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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

当科における小児急性脳症と体温管理療法の現状

小原隆史, 塚原紘平, 平岡知浩, 本郷貴識, 湯本哲也, 内藤宏道, 中尾篤典

日本脳低温療法・体温管理学会誌 26 ( 1 ) 47 - 47 2023年6月

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

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

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

体温管理療法中の温度管理が筋萎縮にあたえる影響の検討

本郷貴識, 小原隆史, 湯本哲也, 内藤宏道, 中尾篤典

日本脳低温療法・体温管理学会誌 26 ( 1 ) 48 - 48 2023年6月

当科における小児急性脳症と体温管理療法の現状

小原隆史, 塚原紘平, 平岡知浩, 本郷貴識, 湯本哲也, 内藤宏道, 中尾篤典

日本脳低温療法・体温管理学会誌 26 ( 1 ) 47 - 47 2023年6月

体温管理療法中の温度管理が筋萎縮にあたえる影響の検討

本郷貴識, 小原隆史, 湯本哲也, 内藤宏道, 中尾篤典

日本脳低温療法・体温管理学会誌 26 ( 1 ) 48 - 48 2023年6月

Hydrogen inhalation attenuates lung contusion after blunt chest trauma in mice. 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

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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Impact of frailty on long-term mortality in older patients receiving intensive care via the emergency department. 国際誌

Mototaka Inaba, Hiromichi Naito, Takashi Yorifuji, Chikaaki Nakamichi, Hiroki Maeyama, Hideki Ishikawa, Nobuaki Shime, Sadayori Uemori, Satoshi Ishihara, Makoto Takaoka, Tsuyoshi Ohtsuka, Masahiro Harada, Satoshi Nozaki, Keisuke Kohama, Ryota Sakurai, Shuho Sato, Shun Muramatsu, Kazunori Yamashita, Toshihiko Mayumi, Kaoruko Aita, Atsunori Nakao

Scientific reports 13 ( 1 ) 5433 - 5433 2023年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

The aim of this study was to evaluate whether frailty was associated with 6-month mortality in older adults who were admitted to the intensive care unit (ICU) with an illness requiring emergency care. The investigation was a prospective, multi-center, observational study conducted among the ICUs of 17 participating hospitals. Patients ≥ 65 years of age who were admitted to the ICU directly from an emergency department visit were assessed to determine their baseline Clinical Frailty Scale (CFS) scores before the illness and were surveyed 6 months after admission. Among 650 patients included in the study, the median age was 79 years old, and overall mortality at 6 months was as low as 21%, ranging from 6.2% in patients with CFS 1 to 42.9% in patients with CFS ≥ 7. When adjusted for potential confounders, CFS score was an independent prognostic factor for mortality (one-point increase in CFS, adjusted risk ratio with 95% confidence interval 1.19 [1.09-1.30]). Quality of life 6 months after admission worsened as baseline CFS score increased. However, there was no association between total hospitalization cost and baseline CFS. CFS is an important predictor of long-term outcomes among critically ill older patients requiring emergent admission.

DOI： 10.1038/s41598-023-32519-2

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Association between prehospital advanced life support by emergency medical services personnel and neurological outcomes among adult out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation: A secondary analysis of the SAVE-J II study. 国際誌

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

Journal of the American College of Emergency Physicians open 4 ( 2 ) e12948 2023年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

STUDY OBJECTIVE: Early deployment of extracorporeal cardiopulmonary resuscitation (ECPR) is critical in treating refractory out-of-hospital cardiac arrest (OHCA) patients who are potential candidates for ECPR. The effect of prehospital advanced life support (ALS), including epinephrine administration or advanced airway, compared with no ALS in this setting remains unclear. This study's objective was to determine the association between any prehospital ALS care and outcomes of patients who received ECPR with emergency medical services-treated OHCA. METHODS: This was a secondary analysis of data from the Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J) II study. Patients were separated into 2 groups-those who received prehospital ALS (ALS group) and those did not receive prehospital ALS (no ALS group). Multiple logistic regression analysis was used to investigate the association between prehospital ALS and favorable neurological outcomes (defined as Cerebral Performance Category scores 1-2) at hospital discharge. RESULTS: A total of 1289 patients were included, with 644 patients in the ALS group and 645 patients in the no ALS group. There were fewer favorable neurological outcomes at hospital discharge in the ALS group compared with the no ALS group (10.4 vs 19.8%, p <0.001). A multiple logistic regression analysis revealed that any prehospital ALS care (adjusted odds ratios 0.47; 95% confidence interval 0.34-0.66; p <0.001) was associated with unfavorable neurological outcomes at hospital discharge. CONCLUSION: Prehospital ALS was associated with worse neurological outcomes at hospital discharge in patients treated with ECPR for OHCA. Further prospective studies are required to determine the clinical implications of these findings.

