2024/05/24 更新

写真a

ノジマ ツヨシ
野島 剛
Nojima Tsuyoshi
所属
医歯薬学域 助教(特任)
職名
助教(特任)

学位

  • 学士 ( 岡山大学 )

研究分野

  • ライフサイエンス / 内科学一般

  • ライフサイエンス / 救急医学

経歴

  • 岡山大学   地域医療人材育成講座

    2021年4月 - 現在

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    国名:日本国

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  • 岡山大学   救命救急・災害医学講座   医員

    2019年4月 - 2021年3月

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  • 高知医療センター   救命救急科

    2011年4月 - 2019年3月

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  • 高知医療センター   初期研修医

    2009年4月 - 2011年3月

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論文

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

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

    Resuscitation plus   18   100659 - 100659   2024年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    DOI: 10.1016/j.resplu.2024.100659

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

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

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

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    DOI: 10.1186/s13054-024-04949-5

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

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

    Resuscitation Plus   17   100527 - 100527   2024年3月

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

    DOI: 10.1016/j.resplu.2023.100527

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

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

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

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    記述言語:英語  

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

    DOI: 10.31662/jmaj.2023-0081

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

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

    Biomedicines   12 ( 1 )   2024年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    DOI: 10.3390/biomedicines12010118

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

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

    Resuscitation plus   16   100507 - 100507   2023年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    DOI: 10.1016/j.resplu.2023.100507

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  • Transversal Survey of Emergency Medicine Policy and Quality Metrics in Japan's Regional Health Care Plans.

    Atsuyoshi Iida, Shinya Saito, Jun Hamada, Shunsuke Nakamura, Tsuyoshi Nojima, Hiromichi Naito, Takeshi Mikane

    JMA journal   6 ( 3 )   284 - 291   2023年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: It is essential to establish appropriate medical quality metrics and make improvements to safely and efficiently deliver optimum emergency medical services. The Ministry of Health, Labor and Welfare (MHLW) recommends prefectures to establish numerical quality metrics in their regional healthcare plans (RHCP). The 7th RHCP was issued by the MHLW in 2017 along with a notice of planning in covering the six-year period from 2018 to 2023. In this descriptive study, the emergency medicine policies in the 7th RHCP of each prefecture were analyzed from a quality improvement perspective. METHOD: The authors examined the chapters on emergency medicine in the RHCPs of 47 prefectural governments for the overall structure, cost-benefits, and connection to community-based integrated care systems. The type and number of clinical measures listed as numerical metrics and their classification methods were emphasized. RESULT: Regarding the overall plan structure, 40 prefectural governments began their description with an analysis of current surroundings. In total, 24 prefectural governments mentioned community-based integrated care systems but none mentioned cost-benefit analysis. Altogether, only 43 of 47 prefectural governments (91%) indicated numerical metrics. The maximum number of numerical targets for quality measures by prefecture was 19, the minimum was 0, and the median was 4 (IQR: 3-6.5); there were 220 metrics in total, with 82 structural, 96 process, and 42 outcome measures. Additionally, 13 prefectures (28%) classified quality measures according to the MHLW's guidance, 6 (13%) used their own classification manner, while the others did not classify their measures. CONCLUSIONS: There were significant differences in emergency medicine policies and quality metrics among the prefectural governments. Further research is needed to develop and establish more comprehensive and appropriate metrics based on a common methodology to improve the quality of emergency medicine.

    DOI: 10.31662/jmaj.2022-0172

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

    Kenji Aoshima, Takafumi Obara, Tsuyoshi Nojima, Atsunori Nakao

    Internal medicine (Tokyo, Japan)   2023年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.2169/internalmedicine.2203-23

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  • アセトアミノフェン中毒におけるプロカルシトニンの有用性

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

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

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    記述言語:日本語   出版者・発行元:(株)へるす出版  

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

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

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

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

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

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

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

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

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  • アセトアミノフェン中毒におけるプロカルシトニンの有用性

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

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

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    記述言語:日本語   出版者・発行元:(株)へるす出版  

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

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

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

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

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  • 集中治療領域での嚥下障害

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

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

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

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

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

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

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

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

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

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

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

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  • 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   2023年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    DOI: 10.1016/j.surg.2023.04.029

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  • Hydrogen gas treatment improves survival in a rat model of crush syndrome by ameliorating rhabdomyolysis 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3月

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

    Objectives

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

    Methods

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

    Results

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

    Conclusion

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

    DOI: 10.1177/1721727x231168547

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

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

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    DOI: 10.1097/PCC.0000000000003206

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  • 遺伝性血管浮腫(HAE)の診断後に、腹痛発作で救急搬送を繰り返していた一例

    佐々並 三紗, 薬師寺 泰匡, 本郷 貴識, 野島 剛, 上田 浩平, 内藤 宏道, 中尾 篤典

    日本腹部救急医学会雑誌   43 ( 2 )   520 - 520   2023年2月

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    記述言語:日本語   出版者・発行元:(一社)日本腹部救急医学会  

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  • 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

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1002/ams2.875

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

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

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

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1111/ped.15587

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  • 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

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    記述言語:英語  

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

    DOI: 10.1002/ams2.828

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

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

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

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

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  • Bile pigments in emergency and critical care medicine. 査読 国際誌

    Mizuki Seya, Toshiyuki Aokage, Tsuyoshi Nojima, Atsunori Nakao, Hiromichi Naito

    European journal of medical research   27 ( 1 )   224 - 224   2022年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Bile pigments, such as bilirubin and biliverdin, are end products of the heme degradation pathway in mammals and are widely known for their cytotoxic effects. However, recent studies have revealed that they exert cytoprotective effects through antioxidative, anti-inflammatory, and immunosuppressive properties. All these mechanisms are indispensable in the treatment of diseases in the field of emergency and critical care medicine, such as coronary ischemia, stroke, encephalomyelitis, acute lung injury/acute respiratory distress syndrome, mesenteric ischemia, and sepsis. While further research is required before the safe application of bile pigments in the clinical setting, their underlying mechanisms shed light on their utilization as therapeutic agents in the field of emergency and critical care medicine. This article aims to summarize the current understanding of bile pigments and re-evaluate their therapeutic potential in the diseases listed above.

    DOI: 10.1186/s40001-022-00863-0

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  • 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

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1002/emp2.12806

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  • 水素含有臓器保護液は,虚血再灌流後のミトコンドリアの機能回復を早め,細胞死を軽減する

    瀬谷 海月, 青景 聡之, 山田 太平, 渡邉 暁洋, 山本 浩継, 平山 隆浩, 野島 剛, 中尾 篤典, 内藤 宏道

    日本救急医学会雑誌   33 ( 10 )   891 - 891   2022年10月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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

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

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

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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

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

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

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • 医学生による女性型シミュレーターを用いた蘇生実習の検討

    久保 卓也, 本郷 貴識, 塚原 紘平, 野島 剛, 小崎 吉訓, 内藤 宏道, 中尾 篤典

    日本救急医学会雑誌   33 ( 10 )   875 - 875   2022年10月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • 地域枠制度・地域医療に対する持続的発展を担う救急医療教育

    野島 剛, 湯本 哲也, 小崎 吉訓, 長谷川 徹, 塚原 紘平, 内藤 宏道, 小川 弘子, 佐藤 勝, 忠田 正樹, 中尾 篤典

    日本救急医学会雑誌   33 ( 10 )   850 - 850   2022年10月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • 組織の体制整備による持続可能な「臓器提供」

