2024/05/24 更新

写真a

オバラ タカフミ
小原 隆史
Obara Takafumi
所属
医歯薬学域 助教(特任)
職名
助教(特任)

学位

  • 医学博士 ( 2023年3月   岡山大学 )

  • 学士 ( 2012年3月   熊本大学 )

研究分野

  • ライフサイエンス / 救急医学  / 小児救急、小児集中治療、神経集中治療、臓器保護

学歴

  • 岡山大学   Graduate School of Medicine , Dentistry and Pharmaceutical Sciences  

    2020年4月 - 2023年3月

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  • 熊本大学   School of Medicine   School of Medicine

    2006年4月 - 2012年3月

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論文

  • Impact of sex of bystanders who perform cardiopulmonary resuscitation on return of spontaneous circulation in out-of-hospital cardiac arrest patients: A retrospective, observational study. 国際誌

    Shunsuke Nakamura, Tsuyoshi Nojima, Takafumi Obara, Takashi Hongo, Tetsuya Yumoto, Takashi Yorifuji, Atsunori Nakao, Hiromichi Naito

    Resuscitation plus   18   100659 - 100659   2024年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: The impact of the sex of bystanders who initiate cardiopulmonary resuscitation (CPR) on out-of-hospital cardiac arrest (OHCA) patients has not been fully elucidated. This study aims to investigate the association between the sex of bystanders who perform CPR and the clinical outcomes of OHCA patients in real-world clinical settings. METHODS: We conducted a retrospective, observational study using data from the Okayama City Fire Department in Japan. Patients were categorized based on bystanders' sex. Our primary outcomes were return of spontaneous circulation (ROSC). Our secondary outcome was 30-day survival and 30-day favorable neurological outcome, defined as Cerebral Performance Category score of 1 or 2. Multivariable logistic regression analysis was used to examine the association between these groups and outcomes. RESULTS: The study included 3,209 patients with a comparable distribution of male (1,540 patients: 48.0%) and female bystanders (1,669 patients: 52.0%) between the groups. Overall, 221 (6.9%) ROSC at hospital arrival, 226 (7.0%) patients had 30-day survival, and 121 (3.8%) patients had 30-day favorable neurological outcomes. Bystander sex (female as reference) did not contribute to ROSC at hospital arrival (adjusted OR [aOR] 1.11, 95% CI: 0.76-1.61), 30-day survival (aOR 1.23, 95% CI: 0.83-1.82), or 30-day favorable neurological outcomes (aOR 0.66, 95% CI: 0.34-1.27). Basic life support education experience was a bystander factor positively associated with ROSC. Patient factors positively associated with ROSC were initial shockable rhythm and witness of cardiac arrest. CONCLUSION: There were no differences in ROSC, 30-day survival, or 30-day neurological outcomes in OHCA patients based on bystander sex.

    DOI: 10.1016/j.resplu.2024.100659

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  • Organ donation after extracorporeal cardiopulmonary resuscitation: a nationwide retrospective cohort study. 国際誌

    Tetsuya Yumoto, Kohei Tsukahara, Takafumi Obara, Takashi Hongo, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao

    Critical care (London, England)   28 ( 1 )   160 - 160   2024年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Limited data are available on organ donation practices and recipient outcomes, particularly when comparing donors who experienced cardiac arrest and received extracorporeal cardiopulmonary resuscitation (ECPR) followed by veno-arterial extracorporeal membrane oxygenation (ECMO) decannulation, versus those who experienced cardiac arrest without receiving ECPR. This study aims to explore organ donation practices and outcomes post-ECPR to enhance our understanding of the donation potential after cardiac arrest. METHODS: We conducted a nationwide retrospective cohort study using data from the Japan Organ Transplant Network database, covering all deceased organ donors between July 17, 2010, and August 31, 2022. We included donors who experienced at least one episode of cardiac arrest. During the study period, patients undergoing ECMO treatment were not eligible for a legal diagnosis of brain death. We compared the timeframes associated with each donor's management and the long-term graft outcomes of recipients between ECPR and non-ECPR groups. RESULTS: Among 370 brain death donors with an episode of cardiac arrest, 26 (7.0%) received ECPR and 344 (93.0%) did not; the majority were due to out-of-hospital cardiac arrests. The median duration of veno-arterial ECMO support after ECPR was 3 days. Patients in the ECPR group had significantly longer intervals from admission to organ procurement compared to those not receiving ECPR (13 vs. 9 days, P = 0.005). Lung graft survival rates were significantly lower in the ECPR group (log-rank test P = 0.009), with no significant differences in other organ graft survival rates. Of 160 circulatory death donors with an episode of cardiac arrest, 27 (16.9%) received ECPR and 133 (83.1%) did not. Time intervals from admission to organ procurement following circulatory death and graft survival showed no significant differences between ECPR and non-ECPR groups. The number of organs donated was similar between the ECPR and non-ECPR groups, regardless of brain or circulatory death. CONCLUSIONS: This nationwide study reveals that lung graft survival was lower in recipients from ECPR-treated donors, highlighting the need for targeted research and protocol adjustments in post-ECPR organ donation.

    DOI: 10.1186/s13054-024-04949-5

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  • Changes in temporal muscle dimensions and their clinical impact in out-of-hospital cardiac arrest survivors

    Takashi Hongo, Hiromichi Naito, Keibun Liu, Yuya Murakami, Satoshi Nozaki, Hiroki Maeyama, Ayaka Matsuoka, Hisashi Dote, Kazumasa Inaba, Satoshi Miike, Shigeki Fujitani, Tomohiro Hiraoka, Takafumi Obara, Tsuyoshi Nojima, Atsunori Nakao, Tetsuya Yumoto

    Resuscitation Plus   17   100527 - 100527   2024年3月

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    掲載種別:研究論文(学術雑誌)   出版者・発行元:Elsevier BV  

    DOI: 10.1016/j.resplu.2023.100527

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  • 法的脳死判定時にCPAPモードを用いた無呼吸テストを実施した小児2例

    平岡 知浩, 小原 隆史, 塚原 紘平, 難波 宏太, 岡田 真澄, 平山 隆浩, 湯本 哲也, 内藤 宏道, 中尾 篤典

    日本小児科学会雑誌   128 ( 2 )   361 - 361   2024年2月

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    記述言語:日本語   出版者・発行元:(公社)日本小児科学会  

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  • Successful Cardiac, Lung, and Kidney Transplantation from a Methanol-poisoned Donor.

    Takashi Hongo, Tetsuya Yumoto, Yoshinori Kosaki, Tomohiro Hiraoka, Kohei Tsukahara, Tsuyoshi Nojima, Takafumi Obara, Kohei Ageta, Yukie Yamasaki, Kaori Taniguchi, Masanobu Miura, Satoru Miyaishi, Hiromichi Naito, Atsunori Nakao

    JMA journal   7 ( 1 )   133 - 135   2024年1月

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    記述言語:英語  

    Massive methanol exposure can lead to severe and detrimental effects that can result in death or brain death. As organs from patients with brain death after methanol ingestion are less likely to be recovered, these patients have been considered marginal donors. We present a case of successful multiple organ transplantation (heart, lungs, and kidneys) from a methanol-poisoned patient. Our experience illustrates that donor death from methanol intoxication does not preclude organ transplantation.

    DOI: 10.31662/jmaj.2023-0081

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  • Hydrogen in Transplantation: Potential Applications and Therapeutic Implications. 国際誌

    Takafumi Obara, Hiromichi Naito, Tsuyoshi Nojima, Takahiro Hirayama, Takashi Hongo, Kohei Ageta, Toshiyuki Aokage, Masaki Hisamura, Tetsuya Yumoto, Atsunori Nakao

    Biomedicines   12 ( 1 )   2024年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Hydrogen gas, renowned for its antioxidant properties, has emerged as a novel therapeutic agent with applications across various medical domains, positioning it as a potential adjunct therapy in transplantation. Beyond its antioxidative properties, hydrogen also exerts anti-inflammatory effects by modulating pro-inflammatory cytokines and signaling pathways. Furthermore, hydrogen's capacity to activate cytoprotective pathways bolsters cellular resilience against stressors. In recent decades, significant advancements have been made in the critical medical procedure of transplantation. However, persistent challenges such as ischemia-reperfusion injury (IRI) and graft rejection continue to hinder transplant success rates. This comprehensive review explores the potential applications and therapeutic implications of hydrogen in transplantation, shedding light on its role in mitigating IRI, improving graft survival, and modulating immune responses. Through a meticulous analysis encompassing both preclinical and clinical studies, we aim to provide valuable insights into the promising utility of hydrogen as a complementary therapy in transplantation.

    DOI: 10.3390/biomedicines12010118

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  • Treatment patterns and clinician stress related to care of out-of-hospital cardiac arrest patients with a do not attempt resuscitation order. 国際誌

    Ryo Tanabe, Takashi Hongo, Takafumi Obara, Tsuyoshi Nojima, Atsunori Nakao, Jonathan Elmer, Hiromichi Naito, Tetsuya Yumoto

    Resuscitation plus   16   100507 - 100507   2023年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: This research investigated treatment patterns for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders in Japanese emergency departments and the associated clinician stress. METHODS: A cross-sectional survey was conducted at 9 hospitals in Okayama, Japan, targeting emergency department nurses and physicians. The questionnaire inquired about the last treated out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation. We assessed emotional stress on a 0-10 scale and moral distress on a 1-5 scale among clinicians. RESULTS: Of 208 participants, 107 (51%) had treated an out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation order in the past 6 months. Of these, 65 (61%) clinicians used a "slow code" due to perceived futility in resuscitation (42/65 [65%]), unwillingness to terminate resuscitation upon arrival (38/65 [59%]), and absence of family at the time of patient's arrival (35/65 [54%]). Female clinicians had higher emotional stress (5 vs. 3; P = 0.007) and moral distress (3 vs. 2; P = 0.002) than males. Nurses faced more moral distress than physicians (3 vs. 2; P < 0.001). Adjusted logistic regression revealed that having performed a "slow code" (adjusted odds ratio, 5.09 [95% CI, 1.68-17.87]) and having greater ethical concerns about "slow code" (adjusted odds ratio, 0.35 [95% CI, 0.19-0.58]) were associated with high stress levels. CONCLUSIONS: The prevalent use of "slow code" for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders underscores the challenges in managing these patients in clinical practice.

