area under the receiver operating characteristic curve. Among 369 patients with sepsis, infection sites were as follows: lungs, 186 (50.4%); urinary tract, 45 (12.2%); abdomen, 102 (27.6%); and other, 36 (9.8%). Patients were divided into a pneumonia group or non-pneumonia group depending on their infection site. The pneumonia group displayed a higher in-hospital mortality than the non-pneumonia group (24.2% vs. 15.8%, p = 0.051). In the multivariate analysis, lower LC was associated with higher in-hospital mortality [adjusted odds ratio (AOR), 0.97; 95% confidence interval (CI) 0.96–0.98; p < 0.001] and fewer VFD [adjusted difference p value (AD), − 1.23; 95% CI − 2.42 to − 0.09; p = 0.025] in the non-pneumonia group. Conversely, LC did not affect in-hospital mortality (AOR 0.99; 95% CI 0.99–1.00; p = 0.134) and VFD (AD − 0.08; 95% CI − 2.06 to 1.91; p = 0.854) in the pneumonia group. Given the differences in the impact of LC on outcomes between the pneumonia and non-pneumonia groups, this study suggests that optimal treatment strategies might improve outcomes. Further studies are warranted to validate our results and develop optimal therapeutic strategies for sepsis patients.
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Affiliation(s)
- Momoko Sugimoto
- Department of Emergency and Disaster Medicine, Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Wataru Takayama
- Department of Emergency and Disaster Medicine, Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan.
| | - Kiyoshi Murata
- The Shock Trauma and Emergency Medical Center, Matsudo City General Hospital, 933-1 Sendabori, Matsudo, Chiba, Japan
| | - Yasuhiro Otomo
- Department of Emergency and Disaster Medicine, Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
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48
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Ishii E, Nawa N, Matsui H, Otomo Y, Fujiwara T. Response to the Letter to the Editor on "Comparison of disease patterns and outcomes between non-Japanese and Japanese patients at a single tertiary emergency care center in Japan". J Epidemiol 2021; 32:114. [PMID: 34744102 PMCID: PMC8761566 DOI: 10.2188/jea.je20210435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Euma Ishii
- Department of Global Health Promotion, Tokyo Medical and Dental University
| | - Nobutoshi Nawa
- Department of Global Health Promotion, Tokyo Medical and Dental University.,Department of Medical Education Research and Development, Tokyo Medical and Dental University
| | - Hiroki Matsui
- Department of Global Health Promotion, Tokyo Medical and Dental University.,Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University
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49
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Nakatsutsumi K, Morishita K, Yagi M, Doki S, Watanabe A, Ikegami N, Kobayashi T, Kojima M, Senda A, Yamamoto K, Aiboshi J, Coimbra R, Otomo Y. Vagus nerve stimulation modulates arachidonic acid production in the mesenteric lymph following intestinal ischemia-reperfusion injury. J Trauma Acute Care Surg 2021; 91:700-707. [PMID: 34238858 DOI: 10.1097/ta.0000000000003345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inflammatory lipid mediators in mesenteric lymph (ML), including arachidonic acid (AA), are considered to play an important role in the pathogenesis of multiple-organ dysfunction after hemorrhagic shock. A previous study suggested that vagus nerve stimulation (VNS) could relieve shock-induced gut injury and abrogate ML toxicity, resulting in the prevention of multiple-organ dysfunction. However, the detailed mechanism of VNS in lymph toxicity remains unclear. The study aimed to investigate the relationship between VNS and inflammatory lipid mediators in ML. METHODS Male Sprague-Dawley rats underwent laparotomy and superior mesenteric artery obstruction (SMAO) for 60 minutes to induce intestinal ischemia followed by reperfusion and observation. The ML duct was cannulated, and ML samples were obtained both before and after SMAO. The distal ileum was removed at the end of the observation period. In one group of animals, VNS was performed from 10 minutes before 10 minutes after SMAO (5 V, 0.5 Hz). Liquid chromatography-electrospray ionization-tandem mass spectrometry analysis of AA was performed for each ML sample. The biological activity of ML was examined using a monocyte nuclear factor κ-light-chain-enhancer of activated B cells activation assay. Western blotting of phospholipase A2 group IIA (PLA2-IIA) was also performed for ML and ileum samples. RESULTS Vagus nerve stimulation relieved the SMAO-induced histological gut injury. The concentration of AA and level of nuclear factor κ-light-chain-enhancer of activated B cells activation in ML increased significantly after SMAO, whereas VNS prevented these responses. Western blotting showed PLA2-IIA expression in the ML and ileum after SMAO; however, the appearance of PLA2-IIA band was remarkably decreased in the samples from VNS-treated animals. CONCLUSION The results suggested that VNS could relieve gut injury induced by SMAO and decrease the production of AA in ML by altering PLA2-IIA expression in the gut and ML.
