論文 - 湯本　哲也

Association between timing of speech and language therapy initiation and outcomes among post-extubation dysphagia patients: a multicenter retrospective cohort study. 査読 国際誌

Takashi Hongo, Ryohei Yamamoto, Keibun Liu, Takahiko Yaguchi, Hisashi Dote, Ryusuke Saito, Tomoyuki Masuyama, Kosuke Nakatsuka, Shinichi Watanabe, Takahiro Kanaya, Tomoya Yamaguchi, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Critical care (London, England)   26 ( 1 )   98 - 98   2022年4月

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Post-extubation dysphagia (PED) is recognized as a common complication in the intensive care unit (ICU). Speech and language therapy (SLT) can potentially help improve PED; however, the impact of the timing of SLT initiation on persistent PED has not been well investigated. This study aimed to examine the timing of SLT initiation and its effect on patient outcomes after extubation in the ICU. METHODS: We conducted this multicenter, retrospective, cohort study, collecting data from eight ICUs in Japan. Patients aged ≥ 20 years with orotracheal intubation and mechanical ventilation for longer than 48 h, and those who received SLT due to PED, defined as patients with modified water swallowing test scores of 3 or lower, were included. The primary outcome was dysphagia at hospital discharge, defined as functional oral intake scale score < 5 or death after extubation. Secondary outcomes included dysphagia or death at the seventh, 14th, or 28th day after extubation, aspiration pneumonia, and in-hospital mortality. Associations between the timing of SLT initiation and outcomes were determined using multivariable logistic regression. RESULTS: A total of 272 patients were included. Of them, 82 (30.1%) patients exhibited dysphagia or death at hospital discharge, and their time spans from extubation to SLT initiation were 1.0 days. The primary outcome revealed that every day of delay in SLT initiation post-extubation was associated with dysphagia or death at hospital discharge (adjusted odds ratio (AOR), 1.09; 95% CI, 1.02-1.18). Similarly, secondary outcomes showed associations between this per day delay in SLT initiation and dysphagia or death at the seventh day (AOR, 1.28; 95% CI, 1.05-1.55), 14th day (AOR, 1.34; 95% CI, 1.13-1.58), or 28th day (AOR, 1.21; 95% CI, 1.07-1.36) after extubation and occurrence of aspiration pneumonia (AOR, 1.09; 95% CI, 1.02-1.17), while per day delay in post-extubation SLT initiation did not affect in-hospital mortality (AOR, 1.04; 95% CI, 0.97-1.12). CONCLUSIONS: Delayed initiation of SLT in PED patients was associated with persistent dysphagia or death. Early initiation of SLT may prevent this complication post-extubation. A randomized controlled study is needed to validate these results.

DOI： 10.1186/s13054-022-03974-6

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Impact of different medical direction policies on prehospital advanced airway management for out-of hospital cardiac arrest patients: A retrospective cohort study. 査読 国際誌

Takashi Hongo, Tetsuya Yumoto, Hiromichi Naito, Takeshi Mikane, Atsunori Nakao

Resuscitation plus   9   100210 - 100210   2022年3月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although optimal prehospital airway management after out-of-hospital cardiac arrest (OHCA) remains undetermined, no studies have compared different advanced airway management (AAM) policies adopted by two hospitals in charge of online medical direction by emergency physicians. We examined the impact of two different AAM policies on OHCA patient survival. METHODS: This observational cohort study included adult OHCA patients treated in Okayama City from 2013 to 2016. Patients were divided into two groups: the O group - those treated on odd days when a hospital with a policy favoring laryngeal tube ventilation (LT) supervised, and the E group - those treated on even days when the other hospital with a policy favoring endotracheal intubation (ETI) supervised. Multiple logistic regression analysis was performed to assess airway device effects. The primary outcome measure was seven-day survival. RESULTS: Of 2,406 eligible patients, 50.1% were in the O group and 49.9% were in the E group. O group patients received less ETI (1.0% vs. 12.0%) and more LT (53.3% vs. 43.0%) compared with E group patients. In univariate analysis, no differences were observed in seven-day survival (9.4% vs 10.1%). Multiple regression analysis revealed neither LT nor ETI had a significant independent effect on seven-day survival, considering bag-valve mask ventilation as a reference (OR, 0.78; 95% CI, 0.54 to 1.13, OR, 0.79; 95% CI, 0.36 to 1.72, respectively). CONCLUSION: Despite different advanced airway medical direction policies in a single city, there were no substantial impact on outcomes for OHCA patients.

