研究者詳細 - 湯本　哲也

論文 - 湯本　哲也

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Successful Transplantation of Multiple Organs from Donor after Helium Asphyxiation: First Case Report in Japan. 査読

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

JMA journal 8 ( 2 ) 650 - 653 2025年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Helium inhalation has increased, but most cases are either minor injuries or deaths; there have not yet been any reported cases of brain death leading to organ donation. We report a patient who attempted helium inhalation and was declared brain dead and became an organ donor without complications. To the best of our knowledge, this is the first reported case of deceased organ donation following helium asphyxiation in Japan. The patient in cardiac arrest was found with a helium-filled vinyl bag sealed around the neck. During emergency medical transport to the hospital, a spontaneous return of circulation was obtained after 31 minutes of cardiopulmonary resuscitation. Upon hospital arrival, the physical examination revealed dilated pupils with no response to light. Electrocardiography showed widespread ST-segment depression and ST-segment elevation in augmented Vector Right, as well as elevated cardiac enzymes and decreased myocardial contractility. Head computed tomography revealed diffuse cerebral edema and loss of the gray-white matter boundary without signs of air embolism in the cerebral and coronary arteries. Despite comprehensive post-cardiac arrest care with recovery of organ function, brain death was confirmed on day 4 after hospitalization. The family consented to organ donation on the 11th day of hospitalization. The heart, lungs, liver, and two kidneys were successfully transplanted and all organs functioned. All organ grafts were functioning well at the 3-month follow-up. Our case demonstrates that brain death caused by helium inhalation is not a contraindication to organ donation.

DOI： 10.31662/jmaj.2024-0395

Association of emergency intensive care unit occupancy due to brain-dead organ donors with ambulance diversion. 査読国際誌

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

Scientific reports 15 ( 1 ) 12633 - 12633 2025年4月

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）

Our study aims to explore how intensive care unit (ICU) occupancy by brain-dead organ donors affects emergency ambulance diversions. In this retrospective, single-center study at an emergency ICU (EICU), brain-dead organ donors were managed until organ procurement. We classified each day between August 1, 2021, and July 31, 2023, as either an exposure day (any day with a brain-dead organ donor in the EICU from admission to organ procurement) or a control day (all other days). The study compared these days and used multiple logistic regression analysis to assess the impact of EICU occupancy by brain-dead organ donors on ambulance diversions. Over two years, 6,058 emergency patients were transported by ambulance, with 1327 admitted to the EICU, including 13 brain-dead organ donors. Brain-dead donors had longer EICU stays (17 vs. 2 days, P < 0.001). With 168 exposure and 562 control days, EICU occupancy was higher on exposure days (75% vs. 67%, P = 0.003), leading to more ambulance diversions. Logistic regression showed exposure days significantly increased ambulance diversions, with an odds ratio of 1.79 (95% CIs 1.10-2.88). This study shows that managing brain-dead organ donors in the EICU leads to longer stays and higher occupancy, resulting in more frequent ambulance diversions. These findings highlight the critical need for policies that optimize ICU resource allocation while maintaining the infrastructure necessary to support organ donation programs and ensuring continued care for brain-dead donors, who play an essential role in addressing the organ shortage crisis.

DOI： 10.1038/s41598-025-97198-7

Subcutaneous and Periorbital Emphysema Following a Dental Procedure. 査読国際誌

Takafumi Obara, Tsuyoshi Nojima, Kazuki Nakatsuji, Takashi Hongo, Tetsuya Yumoto, Atsunori Nakao

Cureus 17 ( 4 ) e83089 2025年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Subcutaneous emphysema following dental procedures is rare. We present the case of a young, healthy woman who was transferred from a dental clinic to our emergency department due to sudden swelling of the left orbit immediately after a dental procedure involving the use of the dental air and water syringe. The diagnosis of subcutaneous facial emphysema was made based on the patient's history, physical examination, and computed tomography imaging. The patient received prophylactic amoxicillin, and the lesion resolved completely in one week. Prompt clinical suspicion and a thorough evaluation of the signs and symptoms, including a detailed clinical history, are crucial for diagnosing subcutaneous emphysema following a dental procedure.

DOI： 10.7759/cureus.83089

Gut integrity in intensive care: alterations in host permeability and the microbiome as potential therapeutic targets. 査読国際誌

Takehiko Oami, Takashi Shimazui, Tetsuya Yumoto, Shunsuke Otani, Yosuke Hayashi, Craig M Coopersmith

Journal of intensive care 13 ( 1 ) 16 - 16 2025年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The gut has long been hypothesized to be the "motor" of critical illness, propagating inflammation and playing a key role in multiple organ dysfunction. However, the exact mechanisms through which impaired gut integrity potentially contribute to worsened clinical outcome remain to be elucidated. Critical elements of gut dysregulation including intestinal hyperpermeability and a perturbed microbiome are now recognized as potential therapeutic targets in critical care. MAIN BODY: The gut is a finely tuned ecosystem comprising ~ 40 trillion microorganisms, a single cell layer intestinal epithelia that separates the host from the microbiome and its products, and the mucosal immune system that actively communicates in a bidirectional manner. Under basal conditions, these elements cooperate to maintain a finely balanced homeostasis benefitting both the host and its internal microbial community. Tight junctions between adjacent epithelial cells selectively transport essential molecules while preventing translocation of pathogens. However, critical illness disrupts gut barrier function leading to increased gut permeability, epithelial apoptosis, and immune activation. This disruption is further exacerbated by a shift in the microbiome toward a "pathobiome" dominated by pathogenic microbes with increased expression of virulence factors, which intensifies systemic inflammation and accelerates organ dysfunction. Research has highlighted several potential therapeutic targets to restore gut integrity in the host, including the regulation of epithelial cell function, modulation of tight junction proteins, and inhibition of epithelial apoptosis. Additionally, microbiome-targeted therapies, such as prebiotics, probiotics, fecal microbiota transplantation, and selective decontamination of the digestive tract have also been extensively investigated to promote restoration of gut homeostasis in critically ill patients. Future research is needed to validate the potential efficacy of these interventions in clinical settings and to determine if the gut can be targeted in an individualized fashion. CONCLUSION: Increased gut permeability and a disrupted microbiome are common in critical illness, potentially driving dysregulated systemic inflammation and organ dysfunction. Therapeutic strategies to modulate gut permeability and restore the composition of microbiome hold promise as novel treatments for critically ill patients.

DOI： 10.1186/s40560-025-00786-y

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024. 査読国際誌

Nobuaki Shime, Taka-Aki Nakada, Tomoaki Yatabe, Kazuma Yamakawa, Yoshitaka Aoki, Shigeaki Inoue, Toshiaki Iba, Hiroshi Ogura, Yusuke Kawai, Atsushi Kawaguchi, Tatsuya Kawasaki, Yutaka Kondo, Masaaki Sakuraya, Shunsuke Taito, Kent Doi, Hideki Hashimoto, Yoshitaka Hara, Tatsuma Fukuda, Asako Matsushima, Moritoki Egi, Shigeki Kushimoto, Takehiko Oami, Kazuya Kikutani, Yuki Kotani, Gen Aikawa, Makoto Aoki, Masayuki Akatsuka, Hideki Asai, Toshikazu Abe, Yu Amemiya, Ryo Ishizawa, Tadashi Ishihara, Tadayoshi Ishimaru, Yusuke Itosu, Hiroyasu Inoue, Hisashi Imahase, Haruki Imura, Naoya Iwasaki, Noritaka Ushio, Masatoshi Uchida, Michiko Uchi, Takeshi Umegaki, Yutaka Umemura, Akira Endo, Marina Oi, Akira Ouchi, Itsuki Osawa, Yoshiyasu Oshima, Kohei Ota, Takanori Ohno, Yohei Okada, Hiromu Okano, Yoshihito Ogawa, Masahiro Kashiura, Daisuke Kasugai, Ken-Ichi Kano, Ryo Kamidani, Akira Kawauchi, Sadatoshi Kawakami, Daisuke Kawakami, Yusuke Kawamura, Kenji Kandori, Yuki Kishihara, Sho Kimura, Kenji Kubo, Tomoki Kuribara, Hiroyuki Koami, Shigeru Koba, Takehito Sato, Ren Sato, Yusuke Sawada, Haruka Shida, Tadanaga Shimada, Motohiro Shimizu, Kazushige Shimizu, Takuto Shiraishi, Toru Shinkai, Akihito Tampo, Gaku Sugiura, Kensuke Sugimoto, Hiroshi Sugimoto, Tomohiro Suhara, Motohiro Sekino, Kenji Sonota, Mahoko Taito, Nozomi Takahashi, Jun Takeshita, Chikashi Takeda, Junko Tatsuno, Aiko Tanaka, Masanori Tani, Atsushi Tanikawa, Hao Chen, Takumi Tsuchida, Yusuke Tsutsumi, Takefumi Tsunemitsu, Ryo Deguchi, Kenichi Tetsuhara, Takero Terayama, Yuki Togami, Takaaki Totoki, Yoshinori Tomoda, Shunichiro Nakao, Hiroki Nagasawa, Yasuhisa Nakatani, Nobuto Nakanishi, Norihiro Nishioka, Mitsuaki Nishikimi, Satoko Noguchi, Suguru Nonami, Osamu Nomura, Katsuhiko Hashimoto, Junji Hatakeyama, Yasutaka Hamai, Mayu Hikone, Ryo Hisamune, Tomoya Hirose, Ryota Fuke, Ryo Fujii, Naoki Fujie, Jun Fujinaga, Yoshihisa Fujinami, Sho Fujiwara, Hiraku Funakoshi, Koichiro Homma, Yuto Makino, Hiroshi Matsuura, Ayaka Matsuoka, Tadashi Matsuoka, Yosuke Matsumura, Akito Mizuno, Sohma Miyamoto, Yukari Miyoshi, Satoshi Murata, Teppei Murata, Hiromasa Yakushiji, Shunsuke Yasuo, Kohei Yamada, Hiroyuki Yamada, Ryo Yamamoto, Ryohei Yamamoto, Tetsuya Yumoto, Yuji Yoshida, Shodai Yoshihiro, Satoshi Yoshimura, Jumpei Yoshimura, Hiroshi Yonekura, Yuki Wakabayashi, Takeshi Wada, Shinichi Watanabe, Atsuhiro Ijiri, Kei Ugata, Shuji Uda, Ryuta Onodera, Masaki Takahashi, Satoshi Nakajima, Junta Honda, Tsuguhiro Matsumoto

Journal of intensive care 13 ( 1 ) 15 - 15 2025年3月

記述言語：英語

The 2024 revised edition of the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock (J-SSCG 2024) is published by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine. This is the fourth revision since the first edition was published in 2012. The purpose of the guidelines is to assist healthcare providers in making appropriate decisions in the treatment of sepsis and septic shock, leading to improved patient outcomes. We aimed to create guidelines that are easy to understand and use for physicians who recognize sepsis and provide initial management, specialized physicians who take over the treatment, and multidisciplinary healthcare providers, including nurses, physical therapists, clinical engineers, and pharmacists. The J-SSCG 2024 covers the following nine areas: diagnosis of sepsis and source control, antimicrobial therapy, initial resuscitation, blood purification, disseminated intravascular coagulation, adjunctive therapy, post-intensive care syndrome, patient and family care, and pediatrics. In these areas, we extracted 78 important clinical issues. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 42 GRADE-based recommendations, 7 good practice statements, and 22 information-to-background questions were created as responses to clinical questions. We also described 12 future research questions.

DOI： 10.1186/s40560-025-00776-0

Age-specific assessment of initial hemoglobin levels and shock index for predicting life-saving interventions in pediatric blunt liver and spleen injuries. 査読国際誌

Tetsuya Yumoto, Takafumi Obara, Takashi Hongo, Atsuyoshi Iida, Kohei Tsukahara, Morihiro Katsura, Yutaka Kondo, Hideto Yasuda, Shigeki Kushimoto, Takashi Yorifuji, Hiromichi Naito, Atsunori Nakao

Scientific reports 15 ( 1 ) 8502 - 8502 2025年3月

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）

This study aimed to evaluate the effectiveness of combining initial hemoglobin levels with the shock index for predicting the need for life-saving interventions (LSI) in pediatric patients with blunt liver and spleen injuries (BLSI), specifically tailored to different age groups. This was a multicenter retrospective cohort study of pediatric patients with BLSI in Japan. The area under the receiver operating characteristic curve (AUROC) were used to assess predictive accuracy. The study included 1,370 patients. LSI was required in 59 of 247 (23.9%) aged 1 to 6 years, 100 of 402 (24.9%) aged 7 to 12 years, and 125 of 297 (42.1%) patients aged 13 to 16 years. Within each specific age group, the predictability was categorized as fair and appeared higher than that of the entire cohort or when using either parameter alone. Notably, in the 1 to 6-year age group, the combined values showed the highest predictability, which was statistically superior to the shock index alone (AUROC of 0.770 vs. 0.671, P = 0.025). Tailoring initial hemoglobin levels and shock index to specific age groups enhances predictability of LSI in pediatric BLSI, showing a fair level of predictive accuracy.

DOI： 10.1038/s41598-025-92673-7

Prevalence, characteristics, and outcomes of suicide-related out-of-hospital cardiac arrest among patients committing self-harm and suicide-attempts in Japan: A nationwide registry study. 査読国際誌

Takashi Hongo, Tetsuya Yumoto, Shunta Jinno, Yuka Yamamura, Takafumi Obara, Tsuyoshi Nojima, Kohei Tsukahara, Hiromichi Naito, Takashi Yorifuji, Atsunori Nakao

Resuscitation plus 22 100923 - 100923 2025年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Suicide-related out-of-hospital cardiac arrest (OHCA) is characterized by extremely low survival rates and represents a considerable global public health concern. This study aimed to investigate the prevalence, characteristics, and outcomes of suicide-related OHCA. METHODS: This multicenter, retrospective cohort study is an analysis of data collected from the JAPAN Registry of Self-harm and Suicide Attempts. Patients were divided into two groups, the OHCA group and the non-OHCA group. The primary outcome was death at 30 days. RESULTS: Among 1,960 self-harm and suicide attempts patients, 213 patients (10.9 %) were assigned to the OHCA group and 1,747 (89.1%) were in the non-OHCA group.Patients in the OHCA group were older (44 vs. 33 years old, p < 0.001), and the OHCA group had a higher proportion of males compared to the non-OHCA group (122 [57.3%] vs. 604 [34.6%], p < 0.001). Despite missing and unknown data, lower proportions of psychiatric consultation history (54 [30.8%] vs. 1177 [70.5%], p < 0.001), psychiatric hospitalization history (9 [5.1%] vs. 386 [23.1%], p < 0.001), and previous suicide attempts (16 [9.2%] vs. 807 [48.4%], p < 0.001) were observed in the OHCA group. Risk of death at 30 days was significantly higher in the OHCA group (200 [93.9%] vs. 31 [1.8%], p < 0.001). CONCLUSION: Suicide-related OHCA was rare and associated with poorer prognosis compared to patients without OHCA. It was more common in middle-aged men without a history of psychiatric care or prior suicide attempts, although the study was limited by missing data.

DOI： 10.1016/j.resplu.2025.100923

Undetermined Ruptured Low-Grade Appendiceal Mucinous Neoplasm Following High-Energy Blunt Abdominal Trauma Requiring Emergency Laparotomy. 査読国際誌

Ippei Matsuo, Tetsuya Yumoto, Akari Tsuji, Ryo Tanabe, Toshihisa Matsumura, Mikoto Shimabara, Masaaki Akai, Shoji Takagi, Hiromichi Naito, Atsunori Nakao

Clinical case reports 13 ( 1 ) e70071 2025年1月

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）

Blunt abdominal trauma causing intraperitoneal injury and/or bleeding can be life-threatening, requiring immediate intervention. Diagnosing these cases can be challenging, especially when pre-existing conditions are involved. Low-grade appendiceal mucinous neoplasm (LAMN) is a rare tumor of the appendix that can lead to pseudomyxoma peritonei. Herein, we present a case of ruptured LAMN following blunt abdominal trauma after a high-energy head-on collision, complicating the differentiation from other intraperitoneal injuries. A 42-year-old Japanese female was brought to our hospital following high-energy head-on collision. She presented with stable vital signs, complaining of anterior chest pain and abdominal tenderness without peritoneal irritation. Computed tomography scans indicated multiple fractures in her chest and complex fluid around the Douglas fossa extending to the ileocecal area, with a slightly dilated appendix tip. Despite stable vitals, emergency laparotomy was needed for suspected peritonitis and/or intraperitoneal hemorrhage. Emergency laparotomy revealed yellowish, jelly-like ascites and a ruptured appendiceal tumor. LAMN was suspected, and the appendix was completely resected, with cytoreductive surgery carefully performed. Histopathological examination confirmed the diagnosis of LAMN. Postoperative course was uneventful, and the patient was discharged on Day 13 and referred for further LAMN management. This case report highlights the diagnostic difficulties of LAMN rupture following blunt abdominal trauma, stressing the need to consider rare conditions like LAMN in differential diagnoses of acute abdomen posttrauma.