    DOI: 10.1016/j.resplu.2023.100507

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  • アセトアミノフェン中毒に対する一酸化炭素放出物質(CORM-401)の新規治療法としての可能性

    青景 聡之, Meng Ying, 小原 隆史, 湯本 哲也, 平山 隆浩, 内藤 宏道, 中尾 篤典

    日本救急医学会雑誌   34 ( 12 )   717 - 717   2023年12月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • Evaluation for Blood Concentration and Efficacy/Safety of Continuous Administration of Thiamylal in Children. 国際誌

    Kenshiro Hirata, Takafumi Obara, Tokunori Ikeda, Hiroshi Watanabe, Issei Fujita, Hirokazu Furusho, Takako Ishiguro, Sachiko Jingami, Toru Maruyama, Katsuki Hirai, Shigeyuki Miyamura

    Therapeutic drug monitoring   46 ( 3 )   397 - 403   2023年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Thiamylal exerts excellent sedative effects. However, it is not routinely used because of its serious adverse effects. This study aimed to clarify the target blood concentration range and infusion rate of thiamylal in children by measuring its blood concentration and evaluating its relationship with efficacy and adverse effects. METHODS: This study was approved by the Ethics Committee of Japanese Red Cross Kumamoto Hospital. The authors included 10 children aged between 1 and 7 years who had received continuous intravenous (IV) infusion of thiamylal for the management of refractory status epilepticus, excluding those who met the exclusion criteria. After a 2 mg/kg bolus injection of thiamylal, continuous IV infusion was initiated at a rate of 2-3 mg/kg/h. Thiamylal concentration in the blood was measured using high-performance liquid chromatography. The State Behavioral Scale and the frequency of bolus injections were used to evaluate efficacy. Blood pressure and heart rate were measured to evaluate adverse effects. Statistical analyses of the time to awakening and the factors affecting it were also conducted. RESULTS: The State Behavioral Scale score during thiamylal administration was -2 or lower in all cases, suggesting that the depth of sedation was sufficient. The frequency of bolus injections decreased in a blood concentration-dependent manner, suggesting that the frequency tended to decrease, especially at thiamylal blood concentrations of 20 mcg/mL or higher. An increase of the infusion rate to 3 mg/kg/h was recommended, because the blood concentration may not reach 20 mcg/mL at an infusion rate of 2 mg/kg/h. There was also a case in which a rapid increase in blood concentration accompanied by a decrease in blood pressure and heart rate was observed when the infusion rate was increased to 4 mg/kg/h. Furthermore, the time to awakening after the end of administration correlated with the highest blood concentration during administration; therefore, delayed awakening was noted when using a high dose of thiamylal. CONCLUSIONS: The target blood concentration of thiamylal in children should be 20-30 mcg/mL, and the infusion rate should be based on 3 mg/kg/h.

    DOI: 10.1097/FTD.0000000000001153

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  • Radiation in an emergency situation: attempting to respect the patient's beliefs as reported by a minor. 国際誌

    Tetsuya Yumoto, Takashi Hongo, Yasuhiro Koide, Takafumi Obara, Kohei Tsukahara, Hiromichi Naito, Atsunori Nakao

    BMC medical ethics   24 ( 1 )   80 - 80   2023年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Each individual's unique health-related beliefs can greatly impact the patient-clinician relationship. When there is a conflict between the patient's preferences and recommended medical care, it can create a serious ethical dilemma, especially in an emergency setting, and dramatically alter this important relationship. CASE PRESENTATION: A 56-year-old man, who remained comatose after out-of-hospital cardiac arrest, was rushed to our hospital. The patient was scheduled for emergency coronary angiography when his adolescent daughter reported that she and her father held sincere beliefs against radiation exposure. We were concerned that she did not fully understand the potential consequences if her father did not receive the recommended treatment. A physician provided her with in depth information regarding the risks and benefits of the treatment. While we did not want to disregard her statement, we opted to save the patient's life due to concerns about the validity of her report. CONCLUSIONS: Variations in beliefs regarding medical care force clinicians to incorporate patient beliefs into medical practice. However, an emergency may require a completely different approach. When faced with a patient in a life-threatening condition and unconscious, we should take action to prioritize saving their life, unless we are highly certain about the validity of their advance directives.

    DOI: 10.1186/s12910-023-00962-5

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  • Schmorl's Node Found with Acute Lower Back Pain.

    Kenji Aoshima, Takafumi Obara, Tsuyoshi Nojima, Atsunori Nakao

    Internal medicine (Tokyo, Japan)   2023年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.2169/internalmedicine.2203-23

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  • アセトアミノフェン中毒におけるプロカルシトニンの有用性

    野島 剛, 本郷 貴識, 小原 隆史, 小崎 吉訓, 飯田 淳義, 湯本 哲也, 青景 聡之, 塚原 紘平, 内藤 宏道, 中尾 篤典

    中毒研究   36 ( 2 )   207 - 207   2023年7月

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    記述言語:日本語   出版者・発行元:(株)へるす出版  

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  • 救急医療現場における個人的信念に基づく医療行為拒否への対応 放射線被曝拒否事例から考える

    小出 恭大, 湯本 哲也, 本郷 貴識, 小崎 吉訓, 野島 剛, 上田 浩平, 小原 隆史, 飯田 淳義, 山本 浩継, 青景 聡之, 塚原 紘平, 内藤 宏道, 中尾 篤典

    日本臨床救急医学会雑誌   26 ( 3 )   358 - 358   2023年7月

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    記述言語:日本語   出版者・発行元:(一社)日本臨床救急医学会  

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  • Hydrogen inhalation attenuates lung contusion after blunt chest trauma in mice. 国際誌

    Kohei Ageta, Takahiro Hirayama, Toshiyuki Aokage, Mizuki Seya, Ying Meng, Tsuyoshi Nojima, Hirotsugu Yamamoto, Takafumi Obara, Atsunori Nakao, Tetsuya Yumoto, Kohei Tsukahara, Hiromichi Naito

    Surgery   2023年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Lung contusion caused by blunt chest trauma evokes a severe inflammatory reaction in the pulmonary parenchyma that may be associated with acute respiratory distress syndrome. Although hydrogen gas has antioxidant and anti-inflammatory effects and is protective against multiple types of lung injury at safe concentrations, the effects of inhaled hydrogen gas on blunt lung injury have not been previously investigated. Therefore, using a mouse model, we tested the hypothesis that hydrogen inhalation after chest trauma would reduce pulmonary inflammation and acute lung injury associated with lung contusion. METHODS: Inbred male C57BL/6 mice were randomly divided into 3 groups: sham with air inhalation, lung contusion with air inhalation, and lung contusion with 1.3% hydrogen inhalation. Experimental lung contusion was induced using a highly reproducible and standardized apparatus. Immediately after induction of lung contusion, mice were placed in a chamber exposed to 1.3% hydrogen gas in the air. Histopathological analysis and real-time polymerase chain reaction in lung tissue and blood gas analysis were performed 6 hours after contusion. RESULTS: Histopathological examination of the lung tissue after contusion revealed perivascular/intra-alveolar hemorrhage, perivascular/interstitial leukocyte infiltration, and interstitial/intra-alveolar edema. These histological changes and the extent of lung contusion, as determined by computed tomography, were significantly mitigated by hydrogen inhalation. Hydrogen inhalation also significantly reduced inflammatory cytokine and chemokine mRNA levels and improved oxygenation. CONCLUSION: Hydrogen inhalation therapy significantly mitigated inflammatory responses associated with lung contusion in mice. Hydrogen inhalation therapy may be a supplemental therapeutic strategy for treating lung contusion.

    DOI: 10.1016/j.surg.2023.04.029

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  • Hydrogen gas treatment improves survival in a rat model of crush syndrome by ameliorating rhabdomyolysis

    Tetsuya Yumoto, Toshiyuki Aokage, Takahiro Hirayama, Hirotsugu Yamamoto, Takafumi Obara, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao

    European Journal of Inflammation   21   1721727X2311685 - 1721727X2311685   2023年3月

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    掲載種別:研究論文(学術雑誌)   出版者・発行元:SAGE Publications  

    Objectives

    Crush syndrome (CS) is characterized by a systemic manifestation of traumatic rhabdomyolysis, leading to multiple organ dysfunction and death. Ischemia-reperfusion (IR) injury is commonly responsible for systemic response. Extending studies have shown that hydrogen gas treatment ameliorated IR injury in numerous experimental models; however, its effect on CS has not been well examined. This study aimed to investigate the effects of hydrogen gas inhalation following crush injury in an experimental model of CS.

    Methods

    Male Sprague-Dawley rats were subjected to experimental CS by applying a total of 3.0 kg weight to both hindlimb under general anesthesia for 6 h. Immediately after decompression, the animals were randomly placed in a gas chamber filled with either air or 1.3% hydrogen gas. Animals were sacrificed 18 h or 24 h following gas exposure for non-survival studies or for survival study, respectively.