DOI： 10.1016/j.resplu.2022.100210

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Hamman's Syndrome Accompanied by Diabetic Ketoacidosis; a Case Report. 査読 国際誌

Koya Yamashita, Takashi Hongo, Tsuyoshi Nojima, Tetsuya Yumoto, Atsunori Nakao, Hiromichi Naito

Archives of academic emergency medicine   10 ( 1 )   e68   2022年

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担当区分：責任著者   記述言語：英語  

Hamman's syndrome is an uncommon clinical entity characterized by an idiopathic spontaneous pneumomediastinum as a result of a sudden increase in intra-alveolar pressure. It can be triggered by repeated vomiting or Kussmaul breathing associated with diabetic ketoacidosis (DKA). Careful attention to this particular condition is needed to avoid under-diagnosis and to provide optimal management. Herein, we report a case of an 18-year-old man complaining of chest discomfort and progressive weight loss, ultimately diagnosed with Hamman's syndrome secondary to DKA. The patient's symptoms disappeared after intravenous fluid and insulin administration, while his pneumomediastinum resolved following conservative treatment. Our report highlights the importance of recognition of the links between pneumomediastinum as a cause of chest pain in patients with DKA.

DOI： 10.22037/aaem.v10i1.1709

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Association between emergency medical service transport time and survival in patients with traumatic cardiac arrest: a Nationwide retrospective observational study. 査読 国際誌

Hiromichi Naito, Tetsuya Yumoto, Takashi Yorifuji, Tsuyoshi Nojima, Hirotsugu Yamamoto, Taihei Yamada, Kohei Tsukahara, Mototaka Inaba, Takeshi Nishimura, Takenori Uehara, Atsunori Nakao

BMC emergency medicine   21 ( 1 )   104 - 104   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）  

BACKGROUND: Patients with traumatic cardiac arrest (TCA) are known to have poor prognoses. In 2003, the joint committee of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma proposed stopping unsuccessful cardiopulmonary resuscitation (CPR) sustained for > 15 min after TCA. However, in 2013, a specific time-limit for terminating resuscitation was dropped, due to the lack of conclusive studies or data. We aimed to define the association between emergency medical services transport time and survival to demonstrate the survival curve of TCA. METHODS: A retrospective review of the Japan Trauma Data Bank. Inclusion criteria were age ≥ 16, at least one trauma with Abbreviated Injury Scale score (AIS) ≥ 3, and CPR performed in a prehospital setting. Exclusion criteria were burn injury, AIS score of 6 in any region, and missing data. Estimated survival rate and risk ratio for survival were analyzed according to transport time for all patients. Analysis was also performed separately on patients with sustained TCA at arrival. RESULTS: Of 292,027 patients in the database, 5336 were included in the study with 4141 sustained TCA. Their median age was 53 years (interquartile range (IQR) 36-70), and 67.2% were male. Their median Injury Severity Score was 29 (IQR 22-41), and median transport time was 11 min (IQR 6-17). Overall survival after TCA was 4.5%; however, survival of patients with sustained TCA at arrival was only 1.2%. The estimated survival rate and risk ratio for sustained TCA rapidly decreased after 15 min of transport time, with estimated survival falling below 1%. CONCLUSION: The chances of survival for sustained TCA declined rapidly while the patient is transported with CPR support. Time should be one reasonable factor for considering termination of resuscitation in patients with sustained TCA, although clinical signs of life, and type and severity of trauma should be taken into account clinically.

