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衝突事故検出能を有するスマートフォン/スマートウォッチからの自動緊急通報の現状岡山市における後方視的検討

山本隼究, 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 34 ( 12 ) 753 - 753 2023年12月

蘇生を希望しない院外心停止の診療に関する救急外来での実態調査多機関共同横断研究

田邉綾, 湯本哲也, 本郷貴識, 内藤宏道, 中尾篤典

日本救急医学会雑誌 34 ( 12 ) 720 - 720 2023年12月

Effect of stomach inflation during cardiopulmonary resuscitation on return of spontaneous circulation in out-of-hospital cardiac arrest patients: A retrospective observational study. 査読

Naito H, Hanafusa H, Hongo T, Yumoto T, Yorifuji T, Weissman A, Rittenberger JC, Guyette FX, Fujishima M, Maeyama H, Nakao A

Resuscitation. 109994 2023年10月

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

Tetsuya Yumoto, Takashi Hongo, Yasuhiro Koide, Takafumi Obara, Kohei Tsukahara, Hiromichi Naito, Atsunori Nakao

BMC medical ethics 24 ( 1 ) 80 - 80 2023年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Each individual's unique health-related beliefs can greatly impact the patient-clinician relationship. When there is a conflict between the patient's preferences and recommended medical care, it can create a serious ethical dilemma, especially in an emergency setting, and dramatically alter this important relationship. CASE PRESENTATION: A 56-year-old man, who remained comatose after out-of-hospital cardiac arrest, was rushed to our hospital. The patient was scheduled for emergency coronary angiography when his adolescent daughter reported that she and her father held sincere beliefs against radiation exposure. We were concerned that she did not fully understand the potential consequences if her father did not receive the recommended treatment. A physician provided her with in depth information regarding the risks and benefits of the treatment. While we did not want to disregard her statement, we opted to save the patient's life due to concerns about the validity of her report. CONCLUSIONS: Variations in beliefs regarding medical care force clinicians to incorporate patient beliefs into medical practice. However, an emergency may require a completely different approach. When faced with a patient in a life-threatening condition and unconscious, we should take action to prioritize saving their life, unless we are highly certain about the validity of their advance directives.

DOI： 10.1186/s12910-023-00962-5

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救急救命士へのタスクシフト内閣府デジタル田園健康特区での取り組み

上田浩平, 平山隆浩, 牧尉太, 増山寿, 那須保友, 中尾篤典

日本在宅救急医学会誌 7 ( 1 ) 9 - 11 2023年10月

救急救命士へのタスクシフト内閣府デジタル田園健康特区での取り組み

上田浩平, 平山隆浩, 牧尉太, 増山寿, 那須保友, 中尾篤典

日本在宅救急医学会誌 7 ( 1 ) 9 - 11 2023年10月

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

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

Resuscitation plus 15 100418 - 100418 2023年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1016/j.resplu.2023.100418

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Attenuation of pulmonary damage in aged lipopolysaccharide-induced inflammation mice through continuous 2 % hydrogen gas inhalation: A potential therapeutic strategy for geriatric inflammation and survival. 国際誌

Toshiyuki Aokage, Masumi Iketani, Mizuki Seya, Ying Meng, Kohei Ageta, Hiromichi Naito, Atsunori Nakao, Ikuroh Ohsawa

Experimental gerontology 180 112270 - 112270 2023年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: With the global population aging, there is an increased prevalence of sepsis among the elderly, a demographic particularly susceptible to inflammation. This study aimed to evaluate the therapeutic potential of hydrogen gas, known for its anti-inflammatory and antioxidant properties, in attenuating inflammation specifically in the lungs and liver, and age-associated molecular markers in aged mice. METHODS: Male mice aged 21 to 23 months, representative of the human elderly population, were subjected to inflammation via intraperitoneal injection of lipopolysaccharide (LPS). The mice were allocated into eight groups to examine the effects of varying durations and concentrations of hydrogen gas inhalation: control, saline without hydrogen, saline with 24-hour 2 % hydrogen, LPS without hydrogen, LPS with 24-hour 2 % hydrogen, LPS with 6-hour 2 % hydrogen, LPS with 1-hour 2 % hydrogen, and LPS with 24-hour 1 % hydrogen. Parameters assessed included survival rate, activity level, inflammatory biomarkers, and organ injury. RESULTS: Extended administration of hydrogen gas specifically at a 2 % concentration for 24 h led to a favorable prognosis in the aged mice by reducing mRNA expression of inflammatory biomarkers in lung and liver tissue, mitigating lung injury, and diminishing the expression of the senescence-associated protein p21. Moreover, hydrogen gas inhalation selectively ameliorated senescence-related markers in lung tissue, including C-X-C motif chemokine 2, metalloproteinase-3, and arginase-1. Notably, hydrogen gas did not alleviate LPS-induced liver injury under the conditions tested. CONCLUSION: The study highlights that continuous inhalation of hydrogen gas at a 2 % concentration for 24 h can be a potent intervention in the geriatric population for improving survival and physical activity by mitigating pulmonary inflammation and modulating senescence-related markers in aged mice with LPS-induced inflammation. This finding paves the way for future research into hydrogen gas as a therapeutic strategy to alleviate severe inflammation that can lead to organ damage in the elderly.

DOI： 10.1016/j.exger.2023.112270

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

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

Resuscitation plus 15 100434 - 100434 2023年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1016/j.resplu.2023.100434

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補助検査として4vessel studyを行った法的脳死判定の1例

塚原紘平, 内藤宏道, 萩原万龍, 野島剛, 湯本哲也, 中尾篤典, 横田裕行

移植 58 ( 総会臨時 ) 249 - 249 2023年9月

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

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

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

記述言語：英語

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

DOI： 10.18926/AMO/65755

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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

レボチロキシン多量服薬の一例

小崎吉訓, 内藤宏道, 小出恭大, 塚原紘平, 湯本哲也, 中尾篤典

日本臨床救急医学会雑誌 26 ( 3 ) 351 - 351 2023年7月

大規模地震訓練に対する臨床工学技士の取り組みと課題

岡田真澄, 平山隆浩, 渡邉暁洋, 上田浩平, 飯田淳義, 中尾篤典, 中尾博之

日本臨床救急医学会雑誌 26 ( 3 ) 372 - 372 2023年7月

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

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

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

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

大規模地震訓練に対する臨床工学技士の取り組みと課題

岡田真澄, 平山隆浩, 渡邉暁洋, 上田浩平, 飯田淳義, 中尾篤典, 中尾博之

日本臨床救急医学会雑誌 26 ( 3 ) 372 - 372 2023年7月

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

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

Critical Care 27 ( 1 ) 2023年6月

掲載種別：研究論文（学術雑誌）出版者・発行元：Springer Science and Business Media LLC

Abstract

Background

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

Methods

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

Results

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

Conclusion

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

DOI： 10.1186/s13054-023-04534-2

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

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