    Results

    The rats with hydrogen treatment ( n = 6) had a higher 24-h survival than the rats with air treatment ( n = 9) (100% vs. 44%, p = 0.035). Lactate concentrations (2.9 ± 0.2 vs. 2.2 ± 0.2 mmol/L, p = 0.040) and creatine kinase (34,178 ± 13,580 vs. 5005 ± 842 IU/L, p = 0.016) were lower in the hydrogen group compared with the air group 18 h after decompression ( n = 4 in the air group, and n = 5 in the H2 group). Histological analysis revealed that the damage to the rectus femoris muscle and kidney appeared to be ameliorated by hydrogen treatment.

    Conclusion

    Hydrogen gas inhalation may be a promising therapeutic approach in the treatment of CS.

    DOI: 10.1177/1721727x231168547

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    その他リンク: http://journals.sagepub.com/doi/full-xml/10.1177/1721727X231168547

  • Association of Prehospital Physician Presence During Pediatric Out-of-Hospital Cardiac Arrest With Neurologic Outcomes. 国際誌

    Takafumi Obara, Tetsuya Yumoto, Tsuyoshi Nojima, Takashi Hongo, Kohei Tsukahara, Naomi Matsumoto, Takashi Yorifuji, Atsunori Nakao, Jonathan Elmer, Hiromichi Naito

    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies   2023年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVES: To examine the association of prehospital physician presence with neurologic outcomes of pediatric patients with out-of-hospital cardiac arrest (OHCA). DESIGN: Retrospective cohort study. SETTING: Data from the Japanese Association for Acute Medicine-OHCA Registry. INTERVENTIONS: None. PATIENTS: Pediatric patients (age 17 yr old or younger) registered in the database between June 2014 and December 2019. MEASUREMENT AND MAIN RESULTS: We used logistic regression models with stabilized inverse probability of treatment weighting (IPTW) to estimate the associated treatment effect of a prehospital physician with 1-month neurologically intact survival. Secondary outcomes included in-hospital return of spontaneous circulation (ROSC) and 1-month survival after OHCA. A total of 1,187 patients (276 in the physician presence group and 911 in the physician absence group) were included (median age 3 yr [interquartile range 0-14 yr]; 723 [61%] male). Comparison of the physician presence group, versus the physician absence, showed 1-month favorable neurologic outcomes of 8.3% (23/276) versus 3.6% (33/911). Physician presence was associated with greater odds of 1-month neurologically intact survival after stabilized IPTW adjustment (adjusted odds ratio [aOR] 1.98, 95% CI 1.08-3.66). We also found an association in the secondary outcome between physician presence, opposed to absence, and in-hospital ROSC (aOR 1.48, 95% CI 1.08-2.04). However, we failed to identify an association with 1-month survival (aOR 1.49, 95% CI 0.97-2.88). CONCLUSIONS: Among pediatric patients with OHCA, prehospital physician presence, compared with absence, was associated almost two-fold greater odds of 1-month favorable neurologic outcomes.

    DOI: 10.1097/PCC.0000000000003206

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  • Organ Donation after Extracorporeal Cardiopulmonary Resuscitation and Brain Death.

    Takafumi Obara, Tetsuya Yumoto, Kenji Aoshima, Kohei Tsukahara, Hiromichi Naito, Atsunori Nakao

    Acta medica Okayama   77 ( 1 )   117 - 120   2023年2月

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    記述言語:英語  

    A 38-year-old primipara Japanese woman suffered cardiac arrest due to a pulmonary thromboembolism 1 day after undergoing a cesarean section. Extracorporeal cardiopulmonary resuscitation was initiated and extracorporeal membrane oxygenation support was needed for 24 h. Despite intensive care, the patient was diagnosed with brain death on day 6. With the family's consent, comprehensive end-of-life care including organ donation was discussed based on our hospital's policy. The family decided to donate her organs. Specific training and education are required for emergency physicians to optimize the process of incorporating organ donation into end-of-life care while respecting the patient's and family's wishes.

    DOI: 10.18926/AMO/64372

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  • Successfully treated case of severe hypothermia secondary to myxedema coma. 国際誌

    Hirotsugu Yamamoto, Takashi Hongo, Tsuyoshi Nojima, Takafumi Obara, Yoshinori Kosaki, Kohei Ageta, Kohei Tsukahara, Tetsuya Yumoto, Atsunori Nakao, Hiromichi Naito

    Acute medicine & surgery   10 ( 1 )   e828   2023年

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    記述言語:英語  

    BACKGROUND: Myxedema coma is an extremely rare but fatal endocrine emergency that requires urgent recognition and treatment. We describe a case of severe hypothermia that rapidly deteriorated to cardiac arrest that was attributed to myxedema coma. CASE PRESENTATION: A 52-year-old man without a history of hypothyroidism was transferred to our emergency department due to coma and profound hypothermia. The patient developed cardiac arrest immediately after hospital arrival but return of spontaneous circulation was achieved shortly after resuscitation. The patient was noted to have generalized, nonpitting edema, dry skin, severe respiratory acidosis, hyponatremia, and elevated creatinine kinase, which was indicative of hypothyroidism. Myxedema coma was confirmed by a thyroid profile. The patient was successfully treated with intravenous levothyroxine and glucocorticoid. CONCLUSION: Although myxedema coma is a rare cause of severe hypothermia, emergency physicians should be familiar with its clinical features and management.

    DOI: 10.1002/ams2.828

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  • Transcranial doppler ultrasound in a 3-month-old infant with brain death. 国際誌

    Tomohiro Hiraoka, Takafumi Obara, Takashi Hongo, Tsuyoshi Nojima, Kohei Tsukahara, Tetsuya Yumoto, Atsunori Nakao

    Pediatrics international : official journal of the Japan Pediatric Society   65 ( 1 )   e15587   2023年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1111/ped.15587

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  • Early-stage antibody kinetics after the third dose of BNT162b2 mRNA COVID-19 vaccination measured by a point-of-care fingertip whole blood testing

    Hideharu Hagiya, Yasuhiro Nakano, Masanori Furukawa, Naruhiko Sunada, Toru Hasegawa, Yasue Sakurada, Kou Hasegawa, Koichiro Yamamoto, Hiroko Ogawa, Takafumi Obara, Kouhei Ageta, Naomi Matsumoto, Rumi Matsuo, Tomoka Kadowaki, Akihito Higashikage, Takao Hikita, Takashi Yorifuji, Shinichi Toyooka, Yoshinobu Maeda, Yoshinori Yokokura, Fumio Otsuka, Masanori Nakayama

    Scientific Reports   12 ( 1 )   2022年11月

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    掲載種別:研究論文(学術雑誌)   出版者・発行元:Springer Science and Business Media LLC  

    Abstract

    Amid the Coronavirus Disease 2019 pandemic, we aimed to demonstrate the accuracy of the fingertip whole blood sampling test (FWT) in measuring the antibody titer and uncovering its dynamics shortly after booster vaccination. Mokobio SARS-CoV-2 IgM &amp; IgG Quantum Dot immunoassay (Mokobio Biotechnology R&amp;D Center Inc., MD, USA) was used as a point-of-care FWT in 226 health care workers (HCWs) who had received two doses of the BNT162b2 mRNA vaccine (Pfizer-BioNTech) at least 8 months prior. Each participant tested their antibody titers before and after the third-dose booster up to 14-days. The effect of the booster was observed as early as the fourth day after vaccination, which exceeded the detection limit (&gt; 30,000 U/mL) by 2.3% on the fifth day, 12.2% on the sixth day, and 22.5% after the seventh day. Significant positive correlations were observed between the pre- and post-vaccination (the seventh and eighth days) antibody titers (correlation coefficient, 0.405; p &lt; 0.001). FWT is useful for examining antibody titers as a point-of-care test. Rapid response of antibody titer started as early as the fourth day post-vaccination, while the presence of weak responders to BNT162b2 vaccine was indicated.

    DOI: 10.1038/s41598-022-24464-3

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    その他リンク: https://www.nature.com/articles/s41598-022-24464-3

  • 臓器移植におけるドナー管理(臓器保護の観点から) 6歳未満おける臓器移植ドナー管理の特徴

    小原 隆史, 内藤 宏道, 塚原 紘平, 青景 聡之, 野島 剛, 上田 浩平, 小崎 吉訓, 山田 太平, 藤崎 宣友, 中尾 篤典

    日本集中治療医学会雑誌   29 ( Suppl.1 )   297 - 297   2022年11月

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    記述言語:日本語   出版者・発行元:(一社)日本集中治療医学会  

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  • 治療的医学ガス(Medical gas)を救急集中治療領域へ応用する 救急医による挑戦

    小原 隆史, 青景 聡之, 山本 浩継, 野島 剛, 上田 浩平, 湯本 哲也, 内藤 宏道, 中尾 篤典

    日本救急医学会雑誌   33 ( 10 )   823 - 823   2022年10月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • デジタル田園健康特区における救急救命士の権限・役割の拡大による救急体制の充実への取り組み

    上田 浩平, 本郷 貴識, 小原 隆史, 野島 剛, 湯本 哲也, 塚原 紘平, 内藤 宏道, 中尾 篤典

    日本救急医学会雑誌   33 ( 10 )   872 - 872   2022年10月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • 産科情報共有システム「iPicss」により迅速な対応ができた出産中の脳出血の搬送例

    佐々並 三紗, 小崎 吉訓, 塚原 紘平, 牧 尉太, 中尾 篤典, 内藤 宏道, 湯本 哲也, 上田 浩平, 小原 隆史, 本郷 貴識, 平岡 知浩

    日本救急医学会雑誌   33 ( 10 )   806 - 806   2022年10月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • Luminal administration of biliverdin ameliorates ischemia-reperfusion injury following intestinal transplant in rats. 国際誌