DOI： 10.1186/s12873-021-00499-z

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Anti-TIGIT differentially affects sepsis survival in immunologically experienced versus previously naive hosts. 査読 国際誌

Yini Sun, Jerome C Anyalebechi, He Sun, Tetsuya Yumoto, Ming Xue, Danya Liu, Zhe Liang, Craig M Coopersmith, Mandy L Ford

JCI insight   6 ( 5 )   2021年3月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Mounting evidence suggests that the balance of T cell costimulatory and coinhibitory signals contributes to mortality during sepsis. Here, we identified a critical role of the coinhibitory molecule T cell Ig and ITIM domain (TIGIT) in regulating sepsis mortality. Because TIGIT is significantly upregulated on memory T cells, we developed a "memory mouse" model to study the role of TIGIT during sepsis in a more physiologically relevant context. Mice received sequential pathogen exposure and developed memory T cell frequencies, similar to those observed in adult humans, and were then subjected to sepsis induction via cecal ligation and puncture. Our results show that targeting the TIGIT pathway during sepsis is fundamentally different in previously naive versus memory mice, in that αTIGIT Ab had no effect on survival in previously naive septic mice but sharply worsened survival in memory septic mice. Mechanistically, αTIGIT increased apoptosis of memory T cells, decreased T cell function, and downregulated the costimulatory receptor DNAM on memory CD8+ T cells in memory septic mice, but not in previously naive septic mice. Additionally, αTIGIT diminished Helios expression in Tregs in memory but not previously naive septic mice. These data highlight fundamental differences in the pathophysiological impact of targeting TIGIT in immunologically experienced versus previously naive hosts during sepsis.

DOI： 10.1172/jci.insight.141245

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The trend of treatment and conveyance system for upper extremity replantation in Japan: A nationwide population-based study from the Japan trauma data bank. 査読

Taichi Saito, Satoshi Nezu, Minami Matsuhashi, Ryuichi Nakahara, Yasunori Shimamura, Tomoyuki Noda, Tetsuya Yumoto, Atsunori Nakao, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   26 ( 2 )   271 - 275   2021年3月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In Japan, microsurgical skill development and a system to transfer patients to an appropriate hospital for upper extremity amputation have been promoted; however, information about trends of replantation is limited. Therefore, the aim of this study was to clarify the trends in the treatment for upper extremity amputation using the Japan Trauma Data Bank (JTDB). METHODS: Data derived from JTDB (2004-2015) were used to quantify trends in the volume of replantation for upper extremity amputation including finger amputation. Trauma was diagnosed based on the Abbreviated Injury Scale code; a subgroup of patients who underwent replantation was delineated. We investigated patient demographics, infection rate, and characteristics of treating facilities. RESULTS: A total of 1240 patients underwent upper extremity amputation. Among these, 510 (41.1%) underwent replantation, and the rate of replantation did not change over the study period. The average age of patients who underwent or did not undergo replantation was 45.5 and 47.2 years, respectively. The proportion of the patients who were transferred to another hospital for treatment significantly decreased between 2004 (28.5%) and 2015 (16.3%) (P < 0.01). Time taken for transfer from the accident site to hospitals increased. The rate of patients who underwent replantation differed among different hospitals; however, higher-volume hospitals were more likely to perform replantation. CONCLUSION: The rate of patients transferred to another hospital decreased between 2004 and 2015; however, the rate of patients who underwent replantation remained unchanged. This suggests that the number of patients who were transported directly from the accident site to an appropriate hospital has increased, whereas the indication for care in each hospital remains unchanged. Common criteria for amputations are needed to address the differing rates of replantation among hospitals.

DOI： 10.1016/j.jos.2020.03.006

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State‐of‐the‐art methods for the treatment of severe hemorrhagic trauma: selective aortic arch perfusion and emergency preservation and resuscitation—what is next? 査読

Atsuyoshi Iida, Hiromichi Naito, Tsuyoshi Nojima, Tetsuya Yumoto, Taihei Yamada, Noritomo Fujisaki, Atsunori Nakao, Takeshi Mikane

Acute Medicine & Surgery   8 ( 1 )   2021年1月

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/ams2.641

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.641

Urinary Retention as the Presenting Clinical Manifestation of Unstable Thoracic Spinal Fracture with Diffuse Idiopathic Skeletal Hyperostosis. 査読 国際誌

Hisashi Hamaguchi, Tetsuya Yumoto, Soichiro Mae, Ayumu Takeshita, Minae Aoyama, Keiya Yamana, Atsunori Nakao

Clinical medicine insights. Case reports   14   11795476211027988 - 11795476211027988   2021年

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担当区分：責任著者   記述言語：英語  

Patients with diffuse idiopathic skeletal hyperostosis (DISH) are at high risk for unstable vertebral fracture, which can be frequently missed. An 80-year-old man with pre-existing muscle lower limb weakness due to frailty was referred from another hospital, presenting with progressive urinary retention and its related symptoms, which had been treated as a urinary tract infection at previous hospital. One week prior to our visit, he had fallen. On arrival, he appeared lethargic and unable to follow commands. He denied any back pain. Computed tomography identified a T10 fracture and dislocation associated with DISH. Although immediate surgical fixation was performed, the patient did not recover from the neurological deficits. Diagnostic delay of DISH-associated vertebral fracture can occur due to both patients' and clinicians' delayed action. We believe this case report can help clinicians recognize this potentially devastating condition.

