Faculty Profiles - NAKAO Atsunori

Papers - NAKAO Atsunori

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Association of emergency intensive care unit occupancy due to brain-dead organ donors with ambulance diversion. International journal

Tetsuya Yumoto, Takafumi Obara, Takashi Hongo, Tsuyoshi Nojima, Kohei Tsukahara, Masaki Hisamura, Atsunori Nakao, Takashi Yorifuji, Hiromichi Naito

Scientific reports 15 ( 1 ) 12633 - 12633 2025.4

Language：English Publishing type：Research paper (scientific journal)

Our study aims to explore how intensive care unit (ICU) occupancy by brain-dead organ donors affects emergency ambulance diversions. In this retrospective, single-center study at an emergency ICU (EICU), brain-dead organ donors were managed until organ procurement. We classified each day between August 1, 2021, and July 31, 2023, as either an exposure day (any day with a brain-dead organ donor in the EICU from admission to organ procurement) or a control day (all other days). The study compared these days and used multiple logistic regression analysis to assess the impact of EICU occupancy by brain-dead organ donors on ambulance diversions. Over two years, 6,058 emergency patients were transported by ambulance, with 1327 admitted to the EICU, including 13 brain-dead organ donors. Brain-dead donors had longer EICU stays (17 vs. 2 days, P < 0.001). With 168 exposure and 562 control days, EICU occupancy was higher on exposure days (75% vs. 67%, P = 0.003), leading to more ambulance diversions. Logistic regression showed exposure days significantly increased ambulance diversions, with an odds ratio of 1.79 (95% CIs 1.10-2.88). This study shows that managing brain-dead organ donors in the EICU leads to longer stays and higher occupancy, resulting in more frequent ambulance diversions. These findings highlight the critical need for policies that optimize ICU resource allocation while maintaining the infrastructure necessary to support organ donation programs and ensuring continued care for brain-dead donors, who play an essential role in addressing the organ shortage crisis.

DOI： 10.1038/s41598-025-97198-7

Age-specific assessment of initial hemoglobin levels and shock index for predicting life-saving interventions in pediatric blunt liver and spleen injuries. International journal

Tetsuya Yumoto, Takafumi Obara, Takashi Hongo, Atsuyoshi Iida, Kohei Tsukahara, Morihiro Katsura, Yutaka Kondo, Hideto Yasuda, Shigeki Kushimoto, Takashi Yorifuji, Hiromichi Naito, Atsunori Nakao

Scientific reports 15 ( 1 ) 8502 - 8502 2025.3

Language：English Publishing type：Research paper (scientific journal)

This study aimed to evaluate the effectiveness of combining initial hemoglobin levels with the shock index for predicting the need for life-saving interventions (LSI) in pediatric patients with blunt liver and spleen injuries (BLSI), specifically tailored to different age groups. This was a multicenter retrospective cohort study of pediatric patients with BLSI in Japan. The area under the receiver operating characteristic curve (AUROC) were used to assess predictive accuracy. The study included 1,370 patients. LSI was required in 59 of 247 (23.9%) aged 1 to 6 years, 100 of 402 (24.9%) aged 7 to 12 years, and 125 of 297 (42.1%) patients aged 13 to 16 years. Within each specific age group, the predictability was categorized as fair and appeared higher than that of the entire cohort or when using either parameter alone. Notably, in the 1 to 6-year age group, the combined values showed the highest predictability, which was statistically superior to the shock index alone (AUROC of 0.770 vs. 0.671, P = 0.025). Tailoring initial hemoglobin levels and shock index to specific age groups enhances predictability of LSI in pediatric BLSI, showing a fair level of predictive accuracy.

DOI： 10.1038/s41598-025-92673-7

Prevalence, characteristics, and outcomes of suicide-related out-of-hospital cardiac arrest among patients committing self-harm and suicide-attempts in Japan: A nationwide registry study. International journal

Takashi Hongo, Tetsuya Yumoto, Shunta Jinno, Yuka Yamamura, Takafumi Obara, Tsuyoshi Nojima, Kohei Tsukahara, Hiromichi Naito, Takashi Yorifuji, Atsunori Nakao

Resuscitation plus 22 100923 - 100923 2025.3

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Suicide-related out-of-hospital cardiac arrest (OHCA) is characterized by extremely low survival rates and represents a considerable global public health concern. This study aimed to investigate the prevalence, characteristics, and outcomes of suicide-related OHCA. METHODS: This multicenter, retrospective cohort study is an analysis of data collected from the JAPAN Registry of Self-harm and Suicide Attempts. Patients were divided into two groups, the OHCA group and the non-OHCA group. The primary outcome was death at 30 days. RESULTS: Among 1,960 self-harm and suicide attempts patients, 213 patients (10.9 %) were assigned to the OHCA group and 1,747 (89.1%) were in the non-OHCA group.Patients in the OHCA group were older (44 vs. 33 years old, p < 0.001), and the OHCA group had a higher proportion of males compared to the non-OHCA group (122 [57.3%] vs. 604 [34.6%], p < 0.001). Despite missing and unknown data, lower proportions of psychiatric consultation history (54 [30.8%] vs. 1177 [70.5%], p < 0.001), psychiatric hospitalization history (9 [5.1%] vs. 386 [23.1%], p < 0.001), and previous suicide attempts (16 [9.2%] vs. 807 [48.4%], p < 0.001) were observed in the OHCA group. Risk of death at 30 days was significantly higher in the OHCA group (200 [93.9%] vs. 31 [1.8%], p < 0.001). CONCLUSION: Suicide-related OHCA was rare and associated with poorer prognosis compared to patients without OHCA. It was more common in middle-aged men without a history of psychiatric care or prior suicide attempts, although the study was limited by missing data.

DOI： 10.1016/j.resplu.2025.100923

Undetermined Ruptured Low-Grade Appendiceal Mucinous Neoplasm Following High-Energy Blunt Abdominal Trauma Requiring Emergency Laparotomy. International journal

Ippei Matsuo, Tetsuya Yumoto, Akari Tsuji, Ryo Tanabe, Toshihisa Matsumura, Mikoto Shimabara, Masaaki Akai, Shoji Takagi, Hiromichi Naito, Atsunori Nakao

Clinical case reports 13 ( 1 ) e70071 2025.1

Language：English Publishing type：Research paper (scientific journal)

Blunt abdominal trauma causing intraperitoneal injury and/or bleeding can be life-threatening, requiring immediate intervention. Diagnosing these cases can be challenging, especially when pre-existing conditions are involved. Low-grade appendiceal mucinous neoplasm (LAMN) is a rare tumor of the appendix that can lead to pseudomyxoma peritonei. Herein, we present a case of ruptured LAMN following blunt abdominal trauma after a high-energy head-on collision, complicating the differentiation from other intraperitoneal injuries. A 42-year-old Japanese female was brought to our hospital following high-energy head-on collision. She presented with stable vital signs, complaining of anterior chest pain and abdominal tenderness without peritoneal irritation. Computed tomography scans indicated multiple fractures in her chest and complex fluid around the Douglas fossa extending to the ileocecal area, with a slightly dilated appendix tip. Despite stable vitals, emergency laparotomy was needed for suspected peritonitis and/or intraperitoneal hemorrhage. Emergency laparotomy revealed yellowish, jelly-like ascites and a ruptured appendiceal tumor. LAMN was suspected, and the appendix was completely resected, with cytoreductive surgery carefully performed. Histopathological examination confirmed the diagnosis of LAMN. Postoperative course was uneventful, and the patient was discharged on Day 13 and referred for further LAMN management. This case report highlights the diagnostic difficulties of LAMN rupture following blunt abdominal trauma, stressing the need to consider rare conditions like LAMN in differential diagnoses of acute abdomen posttrauma.

DOI： 10.1002/ccr3.70071

Association of blood carboxyhemoglobin levels with mortality and neurological outcomes in out-of-hospital cardiac arrest. International journal

Takashi Hongo, Tetsuya Yumoto, Hiromichi Naito, Tomohiro Hiraoka, Yuya Murakami, Takafumi Obara, Tsuyoshi Nojima, Toshiyuki Aokage, Atsunori Nakao

Acute medicine & surgery 12 ( 1 ) e70053 2025

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Carbon monoxide (CO), produced endogenously by heme oxygenase-1, plays a crucial role in the immune system by mitigating cellular damage under stress. However, the significance of carboxyhemoglobin (COHb) levels after out-of-hospital cardiac arrest (OHCA) is not well understood. This study aimed to explore the association between COHb levels at hospital arrival and within the first 24 h post-arrival with 30-day mortality and neurological outcomes in patients who experienced OHCA. METHODS: This single-center, retrospective study analyzed data from adult patients who experienced OHCA seen at Okayama University Hospital from 2019 to 2023. The patients were assigned to one of two study groups based on COHb levels (0.0% or ≥0.1%) upon hospital arrival. The primary outcome was 30-day mortality. RESULTS: Among the 560 eligible patients who experienced OHCA, 284 (50.7%) were in the COHb 0.0% group and 276 (49.3%) were in the COHb ≥ 0.1% group. The 30-day mortality was significantly higher in the COHb 0.0% group compared to the COHb ≥ 0.1% group (264 [92.9%] vs. 233 [84.4%]). Multivariable logistic regression showed that the COHb 0.0% group was associated with 30-day mortality (adjusted ORs: 2.24, 95% CIs: 1.10-4.56). Non-survivors at 30 days who were admitted to the intensive care unit had lower COHb levels at hospital arrival (0.0% vs. 0.2%) and lower mean COHb levels during the first 24 h post-arrival (0.7% vs. 0.9%) compared to survivors. CONCLUSIONS: COHb levels of 0.0% were linked to worse outcomes in patients experiencing OHCA, warranting further research on the prognostic implications of COHb in this context.

DOI： 10.1002/ams2.70053

Association between metabolic acidosis and post-intubation hypotension in airway management performed in the emergency department. International journal

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

Heliyon 10 ( 23 ) e40224 2024.12

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Post-intubation hypotension (PIH) is a common complication of intubations performed in the emergency department (ED). Identification of patients at high-risk for PIH is a major challenge. We aimed to determine whether pre-intubation metabolic acidosis affects the incidence of PIH in the ED. METHODS: This was a single-center, retrospective, observational study of consecutive patients requiring emergent endotracheal intubation (ETI) from November 1, 2016 to March 31, 2022 at Hyogo Emergency Medical Center, an urban ED. The primary outcome was PIH, defined as a decreased systolic blood pressure (sBP) of <90 mmHg, required initiation of any vasopressor, or a decrease in sBP by ≥ 20 % within 30 min following intubation. Patients were divided into two groups: those with pre-intubation metabolic acidosis (metabolic acidosis group), defined as pH < 7.3 and base excess (BE) < -4 mmol/L on arterial blood gas analysis, and those with no metabolic acidosis (without-metabolic acidosis group). The association between PIH and pre-intubation metabolic acidosis was examined using multivariable logistic regression models. A receiver operating characteristic (ROC) curve was produced to assess the predictive value of pre-intubation BE for PIH. RESULTS: The study included 311 patients. PIH occurred in 65.5 % (74/113) of patients in the metabolic acidosis group and 29.3 % (58/198) of patients in the without-metabolic acidosis group. Multivariable logistic regression demonstrated that metabolic acidosis was associated with PIH (odds ratio 4.06, 95 % confidence interval 2.31-7.11). In the ROC analysis, the optimal cut-off point for BE was -4.1 (sensitivity = 71 %, specificity = 70 %), with the area under the ROC curve 0.74. CONCLUSION: Pre-intubation metabolic acidosis was significantly associated with PIH. Physicians.

DOI： 10.1016/j.heliyon.2024.e40224

Differences in the Usability of Fully Automated External Defibrillators between Medical and Nonmedical Professionals.

Tsuyoshi Nojima, Takafumi Obara, Takashi Hongo, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Internal medicine (Tokyo, Japan) 2024.12

Language：English Publishing type：Research paper (scientific journal)

Objective Early defibrillation is crucial for improving the survival rates of patients with shockable cardiac arrest (OHCA). Automated external defibrillators (AEDs) are essential in basic life support (BLS), yet their usage in out-of-hospital cardiac arrests remains around 10%. There are two types of AEDs: semi-automatic (s-AED) and fully automatic (f-AED), with the latter automatically delivering a shock if indicated. Although f-AEDs were introduced in Japan in 2021, they have not yet been widely adopted. The present study investigated whether or not the ease of use and preferences for these AED types differ between healthcare professionals and laypersons. Methods BLS courses, including training on both AED types, were conducted between 2021 and 2022 at our institution. The participants were divided into medical and non-medical professional groups, and a survey was administered. Results A total of 443 participants were included, with 47 medical professionals and 396 non-medical professionals. Notably, 401 participants were new to f-AED lectures. The medical professional group had more prior experience with AED training courses than non-medical professionals and showed a preference for s-AEDs, whereas the non-medical professional group showed no significant preference. Although a subset of participants expressed hesitation in pressing the shock button on the s-AEDs, no statistically significant difference was observed between the groups. Conclusion This study suggests that preferences for AED types may vary between medical and non-medical professional groups, with some reluctance in using s-AEDs. Although no significant differences in hesitation were found between the groups, f-AEDs may reduce hesitation and potentially improve AED effectiveness during cardiopulmonary resuscitation.

DOI： 10.2169/internalmedicine.4578-24

救急搬送件数の急増と働き方改革への対応岡山大学の取り組み

湯本哲也, 内藤宏道, 本郷貴識, 小原隆史, 小崎吉訓, 上田浩平, 野島剛, 飯田淳義, 塚原紘平, 中尾篤典

日本臨床救急医学会雑誌 27 ( 6 ) 765 - 771 2024.12

Language：Japanese Publisher：(一社)日本臨床救急医学会

2024年4月から医師にも働き方改革が適用された。当院では救急搬送件数が直近3年間で3倍に急増した。これに対応するため院内外の協力・連携や下り搬送の体制強化,病院救命士の活用・育成によるタスク・シェア/シフトの促進に努めてきた。その他,徹底したシフト制など働き方改革を進めてきた。また,大学病院としての使命でもある研究・教育にも注力してきた。2023年度の院内時間外勤務時間は2022年度のそれと比較して有意に減少したものの,働き方改革前後での全体的な満足度に変化はなかった。働き方改革は労働時間もさることながら,その中身が重要であり,救急科としての専門性や役割を発揮しながら,個々がやりがいを実感できる環境づくりが重要であるが,自己研鑽という名の時間外労働の実態は反映されにくく,地域救急医療体制維持と働き方改革とのバランスも今後の課題である。(著者抄録)

COVID-19流行前後における小児院外心停止例に対するBystander CPRの変化とアウトカムの検証

小原隆史, 内藤宏道, 塚原紘平, 本郷貴識, 野島剛, 湯本哲也, 中尾篤典

蘇生 43 ( 3 ) 188 - 188 2024.11

脳疾患による院外心停止の特徴に関して

内藤宏道, 野島剛, 本郷貴識, 小原隆史, 湯本哲也, 中尾篤典

蘇生 43 ( 3 ) 182 - 182 2024.11

院外心停止患者における来院時体温による体温管理療法と30日後の神経学的予後

野島剛, 内藤宏道, 小原隆史, 田邉綾, 本郷貴識, 小崎吉訓, 上田浩平, 湯本哲也, 塚原紘平, 中尾篤典

蘇生 43 ( 3 ) 181 - 181 2024.11

敗血症患者における来院時血中COHbの意義についての検証

福留将真, 湯本哲也, 薬師寺泰匡, 本郷貴識, 小原隆史, 小崎吉訓, 野島剛, 上田浩平, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 645 - 645 2024.11

いざ、多臓器不全に立ち向かえ!最新の基礎研究を眺めてみよう治療的医療ガスのクリティカルケア領域への応用

湯本哲也, 青景聡之, 小原隆史, 上田浩平, 野島剛, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 613 - 613 2024.11

低体温症における来院時血中COHbの意義についての検証

三次悠哉, 湯本哲也, 本郷貴識, 小原隆史, 小崎吉訓, 野島剛, 上田浩平, 飯田淳義, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 812 - 812 2024.11

ヘリウムガス吸入による心停止蘇生後に脳死下臓器提供に至った一例

神野駿太, 湯本哲也, 本郷貴識, 小原隆史, 野島剛, 上田浩平, 小崎吉訓, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 782 - 782 2024.11

心停止のエピソードがあった症例の脳死下および心停止下臓器提供 ECPRの有無による比較

湯本哲也, 塚原紘平, 小原隆史, 本郷貴識, 野島剛, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 781 - 781 2024.11

心肺蘇生を望まない意思表示のある院外心停止患者対応の実態と今後の展望

田邉綾, 本郷貴識, 小原隆史, 野島剛, 上田浩平, 稲葉基高, 小崎吉訓, 塚原紘平, 湯本哲也, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 752 - 752 2024.11

オール岡山での搬送困難事例を減らすための取り組み高齢者施設における急変時等相談対応事業を開始して

湯本哲也, 田邉綾, 本郷貴識, 小原隆史, 小崎吉訓, 野島剛, 上田浩平, 飯田淳義, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 688 - 688 2024.11

脳死下臓器提供のプロセスに関する包括的研究多機関共同後ろ向き研究J-RESPECT studyより

湯本哲也, 内藤宏道, 塚原紘平, 小原隆史, 本郷貴識, 早川峰司, 横堀將司, 西山慶, 渥美生弘, 田崎修, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 666 - 666 2024.11

Prevalence and Management of Oral Intake Restrictions in Critically Ill Patients: Insights from a Multicenter Point Prevalence Study. International journal

Takashi Hongo, Tetsuya Yumoto, Keibun Liu, Kensuke Nakamura, Akira Kawauchi, Takefumi Tsunemitsu, Nobuto Nakanishi, Atsunori Nakao, Hiromichi Naito

Dysphagia 2024.10

Language：English Publishing type：Research paper (scientific journal)

Oral intake restrictions due to dysphagia in the intensive care unit (ICU) can increase morbidity, mortality, and negatively impact quality of life. The current oral intake practice and clinical management strategies for addressing dysphagia in the ICU are not well-defined. This study aimed to elucidate the clinical practices surrounding oral intake restrictions due to dysphagia and its management strategies in the ICU. A multicenter, prospective, cross-sectional, 2-day point prevalence study was conducted in Japan. Relevant data on the clinical circumstances surrounding oral intake practice and the implementation of strategies to prevent dysphagia for patients admitted to the ICU on November 1, 2023, and December 1, 2023, were collected. The primary outcome was the prevalence of oral intake restrictions in patients, defined by a Functional Oral Intake Scale score of less than 7 among eligible patients for oral intake. Out of 326 participants, 187 were eligible for the final analysis after excluding 139 patients who were not eligible for oral intake, primarily due to tracheal intubation. Among those eligible, 69.0% (129/187) encountered oral intake restrictions. About 52.4% (98/187) of patients underwent swallowing screenings; 36.7% (36/98) of these were suspected of having dysphagia. Compensatory and behavioral swallowing rehabilitation were provided to 21.9% (41/187) and 10.6% (20/187) of patients, respectively, from ICU admission to the survey date. Only 27.4% (14/51) of post-extubation and 9.3% (3/32) of post-stroke patients received swallowing rehabilitation. Notably, no ICUs had dedicated speech and language therapists, and most (85.7%, 18/21) lacked established swallowing rehabilitation protocols. This 2-point prevalence survey study revealed that oral intake restrictions due to dysphagia are common in ICUs, but few patients are screened for swallowing issues or receive rehabilitation. More clinical studies are needed to develop effective protocols for identifying and managing dysphagia, including screenings and rehabilitation in the ICU.