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

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

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • 縦隔気腫を合併した糖尿病性ケトアシドーシスの1例

    山下 航矢, 本郷 貴識, 野島 剛, 湯本 哲也, 内藤 宏道, 中尾 篤典

    日本救急医学会雑誌   33 ( 10 )   881 - 881   2022年10月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    DOI: 10.1016/j.surg.2022.07.021

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  • Mid-term (30- to 90-day) neurological changes in out-of-hospital cardiac arrest patients: A nationwide retrospective study (the JAAM-OHCA registry) 査読 国際誌

    Hiromichi Naito, Tsuyoshi Nojima, Takashi Yorifuji, Noritomo Fujisaki, Atsunori Nakao

    The American Journal of Emergency Medicine   58   27 - 32   2022年8月

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

    OBJECTIVE: Few studies have focused on mid/long-term neurological changes in out-of- hospital cardiac arrest (OHCA) survivors. Some studies suggest that there is still a slow, small, progressive improvement in cognitive function and quality of life for this population, even in the mid/long term. However, clinical data focused on mid/long-term outcomes for OHCA patients are still lacking. This study aimed to assess mid-term neurological changes in OHCA patients. We summarized patients' improved or worsened neurological changes between 30 and 90 days. Then we identified the relationship between clinical variables and 30- to 90-day neurological improvement. METHODS: A retrospective review of data (Jun 2014 - Dec 2017) from a Japanese nationwide OHCA registry was conducted. Inclusion criteria were OHCA patients ≥18 years old. Exclusion criteria were death within 30 days and missing Cerebral Performance Category (CPC) score at 30 and 90 days. We described the distributions of 30-day and 90-day CPC scores as well as the number and portion of patients whose CPC scores improved and worsened between 30 and 90 days. Additionally, factors affecting improved neurological changes over the time period were examined using multivariable logistic regression. RESULTS: Of the registry's 34,745 patients, 1868 were analyzed. Favorable neurological outcomes (CPC scores of 1 and 2) were seen in 1020/1868 patients at 90 days. CPC scores at 90 days were: CPC 1: 866 (46%), CPC 2: 154 (8.2%), CPC 3: 224 (12%), and CPC 4: 392 (20%), respectively. A total of 232 patients (CPC 5: 12%) died between 30 and 90 days. In 133 patients (7%), 90-day CPC scores improved compared to their 30-day scores. In 260 patients (14%), 90-day CPC scores worsened compared with their 30-day scores. Application of target temperature management was an independent factor for 30- to 90-day neurological improvement (adjusted odds ratio: 1.69, 95% confidence interval: 1.07-2.68). CONCLUSIONS: In our nationwide registry, 7% of resuscitated patients had improved neurological changes in the 30- to 90-day period; most of the improvements were CPC scores improving from 2 to 1. Target temperature management was an independent factor associated with CPC improvement over the 30- to 90-day period.

    DOI: 10.1016/j.ajem.2022.05.017

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  • キノコ中毒におけるプロカルシトニンによる診断は有用か

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

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

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    記述言語:日本語   出版者・発行元:(株)へるす出版  

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  • The Impact of Medical Students Teaching Basic Life Support to Laypersons. 査読

    Yoshinori Kosaki, Hiromichi Naito, Atsuyoshi Iida, Hiromi Ihoriya, Tsuyoshi Nojima, Taihei Yamada, Hirotsugu Yamamoto, Shunsuke Nakamura, Yasuhiro Mandai, Atsunori Nakao

    Acta medica Okayama   76 ( 3 )   265 - 271   2022年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Basic life support (BLS) courses for laypersons, including cardiopulmonary resuscitation (CPR) training, is known to improve outcomes of out-of-hospital cardiac events. We asked medical students to provide BLS training for laypersons as a part of their emergency medicine education and evaluated the effects of training on the BLS skills of laypersons. We also used a questionnaire to determine whether the medical students who provided the BLS training were themselves more confident and motivated to perform BLS compared to students who did not provide BLS training. The proportions of laypersons who reported confidence in checking for a response, performing chest compressions, and automated external defibrillator (AED) use were significantly increased after the BLS training. The proportions of medical students who reported increased confidence/motivation in terms of understanding BLS, checking for a response, chest compression, use of AED, and willingness to perform BLS were significantly greater among medical students who provided BLS instructions compared to those who did not. BLS instruction by medical students was associated with an improvement in laypersons' CPR accuracy and confidence in responding to cardiac arrest. The results indicate that medical students could gain understanding, confidence, and motivation in regard to their BLS skills by teaching BLS to laypersons.

    DOI: 10.18926/AMO/63720

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  • 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

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1016/j.resplu.2022.100261

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  • Prehospital emergency life-saving technicians promote the survival of trauma patients: A retrospective cohort study. 査読 国際誌

    Takeshi Nishimura, Tsuyoshi Nojima, Hiromichi Naito, Satoshi Ishihara, Shinichi Nakayama, Atsunori Nakao

    The American journal of emergency medicine   56   218 - 222   2022年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Appropriate decisions by medical technicians at a trauma scene may influence a patient's prognosis. Emergency life-saving technicians (ELSTs) are certified specialists trained with the knowledge to provide advanced techniques for prehospital emergency care in Japan. However, the benefit of treatment by ELSTs compared to basic emergency medical technicians (BEMTs) remains unclear. The aim of this study is to determine whether treatment by ELSTs improves outcomes for trauma patients. METHODS: We retrospectively reviewed the Japan Trauma Data Bank for the years 2004 to 2017. Patients transferred to the hospital directly from the trauma scene and at least 16 years old were included in this study. The following criteria were used to exclude patients; presence of burns, untreatable severe traumas, unknown ELST attendance, and missing prognosis. We compared two groups (ELST group: patients transported by emergency medical services (EMS) with the presence of at least one ELST; BEMT group: patients transported only by BEMTs). Primary outcome was survival to discharge. Secondary outcomes were the need of definitive treatments defined by surgical intervention, intravascular radiology and blood transfusion at the receiving hospital within 24 h. A multivariable logistic regression model was used to calculate odds ratio (OR) and confidence intervals (CI) adjusted by age, sex, revised trauma score, and Injury severity score (ISS). RESULTS: Overall survival to discharge did not improve significantly (adjusted OR 1.13, 95% CI 0.99-1.30) with ELST intervention. In-hospital blood transfusion was more frequently required in the ELST group (adjusted OR 1.10, 95% CI 1.01-1.20). Emergency interventions (adjusted OR 1.03, 95% CI 0.97-1.09) were not different between the groups. In stratified analysis, the benefit of ELST attendance for survival was observed among patients with ISS <16 (adjusted OR 1.53, 95% CI 1.10-2.15), aged 65 years or older (adjusted OR 1.27, 95% CI 1.07-1.52), during the earlier study period (2004-2008, adjusted OR 1.50, 95% CI 1.14-1.97), and shorter transportation time (adjusted OR 1.21, 95% CI 1.03-1.41). CONCLUSIONS: Dispatch systems with ELST should be considered for trauma transports, which may benefit elderly or moderate severity trauma groups, with shorter transportation time conditions.