DOI： 10.1177/11795476211027988

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Potentially fatal ingestion of heat-not-burn cigarettes successfully treated by gastric lavage. 査読 国際誌

Tetsuya Yumoto, Hisashi Hamaguchi, Souichiro Mae, Atsunori Nakao

Journal of the American College of Emergency Physicians open   1 ( 6 )   1709 - 1711   2020年12月

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担当区分：筆頭著者,　責任著者   記述言語：英語  

Newly introduced heat-not-burn or electronic cigarettes can cause lethal nicotine intoxication if ingested at higher doses. Although routine gastric lavage is not recommended, it should be considered if the amount of intoxicant is lethal. A 59-year-old man with a history of depression was brought to our emergency department after intentional ingestion of 8 heat-not-burn cigarettes, which were estimated to contain a total of 100 mg of nicotine. Abdominal computed tomography confirmed the gastric contents, detecting multiple stick-like and rod-shaped high-density structures. Gastric lavage was performed to minimize absorption of the potentially lethal nicotine dose. The patient exhibited only mild gastrointestinal symptoms. Emergency physicians should be aware of this novel heat-not-burn cigarette and its toxicity.

DOI： 10.1002/emp2.12283

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Intubation during a medevac flight: safety and effect on total prehospital time in the helicopter emergency medical service system. 査読 国際誌

Hiroki Maeyama, Hiromichi Naito, Francis X Guyette, Takashi Yorifuji, Yuki Banshotani, Daisaku Matsui, Tetsuya Yumoto, Atsunori Nakao, Makoto Kobayashi

Scandinavian journal of trauma, resuscitation and emergency medicine   28 ( 1 )   89 - 89   2020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）  

INTRODUCTION: The Helicopter Emergency Medical Service (HEMS) commonly intubates patients who require advanced airway support prior to takeoff. In-flight intubation (IFI) is avoided because it is considered difficult due to limited space, difficulty communicating, and vibration in flight. However, IFI may shorten the total prehospital time. We tested whether IFI can be performed safely by the HEMS. METHODS: We conducted a retrospective cohort study in adult patients transported from 2010 to 2017 who received prehospital, non-emergent intubation from a single HEMS. We divided the cohort in two groups, patients intubated during flight (flight group, FG) and patients intubated before takeoff (ground group, GG). The primary outcome was the proportion of successful intubations. Secondary outcomes included total prehospital time and the incidence of complications. RESULTS: We analyzed 376 patients transported during the study period, 192 patients in the FG and 184 patients in the GG. The intubation success rate did not differ between the two groups (FG 189/192 [98.4%] vs. GG 179/184 [97.3%], p = 0.50). There were also no differences in hypoxia (FG 4/117 [3.4%] vs. GG 4/95 [4.2%], p = 1.00) or hypotension (FG 6/117 [5.1%] vs. GG 5/95 [5.3%], p = 1.00) between the two groups. Scene time and total prehospital time were shorter in the FG (scene time 7 min vs. 14 min, p <  0.001; total prehospital time 33.5 min vs. 40.0 min, p <  0.001). CONCLUSIONS: IFI was safely performed with high success rates, similar to intubation on the ground, without increasing the risk of hypoxia or hypotension. IFI by experienced providers shortened transportation time, which may improve patient outcomes.