DOI： 10.1002/ccr3.70071

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024. 査読国際誌

Nobuaki Shime, Taka-Aki Nakada, Tomoaki Yatabe, Kazuma Yamakawa, Yoshitaka Aoki, Shigeaki Inoue, Toshiaki Iba, Hiroshi Ogura, Yusuke Kawai, Atsushi Kawaguchi, Tatsuya Kawasaki, Yutaka Kondo, Masaaki Sakuraya, Shunsuke Taito, Kent Doi, Hideki Hashimoto, Yoshitaka Hara, Tatsuma Fukuda, Asako Matsushima, Moritoki Egi, Shigeki Kushimoto, Takehiko Oami, Kazuya Kikutani, Yuki Kotani, Gen Aikawa, Makoto Aoki, Masayuki Akatsuka, Hideki Asai, Toshikazu Abe, Yu Amemiya, Ryo Ishizawa, Tadashi Ishihara, Tadayoshi Ishimaru, Yusuke Itosu, Hiroyasu Inoue, Hisashi Imahase, Haruki Imura, Naoya Iwasaki, Noritaka Ushio, Masatoshi Uchida, Michiko Uchi, Takeshi Umegaki, Yutaka Umemura, Akira Endo, Marina Oi, Akira Ouchi, Itsuki Osawa, Yoshiyasu Oshima, Kohei Ota, Takanori Ohno, Yohei Okada, Hiromu Okano, Yoshihito Ogawa, Masahiro Kashiura, Daisuke Kasugai, Ken-Ichi Kano, Ryo Kamidani, Akira Kawauchi, Sadatoshi Kawakami, Daisuke Kawakami, Yusuke Kawamura, Kenji Kandori, Yuki Kishihara, Sho Kimura, Kenji Kubo, Tomoki Kuribara, Hiroyuki Koami, Shigeru Koba, Takehito Sato, Ren Sato, Yusuke Sawada, Haruka Shida, Tadanaga Shimada, Motohiro Shimizu, Kazushige Shimizu, Takuto Shiraishi, Toru Shinkai, Akihito Tampo, Gaku Sugiura, Kensuke Sugimoto, Hiroshi Sugimoto, Tomohiro Suhara, Motohiro Sekino, Kenji Sonota, Mahoko Taito, Nozomi Takahashi, Jun Takeshita, Chikashi Takeda, Junko Tatsuno, Aiko Tanaka, Masanori Tani, Atsushi Tanikawa, Hao Chen, Takumi Tsuchida, Yusuke Tsutsumi, Takefumi Tsunemitsu, Ryo Deguchi, Kenichi Tetsuhara, Takero Terayama, Yuki Togami, Takaaki Totoki, Yoshinori Tomoda, Shunichiro Nakao, Hiroki Nagasawa, Yasuhisa Nakatani, Nobuto Nakanishi, Norihiro Nishioka, Mitsuaki Nishikimi, Satoko Noguchi, Suguru Nonami, Osamu Nomura, Katsuhiko Hashimoto, Junji Hatakeyama, Yasutaka Hamai, Mayu Hikone, Ryo Hisamune, Tomoya Hirose, Ryota Fuke, Ryo Fujii, Naoki Fujie, Jun Fujinaga, Yoshihisa Fujinami, Sho Fujiwara, Hiraku Funakoshi, Koichiro Homma, Yuto Makino, Hiroshi Matsuura, Ayaka Matsuoka, Tadashi Matsuoka, Yosuke Matsumura, Akito Mizuno, Sohma Miyamoto, Yukari Miyoshi, Satoshi Murata, Teppei Murata, Hiromasa Yakushiji, Shunsuke Yasuo, Kohei Yamada, Hiroyuki Yamada, Ryo Yamamoto, Ryohei Yamamoto, Tetsuya Yumoto, Yuji Yoshida, Shodai Yoshihiro, Satoshi Yoshimura, Jumpei Yoshimura, Hiroshi Yonekura, Yuki Wakabayashi, Takeshi Wada, Shinichi Watanabe, Atsuhiro Ijiri, Kei Ugata, Shuji Uda, Ryuta Onodera, Masaki Takahashi, Satoshi Nakajima, Junta Honda, Tsuguhiro Matsumoto

Acute medicine & surgery 12 ( 1 ) e70037 2025年

記述言語：英語掲載種別：研究論文（学術雑誌）

The 2024 revised edition of the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock (J-SSCG 2024) is published by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine. This is the fourth revision since the first edition was published in 2012. The purpose of the guidelines is to assist healthcare providers in making appropriate decisions in the treatment of sepsis and septic shock, leading to improved patient outcomes. We aimed to create guidelines that are easy to understand and use for physicians who recognize sepsis and provide initial management, specialized physicians who take over the treatment, and multidisciplinary healthcare providers, including nurses, physical therapists, clinical engineers, and pharmacists. The J-SSCG 2024 covers the following nine areas: diagnosis of sepsis and source control, antimicrobial therapy, initial resuscitation, blood purification, disseminated intravascular coagulation, adjunctive therapy, post-intensive care syndrome, patient and family care, and pediatrics. In these areas, we extracted 78 important clinical issues. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 42 GRADE-based recommendations, 7 good practice statements, and 22 information-to-background questions were created as responses to clinical questions. We also described 12 future research questions.

DOI： 10.1002/ams2.70037

Association of blood carboxyhemoglobin levels with mortality and neurological outcomes in out-of-hospital cardiac arrest. 査読国際誌

Takashi Hongo, Tetsuya Yumoto, Hiromichi Naito, Tomohiro Hiraoka, Yuya Murakami, Takafumi Obara, Tsuyoshi Nojima, Toshiyuki Aokage, Atsunori Nakao

Acute medicine & surgery 12 ( 1 ) e70053 2025年

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Carbon monoxide (CO), produced endogenously by heme oxygenase-1, plays a crucial role in the immune system by mitigating cellular damage under stress. However, the significance of carboxyhemoglobin (COHb) levels after out-of-hospital cardiac arrest (OHCA) is not well understood. This study aimed to explore the association between COHb levels at hospital arrival and within the first 24 h post-arrival with 30-day mortality and neurological outcomes in patients who experienced OHCA. METHODS: This single-center, retrospective study analyzed data from adult patients who experienced OHCA seen at Okayama University Hospital from 2019 to 2023. The patients were assigned to one of two study groups based on COHb levels (0.0% or ≥0.1%) upon hospital arrival. The primary outcome was 30-day mortality. RESULTS: Among the 560 eligible patients who experienced OHCA, 284 (50.7%) were in the COHb 0.0% group and 276 (49.3%) were in the COHb ≥ 0.1% group. The 30-day mortality was significantly higher in the COHb 0.0% group compared to the COHb ≥ 0.1% group (264 [92.9%] vs. 233 [84.4%]). Multivariable logistic regression showed that the COHb 0.0% group was associated with 30-day mortality (adjusted ORs: 2.24, 95% CIs: 1.10-4.56). Non-survivors at 30 days who were admitted to the intensive care unit had lower COHb levels at hospital arrival (0.0% vs. 0.2%) and lower mean COHb levels during the first 24 h post-arrival (0.7% vs. 0.9%) compared to survivors. CONCLUSIONS: COHb levels of 0.0% were linked to worse outcomes in patients experiencing OHCA, warranting further research on the prognostic implications of COHb in this context.

DOI： 10.1002/ams2.70053

Association between metabolic acidosis and post-intubation hypotension in airway management performed in the emergency department. 査読国際誌

Masafumi Suga, Takeshi Nishimura, Tatsuya Ochi, Takashi Hongo, Tetsuya Yumoto, Atsunori Nakao, Satoshi Ishihara, Hiromichi Naito

Heliyon 10 ( 23 ) e40224 2024年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Post-intubation hypotension (PIH) is a common complication of intubations performed in the emergency department (ED). Identification of patients at high-risk for PIH is a major challenge. We aimed to determine whether pre-intubation metabolic acidosis affects the incidence of PIH in the ED. METHODS: This was a single-center, retrospective, observational study of consecutive patients requiring emergent endotracheal intubation (ETI) from November 1, 2016 to March 31, 2022 at Hyogo Emergency Medical Center, an urban ED. The primary outcome was PIH, defined as a decreased systolic blood pressure (sBP) of <90 mmHg, required initiation of any vasopressor, or a decrease in sBP by ≥ 20 % within 30 min following intubation. Patients were divided into two groups: those with pre-intubation metabolic acidosis (metabolic acidosis group), defined as pH < 7.3 and base excess (BE) < -4 mmol/L on arterial blood gas analysis, and those with no metabolic acidosis (without-metabolic acidosis group). The association between PIH and pre-intubation metabolic acidosis was examined using multivariable logistic regression models. A receiver operating characteristic (ROC) curve was produced to assess the predictive value of pre-intubation BE for PIH. RESULTS: The study included 311 patients. PIH occurred in 65.5 % (74/113) of patients in the metabolic acidosis group and 29.3 % (58/198) of patients in the without-metabolic acidosis group. Multivariable logistic regression demonstrated that metabolic acidosis was associated with PIH (odds ratio 4.06, 95 % confidence interval 2.31-7.11). In the ROC analysis, the optimal cut-off point for BE was -4.1 (sensitivity = 71 %, specificity = 70 %), with the area under the ROC curve 0.74. CONCLUSION: Pre-intubation metabolic acidosis was significantly associated with PIH. Physicians.

DOI： 10.1016/j.heliyon.2024.e40224

Differences in the Usability of Fully Automated External Defibrillators between Medical and Nonmedical Professionals. 査読

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

Internal medicine (Tokyo, Japan) 2024年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

Objective Early defibrillation is crucial for improving the survival rates of patients with shockable cardiac arrest (OHCA). Automated external defibrillators (AEDs) are essential in basic life support (BLS), yet their usage in out-of-hospital cardiac arrests remains around 10%. There are two types of AEDs: semi-automatic (s-AED) and fully automatic (f-AED), with the latter automatically delivering a shock if indicated. Although f-AEDs were introduced in Japan in 2021, they have not yet been widely adopted. The present study investigated whether or not the ease of use and preferences for these AED types differ between healthcare professionals and laypersons. Methods BLS courses, including training on both AED types, were conducted between 2021 and 2022 at our institution. The participants were divided into medical and non-medical professional groups, and a survey was administered. Results A total of 443 participants were included, with 47 medical professionals and 396 non-medical professionals. Notably, 401 participants were new to f-AED lectures. The medical professional group had more prior experience with AED training courses than non-medical professionals and showed a preference for s-AEDs, whereas the non-medical professional group showed no significant preference. Although a subset of participants expressed hesitation in pressing the shock button on the s-AEDs, no statistically significant difference was observed between the groups. Conclusion This study suggests that preferences for AED types may vary between medical and non-medical professional groups, with some reluctance in using s-AEDs. Although no significant differences in hesitation were found between the groups, f-AEDs may reduce hesitation and potentially improve AED effectiveness during cardiopulmonary resuscitation.

DOI： 10.2169/internalmedicine.4578-24

Intestinal epithelial-specific occludin deletion worsens gut permeability and survival following sepsis. 査読国際誌

Tetsuya Yumoto, Takehiko Oami, Zhe Liang, Eileen M Burd, Mandy L Ford, Jerrold R Turner, Craig M Coopersmith

Shock (Augusta, Ga.) 2024年12月

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）

Sepsis induces intestinal hyperpermeability, which is associated with higher mortality. Occludin is a tight junction protein that plays a critical role in regulating disease-associated intestinal barrier loss. This study examined the role of intestinal occludin on gut barrier function and survival in a pre-clinical model of sepsis. Intestinal epithelial-specific occludin knockout (occludin KOIEC) mice and wild type controls were subjected to intra-abdominal sepsis and sacrificed at pre-determined endpoints for mechanistic studies or followed for survival. Occludin KOIEC mice had a significant increase in intestinal permeability, that was induced only in the setting of sepsis as knockout mice and control mice had similar baseline permeability. The worsened barrier was specific to the leak pathway of permeability, without changes in either the pore or unrestricted pathways. Increased sepsis-induced permeability was associated with increased levels of the tight junction ZO-1 in occludin KOIEC mice. Occludin KOIEC mice also had significant increases in systemic cytokines IL-6 and MCP-1and increased bacteremia. Further, occludin KOIEC mice had higher levels of jejunal IL-1β and MCP-1 as well as increased MCP-1 and IL-17A in the peritoneal fluid although peritoneal bacteria levels were unchanged. Notably, 7-day mortality was significantly higher in occludin KOIEC mice following sepsis. Occludin thus plays a critical role in preserving gut barrier function and mediating survival during sepsis, associated with alterations in inflammation and bacteremia. Agents that preserve occludin function may represent a new therapeutic strategy in the treatment of sepsis.

DOI： 10.1097/SHK.0000000000002531

救急搬送件数の急増と働き方改革への対応岡山大学の取り組み査読

湯本哲也, 内藤宏道, 本郷貴識, 小原隆史, 小崎吉訓, 上田浩平, 野島剛, 飯田淳義, 塚原紘平, 中尾篤典

日本臨床救急医学会雑誌 27 ( 6 ) 765 - 771 2024年12月

担当区分：筆頭著者,　責任著者記述言語：日本語出版者・発行元：(一社)日本臨床救急医学会

2024年4月から医師にも働き方改革が適用された。当院では救急搬送件数が直近3年間で3倍に急増した。これに対応するため院内外の協力・連携や下り搬送の体制強化,病院救命士の活用・育成によるタスク・シェア/シフトの促進に努めてきた。その他,徹底したシフト制など働き方改革を進めてきた。また,大学病院としての使命でもある研究・教育にも注力してきた。2023年度の院内時間外勤務時間は2022年度のそれと比較して有意に減少したものの,働き方改革前後での全体的な満足度に変化はなかった。働き方改革は労働時間もさることながら,その中身が重要であり,救急科としての専門性や役割を発揮しながら,個々がやりがいを実感できる環境づくりが重要であるが,自己研鑽という名の時間外労働の実態は反映されにくく,地域救急医療体制維持と働き方改革とのバランスも今後の課題である。(著者抄録)

Prevalence and Management of Oral Intake Restrictions in Critically Ill Patients: Insights from a Multicenter Point Prevalence Study. 査読国際誌

Takashi Hongo, Tetsuya Yumoto, Keibun Liu, Kensuke Nakamura, Akira Kawauchi, Takefumi Tsunemitsu, Nobuto Nakanishi, Atsunori Nakao, Hiromichi Naito

Dysphagia 2024年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

Oral intake restrictions due to dysphagia in the intensive care unit (ICU) can increase morbidity, mortality, and negatively impact quality of life. The current oral intake practice and clinical management strategies for addressing dysphagia in the ICU are not well-defined. This study aimed to elucidate the clinical practices surrounding oral intake restrictions due to dysphagia and its management strategies in the ICU. A multicenter, prospective, cross-sectional, 2-day point prevalence study was conducted in Japan. Relevant data on the clinical circumstances surrounding oral intake practice and the implementation of strategies to prevent dysphagia for patients admitted to the ICU on November 1, 2023, and December 1, 2023, were collected. The primary outcome was the prevalence of oral intake restrictions in patients, defined by a Functional Oral Intake Scale score of less than 7 among eligible patients for oral intake. Out of 326 participants, 187 were eligible for the final analysis after excluding 139 patients who were not eligible for oral intake, primarily due to tracheal intubation. Among those eligible, 69.0% (129/187) encountered oral intake restrictions. About 52.4% (98/187) of patients underwent swallowing screenings; 36.7% (36/98) of these were suspected of having dysphagia. Compensatory and behavioral swallowing rehabilitation were provided to 21.9% (41/187) and 10.6% (20/187) of patients, respectively, from ICU admission to the survey date. Only 27.4% (14/51) of post-extubation and 9.3% (3/32) of post-stroke patients received swallowing rehabilitation. Notably, no ICUs had dedicated speech and language therapists, and most (85.7%, 18/21) lacked established swallowing rehabilitation protocols. This 2-point prevalence survey study revealed that oral intake restrictions due to dysphagia are common in ICUs, but few patients are screened for swallowing issues or receive rehabilitation. More clinical studies are needed to develop effective protocols for identifying and managing dysphagia, including screenings and rehabilitation in the ICU.

DOI： 10.1007/s00455-024-10772-5

A nationwide longitudinal survey of infantile injury and its recurrence in Japan. 査読国際誌

Tomohiro Hiraoka, Takafumi Obara, Naomi Matsumoto, Kohei Tsukahara, Takashi Hongo, Tsuyoshi Nojima, Masaki Hisamura, Tetsuya Yumoto, Atsunori Nakao, Takashi Yorifuji, Hiromichi Naito

Scientific reports 14 ( 1 ) 24716 - 24716 2024年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

Injury recurrence in young children is a significant public health concern, as it may indicate an unfavorable home environment. This study evaluates whether infantile injuries increase recurrence during preschool years, contributing to more effective prevention strategies for vulnerable families. The study included 20,191 children from "The Longitudinal Survey of Babies in the 21st Century," a representative sample of infants born in Japan between May 10 and 24, 2010. We conducted a logistic regression analysis to compare injury recurrence risk between children aged 18 months to seven years with and without infantile injury histories. The study revealed that infants with a history of injuries had a higher risk of subsequent hospital visits for injuries during preschool years (crude Odds Ratio (cOR) 1.52, 95% CI, 1.41-1.64, adjusted OR (aOR) 1.48, 95% CI 1.37-1.60). Specific injuries, such as falls (aOR 1.34, 95% CI, 1.26-1.43), pinches (aOR 1.22, 95% CI, 1.15-1.29), drowning (aOR 1.29, 95% CI, 1.19-1.40), ingestion (aOR 1.35, 95% CI, 1.17-1.55), and burns (aOR 1.47, 95% CI, 1.31-1.65), independently increased the risk of future injuries. Our findings highlight the necessity of universal safety measures in the home environment and targeted interventions for families with a history of high-risk injuries.

DOI： 10.1038/s41598-024-76403-z

Management of Obesity Hypoventilation Syndrome in Extreme Obesity: A Case Study. 査読国際誌

Yuya Miyoshi, Tetsuya Yumoto, Yoshinori Kosaki, Takashi Hongo, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

The American journal of case reports 25 e945112 2024年10月

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 Obesity hypoventilation syndrome (OHS) is characterized by hypercapnia in obese patients, with acute hypercapnic respiratory failure often worsened by various conditions. Managing super-super obese patients presents complex challenges in critical care. Our case report details the successful treatment of acute respiratory failure in a patient with a body mass index (BMI) over 80 kg/m², highlighting the importance of comprehensive, multidisciplinary care in the Intensive Care Init (ICU). CASE REPORT A 39-year-old man with a BMI of 81.1 kg/m² presented to our emergency department with respiratory distress, altered consciousness, and an inability to move independently. Arterial blood gas analysis revealed severe hypercapnia and hypoxemia, indicating decompensated OHS. Laboratory tests and computed tomography scans suggested his condition was exacerbated by pneumonia and congestive heart failure. The patient was managed in the ICU with endotracheal intubation, mechanical ventilation, and esophageal pressure monitoring. In addition to antibiotics, diuretics were used to manage fluid balance. His care included multidisciplinary support with nutritional management and active physiotherapy. After 15 days, he was weaned from the ventilator and discharged from the ICU on day 20, continuing rehabilitation until he was discharged home on day 60. CONCLUSIONS This case report describes the successful treatment of acute hypercapnic respiratory failure from decompensated OHS in a super-super obese patient. Addressing the underlying conditions and tailoring clinical practices to the patient's specific needs, especially regarding ventilatory support, fluid balance, and nutrition, were crucial. A collaborative multidisciplinary approach was essential for improving outcomes.