    DOI: 10.1016/j.ajem.2022.04.004

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

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    DOI: 10.3390/jcm11092566

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  • 智の探求:プレホスピタルと医療機関における心肺蘇生を望まない患者への対応 DNAR指示を有する院外心停止の特徴、病院前処置、転機に関する検討

    田邉 綾, 内藤 宏道, 野島 剛, 塚原 紘平, 山田 太平, 中尾 篤典

    日本臨床救急医学会雑誌   25 ( 2 )   275 - 275   2022年5月

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

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  • 当院高度救命救急センターにおける小児の熱傷と感染に関するまとめ

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

    熱傷   48 ( 1 )   41 - 41   2022年3月

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    記述言語:日本語   出版者・発行元:(一社)日本熱傷学会  

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  • 日本外傷学会データバンクを用いた熱傷症例の検討

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

    熱傷   48 ( 1 )   38 - 39   2022年3月

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    記述言語:日本語   出版者・発行元:(一社)日本熱傷学会  

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  • 当院EICUにおいて、熱傷患者の熱傷面積が広いほど緑膿菌は検出されるかの検証

    木口 隆, 加藤 湖月, 野島 剛, 小崎 吉訓, 藤崎 宣友, 塚原 紘平, 内藤 宏道, 中尾 篤典

    熱傷   48 ( 1 )   40 - 40   2022年3月

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    記述言語:日本語   出版者・発行元:(一社)日本熱傷学会  

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  • Adult Scurvy Presenting with Painful Purpura on the Legs 査読

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

    Internal Medicine   61 ( 12 )   1913 - 1916   2022年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Japanese Society of Internal Medicine  

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

    DOI: 10.2169/internalmedicine.8409-21

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

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

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

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    記述言語:英語  

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

    DOI: 10.22037/aaem.v10i1.1709

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

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

    Transplantation   106 ( 7 )   1365 - 1375   2021年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    DOI: 10.1097/TP.0000000000004007

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  • 蘇生実習における性差教育が与えるインパクト

    谷田 貴, 折田 沙穂, 塚原 紘平, 中村 俊介, 久保 卓也, 小崎 吉訓, 野島 剛, 内藤 宏道, 中尾 篤典

    日本救急医学会雑誌   32 ( 12 )   2703 - 2703   2021年11月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • The effects of inhaling hydrogen gas on macrophage polarization, fibrosis, and lung function in mice with bleomycin-induced lung injury. 査読 国際誌

    Toshiyuki Aokage, Mizuki Seya, Takahiro Hirayama, Tsuyoshi Nojima, Masumi Iketani, Michiko Ishikawa, Yasuhiro Terasaki, Akihiko Taniguchi, Nobuaki Miyahara, Atsunori Nakao, Ikuroh Ohsawa, Hiromichi Naito

    BMC pulmonary medicine   21 ( 1 )   339 - 339   2021年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Acute respiratory distress syndrome, which is caused by acute lung injury, is a destructive respiratory disorder caused by a systemic inflammatory response. Persistent inflammation results in irreversible alveolar fibrosis. Because hydrogen gas possesses anti-inflammatory properties, we hypothesized that daily repeated inhalation of hydrogen gas could suppress persistent lung inflammation by inducing functional changes in macrophages, and consequently inhibit lung fibrosis during late-phase lung injury. METHODS: To test this hypothesis, lung injury was induced in mice by intratracheal administration of bleomycin (1.0 mg/kg). Mice were exposed to control gas (air) or hydrogen (3.2% in air) for 6 h every day for 7 or 21 days. Respiratory physiology, tissue pathology, markers of inflammation, and macrophage phenotypes were examined. RESULTS: Mice with bleomycin-induced lung injury that received daily hydrogen therapy for 21 days (BH group) exhibited higher static compliance (0.056 mL/cmH2O, 95% CI 0.047-0.064) than mice with bleomycin-induced lung injury exposed only to air (BA group; 0.042 mL/cmH2O, 95% CI 0.031-0.053, p = 0.02) and lower static elastance (BH 18.8 cmH2O/mL, [95% CI 15.4-22.2] vs. BA 26.7 cmH2O/mL [95% CI 19.6-33.8], p = 0.02). When the mRNA levels of pro-inflammatory cytokines were examined 7 days after bleomycin administration, interleukin (IL)-6, IL-4 and IL-13 were significantly lower in the BH group than in the BA group. There were significantly fewer M2-biased macrophages in the alveolar interstitium of the BH group than in the BA group (3.1% [95% CI 1.6-4.5%] vs. 1.1% [95% CI 0.3-1.8%], p = 0.008). CONCLUSIONS: The results suggest that hydrogen inhalation inhibits the deterioration of respiratory physiological function and alveolar fibrosis in this model of lung injury.

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

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

    BMC emergency medicine   21 ( 1 )   104 - 104   2021年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    DOI: 10.1186/s12873-021-00499-z

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  • Right Hemiplegia Following Acute Carbon Monoxide Poisoning 査読 国際誌

    Kenji Aoshima, Hidenaru Yamaoka, Shunsuke Nakamura, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao

    Cureus   13 ( 7 )   e16738   2021年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Cureus, Inc.  

    Acute carbon monoxide (CO) poisoning remains a common cause of poison-related death and influences neurological function. An 83-year-old female was transferred to our emergency unit due to hypertension with dizziness, headache, and right hemiplegia. There was no radiographic evidence of ischemic stroke. The family members reported that the patient may have been exposed to CO by briquettes burned inside a closed room. High flow oxygen therapy was given for suspected CO intoxication and her symptoms quickly improved. Although we do not have clear evidence, we presume that hemiplegia in our patient was caused by CO intoxication, based on rapid recovery with oxygen therapy, carboxyhemoglobin (COHb) level elevation (3.0%), polycythemia, and neuroimaging. Despite the hematogenous effects of CO, paralysis appeared to be more severe on her right side than on her left side. MRI and blood tests helped to support CO as the suspected cause of her hemiplegia. This case reconfirms the importance of medical interviewing by medical practitioners, even in an emergency setting.

    DOI: 10.7759/cureus.16738

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

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

    Case Reports in Emergency Medicine   2021   1 - 3   2021年6月

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    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Hindawi Limited  

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

    DOI: 10.1155/2021/9940395

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    その他リンク: http://downloads.hindawi.com/journals/criem/2021/9940395.xml

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

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

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

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    記述言語:英語  

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

    DOI: 10.1002/ccr3.4138

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  • 早期血管内治療を必要とした鋭的外傷による大動脈瘤の一例

    中村 俊介, 山田 太平, 野島 剛, 小崎 吉訓, 内藤 宏道, 中尾 篤典

    日本外傷学会雑誌   35 ( 2 )   156 - 156   2021年5月

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    記述言語:日本語   出版者・発行元:(一社)日本外傷学会  

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  • Takotsubo Cardiomyopathy Caused by Carbon Dioxide Intoxication 査読 国際誌

    Haruna Inoue, Takeshi Nishimura, Tsuyoshi Nojima, Hiromichi Naito

    Cureus   13 ( 3 )   e14179   2021年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Cureus, Inc.  

    A 49-year-old man transferred to our hospital for dyspnea that developed while transporting significant loads of dry ice, which may have caused potential carbon dioxide intoxication. On admission, he presented hyperventilation and disorientation. Transthoracic echocardiography showed the reduced motion of the anterior wall of the left ventricle with decreased left ventricular ejection fraction. The patient underwent coronary angiography, which did not show apparent coronary arterial stenosis. The electrocardiogram revealed T-wave change and echocardiography results showed the subsided changes on the third hospital day. He was discharged without any symptoms on the fourth hospital day. Our case demonstrates the potential association between carbon dioxide intoxication and Takotsubo cardiomyopathy. Our experience may inform emergency physicians in formulating diagnostic/therapeutic approaches for similar patients experiencing cardiac failure following carbon dioxide intoxication.