DOI： 10.1186/s13049-020-00784-z

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Restrictive transfusion strategy for critically injured patients (RESTRIC) trial: a study protocol for a cluster-randomised, crossover non-inferiority trial. 査読 国際誌

Mineji Hayakawa, Takashi Tagami, Hiroaki IIjima, Daisuke Kudo, Kazuhiko Sekine, Takayuki Ogura, Tetsuya Yumoto, Yutaka Kondo, Akira Endo, Kaori Ito, Yosuke Matsumura, Shigeki Kushimoto

BMJ open   10 ( 9 )   e037238   2020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）  

INTRODUCTION: Resuscitation using blood products is critical during the acute postinjury period. However, the optimal target haemoglobin (Hb) levels have not been adequately investigated. With the restrictive transfusion strategy for critically injured patients (RESTRIC) trial, we aim to compare the restrictive and liberal red blood cell (RBC) transfusion strategies. METHODS AND ANALYSIS: This is a cluster-randomised, crossover, non-inferiority trial of patients with severe trauma at 22 hospitals that have been randomised in a 1:1 ratio based on the use of a restrictive or liberal transfusion strategy with target Hb levels of 70-90 or 100-120 g/L, respectively, during the first year. Subsequently, after 1-month washout period, another transfusion strategy will be applied for an additional year. RBC transfusion requirements are usually unclear on arrival at the emergency department. Therefore, patients with severe bleeding, which could lead to haemorrhagic shock, will be included in the trial based on the attending physician's judgement. Each RBC transfusion strategy will be applied until 7 days postadmission to the hospital or discharge from the intensive care unit. The outcomes measured will include the 28-day survival rate after arrival at the emergency department (primary), the cumulative amount of blood transfused, event-free days and frequency of transfusion-associated lung injury and organ failure (secondary). Demonstration of the non-inferiority of restrictive transfusion will emphasise its clinical advantages. ETHICS AND DISSEMINATION: The trial will be performed according to the Japanese and International Ethical guidelines. It has been approved by the Ethics Committee of each participating hospital and The Japanese Association for the Surgery of Trauma (JAST). Written informed consent will be obtained from all patients or their representatives. The results of the trial will be disseminated to the participating hospitals and board-certified educational institutions of JAST, submitted to peer-reviewed journals for publication, and presented at congresses. TRIAL REGISTRATION NUMBER: UMIN Clinical Trials Registry; UMIN000034405. Registered 8 October 2018.

DOI： 10.1136/bmjopen-2020-037238

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Improved outcomes for out-of-hospital cardiac arrest patients treated by emergency life-saving technicians compared with basic emergency medical technicians: A JCS-ReSS study report. 査読 国際誌

Hiromichi Naito, Tetsuya Yumoto, Takashi Yorifuji, Yoshio Tahara, Naohiro Yonemoto, Hiroshi Nonogi, Ken Nagao, Takanori Ikeda, Naoki Sato, Hiroyuki Tsutsui

Resuscitation   153   251 - 257   2020年8月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Emergency life-saving technicians (ELSTs) are specially trained prehospital medical providers believed to provide better care than basic emergency medical technicians (BEMTs). ELSTs are certified to perform techniques such as administration of advanced airways or adrenaline and are considered to have more knowledge; nevertheless, ELSTs' effectiveness over BEMTs regarding out-of-hospital cardiac arrest (OHCA) remains unclear. We investigated whether the presence of an ELST improves OHCA patient outcomes. METHODS: In a retrospective study of adult OHCA patients treated in Japan from 2011 to 2015, we compared two OHCA patient groups: patients transported with at least one ELST and patients transported by only BEMTs. The primary outcome measure was one-month favorable neurological outcomes, defined as Cerebral Performance Category ≤ 2. A multivariable logistic regression model was used to calculate odds ratios (ORs) and their confidence intervals (CIs) to evaluate the effect of ELSTs. RESULTS: Included were 552,337 OHCA patients, with 538,222 patients in the ELST group and 14,115 in the BEMT group. The ELST group had a significantly higher odds of favorable neurological outcomes (2.5% vs. 2.1%, adjusted OR 1.39, 95% CI 1.17-1.66), one-month survival (4.9% vs. 4.1%, adjusted OR 1.37, 95% CI 1.22-1.54), and return of spontaneous circulation (8.1% vs. 5.1%, adjusted OR 1.90, 95% CI 1.72-2.11) compared with the BEMT group. However, ELSTs' limited procedure range (adrenaline administration or advanced airway management) did not promote favorable neurological outcomes. CONCLUSIONS: Compared with the BEMT group, transport by the ELST group was associated with better neurological outcomes in OHCA.

