Faculty Profiles - Nojima Tsuyoshi

Papers - Nojima Tsuyoshi

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Refractory gastric ulcer due to undisclosed use of topical diclofenac epolamine patches Reviewed International journal

Yuta Oda, Hiromichi Naito, Tsuyoshi Nojima, Atsunori Nakao

Acute Medicine & Surgery 8 ( 1 ) e710 2021.1

Language：English Publishing type：Research paper (scientific journal) Publisher：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

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.710

Cardiac arrest due to liquid nicotine intoxication: a case report Reviewed International journal

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

Acute Medicine & Surgery 8 ( 1 ) e720 2021.1

Language：English Publishing type：Research paper (scientific journal) Publisher：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

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.720

Plastic Bronchitis in a Five-Year-Old Boy Treated Using Extracorporeal Membrane Oxygenation; a Case Report. Reviewed International journal

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

Archives of academic emergency medicine 9 ( 1 ) e16 2021

Authorship：Lead author Language：English

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.

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

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 2020.12

Language：English Publishing type：Research paper (scientific journal)

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

Feasibility study of a portable transparent vinyl chloride shield for use in an ambulance during the COVID-19 pandemic. Reviewed International journal

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

Critical care (London, England) 24 ( 1 ) 651 - 651 2020.11

Burning Mouth Syndrome Induced by Angiotensin-Converting Enzyme Inhibitors. Reviewed International journal

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

Cureus 12 ( 11 ) e11376 2020.11

Language：English

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

Luminal preloading with hydrogen‐rich saline ameliorates ischemia‐reperfusion injury following intestinal transplantation in rats Reviewed International journal

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

Pediatric Transplantation 24 ( 7 ) e13848 2020.11

Language：English Publishing type：Research paper (scientific journal) Publisher：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

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/petr.13848

Glycogenic hepatopathy following attempted suicide by long-acting insulin overdose in patient with type 1 diabetes. Reviewed International journal

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 2020.10

Language：English

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

Therapeutic strategies for ischemia reperfusion injury in emergency medicine Reviewed International journal

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 2020.1

Language：English Publishing type：Research paper (scientific journal) Publisher：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

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ams2.501

A family intoxicated by daffodil bulbs mistaken for onions Reviewed International journal

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

Acute Medicine & Surgery 7 ( 1 ) e595 2020.1

Pediatric airway compromise due to thyroid storm associated with influenza A infection: A case report. Reviewed International journal

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

Respiratory medicine case reports 31 101182 - 101182 2020

Language：English

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

Retropharyngeal hematoma presenting airway obstruction: A case report. Reviewed International journal

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

International journal of surgery case reports 77 321 - 324 2020

Language：English

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

Epileptic Seizure from Ginkgo Nut Intoxication in an Adult. Reviewed International journal

Yoshinori Kosaki, Hiromichi Naito, Tsuyoshi Nojima, Atsunori Nakao

Case reports in emergency medicine 2020 5072954 - 5072954 2020

Language：English

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.

DOI： 10.1155/2020/5072954

Caffeine Intoxication in Pregnancy; a Case Report Reviewed International journal

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

Archives of Academic Emergency Medicine 7 ( 1 ) e67 2019.11

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

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.

A case of spontaneous mesenteric hematoma successfully diagnosed and treated with aggressive imaging. Reviewed International journal

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

Language：English Publishing type：Research paper (scientific journal)

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

Early predictors for massive transfusion in older adult severe trauma patients Reviewed International journal

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 2017.5

Language：English Publishing type：Research paper (scientific journal) Publisher：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 >= 16 and age >= 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 < 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

Other Link： http://orcid.org/0000-0003-0768-0179

Effect of pre-injury anticoagulant and antiplatelet agents on blood loss in elderly patients with severe trauma. Reviewed International journal

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

Acute medicine & surgery 3 ( 2 ) 114 - 119 2016.4

Language：English Publishing type：Research paper (scientific journal)

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.

DOI： 10.1002/ams2.152

Bleeding sites in elderly trauma patients who required massive transfusion: a comparison with younger patients Reviewed International journal

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 2016.2

Language：English Publishing type：Research paper (scientific journal) Publisher：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 >= 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 >= 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 >= 10 red cell concentrate units within the first 24 hours after their admission.
Results: Eighty-four patients met our inclusion criterion. The younger group (<65 years old) included 40 patients (48%), whereas the older group (>= 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.

DOI： 10.1016/j.ajem.2015.09.047

Other Link： http://orcid.org/0000-0003-0768-0179

Admission fibrinogen levels in severe trauma patients: A comparison of elderly and younger patients Reviewed International journal

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 2015.9

Language：English Publishing type：Research paper (scientific journal) Publisher：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) >= 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 (>= 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 < 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 < 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

Other Link： http://orcid.org/0000-0003-0768-0179

Presepsin as a powerful monitoring tool for the prognosis and treatment of sepsis: A multicenter prospective study Reviewed International journal

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 2014.1

Language：English Publishing type：Research paper (scientific journal) Publisher：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 < 0.05). The unfavorable prognosis group had significantly higher 28-day mortality than the favorable prognosis group (P < 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

Other Link： http://orcid.org/0000-0003-0768-0179

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