DOI： 10.1007/s00455-024-10772-5

A nationwide longitudinal survey of infantile injury and its recurrence in Japan. International journal

Tomohiro Hiraoka, Takafumi Obara, Naomi Matsumoto, Kohei Tsukahara, Takashi Hongo, Tsuyoshi Nojima, Masaki Hisamura, Tetsuya Yumoto, Atsunori Nakao, Takashi Yorifuji, Hiromichi Naito

Scientific reports 14 ( 1 ) 24716 - 24716 2024.10

Language：English Publishing type：Research paper (scientific journal)

Injury recurrence in young children is a significant public health concern, as it may indicate an unfavorable home environment. This study evaluates whether infantile injuries increase recurrence during preschool years, contributing to more effective prevention strategies for vulnerable families. The study included 20,191 children from "The Longitudinal Survey of Babies in the 21st Century," a representative sample of infants born in Japan between May 10 and 24, 2010. We conducted a logistic regression analysis to compare injury recurrence risk between children aged 18 months to seven years with and without infantile injury histories. The study revealed that infants with a history of injuries had a higher risk of subsequent hospital visits for injuries during preschool years (crude Odds Ratio (cOR) 1.52, 95% CI, 1.41-1.64, adjusted OR (aOR) 1.48, 95% CI 1.37-1.60). Specific injuries, such as falls (aOR 1.34, 95% CI, 1.26-1.43), pinches (aOR 1.22, 95% CI, 1.15-1.29), drowning (aOR 1.29, 95% CI, 1.19-1.40), ingestion (aOR 1.35, 95% CI, 1.17-1.55), and burns (aOR 1.47, 95% CI, 1.31-1.65), independently increased the risk of future injuries. Our findings highlight the necessity of universal safety measures in the home environment and targeted interventions for families with a history of high-risk injuries.

DOI： 10.1038/s41598-024-76403-z

Management of Obesity Hypoventilation Syndrome in Extreme Obesity: A Case Study. International journal

Yuya Miyoshi, Tetsuya Yumoto, Yoshinori Kosaki, Takashi Hongo, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

The American journal of case reports 25 e945112 2024.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND Obesity hypoventilation syndrome (OHS) is characterized by hypercapnia in obese patients, with acute hypercapnic respiratory failure often worsened by various conditions. Managing super-super obese patients presents complex challenges in critical care. Our case report details the successful treatment of acute respiratory failure in a patient with a body mass index (BMI) over 80 kg/m², highlighting the importance of comprehensive, multidisciplinary care in the Intensive Care Init (ICU). CASE REPORT A 39-year-old man with a BMI of 81.1 kg/m² presented to our emergency department with respiratory distress, altered consciousness, and an inability to move independently. Arterial blood gas analysis revealed severe hypercapnia and hypoxemia, indicating decompensated OHS. Laboratory tests and computed tomography scans suggested his condition was exacerbated by pneumonia and congestive heart failure. The patient was managed in the ICU with endotracheal intubation, mechanical ventilation, and esophageal pressure monitoring. In addition to antibiotics, diuretics were used to manage fluid balance. His care included multidisciplinary support with nutritional management and active physiotherapy. After 15 days, he was weaned from the ventilator and discharged from the ICU on day 20, continuing rehabilitation until he was discharged home on day 60. CONCLUSIONS This case report describes the successful treatment of acute hypercapnic respiratory failure from decompensated OHS in a super-super obese patient. Addressing the underlying conditions and tailoring clinical practices to the patient's specific needs, especially regarding ventilatory support, fluid balance, and nutrition, were crucial. A collaborative multidisciplinary approach was essential for improving outcomes.

DOI： 10.12659/AJCR.945112

Reply to: The gray-white matter ratio in adult out-of-hospital cardiac arrest patients must be assessed comprehensively. International journal

Takashi Hongo, Hiromichi Naito, Tetsuya Yumoto, Atsunori Nakao

Resuscitation 110383 - 110383 2024.9

Association between signs of life and survival in traumatic cardiac arrest patients: A nationwide, retrospective cohort study. International journal

Takafumi Obara, Tetsuya Yumoto, Naofumi Bunya, Tsuyoshi Nojima, Tomohiro Hiraoka, Takashi Hongo, Yoshinori Kosaki, Kohei Tsukahara, Takenori Uehara, Atsunori Nakao, Hiromichi Naito

Resuscitation plus 19 100701 - 100701 2024.9

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The clinical impact of signs of life (SOLs) in traumatic cardiac arrest (TCA) remains to be elucidated. The aim of this study was to examine the association between SOLs and survival/neurological outcomes in TCA patients. METHODS: Retrospective data from the Japan Trauma Data Bank (2019-2021) was reviewed. TCA patients were assigned to one of two study groups based on the presence or absence of SOLs and compared. SOLs were defined as having at least one of following criteria: pulseless electrical activity >40 beats per minute, gasping, positive light reflex, or extremity/eye movement at hospital arrival. The primary outcome was survival at hospital discharge. The secondary outcome was favorable neurological status (Glasgow Outcome Scale score of 4 or 5) at hospital discharge. RESULTS: A total of 1,981 patients (114 with SOLs and 1,867 without SOLs) were included. Characteristics of patients were as follows: age (median age 60.0 years old [interquartile range: 41-80] years vs. 55.4 [38-75] years), gender (male: 76/114 (66.7%) vs. 1,207/1,867 (65.0%), blunt trauma (90/111 [81.1%] vs. 1,559/1,844 [84.5%]), Injury Severity Score (29.2 [22-41] vs. 27.9 [20-34]). Patients with SOLs showed higher survival (10/114 (8.8%) vs. 25/1,867 (1.3%), OR 1.96 [CI 1.20-2.72]) and higher favorable neurological outcomes (4/110 (3.5%) vs. 6/1,865 (0.3%), OR 2.42 [CI 1.14-3.70]) compared with patients without SOLs. CONCLUSIONS: TCA patients with SOLs at hospital arrival showed higher survival and favorable neurological outcomes at hospital discharge compared with TCA patients without SOLs.

DOI： 10.1016/j.resplu.2024.100701

Prognostic value of grey-white matter ratio obtained within two hours after return of spontaneous circulation in out-of-hospital cardiac arrest survivors: A multicenter, observational study. International journal

Yuya Murakami, Takashi Hongo, Tetsuya Yumoto, Yoshinori Kosaki, Atsuyoshi Iida, Hiroki Maeyama, Fumiya Inoue, Toshihisa Ichiba, Atsunori Nakao, Hiromichi Naito

Resuscitation plus 19 100746 - 100746 2024.9

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Grey-white matter ratio (GWR) measured by head computed tomography (CT) scan is known as a neurological prognostication tool for out-of-hospital cardiac arrest (OHCA) survivors. The prognostic value of GWR obtained early (within two hours after return of spontaneous circulation [ROSC]) remains a matter of debate. METHODS: We conducted a multicenter, retrospective, observational study at five hospitals. We included adult OHCA survivors who underwent head CT within two hours following ROSC. GWR values were measured using head CT. Average GWR values were calculated by the mean of the GWR-basal ganglia and GWR-Cerebrum. We divided the patients into poor or favorable neurological outcome groups defined by Glasgow-Pittsburgh Cerebral Performance Category scores. The predictive accuracy of GWR performance was assessed using the area under the curve (AUC). The sensitivities and specificities for predicting poor outcome were examined. RESULTS: Of 377 eligible patients, 281 (74.5%) showed poor neurological outcomes at one month after ROSC. Average GWR values of the poor neurological outcome group were significantly lower than those of the favorable neurological outcome. The average GWR value to predict neurological outcome with Youden index was 1.24 with AUC of 0.799. When average GWR values were 1.15 or lower, poor neurological outcomes could be predicted with 100% specificity. CONCLUSIONS: GWR values measured by head CT scans early (within two hours after ROSC) demonstrated moderate predictive performance for overall ROSC patients. When limited to the patients with GWR values of 1.15 or lower, poor neurological outcomes could be predicted with high specificity.

DOI： 10.1016/j.resplu.2024.100746

移植医療における診療連携(術前、術後管理/集中治療) 岡山大学病院での脳死下臓器提供のプロセスにおける連携と取り組み救急集中治療の立場から

湯本哲也, 小原隆史, 塚原紘平, 内藤宏道, 中尾篤典

移植 59 ( 総会臨時 ) 148 - 148 2024.9

臓器提供支援事業の現状と課題岡山県の臓器提供施設連携体制構築事業

内藤宏道, 塚原紘平, 湯本哲也, 本郷貴織, 小崎吉訓, 小原隆史, 野島剛, 上田浩平, 飯田淳義, 久村正樹, 安田和広, 中尾篤典

移植 59 ( 総会臨時 ) 231 - 231 2024.9

私(僕)の臨床研究、興味ありませんか? 救急集中治療の現場で臨床医が取り組む「小児」のデータベース研究の可能性

小原隆史, 内藤宏道, 塚原紘平, 本郷貴識, 野島剛, 湯本哲也, 中尾篤典

日本集中治療医学会雑誌 31 ( Suppl.1 ) S485 - S485 2024.9

ドナー管理における臓器保護に関する取り組み小児のドナー管理における多臓器不全の経時的変化単施設後方視的観察研究

小原隆史, 塚原紘平, 湯本哲也, 内藤宏道, 中尾篤典

移植 59 ( 総会臨時 ) 233 - 233 2024.9

筋肉量評価の最新ノウハウ!多職種チームがICUのカラダを測り尽くす PCAS管理中の側頭筋の萎縮

本郷貴識, 村上勇也, 劉啓文, 松岡綾華, 土手尚, 三池慧, 上田浩平, 湯本哲也, 内藤宏道, 中尾篤典

日本集中治療医学会雑誌 31 ( Suppl.1 ) S443 - S443 2024.9

臓器提供支援事業の現状と課題岡山県の臓器提供施設連携体制構築事業

内藤宏道, 塚原紘平, 湯本哲也, 本郷貴織, 小崎吉訓, 小原隆史, 野島剛, 上田浩平, 飯田淳義, 久村正樹, 安田和広, 中尾篤典

移植 59 ( 総会臨時 ) 231 - 231 2024.9

私(僕)の臨床研究、興味ありませんか? 救急集中治療の現場で臨床医が取り組む「小児」のデータベース研究の可能性

小原隆史, 内藤宏道, 塚原紘平, 本郷貴識, 野島剛, 湯本哲也, 中尾篤典

日本集中治療医学会雑誌 31 ( Suppl.1 ) S485 - S485 2024.9

Prognostic Performance of Gray-White Matter Ratio in Adult Out-of-Hospital Cardiac Arrest Patients after Receiving Extracorporeal Cardiopulmonary Resuscitation. International journal

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

Resuscitation 110351 - 110351 2024.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Gray-to-white matter ratio (GWR), measured by computed tomography (CT), is commonly used to predict poor neurological outcomes after out-of-hospital cardiac arrest (OHCA). The prognostic performance of GWR in OHCA patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) is not known. METHODS: This study is a secondary analysis of data from the SAVE-J II registry, a retrospective, multicenter study. Participants were divided into four groups according to average GWR (aGWR) values ranging from 1.00 to 1.39, separated by 0.1 intervals. The aGWR values were calculated for bilateral basal ganglia, centrum semiovale, and high convexity obtained by head CT within 24 h after ECPR. Primary outcome was poor neurological outcomes at 30-day. RESULTS: In total, 1,146 OHCA patients treated with ECPR were included in our analysis. Overall, participants with lower aGWR more likely had poor neurological outcomes, aGWR 1.00-1.09 (94.6%), aGWR 1.10-1-19 (87.8%), aGWR 1.20-1.29 (78.5%), and aGWR 1.30-1.39 (70.3%). Multivariable logistic regression showed that lower aGWR was associated with poor neurological outcome at 30-day, aGWR 1.30-1.39: reference, aGWR 1.00-1.09: adjusted odds ratio (aOR) 10.01 (95% confidence interval (CI) [3.58-27.99]), aGWR 1.10-1.19: aOR 4.83 (95% CI [2.31-10.12]), aGWR 1.20-1.29: aOR 2.16 (95% CI [1.02-4.55]). Receiver operating characteristic curve analysis revealed that the prognostic performance of aGWR had an area under the curve of 0.628, 95% CI [0.59-0.66]). The aGWR threshold of 1.005 for predicting poor neurological outcome reached 100% specificity with 0.1% sensitivity. CONCLUSION: Early neuro-prognostication depending on GWR may not be sufficient after ECPR and requires a multimodal approach.

DOI： 10.1016/j.resuscitation.2024.110351

Evolution and Effects of Ad Hoc Multidisciplinary Team Meetings in the Emergency Intensive Care Unit: A Five-Year Analysis. International journal

Tetsuya Yumoto, Takashi Hongo, Takafumi Obara, Kohei Ageta, Toshiyuki Aokage, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

Journal of clinical medicine 13 ( 15 ) 2024.7

Language：English Publishing type：Research paper (scientific journal)

Background: Multidisciplinary team meetings (MDTMs) are crucial in the ICU. However, daily rounds may not address all sensitive issues due to time constraints and the complexity of cases. This study aimed to describe detailed information and characteristics of ad hoc MDTMs in the ICU. Methods: This single-center, retrospective study analyzed adult emergency ICU admissions at Okayama University Hospital from 1 January 2019 to 31 December 2023. During this period, weekly regular multidisciplinary team ICU rounds were introduced in June 2020, and regular weekday morning MDTMs began in April 2022. A multiple logistic regression analysis was applied to determine the impact of these changes on the frequency of ad hoc MDTMs, adjusting for variables including annual changes. Results: The study analyzed 2487 adult EICU patients, with a median age of 66, and 63.3% of them male. MDTMs were held for 168 patients (6.8%), typically those with severe conditions, including higher COVID-19 prevalence and APACHE II scores, and longer ICU stays. Despite a constant total number of MDTMs, the likelihood of conducting ad hoc MDTMs increased annually (adjusted OR 1.19; 95% CI, 1.04-1.35). Of the 329 MDTMs conducted for these patients, 59.0% addressed end-of-life care, involving an average of 11 participants, mainly nurses and emergency and critical-care physicians. Conclusions: Changes in ICU round and meeting structures might be associated with a higher frequency of conducting ad hoc MDTMs, highlighting their evolving role and importance in patient care management.

DOI： 10.3390/jcm13154324

アセトアミノフェンと鉄剤を大量内服し、血漿交換を行った肝障害の一例

小崎吉訓, 松尾逸平, 薬師寺泰匡, 野島剛, 塚原紘平, 内藤宏道, 中尾篤典

中毒研究 37 ( 2 ) 252 - 252 2024.7

来院時低体温症例における甲状腺ホルモンと復温速度の検討

野島剛, 内藤宏道, 本郷貴識, 小原隆史, 小崎吉訓, 薬師寺泰匡, 湯本哲也, 塚原紘平, 久村正樹, 中尾篤典

日本脳低温療法・体温管理学会誌 27 ( 1 ) 45 - 45 2024.7

amplitude-integrated EEG/SEFモードを用いた小児急性脳症の体温管理療法中の脳波変化

小原隆史, 塚原紘平, 内藤宏道, 湯本哲也, 中尾篤典

日本脳低温療法・体温管理学会誌 27 ( 1 ) 47 - 47 2024.7

TTM中の温度管理が咬筋にあたえる影響の検討

本郷貴識, 小原隆史, 野島剛, 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 27 ( 1 ) 49 - 49 2024.7

救命救急センターにおける小児のICU入室数は救急応需に影響するのか?

小原隆史, 塚原紘平, 松尾逸平, 湯本哲也, 内藤宏道, 中尾篤典

日本小児救急医学会雑誌 23 ( 2 ) 267 - 267 2024.7

岡山大学病院における病院救急救命士の教育とタスクシェア

上田浩平, 佐々木史哉, 野島剛, 湯本哲也, 内藤宏道, 中尾篤典

日本臨床救急医学会雑誌 27 ( 3 ) 382 - 382 2024.7

岡山大学病院での現場出動における病院救急救命士の導入の効果

佐々木史哉, 野島剛, 上田浩平, 湯本哲也, 内藤宏道, 中尾篤典

日本臨床救急医学会雑誌 27 ( 3 ) 350 - 350 2024.7

Impact of sex of bystanders who perform cardiopulmonary resuscitation on return of spontaneous circulation in out-of-hospital cardiac arrest patients: A retrospective, observational study. International journal

Shunsuke Nakamura, Tsuyoshi Nojima, Takafumi Obara, Takashi Hongo, Tetsuya Yumoto, Takashi Yorifuji, Atsunori Nakao, Hiromichi Naito

Resuscitation plus 18 100659 - 100659 2024.6

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The impact of the sex of bystanders who initiate cardiopulmonary resuscitation (CPR) on out-of-hospital cardiac arrest (OHCA) patients has not been fully elucidated. This study aims to investigate the association between the sex of bystanders who perform CPR and the clinical outcomes of OHCA patients in real-world clinical settings. METHODS: We conducted a retrospective, observational study using data from the Okayama City Fire Department in Japan. Patients were categorized based on bystanders' sex. Our primary outcomes were return of spontaneous circulation (ROSC). Our secondary outcome was 30-day survival and 30-day favorable neurological outcome, defined as Cerebral Performance Category score of 1 or 2. Multivariable logistic regression analysis was used to examine the association between these groups and outcomes. RESULTS: The study included 3,209 patients with a comparable distribution of male (1,540 patients: 48.0%) and female bystanders (1,669 patients: 52.0%) between the groups. Overall, 221 (6.9%) ROSC at hospital arrival, 226 (7.0%) patients had 30-day survival, and 121 (3.8%) patients had 30-day favorable neurological outcomes. Bystander sex (female as reference) did not contribute to ROSC at hospital arrival (adjusted OR [aOR] 1.11, 95% CI: 0.76-1.61), 30-day survival (aOR 1.23, 95% CI: 0.83-1.82), or 30-day favorable neurological outcomes (aOR 0.66, 95% CI: 0.34-1.27). Basic life support education experience was a bystander factor positively associated with ROSC. Patient factors positively associated with ROSC were initial shockable rhythm and witness of cardiac arrest. CONCLUSION: There were no differences in ROSC, 30-day survival, or 30-day neurological outcomes in OHCA patients based on bystander sex.