    Tsuyoshi Nojima, Takafumi Obara, Hirotsugu Yamamoto, Tetsuya Yumoto, Takuro Igawa, Toshiyuki Aokage, Mizuki Seya, Atsunori Nakao, Hiromichi Naito

    Surgery   172 ( 5 )   1522 - 1528   2022年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Intestinal grafts are susceptible to ischemia-reperfusion injury, resulting in the loss of mucosal barrier function and graft failure. Biliverdin is known to exert a variety of cytoprotective functions against oxidative tissue injury. Because the mucosal layer is the primary site of ischemia-reperfusion injury, mucosa-targeting strategies by luminal delivery of reagents might be beneficial. We tested whether intraluminal administration of biliverdin as an adjuvant to standard preservation solutions protected against ischemia-reperfusion injury. METHODS: Orthotopic syngeneic intestinal transplants were performed on Lewis rats after 6 hours of cold preservation. Saline containing biliverdin (10 μM) or without biliverdin was introduced into the lumen of the intestinal grafts immediately before cold preservation. RESULTS: Damage to the intestinal mucosa caused by ischemia-reperfusion injury resulted in severe morphological changes, including blunting of the villi and erosion, and led to significant loss of gut barrier function 3 hours after reperfusion. These changes to the mucosa were notably ameliorated by intraluminal administration of biliverdin. Biliverdin also effectively inhibited upregulation of messenger RNAs for interleukin-6, inducible nitric oxide synthase, and C-C motif chemokine 2. Additionally, biliverdin treatment prevented the loss of expression of claudin-1, a transmembrane, tight-junction barrier protein. The 14-day survival of recipients of biliverdin-treated grafts was significantly improved as compared with the recipients of saline-treated control grafts (83.3% vs 38.9%, P = .030). CONCLUSION: This study demonstrated that luminally delivered biliverdin provides beneficial effects during the transplant of rat small intestinal grafts and could be an attractive therapeutic option in organ transplantation.

    DOI: 10.1016/j.surg.2022.07.021

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  • Luminal Administration of a Water-soluble Carbon Monoxide-releasing Molecule (CORM-3) Mitigates Ischemia/Reperfusion Injury in Rats Following Intestinal Transplantation. 国際誌

    Takafumi Obara, Hirotsugu Yamamoto, Toshiyuki Aokage, Takuro Igawa, Tsuyoshi Nojima, Takahiro Hirayama, Mizuki Seya, Michiko Ishikawa-Aoyama, Atsunori Nakao, Roberto Motterlini, Hiromichi Naito

    Transplantation   106 ( 7 )   1365 - 1375   2022年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: The protective effects of carbon monoxide (CO) against ischemia/reperfusion (IR) injury during organ transplantation have been extensively investigated. Likewise, CO-releasing molecules (CORMs) are known to exert a variety of pharmacological activities via liberation of controlled amounts of CO in organs. Therefore, we hypothesized that intraluminal administration of water-soluble CORM-3 during cold storage of intestinal grafts would provide protective effects against IR injury. METHODS: Orthotopic syngeneic intestinal transplantation was performed in Lewis rats following 6 h of cold preservation in Ringer solution or University of Wisconsin solution. Saline containing CORM-3 (100 µmol/L) or its inactive counterpart (iCORM-3) was intraluminally introduced in the intestinal graft before cold preservation. RESULTS: Histopathological analysis of untreated and iCORM-3-treated grafts revealed a similar erosion and blunting of the intestinal villi. These changes in the mucosa structure were significantly attenuated by intraluminal administration of CORM-3. Intestinal mucosa damage caused by IR injury led to considerable deterioration of gut barrier function 3 h postreperfusion. CORM-3 significantly inhibited upregulation of proinflammatory mRNA levels, ameliorated intestinal morphological changes, and improved graft blood flow and mucosal barrier function. Additionally, CORM-3-treated grafts increased recipient survival rates. Pharmacological blockade of soluble guanylyl cyclase activity significantly reversed the protective effects conferred by CORM-3, indicating that CO partially mediates its therapeutic actions via soluble guanylyl cyclase activation. CONCLUSIONS: Our study demonstrates that luminally delivered CORM-3 provides beneficial effects in cold-stored rat small intestinal grafts and could be an attractive therapeutic application of CO in the clinical setting of organ preservation and transplantation.

    DOI: 10.1097/TP.0000000000004007

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  • キノコ中毒におけるプロカルシトニンによる診断は有用か

    野島 剛, 湯本 哲也, 小崎 吉訓, 小原 隆史, 上田 浩平, 塚原 紘平, 山田 太平, 内藤 宏道, 中尾 篤典

    中毒研究   35 ( 2 )   153 - 153   2022年7月

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    記述言語:日本語   出版者・発行元:(株)へるす出版  

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  • Adult Scurvy Presenting with Painful Purpura on the Legs.

    Nayu Tamura, Takafumi Obara, Taihei Yamada, Tsuyoshi Nojima, Shunsuke Nakamura, Yasuhiro Koide, Makoto Takaoka, Hiromichi Naito, Atsunori Nakao

    Internal medicine (Tokyo, Japan)   61 ( 12 )   1913 - 1916   2022年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Prolonged vitamin C deficiency can result in numerous metabolic abnormalities like impaired tissue repair and defective collagen synthesis. This case report describes a middle-age Japanese man presenting painful purpura on his lower limbs, severe anemia, and altered consciousness. The patient had been eating a selective diet lacking in vegetables and fruits since childhood. A serum analysis demonstrated a low level of vitamin C. The patient was treated with vitamin supplementation and psychological intervention. Scurvy is an under-considered illness with a favorable prognosis if diagnosed early while it is still sporadically encountered in some patients with malabsorption or malnutrition even in modern times.

    DOI: 10.2169/internalmedicine.8409-21

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  • Can Blood Ammonia Level, Prehospital Time, and Return of Spontaneous Circulation Predict Neurological Outcomes of Out-of-Hospital Cardiac Arrest Patients? A Nationwide, Retrospective Cohort Study. 国際誌

    Tsuyoshi Nojima, Hiromichi Naito, Takafumi Obara, Kohei Ageta, Hiromasa Yakushiji, Tetsuya Yumoto, Noritomo Fujisaki, Atsunori Nakao

    Journal of clinical medicine   11 ( 9 )   2022年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: This study aimed to test if blood ammonia levels at hospital arrival, considering prehospital time and the patient's condition (whether return of spontaneous circulation [ROSC] was achieved at hospital arrival), can predict neurological outcomes after out-of-hospital cardiac arrest (OHCA). METHODS: This was a retrospective cohort study on data from a nationwide OHCA registry in Japan. Patients over 17 years old and whose blood ammonia levels had been recorded were included. The primary outcome was favorable neurological outcome at 30 days after OHCA. Blood ammonia levels, prehospital time, and the combination of the two were evaluated using the receiver operating characteristic curve to predict favorable outcomes. Then, cut-off blood ammonia values were determined based on whether ROSC was achieved at hospital arrival. RESULTS: Blood ammonia levels alone were sufficient to predict favorable outcomes. The overall cut-off ammonia value for favorable outcomes was 138 μg/dL; values were different for patients with ROSC (96.5 μg/dL) and those without ROSC (156 μg/dL) at hospital arrival. CONCLUSIONS: Our results using patient data from a large OHCA registry showed that blood ammonia levels at hospital arrival can predict neurological outcomes, with different cut-off values for patients with or without ROSC at hospital arrival.

    DOI: 10.3390/jcm11092566

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  • 日本外傷学会データバンクを用いた熱傷症例の検討

    野島 剛, 内藤 宏道, 小原 隆史, 小崎 吉訓, 上田 浩平, 塚原 紘平, 中尾 篤典

    熱傷   48 ( 1 )   38 - 39   2022年3月

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    記述言語:日本語   出版者・発行元:(一社)日本熱傷学会  

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  • 当院高度救命救急センターにおける小児の熱傷と感染に関するまとめ

    小原 隆史, 塚原 紘平, 野島 剛, 上田 浩平, 山本 浩継, 内藤 宏道, 中尾 篤典

    熱傷   48 ( 1 )   41 - 41   2022年3月

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    記述言語:日本語   出版者・発行元:(一社)日本熱傷学会  

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  • Short or Irregular Sleep Duration in Early Childhood Increases Risk of Injury for Primary School-Age Children: A Nationwide Longitudinal Birth Cohort in Japan. 国際誌

    Takafumi Obara, Hiromichi Naito, Kohei Tsukahara, Naomi Matsumoto, Hirotsugu Yamamoto, Takashi Yorifuji, Atsunori Nakao

    International journal of environmental research and public health   18 ( 18 )   2021年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    The aim of this study was to investigate the longitudinal relationship between shorter or irregular sleep duration (SD) in early childhood and increased risk of injury at primary school age using data from a nationwide survey in Japan. We categorized SD into seven groups: 6 h, 7 h, 8 h, 9 hrs, 10 or 11 h, >12 h, and irregular, based on questionnaire responses collected at 5.5 years old. The relationship between SD and incidence of injury at 5.5-nine years of age is shown. In addition, we completed a stratified analysis on children with or without problematic behavior at eight years old. We included 32,044 children, of which 6369 were classified as having an injury and 25,675 as not having an injury. Logistic regression model showed that shorter or irregular SD categories were associated with an increased adjusted odds ratio (aOR) for injuries (6 h: aOR 1.40, 95% confidence interval (CI) 1.19-1.66, 7 h: aOR 1.10, 95% CI, 0.98-1.23, 8 h: aOR 1.13, 95% CI, 1.02-1.26, irregular: aOR 1.26, 95% CI 1.10-1.43). The same tendency was observed with shorter or irregular SD in subgroups with or without behavioral problems. Shorter or irregular sleep habits during early childhood are associated with injury during primary school age.