    DOI: 10.7759/cureus.14179

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

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

    Acute Medicine & Surgery   8 ( 1 )   e651   2021年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Wiley  

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

    DOI: 10.1002/ams2.651

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  • Prevalence and predictors of direct discharge home following hospitalization of patients with serious adverse events managed by the rapid response system in Japan: a multicenter, retrospective, observational study 査読 国際誌

    Takashi Hongo, Hiromichi Naito, Toshifumi Fujiwara, Takaki Naito, Yosuke Homma, Yoshihisa Fujimoto, Morooka Takaya, Yuji Yamamori, Taka‐aki Nakada, Tsuyoshi Nojima, Atsunori Nakao, Shigeki Fujitani, Shinsuke Fujiwara, Masayasu Arai, Eiji Kawamoto, Yoshiki Sento, Yuta Kawase, Kazuma Nagata, Takuro Saito, Masahiro Tamashiro, Kazuhiro Aoki, Atsushi Miyawaki, Tomoyuki Masuyama, Tatsuya Kawasaki, Takuya Kawaguchi, Takahiro Atsumi, Tomoyuki Ikeda, Yoshiro Hayashi, Takanao Otake, Masaru Tobe, Ryosuke Sekine, Takaaki Nakada, Kazuhiko Sugimoto, Hiroshi Onozawa, Kentaro Miyake, Chikaaki Nakamichi, Naraba Hiromu, Jun Makino, Kenzo Ishii, Yasunobu Goto, Hitoshi Kikuchi, Tadaaki Takada, Dai Taguchi, Kenzo Ishii, Eisei Hoshiyama, Hiromichi Miyabe, Masaru Okamoto, Masahiro Koide, Yoichi Kase, Takuya Hashino, Takehiro Niitsu, Hiroshi Kamijo

    Acute Medicine & Surgery   8 ( 1 )   e690   2021年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Wiley  

    AIM: The rapid response system (RRS) is an in-hospital medical safety system. To date, not much is known about patient disposition after RRS activation, especially discharge home. This study aimed to investigate the prevalence, characteristics, and outcomes of patients with adverse events who required RRS activation. METHODS: Retrospective data from the In-Hospital Emergency Registry in Japan collected from April 2016 to November 2020 were eligible for our analysis. We divided patients into Home Discharge, Transfer, and Death groups. The primary outcome was the prevalence of direct discharge home, and independently associated factors were determined using multivariable logistic regression. RESULTS: We enrolled 2,043 patients who met the inclusion criteria. The prevalence of discharge home was 45.7%; 934 patients were included in the Home Discharge group. Age (adjusted odds ratio [AOR] 0.96; 95% confidence interval [CI], 0.95-0.97), malignancy (AOR 0.69; 95% CI, 0.48-0.99), oxygen administration before RRS (AOR 0.49; 95% CI, 0.36-0.66), cerebral performance category score on admission (AOR 0.38; 95% CI, 0.26-0.56), do not attempt resuscitation order before RRS (AOR 0.17; 95% CI, 0.10-0.29), RRS call for respiratory failure (AOR 0.50; 95% CI, 0.34-0.72), RRS call for stroke (AOR 0.12; 95% CI, 0.03-0.37), and intubation (AOR 0.20; 95% CI, 0.12-0.34) were independently negative, and RRS call for anaphylaxis (AOR 15.3; 95% CI, 2.72-86.3) was positively associated with discharge home. CONCLUSION: Less than half of the in-hospital patients under RRS activation could discharge home. Patients' conditions before RRS activation, disorders requiring RRS activation, and intubation were factors that affected direct discharge home.

    DOI: 10.1002/ams2.690

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

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

    Acute Medicine & Surgery   8 ( 1 )   e641   2021年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Wiley  

    Trauma is a primary cause of death globally, with non-compressible torso hemorrhage constituting an important part of "potentially survivable trauma death." Resuscitative endovascular balloon occlusion of the aorta has become a popular alternative to aortic cross-clamping under emergent thoracotomy for non-compressible torso hemorrhage in recent years, however, it alone does not improve the survival rate of patients with severe shock or traumatic cardiac arrest from non-compressible torso hemorrhage. Development of novel advanced maneuvers is essential to improve these patients' survival, and research on promising methods such as selective aortic arch perfusion and emergency preservation and resuscitation is ongoing. This review aimed to provide physicians in charge of severe trauma cases with a broad understanding of these novel therapeutic approaches to manage patients with severe hemorrhagic trauma, which may allow them to develop lifesaving strategies for exsanguinating trauma patients. Although there are still hurdles to overcome before their clinical application, promising research on these novel strategies is in progress, and ongoing development of synthetic red blood cells and techniques that reduce ischemia-reperfusion injury may further maximize their effects. Both continuous proof-of-concept studies and translational clinical evaluations are necessary to clinically apply these hemostasis approaches to trauma patients.

    DOI: 10.1002/ams2.641

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  • Refractory gastric ulcer due to undisclosed use of topical diclofenac epolamine patches 査読 国際誌

    Yuta Oda, Hiromichi Naito, Tsuyoshi Nojima, Atsunori Nakao

    Acute Medicine & Surgery   8 ( 1 )   e710   2021年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Wiley  

    BACKGROUND: Topical forms of nonsteroidal anti-inflammatory drugs (NSAIDs) have been created to lessen systemic adverse effects. In general, they are believed to be well tolerated and appropriate for use as an over-the-counter (OTC) drug. CASE PRESENTATION: A 68-year-old woman visited our clinic due to tarry stool. The patient reported multiple episodes of recurrent bleeding from a gastric ulcer for 2 months and was treated with endoscopic hemostatic clipping. The patient disclosed she had been using a large number of diclofenac patches for more than 3 months. The patient was treated conservatively by discontinuation of diclofenac patches and treatment with a proton pump inhibitor and omeprazole. CONCLUSION: In conclusion, inappropriate use of topical NSAID patches can be a cause of peptic ulcer bleeding. Patients reporting multiple episodes of recurrent bleeding from a gastric ulcer should be questioned, particularly about the use of OTC medications that might include topical NSAID patches.

    DOI: 10.1002/ams2.710

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  • Cardiac arrest due to liquid nicotine intoxication: a case report 国際誌

    Atsuyoshi Iida, Yuki Fujiwara, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao, Takeshi Mikane

    Acute Medicine &amp; Surgery   8 ( 1 )   e720   2021年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Wiley  

    BACKGROUND: With the introduction of electronic cigarettes, reports of nicotine intoxication due to ingestion of large amounts of liquid nicotine have increased. This report presents a rare case of cardiac arrest due to nicotine intoxication that was successfully treated with appropriate respiratory and circulatory support. CASE PRESENTATION: A 55-year-old man ingested 600 mg of liquid nicotine and developed sinus bradycardia followed by asystole. Appropriate and prompt resuscitation led to the return of spontaneous circulation. He was admitted to the intensive care unit and discharged 24 days later without any medical sequelae of nicotine intoxication. CONCLUSION: Ingestion of a large amount of liquid nicotine, as in this case, can result in lethal bradycardia followed by cardiac arrest. Prompt basic life support by paramedic produced good neurological outcomes. Emergency physicians should be aware of the symptoms and appropriate treatment of severe nicotine intoxication.

