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Geriatric Trauma in Patients ≧85 Years Old in an Urban District of Japan.

Takeshi Nishimura, Hiromichi Naito, Shigenari Matsuyama, Satoshi Ishihara, Atsunori Nakao, Shinichi Nakayama

Acta medica Okayama 73 ( 3 ) 197 - 203 2019年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

Japan's population has been skewing toward the elderly, but the outcomes of advanced elderly trauma are not clear. Here we compared the outcomes of very elderly trauma patients (≧85 years old) with those of 65- to 84-year-old trauma patients. We retrospectively reviewed the medical records of patients treated at Hyogo Emergency Medical Center from August 2010 to August 2016; 631 patients were entered in the study. We divided them into the younger geriatrics (YG group, 65-84 years old: n=534) and older geriatrics (OG group, ≧85 years old: n=97). The group's patient characteristics, mortality, 1-year survival rate, and Barthel index were tabulated and compared. The patients' mean age was 75.6±7.5 years. There was no significant difference in mortality between the YG and OG groups (9.6% vs. 15.1%, odds ratio [OR] 1.73; 95% confidence interval [CI] 0.93-3.23, p=0.083). The 1-year survival rate (94.4% vs. 77.8%, OR 0.19, 95% CI 0.07-0.51; p<0.01) and Barthel index (Median score; 100 (IQR: 85-100) vs. 80 (IQR: 15-95), OR 0.98, 95% CI 0.97 to 0.99, p<0.01) differed significantly between the groups. Our study did not find a significant difference in-hospital mortality between patients in the YG group and those in the OG group.

DOI： 10.18926/AMO/56861

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Atypical case of posterior reversible encephalopathy syndrome related to late onset postpartum eclampsia: A case report. 査読国際誌

Kaori Masai, Yayoi Ueda, Hiromichi Naito, Kohei Tsukahara, Toshiyuki Aokage, Noritomo Fujisaki, Hirotsugu Yamamoto, Atsunori Nakao

Medicine 98 ( 16 ) e15187 2019年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

RATIONALE: Eclampsia, an obstetric emergency frequently seen in pregnant or puerperal women, is a risk factor for posterior reversible encephalopathy syndrome (PRES). Most cases of eclampsia occur postpartum. We report a woman with PRES associated with eclampsia 10 weeks post-delivery, the latest onset ever reported. PATIENT CONCERNS: A 23-year-old healthy woman presented headache and nausea 10 weeks after delivery. Two days later, she generalized tonic-clonic seizure. Her brain MRI presented the foci which is typical of PRES. DIAGNOSIS: The patient was diagnosed as PRES associated with eclampsia. INTERVENTIONS: The patient received levetiracetam and edaravone. OUTCOMES: Her clinical course was uneventful and she fully recovered without neurological complications LESSONS:: The possible diagnosis of late onset postpartum eclampsia, even weeks post-delivery, should be considered, since initiation of early treatment averts severe complications and decreases mortality. Sharing our experience may increase awareness of PRES induced by late-onset postpartum eclampsia.

DOI： 10.1097/MD.0000000000015187

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

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

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

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.21037/jtd.2019.03.23

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Factors Affecting the Absorption of Midazolam to the Extracorporeal Membrane Oxygenation Circuit. 査読

Atsuyoshi Iida, Hiromichi Naito, Takashi Yorifuji, Yoshito Zamami, Akane Yamada, Tadashi Koga, Toru Imai, Toshiaki Sendo, Atsunori Nakao, Shingo Ichiba

Acta medica Okayama 73 ( 2 ) 101 - 107 2019年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Sedatives are administered during extracorporeal membrane oxygenation (ECMO) therapy to ensure patient safety, reduce the metabolic rate and correct the oxygen supply-demand balance. However, the concentrations of sedatives can be decreased due to absorption into the circuit. This study examined factors affecting the absorption of a commonly used sedative, midazolam (MDZ). Using multiple ex vivo simulation models, three factors that may influence MDZ levels in the ECMO circuit were examined: polyvinyl chloride (PVC) tubing in the circuit, use of a membrane oxygenator in the circuit, and heparin coating of the circuit. We also assessed changes in drug concentration when MDZ was re-injected in a circuit. The MDZ level decreased to approximately 60% of the initial concentration in simulated circuits within the first 30 minutes. The strongest factor in this phenomenon was contact with the PVC tubing. Membrane oxygenator use tended to increase MDZ loss, whereas heparin circuit coating had no influence on MDZ absorption. Similar results were obtained when a second dose of MDZ was injected to the second-use circuits.