    DOI: 10.3390/ijerph18189512

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  • Carbon monoxide poisoning during pregnancy treated with hyperbaric oxygen. 国際誌

    Yoshinori Kosaki, Hiroki Maeyama, Tsuyoshi Nojima, Takafumi Obara, Atsunori Nakao, Hiromichi Naito

    Clinical case reports   9 ( 5 )   e04138   2021年5月

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    記述言語:英語  

    Acute carbon monoxide (CO) intoxication during pregnancy causes fetal death and teratogenic effects. Hyperbaric oxygen (HBO2) therapy has the potential to improve them. HBO2 therapy should be considered to treat CO intoxication during pregnancy.

    DOI: 10.1002/ccr3.4138

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  • Plastic Bronchitis in a Five-Year-Old Boy Treated Using Extracorporeal Membrane Oxygenation; a Case Report. 国際誌

    Tsuyoshi Nojima, Hiromichi Naito, Takafumi Obara, Kohei Tsukahara, Atsunori Nakao

    Archives of academic emergency medicine   9 ( 1 )   e16   2021年

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    記述言語:英語  

    Plastic bronchitis is an uncommon disorder marked by the production of bronchial casts and acute respiratory failure development. In pediatric cases, influenza infection sometimes results in the obstruction of bronchi and leads to this potentially life-threatening condition. We report the case of a five-year-old boy with plastic bronchitis related to influenza A infection, which could only be recovered by the use of extracorporeal membrane oxygenation (ECMO). ECMO could effectively provide sufficient oxygenation for patients suffering from severe reversible acute respiratory failure. If patients infected with the influenza virus present acute respiratory distress with total lung atelectasis, clinicians should consider the diagnosis of plastic bronchitis and the subsequent treatment interventions with ECMO in a severe cases.

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  • Unrecognized Orbital Images Cause Diagnostic Confusion: Silicone Oil and Implanted Silicone Encircling Bands. 国際誌

    Tsuyoshi Nojima, Takafumi Obara, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

    Case reports in emergency medicine   2021   9940395 - 9940395   2021年

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    記述言語:英語  

    INTRODUCTION: Most physicians are not familiar with postoperative changes to the orbit, so radiologists and clinicians may sometimes find it challenging to conduct a proper radiological assessment of the globe of the eye and orbital abnormalities. We present a patient with head trauma who had surgery for retinal detachment with implantation of silicone encircling bands. This case report may help clinicians recognize imaging characteristics after ophthalmic surgery to prevent misdiagnosis and unnecessary workup. Case Report. An 18-year-old man with severe head trauma was admitted to our hospital. Initial computed tomography (CT) revealed a high attenuation of intraocular silicone that could be mistaken for a hemorrhage. Ophthalmological examination and detailed ophthalmic history confirmed silicone oil in his eye for treatment of retinal detachment. Knowledge of the anatomical changes and radiological appearance of postsurgical findings following retinal detachment, including the surgical materials of silicone oil or bands, can prevent unnecessary alarm. CONCLUSION: Implanted ophthalmic devices, for example, silicone oil, appear similar to hemorrhages on CT and magnetic resonance imaging and cause diagnostic confusion. When in doubt, it is useful to assess the clinical presentation and obtain an accurate medical history.

    DOI: 10.1155/2021/9940395

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  • Incidence and characteristics of medical emergencies related to dental treatment: a retrospective single-center study. 国際誌

    Kyoichi Obata, Hiromichi Naito, Hiromasa Yakushiji, Takafumi Obara, Kisho Ono, Tsuyoshi Nojima, Kohei Tsukahara, Taihei Yamada, Akira Sasaki, Atsunori Nakao

    Acute medicine & surgery   8 ( 1 )   e651   2021年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    AIM: Although uncommon, medical emergencies arise in general dental practice. Inadequate data on their severity and frequency makes targeting medical education for general dental practitioners difficult. This also makes planning for unexpected events challenging for practitioners and makes collaborating with emergency physicians burdensome. We aimed to clarify the incidence and characteristics of a dental outpatient department's medical emergencies. METHODS: This single-center, retrospective, observational study was undertaken with patients who visited the dental outpatient department of Okayama University Hospital during the 8-year period. The primary outcome of the study was to identify the incidence and characteristics of medical emergencies in the dental outpatient department. Then we examined the timing of medical emergencies, administered medications, and final disposition (home/admission). RESULTS: During the period, 1,146,929 patients were enrolled. Forty-two patients (0.0037%) were consulted as medical emergencies. More than 60% of the incidents were vasovagal syncope, and dehydration and hypoglycemia were the second most prevalent at 9.5%. The most common types of dental treatments were tooth extraction (45.2%), followed by general dental treatment (28.6%), and other dental surgery such as implant placement (14.3%). Types of medical emergencies occurred equally before, during, and after dental treatment. Antihypertensive agents, sedatives, or glucose were used. For patients with emergencies, 90.5% recovered during the day and returned home, and 9.5% were hospitalized. CONCLUSION: The incidence of medical emergencies was low in our dental outpatient department. Knowledge of basic management principles, regular education for emergency care, and practicing first aid skills are mandatory for safe patient management.

    DOI: 10.1002/ams2.651

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  • Oral Ethanol Treatment for Ethylene Glycol Intoxication. 国際誌

    Misa Sasanami, Taihei Yamada, Takafumi Obara, Atsunori Nakao, Hiromichi Naito

    Cureus   12 ( 12 )   e12268   2020年12月

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    記述言語:英語  

    Ethylene glycol is an odorless, sweet-tasting liquid found in industrial solutions such as antifreeze and windshield wiper fluid. Brake fluid, an automobile transmission liquid, contains poisonous alcohols such as glycol ethers and ethylene glycols. The toxicity of ethylene glycol is associated with toxic metabolite production by the liver enzyme alcohol dehydrogenase. Administration of either intravenous ethanol or fomepizole, both of which competitively inhibit ethylene glycol metabolism by alcohol dehydrogenase and can prevent the production and accumulation of the toxic metabolites, can be used as an antidote. A 42-year-old male car mechanic was transferred to our hospital after accidentally ingesting approximately 100 mL of brake fluid. Immediately after ingestion, he threw up most of the ingested liquid; however, he complained of nausea and throat pain and was moved to our emergency department. The patient was successfully treated with administration of oral ethanol in the form of whisky through a nasogastric tube since neither intravenous ethanol nor fomepizole was available in our hospital at the time of his presentation. Our case demonstrates that oral ethanol can be used as an alternative treatment for patients with ethylene glycol intoxication.

    DOI: 10.7759/cureus.12268

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  • Delay in Emergency Medical Service Transportation Responsiveness during the COVID-19 Pandemic in a Minimally Affected Region.

    Kohei Ageta, Hiromichi Naito, Takashi Yorifuji, Takafumi Obara, Tsuyoshi Nojima, Taihei Yamada, Kohei Tsukahara, Hiromasa Yakushiji, Atsunori Nakao

    Acta medica Okayama   74 ( 6 )   513 - 520   2020年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Few studies have investigated the influence of the Coronavirus Disease 2019 (COVID-19) pandemic on emer-gency medical service (EMS) systems, especially in areas less affected or unaffected by COVID-19. In this study, we investigated changes in prehospital EMS activity and transport times during the COVID-19 pandemic. All patients transported by EMS in the city of Okayama from March-May 2019 or March-May 2020 were included. Interfacility transports were excluded. The primary outcome was the time from a patient's first emergency call until hospital arrival (total prehospital time). Secondary outcomes included three segments of total prehospital time: the response time, on-scene time, and transportation time. Total prehospital time and the durations of each segment were compared between corresponding months in 2020 (COVID19-affected) and 2019 (control). The results showed that total prehospital times in April 2020 were significantly higher than those in 2019 (33.8 ± 11.6 vs. 32.2 ± 10.8 min, p < 0.001). Increases in total prehospital time were caused by longer response time (9.3 ± 3.8 vs. 8.7 ± 3.7 min, p < 0.001) and on-scene time (14.4 ± 7.9 vs. 13.5 ± 6.2min, p < 0.001). The COVID-19 pandemic was thus shown to affect EMS and delayed arrival/response even in a minimally affected region. A system to minimize transportation delays should be developed for emerging pandemics.

    DOI: 10.18926/AMO/61210

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  • Burning Mouth Syndrome Induced by Angiotensin-Converting Enzyme Inhibitors. 国際誌

    Takafumi Obara, Hiromichi Naito, Tsuyoshi Nojima, Hitoshi Koga, Atsunori Nakao

    Cureus   12 ( 11 )   e11376   2020年11月

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    記述言語:英語  

    Burning mouth syndrome (BMS) is characterized as the sensation of burning in the tongue or any other area of the oral mucosa without a medical or dental cause. BMS's pathophysiology is poorly understood and may be caused by its association with various factors, particularly with antihypertensive or psychotropic medicines. Although BMS is a relatively common intraoral disorder in the dental field, emergency physicians rarely recognize it. We report a 53-year-old Japanese woman who presented to our ED with a three-week history of a strange taste and burning tongue. The patient had poor control of hypertension, captopril, an angiotensin-converting enzyme (ACE) inhibitor, was added three weeks before presentation. We discontinued her ACE inhibitor and changed her medication to a beta-blocker. After two weeks, her symptoms improved. Emergency physicians must be aware that ACE inhibitors play some roles in the pathogenesis of BMS. The correct diagnosis of the condition depends on recognizing the disease and improving the quality of life.