    DOI: 10.1002/ams2.720

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

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

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

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    担当区分:筆頭著者   記述言語:英語  

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

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

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

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

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    DOI: 10.18926/AMO/61210

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  • Feasibility study of a portable transparent vinyl chloride shield for use in an ambulance during the COVID-19 pandemic. 査読 国際誌

    Kohei Tsukahara, Hiromichi Naito, Tsuyoshi Nojima, Takashi Yorifuji, Atsunori Nakao

    Critical care (London, England)   24 ( 1 )   651 - 651   2020年11月

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

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

    Cureus   12 ( 11 )   e11376   2020年11月

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    記述言語:英語  

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

    DOI: 10.7759/cureus.11376

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  • Luminal preloading with hydrogen‐rich saline ameliorates ischemia‐reperfusion injury following intestinal transplantation in rats 査読 国際誌

    Hirotsugu Yamamoto, Toshiyuki Aokage, Takuro Igawa, Takahiro Hirayama, Mizuki Seya, Michiko Ishikawa‐Aoyama, Tsuyoshi Nojima, Atsunori Nakao, Hiromichi Naito

    Pediatric Transplantation   24 ( 7 )   e13848   2020年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Wiley  

    Prolonged intestinal cold storage causes considerable mucosal breakdown, which could bolster bacterial translocation and cause life-threatening infection for the transplant recipient. The intestine has an intraluminal compartment, which could be a target for intervention, but has not yet been fully investigated. Hydrogen gas exerts organ protection and has used been recently in several clinical and basic research studies on topics including intestinal transplantation. In this study, we aimed to investigate the cytoprotective efficacy of intraluminally administered hydrogen-rich saline on cold IR injury in intestinal transplantation. Isogeneic intestinal transplantation with 6 hours of cold ischemia was performed on Lewis rats. Hydrogen-rich saline (H2 concentration at 5 ppm) or normal saline was intraluminally introduced immediately before preservation. Graft intestine was excised 3 hours after reperfusion and analyzed. Histopathological analysis of control grafts revealed blunting of the villi and erosion. These mucosal changes were notably attenuated by intraluminal hydrogen. Intestinal mucosa damage caused by IR injury led to considerable deterioration of gut barrier function 3 h post-reperfusion. However, this decline in permeability was critically prevented by hydrogen treatment. IR-induced upregulation of proinflammatory cytokine mRNAs such as IL-6 was mitigated by hydrogen treatment. Western blot revealed that hydrogen treatment regulated loss of the transmembrane protein ZO-1. Hydrogen-rich saline intraluminally administered in the graft intestine modulated IR injury to transplanted intestine in rats. Successful abrogation of intestinal IR injury with a novel strategy using intraluminal hydrogen may be easily clinically applicable and will compellingly improve patient care after transplantation.

    DOI: 10.1111/petr.13848

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

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

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

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • 食事に関する詳細な問診を必要とした壊血病の一例

    小出 恭大, 山田 太平, 小崎 吉訓, 野島 剛, 塚原 紘平, 藤崎 宣友, 尾迫 貴章, 内藤 宏道, 城端 慧, 高岡 諒, 中尾 篤典

    日本救急医学会雑誌   31 ( 11 )   2105 - 2105   2020年11月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • amplitude-integrated EEGが意識障害患者の診断・早期治療に有効であった悪性症候群の1例

    中村 俊介, 内藤 宏道, 野島 剛, 小崎 吉訓, 山本 浩継, 藤崎 宣友, 青景 聡之, 塚原 紘平, 山田 太平, 尾迫 貴章, 中尾 篤典

    日本救急医学会雑誌   31 ( 11 )   1105 - 1105   2020年11月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • 当院における産科救急の現状

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

    日本救急医学会雑誌   31 ( 11 )   1921 - 1921   2020年11月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • Glycogenic hepatopathy following attempted suicide by long-acting insulin overdose in patient with type 1 diabetes. 査読 国際誌

    Noritomo Fujisaki, Yoshinori Kosaki, Tsuyoshi Nojima, Taiki Higaki, Taihei Yamada, Hitoshi Koga, Akira Gochi, Hiromichi Naito, Atsunori Nakao

    Journal of the American College of Emergency Physicians open   1 ( 5 )   1097 - 1100   2020年10月

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    記述言語:英語  

    Patients with poorly controlled insulin-dependent type 1 or type 2 diabetes rarely present with glycogenic hepatopathy, which is characterized by hepatomegaly and liver enzyme abnormalities. Glycogenic hepatopathy occurs as a consequence of excessive accumulation of glycogen in hepatocytes caused by insulin. We report a young male patient with type 1 diabetes mellitus who developed glycogenic hepatopathy following a suicide attempt by insulin overdose via subcutaneous injection. The patient's medication/nutrition compliance and adherence to insulin were poorly controlled due to comorbid schizophrenia. Our patient required a large amount of continuous glucose to maintain euglycemia for persistent intractable hypoglycemia induced by overdose of long-acting insulin. On admission day 4, the patient presented elevated transaminases, hepatomegaly, and lactic acidosis. Computed tomography revealed swollen liver parenchyma with a diffusely high absorption. The patient gradually recovered without any medical intervention except for adequate control of blood sugar and was moved to a psychiatric ward on day 8 for schizophrenia management. This report may help emergency physicians be aware of the common symptoms, clinical course, and pathophysiology of glycogenic hepatopathy. Doctors should include glycogenic hepatopathy in the differential diagnosis of abnormal liver enzymes and hepatomegaly for those with poorly controlled insulin-dependent diabetes mellitus or unstable blood sugar levels due to insulin overdose like our patient.

    DOI: 10.1002/emp2.12093

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  • 一酸化炭素中毒に対し高気圧酸素療法を行った妊婦の一例

    小崎 吉訓, 小出 恭大, 野島 剛, 藤崎 宣友, 青景 聡之, 塚原 紘平, 山田 太平, 尾迫 貴章, 内藤 宏道, 中尾 篤典

    中毒研究   33 ( 2 )   162 - 162   2020年9月

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    記述言語:日本語   出版者・発行元:(株)へるす出版  

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  • Therapeutic strategies for ischemia reperfusion injury in emergency medicine 査読 国際誌

    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 )   e501   2020年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Wiley  

    Ischemia reperfusion (IR) injury occurs when blood supply, perfusion, and concomitant reoxygenation is restored to an organ or area following an initial poor blood supply after a critical time period. Ischemia reperfusion injury contributes to mortality and morbidity in many pathological conditions in emergency medicine clinical practice, including trauma, ischemic stroke, myocardial infarction, and post-cardiac arrest syndrome. The process of IR is multifactorial, and its pathogenesis involves several mechanisms. Reactive oxygen species are considered key molecules in reperfusion injury due to their potent oxidizing and reducing effects that directly damage cellular membranes by lipid peroxidation. In general, IR injury to an individual organ causes various pro-inflammatory mediators to be released, which could then induce inflammation in remote organs, thereby possibly advancing the dysfunction of multiple organs. In this review, we summarize IR injury in emergency medicine. Potential therapies include pharmacological treatment, ischemic preconditioning, and the use of medical gases or vitamin therapy, which could significantly help experts develop strategies to inhibit IR injury.

    DOI: 10.1002/ams2.501

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

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

    Acute Medicine & Surgery   7 ( 1 )   e595   2020年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Wiley  

    DOI: 10.1002/ams2.595

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

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

    Respiratory medicine case reports   31   101182 - 101182   2020年

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    記述言語:英語  

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

    DOI: 10.1016/j.rmcr.2020.101182

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  • Retropharyngeal hematoma presenting airway obstruction: A case report. 査読 国際誌

    Atsuyoshi Iida, Ayumi Nishida, Seiji Yoshitomi, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao

    International journal of surgery case reports   77   321 - 324   2020年

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    記述言語:英語  

    INTRODUCTION: Blunt neck trauma patients can suffer from an airway emergency and are necessary to careful observation. PRESENTATION OF CASE: A 79-year-old man under anticoagulation therapy presented to our hospital three hours after a fall. Shortly after arrival, he developed dyspnea. Oral intubation was attempted, but with no success; therefore, an emergency tracheotomy was performed. Contrast-enhanced computed tomography (CT) and subsequent angiography revealed active bleeding from a branch of the right ascending cervical artery. Subsequently, the right thyrocervical trunk, which is upstream from the ascending cervical artery, was embolized and hemostasis was achieved. He was discharged 52 days after the emergency admission. DISCUSSION: This is the first case report of an ascending cervical artery injury due to blunt trauma that resulted in an airway emergency. Contrast-enhanced CT and cervical angiography are useful for confirming the area of injury and size of the hematoma. Half of patients with respiratory distress accompanied by a cervical spine injury require definitive airway management within five hours of the injury and all by 24 h. Neck trauma can lead to fatal airway obstruction and careful monitoring is warranted to detect any signs of impeding respiratory obstruction. CONCLUSION: All emergency physicians need to keep their airway management skills updated in order to perform reliably and rapidly in difficult and urgent situations.