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Affiliation(s)
- Keita Nakatsutsumi
- From the Department of Acute Critical Care and Disaster Medicine (K.N., Y.O.), Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University; Department of Acute Critical Care and Disaster Medicine (K.N., K.M., A.S., J.A., Y.O.), Tokyo Medical and Dental University Hospital of Medicine; Department of Biological Sciences (S.D., A.W., N.I., T.K.), Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo; Emergency Medicine and Acute Care Surgery (M.Y.), Matsudo City General Hospital, Chiba; Emergency and Critical Care Center (M.K.), Tokyo Women's Medical University Medical Center East; Department of Comprehensive Pathology (K.Y.), Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; and Department of Surgery (R.C.), Riverside University Health System Medical Center, Loma Linda University School of Medicine, Loma Linda, California
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50
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Hatakeyama T, Kiguchi T, Sera T, Nachi S, Ochiai K, Kitamura T, Ogura S, Otomo Y, Iwami T. Physician's presence in pre-hospital setting improves one-month favorable neurological survival after out-of-hospital cardiac arrest: a propensity score matching analysis of the JAAM-OHCA Registry. Resuscitation 2021; 167:38-46. [PMID: 34390825 DOI: 10.1016/j.resuscitation.2021.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Using the out-of-hospital cardiac arrest (OHCA) registry in Japan, we evaluated the effectiveness of physicians' presence in pre-hospital settings after adjusting in-hospital treatments. METHODS This was a multicenter cohort study. We registered all consecutive OHCA patients in Japan who, from 1 June 2014 through 31 December 2017, were transported to institutions participating in the Japanese Association for Acute Medicine OHCA registry. We included OHCA patients aged at least 18 years, with medical etiology, and who received resuscitation from emergency medical services (EMS) personnel and medical professionals in hospitals. The primary outcome was one-month favorable neurological survival. We estimated the propensity score by fitting a logistic regression model that was adjusted for several variables before the arrival of EMS personnel and/or pre-hospital physician. A multivariable logistic regression analysis in propensity score-matched patients was used to adjust confounders, including extracorporeal membrane oxygenation, percutaneous coronary intervention, intra-aortic balloon pumping, and targeted temperature management. RESULTS We analyzed 19,247 patients. Among them, 5.4% (N = 1,040) had a neurologically favorable outcome. The adjusted odds ratio (AOR) of the physicians' presence compared with their absence for primary outcome was 1.84 (95% confidence interval (CI): 1.43-2.37). Among first documented non-shockable cardiac rhythm, the AOR was 1.51 (95% CI: 1.04-2.22). Among first documented shockable cardiac rhythm, the AOR of the physicians' presence for primary outcome was 1.15 (95% CI: 0.83-1.59). CONCLUSION The improved one-month favorable neurological survival was significantly associated with the physicians' presence in pre-hospital settings, compared with the physicians' absence.
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Affiliation(s)
- Toshihiro Hatakeyama
- Department of Emergency and Critical Care Medicine, Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan; Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan
| | - Takeyuki Kiguchi
- Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan; Department of Critical Care and Trauma Center, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan.
| | - Toshiki Sera
- Department of Emergency Medicine, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima 734-8530, Japan; Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Sho Nachi
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagito, Gifu, Gifu 501-1194, Japan
| | - Kanae Ochiai
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Shinji Ogura
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagito, Gifu, Gifu 501-1194, Japan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Taku Iwami
- Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan
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