DOI： 10.18926/AMO/56645

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

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

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

高度救命救急センターにおける重症患者への蛋白質投与について

皆尾望, 藤崎宣友, 庵谷紘美, 小崎吉訓, 山川泰明, 飯田淳義, 湯本哲也, 山本浩継, 山田太平, 青景聡之, 塚原紘平, 万代康弘, 尾迫貴章, 内藤宏道, 中尾篤典

日本臨床外科学会雑誌 80 ( 3 ) 608 - 608 2019年3月

外傷性視神経症に対し早期ステロイドパルス療法が奏功したと考えられた1症例

庵谷紘美, 山田太平, 小崎吉訓, 山川泰明, 飯田淳義, 湯本哲也, 山本浩継, 青景聡之, 藤崎宣友, 塚原紘平, 万代康弘, 尾迫貴章, 内藤宏道, 中尾博之, 中尾篤典

日本臨床外科学会雑誌 80 ( 3 ) 608 - 608 2019年3月

V-Pシャント機能不全を来たした腹腔内髄液仮性嚢胞の一例

高瀬了輔, 庵谷紘美, 井本良二, 亀田雅博, 小崎吉訓, 山川泰明, 飯田淳義, 湯本哲也, 青景聡之, 藤崎宣友, 山田太平, 山本浩継, 塚原紘平, 万代康弘, 尾迫貴章, 内藤宏道, 中尾篤典

日本臨床外科学会雑誌 80 ( 3 ) 608 - 608 2019年3月

日本のキノコ中毒5年間の報告

小崎吉訓, 内藤宏道, 庵谷紘美, 山川泰明, 飯田淳義, 湯本哲也, 青景聡之, 藤崎宣友, 山田太平, 山本継, 塚原紘平, 万代康弘, 尾迫貴章, 中尾博之, 中尾篤典

中毒研究 32 ( 1 ) 99 - 99 2019年3月

千枚通しによる穿通性胸部外傷の一例

川口満理奈, 湯本哲也, 青景聡之, 山田太平, 衛藤弘城, 末澤孝徳, 中尾篤典

日本臨床外科学会雑誌 80 ( 3 ) 607 - 607 2019年3月

初療時には診断をつけられなかった農薬中毒の2例

有吉雪乃, 内藤宏道, 竹居セラ, 森本直樹, 三浦雅布, 中尾篤典, 宮石智

中毒研究 32 ( 1 ) 100 - 100 2019年3月

Impact of contrast extravasation on computed tomography of the psoas major muscle in patients with blunt torso trauma

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

Journal of Trauma and Acute Care Surgery 86 ( 2 ) 268 - 273 2019年2月

平成30年7月豪雨水害時の消毒用消石灰散布が及ぼす健康被害

山田太平, 小崎吉訓, 飯田淳義, 塚原紘平, 内藤宏道, 高田洋介, 渡邉暁洋, 大川恭昌, 名倉弘哲, 三木真彩菜, 三橋乙矢, 井上智美, 加藤湖月, 中尾博之, 中尾篤典

Japanese Journal of Disaster Medicine 23 ( 3 ) 423 - 423 2019年2月

平成30年7月豪雨災害時の病院避難における現場救護所での活動報告

三橋乙矢, 三木真彩菜, 西尾拓真, 加藤湖月, 大川恭昌, 小崎吉訓, 飯田淳義, 塚原紘平, 山田太平, 内藤宏道, 中尾篤典, 高田洋介, 渡邉暁洋, 中尾博之

Japanese Journal of Disaster Medicine 23 ( 3 ) 363 - 363 2019年2月

豪雨水害に対する岡山県下の対応と課題

中尾博之, 渡邉暁洋, 高田洋介, 山田太平, 内藤宏道, 飯田淳義, 小崎吉訓, 塚原紘平, 名倉弘哲, 大川恭昌, 三橋乙矢, 三木真彩菜, 井上智美, 加藤湖月, 中尾篤典

Japanese Journal of Disaster Medicine 23 ( 3 ) 331 - 331 2019年2月

「トリアージの諸問題」目的に適した災害時トリアージ法の選択だれがどんなトリアージをいつ行うべきか?

中尾博之, 渡邉暁洋, 山田太平, 小崎吉訓, 内藤宏道, 中尾篤典, 高田洋介

Japanese Journal of Disaster Medicine 23 ( 3 ) 290 - 290 2019年2月

薬剤師における災害支援の新たな課題

渡邉暁洋, 大川恭昌, 井上知美, 井上誠子, 大川, 高田洋介, 山田太平, 中尾博之, 中尾篤典

Japanese Journal of Disaster Medicine 23 ( 3 ) 346 - 346 2019年2月

「地域包括ケアシステムと地域災害医療体制のあり方」 BCPに基づく地域包括ケアシステムの構築

中尾博之, 渡邉暁洋, 高田洋介, 飯田淳義, 塚原紘平, 中尾篤典

Japanese Journal of Disaster Medicine 23 ( 3 ) 273 - 273 2019年2月

Mortality in trauma patients admitted during, before, and after national academic emergency medicine and trauma surgery meeting dates in Japan

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

PLOS ONE 14 ( 1 ) e0207049 - e0207049 2019年1月

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

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

Case reports in critical care 2019 1824101 - 1824101 2019年

記述言語：英語

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

DOI： 10.1155/2019/1824101

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