DOI： 10.12659/AJCR.945112

Reply to: The gray-white matter ratio in adult out-of-hospital cardiac arrest patients must be assessed comprehensively. 査読国際誌

Takashi Hongo, Hiromichi Naito, Tetsuya Yumoto, Atsunori Nakao

Resuscitation 110383 - 110383 2024年9月

Prognostic value of grey-white matter ratio obtained within two hours after return of spontaneous circulation in out-of-hospital cardiac arrest survivors: A multicenter, observational study. 査読国際誌

Yuya Murakami, Takashi Hongo, Tetsuya Yumoto, Yoshinori Kosaki, Atsuyoshi Iida, Hiroki Maeyama, Fumiya Inoue, Toshihisa Ichiba, Atsunori Nakao, Hiromichi Naito

Resuscitation plus 19 100746 - 100746 2024年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Grey-white matter ratio (GWR) measured by head computed tomography (CT) scan is known as a neurological prognostication tool for out-of-hospital cardiac arrest (OHCA) survivors. The prognostic value of GWR obtained early (within two hours after return of spontaneous circulation [ROSC]) remains a matter of debate. METHODS: We conducted a multicenter, retrospective, observational study at five hospitals. We included adult OHCA survivors who underwent head CT within two hours following ROSC. GWR values were measured using head CT. Average GWR values were calculated by the mean of the GWR-basal ganglia and GWR-Cerebrum. We divided the patients into poor or favorable neurological outcome groups defined by Glasgow-Pittsburgh Cerebral Performance Category scores. The predictive accuracy of GWR performance was assessed using the area under the curve (AUC). The sensitivities and specificities for predicting poor outcome were examined. RESULTS: Of 377 eligible patients, 281 (74.5%) showed poor neurological outcomes at one month after ROSC. Average GWR values of the poor neurological outcome group were significantly lower than those of the favorable neurological outcome. The average GWR value to predict neurological outcome with Youden index was 1.24 with AUC of 0.799. When average GWR values were 1.15 or lower, poor neurological outcomes could be predicted with 100% specificity. CONCLUSIONS: GWR values measured by head CT scans early (within two hours after ROSC) demonstrated moderate predictive performance for overall ROSC patients. When limited to the patients with GWR values of 1.15 or lower, poor neurological outcomes could be predicted with high specificity.

DOI： 10.1016/j.resplu.2024.100746

Association between signs of life and survival in traumatic cardiac arrest patients: A nationwide, retrospective cohort study. 査読国際誌

Takafumi Obara, Tetsuya Yumoto, Naofumi Bunya, Tsuyoshi Nojima, Tomohiro Hiraoka, Takashi Hongo, Yoshinori Kosaki, Kohei Tsukahara, Takenori Uehara, Atsunori Nakao, Hiromichi Naito

Resuscitation plus 19 100701 - 100701 2024年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The clinical impact of signs of life (SOLs) in traumatic cardiac arrest (TCA) remains to be elucidated. The aim of this study was to examine the association between SOLs and survival/neurological outcomes in TCA patients. METHODS: Retrospective data from the Japan Trauma Data Bank (2019-2021) was reviewed. TCA patients were assigned to one of two study groups based on the presence or absence of SOLs and compared. SOLs were defined as having at least one of following criteria: pulseless electrical activity >40 beats per minute, gasping, positive light reflex, or extremity/eye movement at hospital arrival. The primary outcome was survival at hospital discharge. The secondary outcome was favorable neurological status (Glasgow Outcome Scale score of 4 or 5) at hospital discharge. RESULTS: A total of 1,981 patients (114 with SOLs and 1,867 without SOLs) were included. Characteristics of patients were as follows: age (median age 60.0 years old [interquartile range: 41-80] years vs. 55.4 [38-75] years), gender (male: 76/114 (66.7%) vs. 1,207/1,867 (65.0%), blunt trauma (90/111 [81.1%] vs. 1,559/1,844 [84.5%]), Injury Severity Score (29.2 [22-41] vs. 27.9 [20-34]). Patients with SOLs showed higher survival (10/114 (8.8%) vs. 25/1,867 (1.3%), OR 1.96 [CI 1.20-2.72]) and higher favorable neurological outcomes (4/110 (3.5%) vs. 6/1,865 (0.3%), OR 2.42 [CI 1.14-3.70]) compared with patients without SOLs. CONCLUSIONS: TCA patients with SOLs at hospital arrival showed higher survival and favorable neurological outcomes at hospital discharge compared with TCA patients without SOLs.

DOI： 10.1016/j.resplu.2024.100701

Prognostic Performance of Gray-White Matter Ratio in Adult Out-of-Hospital Cardiac Arrest Patients after Receiving Extracorporeal Cardiopulmonary Resuscitation. 査読国際誌

Takashi Hongo, Hiromichi Naito, Michitaka Nasu, Tetsuya Yumoto, Yoshinori Kosaki, Takashi Yorifuji, Toru Hifumi, Akihiko Inoue, Tetsuya Sakamoto, Yasuhiro Kuroda, Atsunori Nakao

Resuscitation 110351 - 110351 2024年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Gray-to-white matter ratio (GWR), measured by computed tomography (CT), is commonly used to predict poor neurological outcomes after out-of-hospital cardiac arrest (OHCA). The prognostic performance of GWR in OHCA patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) is not known. METHODS: This study is a secondary analysis of data from the SAVE-J II registry, a retrospective, multicenter study. Participants were divided into four groups according to average GWR (aGWR) values ranging from 1.00 to 1.39, separated by 0.1 intervals. The aGWR values were calculated for bilateral basal ganglia, centrum semiovale, and high convexity obtained by head CT within 24 h after ECPR. Primary outcome was poor neurological outcomes at 30-day. RESULTS: In total, 1,146 OHCA patients treated with ECPR were included in our analysis. Overall, participants with lower aGWR more likely had poor neurological outcomes, aGWR 1.00-1.09 (94.6%), aGWR 1.10-1-19 (87.8%), aGWR 1.20-1.29 (78.5%), and aGWR 1.30-1.39 (70.3%). Multivariable logistic regression showed that lower aGWR was associated with poor neurological outcome at 30-day, aGWR 1.30-1.39: reference, aGWR 1.00-1.09: adjusted odds ratio (aOR) 10.01 (95% confidence interval (CI) [3.58-27.99]), aGWR 1.10-1.19: aOR 4.83 (95% CI [2.31-10.12]), aGWR 1.20-1.29: aOR 2.16 (95% CI [1.02-4.55]). Receiver operating characteristic curve analysis revealed that the prognostic performance of aGWR had an area under the curve of 0.628, 95% CI [0.59-0.66]). The aGWR threshold of 1.005 for predicting poor neurological outcome reached 100% specificity with 0.1% sensitivity. CONCLUSION: Early neuro-prognostication depending on GWR may not be sufficient after ECPR and requires a multimodal approach.

DOI： 10.1016/j.resuscitation.2024.110351

Evolution and Effects of Ad Hoc Multidisciplinary Team Meetings in the Emergency Intensive Care Unit: A Five-Year Analysis. 査読国際誌

Tetsuya Yumoto, Takashi Hongo, Takafumi Obara, Kohei Ageta, Toshiyuki Aokage, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

Journal of clinical medicine 13 ( 15 ) 2024年7月

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: Multidisciplinary team meetings (MDTMs) are crucial in the ICU. However, daily rounds may not address all sensitive issues due to time constraints and the complexity of cases. This study aimed to describe detailed information and characteristics of ad hoc MDTMs in the ICU. Methods: This single-center, retrospective study analyzed adult emergency ICU admissions at Okayama University Hospital from 1 January 2019 to 31 December 2023. During this period, weekly regular multidisciplinary team ICU rounds were introduced in June 2020, and regular weekday morning MDTMs began in April 2022. A multiple logistic regression analysis was applied to determine the impact of these changes on the frequency of ad hoc MDTMs, adjusting for variables including annual changes. Results: The study analyzed 2487 adult EICU patients, with a median age of 66, and 63.3% of them male. MDTMs were held for 168 patients (6.8%), typically those with severe conditions, including higher COVID-19 prevalence and APACHE II scores, and longer ICU stays. Despite a constant total number of MDTMs, the likelihood of conducting ad hoc MDTMs increased annually (adjusted OR 1.19; 95% CI, 1.04-1.35). Of the 329 MDTMs conducted for these patients, 59.0% addressed end-of-life care, involving an average of 11 participants, mainly nurses and emergency and critical-care physicians. Conclusions: Changes in ICU round and meeting structures might be associated with a higher frequency of conducting ad hoc MDTMs, highlighting their evolving role and importance in patient care management.

DOI： 10.3390/jcm13154324

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. 査読国際誌

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

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

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

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

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: 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

Long-term, patient-centered, frailty-based outcomes of older critical illness survivors from the emergency department: a post hoc analysis of the LIFE Study. 査読国際誌

Takashi Hongo, Tetsuya Yumoto, Mototaka Inaba, Shunsuke Taito, Takashi Yorifuji, Atsunori Nakao, Hiromichi Naito

BMC geriatrics 24 ( 1 ) 257 - 257 2024年3月

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: Evidence indicates frailty before intensive care unit (ICU) admission leads to poor outcomes. However, it is unclear whether quality of life (QOL) and activities of daily living (ADL) for survivors of critical illness admitted to the ICU via the emergency department remain consistent or deteriorate in the long-term compared to baseline. This study aimed to evaluate long-term QOL/ADL outcomes in these patients, categorized by the presence or absence of frailty according to Clinical Frailty Scale (CFS) score, as well as explore factors that influence these outcomes. METHODS: This was a post-hoc analysis of a prospective, multicenter, observational study conducted across Japan. It included survivors aged 65 years or older who were admitted to the ICU through the emergency department. Based on CFS scores, participants were categorized into either the not frail group or the frail group, using a threshold CFS score of < 4. Our primary outcome was patient-centered outcomes (QOL/ADL) measured by the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the Barthel Index six months post-ICU admission, comparing results from baseline. Secondary outcomes included exploration of factors associated with QOL/ADL six months post-ICU admission using multiple linear regression analyses. RESULTS: Of 514 candidates, 390 participants responded to the EQ-5D-5L questionnaire, while 237 responded to the Barthel Index. At six months post-admission, mean EQ-5D-5L values declined in both the not frail and frail groups (0.80 to 0.73, p = 0.003 and 0.58 to 0.50, p = 0.002, respectively); Barthel Index scores also declined in both groups (98 to 83, p < 0.001 and 79 to 61, p < 0.001, respectively). Multiple linear regression analysis revealed that baseline frailty (β coefficient, -0.15; 95% CI, - 0.23 to - 0.07; p < 0.001) and pre-admission EQ-5D-5L scores (β coefficient, 0.14; 95% CI, 0.02 to 0.26; p = 0.016) affected EQ-5D-5L scores at six months. Similarly, baseline frailty (β coefficient, -12.3; 95% CI, - 23.9 to - 0.80; p = 0.036) and Barthel Index scores (β coefficient, 0.54; 95% CI, 0.30 to 0.79; p < 0.001) influenced the Barthel Index score at six months. CONCLUSIONS: Regardless of frailty, older ICU survivors from the emergency department were more likely to experience reduced QOL and ADL six months after ICU admission compared to baseline.

DOI： 10.1186/s12877-024-04881-x

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

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

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

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

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

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

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

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

Association of initial lactate levels and red blood cell transfusion strategy with outcomes after severe trauma: a post hoc analysis of the RESTRIC trial. 査読国際誌

Yoshinori Kosaki, Takashi Hongo, Mineji Hayakawa, Daisuke Kudo, Shigeki Kushimoto, Takashi Tagami, Hiromichi Naito, Atsunori Nakao, Tetsuya Yumoto

World journal of emergency surgery : WJES 19 ( 1 ) 1 - 1 2024年1月

担当区分：最終著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The appropriateness of a restrictive transfusion strategy for those with active bleeding after traumatic injury remains uncertain. Given the association between tissue hypoxia and lactate levels, we hypothesized that the optimal transfusion strategy may differ based on lactate levels. This post hoc analysis of the RESTRIC trial sought to investigate the association between transfusion strategies and patient outcomes based on initial lactate levels. METHODS: We performed a post hoc analysis of the RESTRIC trial, a cluster-randomized, crossover, non-inferiority multicenter trials, comparing a restrictive and liberal red blood cell transfusion strategy for adult trauma patients at risk of major bleeding. This was conducted during the initial phase of trauma resuscitation; from emergency department arrival up to 7 days after hospital admission or intensive care unit (ICU) discharge. Patients were grouped by lactate levels at emergency department arrival: low (< 2.5 mmol/L), middle (≥ 2.5 and < 4.0 mmol/L), and high (≥ 4.0 mmol/L). We compared 28 days mortality and ICU-free and ventilator-free days using multiple linear regression among groups. RESULTS: Of the 422 RESTRIC trial participants, 396 were analyzed, with low (n = 131), middle (n = 113), and high (n = 152) lactate. Across all lactate groups, 28 days mortality was similar between strategies. However, in the low lactate group, the restrictive approach correlated with more ICU-free (β coefficient 3.16; 95% CI 0.45 to 5.86) and ventilator-free days (β coefficient 2.72; 95% CI 0.18 to 5.26) compared to the liberal strategy. These findings persisted even after excluding patients with severe traumatic brain injury. CONCLUSIONS: Our results suggest that restrictive transfusion strategy might not have a significant impact on 28-day survival rates, regardless of lactate levels. However, the liberal transfusion strategy may lead to shorter ICU- and ventilator-free days for patients with low initial blood lactate levels.

DOI： 10.1186/s13017-023-00530-7

Targeting AMP-activated protein kinase in sepsis. 査読国際誌

Tetsuya Yumoto, Craig M Coopersmith

Frontiers in endocrinology 15 1452993 - 1452993 2024年

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）

Sepsis is a global health challenge marked by limited clinical options and high mortality rates. AMP-activated protein kinase (AMPK) is a cellular energy sensor that mediates multiple crucial metabolic pathways that may be an attractive therapeutic target in sepsis. Pre-clinical experimental studies have demonstrated that pharmacological activation of AMPK can offer multiple potential benefits during sepsis, including anti-inflammatory effects, induction of autophagy, promotion of mitochondrial biogenesis, enhanced phagocytosis, antimicrobial properties, and regulation of tight junction assembly. This review aims to discuss the existing evidence supporting the therapeutic potential of AMPK activation in sepsis management.

DOI： 10.3389/fendo.2024.1452993

Characteristics and outcomes of subarachnoid hemorrhage from vertebral artery dissection: A comparative study with other non-traumatic etiologies. 査読国際誌

Shu Oshita, Tetsuya Yumoto, Shunta Jinno, Ippei Matsuo, Takashi Hongo, Hiromichi Naito, Masafumi Hiramatsu, Jun Haruma, Kenji Sugiu, Shota Tanaka, Atsunori Nakao

Acute medicine & surgery 11 ( 1 ) e70031 2024年

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）

AIM: Vertebral artery dissection (VAD) is a rare cause of non-traumatic subarachnoid hemorrhage (SAH) with significant clinical implications. This study compared the clinical characteristics and outcomes of SAH from intracranial VAD rupture to those from other etiologies, primarily aneurysmal rupture. METHODS: This single-center retrospective cohort study at Okayama University Hospital included patients with non-traumatic SAH diagnosed between 2019 and 2023. Patients were categorized into "VAD rupture" and "other etiologies" groups. The main outcome was clinical presentation and symptoms. Additional outcomes included ICU mortality, in-hospital mortality, and unfavorable outcomes at discharge and 6 months, defined as a modified Rankin Scale score of 3-6. RESULTS: A total of 66 patients were included, with 14 in the VAD rupture group and 52 in the other etiologies group. The VAD rupture group was younger (median age 49 vs. 64 years, p = 0.003) and had a higher incidence of out-of-hospital cardiac arrest (42.9% vs. 9.6%, p = 0.011). Preceding headache was more common in the VAD rupture group (78.6% vs. 11.5%, p < 0.001), with a median duration of 36 h before presentation. ICU and in-hospital mortality was higher in the VAD rupture group (both 50.0% vs. 19.3%, p = 0.019). No significant differences were found in unfavorable neurological outcomes at hospital discharge and 6 months. CONCLUSIONS: VAD-related SAH often presents with prodromal headaches, severe symptoms like out-of-hospital cardiac arrest, and higher ICU and in-hospital mortality than other SAH causes, though long-term outcomes are similar. Larger, prospective studies are needed to refine interventions.

DOI： 10.1002/ams2.70031

Reply to: Stomach inflation during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients: where did the air go? 査読国際誌

Hiromichi Naito, Takashi Hongo, Tetsuya Yumoto, Hiroki Maeyama, Astunori Nakao

Resuscitation 110099 - 110099 2023年12月

A Novel Scoring System for Humane Endpoints in Mice with Cecal Ligation and Puncture-Induced Sepsis. 査読国際誌

Lindsey T Ferguson, Ammar A Rashied, Zhe Liang, Tetsuya Yumoto, Jerome C Anyalebechi, David A Swift, Marina S Hernandes, Robert T Krafty, Craig M Coopersmith, Vanessa K Lee

Comparative medicine 73 ( 6 ) 446 - 460 2023年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

Animal-based research is essential to the study of sepsis pathophysiology, diagnostics, and therapeutics. However, animal models of sepsis are often associated with high mortality because of the difficulty in predicting imminent death based on premortem assessment of the animals. The use of validated visual scoring would allow researchers to systematically identify humane endpoints but visual approaches require high interobserver agreement for accurate results. The objective of this study was to establish a scoring system for mice undergoing cecal ligation and puncture (CLP)-induced sepsis based on 3 visual parameters: respiratory status, activity and response to stimulus (ASR), and eye appearance, with scores ranging from 0 to 3. In the first study, we evaluated interobserver agreement. Veterinary and investigative staff assessed 283 mice with CLP and had substantial to near-perfect agreement for all 3 parameters as evaluated using weighted Cohen κ statistic. The second study assessed the ability of the scoring system and temperature to predict death. The scoring system and subcutaneous transpond- ers were used to monitor C57BL/6J mice (n = 80, male and female) until death or for 7 days after CLP. Results showed that the scoring system discriminates between surviving (n = 26) and nonsurviving (n = 54) septic mice. The scoring system was accurate in predicting death, with an AUC of 0.8997. The sensitivity and specificity of the ASR parameter were 96% and 92%, respectively, and for the eye parameter were 94% and 73%. A sum of the ASR and eye scores that was 5 or more was also predictive of death. Temperature was a quantitative predictor, with sensitivity and specificity of 93% and 92%, respectively. This scoring system refines the CLP model by allowing identification of humane endpoints and avoidance of spontaneous death.