    DOI: 10.7759/cureus.11376

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  • インフルエンザウイルス感染を契機に上気道閉塞、意識障害を呈した甲状腺クリーゼ一例

    佐々並 三紗, 塚原 紘平, 小崎 吉訓, 小原 隆史, 野島 剛, 上田 浩平, 山本 浩継, 尾迫 貴章, 内藤 宏道, 中尾 篤典

    日本救急医学会雑誌   31 ( 11 )   1075 - 1075   2020年11月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • Transient Global Amnesia in a Patient Presenting with Hypertensive Emergency; a Case Report. 国際誌

    Takafumi Obara, Tsuyosi Nojima, Hitoshi Koga, Atsunori Nakao, Hiromichi Naito

    Archives of academic emergency medicine   8 ( 1 )   e66   2020年

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    記述言語:英語  

    Transient global amnesia (TGA) is characterized by the abrupt onset of global amnesia, particularly anterograde amnesia. The pathophysiology of TGA is poorly understood and it could be caused by various factors and be associated with various diseases. We report a 58-year-old man who presented to the local emergency room with TGA lasting for several hours. The patient had complete anterograde amnesia without a past medical history of migraine or neurological findings. His systolic blood pressure on presentation was 220 mmHg, which was immediately treated with intravenous calcium ion influx inhibitor. Other than global amnesia, there was no evidence of neurological disturbance. Computed tomography and magnetic resonance imaging results were unremarkable. After treatment of his hypertension, his amnesia resolved within 12 hours. Emergency department physicians may encounter TGA. Correct diagnosis of the condition depends on recognizing the disease.

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  • Pediatric airway compromise due to thyroid storm associated with influenza A infection: A case report. 国際誌

    Taiki Higaki, Kohei Tsukahara, Takafumi Obara, Tsuyoshi Nojima, Hirotsugu Yamamoto, Takaaki Osako, Hiromichi Naito, Atsunori Nakao

    Respiratory medicine case reports   31   101182 - 101182   2020年

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    記述言語:英語  

    Thyroid storm is a potentially fatal intensification of thyrotoxicosis normally marked by tachycardia, hyperthermia, impaired mental status, and severe agitation. It can be initiated by numerous causes. Failure to promptly diagnose the condition may lead to high mortality. Early diagnosis and treatment of thyroid storm are essential to prevent further life-threatening complications. A 10-year-old girl was admitted to our emergency center for intensive care. The patient presented tachypnea with stridor, paradoxical abdominal breathing, and "barking" cough. The patient was diagnosed as upper airway obstruction complicated by thyroid storm associated with influenza infection. Following immediate airway management, the patient was administered a short-acting beta-blocker, hydrocortisone, thiamazole, and saturated solution of potassium iodide was initiated. The patient was extubated on day 8 and transferred to a local hospital on day 11 without adverse complications. When examining patients with influenza infection, emergency doctors should be more attentive not to miss other critical diagnoses. The present case was initially diagnosed as croup due to influenza infection. Sharing our experience may help emergency physicians treat similar cases of pediatric airway compromise due to thyroid storm.

    DOI: 10.1016/j.rmcr.2020.101182

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  • A family intoxicated by daffodil bulbs mistaken for onions. 国際誌

    Kohei Ageta, Hiromasa Yakushiji, Yoshinori Kosaki, Takafumi Obara, Tsuyoshi Nojima, Akira Gochi, Hiromichi Naito, Atsunori Nakao

    Acute medicine & surgery   7 ( 1 )   e595   2020年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1002/ams2.595

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MISC

  • アセトアミノフェン中毒におけるプロカルシトニンの有用性

    野島 剛, 本郷 貴識, 小原 隆史, 小崎 吉訓, 飯田 淳義, 湯本 哲也, 青景 聡之, 塚原 紘平, 内藤 宏道, 中尾 篤典

    中毒研究   36 ( 2 )   207 - 207   2023年7月

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    記述言語:日本語   出版者・発行元:(株)へるす出版  

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  • 救急医療現場における個人的信念に基づく医療行為拒否への対応 放射線被曝拒否事例から考える

    小出 恭大, 湯本 哲也, 本郷 貴識, 小崎 吉訓, 野島 剛, 上田 浩平, 小原 隆史, 飯田 淳義, 山本 浩継, 青景 聡之, 塚原 紘平, 内藤 宏道, 中尾 篤典

    日本臨床救急医学会雑誌   26 ( 3 )   358 - 358   2023年7月

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    記述言語:日本語   出版者・発行元:(一社)日本臨床救急医学会  

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  • つなぐいのち~小児脳死下臓器ドナー管理 小児脳死下臓器ドナー管理の特徴 当センターでの経験から

    小原 隆史, 内藤 宏道, 塚原 紘平, 野島 剛, 上田 浩平, 本郷 貴識, 小崎 吉訓, 山本 浩継, 青景 聡之, 湯本 哲也, 中尾 篤典

    日本集中治療医学会雑誌   30 ( Suppl.1 )   S283 - S283   2023年6月

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    記述言語:日本語   出版者・発行元:(一社)日本集中治療医学会  

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  • 当科における小児急性脳症と体温管理療法の現状

    小原 隆史, 塚原 紘平, 平岡 知浩, 本郷 貴識, 湯本 哲也, 内藤 宏道, 中尾 篤典

    日本脳低温療法・体温管理学会誌   26 ( 1 )   47 - 47   2023年6月

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    記述言語:日本語   出版者・発行元:日本脳低温療法・体温管理学会  

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  • 小児の院外心停止における医師の病院前救急診療は神経学的転帰を改善する

    小原 隆史, 湯本 哲也, 塚原 紘平, 野島 剛, 本郷 貴識, 松本 尚美, 頼藤 貴志, 中尾 篤典, 内藤 宏道

    日本集中治療医学会雑誌   30 ( Suppl.1 )   S422 - S422   2023年6月

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    記述言語:日本語   出版者・発行元:(一社)日本集中治療医学会  

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  • 集中治療領域での嚥下障害

    本郷 貴識, 小原 隆史, 野島 剛, 上田 浩平, 青景 聡之, 塚原 紘平, 湯本 哲也, 内藤 宏道, 中尾 篤典

    日本集中治療医学会雑誌   30 ( Suppl.1 )   S269 - S269   2023年6月

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    記述言語:日本語   出版者・発行元:(一社)日本集中治療医学会  

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  • 体温管理療法中の温度管理が筋萎縮にあたえる影響の検討

    本郷 貴識, 小原 隆史, 湯本 哲也, 内藤 宏道, 中尾 篤典

    日本脳低温療法・体温管理学会誌   26 ( 1 )   48 - 48   2023年6月

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    記述言語:日本語   出版者・発行元:日本脳低温療法・体温管理学会  

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  • つなぐ命と気持ち~脳死移植における集中治療の役割~潜在的なドナーの認知から移植外科医につなげるところまで 終末期の児童に対し「臓器移植の情報提供」を含めた選択肢提示を行うために 当院の体制作りと現状

    塚原 紘平, 小原 隆史, 野島 剛, 上田 浩平, 本郷 貴識, 小崎 吉訓, 山本 浩継, 飯田 淳義, 青景 聡之, 湯本 哲也, 内藤 宏道, 中尾 篤典

    日本集中治療医学会雑誌   30 ( Suppl.1 )   S331 - S331   2023年6月

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    記述言語:日本語   出版者・発行元:(一社)日本集中治療医学会  

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  • aEEGモニタリングが診断・薬物調整に有用であったFIRESの一例

    小原 隆史, 平岡 知浩, 山本 浩継, 塚原 紘平

    日本小児救急医学会雑誌   22 ( 2 )   292 - 292   2023年6月

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    記述言語:日本語   出版者・発行元:(一社)日本小児救急医学会  

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  • 脳死の状態判断に補助検査として脳血流シンチグラフィを施行した1例

    庵谷 紘美, 内藤 宏道, 小原 隆史, 青景 聡之, 塚原 紘平, 中尾 篤典

    日本集中治療医学会雑誌   29 ( Suppl.1 )   667 - 667   2022年11月

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    記述言語:日本語   出版者・発行元:(一社)日本集中治療医学会  

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  • 組織の体制整備による持続可能な「臓器提供」

    塚原 紘平, 平岡 知浩, 薬師寺 泰匡, 小原 隆史, 小崎 吉訓, 野島 剛, 湯本 哲也, 山本 浩継, 青景 聡之, 内藤 宏道, 中尾 篤典

    日本救急医学会雑誌   33 ( 10 )   847 - 847   2022年10月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • 前頸部の腫脹によるICP上昇に対し厳密な体位保持が有用であった重症頭部外傷の小児例

    小原 隆史, 塚原 紘平, 山本 浩継, 内藤 宏道, 中尾 篤典

    日本小児救急医学会雑誌   21 ( 2 )   287 - 287   2022年6月

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    記述言語:日本語   出版者・発行元:(一社)日本小児救急医学会  

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  • 日本外傷学会データバンクを用いた熱傷症例の検討

    野島 剛, 内藤 宏道, 小原 隆史, 小崎 吉訓, 上田 浩平, 塚原 紘平, 中尾 篤典

    熱傷   48 ( 1 )   38 - 39   2022年3月

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    記述言語:日本語   出版者・発行元:(一社)日本熱傷学会  

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  • 当院高度救命救急センターにおける小児の熱傷と感染に関するまとめ