DOI： 10.1016/j.resplu.2024.100659

Organ donation after extracorporeal cardiopulmonary resuscitation: a nationwide retrospective cohort study. International journal

Tetsuya Yumoto, Kohei Tsukahara, Takafumi Obara, Takashi Hongo, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao

Critical care (London, England) 28 ( 1 ) 160 - 160 2024.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Limited data are available on organ donation practices and recipient outcomes, particularly when comparing donors who experienced cardiac arrest and received extracorporeal cardiopulmonary resuscitation (ECPR) followed by veno-arterial extracorporeal membrane oxygenation (ECMO) decannulation, versus those who experienced cardiac arrest without receiving ECPR. This study aims to explore organ donation practices and outcomes post-ECPR to enhance our understanding of the donation potential after cardiac arrest. METHODS: We conducted a nationwide retrospective cohort study using data from the Japan Organ Transplant Network database, covering all deceased organ donors between July 17, 2010, and August 31, 2022. We included donors who experienced at least one episode of cardiac arrest. During the study period, patients undergoing ECMO treatment were not eligible for a legal diagnosis of brain death. We compared the timeframes associated with each donor's management and the long-term graft outcomes of recipients between ECPR and non-ECPR groups. RESULTS: Among 370 brain death donors with an episode of cardiac arrest, 26 (7.0%) received ECPR and 344 (93.0%) did not; the majority were due to out-of-hospital cardiac arrests. The median duration of veno-arterial ECMO support after ECPR was 3 days. Patients in the ECPR group had significantly longer intervals from admission to organ procurement compared to those not receiving ECPR (13 vs. 9 days, P = 0.005). Lung graft survival rates were significantly lower in the ECPR group (log-rank test P = 0.009), with no significant differences in other organ graft survival rates. Of 160 circulatory death donors with an episode of cardiac arrest, 27 (16.9%) received ECPR and 133 (83.1%) did not. Time intervals from admission to organ procurement following circulatory death and graft survival showed no significant differences between ECPR and non-ECPR groups. The number of organs donated was similar between the ECPR and non-ECPR groups, regardless of brain or circulatory death. CONCLUSIONS: This nationwide study reveals that lung graft survival was lower in recipients from ECPR-treated donors, highlighting the need for targeted research and protocol adjustments in post-ECPR organ donation.

DOI： 10.1186/s13054-024-04949-5

Long-term, patient-centered, frailty-based outcomes of older critical illness survivors from the emergency department: a post hoc analysis of the LIFE Study. International journal

Takashi Hongo, Tetsuya Yumoto, Mototaka Inaba, Shunsuke Taito, Takashi Yorifuji, Atsunori Nakao, Hiromichi Naito

BMC geriatrics 24 ( 1 ) 257 - 257 2024.3

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Evidence indicates frailty before intensive care unit (ICU) admission leads to poor outcomes. However, it is unclear whether quality of life (QOL) and activities of daily living (ADL) for survivors of critical illness admitted to the ICU via the emergency department remain consistent or deteriorate in the long-term compared to baseline. This study aimed to evaluate long-term QOL/ADL outcomes in these patients, categorized by the presence or absence of frailty according to Clinical Frailty Scale (CFS) score, as well as explore factors that influence these outcomes. METHODS: This was a post-hoc analysis of a prospective, multicenter, observational study conducted across Japan. It included survivors aged 65 years or older who were admitted to the ICU through the emergency department. Based on CFS scores, participants were categorized into either the not frail group or the frail group, using a threshold CFS score of < 4. Our primary outcome was patient-centered outcomes (QOL/ADL) measured by the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the Barthel Index six months post-ICU admission, comparing results from baseline. Secondary outcomes included exploration of factors associated with QOL/ADL six months post-ICU admission using multiple linear regression analyses. RESULTS: Of 514 candidates, 390 participants responded to the EQ-5D-5L questionnaire, while 237 responded to the Barthel Index. At six months post-admission, mean EQ-5D-5L values declined in both the not frail and frail groups (0.80 to 0.73, p = 0.003 and 0.58 to 0.50, p = 0.002, respectively); Barthel Index scores also declined in both groups (98 to 83, p < 0.001 and 79 to 61, p < 0.001, respectively). Multiple linear regression analysis revealed that baseline frailty (β coefficient, -0.15; 95% CI, - 0.23 to - 0.07; p < 0.001) and pre-admission EQ-5D-5L scores (β coefficient, 0.14; 95% CI, 0.02 to 0.26; p = 0.016) affected EQ-5D-5L scores at six months. Similarly, baseline frailty (β coefficient, -12.3; 95% CI, - 23.9 to - 0.80; p = 0.036) and Barthel Index scores (β coefficient, 0.54; 95% CI, 0.30 to 0.79; p < 0.001) influenced the Barthel Index score at six months. CONCLUSIONS: Regardless of frailty, older ICU survivors from the emergency department were more likely to experience reduced QOL and ADL six months after ICU admission compared to baseline.

DOI： 10.1186/s12877-024-04881-x

Changes in temporal muscle dimensions and their clinical impact in out-of-hospital cardiac arrest survivors

Takashi Hongo, Hiromichi Naito, Keibun Liu, Yuya Murakami, Satoshi Nozaki, Hiroki Maeyama, Ayaka Matsuoka, Hisashi Dote, Kazumasa Inaba, Satoshi Miike, Shigeki Fujitani, Tomohiro Hiraoka, Takafumi Obara, Tsuyoshi Nojima, Atsunori Nakao, Tetsuya Yumoto

Resuscitation Plus 17 100527 - 100527 2024.3

法的脳死判定時にCPAPモードを用いた無呼吸テストを実施した小児2例

平岡知浩, 小原隆史, 塚原紘平, 難波宏太, 岡田真澄, 平山隆浩, 湯本哲也, 内藤宏道, 中尾篤典

日本小児科学会雑誌 128 ( 2 ) 361 - 361 2024.2

法的脳死判定時にCPAPモードを用いた無呼吸テストを実施した小児2例

平岡知浩, 小原隆史, 塚原紘平, 難波宏太, 岡田真澄, 平山隆浩, 湯本哲也, 内藤宏道, 中尾篤典

日本小児科学会雑誌 128 ( 2 ) 361 - 361 2024.2

Successful Cardiac, Lung, and Kidney Transplantation from a Methanol-poisoned Donor.

Takashi Hongo, Tetsuya Yumoto, Yoshinori Kosaki, Tomohiro Hiraoka, Kohei Tsukahara, Tsuyoshi Nojima, Takafumi Obara, Kohei Ageta, Yukie Yamasaki, Kaori Taniguchi, Masanobu Miura, Satoru Miyaishi, Hiromichi Naito, Atsunori Nakao

JMA journal 7 ( 1 ) 133 - 135 2024.1

Language：English

Massive methanol exposure can lead to severe and detrimental effects that can result in death or brain death. As organs from patients with brain death after methanol ingestion are less likely to be recovered, these patients have been considered marginal donors. We present a case of successful multiple organ transplantation (heart, lungs, and kidneys) from a methanol-poisoned patient. Our experience illustrates that donor death from methanol intoxication does not preclude organ transplantation.

DOI： 10.31662/jmaj.2023-0081

Hydrogen in Transplantation: Potential Applications and Therapeutic Implications. International journal

Takafumi Obara, Hiromichi Naito, Tsuyoshi Nojima, Takahiro Hirayama, Takashi Hongo, Kohei Ageta, Toshiyuki Aokage, Masaki Hisamura, Tetsuya Yumoto, Atsunori Nakao

Biomedicines 12 ( 1 ) 2024.1

Language：English Publishing type：Research paper (scientific journal)

Hydrogen gas, renowned for its antioxidant properties, has emerged as a novel therapeutic agent with applications across various medical domains, positioning it as a potential adjunct therapy in transplantation. Beyond its antioxidative properties, hydrogen also exerts anti-inflammatory effects by modulating pro-inflammatory cytokines and signaling pathways. Furthermore, hydrogen's capacity to activate cytoprotective pathways bolsters cellular resilience against stressors. In recent decades, significant advancements have been made in the critical medical procedure of transplantation. However, persistent challenges such as ischemia-reperfusion injury (IRI) and graft rejection continue to hinder transplant success rates. This comprehensive review explores the potential applications and therapeutic implications of hydrogen in transplantation, shedding light on its role in mitigating IRI, improving graft survival, and modulating immune responses. Through a meticulous analysis encompassing both preclinical and clinical studies, we aim to provide valuable insights into the promising utility of hydrogen as a complementary therapy in transplantation.

DOI： 10.3390/biomedicines12010118

Association of initial lactate levels and red blood cell transfusion strategy with outcomes after severe trauma: a post hoc analysis of the RESTRIC trial. International journal

Yoshinori Kosaki, Takashi Hongo, Mineji Hayakawa, Daisuke Kudo, Shigeki Kushimoto, Takashi Tagami, Hiromichi Naito, Atsunori Nakao, Tetsuya Yumoto

World journal of emergency surgery : WJES 19 ( 1 ) 1 - 1 2024.1

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The appropriateness of a restrictive transfusion strategy for those with active bleeding after traumatic injury remains uncertain. Given the association between tissue hypoxia and lactate levels, we hypothesized that the optimal transfusion strategy may differ based on lactate levels. This post hoc analysis of the RESTRIC trial sought to investigate the association between transfusion strategies and patient outcomes based on initial lactate levels. METHODS: We performed a post hoc analysis of the RESTRIC trial, a cluster-randomized, crossover, non-inferiority multicenter trials, comparing a restrictive and liberal red blood cell transfusion strategy for adult trauma patients at risk of major bleeding. This was conducted during the initial phase of trauma resuscitation; from emergency department arrival up to 7 days after hospital admission or intensive care unit (ICU) discharge. Patients were grouped by lactate levels at emergency department arrival: low (< 2.5 mmol/L), middle (≥ 2.5 and < 4.0 mmol/L), and high (≥ 4.0 mmol/L). We compared 28 days mortality and ICU-free and ventilator-free days using multiple linear regression among groups. RESULTS: Of the 422 RESTRIC trial participants, 396 were analyzed, with low (n = 131), middle (n = 113), and high (n = 152) lactate. Across all lactate groups, 28 days mortality was similar between strategies. However, in the low lactate group, the restrictive approach correlated with more ICU-free (β coefficient 3.16; 95% CI 0.45 to 5.86) and ventilator-free days (β coefficient 2.72; 95% CI 0.18 to 5.26) compared to the liberal strategy. These findings persisted even after excluding patients with severe traumatic brain injury. CONCLUSIONS: Our results suggest that restrictive transfusion strategy might not have a significant impact on 28-day survival rates, regardless of lactate levels. However, the liberal transfusion strategy may lead to shorter ICU- and ventilator-free days for patients with low initial blood lactate levels.

DOI： 10.1186/s13017-023-00530-7

Reply to: Stomach inflation during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients: Where did the air go? International journal

Hiromichi Naito, Takashi Hongo, Tetsuya Yumoto, Hiroki Maeyama, Atsunori Nakao

Resuscitation 194 110099 - 110099 2024.1

Multidisciplinary approach to a 93-year-old survivor with crush syndrome: A 124-h rescue operation after the 2024 Noto Peninsula earthquake. International journal

Mototaka Inaba, Hiromichi Naito, Masaki Hisamura, Kaoru Harada, Atsunori Nakao

Acute medicine & surgery 11 ( 1 ) e967 2024

Characteristics and outcomes of subarachnoid hemorrhage from vertebral artery dissection: A comparative study with other non-traumatic etiologies. International journal

Shu Oshita, Tetsuya Yumoto, Shunta Jinno, Ippei Matsuo, Takashi Hongo, Hiromichi Naito, Masafumi Hiramatsu, Jun Haruma, Kenji Sugiu, Shota Tanaka, Atsunori Nakao

Acute medicine & surgery 11 ( 1 ) e70031 2024

Language：English Publishing type：Research paper (scientific journal)

AIM: Vertebral artery dissection (VAD) is a rare cause of non-traumatic subarachnoid hemorrhage (SAH) with significant clinical implications. This study compared the clinical characteristics and outcomes of SAH from intracranial VAD rupture to those from other etiologies, primarily aneurysmal rupture. METHODS: This single-center retrospective cohort study at Okayama University Hospital included patients with non-traumatic SAH diagnosed between 2019 and 2023. Patients were categorized into "VAD rupture" and "other etiologies" groups. The main outcome was clinical presentation and symptoms. Additional outcomes included ICU mortality, in-hospital mortality, and unfavorable outcomes at discharge and 6 months, defined as a modified Rankin Scale score of 3-6. RESULTS: A total of 66 patients were included, with 14 in the VAD rupture group and 52 in the other etiologies group. The VAD rupture group was younger (median age 49 vs. 64 years, p = 0.003) and had a higher incidence of out-of-hospital cardiac arrest (42.9% vs. 9.6%, p = 0.011). Preceding headache was more common in the VAD rupture group (78.6% vs. 11.5%, p < 0.001), with a median duration of 36 h before presentation. ICU and in-hospital mortality was higher in the VAD rupture group (both 50.0% vs. 19.3%, p = 0.019). No significant differences were found in unfavorable neurological outcomes at hospital discharge and 6 months. CONCLUSIONS: VAD-related SAH often presents with prodromal headaches, severe symptoms like out-of-hospital cardiac arrest, and higher ICU and in-hospital mortality than other SAH causes, though long-term outcomes are similar. Larger, prospective studies are needed to refine interventions.

DOI： 10.1002/ams2.70031

Treatment patterns and clinician stress related to care of out-of-hospital cardiac arrest patients with a do not attempt resuscitation order. International journal

Ryo Tanabe, Takashi Hongo, Takafumi Obara, Tsuyoshi Nojima, Atsunori Nakao, Jonathan Elmer, Hiromichi Naito, Tetsuya Yumoto

Resuscitation plus 16 100507 - 100507 2023.12

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: This research investigated treatment patterns for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders in Japanese emergency departments and the associated clinician stress. METHODS: A cross-sectional survey was conducted at 9 hospitals in Okayama, Japan, targeting emergency department nurses and physicians. The questionnaire inquired about the last treated out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation. We assessed emotional stress on a 0-10 scale and moral distress on a 1-5 scale among clinicians. RESULTS: Of 208 participants, 107 (51%) had treated an out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation order in the past 6 months. Of these, 65 (61%) clinicians used a "slow code" due to perceived futility in resuscitation (42/65 [65%]), unwillingness to terminate resuscitation upon arrival (38/65 [59%]), and absence of family at the time of patient's arrival (35/65 [54%]). Female clinicians had higher emotional stress (5 vs. 3; P = 0.007) and moral distress (3 vs. 2; P = 0.002) than males. Nurses faced more moral distress than physicians (3 vs. 2; P < 0.001). Adjusted logistic regression revealed that having performed a "slow code" (adjusted odds ratio, 5.09 [95% CI, 1.68-17.87]) and having greater ethical concerns about "slow code" (adjusted odds ratio, 0.35 [95% CI, 0.19-0.58]) were associated with high stress levels. CONCLUSIONS: The prevalent use of "slow code" for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders underscores the challenges in managing these patients in clinical practice.

DOI： 10.1016/j.resplu.2023.100507

アセトアミノフェン中毒に対する一酸化炭素放出物質(CORM-401)の新規治療法としての可能性

青景聡之, Meng Ying, 小原隆史, 湯本哲也, 平山隆浩, 内藤宏道, 中尾篤典

日本救急医学会雑誌 34 ( 12 ) 717 - 717 2023.12

暑熱環境下における気温上昇と心血管救急搬送リスクとの関連時間依存の予防対策

藤本竜平, 鈴木越治, 鹿嶋小緒里, 内藤宏道, 中村一文, 中尾篤典, 岡岳文, 伊藤浩, 頼藤貴志

日本救急医学会雑誌 34 ( 12 ) 739 - 739 2023.12

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 2023.12

メタノール中毒患者での脳死下臓器提供の一例

小崎吉訓, 薬師寺泰匡, 野島剛, 飯田淳義, 塚原紘平, 湯本哲也, 内藤宏道, 中尾篤典

日本救急医学会雑誌 34 ( 12 ) 856 - 856 2023.12

EICUでのドナー管理と救急応需率との関係

湯本哲也, 本郷貴識, 小崎吉訓, 小原隆史, 上田浩平, 野島剛, 飯田淳義, 青景聡之, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 34 ( 12 ) 855 - 855 2023.12

バルプロ酸徐放剤とオランザピン過量内服により遅発性に高アンモニア血症を生じた1例

萩原万瀧, 野島剛, 本郷貴識, 小原隆史, 小崎吉訓, 湯本哲也, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 34 ( 12 ) 798 - 798 2023.12

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 2023.12

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 2023.12

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

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

Resuscitation. 109994 2023.10

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

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

BMC medical ethics 24 ( 1 ) 80 - 80 2023.10

Language：English Publishing type：Research paper (scientific journal)

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

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 2023.10

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 2023.10

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

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 2023.9

Language：English Publishing type：Research paper (scientific journal)

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

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. International journal

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

Experimental gerontology 180 112270 - 112270 2023.9

Language：English Publishing type：Research paper (scientific journal)

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

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

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

Resuscitation plus 15 100434 - 100434 2023.9

Language：English Publishing type：Research paper (scientific journal)

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

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 2023.9

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 2023.8

Language：English

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

Schmorl's Node Found with Acute Lower Back Pain.