DOI： 10.30802/AALAS-CM-22-000124

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

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12月

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）出版者・発行元：{SAGE} Publications

<jats:sec><jats:title>Objectives</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> 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 H<jats:sub>2</jats:sub> group). Histological analysis revealed that the damage to the rectus femoris muscle and kidney appeared to be ameliorated by hydrogen treatment. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Hydrogen gas inhalation may be a promising therapeutic approach in the treatment of CS. </jats:p></jats:sec>

DOI： 10.1177/1721727x231168547

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

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

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

担当区分：最終著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: 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

Effect of Stomach Inflation during Cardiopulmonary Resuscitation on Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest Patients: A Retrospective Observational Study. 査読国際誌

Hiromichi Naito, Hiroaki Hanafusa, Takashi Hongo, Tetsuya Yumoto, Takashi Yorifuji, Alexandra Weissman, Jon C Rittenberger, Francis X Guyette, Mamoru Fujishima, Hiroki Maeyama, Astunori Nakao

Resuscitation 109994 - 109994 2023年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Gastric inflation caused by excessive ventilation is a common complication of cardiopulmonary resuscitation. Gastric inflation may further compromise ventilation via increases in intrathoracic pressure, leading to decreased venous return and cardiac output, which may impair out-of-hospital cardiac arrest (OHCA) outcomes. The purpose of this study was to measure the gastric volume of OHCA patients using computed tomography (CT) scan images and evaluate the effect of gastric inflation on return of spontaneous circulation (ROSC). METHODS: In this single-center, retrospective, observational study, CT scan was conducted after ROSC or immediately after death. Total gastric volume was measured. Primary outcome was ROSC. Achievement of ROSC was compared in the gastric distention group and the no gastric distention group; gastric distension was defined as total gastric volume in the ≥75th percentile. Additionally, factors associated with gastric distention were examined. RESULTS: A total of 446 cases were enrolled in the study; 120 cases (27%) achieved ROSC. The median gastric volume was 400 ml for all OHCA subjects; 1068 ml in gastric distention group vs. 287 ml in no gastric distention group. There was no difference in ROSC between the groups (27/112 [24.1%] vs. 93/334 [27.8%], p=0.440). Gastric distention did not have a significant impact, even after adjustments (adjusted odds ratio 0.73, 95% confidence interval [0.42 - 1.29]). Increased gastric volume was associated with longer emergency medical service activity time. CONCLUSIONS: We observed a median gastric volume of 400 ml in patients after OHCA resuscitation. In our setting, gastric distention did not prevent ROSC.

DOI： 10.1016/j.resuscitation.2023.109994

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

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

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: 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

Collapse-related traumatic intracranial hemorrhage following out-of-hospital cardiac arrest: A multicenter retrospective cohort study. 査読国際誌

Fumiya Inoue, Takashi Hongo, Toshihisa Ichiba, Takayuki Otani, Hiroshi Naito, Yoshinori Kosaki, Yuya Murakami, Atsuyoshi Iida, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Resuscitation plus 15 100418 - 100418 2023年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Sudden loss of consciousness as a result of cardiac arrest can cause severe traumatic head injury. Collapse-related traumatic intracranial hemorrhage (CRTIH) following out-of-hospital cardiac arrest (OHCA) may be linked to poor neurological outcomes; however, there is a paucity of data on this entity. This study aimed to investigate the frequency, characteristics, and outcomes of CRTIH following OHCA. METHODS: Adult patients treated post-OHCA at 5 intensive care units who had head computed tomography (CT) scans were included in the study. CRTIH following OHCA was defined as a traumatic intracranial injury from collapse due to sudden loss of consciousness associated with OHCA. Patients with and without CRTIH were compared. The primary outcome assessed was the frequency of CRTIH following OHCA. Additionally, the clinical features, management, and consequences of CRTIH were analyzed descriptively. RESULTS: CRTIH following OHCA was observed in 8 of 345 enrolled patients (2.3%). CRTIH was more frequent after collapse outside the home, from a standing position, or due to cardiac arrest with a cardiac etiology. Intracranial hematoma expansion on follow up CT was seen in 2 patients; both received anticoagulant therapy, and one required surgical evacuation. Three patients (37.5%) with CRTIH had favorable neurological outcomes 28 days after collapse. CONCLUSIONS: Despite its rare occurrence, physicians should pay special attention to CRTIH following OHCA during the post-resuscitation care period. Larger prospective studies are warranted to provide a more explicit picture of this clinical condition.

DOI： 10.1016/j.resplu.2023.100418

Comparison of outcomes of out-of-hospital cardiac arrest patients: Emergency calls placed from mobile phones vs. landline phones. 査読国際誌

Takeshi Nishimura, Masafumi Suga, Takashi Hongo, Tetsuya Yumoto, Atsunori Nakao, Satoshi Ishihara, Hiromichi Naito

Resuscitation plus 15 100434 - 100434 2023年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Until recently, calls to the emergency medical service (EMS) from landline phones, which display the caller's exact location at the dispatch center, had been common. Since the use of mobile phones has become widespread, many emergency calls are now made from mobile phones. Differences in outcomes of out-of-hospital cardiac arrest (OHCA) patients for whom EMS was called from mobile versus landline phones has not yet been fully elucidated. METHODS: We performed a retrospective, population-based analysis in Kobe, Japan to examine whether EMS calls from mobiles improved the prognosis of OHCA patients over EMS calls placed from landlines. The primary outcome was favorable neurological outcome, defined as Cerebral Performance Category (CPC) scores of 1 or 2 at discharge. Secondary outcomes were survival at one-month, survival at discharge, and time durations between call and EMS activities. RESULTS: Of 4,231 OHCA cases, 2,194 cases (706 landline cases vs. 1,488 mobile cases) were included in this study. The percentages of favorable neurological outcomes were 0.7% (5/706) in the landline group and 3.8% (56/1,488) in the mobile group. Adjusted multivariable logistic regression revealed that favorable neurological outcomes (odds ratio [OR] 3.03, 95% confidence interval [CI] 1.12-8.17, p = 0.03) were better in the mobile group, while one-month survival (OR 1.30, 95% CI 0.80-2.14, p = 0.29) was not significantly different. Bystander CPR was more frequently administered in the mobile group (landlines 61.3% vs. mobiles 68.4%, p < 0.01). Time durations between call to EMS dispatch (184.5 [IQR 157-220 s] vs. 205 [IQR 174-248 s], p < 0.01) and EMS arrival (476.5 [IQR 377-599 s] vs. 491 [IQR 407.5-611.5 s], p < 0.01) were shorter in the landline group. CONCLUSIONS: Although the landline caller location display system seems effective for shorter times between EMS call and EMS arrival, mobile phone use was associated with better neurological outcomes.

DOI： 10.1016/j.resplu.2023.100434

An Unusual Presentation of Chest Pain and Laryngeal Discomfort in a Pregnant Woman: A Case Report and Literature Review. 査読

Misa Sasanami, Atsuyoshi Iida, Masaya Iwamuro, Ryousuke Hirai, Takashi Obara, Kohei Tsukahara, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Acta medica Okayama 77 ( 4 ) 429 - 431 2023年8月

記述言語：英語

Intramural esophageal dissection (IED), characterized by bleeding into the submucosal space, leads to mucosal separation and dissection. The most prevalent symptoms are sudden chest or retrosternal pain, hematemesis, and dysphagia. Therefore, acute coronary syndrome and aortic dissection are among its most notable differential diagnoses. A 31-year-old pregnant woman presented with acute chest pain, laryngeal discomfort, and hematemesis. Emergency esophagogastroscopy revealed longitudinal mucosal dissection (upper esophagus to esophagogastric junction). The patient was successfully treated by avoiding the ingestion of solid foods. Clinicians should consider a diagnosis of IED for pregnant patients with acute chest pain, especially if hematemesis is present.

DOI： 10.18926/AMO/65755

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

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 174 ( 2 ) 343 - 349 2023年8月

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

The Restrictive Red Blood Cell Transfusion Strategy for Critically Injured Patients (RESTRIC) trial: a cluster-randomized, crossover, non-inferiority multicenter trial of restrictive transfusion in trauma. 査読国際誌

Mineji Hayakawa, Takashi Tagami, Daisuke Kudo, Kota Ono, Makoto Aoki, Akira Endo, Tetsuya Yumoto, Yosuke Matsumura, Shiho Irino, Kazuhiko Sekine, Noritaka Ushio, Takayuki Ogura, Sho Nachi, Yuhei Irie, Katsura Hayakawa, Yusuke Ito, Yuko Okishio, Tomohiro Muronoi, Yoshinori Kosaki, Kaori Ito, Keita Nakatsutsumi, Yutaka Kondo, Taichiro Ueda, Hiroshi Fukuma, Yuichi Saisaka, Naoki Tominaga, Takeo Kurita, Fumihiko Nakayama, Tomotaka Shibata, Shigeki Kushimoto

Journal of intensive care 11 ( 1 ) 34 - 34 2023年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The efficacies of fresh frozen plasma and coagulation factor transfusion have been widely evaluated in trauma-induced coagulopathy management during the acute post-injury phase. However, the efficacy of red blood cell transfusion has not been adequately investigated in patients with severe trauma, and the optimal hemoglobin target level during the acute post-injury and resuscitation phases remains unclear. Therefore, this study aimed to examine whether a restrictive transfusion strategy was clinically non-inferior to a liberal transfusion strategy during the acute post-injury phase. METHODS: This cluster-randomized, crossover, non-inferiority multicenter trial was conducted at 22 tertiary emergency medical institutions in Japan and included adult patients with severe trauma at risk of major bleeding. The institutions were allocated a restrictive or liberal transfusion strategy (target hemoglobin levels: 7-9 or 10-12 g/dL, respectively). The strategies were applied to patients immediately after arrival at the emergency department. The primary outcome was 28-day survival after arrival at the emergency department. Secondary outcomes included transfusion volume, complication rates, and event-free days. The non-inferiority margin was set at 3%. RESULTS: The 28-day survival rates of patients in the restrictive (n = 216) and liberal (n = 195) strategy groups were 92.1% and 91.3%, respectively. The adjusted odds ratio for 28-day survival in the restrictive versus liberal strategy group was 1.02 (95% confidence interval: 0.49-2.13). Significant non-inferiority was not observed. Transfusion volumes and hemoglobin levels were lower in the restrictive strategy group than in the liberal strategy group. No between-group differences were noted in complication rates or event-free days. CONCLUSIONS: Although non-inferiority of the restrictive versus liberal transfusion strategy for 28-day survival was not statistically significant, the mortality and complication rates were similar between the groups. The restrictive transfusion strategy results in a lower transfusion volume. TRIAL REGISTRATION NUMBER: umin.ac.jp/ctr: UMIN000034405, registration date: 8 October 2018.

DOI： 10.1186/s40560-023-00682-3

Prevalence, reasons, and timing of decisions to withhold/withdraw life-sustaining therapy for out-of-hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation 査読

Hiromichi Naito, Masaaki Sakuraya, Takashi Hongo, Hiroaki Takada, Tetsuya Yumoto, Takashi Yorifuji, Toru Hifumi, Akihiko Inoue, Tetsuya Sakamoto, Yasuhiro Kuroda, Atsunori Nakao

Critical Care 27 ( 1 ) 2023年6月

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

Background

Extracorporeal cardiopulmonary resuscitation (ECPR) is rapidly becoming a common treatment strategy for patients with refractory cardiac arrest. Despite its benefits, ECPR raises a variety of ethical concerns when the treatment is discontinued. There is little information about the decision to withhold/withdraw life-sustaining therapy (WLST) for out-of-hospital cardiac arrest (OHCA) patients after ECPR.

Methods

We conducted a secondary analysis of data from the SAVE-J II study, a retrospective, multicenter study of ECPR in Japan. Adult patients who underwent ECPR for OHCA with medical causes were included. The prevalence, reasons, and timing of WLST decisions were recorded. Outcomes of patients with or without WLST decisions were compared. Further, factors associated with WLST decisions were examined.

Results

We included 1660 patients in the analysis; 510 (30.7%) had WLST decisions. The number of WLST decisions was the highest on the first day and WSLT decisions were made a median of two days after ICU admission. Reasons for WLST were perceived unfavorable neurological prognosis (300/510 [58.8%]), perceived unfavorable cardiac/pulmonary prognosis (105/510 [20.5%]), inability to maintain extracorporeal cardiopulmonary support (71/510 [13.9%]), complications (10/510 [1.9%]), exacerbation of comorbidity before cardiac arrest (7/510 [1.3%]), and others. Patients with WLST had lower 30-day survival (WLST vs. no-WLST: 36/506 [7.1%] vs. 386/1140 [33.8%], p < 0.001). Primary cerebral disorders as cause of cardiac arrest and higher severity of illness at intensive care unit admission were associated with WLST decisions.

Conclusion

For approximately one-third of ECPR/OHCA patients, WLST was decided during admission, mainly because of perceived unfavorable neurological prognoses. Decisions and neurological assessments for ECPR/OHCA patients need further analysis.

DOI： 10.1186/s13054-023-04534-2

その他リンク： https://link.springer.com/article/10.1186/s13054-023-04534-2/fulltext.html

Chronic ethanol use worsens gut permeability and alters tight junction expression in a murine sepsis model. 査読国際共著国際誌

Takehiko Oami, Tetsuya Yumoto, Takashi Shimazui, Sofia Sarmiento, Nathan J Klingensmith, Ching-Wen Chen, Shunsuke Otani, Zhe Liang, Eileen M Burd, Zaid K Mahdi, Mandy L Ford, Craig M Coopersmith

Shock (Augusta, Ga.) 2023年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

Alcohol use disorder is associated with increased mortality in septic patients. Murine studies demonstrate that ethanol/sepsis is associated with changes in gut integrity. This study examined intestinal permeability following ethanol/sepsis and investigated mechanisms responsible for alterations in barrier function. Mice were randomized to drink either 20% ethanol or water for 12 weeks and then were subjected to either sham laparotomy or cecal ligation and puncture (CLP). Intestinal permeability was disproportionately increased in ethanol/septic mice via the pore, leak and unrestricted pathways. Consistent with increased permeability in the leak pathway, jejunal MLCK expression and the ratio of phospho-MLC to total MLC were both increased in ethanol/CLP. Gut permeability was altered in MLCK-/- mice in water/CLP; however, permeability was not different between WT and MLCK-/- mice in ethanol/CLP. Similarly, jejunal IL-1β levels were decreased while systemic IL-6 levels were increased in MLCK-/- mice in water/CLP but no differences were identified in ethanol/CLP. While we have previously shown that mortality is improved in MLCK-/- mice following water/CLP, mortality was significantly worse in MLCK-/- mice following ethanol/CLP. Consistent with an increase in the pore pathway, claudin 4 levels were also selectively decreased in ethanol/CLP WT mice. Further, mRNA expression of jejunal TNF and IFN-γ were both significantly increased in ethanol/CLP. The frequency of CD4+ cells expressing TNF and IL-17A and the frequency of CD8+ cells expressing IFN-γ in Peyer's Patches were also increased in ethanol/CLP. Thus, there is an ethanol-specific worsening of gut barrier function following CLP that impacts all pathways of intestinal permeability, mediated, in part, via changes to the tight junction. Differences in the host response in the setting of chronic alcohol use may play a role in future precision medicine approaches toward the treatment of sepsis.

DOI： 10.1097/SHK.0000000000002162

Association between prehospital advanced life support by emergency medical services personnel and neurological outcomes among adult out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation: A secondary analysis of the SAVE-J II study. 査読国際誌

Tetsuya Yumoto, Takashi Hongo, Toru Hifumi, Akihiko Inoue, Tetsuya Sakamoto, Yasuhiro Kuroda, Takashi Yorifuji, Atsunori Nakao, Hiromichi Naito

Journal of the American College of Emergency Physicians open 4 ( 2 ) e12948 2023年4月

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）

STUDY OBJECTIVE: Early deployment of extracorporeal cardiopulmonary resuscitation (ECPR) is critical in treating refractory out-of-hospital cardiac arrest (OHCA) patients who are potential candidates for ECPR. The effect of prehospital advanced life support (ALS), including epinephrine administration or advanced airway, compared with no ALS in this setting remains unclear. This study's objective was to determine the association between any prehospital ALS care and outcomes of patients who received ECPR with emergency medical services-treated OHCA. METHODS: This was a secondary analysis of data from the Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J) II study. Patients were separated into 2 groups-those who received prehospital ALS (ALS group) and those did not receive prehospital ALS (no ALS group). Multiple logistic regression analysis was used to investigate the association between prehospital ALS and favorable neurological outcomes (defined as Cerebral Performance Category scores 1-2) at hospital discharge. RESULTS: A total of 1289 patients were included, with 644 patients in the ALS group and 645 patients in the no ALS group. There were fewer favorable neurological outcomes at hospital discharge in the ALS group compared with the no ALS group (10.4 vs 19.8%, p <0.001). A multiple logistic regression analysis revealed that any prehospital ALS care (adjusted odds ratios 0.47; 95% confidence interval 0.34-0.66; p <0.001) was associated with unfavorable neurological outcomes at hospital discharge. CONCLUSION: Prehospital ALS was associated with worse neurological outcomes at hospital discharge in patients treated with ECPR for OHCA. Further prospective studies are required to determine the clinical implications of these findings.

DOI： 10.1002/emp2.12948

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

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

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）

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

Organ Donation after Extracorporeal Cardiopulmonary Resuscitation and Brain Death. 査読

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

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

担当区分：責任著者記述言語：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

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

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

担当区分：責任著者記述言語：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

Automatic emergency calls from smartphone/smartwatch applications in trauma. 査読国際誌

Takashi Hongo, Shunki Yamamoto, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao, Tetsuya Yumoto

Acute medicine & surgery 10 ( 1 ) e875 2023年

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

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

Clinical parameter-guided initial resuscitation in adult patients with septic shock: A systematic review and network meta-analysis. 査読国際誌

Tetsuya Yumoto, Tomoki Kuribara, Kohei Yamada, Takehito Sato, Shigeru Koba, Kenichi Tetsuhara, Masahiro Kashiura, Masaaki Sakuraya

Acute medicine & surgery 10 ( 1 ) e914 2023年

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）

AIM: To identify the most useful tissue perfusion parameter for initial resuscitation in sepsis/septic shock adults using a network meta-analysis. METHODS: We searched major databases until December 2022 for randomized trials comparing four tissue perfusion parameters or against usual care. The primary outcome was short-term mortality up to 90 days. The Confidence in Network Meta-Analysis web application was used to assess the quality of evidence. RESULTS: Seventeen trials were identified. Lactate-guided therapy (risk ratios, 0.59; 95% confidence intervals [0.45-0.76]; high certainty) and capillary refill time-guided therapy (risk ratios, 0.53; 95% confidence intervals [0.33-0.86]; high certainty) were significantly associated with lower short-term mortality compared with usual care, whereas central venous oxygen saturation-guided therapy (risk ratio, 1.50; 95% confidence intervals [1.16-1.94]; moderate certainty) increased the risk of short-term mortality compared with lactate-guided therapy. CONCLUSIONS: Lactate or capillary refill time-guided initial resuscitation for sepsis/septic shock patients may decrease short-term mortality. More research is essential to personalize and optimize treatment strategies for septic shock resuscitation.