DOI： 10.1016/j.resuscitation.2020.05.007

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Therapeutic strategies for ischemia reperfusion injury in emergency medicine 査読

Hiromichi Naito, Tsuyoshi Nojima, Noritomo Fujisaki, Kohei Tsukahara, Hirotsugu Yamamoto, Taihei Yamada, Toshiyuki Aokage, Tetsuya Yumoto, Takaaki Osako, Atsunori Nakao

Acute Medicine & Surgery   7 ( 1 )   2020年1月

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/ams2.501

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.501

Geographical Differences and the National Meeting Effect in Patients with Out-of-Hospital Cardiac Arrests: A JCS-ReSS Study Report. 査読 国際誌

Tetsuya Yumoto, Hiromichi Naito, Takashi Yorifuji, Yoshio Tahara, Naohiro Yonemoto, Hiroshi Nonogi, Ken Nagao, Takanori Ikeda, Naoki Sato, Hiroyuki Tsutsui

International journal of environmental research and public health   16 ( 24 )   2019年12月

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

The "national meeting effect" refers to worse patient outcomes when medical professionals attend academic meetings and hospitals have reduced staffing. The aim of this study was to examine differences in outcomes of patients with out-of-hospital cardiac arrest (OHCA) admitted during, before, and after meeting days according to meeting location and considering regional variation of outcomes, which has not been investigated in previous studies. Using data from a nationwide, prospective, population-based, observational study in Japan, we analyzed adult OHCA patients who underwent resuscitation attempts between 2011 and 2015. Favorable one-month neurological outcomes were compared among patients admitted during the relevant annual meeting dates of three national scientific societies, those admitted on identical days the week before, and those one week after the meeting dates. We developed a multivariate logistic regression model after adjusting for confounding factors, including meeting location and regional variation (better vs. worse outcome areas), using the "during meeting days" group as the reference. A total of 40,849 patients were included in the study, with 14,490, 13,518, and 12,841 patients hospitalized during, before, and after meeting days, respectively. The rates of favorable neurological outcomes during, before, and after meeting days was 1.7, 1.6, and 1.8%, respectively. After adjusting for covariates, favorable neurological outcomes did not differ among the three groups (adjusted OR (95% CI) of the before and after meeting dates groups was 1.03 (0.83-1.28) and 1.01 (0.81-1.26), respectively. The "national meeting effect" did not exist in OHCA patients in Japan, even after comparing data during, before, and after meeting dates and considering meeting location and regional variation.

DOI： 10.3390/ijerph16245130

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Huge abdominal cerebrospinal fluid pseudocyst following ventriculoperitoneal shunt: a case report. 査読 国際誌

Yasuhiro Koide, Takaaki Osako, Masahiro Kameda, Hiromi Ihoriya, Hirotsugu Yamamoto, Noritomo Fujisaki, Toshiyuki Aokage, Tetsuya Yumoto, Isao Date, Hiromichi Naito, Atsunori Nakao

Journal of medical case reports   13 ( 1 )   361 - 361   2019年12月

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記述言語：英語  

INTRODUCTION: Abdominal pseudocysts comprising cerebrospinal fluid are an uncommon but significant complication in patients with ventriculoperitoneal shunt. We present a successfully treated 12-year-old boy with a history of ventriculoperitoneal shunting and a huge abdominal cerebrospinal fluid pseudocyst. CASE PRESENTATION: A12-year-old Japanese boy presented with a deteriorated consciousness and a palpable and elastic large lower abdominal mass. Computed tomography of his abdomen demonstrated a collection of homogenous low-density fluid near the catheter tip of the ventriculoperitoneal shunt. Cerebral computed tomography revealed an increased ventricular size. Based on the clinical diagnosis of abdominal pseudocyst, the peritoneal shunt catheter was secured and divided into two parts by cutting it on the chest; then, the proximal side of the peritoneal shunt catheter was externalized for extraventricular drainage. The cyst was percutaneously aspirated with ultrasound guidance, and the distal side of the peritoneal shunt catheter was removed. The distal side of the peritoneal shunt catheter was reinserted in another position into his abdomen after 3-week extraventricular drainage management. CONCLUSION: Emergency physicians should know about this potential complication as an important differential diagnosis resulting from acute abdominal complaints in patients with ventriculoperitoneal shunts.