    DOI: 10.1016/j.ijscr.2020.11.007

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  • Epileptic Seizure from Ginkgo Nut Intoxication in an Adult. 査読 国際誌

    Yoshinori Kosaki, Hiromichi Naito, Tsuyoshi Nojima, Atsunori Nakao

    Case reports in emergency medicine   2020   5072954 - 5072954   2020年

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    記述言語:英語  

    The ginkgo tree is a well-known, highly adaptable urban plant. Ginkgo nuts are the product of the ginkgo tree. Interior ginkgo nuts are cooked and served in Asian countries; however, the potential toxicity of the gingko nuts is not commonly known. Herein, we report a 48-year-old male patient experiencing acute convulsions presumably due to overconsumption of gingko nuts. The patient was transferred to our department after several episodes of acute generalized tonicclonic seizures lasting approximately 30 seconds each and starting one hour before the visit. The patient also complained of vomiting, vertigo, diarrhea, and tremors in both upper limbs following the seizures. Elevated 4-O-methylpyridoxine (312 ng/mL), low blood pyridoxal phosphate (2.4 μg/L), and low vitamin B1 (20 ng/mL) levels were found in the blood analysis. No other remarkable abnormalities were detected. We diagnosed the patient with ginkgo nut intoxication, and he was orally administered 400 mg of pyridoxal phosphate. His symptoms resolved after treatment, and no seizures recurred thereafter. Our report may help raise awareness of the clinical presentation and management of this intoxication among emergency physicians.

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  • 大規模地震時医療活動訓練における医療資機材の空輸 航空会社との連携と今後の課題

    三木 真彩菜, 三橋 乙矢, 加藤 湖月, 平山 隆浩, 野島 剛, 山田 太平, 塚原 紘平, 尾迫 貴章, 中尾 篤典

    Japanese Journal of Disaster Medicine   24 ( 3 )   338 - 338   2019年12月

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    記述言語:日本語   出版者・発行元:(一社)日本災害医学会  

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  • Caffeine Intoxication in Pregnancy; a Case Report 査読 国際誌

    Tsuyoshi Nojima, Hiromichi Naito, Yoshinori Kosaki, Takaaki Osako, Kimiaki Tanaka, Atsuo Murata, Atsunori Nakao

    Archives of Academic Emergency Medicine   7 ( 1 )   e67   2019年11月

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

    Although fatalities due to caffeine intoxication are uncommon, a caffeine overdose may cause profound toxicity, resulting in tachycardia, arrhythmia, convulsions, vomiting, coma, and possibly death. In particular, high caffeine consumption while pregnant can cause increased fetal catecholamine levels, which could lead to increased fetal heart rate and placental vasoconstriction and impair fetal oxygenation. Therefore, caffeine intoxication in pregnant women should be treated immediately. Herein, we present a 33-year-old pregnant woman who was treated in our department after ingesting 4000mg of caffeine in an attempt to commit suicide. We successfully treated our patient, and she delivered a healthy baby at 38 weeks.

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  • A case of spontaneous mesenteric hematoma successfully diagnosed and treated with aggressive imaging. 査読 国際誌

    Shunsuke Nakamura, Taihei Yamada, Tsuyoshi Nojima, Hiromichi Naito, Hitoshi Koga, Hisashi Yamashita, Akira Gochi, Atsunori Nakao

    International journal of surgery case reports   65   124 - 126   2019年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: Spontaneous mesenteric hematoma is an uncommon syndrome triggered by bleeding localized in the mesenteric vascular tree of a bowel segment for no apparent underlying reason. We herein report a surgical patient with an extremely rapidly growing spontaneous mesenteric hematoma that we successfully diagnosed using careful radiologic examination. PRESENTATION OF CASE: A 56-year-old old male presenting sudden onset lower abdominal pain was referred to our emergency department. At the time of admission, his physical examination revealed stable vital signs without radiological abnormality. On the following day, the patient suddenly presented hypotension, tachycardia, and increased abdominal pain. Contrast-enhanced computed tomography examination showed a mass with both high- and low-density areas with a 130 mm maximum diameter bordering the transverse colon. Since interventional radiologists were not available, we decided to perform emergency exploratory laparotomy. On laparotomy, a 13 × 8 cm hematoma was found in the mesentery of the transverse colon. As bleeding was noted from the branches of the middle colic artery and gastrocolic artery, these responsible vessels were ligated. The patient was finally given the diagnosis of spontaneous mesenteric hematoma. DISCUSSION AND CONCLUSION: The present case, initially diagnosed as enterocolitis, suddenly manifested hypovolemic shock. Close monitoring for any signs of further deterioration, as well as aggressive imaging diagnosis, enabled us to avoid delays in treatment. Early diagnosis and treatment of mesenteric hematomas are essential to prevent them from rupturing and triggering life-threatening adverse events.

    DOI: 10.1016/j.ijscr.2019.10.058

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  • Early predictors for massive transfusion in older adult severe trauma patients 査読 国際誌

    Takao Ohmori, Taisuke Kitamura, Junko Ishihara, Hirokazu Onishi, Tsuyoshi Nojima, Kotaro Yamamoto, Ryu Tamura, Kentaro Muranishi, Toshiyuki Matsumoto, Takamitsu Tokioka

    INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED   48 ( 5 )   1006 - 1012   2017年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER SCI LTD  

    Background: Many scoring systems for the early prediction of the need for massive transfusion (MT) have been reported; in most of these, vital signs are regarded as important. However, the validity of these scoring systems in older patients remains unclear because older trauma patients often present with normal vital signs. In this study, we investigated the effectiveness of previously described scoring systems, as well as risk factors that can provide early prediction of the need for MT in older severe trauma patients.
    Methods: We prospectively collected data from a cohort of severe trauma patients (ISS &gt;= 16 and age &gt;= 16 years) admitted from January 2007 to March 2015. Trauma Associated Severe Hemorrhage (TASH), Assessment of Blood Consumption (ABC), and Prince of Wales Hospital (PWH) scores were compared between a younger and an older group. Furthermore, the predictors associated with MT in older severe trauma patients were assessed using multivariable logistic regression analyses.
    Results: The area under the curve (AUC) was significantly smaller for older group than for younger group for all three scoring systems (p &lt; 0.05). The most important risk factors to predict the need for MT were related to anatomical factors including FAST results (odds ratio (OR): 5.58, 95% confidence interval (CI): 2.10-14.99), unstable pelvic fracture (OR: 21.56, 95% CI: 6.05-90.78), and long bone open fracture of the lower limbs (OR: 12.21, 95% CI: 4.04-39.09), along with pre-injury anticoagulant agent use (OR: 5.22, 95% CI: 1.30-19.61), antiplatelet agent use (OR: 3.81, 95% CI: 1.57-9.04), lactate levels (OR: 1.20, 95% CI: 1.04-1.39) and shock index (OR: 2.67, 95% CI: 1.05-6.84). Traditional vital signs were not early risk factors.
    Conclusion: We suggest that MT in older trauma patients should be considered on the basis of anatomical factors, pre-injury anticoagulant or antiplatelet agent use, lactate level and SI even if traditional vital signs are normal. (C) 2016 Elsevier Ltd. All rights reserved.