Kenji Aoshima, Takafumi Obara, Tsuyoshi Nojima, Atsunori Nakao

Internal medicine (Tokyo, Japan) 2023.7

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 2023.7

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 2023.7

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 2023.7

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 2023.7

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 2023.7

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 2023.7

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 2023.7

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 ) 2023.6

Publishing type：Research paper (scientific journal) Publisher：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

Other Link： https://link.springer.com/article/10.1186/s13054-023-04534-2/fulltext.html

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 2023.6

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 2023.6

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 2023.6

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 2023.6

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 2023.6

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 2023.6

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 2023.6

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 2023.6

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

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 2023.5

Language：English Publishing type：Research paper (scientific journal)

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

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

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 2023.4

Language：English Publishing type：Research paper (scientific journal)

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

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. International journal

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 2023.4

Language：English Publishing type：Research paper (scientific journal)

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

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 2023.4

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 2023.4

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 2023.4

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 2023.4

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 2023.3

Publishing type：Research paper (scientific journal) Publisher：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

Other Link： 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. International journal

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 2023.3

Language：English Publishing type：Research paper (scientific journal)

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

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

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 2023.2

Language：English Publishing type：Research paper (scientific journal)

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

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 2023.2

Language：English

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

A Seat Belt Injury Causing a Large Breast Hematoma: A Case Report. International journal

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

Cureus 15 ( 2 ) e35440 2023.2

Language：English

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

遺伝性血管浮腫(HAE)の診断後に、腹痛発作で救急搬送を繰り返していた一例

佐々並三紗, 薬師寺泰匡, 本郷貴識, 野島剛, 上田浩平, 内藤宏道, 中尾篤典

日本腹部救急医学会雑誌 43 ( 2 ) 520 - 520 2023.2

Automatic emergency calls from smartphone/smartwatch applications in trauma. International journal

Takashi Hongo, Shunki Yamamoto, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao, Tetsuya Yumoto

Acute medicine & surgery 10 ( 1 ) e875 2023

Successfully treated case of severe hypothermia secondary to myxedema coma. International journal

Hirotsugu Yamamoto, Takashi Hongo, Tsuyoshi Nojima, Takafumi Obara, Yoshinori Kosaki, Kohei Ageta, Kohei Tsukahara, Tetsuya Yumoto, Atsunori Nakao, Hiromichi Naito

Acute medicine & surgery 10 ( 1 ) e828 2023

Language：English

BACKGROUND: Myxedema coma is an extremely rare but fatal endocrine emergency that requires urgent recognition and treatment. We describe a case of severe hypothermia that rapidly deteriorated to cardiac arrest that was attributed to myxedema coma. CASE PRESENTATION: A 52-year-old man without a history of hypothyroidism was transferred to our emergency department due to coma and profound hypothermia. The patient developed cardiac arrest immediately after hospital arrival but return of spontaneous circulation was achieved shortly after resuscitation. The patient was noted to have generalized, nonpitting edema, dry skin, severe respiratory acidosis, hyponatremia, and elevated creatinine kinase, which was indicative of hypothyroidism. Myxedema coma was confirmed by a thyroid profile. The patient was successfully treated with intravenous levothyroxine and glucocorticoid. CONCLUSION: Although myxedema coma is a rare cause of severe hypothermia, emergency physicians should be familiar with its clinical features and management.

DOI： 10.1002/ams2.828

Transcranial doppler ultrasound in a 3-month-old infant with brain death. International journal

Tomohiro Hiraoka, Takafumi Obara, Takashi Hongo, Tsuyoshi Nojima, Kohei Tsukahara, Tetsuya Yumoto, Atsunori Nakao

Pediatrics international : official journal of the Japan Pediatric Society 65 ( 1 ) e15587 2023

Influence of coronavirus disease 2019 case surges on prehospital emergency medical service for patients with trauma in Kobe, Japan. International journal

Takeshi Nishimura, Masafumi Suga, Satoshi Ishihara, Shinichi Nakayama, Atsunori Nakao, Hiromichi Naito

Acute medicine & surgery 10 ( 1 ) e829 2023

Language：English Publishing type：Research paper (scientific journal)

AIM: In the current era of the coronavirus disease 2019 (COVID-19) pandemic, the responsiveness of emergency medical service (EMS) transport for patients with internal illness is often delayed. However, the influence of the COVID-19 pandemic on prehospital transport for patients with trauma has not yet been fully elucidated. This study aims to examine the effect of COVID-19 case surges on EMS transport for patients with trauma during the COVID-19 states of emergency in Kobe, Japan. METHODS: EMS data during the states of emergency were compared with those in the 2019 prepandemic period. The incidence of difficulty securing hospital acceptance (four or more calls to medical institutions and ambulance staying at the scene for 30 min or more) was evaluated as a primary outcome. Secondary outcomes were the time spent at the trauma scene and the number of calls requesting hospital acceptance. The time spent at the trauma scene was stratified by trauma severity. RESULTS: The incidence of difficulty securing hospital acceptance increased (1.2% versus 3.2%, P < 0.01). Logistic regression analysis revealed that the duration of the states of emergency was associated with difficulty securing hospital acceptance (odds ratio [OR] 2.08, 95% confidence interval 1.77-2.45; P < 0.01). Although the mean time spent at the trauma scene among the less severe, moderately severe, and severe trauma groups was prolonged, the time for the life-threatening group did not change. The number of request calls increased during the states of emergency. CONCLUSION: Difficulty securing hospital acceptance increased; however, the time spent at the trauma scene did not significantly change for the life-threatening group.

DOI： 10.1002/ams2.829

Rare case of intracerebral hemorrhage in anaphylactic shock following administration of intramuscular adrenaline: A case report. International journal

Shunki Yamamoto, Takashi Hongo, Tomokazu Tamura, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Clinical case reports 10 ( 11 ) e6534 2022.11

臓器移植におけるドナー管理(臓器保護の観点から) 6歳未満おける臓器移植ドナー管理の特徴

小原隆史, 内藤宏道, 塚原紘平, 青景聡之, 野島剛, 上田浩平, 小崎吉訓, 山田太平, 藤崎宣友, 中尾篤典

日本集中治療医学会雑誌 29 ( Suppl.1 ) 297 - 297 2022.11

脳死の状態判断に補助検査として脳血流シンチグラフィを施行した1例

庵谷紘美, 内藤宏道, 小原隆史, 青景聡之, 塚原紘平, 中尾篤典

日本集中治療医学会雑誌 29 ( Suppl.1 ) 667 - 667 2022.11

認知機能および(または)摂食嚥下機能の障害予防を目指すICU早期リハビリテーション人工呼吸管理後の嚥下障害におけるST介入時期の検討多施設後ろ向き観察研究(中間報告)

本郷貴識, 山本良平, 劉啓文, 内藤宏道, 中尾篤典, 水川俊一

日本集中治療医学会雑誌 29 ( Suppl.1 ) 373 - 373 2022.11

集中治療における高齢者ケア～フレイルという観点から～フレイルが高齢者救急集中治療に与える影響とは?

稲葉基高, 内藤宏道, 中尾篤典

日本集中治療医学会雑誌 29 ( Suppl.1 ) 303 - 303 2022.11

臓器移植におけるドナー管理(臓器保護の観点から) 6歳未満おける臓器移植ドナー管理の特徴

小原隆史, 内藤宏道, 塚原紘平, 青景聡之, 野島剛, 上田浩平, 小崎吉訓, 山田太平, 藤崎宣友, 中尾篤典

日本集中治療医学会雑誌 29 ( Suppl.1 ) 297 - 297 2022.11

Bile pigments in emergency and critical care medicine. International journal

Mizuki Seya, Toshiyuki Aokage, Tsuyoshi Nojima, Atsunori Nakao, Hiromichi Naito

European journal of medical research 27 ( 1 ) 224 - 224 2022.10

Language：English Publishing type：Research paper (scientific journal)

Bile pigments, such as bilirubin and biliverdin, are end products of the heme degradation pathway in mammals and are widely known for their cytotoxic effects. However, recent studies have revealed that they exert cytoprotective effects through antioxidative, anti-inflammatory, and immunosuppressive properties. All these mechanisms are indispensable in the treatment of diseases in the field of emergency and critical care medicine, such as coronary ischemia, stroke, encephalomyelitis, acute lung injury/acute respiratory distress syndrome, mesenteric ischemia, and sepsis. While further research is required before the safe application of bile pigments in the clinical setting, their underlying mechanisms shed light on their utilization as therapeutic agents in the field of emergency and critical care medicine. This article aims to summarize the current understanding of bile pigments and re-evaluate their therapeutic potential in the diseases listed above.

DOI： 10.1186/s40001-022-00863-0

Predictive Factors of Return Home and Return to Work for Intensive Care Unit Survivors after Traumatic Brain Injury with a Follow-up Period of 2 Years.

Satoru Yabuno, Takao Yasuhara, Satoshi Murai, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao, Isao Date

Neurologia medico-chirurgica 62 ( 10 ) 465 - 474 2022.10

Language：English Publishing type：Research paper (scientific journal)

Intensive care unit (ICU) survivors after traumatic brain injury (TBI) frequently have serious disabilities with subsequent difficulty in reintegration into society. We aimed to investigate outcomes for ICU survivors after moderate to severe TBI (msTBI) and to identify predictive factors of return home (RH) and return to work (RTW). This single-center retrospective cohort study was conducted on all trauma patients admitted to the emergency ICU of our hospital between 2013 and 2017. Of these patients, adult (age ≥ 18 years) msTBI patients with head Abbreviated Injury Scale ≥ 3 were extracted. We performed univariate/multivariate logistic regression analyses to explore the predictive factors of RH and RTW. Among a total of 146 ICU survivors after msTBI, 107 were included (median follow-up period: 26 months). The RH and RTW rates were 78% and 35%, respectively. Multivariate analyses revealed that the predictive factors of RH were age < 65 years (P < 0.001), HR < 76 bpm (P = 0.015), platelet count ≥ 19× 104/μL (P = 0.0037), D-dimer < 26 μg/mL (P = 0.034), and Glasgow Coma Scale (GCS) score > 8 (P = 0.0015). Similarly, the predictive factors of RTW were age < 65 years (P < 0.001) and GCS score > 8 (P = 0.0039). This study revealed that "age" and "GCS score on admission" affected RH and RTW for ICU survivors after msTBI.

DOI： 10.2176/jns-nmc.2022-0149

Elderly woman with rapid progression of swallowing difficulty. International journal

Ryo Tanabe, Tsuyoshi Nojima, Tetsuya Yumoto, Atsunori Nakao

Journal of the American College of Emergency Physicians open 3 ( 5 ) e12806 2022.10

水素含有臓器保護液は,虚血再灌流後のミトコンドリアの機能回復を早め,細胞死を軽減する

瀬谷海月, 青景聡之, 山田太平, 渡邉暁洋, 山本浩継, 平山隆浩, 野島剛, 中尾篤典, 内藤宏道

日本救急医学会雑誌 33 ( 10 ) 891 - 891 2022.10

産科情報共有システム「iPicss」により迅速な対応ができた出産中の脳出血の搬送例

佐々並三紗, 小崎吉訓, 塚原紘平, 牧尉太, 中尾篤典, 内藤宏道, 湯本哲也, 上田浩平, 小原隆史, 本郷貴識, 平岡知浩

日本救急医学会雑誌 33 ( 10 ) 806 - 806 2022.10

治療的医学ガス(Medical gas)を救急集中治療領域へ応用する救急医による挑戦

小原隆史, 青景聡之, 山本浩継, 野島剛, 上田浩平, 湯本哲也, 内藤宏道, 中尾篤典

日本救急医学会雑誌 33 ( 10 ) 823 - 823 2022.10

デジタル田園健康特区における救急救命士の権限・役割の拡大による救急体制の充実への取り組み

上田浩平, 本郷貴識, 小原隆史, 野島剛, 湯本哲也, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 33 ( 10 ) 872 - 872 2022.10

地域枠制度・地域医療に対する持続的発展を担う救急医療教育

野島剛, 湯本哲也, 小崎吉訓, 長谷川徹, 塚原紘平, 内藤宏道, 小川弘子, 佐藤勝, 忠田正樹, 中尾篤典

日本救急医学会雑誌 33 ( 10 ) 850 - 850 2022.10

医学生による女性型シミュレーターを用いた蘇生実習の検討

久保卓也, 本郷貴識, 塚原紘平, 野島剛, 小崎吉訓, 内藤宏道, 中尾篤典

日本救急医学会雑誌 33 ( 10 ) 875 - 875 2022.10

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 2022.10

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 2022.10

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 2022.10

Luminal administration of biliverdin ameliorates ischemia-reperfusion injury following intestinal transplant in rats. International journal

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

Surgery 172 ( 5 ) 1522 - 1528 2022.9

Language：English Publishing type：Research paper (scientific journal)

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

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 2022.9

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 2022.9

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 2022.9

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 2022.9

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 2022.9

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 2022.9

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 2022.9

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 2022.9

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 2022.8

Publishing type：Research paper (scientific journal)

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

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 2022.8

Frequency, associated factors, and associated outcomes of dysphagia following sepsis. International journal

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 2022.7

Language：English Publishing type：Research paper (scientific journal)

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

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 2022.7

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

Tsuyoshi Nojima, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Resuscitation plus 10 100261 - 100261 2022.6

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 2022.6

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

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

The American journal of emergency medicine 56 218 - 222 2022.6

Language：English Publishing type：Research paper (scientific journal)

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

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 2022.6

Language：English Publishing type：Research paper (scientific journal)

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

Can Blood Ammonia Level, Prehospital Time, and Return of Spontaneous Circulation Predict Neurological Outcomes of Out-of-Hospital Cardiac Arrest Patients? A Nationwide, Retrospective Cohort Study. International journal

Tsuyoshi Nojima, Hiromichi Naito, Takafumi Obara, Kohei Ageta, Hiromasa Yakushiji, Tetsuya Yumoto, Noritomo Fujisaki, Atsunori Nakao

Journal of clinical medicine 11 ( 9 ) 2022.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: This study aimed to test if blood ammonia levels at hospital arrival, considering prehospital time and the patient's condition (whether return of spontaneous circulation [ROSC] was achieved at hospital arrival), can predict neurological outcomes after out-of-hospital cardiac arrest (OHCA). METHODS: This was a retrospective cohort study on data from a nationwide OHCA registry in Japan. Patients over 17 years old and whose blood ammonia levels had been recorded were included. The primary outcome was favorable neurological outcome at 30 days after OHCA. Blood ammonia levels, prehospital time, and the combination of the two were evaluated using the receiver operating characteristic curve to predict favorable outcomes. Then, cut-off blood ammonia values were determined based on whether ROSC was achieved at hospital arrival. RESULTS: Blood ammonia levels alone were sufficient to predict favorable outcomes. The overall cut-off ammonia value for favorable outcomes was 138 μg/dL; values were different for patients with ROSC (96.5 μg/dL) and those without ROSC (156 μg/dL) at hospital arrival. CONCLUSIONS: Our results using patient data from a large OHCA registry showed that blood ammonia levels at hospital arrival can predict neurological outcomes, with different cut-off values for patients with or without ROSC at hospital arrival.

DOI： 10.3390/jcm11092566

智の探求:プレホスピタルと医療機関における心肺蘇生を望まない患者への対応 DNAR指示を有する院外心停止の特徴、病院前処置、転機に関する検討

田邉綾, 内藤宏道, 野島剛, 塚原紘平, 山田太平, 中尾篤典

日本臨床救急医学会雑誌 25 ( 2 ) 275 - 275 2022.5

脳卒中様症状を呈した急性大動脈解離の1例

加藤篤之, 野島剛, 小原隆史, 塚原紘平, 内藤宏道, 中尾篤典

日本臨床救急医学会雑誌 25 ( 2 ) 329 - 329 2022.5

人工呼吸管理中の喀痰評価の個人差に関する調査喀痰評価デバイス開発に向けて

平山隆浩, 木口隆, 野島剛, 青景聡之, 渡邉暁洋, 内藤宏道, 中尾博之, 中尾篤典

日本臨床救急医学会雑誌 25 ( 2 ) 388 - 388 2022.5

Association between timing of speech and language therapy initiation and outcomes among post-extubation dysphagia patients: a multicenter retrospective cohort study. International journal

Takashi Hongo, Ryohei Yamamoto, Keibun Liu, Takahiko Yaguchi, Hisashi Dote, Ryusuke Saito, Tomoyuki Masuyama, Kosuke Nakatsuka, Shinichi Watanabe, Takahiro Kanaya, Tomoya Yamaguchi, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Critical care (London, England) 26 ( 1 ) 98 - 98 2022.4

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Post-extubation dysphagia (PED) is recognized as a common complication in the intensive care unit (ICU). Speech and language therapy (SLT) can potentially help improve PED; however, the impact of the timing of SLT initiation on persistent PED has not been well investigated. This study aimed to examine the timing of SLT initiation and its effect on patient outcomes after extubation in the ICU. METHODS: We conducted this multicenter, retrospective, cohort study, collecting data from eight ICUs in Japan. Patients aged ≥ 20 years with orotracheal intubation and mechanical ventilation for longer than 48 h, and those who received SLT due to PED, defined as patients with modified water swallowing test scores of 3 or lower, were included. The primary outcome was dysphagia at hospital discharge, defined as functional oral intake scale score < 5 or death after extubation. Secondary outcomes included dysphagia or death at the seventh, 14th, or 28th day after extubation, aspiration pneumonia, and in-hospital mortality. Associations between the timing of SLT initiation and outcomes were determined using multivariable logistic regression. RESULTS: A total of 272 patients were included. Of them, 82 (30.1%) patients exhibited dysphagia or death at hospital discharge, and their time spans from extubation to SLT initiation were 1.0 days. The primary outcome revealed that every day of delay in SLT initiation post-extubation was associated with dysphagia or death at hospital discharge (adjusted odds ratio (AOR), 1.09; 95% CI, 1.02-1.18). Similarly, secondary outcomes showed associations between this per day delay in SLT initiation and dysphagia or death at the seventh day (AOR, 1.28; 95% CI, 1.05-1.55), 14th day (AOR, 1.34; 95% CI, 1.13-1.58), or 28th day (AOR, 1.21; 95% CI, 1.07-1.36) after extubation and occurrence of aspiration pneumonia (AOR, 1.09; 95% CI, 1.02-1.17), while per day delay in post-extubation SLT initiation did not affect in-hospital mortality (AOR, 1.04; 95% CI, 0.97-1.12). CONCLUSIONS: Delayed initiation of SLT in PED patients was associated with persistent dysphagia or death. Early initiation of SLT may prevent this complication post-extubation. A randomized controlled study is needed to validate these results.

DOI： 10.1186/s13054-022-03974-6

Emotional work stress reactions of emergency medical technicians involved in transporting out-of-hospital cardiac arrest patients with "do not attempt resuscitation" orders. International journal

Ryo Tanabe, Takashi Hongo, Yasuhiro Mandai, Mototaka Inaba, Takashi Yorifuji, Atsunori Nakao, Jonathan Elmer, Hiromichi Naito

Resuscitation 173 61 - 68 2022.4

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Emergency medical technicians (EMTs) may be subjected to emotional stress during patient treatment/transport. In Japan, dispatched EMTs must attempt resuscitation in all cases of out-of-hospital cardiac arrest (OHCA), including patients with "do not attempt resuscitation" (DNAR) orders and patients whose families do not support resuscitation. We described the characteristics, prevalence, and outcomes of OHCA/DNAR patients, and aimed to identify factors associated with EMT stress when treating them. METHODS: We included OHCA patients transported by EMTs in the city of Okayama from 2015 to 2019. We identified patients with DNAR orders based on emergency medical service (EMS) records, then EMTs completed questionnaires regarding the management of those patients and EMTs' emotions. RESULTS: Among 3079 eligible OHCA patients, 122 patients (4%) had DNAR orders (DNAR group), and 2957 (96%) patients had no DNAR orders (no DNAR group). Based on responses from 243 EMT participants involved in OHCA/DNAR transports, we divided EMTs into high stress (73/243, 30%) and low stress (170/243, 70%) groups. EMTs experienced emotional stress from treating patients with family physician orders to transport (AOR: 4.74, 95% CI: 2.35-9.56) and those for whom prehospital defibrillation was performed (AOR: 20.7, 95% CI: 3.10-137.9). CONCLUSIONS: Approximately 30% of EMTs providing resuscitation to OHCA/DNAR patients experienced high levels of stress. Establishment of a prehospital emergency system incorporating physician medical direction and updated guidelines for treating patients with DNAR orders may reduce the psychosocial stress of EMTs.