DOI： 10.1186/s13256-019-2308-0

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Higher enhanced computed tomography attenuation value of the aorta is a predictor of massive transfusion in blunt trauma patients. 査読 国際誌

Tetsuya Yumoto, Hiromi Ihoriya, Ryo Tanabe, Hiromichi Naito, Atsunori Nakao

Clinical and experimental emergency medicine   6 ( 4 )   330 - 339   2019年12月

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Several scoring systems have been developed to identify patients who require massive transfusion (MT) after major trauma to improve survival. The primary goal of this study was to investigate the usefulness of enhanced computed tomography attenuation values (CTAVs) of major vessels to determine the need for MT in patients with major blunt trauma. METHODS: This single-center retrospective cohort study evaluated patients aged 16 years or older who underwent contrast-enhanced computed tomography scan of the torso after major blunt trauma. The CTAVs of six major vessel points in both the arterial and portal venous phases at initial computed tomography examination were assessed and compared between the MT and the no MT group. The capability of enhanced CTAVs to predict the necessity for MT was estimated based on the area under the receiver operating characteristic curve. RESULTS: Of the 254 eligible patients, 36 (14%) were in the MT group. Patients in the MT group had significantly higher CTAVs at all sites except the inferior vena cava in both the arterial and portal venous phases than that in the no MT group. The descending aorta in the arterial phase had the highest accuracy for predicting MT, with an AUROC of 0.901 (95% confidence interval, 0.855 to 0.947; P<0.001). CONCLUSION: Initial elevation of enhanced CTAV of the aorta is a predictor for the need for MT. A higher CTAV of the aorta should alert the trauma surgeon or emergency physician to activate their MT protocol.

DOI： 10.15441/ceem.18.090

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Association of Japan Coma Scale score on hospital arrival with in-hospital mortality among trauma patients. 査読 国際誌

Tetsuya Yumoto, Hiromichi Naito, Takashi Yorifuji, Toshiyuki Aokage, Noritomo Fujisaki, Atsunori Nakao

BMC emergency medicine   19 ( 1 )   65 - 65   2019年11月

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The Japan Coma Scale (JCS) score has been widely used to assess patients' consciousness level in Japan. JCS scores are divided into four main categories: alert (0) and one-, two-, and three-digit codes based on an eye response test, each of which has three subcategories. The purpose of this study was to investigate the utility of the JCS score on hospital arrival in predicting outcomes among adult trauma patients. METHODS: Using the Japan Trauma Data Bank, we conducted a nationwide registry-based retrospective cohort study. Patients 16 years old or older directly transported from the trauma scene between January 2004 and December 2017 were included. Our primary outcome was in-hospital mortality. We examined outcome prediction accuracy based on area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis with multiple imputation. RESULTS: A total of 222,540 subjects were included; their in-hospital mortality rate was 7.1% (n = 15,860). The 10-point scale JCS and the total sum of Glasgow Coma Scale (GCS) scores demonstrated similar performance, in which the AUROC (95% CIs) showed 0.874 (0.871-0.878) and 0.878 (0.874-0.881), respectively. Multiple logistic regression analysis revealed that the higher the JCS score, the higher the predictability of in-hospital death. When we focused on the simple four-point scale JCS score, the adjusted odds ratio (95% confidence intervals [CIs]) were 2.31 (2.12-2.45), 4.81 (4.42-5.24), and 27.88 (25.74-30.20) in the groups with one-digit, two-digit, and three-digit scores, respectively, with JCS of 0 as a reference category. CONCLUSIONS: JCS score on hospital arrival after trauma would be useful for predicting in-hospital mortality, similar to the GCS score.