    小原 隆史, 塚原 紘平, 野島 剛, 上田 浩平, 山本 浩継, 内藤 宏道, 中尾 篤典

    熱傷   48 ( 1 )   41 - 41   2022年3月

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    記述言語:日本語   出版者・発行元:(一社)日本熱傷学会  

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  • 経気管切開孔アプローチにて気道異物を摘出した乳児例

    小原 隆史, 永芳 真理子, 余湖 直紀, 水足 佐知子, 武藤 雄一郎, 浅井 栄敏, 平井 克樹

    人工呼吸   39 ( 1 )   63 - 67   2022年

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    記述言語:日本語   出版者・発行元:一般社団法人 日本呼吸療法医学会  

    小児の気道異物に対する検査・治療は硬性気管支鏡を用いることが多く、気管切開や開胸術まで至ることは稀である。症例は1歳4カ月男児。みかんを食べた直後に心肺停止となり当院に搬送された。気管挿管、アドレナリン投与により心拍再開。胸部CTで左主気管支に異物を認め、果実や薄皮による気管閉塞を疑ったが、呼吸状態は安定しており、心停止後の集中治療を優先した。第2病日、左肺の無気肺を認め、第3病日には突発的な酸素化と一回換気量の低下が出現した。ファイバースコープにて黄白色の異物を確認したが、頻回の酸素化低下をきたすため、硬性気管支鏡での経口的アプローチでは気道確保が困難と判断し、気管切開を先行し、気管孔から鉗子付き鼻咽頭ビデオスコープを用いてみかんの種を摘出した。経気管孔的アプロ―チは、気管支の観察・摘出処置において操作性が良く、異物除去の有意義な一選択肢となり得る。

    DOI: 10.50903/jsrcm.39.1_63

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  • コロナ禍における面会制限は脳死下臓器提供に影響を与えたか? 岡山大学病院高度救命救急センターの経験から

    萩原 万瀧, 塚原 紘平, 中村 俊介, 小崎 吉訓, 小田 裕太, 小原 隆史, 上田 浩平, 野島 剛, 山本 浩継, 山田 太平, 青景 聡之, 藤崎 宣友, 内藤 宏道, 中尾 篤典

    移植   56 ( 総会臨時 )   O25 - 1   2021年9月

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    記述言語:日本語   出版者・発行元:(一社)日本移植学会  

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  • 神経集中治療〜脳と全身管理のコラボレーション〜 小児急性脳症バンドルによる神経学予後改善への挑戦

    塚原 紘平, 小原 隆史, 山本 浩継, 野島 剛, 上田 浩平, 小崎 吉訓, 藤崎 宣友, 青景 聡之, 内藤 宏道, 中尾 篤典

    日本集中治療医学会雑誌   28 ( Suppl.2 )   257 - 257   2021年9月

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    記述言語:日本語   出版者・発行元:(一社)日本集中治療医学会  

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  • PCASに対する脳保護療法:TTMの普及とスタンダード 来院時アンモニア値に搬送時間を加味した院外心停止患者の予後予測

    野島 剛, 内藤 宏道, 小崎 吉訓, 小原 隆史, 山本 浩継, 藤崎 宣友, 青景 聡之, 塚原 紘平, 山田 太平, 中尾 篤典

    日本集中治療医学会雑誌   28 ( Suppl.2 )   223 - 223   2021年9月

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    記述言語:日本語   出版者・発行元:(一社)日本集中治療医学会  

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  • ラット小腸移植モデルを使った水素含有生理食塩水の管腔内投与による臓器保護効果の検討

    山本 浩継, 小原 隆史, 青景 聡之, 井川 卓朗, 内藤 宏道, 中尾 篤典

    移植   56 ( 総会臨時 )   O26 - 5   2021年9月

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    記述言語:日本語   出版者・発行元:(一社)日本移植学会  

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  • 一酸化炭素遊離分子(CORM)管腔内投与による小腸移植グラフト保存への新しいアプローチ

    小原 隆史, 山本 浩継, 青景 聡之, 内藤 宏道, 中尾 篤典

    移植   56 ( 総会臨時 )   O26 - 4   2021年9月

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    記述言語:日本語   出版者・発行元:(一社)日本移植学会  

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  • 重症頭部外傷診療の明日 高度救命救急センターでの小児重症頭部外傷の現状と課題

    塚原 紘平, 小原 隆史, 山本 浩継

    日本小児救急医学会雑誌   20 ( 2 )   265 - 265   2021年5月

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    記述言語:日本語   出版者・発行元:(一社)日本小児救急医学会  

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  • 小児の重症外傷に対する治療 小児科医が重症外傷診療に関わる意義とは?

    小原 隆史, 吉元 和彦, 寺住 恵子, 余湖 直紀, 武藤 雄一郎, 林田 和之, 平井 克樹

    日本小児救急医学会雑誌   20 ( 2 )   267 - 267   2021年5月

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    記述言語:日本語   出版者・発行元:(一社)日本小児救急医学会  

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  • 幼児期の睡眠不足は学童期のケガのリスクとなる(21世紀出生児縦断コホート研究)

    小原 隆史, 塚原 紘平, 山本 浩継, 松本 尚美, 頼藤 貴志, 内藤 宏道, 中尾 篤典

    日本小児科学会雑誌   125 ( 2 )   224 - 224   2021年2月

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    記述言語:日本語   出版者・発行元:(公社)日本小児科学会  

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  • 非特定警戒地域における新型コロナウイルス流行下の小児救急搬送の状況変化

    小原 隆史, 塚原 紘平, 上田 浩平, 内藤 宏道, 頼藤 貴志, 中尾 篤典

    日本小児救急医学会雑誌   20 ( 1 )   70 - 72   2021年2月

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    記述言語:日本語   出版者・発行元:(一社)日本小児救急医学会  

    (目的)Coronavirus disease 2019(COVID-19)の流行期、非特定警戒都道府県である岡山市の小児救急搬送の現状を検討した。(方法)2019・2020年の2〜5月に同市消防局内で、転院を除いた18歳未満を対象に後方視的観察研究を行った。(結果)4、5月の搬送数は前年比の半数以下、発熱を有する搬送も減っていた。重症例に変化はなく、軽症・中等症の減少が顕著であった。属性に違いはなく、搬送時間に差は認めなかった。(結論)平時から小児医療体制が確立しており、COVID-19の感染数も少なかったため、体制は適切に保たれていたが、引き続き今後に対する備えが重要である。(著者抄録)

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  • 岡山市消防局の救急活動時間におけるCOVID-19の影響

    上田 浩平, 小原 隆史, 野島 剛, 小崎 吉訓, 藤崎 宣友, 塚原 紘平, 山田 太平, 尾迫 貴章, 青景 聡之, 内藤 宏道, 中尾 篤典

    日本救急医学会雑誌   31 ( 11 )   1368 - 1368   2020年11月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • COVID19パンデミック下における搬送用エアロゾルボックスの検証

    塚原 紘平, 内藤 宏道, 稲葉 基高, 小崎 吉訓, 小原 隆史, 野島 剛, 上田 浩平, 藤崎 宣友, 中尾 篤典, 青井 純子, 藤森 隆史

    日本救急医学会雑誌   31 ( 11 )   1376 - 1376   2020年11月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • 小児傷病者の病院前救護と診療における課題 小児におけるドクターヘリ,ドクターカーによる病院前救急診療の現状

    余湖 直紀, 小原 隆史, 武藤 雄一郎, 平井 克樹

    日本臨床救急医学会雑誌   23 ( 3 )   349 - 349   2020年8月

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    記述言語:日本語   出版者・発行元:(一社)日本臨床救急医学会  

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  • 当院小児救命救急センター開設後の小児院外心停止症例の検討

    武藤 雄一郎, 横山 智美, 小原 隆史, 余湖 直紀, 高木 祐吾, 平井 克樹, 右田 昌宏

    日本小児救急医学会雑誌   18 ( 2 )   247 - 247   2019年6月

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    記述言語:日本語   出版者・発行元:(一社)日本小児救急医学会  

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  • 小児重症患者の長距離搬送における航空機動衛生隊との協力体制とその有益性

    小原 隆史, 平井 克樹, 山田 浩平, 加納 恭子, 市坂 有基, 武藤 雄一郎, 西原 卓宏, 右田 昌宏

    日本小児科学会雑誌   123 ( 2 )   454 - 454   2019年2月

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    記述言語:日本語   出版者・発行元:(公社)日本小児科学会  

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  • 二相性脳症における早期治療介入基準についての比較検討及びその活用

    市坂 有基, 小原 隆史, 平井 克樹, 三浦 義文, 大平 智子, 武藤 雄一郎, 右田 昌宏

    日本小児救急医学会雑誌   17 ( 3 )   396 - 400   2018年10月

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    記述言語:日本語   出版者・発行元:(一社)日本小児救急医学会  

    【目的】二相性脳症早期治療介入基準作成のため、脳症に関連する複数の基準を比較検討する。【対象と方法】2012年1月〜2015年12月に当院小児集中治療室へ入室した複雑型熱性けいれんまたは二相性脳症77例に対し、3つの急性脳症予測基準「重症熱性けいれん基準(Nagase et al.2013)」、「けいれん重積型急性脳症予測スコア(Tada et al.2015)」、「Glasgow Coma Scale(GCS)によるけいれん重積型脳症の基準(天笠ら2016)」を用い、診療録から後方視的に早期治療介入対象の選択妥当性を比較検討した。【結果】Nagaseらの基準では感度100%、特異度70.2%、Tadaらの基準では感度90.0%、特異度89.6%、天笠らの基準では感度90.0%、特異度95.5%であった。【結論】当科の症例では天笠らの基準が最も鋭敏に、治療を要した二相性脳症患者を判別できた。(著者抄録)