DOI： 10.1016/j.resuscitation.2022.01.028

Impact of different medical direction policies on prehospital advanced airway management for out-of hospital cardiac arrest patients: A retrospective cohort study. International journal

Takashi Hongo, Tetsuya Yumoto, Hiromichi Naito, Takeshi Mikane, Atsunori Nakao

Resuscitation plus 9 100210 - 100210 2022.3

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Although optimal prehospital airway management after out-of-hospital cardiac arrest (OHCA) remains undetermined, no studies have compared different advanced airway management (AAM) policies adopted by two hospitals in charge of online medical direction by emergency physicians. We examined the impact of two different AAM policies on OHCA patient survival. METHODS: This observational cohort study included adult OHCA patients treated in Okayama City from 2013 to 2016. Patients were divided into two groups: the O group - those treated on odd days when a hospital with a policy favoring laryngeal tube ventilation (LT) supervised, and the E group - those treated on even days when the other hospital with a policy favoring endotracheal intubation (ETI) supervised. Multiple logistic regression analysis was performed to assess airway device effects. The primary outcome measure was seven-day survival. RESULTS: Of 2,406 eligible patients, 50.1% were in the O group and 49.9% were in the E group. O group patients received less ETI (1.0% vs. 12.0%) and more LT (53.3% vs. 43.0%) compared with E group patients. In univariate analysis, no differences were observed in seven-day survival (9.4% vs 10.1%). Multiple regression analysis revealed neither LT nor ETI had a significant independent effect on seven-day survival, considering bag-valve mask ventilation as a reference (OR, 0.78; 95% CI, 0.54 to 1.13, OR, 0.79; 95% CI, 0.36 to 1.72, respectively). CONCLUSION: Despite different advanced airway medical direction policies in a single city, there were no substantial impact on outcomes for OHCA patients.

DOI： 10.1016/j.resplu.2022.100210

日本外傷学会データバンクを用いた熱傷症例の検討

野島剛, 内藤宏道, 小原隆史, 小崎吉訓, 上田浩平, 塚原紘平, 中尾篤典

熱傷 48 ( 1 ) 38 - 39 2022.3

当院高度救命救急センターにおける小児の熱傷と感染に関するまとめ

小原隆史, 塚原紘平, 野島剛, 上田浩平, 山本浩継, 内藤宏道, 中尾篤典

熱傷 48 ( 1 ) 41 - 41 2022.3

岡山市における重症熱傷患者搬送とコロナウイルス感染症の影響

上田浩平, 内藤宏道, 塚原紘平, 中尾篤典

熱傷 48 ( 1 ) 39 - 39 2022.3

広範囲熱傷患者のエネルギー消費の経過

大塚貴久, 塚原絋平, 内藤宏道, 中尾篤典

熱傷 48 ( 1 ) 38 - 38 2022.3

当院EICUにおいて、熱傷患者の熱傷面積が広いほど緑膿菌は検出されるかの検証

木口隆, 加藤湖月, 野島剛, 小崎吉訓, 藤崎宣友, 塚原紘平, 内藤宏道, 中尾篤典

熱傷 48 ( 1 ) 40 - 40 2022.3

集学的アプローチを用いた小児外傷患者に対する保護活動の実際

上原健敬, 依光正則, 福岡史朗, 佐藤浩平, 畑利彰, 島村安則, 塚原紘平, 中尾篤典, 尾崎敏文

日本整形外科学会雑誌 96 ( 2 ) S311 - S311 2022.3

Reusable Medical Isolation Gowns with a Liquid Barrier: Washing Gowns in the Coronavirus Disease 2019 Pandemic Era?

Hiromichi Naito, Kohei Tsukahara, Soshi Takao, Takashi Yorifuji, Atsunori Nakao

JMA journal 5 ( 1 ) 107 - 108 2022.1

Language：English Publishing type：Research paper (scientific journal)

Healthcare providers are at risk of exposure to SARS-CoV-2 via droplets, respiratory secretions, and contact with contaminated surfaces. Personal protective equipment (PPE) is necessary for primary reliable prevention to treat patients with coronavirus disease 2019 (COVID-19). However, PPE shortages have had a significant impact on every medical facility, and outpatient clinics are especially vulnerable to shortages of medical supplies. During the first stage of the pandemic, efforts were made to reduce the use of medical supplies. Guidance and strategies were proposed to ration the use of PPE, including reusing it. However, reuse (wash) of isolation gowns has not been practically promoted despite these suggestions. Further, reusable products may have advantages for economic and ecologic reasons. We developed an adult universally sized, long-sleeved, 100% polyester, reusable/washable gown with liquid barrier protection. The isolation gown can be worn repeatedly through washing and subsequent disinfection, and it can withstand washing in 80°C hot water for 10 min and/or immersion in 0.05%-0.1% sodium hypochlorite for 30 min and then dried. This new gown's liquid barrier performance is at Association for the Advancement of Medical Instrumentation level 1, even after 20 repeated uses with low cost. The choice of barrier level for gowns should be made based on the risk of contamination. However, the healthcare setting for COVID-19 patients varies greatly with not fully elucidated transmissibility. The newly made reusable isolation gown can be one option for treating COVID-19 patients especially in low-risk settings with economical advantage. Further, preparedness for reuse may have critical implications in extreme shortage. Reconsideration should be focused on reusable gowns with liquid barrier performance and their appropriate use.

DOI： 10.31662/jmaj.2021-0075

Adult Scurvy Presenting with Painful Purpura on the Legs

Nayu Tamura, Takafumi Obara, Taihei Yamada, Tsuyoshi Nojima, Shunsuke Nakamura, Yasuhiro Koide, Makoto Takaoka, Hiromichi Naito, Atsunori Nakao

Internal Medicine 2022

Geriatric trauma prognosis trends over 10 years: analysis of a nationwide trauma registry. International journal

Takeshi Nishimura, Hiromichi Naito, Atsunori Nakao, Shinichi Nakayama

Trauma surgery & acute care open 7 ( 1 ) e000735 2022

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: With Japan's population rapidly skewing toward aging, the number of geriatric trauma patients is expected to increase. Since we need to continue to improve the quality of geriatric trauma patient care, this study aimed to evaluate in-hospital mortality trends among geriatric trauma patients in Japan over a recent 10-year period. METHODS: This was a retrospective cohort study of data from a Japanese nationwide trauma registry (the Japan National Trauma Data Bank) on patients admitted between January 1, 2008 and December 31, 2017. Geriatric patients were defined as those 65 years old and older. The primary outcome was to clarify in-hospital mortality trends and changes over these 10 years. RESULTS: We identified 265 268 eligible trauma patients. Excluding those under 65 years old and those with inadequate or unknown age data, missing prognosis, out-of-hospital cardiac arrest, and burns, 107 766 patients were enrolled in this study. The total trauma patient in-hospital mortality trend was evaluated using the Cochran-Armitage test and showed a significant decrease (p<0.001). Although severe trauma patients (Injury Severity Score (ISS) ≥16) showed a significant decreasing trend (p<0.001) over time (from 26.1% to 14.5%), less-severe trauma patients (ISS <16) did not (p=0.41) (from 2.7% to 2.1%). Mixed logistic regression analysis showed that the number of year patients stayed in the hospital was significantly associated with mortality. CONCLUSIONS: While recognizing the limitations of the current analysis, our data demonstrated that prognoses for severe trauma patients over 65 years old improved dramatically over these 10 years, especially in those with severe trauma. LEVEL OF EVIDENCE: Ⅲ-retrospective cohort study.

DOI： 10.1136/tsaco-2021-000735

Prehospital advanced airway management of emergency medical service-witnessed traumatic out-of-hospital cardiac arrest patients: analysis of nationwide trauma registry. International journal

Takeshi Nishimura, Masafumi Suga, Atsunori Nakao, Satoshi Ishihara, Hiromichi Naito

Acute medicine & surgery 9 ( 1 ) e786 2022

Language：English Publishing type：Research paper (scientific journal)

AIM: Survival of traumatic out-of-hospital cardiac arrest (OHCA) is poor. Early use of advanced airway management (AAM) techniques, including endotracheal intubation and supraglottic devices, are expected to contribute to the improved survival of these patients. The aim of this study was to determine whether prehospital use of AAM improves the outcomes for emergency medical service (EMS)-witnessed traumatic OHCA. METHODS: A nationwide retrospective study was carried out. Trauma patients with EMS-witnessed cardiac arrest who received cardiopulmonary resuscitation during transport were included. Patients younger than 16 years and those with missing data were excluded. We compared two groups using propensity score matching. The primary outcome was survival to discharge. The secondary outcome was return of spontaneous circulation (ROSC) on hospital arrival. A logistic regression model was used to calculate odds ratios (OR) and confidence intervals (CI). RESULTS: After propensity score matching, 1,346 patients were enrolled (AAM 673 versus non-AAM 673). Forty-four AAM cases (6.5%) and 39 non-AAM cases (5.8%) survived. Logistic regression analysis did not show a contribution of AAM for survival to discharge (AAM 44/673 (6.5%), non-AAM 39/673 (5.8%); OR 1.12; 95% CI, 0.70-1.76; P = 0.64). However, AAM improved ROSC on admission (AAM 141/673 (21.0%), non-AAM 77/673 (11.4%); OR 2.05; 95% CI, 1.51-2.78; P < 0.001). This tendency was consistent throughout our subgroup analysis categorized by body region of the severe injury (head trauma, torso trauma, and extremity/spine trauma). CONCLUSIONS: Prehospital AAM among EMS-witnessed traumatic OHCA patients was not associated with survival to discharge; however, ROSC on hospital admission improved for the AAM patients.

DOI： 10.1002/ams2.786

Hamman's Syndrome Accompanied by Diabetic Ketoacidosis; a Case Report. International journal

Koya Yamashita, Takashi Hongo, Tsuyoshi Nojima, Tetsuya Yumoto, Atsunori Nakao, Hiromichi Naito

Archives of academic emergency medicine 10 ( 1 ) e68 2022

Language：English

Hamman's syndrome is an uncommon clinical entity characterized by an idiopathic spontaneous pneumomediastinum as a result of a sudden increase in intra-alveolar pressure. It can be triggered by repeated vomiting or Kussmaul breathing associated with diabetic ketoacidosis (DKA). Careful attention to this particular condition is needed to avoid under-diagnosis and to provide optimal management. Herein, we report a case of an 18-year-old man complaining of chest discomfort and progressive weight loss, ultimately diagnosed with Hamman's syndrome secondary to DKA. The patient's symptoms disappeared after intravenous fluid and insulin administration, while his pneumomediastinum resolved following conservative treatment. Our report highlights the importance of recognition of the links between pneumomediastinum as a cause of chest pain in patients with DKA.

DOI： 10.22037/aaem.v10i1.1709

Luminal Administration of a Water-soluble Carbon Monoxide-releasing Molecule (CORM-3) Mitigates Ischemia/Reperfusion Injury in Rats Following Intestinal Transplantation. International journal

Takafumi Obara, Hirotsugu Yamamoto, Toshiyuki Aokage, Takuro Igawa, Tsuyoshi Nojima, Takahiro Hirayama, Mizuki Seya, Michiko Ishikawa-Aoyama, Atsunori Nakao, Roberto Motterlini, Hiromichi Naito

Transplantation 106 ( 7 ) 1365 - 1375 2021.12

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The protective effects of carbon monoxide (CO) against ischemia/reperfusion (IR) injury during organ transplantation have been extensively investigated. Likewise, CO-releasing molecules (CORMs) are known to exert a variety of pharmacological activities via liberation of controlled amounts of CO in organs. Therefore, we hypothesized that intraluminal administration of water-soluble CORM-3 during cold storage of intestinal grafts would provide protective effects against IR injury. METHODS: Orthotopic syngeneic intestinal transplantation was performed in Lewis rats following 6 h of cold preservation in Ringer solution or University of Wisconsin solution. Saline containing CORM-3 (100 µmol/L) or its inactive counterpart (iCORM-3) was intraluminally introduced in the intestinal graft before cold preservation. RESULTS: Histopathological analysis of untreated and iCORM-3-treated grafts revealed a similar erosion and blunting of the intestinal villi. These changes in the mucosa structure were significantly attenuated by intraluminal administration of CORM-3. Intestinal mucosa damage caused by IR injury led to considerable deterioration of gut barrier function 3 h postreperfusion. CORM-3 significantly inhibited upregulation of proinflammatory mRNA levels, ameliorated intestinal morphological changes, and improved graft blood flow and mucosal barrier function. Additionally, CORM-3-treated grafts increased recipient survival rates. Pharmacological blockade of soluble guanylyl cyclase activity significantly reversed the protective effects conferred by CORM-3, indicating that CO partially mediates its therapeutic actions via soluble guanylyl cyclase activation. CONCLUSION: Our study demonstrates that luminally delivered CORM-3 provides beneficial effects in cold-stored rat small intestinal grafts and could be an attractive therapeutic application of CO in the clinical setting of organ preservation and transplantation.

DOI： 10.1097/TP.0000000000004007

The effects of inhaling hydrogen gas on macrophage polarization, fibrosis, and lung function in mice with bleomycin-induced lung injury

Toshiyuki Aokage, Mizuki Seya, Takahiro Hirayama, Tsuyoshi Nojima, Masumi Iketani, Michiko Ishikawa, Yasuhiro Terasaki, Akihiko Taniguchi, Nobuaki Miyahara, Atsunori Nakao, Ikuroh Ohsawa, Hiromichi Naito

BMC Pulmonary Medicine 21 ( 1 ) 2021.12

Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

<title>Abstract</title><sec>
<title>Background</title>
Acute respiratory distress syndrome, which is caused by acute lung injury, is a destructive respiratory disorder caused by a systemic inflammatory response. Persistent inflammation results in irreversible alveolar fibrosis. Because hydrogen gas possesses anti-inflammatory properties, we hypothesized that daily repeated inhalation of hydrogen gas could suppress persistent lung inflammation by inducing functional changes in macrophages, and consequently inhibit lung fibrosis during late-phase lung injury.

</sec><sec>
<title>Methods</title>
To test this hypothesis, lung injury was induced in mice by intratracheal administration of bleomycin (1.0 mg/kg). Mice were exposed to control gas (air) or hydrogen (3.2% in air) for 6 h every day for 7 or 21 days. Respiratory physiology, tissue pathology, markers of inflammation, and macrophage phenotypes were examined.

</sec><sec>
<title>Results</title>
Mice with bleomycin-induced lung injury that received daily hydrogen therapy for 21 days (BH group) exhibited higher static compliance (0.056 mL/cmH₂O, 95% CI 0.047–0.064) than mice with bleomycin-induced lung injury exposed only to air (BA group; 0.042 mL/cmH₂O, 95% CI 0.031–0.053, <italic>p</italic> = 0.02) and lower static elastance (BH 18.8 cmH₂O/mL, [95% CI 15.4–22.2] vs. BA 26.7 cmH₂O/mL [95% CI 19.6–33.8], <italic>p</italic> = 0.02). When the mRNA levels of pro-inflammatory cytokines were examined 7 days after bleomycin administration, interleukin (IL)-6, IL-4 and IL-13 were significantly lower in the BH group than in the BA group. There were significantly fewer M2-biased macrophages in the alveolar interstitium of the BH group than in the BA group (3.1% [95% CI 1.6–4.5%] vs. 1.1% [95% CI 0.3–1.8%], <italic>p</italic> = 0.008).

</sec><sec>
<title>Conclusions</title>
The results suggest that hydrogen inhalation inhibits the deterioration of respiratory physiological function and alveolar fibrosis in this model of lung injury.

</sec>

DOI： 10.1186/s12890-021-01712-2

Other Link： https://link.springer.com/article/10.1186/s12890-021-01712-2/fulltext.html

Association between emergency medical service transport time and survival in patients with traumatic cardiac arrest: a Nationwide retrospective observational study

Hiromichi Naito, Tetsuya Yumoto, Takashi Yorifuji, Tsuyoshi Nojima, Hirotsugu Yamamoto, Taihei Yamada, Kohei Tsukahara, Mototaka Inaba, Takeshi Nishimura, Takenori Uehara, Atsunori Nakao

BMC Emergency Medicine 21 ( 1 ) 2021.12

Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

<title>Abstract</title><sec>
<title>Background</title>
Patients with traumatic cardiac arrest (TCA) are known to have poor prognoses. In 2003, the joint committee of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma proposed stopping unsuccessful cardiopulmonary resuscitation (CPR) sustained for > 15 min after TCA. However, in 2013, a specific time-limit for terminating resuscitation was dropped, due to the lack of conclusive studies or data. We aimed to define the association between emergency medical services transport time and survival to demonstrate the survival curve of TCA.

</sec><sec>
<title>Methods</title>
A retrospective review of the Japan Trauma Data Bank. Inclusion criteria were age ≥ 16, at least one trauma with Abbreviated Injury Scale score (AIS) ≥ 3, and CPR performed in a prehospital setting. Exclusion criteria were burn injury, AIS score of 6 in any region, and missing data. Estimated survival rate and risk ratio for survival were analyzed according to transport time for all patients. Analysis was also performed separately on patients with sustained TCA at arrival.

</sec><sec>
<title>Results</title>
Of 292,027 patients in the database, 5336 were included in the study with 4141 sustained TCA. Their median age was 53 years (interquartile range (IQR) 36–70), and 67.2% were male. Their median Injury Severity Score was 29 (IQR 22–41), and median transport time was 11 min (IQR 6–17). Overall survival after TCA was 4.5%; however, survival of patients with sustained TCA at arrival was only 1.2%. The estimated survival rate and risk ratio for sustained TCA rapidly decreased after 15 min of transport time, with estimated survival falling below 1%.

</sec><sec>
<title>Conclusion</title>
The chances of survival for sustained TCA declined rapidly while the patient is transported with CPR support. Time should be one reasonable factor for considering termination of resuscitation in patients with sustained TCA, although clinical signs of life, and type and severity of trauma should be taken into account clinically.