DOI： 10.1002/ams2.914

Rare case of intracerebral hemorrhage in anaphylactic shock following administration of intramuscular adrenaline: A case report. 査読国際誌

Shunki Yamamoto, Takashi Hongo, Tomokazu Tamura, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Clinical case reports 10 ( 11 ) e6534 2022年11月

Predictive Factors of Return Home and Return to Work for Intensive Care Unit Survivors after Traumatic Brain Injury with a Follow-up Period of 2 Years. 査読

Satoru Yabuno, Takao Yasuhara, Satoshi Murai, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao, Isao Date

Neurologia medico-chirurgica 62 ( 10 ) 465 - 474 2022年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

Intensive care unit (ICU) survivors after traumatic brain injury (TBI) frequently have serious disabilities with subsequent difficulty in reintegration into society. We aimed to investigate outcomes for ICU survivors after moderate to severe TBI (msTBI) and to identify predictive factors of return home (RH) and return to work (RTW). This single-center retrospective cohort study was conducted on all trauma patients admitted to the emergency ICU of our hospital between 2013 and 2017. Of these patients, adult (age ≥ 18 years) msTBI patients with head Abbreviated Injury Scale ≥ 3 were extracted. We performed univariate/multivariate logistic regression analyses to explore the predictive factors of RH and RTW. Among a total of 146 ICU survivors after msTBI, 107 were included (median follow-up period: 26 months). The RH and RTW rates were 78% and 35%, respectively. Multivariate analyses revealed that the predictive factors of RH were age < 65 years (P < 0.001), HR < 76 bpm (P = 0.015), platelet count ≥ 19× 104/μL (P = 0.0037), D-dimer < 26 μg/mL (P = 0.034), and Glasgow Coma Scale (GCS) score > 8 (P = 0.0015). Similarly, the predictive factors of RTW were age < 65 years (P < 0.001) and GCS score > 8 (P = 0.0039). This study revealed that "age" and "GCS score on admission" affected RH and RTW for ICU survivors after msTBI.

DOI： 10.2176/jns-nmc.2022-0149

Elderly woman with rapid progression of swallowing difficulty. 査読国際誌

Ryo Tanabe, Tsuyoshi Nojima, Tetsuya Yumoto, Atsunori Nakao

Journal of the American College of Emergency Physicians open 3 ( 5 ) e12806 2022年10月

院外心停止患者において,バイスタンダーCPR施行者の性別は神経学的予後に影響しない

中村俊介, 野島剛, 内藤宏道, 湯本哲也, 飯田淳義, 實金健, 中尾篤典

日本救急医学会雑誌 33 ( 10 ) 716 - 716 2022年10月

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

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

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

Frequency, associated factors, and associated outcomes of dysphagia following sepsis. 査読国際誌

Takashi Hongo, Tetsuya Yumoto, Hiromichi Naito, Toshifumi Fujiwara, Jun Kondo, Satoshi Nozaki, Atsunori Nakao

Australian critical care : official journal of the Confederation of Australian Critical Care Nurses 2022年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Identifying dysphagia as a potential complication of sepsis may improve swallowing function and survival while decreasing hospital length of stay. OBJECTIVES: Our goal was to determine the frequency of dysphagia in sepsis survivors on the 7th day after admission, as well as their associated factors and outcomes. METHODS: This single-centre, retrospective, observational study analysed data from sepsis survivors admitted to Okayama Saiseikai General Hospital from 2018 to 2019. Participants with sepsis were assigned to one of two study groups based on the presence or absence of dysphagia using the criterion of Functional Oral Intake Scale score <5 on the 7th day after admission. We used multivariate logistic regression to determine factors independently associated with dysphagia on the 7th day after admission. Multivariate logistic regression was also used to determine associations between groups and outcomes, including dysphagia on hospital discharge, direct discharge home (discharge of patients directly to their home), and total dependency (Barthel Index score ≤20) on hospital discharge. RESULTS: One hundred one patients met the study inclusion criteria, 55 with dysphagia and 46 without dysphagia. Fasting period (adjusted odds ratio [AOR]: 1.31, 95% confidence interval [CI]: 1.07-1.59) and enteral tube feeding (AOR: 8.56, 95% CI: 1.95-37.5) were independently associated with the presence of dysphagia on the 7th day after admission. Dysphagia on the 7th day after admission was associated with dysphagia on hospital discharge (AOR: 46.0, 95%, CI: 7.90-268.3), a lower chance of direct discharge home (AOR: 0.03, 95% CI: 0.01-0.15), and a higher incidence of total dependency (AOR: 9.30, 95% CI: 2.68-32.2). CONCLUSIONS: We found that dysphagia was commonly encountered post sepsis. Fasting period and enteral tube feeding were independently associated with dysphagia on the 7th day after admission. Dysphagia on the 7th day after admission was also associated with dysphagia on hospital discharge, nondirect discharge home, and dependency in activities of daily living at the time of hospital discharge.

DOI： 10.1016/j.aucc.2022.06.003

Thoracic vertebral fractures and azygos or hemiazygos vein injuries during cardiopulmonary resuscitation: Caution needed. 査読国際誌

Tsuyoshi Nojima, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Resuscitation plus 10 100261 - 100261 2022年6月

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. 査読国際誌

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

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

The microbiome restrains melanoma bone growth by promoting intestinal NK and Th1 cells homing to bone. 査読国際誌

Subhashis Pal, Daniel S Perrien, Tetsuya Yumoto, Roberta Faccio, Andreea Stoica, Jonathan Adams, Craig M Coopersmith, Rheinallt M Jones, M Neale Weitzmann, Roberto Pacifici

The Journal of clinical investigation 132 ( 12 ) 2022年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

Bone metastases are frequent complications of malignant melanoma leading to reduced quality of life and significant morbidity. Regulation of immune cells by the gut microbiome influences cancer progression, but the role of the microbiome in tumor growth in bone is unknown. Using intracardiac or intratibial injections of B16-F10 melanoma cells in mice we showed that gut microbiome depletion by broad-spectrum antibiotics accelerated intraosseous tumor growth and osteolysis. Microbiome depletion blunted melanoma-induced expansion of intestinal natural killer (NK) cells and T helper 1 (Th1) cells and their migration from the gut to tumor bearing bones. Demonstrating the functional relevance of immune cell trafficking from the gut to the bone marrow (BM) in bone metastasis, blockade of S1P-mediated NK and Th1 cells intestinal egress, or inhibition of their CXCR3/CXCL9-mediated influx into the BM prevented expansion of BM NK and Th1 cells and accelerated tumor growth and osteolysis. Using a mouse model, this study revealed mechanisms of microbiota-mediated gut-bone crosstalk that are relevant to the immunological restraint of melanoma metastasis and tumor growth in bone. Microbiome modifications induced by antibiotics might have negative clinical consequences in melanoma patients.

DOI： 10.1172/JCI157340

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Impact of contrast extravasation on computed tomography of the psoas major muscle in patients with blunt torso trauma. 査読国際誌

Tetsuya Yumoto, Hiromichi Naito, Takao Hiraki, Yasuaki Yamakawa, Taihei Yamada, Atsunori Nakao

The journal of trauma and acute care surgery 86 ( 2 ) 268 - 273 2019年2月

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 clinical significance of contrast extravasation (CE) on computed tomography (CT) of the psoas major muscle after blunt torso trauma and the optimal management of patients requiring transcatheter arterial embolization (TAE) of the lumbar artery have not been well elucidated. The aim of this study was to investigate the impact of CE on CT to determine the need for TAE of the lumbar artery. METHODS: We examined a single-center retrospective cohort of blunt torso trauma patients who underwent contrast-enhanced CT from 2008 to 2017. Basic demographics and clinical data were obtained, including the number of lumbar transverse process fractures (LTPFs) and maximum psoas major muscle hematoma (PMMH) size and ratio. Maximum PMMH size was analyzed by measuring the cross-sectional area of hematoma size at the level of CE. Psoas major muscle hematoma size ratio was obtained by dividing maximum PMMH size by psoas major muscle size of the unaffected side at the same slice level. RESULTS: A total of 762 patients were included. One hundred seventeen patients had LTPFs and/or PMMH. Of 117 patients, 25 had CE on CT of the psoas major muscle and had significantly higher rates of older age and severe injury compared with those without CE. Of the 25 patients with CE, 13 required TAE of the lumbar artery. Patients who required TAE had a significantly higher number of LTPFs (4 vs. 2, p = 0.011) and higher PMMH size ratio (2.10 vs. 1.32, p = 0.016). Psoas major muscle hematoma size ratio revealed moderate accuracy (area under the receiver operating characteristic curve, 0.782). CONCLUSIONS: Approximately half of the blunt torso trauma patients with CE on CT of the psoas major muscle will require TAE of the lumbar artery. Higher number of LTPFs and larger PMMH size can be a predictor of the need for TAE of the lumbar artery among patients with CE on CT. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.

DOI： 10.1097/TA.0000000000002121

Case of Nontraumatic Rectus Sheath Hematoma from Muscle Training Mimicking Acute Abdomen. 査読国際誌

Yukino Ariyoshi, Hiromichi Naito, Hiromi Ihoriya, Tetsuya Yumoto, Noritomo Fujisaki, Kohei Tsukahara, Taihei Yamada, Yasuhiro Mandai, Takaaki Osako, Atsunori Nakao

Case reports in emergency medicine 2019 3158969 - 3158969 2019年

記述言語：英語

Rectus sheath hematoma is an unusual but well-known clinical problem. Our hospital admitted a 54-year-old woman complaining of harsh right-sided hypogastric pain that started while muscle training. Computed tomography of the abdomen and pelvis demonstrated a right rectus sheath hematoma. As the hematoma did not increase, the patient was conservatively treated. Despite increased awareness of rectus sheath hematoma, its early diagnosis and treatment still present a challenge to emergency physicians. Swift acknowledgement of this rare cause of abdominal pain may avoid more intrusive examination, unnecessary hospitalization, and laparotomy. Careful consideration of the patient's medical history and a high index of suspicion are needed to diagnose this complication.

DOI： 10.1155/2019/3158969

Mortality in trauma patients admitted during, before, and after national academic emergency medicine and trauma surgery meeting dates in Japan. 査読国際誌

Tetsuya Yumoto, Hiromichi Naito, Hiromi Ihoriya, Takashi Yorifuji, Atsunori Nakao

PloS one 14 ( 1 ) e0207049 2019年

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）

Annually, many physicians attend national academic meetings. While participating in these meetings can have a positive impact on daily medical practice, attendance may result in reduced medical staffing during the meeting dates. We sought to examine whether there were differences in mortality after trauma among patients admitted to the hospital during, before, and after meeting dates. Using the Japan Trauma Data Bank, we analyzed in-hospital mortality in patients with traumatic injury admitted to the hospital from 2004 to 2015 during the dates of two national academic meetings-the Japanese Association for Acute Medicine (JAAM) and the Japanese Association for the Surgery of Trauma (JAST). We compared the data with that of patients admitted with trauma during identical weekdays in the weeks before and after the meetings, respectively. We used multiple logistic regression analysis to compare outcomes among the three groups. A total of 7,491 patients were included in our analyses, with 2,481, 2,492, and 2,518 patients in the during, before, and after meeting dates groups, respectively; their mortality rates were 7.3%, 8.0%, and 8.5%, respectively. After adjusting for covariates, no significant differences in in-hospital mortality were found among the three groups (adjusted odds ratio [95% CI] of the before meeting dates and after meeting dates groups; 1.18 [0.89-1.56] and 1.23 [0.93-1.63], respectively, with the during meeting dates group as the reference category). No significant differences in in-hospital mortality were found among trauma patients admitted during, before, and after the JAAM and JAST meeting dates.

DOI： 10.1371/journal.pone.0207049

A patient presenting painful chest wall swelling: Tietze syndrome. 査読国際誌

Kohei Sawada, Hiromi Ihoriya, Taihei Yamada, Tetsuya Yumoto, Kohei Tsukahara, Takaaki Osako, Hiromichi Naito, Atsunori Nakao

World journal of emergency medicine 10 ( 2 ) 122 - 124 2019年

Gastric Emphysema in a Critically Ill Patient Successfully Treated without Surgery. 査読国際誌

Hiromi Ihoriya, Tetsuya Yumoto, Masaya Iwamuro, Noritomo Fujisaki, Takaaki Osako, Hiromichi Naito, Atsunori Nakao

Case reports in critical care 2019 1824101 - 1824101 2019年

担当区分：責任著者記述言語：英語

Gastric emphysema is a relatively rare clinical entity caused by injury to the gastric mucosa. A 62-year-old Japanese male with a history of heavy alcohol consumption and smoking was admitted to the emergency intensive care unit due to severe hypercapnic respiratory acidosis. His body mass index was only 12.6. Ten days after initiation of enteral feeding, he complained of abdominal pain. Computed tomography revealed intraluminal air in the distended gastric wall. Esophagogastroduodenoscopy showed diffuse edema, redness, and erosion throughout the stomach. Based on the findings of narrow angle and short distance of the aorta-superior mesenteric artery, the patient was diagnosed with gastric emphysema associated with superior mesenteric artery syndrome. He was successfully managed nonoperatively with treatments including intravenous antibiotics, gastric decompression, and bowel rest. Physicians should be aware of this unusual condition in such critically ill patients complaining of abdominal pain and needing close monitoring and observation to exclude gastric necrosis or perforation.

DOI： 10.1155/2019/1824101

Orbital Emphysema as a Consequence of Forceful Nose-Blowing: Report of a Case. 査読国際誌

Yukino Ariyoshi, Hiromichi Naito, Tetsuya Yumoto, Atsuyoshi Iida, Hirotsugu Yamamoto, Noritomo Fujisaki, Toshiyuki Aokage, Kohei Tsukahara, Taihei Yamada, Yasuhiro Mandai, Takaaki Osako, Atsunori Nakao

Case reports in emergency medicine 2019 4383086 - 4383086 2019年

記述言語：英語

Orbital emphysema occurs when air enters the soft tissue surrounding the orbit. Although orbital blowout fractures are often caused by face trauma, nontraumatic orbital fractures can also occur but have been rarely described. Here, a case of orbital and palpebral emphysema caused by forceful nose-blowing is presented. Examination uncovered gross swelling of the right eye and discernable subcutaneous emphysema. The patient had normal eye movement and visual acuity. Orbital computed tomography (CT) revealed orbital emphysema secondary to an orbit floor fracture into the maxillary sinus, resulting from high intranasal pressure upon blowing her nose. The patient received conservative management with antibiotics and was given instructions not to sneeze or blow her nose. She fully recovered and all her symptoms completely resolved.

DOI： 10.1155/2019/4383086

Emphysematous cystitis successfully treated with hyperbaric oxygen therapy: case report 査読

Hirotaka Yasuhara, Hiromichi Naito, Yoshinori Kosaki, Yasuaki Yamakawa, Atsuyoshi Iida, Tetsuya Yumoto, Hirotsugu Yamamoto, Taihei Yamada, Kohei Tsukahara, Takaaki Osako, Yasuhiro Mandai, Atsunori Nakao

UNDERSEA AND HYPERBARIC MEDICINE 45 ( 6 ) 701 - 703 2018年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：UNDERSEA & HYPERBARIC MEDICAL SOC INC

Emphysematous cystitis is an uncommon acute infection of the underlying bladder musculature and mucosa, caused by gas-producing organisms. Here we describe an 87-year-old woman with diabetes mellitus and emphysematous cystitis who was successfully treated with hyperbaric oxygen (HBO2) therapy. Her predisposition of diabetes and infection with gas-producing bacteria was considered to precede the development of emphysematous cystitis. Computed tomography revealed gas accumulation in the bladder wall and lumen. Antibiotics and HBO2 therapy were administered. HBO2 therapy may be beneficial due to the improvement in oxygenation of the tissues affected by the disease. HBO2 is a useful adjunct therapy for the management of severe emphysematous cystitis.

Subperiosteal Hematoma of the Iliac Bone: An Unusual Cause of Acute Hip Pain after a Fall. 査読国際誌

Tetsuya Yumoto, Ryoji Joko, Yasuaki Yamakawa, Taihei Yamada, Hiromichi Naito, Atsunori Nakao

The American journal of case reports 19 1083 - 1086 2018年9月

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 Subperiosteal hematoma (SPH) of the iliac bone is an extremely uncommon clinical entity that occurs mostly in young patients with a history of a recent fall or sports-related injury. Patients usually complain of severe hip pain after a fall, mimicking femoral neck fracture. CASE REPORT An 18-year-old female was transported to our hospital complaining of pain in her left hip after falling on her buttocks while engaging in martial arts. Ultrasound of her left iliac region revealed a subperiosteal mass on the internal aspect of the iliac bone lifting the iliac muscle. SPH of the iliac bone was suspected, which was also evident on pelvis and hip magnetic resonance imaging. Repetitive ultrasound did not reveal hematoma expansion. She was discharged from the hospital the next day without femoral neuropathy. CONCLUSIONS Physicians should be aware of our report, which highlights a patient with the rare clinical condition of SPH of the iliac bone occurring immediately after a fall. The differential diagnosis of acute hip pain, which mimics femoral neck fracture, should be considered in young patients. Ultrasound of the iliac region may be useful in detection and further management of SPH of the iliac bone.

DOI： 10.12659/AJCR.910010

Ictal Cardiorespiratory Arrest Associated with Status Epilepticus in Panayiotopoulos Syndrome. 査読

Hirotsugu Yamamoto, Hiromichi Naito, Takaaki Osako, Kohei Tsukahara, Taihei Yamada, Tetsuya Yumoto, Atsuyoshi Iida, Yoshinori Kosaki, Makio Oka, Fumika Endo, Akira Gochi, Atsunori Nakao

Acta medica Okayama 72 ( 3 ) 297 - 300 2018年6月

記述言語：英語

A healthy 10-year-old boy vomited during sleep and later complained of abdominal pain; he became drowsy and uncommunicative. At the nearby hospital E.R., he deteriorated rapidly, and his respiratory movements were absent with cardiac arrest. He was immediately resuscitated. Brain MRI showed no abnormalities. EEG revealed an abnormal pattern with recurrent multifocal epileptiform activity over the bilateral occipital and frontal regions during sleep. Based on the clinical/radiological findings we diagnosed Panayiotopoulos syndrome (PS), a benign form of early-onset pediatric epilepsy characterized by autonomic symptoms. Lifethreating cardiopulmonary arrest is rare in PS, but long seizure duration of PS may associate with apnea and bradycardia.