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  • 保育士が自動体外式除細動器で救命できたカテコラミン誘発多形性心室頻拍

    田邉 のぞみ, 西原 卓宏, 小原 隆史, 山下 貴大, 三浦 義文, 武藤 雄一郎, 小松 なぎさ, 平井 克樹, 右田 昌宏, 八浪 浩一

    日本小児科学会雑誌   121 ( 12 )   1987 - 1994   2017年12月

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    記述言語:日本語   出版者・発行元:(公社)日本小児科学会  

    5歳2ヵ月男児。7ヵ月検診で不整脈を指摘され、上室性期外収縮と診断されたが、家族の判断で受診を中断していた。精神運動発達遅滞にて他院フォロー中であり、保育所での水遊び中に突然脱力し意識消失したため、保育士が速やかに心肺蘇生を行い、保育所に設置していた自動体外式除細動器(AED)を使用した。救急隊到着時には洞調律に復帰していたが、来院時の心電図では心房細動、心室性期外収縮の頻発と二方向性心室頻拍を認め、カテコラミン誘発多型性心室頻拍と診断してプロプラノール、フレカイニドの内服を開始し、不整脈は軽快した。また、後日行われた遺伝子検査でリアノジン受容体遺伝子の新規変異(p.Ile4926Met)が確認された。本症例では保育士によるAEDの迅速な使用により、後遺症なく救命することができた。全ての保育所・幼稚園でのAED設置および心肺蘇生法の普及が必要と考えられた。

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  • 母体ZnT2遺伝子変異に基づく低亜鉛母乳による亜鉛欠乏性皮膚炎

    小原 隆史, 小松 なぎさ, 逸村 直也, 神戸 大朋, 武藤 雄一郎, 西原 卓宏, 平井 克樹, 右田 昌宏

    日本小児科学会雑誌   120 ( 11 )   1649 - 1656   2016年11月

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    記述言語:日本語   出版者・発行元:(公社)日本小児科学会  

    5ヵ月女児。完全母乳栄養で体重増加は良好であったが、生後2ヵ月頃から鼻唇溝や四肢の関節部を中心に浸潤性紅斑や膿痂疹様の病変が出現、近医の皮膚科にてアトピー性皮膚炎の診断でステロイド外用剤塗布が行われるも、症状は改善せず、皮疹は肛門周囲まで拡大して後頭部の脱毛も出現した。低出生体重児および早産児に加え、完全母乳栄養児であることから亜鉛欠乏性皮膚炎を疑われ、著者らの施設へ紹介受診となった。初診時、口周囲や鼻唇溝を中心に浸潤性紅斑や膿痂疹様の病変を認め、肘・膝・肛門周囲にも同様の皮膚炎が確認された。また、後頭部には紅斑と脱毛を認めた。血液検査では血清亜鉛濃度の著明な低下とALP低値を認めたが、その他は正常値であった。しかし、低亜鉛母乳の可能性を考え、母親からの採血を行なったところ、血清亜鉛濃度は正常であったものの、母乳中の亜鉛濃度は低く、両者の乖離を認めた。母体ZnT2遺伝子の解析を行なった結果、c.652C>Tのヘテロ接合性変異が認められ、Transient neonatal zinc deficiency(TNZD)と診断された。以後、亜鉛製剤内服と亜鉛化軟膏の外用にて皮膚症状は改善した。

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  • 急性脳症早期治療介入基準についての比較検討および活用について

    市坂 有基, 小原 隆史, 平井 克樹, 三浦 義文, 大平 智子, 武藤 雄一郎, 右田 昌宏

    日本小児救急医学会雑誌   15 ( 2 )   181 - 181   2016年6月

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    記述言語:日本語   出版者・発行元:(一社)日本小児救急医学会  

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  • 母体ZnT2遺伝子変異による低亜鉛母乳にて亜鉛欠乏性皮膚炎を発症した一例

    小原 隆史, 小松 なぎさ, 武藤 雄一郎, 西原 卓宏, 平井 克樹, 右田 昌宏

    日本小児科学会雑誌   120 ( 2 )   238 - 238   2016年2月

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    記述言語:日本語   出版者・発行元:(公社)日本小児科学会  

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  • シートベルト非装着やチャイルドシート不適正使用による小児頸髄損傷3例

    大平 智子, 小原 隆史, 武藤 雄一郎, 平井 克樹, 西原 卓宏, 小松 なぎさ, 右田 昌宏

    日本小児科学会雑誌   120 ( 1 )   61 - 65   2016年1月

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    記述言語:日本語   出版者・発行元:(公社)日本小児科学会  

    シートベルト関連(後部座席シートベルト非装着、チャイルドシート肩ベルト非装着)の自動車事故による小児頸髄損傷の3症例を報告した。症例1(13歳男児)。入院時、頭部CTで歯突起骨折、環軸椎脱臼骨折がみられ、頸部MRIではC1-2にかけて頸髄損傷が認められた。緊急手術にて後方固定術(C1-2)ほか、PICUにて鎮静鎮痛、人工呼吸管理を行なったところ、術後3日目以後、抜管となり一般病棟へ転棟となった。そして、術後13日目には立位や歩行が可能となったが、右上肢不全麻痺は残存し、術後29日目にリハビリ目的で転院となった。症例2(1歳7ヵ月女児)。前医で胸腹部・頭頸部CTおよび頸髄MRIにて頸椎脱臼骨折による頸髄損傷ほか、次いで両下肢麻痺、右腸骨骨折、左急性硬膜外血腫と診断され、気管挿管後に全身管理目的で著者らの施設へ紹介となった。以後、PICUに入室し鎮静鎮痛、人工呼吸管理が施行され、第17病日目には呼吸状態の安定が確保されるとともに、意識レベルも改善し、一般病棟へ転棟となった。尚、患者は両上肢は自発運動良好であったが、下肢は完全麻痺状態であり、最終的は第58病日目にリハビリ専門病院へ転院となった。症例3(10歳女児)。頸部・胸腹部CTにて環椎後頭関節脱臼、外傷性くも膜下出血、脳腫脹がみられ、PICU管理となったが、瞳孔散大は持続し循環は不安定であり、2日後に死亡となった。

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  • 当院における小児急性脳症の治療の変遷と予後に関する比較検討

    三浦 義文, 平井 克樹, 小原 隆史, 市坂 有基, 大平 智子, 武藤 雄一郎

    日本集中治療医学会雑誌   23 ( Suppl. )   797 - 797   2016年1月

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    記述言語:日本語   出版者・発行元:(一社)日本集中治療医学会  

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  • 急性脳症 小児急性脳症の治療と予後の検討 当院における方針の決定と治療の変遷

    三浦 義文, 平井 克樹, 小原 隆史, 市坂 有基, 大平 智子, 武藤 雄一郎

    日本集中治療医学会雑誌   23 ( Suppl. )   286 - 286   2016年1月

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    記述言語:日本語   出版者・発行元:(一社)日本集中治療医学会  

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▼全件表示

受賞

  • 公益財団法人 小林製薬青い鳥財団(調査研究)

    2023年12月   重症小児救急患者の救急集中治療の現状と遠隔期アウトカムに関する追跡調査

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  • 小児の社会医学的研究助成金

    2023年4月   小児医学研究振興財団  

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  • 学術奨励賞

    2021年12月   岡山県医師会  

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  • 優秀論文賞

    2015年12月   第116回 九州小児科学会  

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共同研究・競争的資金等の研究

  • アセトアミノフェン肝障害モデルに対するCORM経口投与による障害抑制効果の検討

    研究課題/領域番号:23K15616  2023年04月 - 2025年03月

    日本学術振興会  科学研究費助成事業  若手研究

    小原 隆史

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    配分額:3640000円 ( 直接経費:2800000円 、 間接経費:840000円 )

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  • CORMを使った小腸グラフト虚血再灌流障害の予防

    研究課題/領域番号:20K22953  2020年09月 - 2022年03月

    日本学術振興会  科学研究費助成事業 研究活動スタート支援  研究活動スタート支援

    小原 隆史

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    配分額:2860000円 ( 直接経費:2200000円 、 間接経費:660000円 )

    近年、腸管機能不全の患者の予後は改善したが、長期にわたる静脈栄養管理は生活の質を低下させ、合併症は時に致死的である。小腸は他の臓器よりも虚血再灌流障害に弱く、移植後も急性・慢性拒絶反応が高い傾向にあることから、移植が困難な臓器であるが、小腸移植でしか救命できない患者がいるのは事実であり、移植後虚血再灌流障害の抑制は小腸移植の発展に必要不可欠と考えられる。本研究の目的は、抗炎症作用、抗アポトーシス作用をもつシグナルガス分子としてCO-releasing molecule; CORMを溶解した保存液を小腸グラフトの管腔内に投与することで、移植後虚血再灌流障害を制御できるかどうかを調べることである。R2年度内までに、雄性LEWラットを用いて、同種同系・同所性小腸移植モデルを既報の方法を用いて作成した。各小腸グラフトにおいて、CORMは25μM、50μM、100μMの濃度で検討した。対照群としてCORMを空気中に48時間放置しCOを脱気させたものをiCORMとして使用した。これらを実験群として犠牲死させた後、小腸グラフトサンプルを採取・凍結保存・ホルマリン固定を行い、組織学的検討を実施した。また、炎症性サイトカインのmRNAをRT-PCRで測定した。組織学的検査でiCORM群では粘膜の脱落が著明であり、腸管透過性が亢進していたが、CORMを充填した腸管はバリア機能が有意に保たれていた。同様にIL-6など炎症性サイトカインmRNAも再灌流後に上昇するが、CORM群では有意に抑制されていた。

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