</sec>

DOI： 10.1186/s12873-021-00499-z

Other Link： https://link.springer.com/article/10.1186/s12873-021-00499-z/fulltext.html

The diagnosis of delayed expanding traumatic pseudoaneurysm of thoracic aorta caused by self-inflicted penetrating injury with crossbow bolt: A case report

Shunsuke Nakamura, Taihei Yamada, Hiromichi Naito, Naoya Sakoda, Atsunori Nakao

International Journal of Surgery Case Reports 88 106474 - 106474 2021.11

水素吸入は高齢者敗血症の予後を改善させるか? 老齢・LPSモデルマウスを用いた検証

青景聡之, 池谷真澄, 藤崎宣友, 大澤郁朗, 内藤宏道, 中尾篤典

日本救急医学会雑誌 32 ( 12 ) 1738 - 1738 2021.11

蘇生実習における性差教育が与えるインパクト

谷田貴, 折田沙穂, 塚原紘平, 中村俊介, 久保卓也, 小崎吉訓, 野島剛, 内藤宏道, 中尾篤典

日本救急医学会雑誌 32 ( 12 ) 2703 - 2703 2021.11

A Rare Case of Pelvic Abscess Due to Spontaneous Non-traumatic Bladder Rupture

Kyosuke Inoguchi, Takashi Hongo, Hiromichi Naito, Atsunori Nakao

Cureus 2021.10

Short or Irregular Sleep Duration in Early Childhood Increases Risk of Injury for Primary School-Age Children: A Nationwide Longitudinal Birth Cohort in Japan. International journal

Takafumi Obara, Hiromichi Naito, Kohei Tsukahara, Naomi Matsumoto, Hirotsugu Yamamoto, Takashi Yorifuji, Atsunori Nakao

International journal of environmental research and public health 18 ( 18 ) 2021.9

Language：English Publishing type：Research paper (scientific journal)

The aim of this study was to investigate the longitudinal relationship between shorter or irregular sleep duration (SD) in early childhood and increased risk of injury at primary school age using data from a nationwide survey in Japan. We categorized SD into seven groups: 6 h, 7 h, 8 h, 9 hrs, 10 or 11 h, >12 h, and irregular, based on questionnaire responses collected at 5.5 years old. The relationship between SD and incidence of injury at 5.5-nine years of age is shown. In addition, we completed a stratified analysis on children with or without problematic behavior at eight years old. We included 32,044 children, of which 6369 were classified as having an injury and 25,675 as not having an injury. Logistic regression model showed that shorter or irregular SD categories were associated with an increased adjusted odds ratio (aOR) for injuries (6 h: aOR 1.40, 95% confidence interval (CI) 1.19-1.66, 7 h: aOR 1.10, 95% CI, 0.98-1.23, 8 h: aOR 1.13, 95% CI, 1.02-1.26, irregular: aOR 1.26, 95% CI 1.10-1.43). The same tendency was observed with shorter or irregular SD in subgroups with or without behavioral problems. Shorter or irregular sleep habits during early childhood are associated with injury during primary school age.

DOI： 10.3390/ijerph18189512

Emergency Dispatches for Suicide Attempts During the COVID-19 Outbreak in Okayama, Japan: A Descriptive Epidemiological Study.

Hiroshi Habu, Soshi Takao, Ryohei Fujimoto, Hiromichi Naito, Atsunori Nakao, Takashi Yorifuji

Journal of epidemiology 31 ( 9 ) 511 - 517 2021.9

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Hardships associated with the ongoing coronavirus disease 2019 (COVID-19) pandemic can affect mental health, potentially leading to increased risk of suicide. We examined the relationship between the COVID-19 outbreak and suicide attempts in Okayama, Japan using information from emergency dispatches. METHODS: This was a descriptive epidemiological study. We collected information on emergency dispatches in Okayama City and Kibichuo from March to August in 2018, 2019, and 2020 (n = 47,770 cases). We compared emergency dispatches and their demographic characteristics, especially focusing on suicide attempts, during these 3 years. RESULTS: The number of emergency dispatches in 2020 decreased compared with the previous 2 years, while the number and proportion of emergency dispatches related to suicide attempts increased. This increase was more pronounced among women and those aged 25-49 years. Among women aged 25-49 years, there was a cumulative total of 43 suicide attempts in 2018 and 2019 and 73 suicide attempts in 2020. CONCLUSIONS: The number and proportion of emergency dispatches related to suicide attempts increased in 2020 compared with the previous 2 years, especially among women and those aged 25-49 years. This increase may be partly explained by hardships, such as economic losses or reduced social ties, during the COVID-19 outbreak.

DOI： 10.2188/jea.JE20210066

Hydrogen inhalation protects against acute lung injury induced by hemorrhagic shock and resuscitation

Kohama K, Yamashita H, Aoyama-Ishikawa M, Takahashi T, Billiar TR, Nishimura T, Kotani J, Nakao A*

Surgery 2021.8

Superior myocardial preservation with HTK solution over Celsior in rat hearts with prolonged cold ischemia

Lee S, Huang CS, Kawamura T, Higemura N, Stolz DB, Billiar TR, Luketich JD, Nakao A, Toyoda Y.

Surgery 2021.8

Right Hemiplegia Following Acute Carbon Monoxide Poisoning

Kenji Aoshima, Hidenaru Yamaoka, Shunsuke Nakamura, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao

Cureus 2021.7

Venous thromboembolism in major trauma patients: a single-center retrospective cohort study of the epidemiology and utility of D-dimer for screening. Reviewed

Yumoto T, Naito H, Yamakawa Y, Iida A, Tsukahara K, Nakao A.

Acute Med Surg 19 ( 4(4) ) 394 - 400 2021.6

Carbon monoxide poisoning during pregnancy treated with hyperbaric oxygen. International journal

Yoshinori Kosaki, Hiroki Maeyama, Tsuyoshi Nojima, Takafumi Obara, Atsunori Nakao, Hiromichi Naito

Clinical case reports 9 ( 5 ) e04138 2021.5

早期血管内治療を必要とした鋭的外傷による大動脈瘤の一例

中村俊介, 山田太平, 野島剛, 小崎吉訓, 内藤宏道, 中尾篤典

日本外傷学会雑誌 35 ( 2 ) 156 - 156 2021.5

日本外傷データバンクを用いた研究最前線救急救命士の現場活動関与は外傷患者の転帰を改善するか

西村健, 野島剛, 湯元哲也, 内藤宏道, 中尾篤典, 石原諭, 中山伸一

日本外傷学会雑誌 35 ( 2 ) 131 - 131 2021.5

Characteristics of self-inflicted injury among suicidal patients: analysis of nation-wide trauma registry

Takeshi Nishimura, Hiromichi Naito, Atsunori Nakao, Shinichi Nakayama

Trauma Surgery & Acute Care Open 6 ( 1 ) e000694 - e000694 2021.4

Publishing type：Research paper (scientific journal) Publisher：BMJ

<sec><title>Purpose</title>Self-inflicted injury is one of the most common causes of suicide. Extremity injury is thought to occur most frequently among penetrating injury; however, epidemiology among patients attempting suicide is unknown. This study aims to find the characteristics of penetrating self-inflicted trauma patients.

</sec><sec><title>Methods</title>This is a retrospective cohort study of Japanese nation-wide trauma registry (the Japan National Trauma Data Bank) between January 1, 2004 and December 31, 2017. Patients who attempted suicide with penetrating injury were eligible. We evaluated the occurrence of injury based on injury site (neck/face, chest, abdomen, extremity) as a dependent variable and aging as an independent variable using a generalized linear model and compare those groups with spline models.

</sec><sec><title>Results</title>4576 trauma patients were eligible. Excluding patients with missing age, missing survival data, and missing abbreviate injury score, 4183 patients were enrolled in this study. Common injury site is follows: abdomen 1772 patients (42.4%), extremity 1344 patients (32.0%), neck/face 1253 patients (30.0%), and chest 993 patients (23.7%). The occurrence of neck/face injury, chest injury, and abdominal injury increased with age. On contrary, the rate of extremity injury decreased with age.

</sec><sec><title>Conclusions</title>Among self-inflicted trauma patients, abdominal injury was the most common injury, and neck/face injury, chest injury, and abdominal injury were related with aging. On the contrary, the rate of extremity injury decreased as patients’ age progressed.

</sec><sec><title>Level of evidence</title>Retrospective cohort study, Level III.

</sec>

DOI： 10.1136/tsaco-2021-000694

Supplementation of parenteral nutrition with fish oil attenuates acute lung injury in a rat model

Kohama K, Nakao A, Terashima M, Aoyama-Ishikawa M, Shimizu T, Harada D, Nakayama M, Yamashita H, Fujiwara M, Kotani J

J Clin Biochem Nutr 2021.3

The trend of treatment and conveyance system for upper extremity replantation in Japan: A nationwide population-based study from the Japan trauma data bank.

Taichi Saito, Satoshi Nezu, Minami Matsuhashi, Ryuichi Nakahara, Yasunori Shimamura, Tomoyuki Noda, Tetsuya Yumoto, Atsunori Nakao, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 26 ( 2 ) 271 - 275 2021.3

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: In Japan, microsurgical skill development and a system to transfer patients to an appropriate hospital for upper extremity amputation have been promoted; however, information about trends of replantation is limited. Therefore, the aim of this study was to clarify the trends in the treatment for upper extremity amputation using the Japan Trauma Data Bank (JTDB). METHODS: Data derived from JTDB (2004-2015) were used to quantify trends in the volume of replantation for upper extremity amputation including finger amputation. Trauma was diagnosed based on the Abbreviated Injury Scale code; a subgroup of patients who underwent replantation was delineated. We investigated patient demographics, infection rate, and characteristics of treating facilities. RESULTS: A total of 1240 patients underwent upper extremity amputation. Among these, 510 (41.1%) underwent replantation, and the rate of replantation did not change over the study period. The average age of patients who underwent or did not undergo replantation was 45.5 and 47.2 years, respectively. The proportion of the patients who were transferred to another hospital for treatment significantly decreased between 2004 (28.5%) and 2015 (16.3%) (P < 0.01). Time taken for transfer from the accident site to hospitals increased. The rate of patients who underwent replantation differed among different hospitals; however, higher-volume hospitals were more likely to perform replantation. CONCLUSION: The rate of patients transferred to another hospital decreased between 2004 and 2015; however, the rate of patients who underwent replantation remained unchanged. This suggests that the number of patients who were transported directly from the accident site to an appropriate hospital has increased, whereas the indication for care in each hospital remains unchanged. Common criteria for amputations are needed to address the differing rates of replantation among hospitals.

DOI： 10.1016/j.jos.2020.03.006

災害教育とインストラクショナルデザイン〜課題解決型人材育成災害対応する薬剤師に求められる要素とその教育方法

渡邉暁洋, 中尾博之, 山田太平, 中尾篤典

Japanese Journal of Disaster Medicine 25 ( 3 ) 136 - 136 2021.3

災害教育とインストラクショナルデザイン～課題解決型人材育成災害対応する薬剤師に求められる要素とその教育方法

渡邉暁洋, 中尾博之, 山田太平, 中尾篤典

Japanese Journal of Disaster Medicine 25 ( 3 ) 136 - 136 2021.3

マムシ抗毒素投与が奏功した血小板減少型マムシ咬傷の1例

岡本彩, 向笠廣太, 小原隆史, 野島剛, 中尾篤典, 鬼塚拡平, 浦部尚吾, 井上智博, 古賀仁士, 山下寿

佐賀救急医学会雑誌 7 ( 1 ) 11 - 14 2021.3

Language：Japanese Publisher：佐賀救急医学会

74歳男性。農作業中に右示指をマムシに咬まれ意識消失し、受傷30分後に当院へ搬送となった。所見では意識清明で、右示指に滲出性出血を伴う創があった。出血持続、全身紫斑、血小板減少を認めたことから、マムシ毒による血小板減少と診断され、受傷5時間後にマムシ抗毒素を投与した。その結果、血小板数や症状は速やかに改善し、第15病日に退院となった。

A successfully treated case of penetrating facial trauma. Reviewed

Yumoto T, Iida A, Tsukahara K, Naito H, Terado M, Sato K, Date I, Nakao A.

Int J Case Rep Images 8 ( 2 ) 120 - 123 2021.2

Reply to comment on “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, Atsunori Nakao

Surgery Today 51 ( 2 ) 329 - 330 2021.2

Refractory gastric ulcer due to undisclosed use of topical diclofenac epolamine patches

Yuta Oda, Hiromichi Naito, Tsuyoshi Nojima, Atsunori Nakao

Acute Medicine & Surgery 8 ( 1 ) 2021.1

State‐of‐the‐art methods for the treatment of severe hemorrhagic trauma: selective aortic arch perfusion and emergency preservation and resuscitation—what is next?

Atsuyoshi Iida, Hiromichi Naito, Tsuyoshi Nojima, Tetsuya Yumoto, Taihei Yamada, Noritomo Fujisaki, Atsunori Nakao, Takeshi Mikane

Acute Medicine & Surgery 8 ( 1 ) 2021.1

Cardiac arrest due to liquid nicotine intoxication: a case report

Atsuyoshi Iida, Yuki Fujiwara, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao, Takeshi Mikane

Acute Medicine & Surgery 8 ( 1 ) 2021.1

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 44回 53 - 53 2021.1

Prevalence and predictors of direct discharge home following hospitalization of patients with serious adverse events managed by the rapid response system in Japan: a multicenter, retrospective, observational study. International journal

Takashi Hongo, Hiromichi Naito, Toshifumi Fujiwara, Takaki Naito, Yosuke Homma, Yoshihisa Fujimoto, Morooka Takaya, Yuji Yamamori, Taka-Aki Nakada, Tsuyoshi Nojima, Atsunori Nakao, Shigeki Fujitani

Acute medicine & surgery 8 ( 1 ) e690 2021

Language：English Publishing type：Research paper (scientific journal)

AIM: The rapid response system (RRS) is an in-hospital medical safety system. To date, not much is known about patient disposition after RRS activation, especially discharge home. This study aimed to investigate the prevalence, characteristics, and outcomes of patients with adverse events who required RRS activation. METHODS: Retrospective data from the In-Hospital Emergency Registry in Japan collected from April 2016 to November 2020 were eligible for our analysis. We divided patients into Home Discharge, Transfer, and Death groups. The primary outcome was the prevalence of direct discharge home, and independently associated factors were determined using multivariable logistic regression. RESULTS: We enrolled 2,043 patients who met the inclusion criteria. The prevalence of discharge home was 45.7%; 934 patients were included in the Home Discharge group. Age (adjusted odds ratio [AOR] 0.96; 95% confidence interval [CI], 0.95-0.97), malignancy (AOR 0.69; 95% CI, 0.48-0.99), oxygen administration before RRS (AOR 0.49; 95% CI, 0.36-0.66), cerebral performance category score on admission (AOR 0.38; 95% CI, 0.26-0.56), do not attempt resuscitation order before RRS (AOR 0.17; 95% CI, 0.10-0.29), RRS call for respiratory failure (AOR 0.50; 95% CI, 0.34-0.72), RRS call for stroke (AOR 0.12; 95% CI, 0.03-0.37), and intubation (AOR 0.20; 95% CI, 0.12-0.34) were independently negative, and RRS call for anaphylaxis (AOR 15.3; 95% CI, 2.72-86.3) was positively associated with discharge home. CONCLUSION: Less than half of the in-hospital patients under RRS activation could discharge home. Patients' conditions before RRS activation, disorders requiring RRS activation, and intubation were factors that affected direct discharge home.

DOI： 10.1002/ams2.690

Plastic Bronchitis in a Five-Year-Old Boy Treated Using Extracorporeal Membrane Oxygenation; a Case Report. International journal

Tsuyoshi Nojima, Hiromichi Naito, Takafumi Obara, Kohei Tsukahara, Atsunori Nakao

Archives of academic emergency medicine 9 ( 1 ) e16 2021

Language：English

Plastic bronchitis is an uncommon disorder marked by the production of bronchial casts and acute respiratory failure development. In pediatric cases, influenza infection sometimes results in the obstruction of bronchi and leads to this potentially life-threatening condition. We report the case of a five-year-old boy with plastic bronchitis related to influenza A infection, which could only be recovered by the use of extracorporeal membrane oxygenation (ECMO). ECMO could effectively provide sufficient oxygenation for patients suffering from severe reversible acute respiratory failure. If patients infected with the influenza virus present acute respiratory distress with total lung atelectasis, clinicians should consider the diagnosis of plastic bronchitis and the subsequent treatment interventions with ECMO in a severe cases.

Unrecognized Orbital Images Cause Diagnostic Confusion: Silicone Oil and Implanted Silicone Encircling Bands. International journal

Tsuyoshi Nojima, Takafumi Obara, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

Case reports in emergency medicine 2021 9940395 - 9940395 2021

Language：English

Introduction: Most physicians are not familiar with postoperative changes to the orbit, so radiologists and clinicians may sometimes find it challenging to conduct a proper radiological assessment of the globe of the eye and orbital abnormalities. We present a patient with head trauma who had surgery for retinal detachment with implantation of silicone encircling bands. This case report may help clinicians recognize imaging characteristics after ophthalmic surgery to prevent misdiagnosis and unnecessary workup. Case Report. An 18-year-old man with severe head trauma was admitted to our hospital. Initial computed tomography (CT) revealed a high attenuation of intraocular silicone that could be mistaken for a hemorrhage. Ophthalmological examination and detailed ophthalmic history confirmed silicone oil in his eye for treatment of retinal detachment. Knowledge of the anatomical changes and radiological appearance of postsurgical findings following retinal detachment, including the surgical materials of silicone oil or bands, can prevent unnecessary alarm. Conclusion: Implanted ophthalmic devices, for example, silicone oil, appear similar to hemorrhages on CT and magnetic resonance imaging and cause diagnostic confusion. When in doubt, it is useful to assess the clinical presentation and obtain an accurate medical history.

DOI： 10.1155/2021/9940395

Urinary Retention as the Presenting Clinical Manifestation of Unstable Thoracic Spinal Fracture with Diffuse Idiopathic Skeletal Hyperostosis. International journal

Hisashi Hamaguchi, Tetsuya Yumoto, Soichiro Mae, Ayumu Takeshita, Minae Aoyama, Keiya Yamana, Atsunori Nakao

Clinical medicine insights. Case reports 14 11795476211027988 - 11795476211027988 2021

Language：English

Patients with diffuse idiopathic skeletal hyperostosis (DISH) are at high risk for unstable vertebral fracture, which can be frequently missed. An 80-year-old man with pre-existing muscle lower limb weakness due to frailty was referred from another hospital, presenting with progressive urinary retention and its related symptoms, which had been treated as a urinary tract infection at previous hospital. One week prior to our visit, he had fallen. On arrival, he appeared lethargic and unable to follow commands. He denied any back pain. Computed tomography identified a T10 fracture and dislocation associated with DISH. Although immediate surgical fixation was performed, the patient did not recover from the neurological deficits. Diagnostic delay of DISH-associated vertebral fracture can occur due to both patients' and clinicians' delayed action. We believe this case report can help clinicians recognize this potentially devastating condition.