DOI： 10.18926/AMO/56076

Delayed hydronephrosis due to retroperitoneal hematoma after a seatbelt injury: A case report. 査読国際誌

Tetsuya Yumoto, Yoshitaka Kondo, Kento Kumon, Yoshihisa Masaoka, Takao Hiraki, Taihei Yamada, Hiromichi Naito, Atsunori Nakao

Medicine 97 ( 23 ) e11022 2018年6月

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）

RATIONALE: Hydronephrosis caused by retroperitoneal hematoma after a seatbelt injury is a unique clinical entity. PATIENT CONCERNS: A 21-year-old man, who had been wearing a seatbelt, was brought to our hospital after a motor vehicle collision, complaining of abdominal pain. Computed tomography (CT) revealed retroperitoneal hematoma in the upper pelvic region. Since he was hemodynamically stable throughout admission, he was managed conservatively. Seventeen days after initial discharge, the patient revisited our emergency department due to right back pain. DIAGNOSES: CT scans indicated retroperitoneal hematoma growth resulting in hydronephrosis of the right kidney. INTERVENTIONS: Laparoscopic drainage of the retroperitoneal hematoma was successfully performed. OUTCOMES: His symptoms resolved after the surgery. Follow-up CT scans three months later demonstrated complete resolution of the hydronephrosis and retroperitoneal hematoma. LESSONS: Our case highlights a patient with delayed hydronephrosis because of retroperitoneal hematoma expansion after a seatbelt injury.

DOI： 10.1097/MD.0000000000011022

Raoultella planticola bacteremia-induced fatal septic shock following burn injury. 査読国際誌

Tetsuya Yumoto, Hiromichi Naito, Hiromi Ihoriya, Kohei Tsukahara, Tomoyuki Ota, Toshiyuki Watanabe, Atsunori Nakao

Annals of clinical microbiology and antimicrobials 17 ( 1 ) 19 - 19 2018年5月

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: Raoultella planticola, a Gram-negative, aerobic bacillus commonly isolated from soil and water, rarely causes invasive infections in humans. Septic shock from R. planticola after burn injury has not been previously reported. CASE PRESENTATION: A 79-year-old male was admitted to the emergency intensive care unit after extensive flame burn injury. He accidently caught fire while burning trash and plunged into a nearby tank filled with contaminated rainwater to extinguish the fire. The patient developed septic shock on day 10. The blood culture detected R. planticola, which was identified using the VITEK-2 biochemical identification system. Although appropriate antibiotic treatment was continued, the patient died on day 12. CONCLUSIONS: Clinicians should be aware of fatal infections in patients with burn injury complicated by exposure to contaminated water.

DOI： 10.1186/s12941-018-0270-0

Bias flow rate and ventilation efficiency during adult high-frequency oscillatory ventilation: a lung model study. 査読国際誌

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

Intensive care medicine experimental 6 ( 1 ) 11 - 11 2018年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Bias flow (BF) is essential to maintain mean airway pressure (MAP) and to washout carbon dioxide (CO2) from the oscillator circuit during high-frequency oscillatory ventilation (HFOV). If the BF rate is inadequate, substantial CO2 rebreathing could occur and ventilation efficiency could worsen. With lower ventilation efficiency, the required stroke volume (SV) would increase in order to obtain the same alveolar ventilation with constant frequency. The aim of this study was to assess the effect of BF rate on ventilation efficiency during adult HFOV. METHODS: The R100 oscillator (Metran, Japan) was connected to an original lung model internally equipped with a simulated bronchial tree. The actual SV 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) was estimated as [Formula: see text]CO2 divided by the stabilized value of PCO2. [Formula: see text]A was evaluated by setting SV from 80 to 180 mL (10 mL increments, n = 5) at a frequency of 8 Hz, a MAP of 25 cmH2O, and a BF of 10, 20, 30, and 40 L/min (study 1). Ventilation efficiency was calculated as [Formula: see text]A divided by the actual minute volume. The experiment was also performed with an actual SV of 80, 100, and 120 mL and a BF from 10 to 60 L/min (10 L/min increments: study 2). RESULTS: Study 1: With the same setting SV, the [Formula: see text]A with a BF of 20 L/min or more was significantly higher than that with a BF of 10 L/min. Study 2: With the same actual SV, the [Formula: see text]A and the ventilation efficiency with a BF of 30 L/min or more were significantly higher than those with a BF of 10 or 20 L/min. CONCLUSIONS: Increasing BF up to 30 L/min or more improved ventilation efficiency in the R100 oscillator.

DOI： 10.1186/s40635-018-0176-3

Portal Venous Gas Following Ingestion of Hydrogen Peroxide Successfully Treated with Hyperbaric Oxygen Therapy. 査読

Chika Tsuboi, Hiromichi Naito, Shingo Hagioka, Hiroaki Hanafusa, Takahiro Hirayama, Yoshinori Kosaki, Atsuyoshi Iida, Tetsuya Yumoto, Kohei Tsukahara, Naoki Morimoto, Atsunori Nakao

Acta medica Okayama 72 ( 2 ) 181 - 183 2018年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

The primary toxicity of hydrogen peroxide results from its interaction with catalase, which liberates water and oxygen. We report the case of a 14-year-old Japanese girl with portal venous gas that was caused by oxygen liberated from intentionally ingested hydrogen peroxide. Although she had a past history of atrial septal defect, recovery without cardiac or neurological sequelae was achieved using hyperbaric oxygen therapy. Emergency physicians must be aware of the danger of liberated oxygen due to hydrogen peroxide ingestion.

DOI： 10.18926/AMO/55859

Hyperammonemic encephalopathy in a patient receiving fluorouracil/oxaliplatin chemotherapy. 査読国際誌

Hiromi Ihoriya, Hirotsugu Yamamoto, Taihei Yamada, Kohei Tsukahara, Kanae Inoue, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Clinical case reports 6 ( 4 ) 603 - 605 2018年4月

Cushing's sign and severe traumatic brain injury in children after blunt trauma: a nationwide retrospective cohort study in Japan. 査読国際誌

Tetsuya Yumoto, Hiromichi Naito, Takashi Yorifuji, Hiroki Maeyama, Yoshinori Kosaki, Hirotsugu Yamamoto, Kohei Tsukahara, Takaaki Osako, Atsunori Nakao

BMJ open 8 ( 3 ) e020781 2018年3月

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: We tested whether Cushing's sign could predict severe traumatic brain injury (TBI) requiring immediate neurosurgical intervention (BI-NSI) in children after blunt trauma. DESIGN: Retrospective cohort study using Japan Trauma Data Bank. SETTING: Emergency and critical care centres in secondary and tertiary hospitals in Japan. PARTICIPANTS: Children between the ages of 2 and 15 years with Glasgow Coma Scale motor scores of 5 or less at presentation after blunt trauma from 2004 to 2015 were included. A total of 1480 paediatric patients were analysed. PRIMARY OUTCOME MEASURES: Patients requiring neurosurgical intervention within 24 hours of hospital arrival and patients who died due to isolated severe TBI were defined as BI-NSI. The combination of systolic blood pressure (SBP) and heart rate (HR) on arrival, which were respectively divided into tertiles, and its correlation with BI-NSI were investigated using a multiple logistic regression model. RESULTS: In the study cohort, 297 (20.1%) exhibited BI-NSI. After adjusting for sex, age category and with or without haemorrhage shock, groups with higher SBP and lower HR (SBP ≥135 mm Hg; HR ≤92 bpm) were significantly associated with BI-NSI (OR 2.84, 95% CI 1.68 to 4.80, P<0.001) compared with the patients with normal vital signs. In age-specific analysis, hypertension and bradycardia were significantly associated with BI-NSI in a group of 7-10 and 11-15 years of age; however, no significant association was observed in a group of 2-6 years of age. CONCLUSIONS: Cushing's sign after blunt trauma was significantly associated with BI-NSI in school-age children and young adolescents.

DOI： 10.1136/bmjopen-2017-020781

Far East Scarlet-like Fever Masquerading as Adult-onset Kawasaki Disease. 査読

Kazuki Ocho, Masaya Iwamuro, Kou Hasegawa, Hideharu Hagiya, Kammei Rai, Tetsuya Yumoto, Fumio Otsuka

Internal medicine (Tokyo, Japan) 57 ( 3 ) 437 - 440 2018年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

A previously healthy 31-year-old man was referred to us with refractory septic shock accompanied by bilateral conjunctival congestion and erythema of his right lower limb. Nine days after admission, he had bilateral desquamation of the fingertips, and his presentation satisfied the criteria for Kawasaki disease. A serological examination was positive for Yersinia pseudotuberculosis, and he was diagnosed with Far East scarlet-like fever (FESLF). Interestingly, his 11-month-old baby boy had similar symptoms around the same time, indicating the intrafamilial transmission of the pathogen. We should consider FESLF when we encounter a familial occurrence of systemic manifestations of Kawasaki disease.

DOI： 10.2169/internalmedicine.9250-17

Traumatic Globe Luxation with Complete Optic Nerve Transection Caused by Heavy Object Compression. 査読

Yoshinori Kosaki, Tetsuya Yumoto, Hiromichi Naito, Nobushige Tsuboi, Masahiro Kameda, Masayuki Hirano, Yuki Morizane, Takaya Senoo, Eijirou Tokuyama, Atsunori Nakao

Acta medica Okayama 72 ( 1 ) 85 - 88 2018年2月

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）

Traumatic eyeball luxation is a rare clinical condition with a dramatic presentation. Here, we describe a unique case of traumatic globe luxation and complete optic nerve transection caused by heavy object compression. A 45-year-old male automobile mechanic was injured when a truck slipped from its supports, crushing his head and face. On arrival, his right eyeball was obviously displaced anteriorly and he had no light perception. Computed tomography revealed complex frontal bone and facial fractures with underlying brain contusion in addition to complete transection of the right optic nerve. The patient was successfully treated using a multidisciplinary approach.

DOI： 10.18926/AMO/55669

Penetrating thoracic ice pick injury extending into pulmonary artery: Report of a case. 査読国際誌

Marina Kawaguchi, Hirotsugu Yamamoto, Taihei Yamada, Tetsuya Yumoto, Toshiyuki Aokage, Hiromi Ihoriya, Koki Eto, Takanori Suezawa, Hiromichi Naito, Atsunori Nakao

International journal of surgery case reports 52 63 - 66 2018年

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Penetrating thoracic traumas have a wide spectrum, ranging from mild traumas to life-threatening injuries. PRESENTATION OF CASE: This paper illustrates a 40-year-old male with a penetrating pulmonary artery injury that was successfully treated with emergency surgery. The patient visited local hospital by foot complaining of moving object on his chest and was found that an ice pick was penetrating the man's left chest. An ambulance took the patient to our emergency department. Computed tomography of the chest showed linear metallic density in the pulmonary trunk and a small amount of pericardial fluid. Emergency surgery for removal of the object and repair of the pulmonary artery was performed. The ice pick had been stuck in the main pulmonary artery through the pericardium without any injury to the left lung or internal thoracic artery. Postoperative course was uneventful. DISCUSSION: A multidisciplinary team designed our treatment strategy, enabling us to select the optimal treatment, including diagnostic techniques and surgical approach. A successful trauma management depends on whether a life-threatening conditionexists. Major vascular injury should be rapidly assessed in these cases. Psychiatric aspects of the case are also discussed. CONCLUSION: Early removal of the foreign body is recommended to prevent further damage to the heart.

DOI： 10.1016/j.ijscr.2018.09.052

Acute Agitation as an Initial Manifestation of Neuro-Behçet's Disease. 査読国際誌

Yuki Otsuka, Tetsuya Yumoto, Hiromi Ihoriya, Namiko Matsumoto, Kota Sato, Koji Abe, Hiromichi Naito, Atsunori Nakao

Case reports in emergency medicine 2018 5437027 - 5437027 2018年

担当区分：責任著者記述言語：英語

Managing acutely agitated or violent patients in the emergency department (ED) represents a significant challenge. Acute agitation as an initial manifestation of neuro-Behcet's disease (NBD) is an extremely rare clinical entity. A 44-year-old male, who had been complaining about a severe headache and fever for several days, was admitted to our ED due to acutely presented incontinence and agitation. On admission, physical restraint and sedation with sevoflurane and propofol were required for his combative and violent behavior. Cerebrospinal fluid examination revealed increased cell count. Fluid attenuated inversion recovery magnetic resonance imaging showed a high intensity signal in the left parietal lobe and bilateral occipital lobe. As infectious meningoencephalitis was suspected, empirical therapy was immediately started. He recovered uneventfully without neurological defect in seven days. Based on positive human leukocyte antigen B-51 and clinical manifestations, the diagnosis of NBD was made and remitted by steroid therapy. Although acute NBD commonly presents with focal neurological symptoms, psychiatric symptoms could be considered the first manifestation. A focused and thorough examination coupled with appropriate management strategies can assist emergency clinicians safely and effectively manage these patients.

DOI： 10.1155/2018/5437027

Indirect Calorimetry Measurement of Energy Expenditure Related to Body Position Changes in Healthy Adults. 査読

Kengo Obata, Tetsuya Yumoto, Soichiro Fuke, Kohei Tsukahara, Hiromichi Naito, Atsuyoshi Iida, Tetsuya Takahashi, Yoshihito Ujike, Atsunori Nakao

Acta medica Okayama 71 ( 6 ) 467 - 473 2017年12月

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）

Early mobilization is advocated to prevent intensive care unit-acquired physical weakness, but the patient's workload and its changes in response to body position changes have not been established. We used indirect calorimetry to determine the energy expenditure (EE) in response to body position changes, and we assessed EE's correlation with respiratory parameters in healthy volunteers: 8 males and 8 females, mean age 23.4±1.3 years. The subjects started in the resting supine position followed by a 30° head-up position, a 60° head-up position, an upright sitting position, a standing position, and the resting supine position. EE was determined in real time by indirect calorimetry monitoring the subject's respiratory rate, tidal volume (VT), and minute volume (MV). The highest values were observed immediately after the subjects transitioned from standing to supine, and this was significantly higher compared to the original supine position (1,450±285 vs. 2,004±519 kcal/day, p<0.01). Moderate correlations were observed between VT and EE (r=0.609, p<0.001) and between MV and EE (r=0.576, p<0.001). Increasing VT or MV indicates an increasing patient workload during mobilization. Monitoring these parameters may contribute to safe rehabilitation. Further studies should assess EE in critically ill patients.

DOI： 10.18926/AMO/55583

Venous thromboembolism in major trauma patients: a single-center retrospective cohort study of the epidemiology and utility of D-dimer for screening. 査読国際誌

Tetsuya Yumoto, Hiromichi Naito, Yasuaki Yamakawa, Atsuyoshi Iida, Kohei Tsukahara, Atsunori Nakao

Acute medicine & surgery 4 ( 4 ) 394 - 400 2017年10月

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）

Aim: Venous thromboembolism (VTE) can be a life-threatening complication after major trauma. The aim of this study was to investigate the epidemiology of VTE and to assess the usefulness of D-dimer for screening for VTE in major trauma cases among the Japanese population. Methods: We examined a single-center retrospective cohort of severely injured trauma patients who had been admitted to the emergency intensive care unit at Okayama University Hospital (Okayama, Japan) from April 2013 through to March 2016. Venous thromboembolism was confirmed by computed tomography angiography and computed tomography venography, which was determined based on the attending physician monitoring daily D-dimer levels. Independent risk factors for VTE were determined by multiple logistic regression analysis. D-dimer levels were evaluated using area under the receiver operating characteristic curve (AUROC) to predict VTE. Results: The study cohort consisted of 204 trauma patients (median Injury Severity Score, 20). Of the 204 patients, 65 (32%) developed VTE. The median time from admission to VTE diagnosis was 10 days. In multiple logistic regression analysis, higher Injury Severity Score and the presence of lower extremity fractures were revealed to be a risk factor for VTE. D-dimer levels at day 10 showed moderate accuracy, of which the AUROC was 0.785 (95% confidence interval, 0.704-0.866; P < 0.001). The cut-off that maximized the Youden index was 12.45 μg/mL. Conclusions: At least one of every three major trauma patients had potential development of VTE at a median of 10 days following admission to the intensive care unit. D-dimer levels on day 10 can be a useful predictor of VTE.

DOI： 10.1002/ams2.290

Occult Sources of Bleeding in Blunt Trauma : A Narrative Review. 査読

Tetsuya Yumoto, Yoshinori Kosaki, Yasuaki Yamakawa, Atsuyoshi Iida, Hirotsugu Yamamoto, Taihei Yamada, Kohei Tsukahara, Hiromichi Naito, Takaaki Osako, Atsunori Nakao

Acta medica Okayama 71 ( 5 ) 363 - 368 2017年10月

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）

Worldwide, hemorrhagic shock in major trauma remains a major potentially preventable cause of death. Controlling bleeding and subsequent coagulopathy is a big challenge. Immediate assessment of unidentified bleeding sources is essential in blunt trauma patients with hemorrhagic shock. Chest/pelvic X-ray in conjunction with ultrasonography have been established classically as initial diagnostic imaging modalities to identify the major sources of internal bleeding including intra-thoracic, intra-abdominal, or retroperitoneal hemorrhage related to pelvic fracture. Massive soft tissue injury, regardless of whether isolated or associated with multiple injuries, occasionally causes extensive hemorrhage and acute traumatic coagulopathy. Specific types of injuries, including soft tissue injury or retroperitoneal hemorrhage unrelated to pelvic fracture, can potentially be overlooked or be considered "occult" causes of bleeding because classical diagnostic imaging often cannot exclude such injuries. The purpose of this narrative review article is to describe "occult" or unusual sources of bleeding associated with blunt trauma.

DOI： 10.18926/AMO/55433

Citrobacter braakii bacteremia-induced septic shock after colonoscopy preparation with polyethylene glycol in a critically ill patient: a case report. 査読国際誌

Tetsuya Yumoto, Yoshiyasu Kono, Seiji Kawano, Chihiro Kamoi, Atsuyoshi Iida, Motoko Nose, Keiji Sato, Toyomu Ugawa, Hiroyuki Okada, Yoshihito Ujike, Atsunori Nakao

Annals of clinical microbiology and antimicrobials 16 ( 1 ) 22 - 22 2017年4月

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: Polyethylene glycol (PEG) is widely used for bowel cleaning in preparation for colonoscopy because of its safety. Septic shock after PEG preparation is an extremely rare complication. Herein, we describe a case of septic shock that occurred immediately after colonoscopy preparation with PEG. CASE PRESENTATION: A 75-year-old Japanese male who had previously developed diabetes after total pancreatectomy received PEG in preparation for colonoscopy. He had been admitted to the emergency intensive care unit 4 days earlier due to hematochezia presenting with shock. He ingested PEG to prepare for a colonoscopy examination, which was performed to identify the source of his bleeding over a 5-h period, but suddenly exhibited septic shock and markedly elevated procalcitonin levels. A blood culture subsequently revealed Citrobacter braakii. Immediate resuscitation and intensive care with appropriate antibiotics improved his condition. CONCLUSIONS: Clinicians should be aware of the possibility of deteriorating conditions after bowel preparation with PEG among severely ill patients with recent episodes of hemorrhagic shock.