    DOI: 10.1016/j.injury.2016.12.028

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  • Effect of pre-injury anticoagulant and antiplatelet agents on blood loss in elderly patients with severe trauma. 国際誌

    Takao Ohmori, Taisuke Kitamura, Hirokazu Onishi, Junko Ishihara, Tsuyoshi Nojima, Koutarou Yamamoto

    Acute medicine & surgery   3 ( 2 )   114 - 119   2016年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    AIM: It has been widely reported that pre-injury use of anticoagulant and antiplatelet agents can affect traumatic brain injury and the associated risk of mortality, however, the effect of these agents on non-head injury site-related blood loss remains unclear. Therefore, we investigated the effects of pre-injury anticoagulant and antiplatelet agents on the transfusion amount and the need for massive transfusion in elderly patients with severe trauma. METHODS: We retrospectively reviewed a cohort of elderly patients with severe trauma (age, ≥65 years; Injury Severity Score, ≥16) between September 2006 and March 2014. The selected patients were subsequently divided into patients who were: only taking warfarin, aspirin, or clopidogrel; taking various combinations of these agents; and a control group who were not taking any of these agents. RESULTS: During the study period, 67 patients (20%) were taking anticoagulant and antiplatelet agents and 272 patients were included in the control group. Among these patients, 10 were receiving only warfarin, 28 were receiving only aspirin, 14 were receiving only clopidogrel, and 13 were receiving various combinations of these medications. The amount of red cell concentrate and need for massive transfusions were only significantly increased in the warfarin group (P < 0.05). Furthermore, the warfarin group had a significantly higher risk of needing a massive transfusion with multivariate logistic regression analysis (odds ratio, 5.03; 95% confidence interval, 1.25-20.20; P < 0.05). CONCLUSION: Patients who were receiving only warfarin before their injury had an increased risk of bleeding due to non-head injuries.

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  • Bleeding sites in elderly trauma patients who required massive transfusion: a comparison with younger patients 査読 国際誌

    Takao Ohmori, Taisuke Kitamura, Kimiaki Tanaka, Yuichi Saisaka, Junko Ishihara, Hirokazu Onishi, Tsuyoshi Nojima, Kotaro Yamamoto, Toshiyuki Matsumoto, Takamitsu Tokioka

    AMERICAN JOURNAL OF EMERGENCY MEDICINE   34 ( 2 )   123 - 127   2016年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

    Introduction: Among elderly patients with severe trauma, the sites of massive hemorrhage and their clinical characteristics are not well understood. Therefore, we investigated the sites of massive hemorrhage in patients with severe trauma, and compared the results for younger and elderly patients.
    Methods: A cohort of severe trauma patients (Injury Severity Score &gt;= 16) admitted from March 2007 to December 2014 was reviewed retrospectively. The inclusion criterion was massive bleeding, which was defined as bleeding that required the transfusion of &gt;= 10 red cell concentrate units within 24 hours of admission, or as cases of early death that occurred despite continuous blood transfusion and before the patient could receive &gt;= 10 red cell concentrate units within the first 24 hours after their admission.
    Results: Eighty-four patients met our inclusion criterion. The younger group (&lt;65 years old) included 40 patients (48%), whereas the older group (&gt;= 65 years old) included 44 patients (52%). The percentage of nondiagnosable cases at the primary survey (massive bleeding due to multisite damage caused by a bone fracture or contusion, retroperitoneal hematoma without a pelvic ring fracture and with stable pelvic ring fracture) was 14% in the younger group and 40% in the older group (odds ratio, 3.92; 95% confidence interval, 1.37-11.27, P = .017).
    Conclusions: Even if no abnormalities are observed at the primary survey of elderly patients with severe trauma, physicians should consider the possibility of massive bleeding. (C) 2015 Elsevier Inc. All rights reserved.

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  • Admission fibrinogen levels in severe trauma patients: A comparison of elderly and younger patients 査読 国際誌

    Takao Ohmori, Taisuke Kitamura, Kimiaki Tanaka, Yuichi Saisaka, Junko Ishihara, Hirokazu Onishi, Tsuyoshi Nojima, Koutarou Yamamoto, Toshiyuki Matusmoto, Takamitsu Tokioka

    INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED   46 ( 9 )   1779 - 1783   2015年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER SCI LTD  

    Introduction: Acute coagulopathy of trauma has been much discussed recently. However, the changes in coagulation markers after trauma in the elderly are unknown. Furthermore, the baseline fibrinogen level is high in elderly patients, and the question remains as to whether fibrinogen levels also decrease early and the degree of decrease in elderly trauma patients. The purpose of this study was to compare coagulation markers including the fibrinogen level on admission in younger and elderly severe trauma patients.
    Methods: A cohort of severe trauma patients (Injury Severity Score (ISS) &gt;= 16), admitted from January 2011 to June 2014, with coagulation markers including the fibrinogen level on admission available, was reviewed retrospectively. The patients were divided into a younger (16-64 years old) and an older (&gt;= 65 years old) group based upon their age at presentation. Activated partial thromboplastin time (aPTT), international normalized ratio (INR), fibrinogen, and D-dimer were compared between the younger and older groups.
    Results: There were 251 patients who met the inclusion criteria for this analysis. The younger group included 117 patients and the older group included 134 patients. The median aPTT (26.3 vs 27.5 s, P = 0.001) and median D-dimer levels (18.8 vs 40.2 mg/dL, P = 0.006) were significantly higher in the older group. However, the fibrinogen level (205 vs 248 mg/dL, P &lt; 0.001) was significantly higher in the older group. The regression lines of fibrinogen and age in non-massive transfusion and massive transfusion cases are given by Y = 1.03X + 185 (r = 0.24, r(2) = 0.06, P &lt; 0.001) and Y = 0.86X + 134 (r = 0.25, r(2) = 0.06, P = 0.09) respectively, and the fibrinogen levels tended to increase with older age in severe trauma patients.
    Conclusions: The fibrinogen level did not show a low value as it can in younger patients in elderly patients. Therefore, the fibrinogen level is difficult to use as an early indicator of acute blood loss with haemorrhage in elderly severe trauma patients, as it can be used in younger patients. Thus, it is necessary to keep in mind that the fibrinogen level increases by approximately 1 mg/dL when the age increases by 1 year and to carefully observe the fibrinogen level even if the admission level is not low. (C) 2015 Elsevier Ltd. All rights reserved.

