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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

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

記述言語：英語掲載種別：研究論文（学術雑誌）

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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論文執筆も点数化を 2019年度救急科専門医試験受験して

本郷貴識, 藤原俊文, 内藤宏道, 中尾篤典

日本救急医学会雑誌 31 ( 11 ) 880 - 880 2020年11月

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

すべての心停止後患者の社会復帰を目指して院外心停止による心停止後症候群の中期の神経症状改善に関して

内藤宏道, 湯本哲也, 野島剛, 藤崎宣友, 薬師寺泰匡, 中尾篤典

日本救急医学会雑誌 31 ( 11 ) 712 - 712 2020年11月

疑い症例を含むCOVID-19対応下での緊急手術、準備は出来ているか?

山田太平, 小出恭大, 野島剛, 山本浩継, 藤崎宣友, 内藤宏道, 多河慶泰, 高岡諒, 古賀仁士, 山下寿, 中尾篤典

日本救急医学会雑誌 31 ( 11 ) 2220 - 2220 2020年11月

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

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

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

Web of Science

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

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

Scandinavian journal of trauma, resuscitation and emergency medicine 28 ( 1 ) 89 - 89 2020年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1186/s13049-020-00784-z

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急性肺傷害に対する治療開発水素吸入療法の炎症・線維化の抑制効果マウスを用いた検証

青景聡之, 池谷真澄, 瀬谷瑞樹, 平山隆浩, 石川倫子, 内藤宏道, 大澤郁朗, 中尾篤典

日本集中治療医学会雑誌 27 ( Suppl. ) 476 - 476 2020年9月

静脈-静脈体外式膜型人工肺療法(VV ECMO)ラットモデルの構築

青景聡之, 岡田真澄, 平山隆浩, 塚原紘平, 内藤宏道, 中尾篤典

日本集中治療医学会雑誌 27 ( Suppl. ) 471 - 471 2020年9月

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

mobile ECMOシステムの構築に向けての現状と問題点臨床工学技士の立場から

平山隆浩, 落葉佑昌, 堂口琢磨, 岡田真澄, 川田将弘, 青景聡之, 塚原紘平, 小崎吉訓, 内藤宏道, 中尾篤典

日本集中治療医学会雑誌 27 ( Suppl. ) 625 - 625 2020年9月

当院の救急集中治療室における、急性腎障害の持続的腎代替療法の導入時期と予後を検討する

岡田真澄, 平山隆浩, 落葉佑昌, 塚原紘平, 青景聡之, 藤崎宣友, 山田太平, 内藤宏道, 中尾篤典

日本集中治療医学会雑誌 27 ( Suppl. ) 506 - 506 2020年9月

The psoas muscle index as a predictor of mortality and morbidity of geriatric trauma patients: experience of a major trauma center in Kobe

Takeshi Nishimura, Hiromichi Naito, Noritomo Fujisaki, Satoshi Ishihara, Atsunori Nakao, Shinichi Nakayama

Surgery Today 50 ( 9 ) 1016 - 1023 2020年9月

Comparison of direct oral anticoagulant and vitamin K antagonists on outcomes among elderly and nonelderly trauma patients. 国際誌

Takeshi Nishimura, Francis X Guyette, Hiromichi Naito, Atsunori Nakao, Joshua B Brown, Clifton W Callaway