DOI： 10.1177/11795476211027988

Incidence and characteristics of medical emergencies related to dental treatment: a retrospective single-center study. International journal

Kyoichi Obata, Hiromichi Naito, Hiromasa Yakushiji, Takafumi Obara, Kisho Ono, Tsuyoshi Nojima, Kohei Tsukahara, Taihei Yamada, Akira Sasaki, Atsunori Nakao

Acute medicine & surgery 8 ( 1 ) e651 2021

Language：English Publishing type：Research paper (scientific journal)

AIM: Although uncommon, medical emergencies arise in general dental practice. Inadequate data on their severity and frequency makes targeting medical education for general dental practitioners difficult. This also makes planning for unexpected events challenging for practitioners and makes collaborating with emergency physicians burdensome. We aimed to clarify the incidence and characteristics of a dental outpatient department's medical emergencies. METHODS: This single-center, retrospective, observational study was undertaken with patients who visited the dental outpatient department of Okayama University Hospital during the 8-year period. The primary outcome of the study was to identify the incidence and characteristics of medical emergencies in the dental outpatient department. Then we examined the timing of medical emergencies, administered medications, and final disposition (home/admission). RESULTS: During the period, 1,146,929 patients were enrolled. Forty-two patients (0.0037%) were consulted as medical emergencies. More than 60% of the incidents were vasovagal syncope, and dehydration and hypoglycemia were the second most prevalent at 9.5%. The most common types of dental treatments were tooth extraction (45.2%), followed by general dental treatment (28.6%), and other dental surgery such as implant placement (14.3%). Types of medical emergencies occurred equally before, during, and after dental treatment. Antihypertensive agents, sedatives, or glucose were used. For patients with emergencies, 90.5% recovered during the day and returned home, and 9.5% were hospitalized. CONCLUSION: The incidence of medical emergencies was low in our dental outpatient department. Knowledge of basic management principles, regular education for emergency care, and practicing first aid skills are mandatory for safe patient management.

DOI： 10.1002/ams2.651

Oral Ethanol Treatment for Ethylene Glycol Intoxication. International journal

Misa Sasanami, Taihei Yamada, Takafumi Obara, Atsunori Nakao, Hiromichi Naito

Cureus 12 ( 12 ) e12268 2020.12

Language：English

Ethylene glycol is an odorless, sweet-tasting liquid found in industrial solutions such as antifreeze and windshield wiper fluid. Brake fluid, an automobile transmission liquid, contains poisonous alcohols such as glycol ethers and ethylene glycols. The toxicity of ethylene glycol is associated with toxic metabolite production by the liver enzyme alcohol dehydrogenase. Administration of either intravenous ethanol or fomepizole, both of which competitively inhibit ethylene glycol metabolism by alcohol dehydrogenase and can prevent the production and accumulation of the toxic metabolites, can be used as an antidote. A 42-year-old male car mechanic was transferred to our hospital after accidentally ingesting approximately 100 mL of brake fluid. Immediately after ingestion, he threw up most of the ingested liquid; however, he complained of nausea and throat pain and was moved to our emergency department. The patient was successfully treated with administration of oral ethanol in the form of whisky through a nasogastric tube since neither intravenous ethanol nor fomepizole was available in our hospital at the time of his presentation. Our case demonstrates that oral ethanol can be used as an alternative treatment for patients with ethylene glycol intoxication.

DOI： 10.7759/cureus.12268

Potentially fatal ingestion of heat-not-burn cigarettes successfully treated by gastric lavage. Reviewed International journal

Tetsuya Yumoto, Hisashi Hamaguchi, Souichiro Mae, Atsunori Nakao

Journal of the American College of Emergency Physicians open 1 ( 6 ) 1709 - 1711 2020.12

Language：English

Newly introduced heat-not-burn or electronic cigarettes can cause lethal nicotine intoxication if ingested at higher doses. Although routine gastric lavage is not recommended, it should be considered if the amount of intoxicant is lethal. A 59-year-old man with a history of depression was brought to our emergency department after intentional ingestion of 8 heat-not-burn cigarettes, which were estimated to contain a total of 100 mg of nicotine. Abdominal computed tomography confirmed the gastric contents, detecting multiple stick-like and rod-shaped high-density structures. Gastric lavage was performed to minimize absorption of the potentially lethal nicotine dose. The patient exhibited only mild gastrointestinal symptoms. Emergency physicians should be aware of this novel heat-not-burn cigarette and its toxicity.

DOI： 10.1002/emp2.12283

Delay in Emergency Medical Service Transportation Responsiveness during the COVID-19 Pandemic in a Minimally Affected Region. Reviewed

Kohei Ageta, Hiromichi Naito, Takashi Yorifuji, Takafumi Obara, Tsuyoshi Nojima, Taihei Yamada, Kohei Tsukahara, Hiromasa Yakushiji, Atsunori Nakao

Acta medica Okayama 74 ( 6 ) 513 - 520 2020.12

Language：English Publishing type：Research paper (scientific journal)

Few studies have investigated the influence of the Coronavirus Disease 2019 (COVID-19) pandemic on emer-gency medical service (EMS) systems, especially in areas less affected or unaffected by COVID-19. In this study, we investigated changes in prehospital EMS activity and transport times during the COVID-19 pandemic. All patients transported by EMS in the city of Okayama from March-May 2019 or March-May 2020 were included. Interfacility transports were excluded. The primary outcome was the time from a patient's first emergency call until hospital arrival (total prehospital time). Secondary outcomes included three segments of total prehospital time: the response time, on-scene time, and transportation time. Total prehospital time and the durations of each segment were compared between corresponding months in 2020 (COVID19-affected) and 2019 (control). The results showed that total prehospital times in April 2020 were significantly higher than those in 2019 (33.8 ± 11.6 vs. 32.2 ± 10.8 min, p < 0.001). Increases in total prehospital time were caused by longer response time (9.3 ± 3.8 vs. 8.7 ± 3.7 min, p < 0.001) and on-scene time (14.4 ± 7.9 vs. 13.5 ± 6.2min, p < 0.001). The COVID-19 pandemic was thus shown to affect EMS and delayed arrival/response even in a minimally affected region. A system to minimize transportation delays should be developed for emerging pandemics.

DOI： 10.18926/AMO/61210

Feasibility study of a portable transparent vinyl chloride shield for use in an ambulance during the COVID-19 pandemic. Reviewed International journal

Kohei Tsukahara, Hiromichi Naito, Tsuyoshi Nojima, Takashi Yorifuji, Atsunori Nakao

Critical care (London, England) 24 ( 1 ) 651 - 651 2020.11

Burning Mouth Syndrome Induced by Angiotensin-Converting Enzyme Inhibitors. International journal

Takafumi Obara, Hiromichi Naito, Tsuyoshi Nojima, Hitoshi Koga, Atsunori Nakao

Cureus 12 ( 11 ) e11376 2020.11

Language：English

Burning mouth syndrome (BMS) is characterized as the sensation of burning in the tongue or any other area of the oral mucosa without a medical or dental cause. BMS's pathophysiology is poorly understood and may be caused by its association with various factors, particularly with antihypertensive or psychotropic medicines. Although BMS is a relatively common intraoral disorder in the dental field, emergency physicians rarely recognize it. We report a 53-year-old Japanese woman who presented to our ED with a three-week history of a strange taste and burning tongue. The patient had poor control of hypertension, captopril, an angiotensin-converting enzyme (ACE) inhibitor, was added three weeks before presentation. We discontinued her ACE inhibitor and changed her medication to a beta-blocker. After two weeks, her symptoms improved. Emergency physicians must be aware that ACE inhibitors play some roles in the pathogenesis of BMS. The correct diagnosis of the condition depends on recognizing the disease and improving the quality of life.

DOI： 10.7759/cureus.11376

敗血症治療後嚥下障害の発症頻度とリスク因子(Frequency and Risk Factors of Dysphagia Following Sepsis Treatment)

本郷貴識, 内藤宏道, 藤原俊文, 野崎哲, 中尾篤典

日本救急医学会雑誌 31 ( 11 ) 2261 - 2261 2020.11

食事に関する詳細な問診を必要とした壊血病の一例

小出恭大, 山田太平, 小崎吉訓, 野島剛, 塚原紘平, 藤崎宣友, 尾迫貴章, 内藤宏道, 城端慧, 高岡諒, 中尾篤典

日本救急医学会雑誌 31 ( 11 ) 2105 - 2105 2020.11

当院における産科救急の現状

藤崎宣友, 山本浩継, 野島剛, 小崎吉訓, 青景聡之, 塚原紘平, 山田太平, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 31 ( 11 ) 1921 - 1921 2020.11

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 2020.11

COVID-19影響下における救急・集中治療関連医療従事者の心理的健康度

久保卓也, 小崎吉訓, 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

日本救急医学会雑誌 31 ( 11 ) 1035 - 1035 2020.11

Luminal preloading with hydrogen-rich saline ameliorates ischemia-reperfusion injury following intestinal transplantation in rats. Reviewed International journal

Hirotsugu Yamamoto, Toshiyuki Aokage, Takuro Igawa, Takahiro Hirayama, Mizuki Seya, Michiko Ishikawa-Aoyama, Tsuyoshi Nojima, Atsunori Nakao, Hiromichi Naito

Pediatric transplantation 24 ( 7 ) e13848 2020.11

Language：English Publishing type：Research paper (scientific journal)

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

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 2020.11

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 2020.11

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 2020.11

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 2020.11

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

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 2020.10

Language：English Publishing type：Research paper (scientific journal) Publisher：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

Intubation during a medevac flight: safety and effect on total prehospital time in the helicopter emergency medical service system. Reviewed International journal

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 2020.9

Language：English Publishing type：Research paper (scientific journal)

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

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 2020.9

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 2020.9

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 2020.9

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 2020.9

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 2020.9

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 2020.9

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

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 2020.9

Language：English Publishing type：Research paper (scientific journal)

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

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

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

Acta medica Okayama 74 ( 4 ) 285 - 291 2020.8

Language：English Publishing type：Research paper (scientific journal)

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

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 2020.8

Language：English Publishing type：Research paper (scientific journal)

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

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 2020.7

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 2020.2

Therapeutic strategies for ischemia reperfusion injury in emergency medicine Reviewed

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 ) 2020.1

Pediatric airway compromise due to thyroid storm associated with influenza A infection: A case report

Taiki Higaki, Kohei Tsukahara, Takafumi Obara, Tsuyoshi Nojima, Hirotsugu Yamamoto, Takaaki Osako, Hiromichi Naito, Atsunori Nakao

Respiratory Medicine Case Reports 31 101182 - 101182 2020

Three-year-old traumatic liver injury patient treated successfully using transcatheter arterial embolization

Atsuyoshi Iida, Tsuyoshi Ryuko, Masaichi Kemmotsu, Hiroaki Ishii, Hiromichi Naito, Atsunori Nakao

International Journal of Surgery Case Reports 70 205 - 208 2020

A family intoxicated by daffodil bulbs mistaken for onions. International journal

Kohei Ageta, Hiromasa Yakushiji, Yoshinori Kosaki, Takafumi Obara, Tsuyoshi Nojima, Akira Gochi, Hiromichi Naito, Atsunori Nakao

Acute medicine & surgery 7 ( 1 ) e595 2020

Retropharyngeal hematoma presenting airway obstruction: A case report. Reviewed International journal

Atsuyoshi Iida, Ayumi Nishida, Seiji Yoshitomi, Tsuyoshi Nojima, Hiromichi Naito, Atsunori Nakao

International journal of surgery case reports 77 321 - 324 2020

Language：English

INTRODUCTION: Blunt neck trauma patients can suffer from an airway emergency and are necessary to careful observation. PRESENTATION OF CASE: A 79-year-old man under anticoagulation therapy presented to our hospital three hours after a fall. Shortly after arrival, he developed dyspnea. Oral intubation was attempted, but with no success; therefore, an emergency tracheotomy was performed. Contrast-enhanced computed tomography (CT) and subsequent angiography revealed active bleeding from a branch of the right ascending cervical artery. Subsequently, the right thyrocervical trunk, which is upstream from the ascending cervical artery, was embolized and hemostasis was achieved. He was discharged 52 days after the emergency admission. DISCUSSION: This is the first case report of an ascending cervical artery injury due to blunt trauma that resulted in an airway emergency. Contrast-enhanced CT and cervical angiography are useful for confirming the area of injury and size of the hematoma. Half of patients with respiratory distress accompanied by a cervical spine injury require definitive airway management within five hours of the injury and all by 24 h. Neck trauma can lead to fatal airway obstruction and careful monitoring is warranted to detect any signs of impeding respiratory obstruction. CONCLUSION: All emergency physicians need to keep their airway management skills updated in order to perform reliably and rapidly in difficult and urgent situations.

DOI： 10.1016/j.ijscr.2020.11.007

COVID-19 pandemic and shortage of personal protective equipment in Tokyo clinics. International journal

Mototaka Inaba, Hiromichi Naito, Taizo Sakata, Atsunori Nakao

Acute medicine & surgery 7 ( 1 ) e527 2020

Incidence and related factors of hypoxia associated with elderly femoral neck fractures in the emergency department setting. International journal

Takashi Hongo, Hiromichi Naito, Toshifumi Fujiwara, Mototaka Inaba, Noritomo Fujisaki, Atsunori Nakao

Acute medicine & surgery 7 ( 1 ) e618 2020

Language：English Publishing type：Research paper (scientific journal)

AIM: Femoral neck fractures in elderly patients needing oxygen therapy are often encountered in the emergency department. This single-center, retrospective, observational study aimed to examine the frequency, cause, and factors related to hypoxia in elderly patients with femoral neck fractures. METHODS: We analyzed data from 241 patients admitted to Okayama Saiseikai General Hospital (Okayama, Japan) from April 2016 to March 2019. Hypoxia was defined as PaO2 / FiO2 ratio under 300. The independent factors for hypoxia were determined by multiple logistic regression analysis. RESULTS: There were 194 patients who met the study inclusion criteria, 148 in the non-hypoxia group and 46 in the hypoxia group. The hypoxia group included patients with pneumonia (n = 3), chronic obstructive pulmonary disease (n = 2), pulmonary edema (n = 1), and pulmonary embolization (n = 1). The cause of hypoxia was undetermined in 39 cases. However, occult fat embolism syndrome was suspected in 29 of these 39 cases based on Gurd and Wilson criteria after considering clinical examination results. Barthel indexes were significantly lower in the hypoxia group on discharge. Age (adjusted odds ratio [OR] 1.07; 95% confidence interval [CI], 1.00-1.14; P = 0.038), D-dimer (adjusted OR 1.02; 95% CI, 1.00-1.03; P = 0.005), and transtricuspid pressure gradient (adjusted OR 1.03; 95% CI, 1.00-1.07; P = 0.015) were independently associated with the hypoxia. CONCLUSION: We found that hypoxia, including undetermined hypoxia, was commonly encountered in the emergency department. Hypoxia in elderly patients with femoral neck fractures was associated with age, D-dimer, and transtricuspid pressure gradient and needs further investigation.

DOI： 10.1002/ams2.618

Transient Global Amnesia in a Patient Presenting with Hypertensive Emergency; a Case Report. International journal

Takafumi Obara, Tsuyosi Nojima, Hitoshi Koga, Atsunori Nakao, Hiromichi Naito

Archives of academic emergency medicine 8 ( 1 ) e66 2020

Language：English

Transient global amnesia (TGA) is characterized by the abrupt onset of global amnesia, particularly anterograde amnesia. The pathophysiology of TGA is poorly understood and it could be caused by various factors and be associated with various diseases. We report a 58-year-old man who presented to the local emergency room with TGA lasting for several hours. The patient had complete anterograde amnesia without a past medical history of migraine or neurological findings. His systolic blood pressure on presentation was 220 mmHg, which was immediately treated with intravenous calcium ion influx inhibitor. Other than global amnesia, there was no evidence of neurological disturbance. Computed tomography and magnetic resonance imaging results were unremarkable. After treatment of his hypertension, his amnesia resolved within 12 hours. Emergency department physicians may encounter TGA. Correct diagnosis of the condition depends on recognizing the disease.

Huge abdominal cerebrospinal fluid pseudocyst following ventriculoperitoneal shunt: a case report. International journal

Yasuhiro Koide, Takaaki Osako, Masahiro Kameda, Hiromi Ihoriya, Hirotsugu Yamamoto, Noritomo Fujisaki, Toshiyuki Aokage, Tetsuya Yumoto, Isao Date, Hiromichi Naito, Atsunori Nakao

Journal of medical case reports 13 ( 1 ) 361 - 361 2019.12

Language：English

INTRODUCTION: Abdominal pseudocysts comprising cerebrospinal fluid are an uncommon but significant complication in patients with ventriculoperitoneal shunt. We present a successfully treated 12-year-old boy with a history of ventriculoperitoneal shunting and a huge abdominal cerebrospinal fluid pseudocyst. CASE PRESENTATION: A12-year-old Japanese boy presented with a deteriorated consciousness and a palpable and elastic large lower abdominal mass. Computed tomography of his abdomen demonstrated a collection of homogenous low-density fluid near the catheter tip of the ventriculoperitoneal shunt. Cerebral computed tomography revealed an increased ventricular size. Based on the clinical diagnosis of abdominal pseudocyst, the peritoneal shunt catheter was secured and divided into two parts by cutting it on the chest; then, the proximal side of the peritoneal shunt catheter was externalized for extraventricular drainage. The cyst was percutaneously aspirated with ultrasound guidance, and the distal side of the peritoneal shunt catheter was removed. The distal side of the peritoneal shunt catheter was reinserted in another position into his abdomen after 3-week extraventricular drainage management. CONCLUSION: Emergency physicians should know about this potential complication as an important differential diagnosis resulting from acute abdominal complaints in patients with ventriculoperitoneal shunts.

DOI： 10.1186/s13256-019-2308-0

大規模地震時医療活動訓練における医療資機材の空輸航空会社との連携と今後の課題

三木真彩菜, 三橋乙矢, 加藤湖月, 平山隆浩, 野島剛, 山田太平, 塚原紘平, 尾迫貴章, 中尾篤典

Japanese Journal of Disaster Medicine 24 ( 3 ) 338 - 338 2019.12

Higher enhanced computed tomography attenuation value of the aorta is a predictor of massive transfusion in blunt trauma patients. Reviewed International journal

Tetsuya Yumoto, Hiromi Ihoriya, Ryo Tanabe, Hiromichi Naito, Atsunori Nakao

Clinical and experimental emergency medicine 6 ( 4 ) 330 - 339 2019.12

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: Several scoring systems have been developed to identify patients who require massive transfusion (MT) after major trauma to improve survival. The primary goal of this study was to investigate the usefulness of enhanced computed tomography attenuation values (CTAVs) of major vessels to determine the need for MT in patients with major blunt trauma. METHODS: This single-center retrospective cohort study evaluated patients aged 16 years or older who underwent contrast-enhanced computed tomography scan of the torso after major blunt trauma. The CTAVs of six major vessel points in both the arterial and portal venous phases at initial computed tomography examination were assessed and compared between the MT and the no MT group. The capability of enhanced CTAVs to predict the necessity for MT was estimated based on the area under the receiver operating characteristic curve. RESULTS: Of the 254 eligible patients, 36 (14%) were in the MT group. Patients in the MT group had significantly higher CTAVs at all sites except the inferior vena cava in both the arterial and portal venous phases than that in the no MT group. The descending aorta in the arterial phase had the highest accuracy for predicting MT, with an AUROC of 0.901 (95% confidence interval, 0.855 to 0.947; P<0.001). CONCLUSION: Initial elevation of enhanced CTAV of the aorta is a predictor for the need for MT. A higher CTAV of the aorta should alert the trauma surgeon or emergency physician to activate their MT protocol.