    DOI: 10.1016/j.injury.2015.04.007

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  • Presepsin as a powerful monitoring tool for the prognosis and treatment of sepsis: A multicenter prospective study 査読 国際誌

    Shigeatsu Endo, Yasushi Suzuki, Gaku Takahashi, Tatsuyori Shozushima, Hiroyasu Ishikura, Akira Murai, Takeshi Nishida, Yuhei Irie, Masanao Miura, Hironobu Iguchi, Yasuo Fukui, Kimiaki Tanaka, Tsuyoshi Nojima, Yoshikazu Okamura

    JOURNAL OF INFECTION AND CHEMOTHERAPY   20 ( 1-2 )   30 - 34   2014年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER JAPAN KK  

    Presepsin is a protein whose levels increase specifically in the blood of patients with sepsis. It is proposed as a diagnostic and prognostic marker for assessing the degree of sepsis severity. The present multicenter prospective study compared the clinical utility of presepsin with other conventional sepsis biomarkers including procalcitonin, interleukin-6, and C-reactive protein for evaluating the severity of sepsis during follow-up. Patients with sepsis (n = 103) admitted to the emergency room or intensive care unit were enrolled in this study and classified into 3 diagnostic groups: sepsis, severe sepsis, and septic shock. Blood samples were obtained from each patient on admission and after 1, 3, 5, and 7 days. The patients were further divided into the favorable and unfavorable prognosis groups on the basis of several indicators of sepsis severity (i.e., Sequential Organ Failure Assessment score, and Acute Physiology and Chronic Health Evaluation II score). The patients in the favorable prognosis group exhibited significant decreases in all biomarker levels on days 3 and 7 after admission. In the unfavorable prognosis group, only presepsin levels did not decrease significantly during follow-up. The period of antibiotics treatment in the unfavorable prognosis group was significantly longer than those in the favorable prognosis group (P &lt; 0.05). The unfavorable prognosis group had significantly higher 28-day mortality than the favorable prognosis group (P &lt; 0.05). Therefore, the results suggest that presepsin levels correlated with the severity of sepsis during follow-up in comparison with other conventional sepsis biomarkers. (C) 2013, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

    DOI: 10.1016/j.jiac.2013.07.005

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    その他リンク: http://orcid.org/0000-0003-0768-0179

  • Usefulness of presepsin in the diagnosis of sepsis in a multicenter prospective study 査読 国際誌

    Shigeatsu Endo, Yasushi Suzuki, Gaku Takahashi, Tatsuyori Shozushima, Hiroyasu Ishikura, Akira Murai, Takeshi Nishida, Yuhei Irie, Masanao Miura, Hironobu Iguchi, Yasuo Fukui, Kimiaki Tanaka, Tsuyoshi Nojima, Yoshikazu Okamura

    JOURNAL OF INFECTION AND CHEMOTHERAPY   18 ( 6 )   891 - 897   2012年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER JAPAN KK  

    The clinical usefulness of presepsin for discriminating between bacterial and nonbacterial infections (including systemic inflammatory response syndrome) was studied and compared with procalcitonin (PCT) and interleukin-6 (IL-6) in a multicenter prospective study. Suspected sepsis patients (n = 207) were enrolled into the study. Presepsin levels in patients with systemic bacterial infection and localized bacterial infection were significantly higher than in those with nonbacterial infections. In addition, presepsin, PCT, and IL-6 levels in patients with bacterial infectious disease were significantly higher than in those with nonbacterial infectious disease (P &lt; 0.0001, P &lt; 0.0001, and P &lt; 0.0001, respectively). The area under the receiver operating characteristic curve was 0.908 for presepsin, 0.905 for PCT, and 0.825 for IL-6 in patients with bacterial infectious disease and those with nonbacterial infectious disease. The cutoff value of presepsin for discrimination of bacterial and nonbacterial infectious diseases was determined to be 600 pg/ml, of which the clinical sensitivity and specificity were 87.8 % and 81.4 %, respectively. Presepsin levels did not differ significantly between patients with gram-positive and gram-negative bacterial infections. The sensitivity of blood culture was 35.4 %; that for presepsin was 91.9 %. Also there were no significant differences in presepsin levels between the blood culture-positive and -negative groups. Consequently, presepsin is useful for the diagnosis of sepsis, and it is superior to conventional markers and blood culture.

    DOI: 10.1007/s10156-012-0435-2

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    その他リンク: http://orcid.org/0000-0003-0768-0179

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MISC

  • 日本外傷学会データバンクを用いた熱傷症例の検討

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

    熱傷   48 ( 1 )   38 - 39   2022年3月

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    記述言語:日本語   出版者・発行元:(一社)日本熱傷学会  

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  • 当院高度救命救急センターにおける小児の熱傷と感染に関するまとめ

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

    熱傷   48 ( 1 )   41 - 41   2022年3月

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    記述言語:日本語   出版者・発行元:(一社)日本熱傷学会  

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  • DNAR指示を有する院外心停止の特徴,病院前処置,転機に関する検討

    田邉綾, 内藤宏道, 野島剛, 塚原紘平, 山田太平, 中尾篤典

    日本臨床救急医学会雑誌   25 ( 2 )   2022年

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

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

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

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

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

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

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

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

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

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

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

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    記述言語:日本語   出版者・発行元:(一社)日本移植学会  

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  • 飲酒者における外傷の生存率は非飲酒者と同等である 日本外傷データバンクを用いた検討

    野島 剛, 内藤 宏道, 小崎 吉訓, 上原 健敬, 山本 浩継, 藤崎 宣友, 青景 聡之, 塚原 紘平, 山田 太平, 尾迫 貴章, 中尾 篤典

    日本救急医学会雑誌   31 ( 11 )   1969 - 1969   2020年11月

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

    J-GLOBAL

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  • 岡山市消防局の救急活動時間におけるCOVID-19の影響

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

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

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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  • COVID19パンデミック下における搬送用エアロゾルボックスの検証

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

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

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    記述言語:日本語   出版者・発行元:(一社)日本救急医学会  

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共同研究・競争的資金等の研究

  • 水素の抗炎症作用に着目したVV-ECMO中の新規抗凝固療法の基礎的研究

    研究課題/領域番号:20K17896  2020年04月 - 2023年03月

    日本学術振興会  科学研究費助成事業  若手研究

    野島 剛

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    配分額:4290000円 ( 直接経費:3300000円 、 間接経費:990000円 )

    本研究における研究の目的は水素の抗炎症作用に着目したVV-ECMO中の新規抗凝固療法の開発である。ラットモデルを用いて、水素が出血リスクを増加させることなくECMO中の抗凝固作用を強化できるかを検証している。そのために3段階の実験計画を設定している。その段階とは、①健常ラットを用いて最適な抗凝固療法を含めたVV-ECMOモデルの確立と水素の安全性の確認、②リポ多糖(LPS)肺炎モデルを用いて、水素投与によるVV-ECMO中の凝固因子の消耗と回路内血栓の抑制効果の検証、③②で効果が認められれば、水素の抗凝固作用のメカニズムを探求する、の3段階である。
    現在、①のVV-ECMOモデルの確立ができた。右頸静脈より脱血、右大腿静脈より送血を行いつつローラーポンプとラット用人工肺を装着した回路を使用しモデルを作成した。なお、ヘパリン量に関しては、50単位/kg/hrで安定している。その際の回路内には血栓は認められなかったので、今後はこのラットをモデルとして使用する。水素の安全性に関しては、気泡形成やバイタルサインの変動を見つつ量を調整している。
    ②におけるLPS肺炎モデルの確立も行えた。先行研究のラットでは気管内投与のLPS量は2.5mg/kgであったが、肺炎が重症化してしまいラットが研究に耐えられない可能性があることから、LPS量は1.0ml/kgに変更して研究を行なっていくこととした。水素の安全性が確保でき次第、LPS肺炎モデルを使用して水素投与による凝固因子の消耗と回路内血栓の抑制効果の検証を行う。
    現在は、各臓器、血液検査より、水素による抗凝固作用のメカニズムを確認している。

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担当授業科目

  • 地域医療体験実習Ⅱ (2023年度) 特別  - その他

  • 地域医療体験実習Ⅲ (2023年度) 特別  - その他

  • 地域医療体験実習I (2023年度) 特別  - その他