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組織の体制整備による持続可能な「臓器提供」

塚原紘平, 平岡知浩, 薬師寺泰匡, 小原隆史, 小崎吉訓, 野島剛, 湯本哲也, 山本浩継, 青景聡之, 内藤宏道, 中尾篤典

日本救急医学会雑誌 33 ( 10 ) 847 - 847 2022年10月

縦隔気腫を合併した糖尿病性ケトアシドーシスの1例

山下航矢, 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 33 ( 10 ) 881 - 881 2022年10月

院外心停止患者において,バイスタンダーCPR施行者の性別は神経学的予後に影響しない

中村俊介, 野島剛, 内藤宏道, 湯本哲也, 飯田淳義, 實金健, 中尾篤典

日本救急医学会雑誌 33 ( 10 ) 716 - 716 2022年10月

Luminal administration of biliverdin ameliorates ischemia-reperfusion injury following intestinal transplant in rats. 国際誌

Tsuyoshi Nojima, Takafumi Obara, Hirotsugu Yamamoto, Tetsuya Yumoto, Takuro Igawa, Toshiyuki Aokage, Mizuki Seya, Atsunori Nakao, Hiromichi Naito

Surgery 172 ( 5 ) 1522 - 1528 2022年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Intestinal grafts are susceptible to ischemia-reperfusion injury, resulting in the loss of mucosal barrier function and graft failure. Biliverdin is known to exert a variety of cytoprotective functions against oxidative tissue injury. Because the mucosal layer is the primary site of ischemia-reperfusion injury, mucosa-targeting strategies by luminal delivery of reagents might be beneficial. We tested whether intraluminal administration of biliverdin as an adjuvant to standard preservation solutions protected against ischemia-reperfusion injury. METHODS: Orthotopic syngeneic intestinal transplants were performed on Lewis rats after 6 hours of cold preservation. Saline containing biliverdin (10 μM) or without biliverdin was introduced into the lumen of the intestinal grafts immediately before cold preservation. RESULTS: Damage to the intestinal mucosa caused by ischemia-reperfusion injury resulted in severe morphological changes, including blunting of the villi and erosion, and led to significant loss of gut barrier function 3 hours after reperfusion. These changes to the mucosa were notably ameliorated by intraluminal administration of biliverdin. Biliverdin also effectively inhibited upregulation of messenger RNAs for interleukin-6, inducible nitric oxide synthase, and C-C motif chemokine 2. Additionally, biliverdin treatment prevented the loss of expression of claudin-1, a transmembrane, tight-junction barrier protein. The 14-day survival of recipients of biliverdin-treated grafts was significantly improved as compared with the recipients of saline-treated control grafts (83.3% vs 38.9%, P = .030). CONCLUSION: This study demonstrated that luminally delivered biliverdin provides beneficial effects during the transplant of rat small intestinal grafts and could be an attractive therapeutic option in organ transplantation.

DOI： 10.1016/j.surg.2022.07.021

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デジタル田園健康特区での移動中の遠隔超音波検査システムの開発と実証調査(救急車側視点)

三苫智裕, 牧尉太, 大羽輝, 三島桜子, 大平安希子, 桐野智江, 谷和祐, 衛藤英理子, 早田桂, 赤木憲明, 平山隆浩, 上田浩平, 中尾篤典, 増山寿

現代産婦人科 71 ( Suppl. ) S54 - S54 2022年9月

デジタル田園健康特区での移動中の遠隔超音波検査システムの開発と実証調査(受信者側視点)