DOI： 10.1002/emp2.12948

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救急救命士の処置拡大に向けた医師の指示下でのFAST検査におけるSim教育の効果実証

中藤光里, 大平安希子, 牧尉太, 三苫智裕, 三島桜子, 上田浩平, 桐野智江, 衛藤英理子, 中尾篤典, 増山寿

超音波医学 50 ( Suppl. ) S691 - S691 2023年4月

デジタル田園健康特区での移動車両内遠隔超音波検査伝送による遠隔診断の有効性の調査

三苫智裕, 牧尉太, 大羽輝, 上田浩平, 桐野智江, 大平安希子, 谷和祐, 衛藤英理子, 中尾篤典, 増山寿

超音波医学 50 ( Suppl. ) S691 - S691 2023年4月

救急救命士の処置拡大に向けた医師の指示下でのFAST検査におけるSim教育の効果実証

中藤光里, 大平安希子, 牧尉太, 三苫智裕, 三島桜子, 上田浩平, 桐野智江, 衛藤英理子, 中尾篤典, 増山寿

超音波医学 50 ( Suppl. ) S691 - S691 2023年4月

デジタル田園健康特区での移動車両内遠隔超音波検査伝送による遠隔診断の有効性の調査

三苫智裕, 牧尉太, 大羽輝, 上田浩平, 桐野智江, 大平安希子, 谷和祐, 衛藤英理子, 中尾篤典, 増山寿

超音波医学 50 ( Suppl. ) S691 - S691 2023年4月

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

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

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

Heat Exposure Following the Rainy Season Is Associated With an Increased Risk of Cardiovascular Emergency Among the Elderly in Japan. 国際誌

Ryohei Fujimoto, Etsuji Suzuki, Saori Kashima, Kazufumi Nakamura, Hiromichi Naito, Atsunori Nakao, Hiroshi Ito, Takashi Yorifuji

Journal of the American Heart Association 12 ( 6 ) e027046 2023年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

Background Despite the impact of heat exposure caused by global warming, few studies have investigated the hourly effects of heat exposure and the risk of cardiovascular disease (CVD) in the elderly. We examined the associations between short-term heat exposure and the risk of CVD in the elderly in Japan and evaluated possible effect-measure modifications by rainy seasons that occur in East Asia. Methods and Results We conducted a time-stratified case-crossover study. The study included 6527 residents in Okayama City, Japan, aged ≥65 years who were transported to emergency hospitals between 2012 and 2019 for the onset of CVD during and a few months after the rainy seasons. We examined the linear associations between temperature and CVD-related emergency calls for each year and for hourly preceding intervals before the emergency call during the most relevant months. Heat exposure during 1 month after the end of the rainy season was associated with CVD risk; the odds ratio (OR) for a 1° C increase in temperature was 1.34 (95% CI, 1.29-1.40). When we further explored the nonlinear association by using the natural cubic spline model, we found a J-shaped relationship. Exposures 0 to 6 hours before the case event (preceding intervals 0-6 hours) were associated with CVD risk, particularly for the preceding interval 0 to 1 hour (OR, 1.33 [95% CI, 1.28-1.39]). For longer periods, the highest risk was at preceding intervals 0 to 23 hours (OR, 1.40 [95% CI, 1.34-1.46]). Conclusions Elderly individuals may be more susceptible to CVD after heat exposure during the month after the rainy season. As shown by finer temporal resolution analyses, short-term exposure to increasing temperature can trigger CVD onset.

DOI： 10.1161/JAHA.122.027046

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

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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Organ Donation after Extracorporeal Cardiopulmonary Resuscitation and Brain Death.

Takafumi Obara, Tetsuya Yumoto, Kenji Aoshima, Kohei Tsukahara, Hiromichi Naito, Atsunori Nakao

Acta medica Okayama 77 ( 1 ) 117 - 120 2023年2月

記述言語：英語

A 38-year-old primipara Japanese woman suffered cardiac arrest due to a pulmonary thromboembolism 1 day after undergoing a cesarean section. Extracorporeal cardiopulmonary resuscitation was initiated and extracorporeal membrane oxygenation support was needed for 24 h. Despite intensive care, the patient was diagnosed with brain death on day 6. With the family's consent, comprehensive end-of-life care including organ donation was discussed based on our hospital's policy. The family decided to donate her organs. Specific training and education are required for emergency physicians to optimize the process of incorporating organ donation into end-of-life care while respecting the patient's and family's wishes.

DOI： 10.18926/AMO/64372

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A Seat Belt Injury Causing a Large Breast Hematoma: A Case Report. 国際誌

Shunki Yamamoto, Yoshinori Kosaki, Takenori Uehara, Hiromichi Naito, Atsunori Nakao

Cureus 15 ( 2 ) e35440 2023年2月

記述言語：英語

Seat belts with shoulder restraints have decreased the frequency of life-threatening severe chest trauma caused by car accidents. However, the introduction of seat belt legislation has led to an increase in a specific pattern of blunt trauma known as seat belt syndrome, which includes rib, clavicle, spine, and sternum fractures, as well as rupture of hollow pelvic and abdominal viscera, mesenteric tears, and major vessel injuries. The shoulder restraint part of the three-point seat belt commonly rests near or over the female and male breast. A 54-year-old female presented to our emergency department complaining of swelling and pain in her left breast immediately after a traffic accident. The patient had used a seat belt with a shoulder restraint. Bruising was noted along her chest where there had been seat belt contact. Her breast hematoma was most likely caused by breast tissue compression between her rib and the seat belt. Contrast-enhanced computed tomography demonstrated a sizable breast hematoma with active arterial contrast material extravasation, as well as multiple left rib fractures. The patient was conservatively treated with analgesic and anti-inflammatory drugs. Complete resolution was achieved, and her breast returned to its normal appearance. Although endovascular treatment and surgical hemostasis have been proposed for the treatment of breast injuries with active bleeding, conservative treatment such as compression hemostasis may be feasible.

DOI： 10.7759/cureus.35440

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