DOI： 10.1186/s12941-017-0201-5

A Successfully Treated Case of Criminal Thallium Poisoning. 査読国際誌

Tetsuya Yumoto, Kohei Tsukahara, Hiromichi Naito, Atsuyoshi Iida, Atsunori Nakao

Journal of clinical and diagnostic research : JCDR 11 ( 4 ) OD01-OD02 2017年4月

担当区分：筆頭著者,　責任著者記述言語：英語

Thallium was once commonly used as a household rodent or ant killer, but many countries have banned such use due to unintentional or criminal poisonings of humans. A common initial clinical manifestation of thallium poisoning is gastrointestinal symptoms followed by delayed onset of neurological symptoms and alopecia. These clinical characteristics can provide important diagnostic clues regarding thallium poisoning. Here, we report a 23-year-old woman who was poisoned by a business colleague when she unknowingly drank tea containing the toxic substance several times. The patient was treated with multi-dose activated charcoal with airway protection and Prussian blue.

DOI： 10.7860/JCDR/2017/24286.9494

Pneumatosis cystoides intestinalis presenting as pneumoperitoneum in a patient with chronic obstructive pulmonary disease: a case report. 査読国際誌

Atsuyoshi Iida, Hiromichi Naito, Kohei Tsukahara, Tetsuya Yumoto, Nobuyuki Nosaka, Shinnichi Kawana, Keiji Sato, Nobuhiro Takeuchi, Jyunichi Soneda, Atsunori Nakao

Journal of medical case reports 11 ( 1 ) 55 - 55 2017年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Pneumatosis cystoides intestinalis, marked by numerous gas-filled cysts in the intestinal wall and submucosa or intestinal submucosa, is a very uncommon condition. CASE PRESENTATION: A 79-year-old Asian man presented to our emergency department after 2 days of lower abdominal pain with nausea and constipation. His past medical history included chronic obstructive pulmonary disease and he had been treated with home oxygen therapy. The patient was hemodynamically stable and had mild generalized abdominal pain and a soft, distended abdomen without signs of peritonism. A computed tomography scan showed diffuse intraluminal gas and intraperitoneal free gas. Based on the images, a clinical diagnosis of pneumatosis cystoides intestinalis with pneumoperitoneum was made. Considering the patient's physical examination, the peritoneal free air was drained by aspiration and he was observed for 12 h, but remained well. Abdominal symptoms and pneumoperitineum resolved after drainage of the peritoneal air by aspiration. The suspected etiopathogenic mechanism of pneumatosis cystoides intestinalis in the presented patient may have been alveolar air leakage secondary to high airway pressure due to chronic obstructive pulmonary disease; air leakage from an alveolar rupture may have traveled to the retroperitoneum through the mediastinal vessels and entered the mesentery of the bowel. CONCLUSION: Emergency physicians should be aware of the potential development of pneumatosis cystoides intestinalis in chronic obstructive pulmonary disease patients.

DOI： 10.1186/s13256-017-1198-2

Successfully-treated asymptomatic celiac artery aneurysm: A case report. 査読国際誌

Nobuhiro Takeuchi, Junichi Soneda, Hiromichi Naito, Atsuyoshi Iida, Tetsuya Yumoto, Kohei Tsukahara, Atsunori Nakao

International journal of surgery case reports 33 115 - 118 2017年

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Celiac artery aneurysm is a rare vascular lesion. It is frequently discovered after rupture, which leads to death in most cases. We present a case of an asymptomatic celiac artery aneurysm discovered in a 72-year-old female during an evaluation for high grade fever and general fatigue. CASE PRESENTATION: The patient visited our department with complaints of fever and general fatigue. The patient's medical history included type 2 diabetes mellitus with poor control and hypertension. Blood culture and urine culture that were submitted at arrival presented E. Coli. Then, she was diagnosed with bacteremia by urinary tract infection. Transesophageal echocardiography revealed no vegetation at her valves. Computed tomography was performed for investigating her urological abnormalities, revealing a 28×30 mm aneurysm at the trunk of the celiac artery. Blood and urine cultures submitted at arrival were positive for E. coli. Surgical repair performed after the improvement of her urinary tract infection revealed a non-infective aneurysm; thus, aneurysm closure and prosthetic grafting were conducted. CONCLUSION: Clinician awareness regarding this rare entity and discovery efforts to discover the splanchnic aneurysm before rupturing are imperative.

DOI： 10.1016/j.ijscr.2017.02.018

A case of traumatic cardiopulmonary arrest with good neurological outcome predicted by amplitude-integrated electroencephalogram. 査読国際誌

Ko Harada, Kohei Tsukahara, Tetsuya Yumoto, Yasuaki Yamakawa, Atsuyoshi Iida, Hiromichi Naito, Atsunori Nakao

International journal of surgery case reports 36 42 - 45 2017年

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Traumatic cardiopulmonary arrest has a very high mortality, and survival of patients with this condition without neurological disability is rare. PRESENTATION OF CASE: We herein report a case of traumatic cardiopulmonary arrest secondary to accidental amputation of the left lower leg that was successfully treated without any higher brain dysfunction. Although the long duration of cardiopulmonary arrest in this patient suggested hypoxic ischemic encephalopathy, amplitude-integrated electroencephalogram showed normal findings. DISCUSSION: This system may help intensivists evaluate the neurological conditions of patients with suspected hypoxic ischemic encephalopathy in the early stage of the clinical course and may assist in guiding therapeutic interventions. CONCLUSION: Our case supports the usefulness of neurological monitoring using amplitude-integrated electroencephalogram.

DOI： 10.1016/j.ijscr.2017.04.025

Bacteremia or pseudobacteremia? Review of pseudomonas fluorescens infections. 査読国際誌

Takeshi Nishimura, Kenji Hattori, Akihiko Inoue, Taiji Ishii, Tetsuya Yumoto, Kohei Tsukahara, Astunori Nakao, Satoshi Ishihara, Shinichi Nakayama

World journal of emergency medicine 8 ( 2 ) 151 - 154 2017年

Staphylococcus aureus Bacteremia Complicated by Psoas Abscess and Infective Endocarditis in a Patient with Atopic Dermatitis. 査読国際誌

Ichiro Tsuboi, Tetsuya Yumoto, Tatsuya Toyokawa, Katsunori Matsueda, Joichiro Horii, Hiromichi Naito, Atsunori Nakao

Case reports in infectious diseases 2017 4920182 - 4920182 2017年

担当区分：責任著者記述言語：英語

The close relationship between atopic dermatitis (AD) and infective endocarditis (IE) has been implicated. Staphylococcus aureus colonization is frequently seen observed in AD patients' skin lesions. Although a case of IE due to S. aureus bacteremia in an AD patient has been sporadically reported, a case of S. aureus bacteremia complicated by psoas abscess and IE has not been previously reported. A 42-year-old man with a history of AD presented to our hospital complaining of fever, fatigue, chills, lower right back pain, and poor appetite for a week. His blood cultures showed growth of S. aureus. On day 3, the patient presented acute cardiac failure and was diagnosed with IE based on echocardiogram examination. Since the patient's cardiac failure did not respond to medication, an emergency surgery was performed on the fourth day of hospitalization. The patient underwent successful surgical treatment of the heart lesions and subsequent percutaneous drainage of psoas abscess and received intensive antibiotics, which successfully improved his condition. Our report emphasizes awareness of the association between AD and invasive S. aureus infections.

DOI： 10.1155/2017/4920182

Impact of Cushing's sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study. 査読国際誌

Tetsuya Yumoto, Toshiharu Mitsuhashi, Yasuaki Yamakawa, Atsuyoshi Iida, Nobuyuki Nosaka, Kohei Tsukahara, Hiromichi Naito, Atsunori Nakao

Scandinavian journal of trauma, resuscitation and emergency medicine 24 ( 1 ) 147 - 147 2016年12月

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: Cushing's reflex usually results from intracranial hypertension. Although Cushing's sign can implicate severe traumatic brain injury (TBI) in injured patients, no major investigations have been made. The purpose of this study was to assess the predictability of life-threatening brain injury requiring immediate neurosurgical intervention (LT-BI) among trauma patients with Cushing's sign in the prehospital setting. METHODS: This was a retrospective study using data from the Japan Trauma Data Bank from the period of 2010 to 2014. Patients 16 years old or older with blunt mechanisms of injury who were transported directly from the scene and Glasgow Coma Scale for eye opening of one in the prehospital setting were included. LT-BI was defined as patients requiring burr hole evacuation or craniotomy within 24 h of hospital arrival and patients who were non-survivors due to isolated severe TBI. Prehospital systolic blood pressure (pSBP) and heart rate (pHR) were assessed using area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis to predict LT-BI. RESULTS: Of 6332 eligible patients, 1859 (29%) exhibited LT-BI. AUROC of LT-BI using pSBP and pHR was 0.666 (95% confidence interval (CI); 0.652-0.681, P < 0.001), and 0.578 (95% CI; 0.563-0.594, P < 0.001), respectively. AUROC of pSBP was the highest among the 60 ≤ pHR ≤ 99 subgroup, of which AUROC was 0.680 (95% CI; 0.662-0.699, P < 0.001). Multiple logistic regression analysis showed that the higher the pSBP and the lower the pHR, the more likely that the patients had LT-BI. In a group with pSBP ≥ 180 mmHg and pHR ≤ 59 beats/min, the odds ratio and 95% CI of LT-BI after adjusting for age, sex, and severity of injuries to other body regions was 4.77 (2.85-7.97), P < 0.001 was compared with the reference group, which was defined as patients with normal vital signs. DISCUSSION: Our study has found that the combination of hypertension and bradycardia, which are the components of Cushing's sign without eye opening in the prehospital setting was a weak but a significant predictor of LT-BI, or death due to possible isolated severe TBI. CONCLUSIONS: Prehospital Cushing's sign with disturbed level of consciousness in trauma patients was a weak but significant predictor of the need for immediate neurosurgical intervention.

The Clinical Application of Hydrogen as a Medical Treatment. 査読

Atsuyoshi Iida, Nobuyuki Nosaka, Tetsuya Yumoto, Emily Knaup, Hiromichi Naito, Chihiro Nishiyama, Yasuaki Yamakawa, Kohei Tsukahara, Michihisa Terado, Keiji Sato, Toyomu Ugawa, Atsunori Nakao

Acta medica Okayama 70 ( 5 ) 331 - 337 2016年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

In recent years, it has become evident that molecular hydrogen is a particularyl effective treatment for various disease models such as ischemia-reperfusion injury; as a result, research on hydrogen has progressed rapidly. Hydrogen has been shown to be effective not only through intake as a gas, but also as a liquid medication taken orally, intravenously, or locally. Hydrogen's effectiveness is thus multifaceted. Herein we review the recent research on hydrogen-rich water, and we examine the possibilities for its clinical application. Now that hydrogen is in the limelight as a gaseous signaling molecule due to its potential ability to inhibit oxidative stress signaling, new research developments are highly anticipated.

Intraperitoneally administered, hydrogen-rich physiologic solution protects against postoperative ileus and is associated with reduced nitric oxide production. 査読国際誌

Ayana Okamoto, Keisuke Kohama, Michiko Aoyama-Ishikawa, Hayato Yamashita, Noritomo Fujisaki, Taihei Yamada, Tetsuya Yumoto, Nobuyuki Nosaka, Hiromichi Naito, Kohei Tsukahara, Atsuyoshi Iida, Keiji Sato, Joji Kotani, Atsunori Nakao

Surgery 160 ( 3 ) 623 - 31 2016年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Postoperative ileus, a transient impairment of bowel motility initiated by intestinal inflammation, is common after an abdominal operation and leads to increased hospital stays and costs. Hydrogen has potent anti-inflammatory and antioxidant properties and potential therapeutic value. Solubilized hydrogen may be a portable and practical means of administering therapeutic hydrogen gas. We hypothesized that intraperitoneal administration of hydrogen-rich saline would ameliorate postoperative ileus. METHODS: Ileus was induced via surgical manipulation in mice and rats. The peritoneal cavity was filled with 1.0 mL saline or hydrogen-rich saline (≥1.5-2.0 ppm) before closure of the abdominal incision. Intestinal transit was assessed 24 hours postoperatively. Inflammation was examined by quantitation of neutrophil extravasation and expression of proinflammatory markers. Nitric oxide production was assessed in cultured muscularis propria. RESULTS: Surgical manipulation resulted in a marked delay in intestinal transit and was associated with upregulation of proinflammatory cytokines and increased neutrophil extravasation. Bowel dysmotility, induced by surgical manipulation and inflammatory events, was significantly attenuated by intra-abdominal administration of hydrogen-rich saline. Nitric oxide production in the muscle layers of the bowel was inhibited by hydrogen treatment. CONCLUSION: A single intraperitoneal dose of hydrogen-rich saline ameliorates postoperative ileus by inhibiting the inflammatory response and suppressing nitric oxide production.

DOI： 10.1016/j.surg.2016.05.026

Three cases of heparin-induced thrombocytopenia associated with polytrauma. 査読国際誌

Tetsuya Yumoto, Keiji Sato, Nobuharu Fujii, Yo Kinami, Kohei Tsukahara, Toyomu Ugawa, Shingo Ichiba, Yoshihito Ujike

Acute medicine & surgery 3 ( 1 ) 46 - 49 2016年1月

担当区分：筆頭著者,　責任著者記述言語：英語

Case: We present three cases in which patients that had suffered polytrauma developed heparin-induced thrombocytopenia after the start of heparin treatment for thrombosis. All three patients had high injury severity scores and required major surgery. They all started receiving unfractionated heparin for deep venous thrombosis with or without an asymptomatic pulmonary embolism. The patients were clinically diagnosed with heparin-induced thrombocytopenia after their platelet counts fell or exhibited a delayed recovery. Outcome: Heparin-induced thrombocytopenia and the associated thromboses were successfully treated by discontinuing all forms of heparin treatment and administering argatroban followed by warfarin. Conclusion: Early recognition and clinical diagnosis of heparin-induced thrombocytopenia is necessary for clinicians in cases in which severely injured trauma patients show reductions or delayed recovery in their platelet counts in combination with thrombosis after starting heparin treatment.

DOI： 10.1002/ams2.132

Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism. 査読国際誌

Kohei Tsukahara, Keiji Sato, Tetsuya Yumoto, Atsuyoshi Iida, Nobuyuki Nosaka, Michihisa Terado, Hiromichi Naito, Yorihisa Orita, Tomoyuki Naito, Kentaro Miki, Mayu Sugihara, Satoko Nagao, Toyomu Ugawa, Atsunori Nakao

International journal of surgery case reports 26 217 - 20 2016年

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Massive bleeding from the thyroid gland causing airway compromise secondary to indirect neck trauma is rare. PRESENTATION OF CASE: An 89-year-old woman was transferred to our emergency department due to anterior neck pain after a traffic accident. She had been propelled forward and struck her head on the front mirror during emergency braking. Airway patency was confirmed at the first contact. Although her vital signs were stable at presentation, she gradually suffered from respiratory distress and severe dyspnea, implying airway compression, therefore requiring endotracheal intubation. Computed tomography (CT) revealed a large, encapsulated hematoma in the left thyroid gland lobe extending to the upper mediastinum. Contrast-enhanced CT demonstrated an extravasation of the contrast agent around the left superior thyroid artery. The left thyroid artery was ligated and the hematoma was removed immediately. She had a favorable course without further complications and was discharged 36days after admission. DISCUSSION: Airway management is the most important consideration in patients with thyroid injury. Treatment should be customized depending on the degree of respiratory distress resulting from of either involvement of the direct airway or secondary compression. CONCLUSION: Although hemorrhage from the thyroid gland without blunt trauma is rare, emergency physicians should regard possible thyroid gland rupture in patients with swelling of the neck or acute respiratory failure after direct/indirect trauma to the neck. Observation or operative management for limited or expanding hematoma are appropriately based on fundamental neck trauma principles.

DOI： 10.1016/j.ijscr.2016.08.002

A case of cricothyroidotomy for facial trauma in a patient taking antiplatelet agents after a simple ground-level fall. 査読国際誌

Tetsuya Yumoto, Tatsushi Matsumura, Kohei Tsukahara, Keiji Sato, Toyomu Ugawa, Yoshihito Ujike

International journal of surgery case reports 27 87 - 89 2016年

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）

INTRODUCTION: Cricothyroidotomy is an emergency procedure that can be used to secure the airway in situations in which intubation and ventilation are not possible. PRESENTATION OF CASE: We describe a case of 79-year-old male presenting with facial trauma combined with massive upper airway bleeding and swelling in which cricothyroidotomy was required to open the airway in an elderly male patient taking antiplatelet agents who suffered a simple ground-level fall. DISCUSSION: Although emergency airway management is often required in patients with Le Fort fractures, mandibular condyle fractures exhibit a significant relationship with ground-level falls, which are not usually associated with emergency airway management. Prophylactic intubation should be considered prior to transfer or deterioration in a trauma patient with dual antiplatelet drugs and fractures of bilateral mandibular condyle. CONCLUSION: Clinicians should be aware of the life-threatening injuries that can be caused by simple ground-level falls in patients taking antiplatelet agents.