大羽輝, 三苫智裕, 牧尉太, 三島桜子, 大平安希子, 桐野智江, 谷和祐, 衛藤英理子, 早田桂, 赤木憲明, 平山隆浩, 上田浩平, 中尾篤典, 増山寿

現代産婦人科 71 ( Suppl. ) S53 - S54 2022年9月

在宅救急医療における、メディカル・スタッフ(看護師・薬剤師・ケアマネ・MSW・救急救命士など)の重要性とさらなる活躍の可能性救急救命士の処置拡大に向けた取り組み

上田浩平, 平山隆浩, 牧尉太, 那須保友, 中尾篤典

日本在宅救急医学会誌 6 ( Suppl. ) 49 - 49 2022年9月

上田浩平, 平山隆浩, 牧尉太, 那須保友, 中尾篤典

日本在宅救急医学会誌 6 ( Suppl. ) 49 - 49 2022年9月

院外心停止例での体温管理療法に関する無作為化比較試験

内藤宏道, 錦見満暁, 岡田遥平, 前山博輝, 木口雄之, 西田一貴, 松井茂之, 黒田泰弘, 西山慶, 石見拓, 中尾篤典

日本脳低温療法・体温管理学会誌 25 ( 1 ) 12 - 13 2022年9月

院外心停止例での体温管理療法に関する無作為化比較試験

内藤宏道, 錦見満暁, 岡田遥平, 前山博輝, 木口雄之, 西田一貴, 松井茂之, 黒田泰弘, 西山慶, 石見拓, 中尾篤典

日本脳低温療法・体温管理学会誌 25 ( 1 ) 12 - 13 2022年9月

デジタル田園健康特区での移動中の遠隔超音波検査システムの開発と実証調査(受信者側視点)

大羽輝, 三苫智裕, 牧尉太, 三島桜子, 大平安希子, 桐野智江, 谷和祐, 衛藤英理子, 早田桂, 赤木憲明, 平山隆浩, 上田浩平, 中尾篤典, 増山寿

現代産婦人科 71 ( Suppl. ) S53 - S54 2022年9月

デジタル田園健康特区での移動中の遠隔超音波検査システムの開発と実証調査(救急車側視点)

三苫智裕, 牧尉太, 大羽輝, 三島桜子, 大平安希子, 桐野智江, 谷和祐, 衛藤英理子, 早田桂, 赤木憲明, 平山隆浩, 上田浩平, 中尾篤典, 増山寿

現代産婦人科 71 ( Suppl. ) S54 - S54 2022年9月

Risk Factors for Infection Following Operative Treatment of Traumatic Upper Extremity Amputation Injury

Taichi Saito, Takenori Uehara, Ryuichi Nakahara, Yasunori Shimamura, Atsunori Nakao, Toshifumi Ozaki

The journal of hand surgery Asian-Pacific volume 27 ( 4 ) 691 - 697 2022年8月

掲載種別：研究論文（学術雑誌）

Background: Identification of the risk factors for surgical site infection (SSI) can be a straightforward and cost-effective measure to reduce or prevent the occurrence of SSI. However, there are no studies that revealed risk factors for SSI for traumatic upper extremity amputation. The aim of this study is to investigate the risk factors that promote SSI after surgery for traumatic upper extremity amputation using a large nationwide database. Methods: We used data from the Japan Trauma Data Bank. Diagnoses were defined using the Abbreviated Injury Scale code. We applied multivariate logistic regression to evaluate the infection risk factor. We chose age, sex, vital signs, cause and type of trauma, concomitant injury, diabetes, amputation level, Glasgow coma scale, Injury Severity Score (ISS) and blood transfusion within 24 hours following hospital arrival as confounders. Receiver operating characteristic (ROC) curve analysis was adopted to identify thresholds for change in infection risk. We also applied propensity score (PS) matching to adjust for confounding factors that may affect the outcome. Results: A total of 1,150 patients (967 males, 183 females) had traumatic upper extremity amputation. The mean patient age was 46.5 years. A total of 21 patients (1.8%) suffered from SSI. ISS, blood transfusion, systolic blood pressure (BP) and the upper extremity amputation except for finger were identified as the independent significant risk factors for SSI occurrence by the multivariate analysis (p < 0.05, p < 0.005, p < 0.05 and p < 0.005, respectively). ROC modelling revealed that patients with ISS of over 9 or systolic BP of over 160 had a risk for SSI. After PS matching, the patients with blood transfusion or systolic BP of over 160 had a significantly higher risk of infection (OR 9.0; p = 0.01 and OR 7.0; p = 0.03, respectively). Conclusions: In treating patients with these risk factors, we must be especially careful in performing thorough debridement and wound care. Level of Evidence: Level II (Therapeutic).