The journal of trauma and acute care surgery 89 ( 3 ) 514 - 522 2020年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Direct oral anticoagulants (DOACs) are widely used among patients requiring anticoagulant therapy. These drugs are associated with a lower risk of bleeding than vitamin K antagonists (VKAs). However, the outcomes of elderly trauma patients receiving DOACs are not well known. METHODS: We reviewed data from trauma patients at our level I trauma center (University of Pittsburgh Medical Center, Presbyterian Hospital) seen from January 2011 to July 2018. We identified trauma patients taking DOACs or VKAs and compared these cohorts using 1:1 propensity score-matching based on patient characteristics, antiplatelet use, comorbidities, and laboratory values. The primary outcome was in-hospital mortality. Secondary outcomes included the proportion of patients discharged to skilled nursing facility/rehabilitation facility discharge or to home, and transfusion volume. RESULTS: Of 32,272 trauma patients screened, 530 were taking DOACs and 1,702 were taking VKAs. We matched 668 patients in a 1:1 ratio (DOACs group, 334 vs. VKAs group, 334). The DOACs group had similar mortality (4.8% vs. 1.6%; odds ratio (OR), 3.0; 95% confidence interval (CI), 0.31-28.8; p = 0.31) among patients younger than 65 years, but mortality differed (3.0% vs. 6.6%; OR, 0.41; 95% CI, 0.17-0.99; p = 0.048) among patients older than 65 years. The proportion of patients discharged to skilled nursing facility/rehabilitation facility (50.0% vs. 50.6%; OR, 0.98; 95% CI, 0.72-1.32; p = 0.88) and to home (40.4% vs. 38.6%; OR, 1.08; 95% CI, 0.79-1.47; p = 0.64) were similar. Patients in the DOACs group received fewer fresh frozen plasma (p = 0.032), but packed red blood cells (p = 0.86) and prothrombin complex concentrate (p = 0.48) were similar. CONCLUSION: In this matched cohort of anticoagulated trauma patients, DOACs were associated with the decreased in-hospital mortality and decreased administration of fresh frozen plasma compared with VKAs among trauma patients 65 years or older taking anticoagulant therapy. LEVEL OF EVIDENCE: Prognostic/Epidemiological, level III.

DOI： 10.1097/TA.0000000000002823

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Comparison of Two Different Intensive Care Unit Systems for Severely Ill Children in Japan: Data from the JaRPAC Registry. 査読

Kohei Tsukahara, Hiromichi Naitou, Takashi Yorifuji, Nobuyuki Nosaka, Hirotsugu Yamamoto, Takaaki Osako, Atsunori Nakao

Acta medica Okayama 74 ( 4 ) 285 - 291 2020年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

The importance of centralizing treatment services for severely ill children has been well established, but such entralization remains difficult in Japan. We aimed to compare the trauma and illness severity and mortality of children admitted to two common types of ICUs for children. According to the type of management and disposition of the medical provider, we classified ICUs as pediatric ICUs [PICUs] or general ICUs, and analyzed differences in endogenous and exogenous illness settings between them. Overall, 1,333 pediatric patients were included, with 1,143 patients admitted to PICUs and 190 patients to general ICUs. The Pediatric Cerebral Performance Category score (PCPC) at discharge was significantly lower in the PICU group (adjusted OR: 0.45; 95%CI: 0.23-0.88). Death and unfavorable neurological outcomes occurred less often in the PICU group (adjusted OR: 0.29; 95%CI: 0.14-0.60). However, when limited to exogenous illness, PCPC scores (adjusted OR: 0.38; 95%CI: 0.07-1.99) or death/unfavorable outcomes (adjusted OR: 0.72; 95%CI: 0.08-6.34) did not differ between the groups. PCPC deterioration and overall sequelae/death rates were lower in PICUs for children with endogenous illnesses, although the outcomes of exogenous illness were similar between the 2 unit types. Further studies on the necessity of centralization are warranted.

DOI： 10.18926/AMO/60365

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Hospital evacuation assistance from public and private resources: Lessons learned from the 2018 Western Japan floods

Inaba, M., Naito, H., Muramatsu, T., Yamada, T., Sakata, T., Nakao, A.

Acta Medica Okayama 74 ( 4 ) 359 - 364 2020年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

During major flooding in June/July 2018, the Mabi Memorial Hospital in Kurashiki, Okayama, Japan was flooded and patients were stranded in the hospital. Peace Winds Japan, a non-governmental organization, collaborated with the Japanese Disaster Medical Assistance Team and Self-Defense Force Public to transport 8 critical patients from the hospital by helicopter. Ultimately, 54 patients and hospital staff members were safely evacuated. The evacuation was accomplished without any casualties, despite the severe conditions. Public and private organizations can work together and continue to seek ways to collaborate and cooperate in disaster settings.

DOI： 10.18926/AMO/60375

Scopus

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外傷性心停止例の搬送時間と生存率の検討

内藤宏道, 湯本哲也, 野島剛, 頼藤貴志, 中尾篤典

J-ReSS 12 16 - 16 2020年7月

集中治療室管理を要した重症頭部外傷症例の長期予後

安原隆雄, 湯本哲也, 村井智, 中尾篤典, 伊達勲

日本脳神経外傷学会プログラム・抄録集 43回 151 - 151 2020年2月

Therapeutic strategies for ischemia reperfusion injury in emergency medicine 査読

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

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

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