DOI： 10.1016/j.ijscr.2016.08.027

外傷患者における冷汗の意義－多施設共同前向き観察研究より－査読

湯本哲也, 塚原紘平, 飯田淳義, 寺戸通久, 佐藤圭路, 鵜川豊世武, 氏家良人, 西村哲郎, 定光大海, 土谷飛鳥, 植木浜一, 高間辰雄, 真弓俊彦

日本外傷学会雑誌 30 ( 1 ) 1 - 8 2016年

担当区分：筆頭著者,　責任著者記述言語：日本語出版者・発行元：一般社団法人日本外傷学会

ショックを早期に認知するための皮膚所見の１つとして，外傷患者における冷汗の意義を多施設共同前向き観察研究にて検証した．出血性あるいは閉塞性ショックを離脱するためにinterventionを要した症例をショックと定義，冷汗は２人の観察医師が左右それぞれ４ヵ所を別々に評価し，少なくとも１ヵ所でも一致した場合を冷汗ありと定義した．来院時心肺停止，熱傷，転院搬送例を除外した外傷患者411例のうちショックは54例（13％），冷汗は36例（９％）に認めた．ショックで冷汗ありの症例は19例（35％）で，ショックに対する冷汗の感度，特異度，陽性・陰性的中率はそれぞれ35，95，53，91％であった．また，ショックで冷汗ありの症例はなしの症例と比較し，有意に頻脈で，Base excess（BE）が低く，乳酸値が高値であった．ショックに対する冷汗の特異度は高く，冷汗を認めれば介入が必要なショックと認識できる．また，早期認知のためには積極的に冷汗の所見をとりにいくことが重要である．

DOI： 10.11382/jjast.30.1

Donor pretreatment with carbon monoxide prevents ischemia/reperfusion injury following heart transplantation in rats 査読

Atsunori Nakao, Noritomo Fujisaki, Keisuke Kohama, Takeshi Nishimura, Hayato Yamashita, Michiko Ishikawa, Akihiro Kanematsu, Taihei Yamada, Sungsoo Lee, Tetsuya Yumoto, Kohei Tsukahara, Joji Kotani

Medical Gas Research 6 ( 3 ) 122 - 122 2016年

Superior ophthalmic vein thrombosis associated with severe facial trauma: a case report. 査読国際誌

Momoko Mishima, Tetsuya Yumoto, Hiroaki Hashimoto, Takao Yasuhara, Atsuyoshi Iida, Kohei Tsukahara, Keiji Sato, Toyomu Ugawa, Fumio Otsuka, Yoshihito Ujike

Journal of medical case reports 9 244 - 244 2015年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Superior ophthalmic vein thrombosis is a rare entity, but is associated with significant morbidities. We describe a case in which superior ophthalmic vein thrombosis occurred shortly after severe facial trauma. CASE PRESENTATION: A 77-year-old Japanese man was transferred to our tertiary hospital after a motor vehicle accident. Le Fort III facial bone fractures and a minor cerebral contusion were detected. Follow-up computed tomography scans detected dilatation of his left superior ophthalmic vein on day 3 and thrombosis on day 12; however, no causative carotid cavernous fistula was observed. As he did not present with any symptoms other than slight conjunctival congestion, a conservative management strategy was adopted along with anticoagulant therapy against deep venous thrombosis. The superior ophthalmic vein thrombosis resolved spontaneously and the conjunctival congestion also improved. CONCLUSIONS: Superior ophthalmic vein thrombosis should be taken into consideration and managed properly after severe facial injuries, and further investigation of its cause is necessary to prevent morbidities.

DOI： 10.1186/s13256-015-0737-y

An unusual case of a patient who presented with haemorrhagic shock following massive subcutaneous haematomas of the lower back due to blunt trauma. 査読国際誌

Tetsuya Yumoto, Keiji Sato, Toyomu Ugawa, Yoshihito Ujike

BMJ case reports 2015 2015年10月

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）

An 83-year-old woman with no significant medical history was transferred to our tertiary hospital after being hit by a car and presenting with haemorrhagic shock. Immediate fluid resuscitation was performed; physical, chest/pelvic X-ray and echographic examinations did not detect any major sources of bleeding. However, a contrast-enhanced CT scan revealed multiple regions of significant contrast extravasation in an extensive part of the subcutaneous tissue of the patient's lower back, which is an unusual source of bleeding. Transcatheter arterial embolisation of the lumbar and internal iliac arteries and their branches was carried out. In addition, haemostatic resuscitation was performed for damage control resuscitation, which successfully resolved the patient's haemorrhagic shock.

DOI： 10.1136/bcr-2015-211645

Prevalence, risk factors, and short-term consequences of traumatic brain injury-associated hyponatremia. 査読

Tetsuya Yumoto, Keiji Sato, Toyomu Ugawa, Shingo Ichiba, Yoshihito Ujike

Acta medica Okayama 69 ( 4 ) 213 - 8 2015年

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）

Hyponatremia, a common electrolyte disorder associated with traumatic brain injuries (TBIs), has high mortality and morbidity rates. The aim of this study was to identify the risk factors for hyponatremia associated with TBI. We retrospectively analyzed the cases of TBI patients who were admitted to the emergency intensive care unit at Okayama University Hospital between October 2011 and September 2014. A total of 82 TBI patients were enrolled. The incidences of hyponatremia (serum sodium level of＜135mEq/L) and severe hyponatremia (serum sodium level of＜130mEq/L) within the first 14 days after admission were 51% (n＝42) and 20% (n＝16), respectively. After admission, hyponatremia took a median period of 7 days to develop and lasted for a median of 3 days. Multivariate analysis demonstrated that higher fluid intake from days 1 to 3 and the presence of cranial fractures were risk factors for hyponatremia. The 58 patients with hyponatremia experienced fewer ventilator-free days, longer intensive care unit stays, and less favorable outcomes compared to the 24 patients without hyponatremia;however, these differences were not significant. Further studies are needed to determine the optimal management strategy for TBI-associated hyponatremia in the intensive care unit setting.

Characteristics and Costs of Ladder Fall Injuries: A Report from a Single Emergency Center in Okayama. 査読

Nobuyuki Nosaka, Yu Goda, Emily Knaup, Kohei Tsukahara, Tetsuya Yumoto, Toyomu Ugawa, Yoshihito Ujike

Acta medica Okayama 69 ( 5 ) 275 - 8 2015年

記述言語：英語掲載種別：研究論文（学術雑誌）

We sought to identify the incidence, injury patterns, and financial burden of ladder fall injuries to provide a reference for reinforcing guidelines on the prevention of such injuries. We enrolled the patients who were injured in a ladder-related fall and required intensive care between April 2012 and March 2014 at Okayama University Hospital, a tertiary care hospital in Okayama City:9 patients injured in 7 stepladder falls and 2 straight ladder falls. The median patient age was 69 years, and 8 were males. Six falls occurred in non-occupational settings. Head injuries predominated, and the injury severity score ranged from 2 to 35 (mean＝21±12). At the time of discharge from the intensive care unit, one patient had died and 5 patients had some neurological disabilities. The case fatality rate was 11%. The total cost of care during the review period was ￥16,705,794, with a mean cost of ￥1,856,199 per patient. Ladder fall injuries are associated with a high rate of neurological sequelae and pose a financial burden on the health insurance system. A prevention education campaign targeting at older-aged males in non-occupational settings may be a worthwhile health service investment in this community.

Septic shock due to Aeromonas hydrophila bacteremia in a patient with alcoholic liver cirrhosis: a case report. 査読国際誌

Tetsuya Yumoto, Shingo Ichiba, Nao Umei, Sunao Morisada, Kohei Tsukahara, Keiji Sato, Toyomu Ugawa, Yoshihito Ujike

Journal of medical case reports 8 402 - 402 2014年12月

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）

INTRODUCTION: Aeromonas hydrophila sometimes causes bacteremia, which can be fatal in compromised patients, such as those with liver cirrhosis. We present a case of septic shock due to Aeromonas hydrophila bacteremia in a patient with liver cirrhosis, which was successfully treated with rapid resuscitation and critical care. CASE PRESENTATION: A 71-year-old Japanese man with liver cirrhosis was transported to our emergency center by ambulance after presenting with gait difficulties and fever. On arrival, he exhibited shock and severe lactic acidosis, which was suggestive of sepsis, and was immediately resuscitated and administered empiric antibiotic therapy. He also displayed catecholamine-resistant hypotension, which was successfully treated with critical care including supportive therapies, such as polymyxin B hemoperfusion and cytokine-absorbing hemofiltration. Aeromonas hydrophila was detected in his initial blood cultures. CONCLUSIONS: Aeromonas septicemia should be considered in patients with alcoholic liver cirrhosis who have profound shock. In addition to goal-directed therapy and the prompt administration of empiric antibiotic therapy, aggressive critical care involving multiple supportive therapies can save such patients.

DOI： 10.1186/1752-1947-8-402

Mean lung pressure during adult high-frequency oscillatory ventilation: an experimental study using a lung model. 査読

Takahiro Hirayama, Osamu Nagano, Naoki Shiba, Tetsuya Yumoto, Keiji Sato, Michihisa Terado, Toyomu Ugawa, Shingo Ichiba, Yoshihito Ujike

Acta medica Okayama 68 ( 6 ) 323 - 9 2014年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

In adult high-frequency oscillatory ventilation (HFOV), stroke volume (SV) and mean lung pressure (PLung) are important for lung protection. We measured the airway pressure at the Y-piece and the lung pressure during HFOV using a lung model and HFOV ventilators for adults (R100 and 3100B). The lung model was made of a 20-liter, airtight rigid plastic container (adiabatic compliance: 19.3 ml/cmH2O) with or without a resistor (20 cmH2O/l/sec). The ventilator settings were as follows: mean airway pressure (MAP), 30 cmH2O; frequency, 5-15 Hz (every 1 Hz); airway pressure amplitude (AMP), maximum;and % of inspiratory time (IT), 50% for R100, 33% or 50% for 3100B. The measurements were also performed with an AMP of 2/3 or 1/3 maximum at 5, 10 and 15 Hz. The PLung and the measured MAP were not consistently identical to the setting MAP in either ventilator, and decreasing IT decreased the PLung in 3100B. In conclusion, we must pay attention to the possible discrepancy between the PLung and the setting MAP during adult HFOV.

Actual treatments for out-of-hospital ventricular fibrillation at critical care medical centers in Osaka: a pilot descriptive study. 査読国際誌

Tomohiko Sakai, Tetsuhisa Kitamura, Taku Iwami, Yasuyuki Hayashi, Hiroshi Rinka, Yasuo Ohishi, Tomoyoshi Mohri, Masafumi Kishimoto, Ryosuke Kawaguchi, Kentaro Kajino, Tetsuya Yumoto, Toshifumi Uejima, Masahiko Nitta, Tatsuya Nishiuchi, Chizuka Shiokawa, Taro Irisawa, Osamu Tasaki, Hiroshi Ogura, Yasuyuki Kuwagata, Takeshi Shimazu

Acute medicine & surgery 1 ( 3 ) 150 - 158 2014年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

Aim: Although advanced treatments are provided to improve outcomes after out-of-hospital ventricular fibrillation, including shock-resistant ventricular fibrillation, the actual treatments in clinical settings have been insufficiently investigated. The aim of the current study is to describe the actual treatments carried out for out-of-hospital ventricular fibrillation patients, including shock-resistant ventricular fibrillation patients, at critical care medical centers. Methods: We registered consecutive adult patients suffering bystander-witnessed out-of-hospital cardiac arrest of cardiac origin, for whom resuscitation was attempted by emergency medical service personnel, who had ventricular fibrillation as an initial rhythm, and who were transported to critical care medical centers in Osaka from March 2008 to December 2008. This study merged data on treatments after transportation, collected from 11 critical care medical centers in Osaka with the prehospital Utstein-style database. Results: During the study period, there were 260 bystander-witnessed ventricular fibrillation arrests of cardiac origin. Of them, 252 received defibrillations before hospital arrival, 112 (44.4%) were transported to critical care medical centers, and 35 had shock-resistant ventricular fibrillation. At the critical care medical centers, 54% (19/35), 40% (14/35), and 46% (16/35) of shock-resistant ventricular fibrillation patients were treated with extracorporeal life support, percutaneous coronary interventions, and therapeutic hypothermia, respectively, but their treatments differed among institutions. Some patients with prolonged arrest without prehospital return of spontaneous circulation who received advanced treatments had neurologically favorable survival, whereas approximately two-thirds of shock-resistant ventricular fibrillation patients with advanced treatments did not. Conclusion: This pilot descriptive study suggested that actual treatments for prehospital ventricular fibrillation patients differed between critical care medical centers. Further studies are warranted to evaluate the effectiveness of in-hospital advanced treatments for ventricular fibrillation including shock-resistant ventricular fibrillation.

DOI： 10.1002/ams2.27

Immediate screening method for predicting the necessity of massive transfusions in trauma patients: a retrospective single-center study. 査読国際誌

Tetsuya Yumoto, Atsuyoshi Iida, Takahiro Hirayama, Kohei Tsukahara, Naoki Shiba, Hideo Yamanouchi, Keiji Sato, Toyomu Ugawa, Shingo Ichiba, Yoshihito Ujike

Journal of intensive care 2 ( 1 ) 54 - 54 2014年

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: Hemostatic resuscitation might improve the survival of severely injured trauma patients. Our objective was to establish a simplified screening system for determining the necessity of massive transfusions (MT) at an early stage in trauma cases. METHODS: We retrospectively analyzed the cases of trauma patients who had been transported to our institution between November 2011 and October 2013. Patients who were younger than 18 years of age or who were confirmed to have suffered a cardiac arrest at the scene or on arrival were excluded. MT were defined as transfusions involving the delivery of ≥10 units of red blood cell concentrate within the first 24 h after arrival. RESULTS: A total of 259 trauma patients were included in this study (males: 178, 69%). Their mean age was 49 ± 20, and their median injury severity score was 14.4. Thirty-three (13%) of the patients required MT. The presence of a shock index of ≥1, a base excess of ≤ -3 mmol/L, or a positive focused assessment of sonography for trauma (FAST) result was found to exhibit sensitivity and specificity values of 0.97 and 0.81, respectively, for predicting the necessity of MT. Furthermore, this method displayed an area under the receiver operating characteristic curve of 0.934 (95% confidence interval, 0.891-0.978), which indicated that it was highly accurate. CONCLUSIONS: Our screening method based on the shock index, base excess, and FAST result is a simple and useful way of predicting the necessity of MT early after trauma.

DOI： 10.1186/s40560-014-0054-3

Seat belt injury to the inguinal region presenting with hemorrhagic shock. 査読国際誌

Tetsuya Yumoto, Keiji Sato, Reiichiro Tanaka, Yoshihito Ujike

The Journal of emergency medicine 45 ( 6 ) 828 - 30 2013年12月

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: Seat belts uncommonly result in various injuries to the abdominal area, such as mesenteric tears, bowel perforations, and abdominal aortic ruptures. We describe a case of a massive subcutaneous hematoma causing hemorrhagic shock from significant lacerations to the inguinal region, related to the use of a seat belt. OBJECTIVES: To describe a seat belt injury to the inguinal region that presented with a massive subcutaneous hematoma, and to speculate about the mechanism that caused the injury. CASE REPORT: A 60-year-old woman, who was wearing a seat belt, was brought to our tertiary hospital Emergency Department after a head-on motor vehicle accident. The patient had vascular injury around the right inguinal region resulting in hemorrhagic shock. Transcatheter arterial embolization (TAE) was successfully performed to stop the bleeding. CONCLUSION: Seat belts can cause serious injury to the inguinal region, mainly due to shearing forces. In addition to gauze packing, TAE was used effectively to control the hemorrhage in this patient.

DOI： 10.1016/j.jemermed.2012.07.093

Left anomalous brachiocephalic vein in a patient with right lung cancer. 査読国際誌

Ryota Nakamura, Inage Yoshihisa, Kenichi Iwasaki, Tetsuya Yumoto, Kenji Yuzawa, Hamaichi Ueki

The Annals of thoracic surgery 96 ( 1 ) 307 - 9 2013年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

The left anomalous brachiocephalic vein is a rare anomaly without congenital heart disease. It is important to recognize this anomalous vein especially in patients with lung cancer because misinterpretation as a superior mediastinal lymph node enlargement may cause serious complications. We report a case of a 62-year-old lung cancer patient with left anomalous brachiocephalic vein, who underwent surgical treatment safely under video-assisted thoracoscopic surgery after confirmation of this anomaly on contrast-enhanced computed tomographic scan.

DOI： 10.1016/j.athoracsur.2012.11.030

Overheated and melted intracranial pressure transducer as cause of thermal brain injury during magnetic resonance imaging: case report. 査読国際誌

Reiichiro Tanaka, Tetsuya Yumoto, Naoki Shiba, Motohisa Okawa, Takao Yasuhara, Tomotsugu Ichikawa, Koji Tokunaga, Isao Date, Yoshihito Ujike

Journal of neurosurgery 117 ( 6 ) 1100 - 9 2012年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

Magnetic resonance imaging is used with increasing frequency to provide accurate clinical information in cases of acute brain injury, and it is important to ensure that intracranial pressure (ICP) monitoring devices are both safe and accurate inside the MRI suite. A rare case of thermal brain injury during MRI associated with an overheated ICP transducer is reported. This 20-year-old man had sustained a severe contusion of the right temporal and parietal lobes during a motor vehicle accident. An MR-compatible ICP transducer was placed in the left frontal lobe. The patient was treated with therapeutic hypothermia, barbiturate therapy, partial right temporal lobectomy, and decompressive craniectomy. Immediately after MRI examination on hospital Day 6, the ICP monitor was found to have stopped working, and the transducer was subsequently removed. The patient developed meningitis after this event, and repeat MRI revealed additional brain injury deep in the white matter on the left side, at the location of the ICP transducer. It is suspected that this new injury was caused by heating due to the radiofrequency radiation used in MRI because it was ascertained that the tip of the transducer had been melted and scorched. Scanning conditions--including configuration of the transducer, MRI parameters such as the type of radiofrequency coil, and the specific absorption rate limit--deviated from the manufacturer's recommendations. In cooperation with the manufacturer, the authors developed a precautionary tag describing guidelines for safe MR scanning to attach to the display unit of the product. Strict adherence to the manufacturer's guidelines is very important for preventing serious complications in patients with ICP monitors undergoing MRI examinations.

DOI： 10.3171/2012.9.JNS12738

Presentation of Garcin syndrome due to lung cancer. 査読国際誌

Masanori Fujii, Katsuyuki Kiura, Nagio Takigawa, Tetsuya Yumoto, Yoshihide Sehara, Masahiro Tabata, Mitsune Tanimoto

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 2 ( 9 ) 877 - 8 2007年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

Garcin syndrome consists of unilateral palsies of almost all cranial nerves without either sensory or motor long-tract disturbances and without intracranial hypertension, and it is caused by a malignant osteoclastic lesion at the skull base. A 60-year-old woman presented with dizziness and left facial palsy. Progressive left cranial nerve palsies developed over 2 months until gadolinium-enhanced magnetic resonance imaging of the brain revealed an intracranial extension of a tumor from the left skull base. A systemic survey revealed adenocarcinoma of the lung, which had metastasized along the skull base. We experienced a rare case of Garcin syndrome due to skull base metastases from lung cancer.

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