DOI： 10.1142/S2424835522500709

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Mid-term (30- to 90-day) neurological changes in out-of-hospital cardiac arrest patients: A nationwide retrospective study (the JAAM-OHCA registry)

Hiromichi Naito, Tsuyoshi Nojima, Takashi Yorifuji, Noritomo Fujisaki, Atsunori Nakao

The American Journal of Emergency Medicine 58 27 - 32 2022年8月

Frequency, associated factors, and associated outcomes of dysphagia following sepsis. 国際誌

Takashi Hongo, Tetsuya Yumoto, Hiromichi Naito, Toshifumi Fujiwara, Jun Kondo, Satoshi Nozaki, Atsunori Nakao

Australian critical care : official journal of the Confederation of Australian Critical Care Nurses 2022年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Identifying dysphagia as a potential complication of sepsis may improve swallowing function and survival while decreasing hospital length of stay. OBJECTIVES: Our goal was to determine the frequency of dysphagia in sepsis survivors on the 7th day after admission, as well as their associated factors and outcomes. METHODS: This single-centre, retrospective, observational study analysed data from sepsis survivors admitted to Okayama Saiseikai General Hospital from 2018 to 2019. Participants with sepsis were assigned to one of two study groups based on the presence or absence of dysphagia using the criterion of Functional Oral Intake Scale score <5 on the 7th day after admission. We used multivariate logistic regression to determine factors independently associated with dysphagia on the 7th day after admission. Multivariate logistic regression was also used to determine associations between groups and outcomes, including dysphagia on hospital discharge, direct discharge home (discharge of patients directly to their home), and total dependency (Barthel Index score ≤20) on hospital discharge. RESULTS: One hundred one patients met the study inclusion criteria, 55 with dysphagia and 46 without dysphagia. Fasting period (adjusted odds ratio [AOR]: 1.31, 95% confidence interval [CI]: 1.07-1.59) and enteral tube feeding (AOR: 8.56, 95% CI: 1.95-37.5) were independently associated with the presence of dysphagia on the 7th day after admission. Dysphagia on the 7th day after admission was associated with dysphagia on hospital discharge (AOR: 46.0, 95%, CI: 7.90-268.3), a lower chance of direct discharge home (AOR: 0.03, 95% CI: 0.01-0.15), and a higher incidence of total dependency (AOR: 9.30, 95% CI: 2.68-32.2). CONCLUSIONS: We found that dysphagia was commonly encountered post sepsis. Fasting period and enteral tube feeding were independently associated with dysphagia on the 7th day after admission. Dysphagia on the 7th day after admission was also associated with dysphagia on hospital discharge, nondirect discharge home, and dependency in activities of daily living at the time of hospital discharge.

DOI： 10.1016/j.aucc.2022.06.003

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キノコ中毒におけるプロカルシトニンによる診断は有用か

野島剛, 湯本哲也, 小崎吉訓, 小原隆史, 上田浩平, 塚原紘平, 山田太平, 内藤宏道, 中尾篤典

中毒研究 35 ( 2 ) 153 - 153 2022年7月

Thoracic vertebral fractures and azygos or hemiazygos vein injuries during cardiopulmonary resuscitation: Caution needed. 国際誌

Tsuyoshi Nojima, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Resuscitation plus 10 100261 - 100261 2022年6月

前頸部の腫脹によるICP上昇に対し厳密な体位保持が有用であった重症頭部外傷の小児例

小原隆史, 塚原紘平, 山本浩継, 内藤宏道, 中尾篤典

日本小児救急医学会雑誌 21 ( 2 ) 287 - 287 2022年6月

Prehospital emergency life-saving technicians promote the survival of trauma patients: A retrospective cohort study. 国際誌