DOI： 10.1186/s12873-019-0282-x

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Hydrogen gas inhalation ameliorates lung injury after hemorrhagic shock and resuscitation. 査読 国際誌

Duk Hwan Moon, Du-Young Kang, Seok Jin Haam, Tetsuya Yumoto, Kohei Tsukahara, Taihei Yamada, Atsunori Nakao, Sungsoo Lee

Journal of thoracic disease   11 ( 4 )   1519 - 1527   2019年4月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Hemorrhagic shock and resuscitation (HSR) is known to cause inflammatory reactions in the lung parenchyma and acute lung injury, increasing the risk of complications that can lead to death. Hydrogen gas has shown to inhibit the formation and eliminate reactive oxygen species (ROS), which are known to cause reperfusion injury. Hence, the purpose of this study was to investigate the protective effect of 2% inhaled hydrogen gas on post-HSR lung injury. Methods: Rats weighing 300-500 g were divided into three groups: sham, HSR, and hydrogen (H2)/HSR groups. In the latter two groups, HSR was induced via femoral vein cannulation. Gas containing 2% hydrogen gas was inhaled only by those in the H2/HSR group. Lung tissue and abdominal aorta blood were obtained for histologic examination and arterial blood gas analyses, respectively. Neutrophil infiltration and proinflammatory mediators were also measured. Results: PO2 was lower in the HSR and H2/HSR groups than in the sham group. Blood lactate level was not significantly different between the sham and H2/HSR groups, but it was significantly higher in the HSR group. Infiltration of inflammatory cells into the lung tissues was more frequent in the HSR group. Myeloperoxidase (MPO) activity was significantly different among the three groups (highest in the HSR group). All proinflammatory mediators, except IL-6, showed a significant difference among the three groups (highest in the HSR group). Conclusions: Inhalation of 2% hydrogen gas after HSR minimized the extent of lung injury by decreasing MPO activity and reducing infiltration of inflammatory cells into lung tissue.

DOI： 10.21037/jtd.2019.03.23

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Increase in the incidence of dermatitis after flood disaster in Kurashiki area possibly due to calcium hydroxide. 査読 国際誌

Taihei Yamada, Takaaki Osako, Atsuyoshi Iida, Tetsuya Yumoto, Kohei Tsukahara, Akihiro Watanabe, Hiromichi Naito, Atsunori Nakao

Acute medicine & surgery   6 ( 2 )   208 - 209   2019年4月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/ams2.389

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Comparison of the ventilation characteristics in two adult oscillators: a lung model study. 査読 国際誌

Tetsuya Yumoto, Takahisa Fujita, Sunao Asaba, Shunsuke Kanazawa, Atsunori Nishimatsu, Hideo Yamanouchi, Satoshi Nakagawa, Osamu Nagano

Intensive care medicine experimental   7 ( 1 )   15 - 15   2019年3月

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Two recent large randomized controlled trials did not show the superiority of high-frequency oscillatory ventilation (HFOV) in adults with ARDS. These two trials had differing results, and possible causes could be the different oscillators used and their different settings, including inspiratory time % (IT%). The aims of this study were to obtain basic data about the ventilation characteristics in two adult oscillators and to elucidate the effect of the oscillator and IT% on ventilation efficiency. METHODS: The Metran R100 or SensorMedics 3100B was connected to an original lung model internally equipped with a simulated bronchial tree. The actual stroke volume (aSV) was measured with a flow sensor placed at the Y-piece. Carbon dioxide (CO2) was continuously insufflated into the lung model ([Formula: see text]CO2), and the partial pressure of CO2 (PCO2) in the lung model was monitored. Alveolar ventilation ([Formula: see text]A; L/min) was estimated as [Formula: see text]CO2 divided by the stabilized value of PCO2. [Formula: see text]A was evaluated with several stroke volume settings in the R100 (IT = 50%) or several airway pressure amplitude settings in the 3100B (IT = 33%, 50%) at a frequency of 6 and 8 Hz, a mean airway pressure of 25 cmH2O, and a bias flow of 30 L/min. Assuming that [Formula: see text]A = frequencya × aSVb, values of a and b were determined. Ventilation efficiency was calculated as [Formula: see text]A divided by actual minute ventilation. RESULTS: The relationship between aSV and [Formula: see text]A or ventilation efficiency were different depending on the oscillator and IT%. The values of a and b were 0 < a < 1 and 1 < b < 2 and were different for three conditions at both frequencies. [Formula: see text]A and ventilation efficiency were highest with R100 (IT = 50%) and lowest with 3100B (IT = 33%) for high aSV ranges at both frequencies. CONCLUSIONS: In this lung model study, ventilation characteristics were different depending on the oscillator and IT%. Ventilation efficiency was highest with R100 (IT = 50%) and lowest with 3100B (IT = 33%) for high aSV ranges.

DOI： 10.1186/s40635-019-0229-2

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