Takeshi Nishimura, Tsuyoshi Nojima, Hiromichi Naito, Satoshi Ishihara, Shinichi Nakayama, Atsunori Nakao

The American journal of emergency medicine 56 218 - 222 2022年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Appropriate decisions by medical technicians at a trauma scene may influence a patient's prognosis. Emergency life-saving technicians (ELSTs) are certified specialists trained with the knowledge to provide advanced techniques for prehospital emergency care in Japan. However, the benefit of treatment by ELSTs compared to basic emergency medical technicians (BEMTs) remains unclear. The aim of this study is to determine whether treatment by ELSTs improves outcomes for trauma patients. METHODS: We retrospectively reviewed the Japan Trauma Data Bank for the years 2004 to 2017. Patients transferred to the hospital directly from the trauma scene and at least 16 years old were included in this study. The following criteria were used to exclude patients; presence of burns, untreatable severe traumas, unknown ELST attendance, and missing prognosis. We compared two groups (ELST group: patients transported by emergency medical services (EMS) with the presence of at least one ELST; BEMT group: patients transported only by BEMTs). Primary outcome was survival to discharge. Secondary outcomes were the need of definitive treatments defined by surgical intervention, intravascular radiology and blood transfusion at the receiving hospital within 24 h. A multivariable logistic regression model was used to calculate odds ratio (OR) and confidence intervals (CI) adjusted by age, sex, revised trauma score, and Injury severity score (ISS). RESULTS: Overall survival to discharge did not improve significantly (adjusted OR 1.13, 95% CI 0.99-1.30) with ELST intervention. In-hospital blood transfusion was more frequently required in the ELST group (adjusted OR 1.10, 95% CI 1.01-1.20). Emergency interventions (adjusted OR 1.03, 95% CI 0.97-1.09) were not different between the groups. In stratified analysis, the benefit of ELST attendance for survival was observed among patients with ISS <16 (adjusted OR 1.53, 95% CI 1.10-2.15), aged 65 years or older (adjusted OR 1.27, 95% CI 1.07-1.52), during the earlier study period (2004-2008, adjusted OR 1.50, 95% CI 1.14-1.97), and shorter transportation time (adjusted OR 1.21, 95% CI 1.03-1.41). CONCLUSIONS: Dispatch systems with ELST should be considered for trauma transports, which may benefit elderly or moderate severity trauma groups, with shorter transportation time conditions.

DOI： 10.1016/j.ajem.2022.04.004

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The Impact of Medical Students Teaching Basic Life Support to Laypersons.

Yoshinori Kosaki, Hiromichi Naito, Atsuyoshi Iida, Hiromi Ihoriya, Tsuyoshi Nojima, Taihei Yamada, Hirotsugu Yamamoto, Shunsuke Nakamura, Yasuhiro Mandai, Atsunori Nakao

Acta medica Okayama 76 ( 3 ) 265 - 271 2022年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

Basic life support (BLS) courses for laypersons, including cardiopulmonary resuscitation (CPR) training, is known to improve outcomes of out-of-hospital cardiac events. We asked medical students to provide BLS training for laypersons as a part of their emergency medicine education and evaluated the effects of training on the BLS skills of laypersons. We also used a questionnaire to determine whether the medical students who provided the BLS training were themselves more confident and motivated to perform BLS compared to students who did not provide BLS training. The proportions of laypersons who reported confidence in checking for a response, performing chest compressions, and automated external defibrillator (AED) use were significantly increased after the BLS training. The proportions of medical students who reported increased confidence/motivation in terms of understanding BLS, checking for a response, chest compression, use of AED, and willingness to perform BLS were significantly greater among medical students who provided BLS instructions compared to those who did not. BLS instruction by medical students was associated with an improvement in laypersons' CPR accuracy and confidence in responding to cardiac arrest. The results indicate that medical students could gain understanding, confidence, and motivation in regard to their BLS skills by teaching BLS to laypersons.

DOI： 10.18926/AMO/63720

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