DOI： 10.15441/ceem.18.090

岡山大学病院における多数傷病者受入れの現状と課題(続報)

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

Japanese Journal of Disaster Medicine 24 ( 3 ) 246 - 246 2019.12

災害時、都道府県庁には、いつ、だれが行く?西日本豪雨災害を経験した岡山県の取り組み

山田太平, 小崎吉訓, 塚原紘平, 内藤宏道, 高田洋介, 渡邉暁洋, 大川恭昌, 加藤湖月, 中尾篤典

Japanese Journal of Disaster Medicine 24 ( 3 ) 242 - 242 2019.12

岡山市におけるG20保健大臣会合を見据えた爆弾テロ対策訓練の報告

三橋乙矢, 大川恭昌, 小崎吉訓, 加藤湖月, 中尾篤典

Japanese Journal of Disaster Medicine 24 ( 3 ) 443 - 443 2019.12

岡山大学医学部医学科クリニカルクラークシップでの災害医学教育の取り組み

小崎吉訓, 高田洋介, 渡邊暁洋, 山田太平, 中尾篤典

Japanese Journal of Disaster Medicine 24 ( 3 ) 369 - 369 2019.12

Association of Japan Coma Scale score on hospital arrival with in-hospital mortality among trauma patients. Reviewed International journal

Tetsuya Yumoto, Hiromichi Naito, Takashi Yorifuji, Toshiyuki Aokage, Noritomo Fujisaki, Atsunori Nakao

BMC emergency medicine 19 ( 1 ) 65 - 65 2019.11

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The Japan Coma Scale (JCS) score has been widely used to assess patients' consciousness level in Japan. JCS scores are divided into four main categories: alert (0) and one-, two-, and three-digit codes based on an eye response test, each of which has three subcategories. The purpose of this study was to investigate the utility of the JCS score on hospital arrival in predicting outcomes among adult trauma patients. METHODS: Using the Japan Trauma Data Bank, we conducted a nationwide registry-based retrospective cohort study. Patients 16 years old or older directly transported from the trauma scene between January 2004 and December 2017 were included. Our primary outcome was in-hospital mortality. We examined outcome prediction accuracy based on area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis with multiple imputation. RESULTS: A total of 222,540 subjects were included; their in-hospital mortality rate was 7.1% (n = 15,860). The 10-point scale JCS and the total sum of Glasgow Coma Scale (GCS) scores demonstrated similar performance, in which the AUROC (95% CIs) showed 0.874 (0.871-0.878) and 0.878 (0.874-0.881), respectively. Multiple logistic regression analysis revealed that the higher the JCS score, the higher the predictability of in-hospital death. When we focused on the simple four-point scale JCS score, the adjusted odds ratio (95% confidence intervals [CIs]) were 2.31 (2.12-2.45), 4.81 (4.42-5.24), and 27.88 (25.74-30.20) in the groups with one-digit, two-digit, and three-digit scores, respectively, with JCS of 0 as a reference category. CONCLUSIONS: JCS score on hospital arrival after trauma would be useful for predicting in-hospital mortality, similar to the GCS score.

DOI： 10.1186/s12873-019-0282-x

VV-ECMOを駆使して他院に収容された超重症呼吸不全をECMOで救命するチーム派遣・ECMO導入・搬送まで担う高度ECMO搬送システムの構築

青景聡之, 小崎吉訓, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 30 ( 9 ) 557 - 557 2019.9

積極的な画像診断により救命した特発性腸間膜血腫の1例

山田太平, 小崎吉訓, 湯本哲也, 山本浩継, 藤崎宣友, 青景聡之, 塚原紘平, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 30 ( 9 ) 838 - 838 2019.9

開腹止血術と同時に経腹部大動脈アプローチでTEVARを行った1例

山川泰明, 小崎吉訓, 山本浩継, 藤崎宣友, 青景聡之, 塚原紘平, 山田太平, 万代康弘, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 30 ( 9 ) 826 - 826 2019.9

集中治療中に胃壁内気腫症を発症し保存的に治療しえた1例

庵谷紘美, 湯本哲也, 小崎吉訓, 山本浩継, 青景聡之, 藤崎宣友, 山田太平, 塚原紘平, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 30 ( 9 ) 777 - 777 2019.9

エチレングリコール中毒、「早期介入」が功を奏した一症例

佐々並三紗, 山田太平, 庵谷紘美, 小崎吉訓, 湯本哲也, 山本浩継, 藤崎宣友, 塚原紘平, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 30 ( 9 ) 639 - 639 2019.9

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 2019.6

Language：English Publishing type：Research paper (scientific journal)

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

Atypical case of posterior reversible encephalopathy syndrome related to late onset postpartum eclampsia: A case report. Reviewed International journal

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

Medicine 98 ( 16 ) e15187 2019.4

Language：English Publishing type：Research paper (scientific journal)

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

Hydrogen gas inhalation ameliorates lung injury after hemorrhagic shock and resuscitation. Reviewed International journal

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 2019.4

Language：English Publishing type：Research paper (scientific journal)

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

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

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 2019.4

Language：English Publishing type：Research paper (scientific journal)

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

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

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

Acute medicine & surgery 6 ( 2 ) 208 - 209 2019.4

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 2019.3

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 2019.3

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 2019.3

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 2019.3

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 2019.3

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 2019.3

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 2019.2

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 2019.2

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 2019.2

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 2019.2

「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 2019.2

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 2019.2

「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 2019.2

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 2019.1

Gastric Emphysema in a Critically Ill Patient Successfully Treated without Surgery. International journal

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

Case reports in critical care 2019 1824101 - 1824101 2019

Language：English

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

Long-stay pediatric patients in Japanese intensive care units: their significant presence and a newly developed, simple predictive score. International journal

Emily Knaup, Nobuyuki Nosaka, Takashi Yorifuji, Kohei Tsukahara, Hiromichi Naito, Hirokazu Tsukahara, Atsunori Nakao

Journal of intensive care 7 38 - 38 2019

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The length of stay (LOS) in intensive care units (ICUs) has been used as a good indicator not only for resource consumption but also for health outcomes of patients. However, data regarding pediatric LOS in Japanese ICUs are limited. The primary aim of this study was to characterize the Japanese pediatric ICU patients based on their LOS. Second, we aimed to develop a simple scoring system to predict long-stay pediatric ICU patients on admission. METHODS: We performed a retrospective cohort study using consecutive pediatric data (aged < 16 years) registered in the Japanese Registry of Pediatric Acute Care (JaRPAC) from October 2013 to September 2016, which consisted of descriptive and diagnostic information. The factors for long-stay patients (LSPs; LOS > 14 days) were identified using multiple regression analysis, and subsequently, a simple predictive scoring system was developed based on the results. The validity of the score was prospectively tested using data from the JaRPAC registration from October 2016 to September 2017. RESULTS: Overall, 4107 patients were included. Although LSPs were few (8.0% [n = 330]), they consumed 38.0% of ICU bed days (9750 for LSPs versus 25,659 overall). Mortality was seven times higher in LSPs than in short-stay patients (9.1% versus 1.3%). An 11-variable simple predictive scoring system was constructed, including Pediatric Index of Mortality 2 ≥ 1 (2 points), liver dysfunction (non-post operation) (2 points), post-cardiopulmonary resuscitation (1 point), circulatory disorder (1 point), post-operative management of liver transplantation (1 point), encephalitis/encephalopathy (1 point), myocarditis/cardiomyopathy (1 point), congenital heart disease (non-post operation) (1 point), lung tissue disease (1 point), Pediatric Cerebral Performance Category scores ≥ 2 (1 point), and age < 2 years (1 point). A score of ≥ 3 points yielded an area under the receiver operating characteristic curve (AUC) of 0.79, sensitivity of 87.0%, and specificity of 59.4% in the original dataset. Reproducibility was confirmed with the internal validation dataset (AUC 0.80, sensitivity 92.6%, and specificity 60.2%). CONCLUSIONS: Pediatric LSPs possess a significant presence in Japanese ICUs with high rates of bed utilization and mortality. The newly developed predictive scoring system may identify pediatric LSPs on admission.

DOI： 10.1186/s40560-019-0392-2

A patient presenting painful chest wall swelling: Tietze syndrome. Reviewed International journal

Kohei Sawada, Hiromi Ihoriya, Taihei Yamada, Tetsuya Yumoto, Kohei Tsukahara, Takaaki Osako, Hiromichi Naito, Atsunori Nakao

World journal of emergency medicine 10 ( 2 ) 122 - 124 2019

Orbital Emphysema as a Consequence of Forceful Nose-Blowing: Report of a Case. Reviewed International journal

Yukino Ariyoshi, Hiromichi Naito, Tetsuya Yumoto, Atsuyoshi Iida, Hirotsugu Yamamoto, Noritomo Fujisaki, Toshiyuki Aokage, Kohei Tsukahara, Taihei Yamada, Yasuhiro Mandai, Takaaki Osako, Atsunori Nakao

Case reports in emergency medicine 2019 4383086 - 4383086 2019

Language：English

Orbital emphysema occurs when air enters the soft tissue surrounding the orbit. Although orbital blowout fractures are often caused by face trauma, nontraumatic orbital fractures can also occur but have been rarely described. Here, a case of orbital and palpebral emphysema caused by forceful nose-blowing is presented. Examination uncovered gross swelling of the right eye and discernable subcutaneous emphysema. The patient had normal eye movement and visual acuity. Orbital computed tomography (CT) revealed orbital emphysema secondary to an orbit floor fracture into the maxillary sinus, resulting from high intranasal pressure upon blowing her nose. The patient received conservative management with antibiotics and was given instructions not to sneeze or blow her nose. She fully recovered and all her symptoms completely resolved.

DOI： 10.1155/2019/4383086

Caffeine Intoxication in Pregnancy; a case Report. International journal

Tsuyoshi Nojima, Hiromichi Naito, Yoshinori Kosaki, Takaaki Osako, Kimiaki Tanaka, Atsuo Murata, Atsunori Nakao

Archives of academic emergency medicine 7 ( 1 ) e67 2019

Language：English

Although fatalities due to caffeine intoxication are uncommon, a caffeine overdose may cause profound toxicity, resulting in tachycardia, arrhythmia, convulsions, vomiting, coma, and possibly death. In particular, high caffeine consumption while pregnant can cause increased fetal catecholamine levels, which could lead to increased fetal heart rate and placental vasoconstriction and impair fetal oxygenation. Therefore, caffeine intoxication in pregnant women should be treated immediately. Herein, we present a 33-year-old pregnant woman who was treated in our department after ingesting 4000mg of caffeine in an attempt to commit suicide. We successfully treated our patient, and she delivered a healthy baby at 38 weeks.

Heat-not-burn cigarettes induce fulminant acute eosinophilic pneumonia requiring extracorporeal membrane oxygenation. International journal

Toshiyuki Aokage, Kohei Tsukahara, Yasushi Fukuda, Fumiaki Tokioka, Akihiko Taniguchi, Hiromichi Naito, Atsunori Nakao

Respiratory medicine case reports 26 87 - 90 2019

Language：English

Background: Although the cause of acute eosinophilic pneumonia (AEP) has not yet been fully clarified, cigarette smoking is reported to be a risk factor for developing AEP. The heat-not-burn cigarette (HNBC) was developed to reduce the adverse effects of smoke on the user's surroundings. However, the health risks associated with HNBCs have not yet been clarified. We report a successfully treated case of fatal AEP presumably induced by HNBC use. Presentation of case: A 16-year-old man commenced HNBC smoking two weeks before admission and subsequently suffered from shortness of breath that gradually worsened. The patient was transferred to emergency department and immediately intubated because of respiratory failure. Computed tomography showed mosaic ground-glass shadows on the distal side of both lungs with a PaO2/FIO2 ratio of 76. The patient required veno-venous extracorporeal membrane oxygenation (ECMO) for severe respiratory failure. He was diagnosed with AEP by clinical course and detection of eosinophils in sputum; thus, methylprednisolone was administrated. The patient was weaned off ECMO four days after initiation and extubated the day after. He fully recovered without sequelae. Conclusion: As far as we know, our patient is the first case of AEP induced by HNBC use successfully treated with ECMO. Emergency physicians must be aware that HNBCs can induce fatal AEP.

DOI： 10.1016/j.rmcr.2018.12.002

A case of spontaneous mesenteric hematoma successfully diagnosed and treated with aggressive imaging. Reviewed International journal

Shunsuke Nakamura, Taihei Yamada, Tsuyoshi Nojima, Hiromichi Naito, Hitoshi Koga, Hisashi Yamashita, Akira Gochi, Atsunori Nakao

International journal of surgery case reports 65 124 - 126 2019

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Spontaneous mesenteric hematoma is an uncommon syndrome triggered by bleeding localized in the mesenteric vascular tree of a bowel segment for no apparent underlying reason. We herein report a surgical patient with an extremely rapidly growing spontaneous mesenteric hematoma that we successfully diagnosed using careful radiologic examination. PRESENTATION OF CASE: A 56-year-old old male presenting sudden onset lower abdominal pain was referred to our emergency department. At the time of admission, his physical examination revealed stable vital signs without radiological abnormality. On the following day, the patient suddenly presented hypotension, tachycardia, and increased abdominal pain. Contrast-enhanced computed tomography examination showed a mass with both high- and low-density areas with a 130 mm maximum diameter bordering the transverse colon. Since interventional radiologists were not available, we decided to perform emergency exploratory laparotomy. On laparotomy, a 13 × 8 cm hematoma was found in the mesentery of the transverse colon. As bleeding was noted from the branches of the middle colic artery and gastrocolic artery, these responsible vessels were ligated. The patient was finally given the diagnosis of spontaneous mesenteric hematoma. DISCUSSION AND CONCLUSION: The present case, initially diagnosed as enterocolitis, suddenly manifested hypovolemic shock. Close monitoring for any signs of further deterioration, as well as aggressive imaging diagnosis, enabled us to avoid delays in treatment. Early diagnosis and treatment of mesenteric hematomas are essential to prevent them from rupturing and triggering life-threatening adverse events.

DOI： 10.1016/j.ijscr.2019.10.058

Emphysematous cystitis successfully treated with hyperbaric oxygen therapy: case report Reviewed

Hirotaka Yasuhara, Hiromichi Naito, Yoshinori Kosaki, Yasuaki Yamakawa, Atsuyoshi Iida, Tetsuya Yumoto, Hirotsugu Yamamoto, Taihei Yamada, Kohei Tsukahara, Takaaki Osako, Yasuhiro Mandai, Atsunori Nakao

UNDERSEA AND HYPERBARIC MEDICINE 45 ( 6 ) 701 - 703 2018.11

Language：English Publishing type：Research paper (scientific journal) Publisher：UNDERSEA & HYPERBARIC MEDICAL SOC INC

Emphysematous cystitis is an uncommon acute infection of the underlying bladder musculature and mucosa, caused by gas-producing organisms. Here we describe an 87-year-old woman with diabetes mellitus and emphysematous cystitis who was successfully treated with hyperbaric oxygen (HBO2) therapy. Her predisposition of diabetes and infection with gas-producing bacteria was considered to precede the development of emphysematous cystitis. Computed tomography revealed gas accumulation in the bladder wall and lumen. Antibiotics and HBO2 therapy were administered. HBO2 therapy may be beneficial due to the improvement in oxygenation of the tissues affected by the disease. HBO2 is a useful adjunct therapy for the management of severe emphysematous cystitis.

腹筋運動が誘因となったと思われる特発性腹直筋血腫の1症例

山田太平, 小崎吉訓, 湯本哲也, 飯田淳義, 山本浩継, 藤崎宣友, 青景聡之, 塚原紘平, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 29 ( 10 ) 553 - 553 2018.10

大動脈のCT値を利用した重症外傷患者における新規大量輸血予測ツールの開発

庵谷紘美, 湯本哲也, 小崎吉訓, 山川泰明, 飯田淳義, 山本浩継, 山田太平, 塚原紘平, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 29 ( 10 ) 473 - 473 2018.10

本人・家族からの申告のなかった農薬中毒例の検討

有吉雪乃, 内藤宏道, 萩岡信吾, 小崎吉訓, 飯田淳義, 湯本哲也, 山田太平, 塚原紘平, 尾迫貴章, 森本直樹, 中尾篤典

日本救急医学会雑誌 29 ( 10 ) 446 - 446 2018.10

腹部CTからみた薬物過量内服

浅田遼, 塚原紘平, 内藤宏道, 飯田淳義, 小崎吉訓, 山川泰明, 湯本哲也, 山本浩継, 山田太平, 尾迫貴章, 中尾篤典

日本救急医学会雑誌 29 ( 10 ) 444 - 444 2018.10

アンモニアガス曝露による気管狭窄・肺胞障害を認めた症例

沢田孝平, 小崎吉訓, 山本浩継, 藤崎宣友, 青景聡之, 山田太平, 塚原紘平, 万代康弘, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 29 ( 10 ) 437 - 437 2018.10

学会開催日とその前後で外傷患者の死亡率に差はあるか? 日本外傷データバンクより

湯本哲也, 内藤宏道, 庵谷紘美, 小崎吉訓, 山川泰明, 飯田淳義, 山本浩継, 山田太平, 塚原紘平, 尾迫貴章, 中尾篤典

日本救急医学会雑誌 29 ( 10 ) 473 - 473 2018.10

A rapid caliber change in the inferior vena cava during multiphasic contrast-enhanced computed tomography may signal an acute anaphylactic reaction to nonionic contrast medium. International journal

Takayoshi Shinya, Akihiro Tada, Yoshihisa Masaoka, Nanako Ogawa, Satoko Makimoto, Hiroki Ihara, Ryuichiro Fukuhara, Noriaki Akagi, Takao Hiraki, Atsunori Nakao, Susumu Kanazawa

Radiology case reports 13 ( 5 ) 970 - 974 2018.10

Language：English

Severe anaphylactic reactions to an intravenous nonionic iodine contrast medium (NICM) are uncommon but can result in permanent morbidity or death if not managed appropriately. An anaphylactic reaction to an NICM typically manifests as clinical symptoms that include an itchy nose, sneezing, and skin redness. To our knowledge, a rapid change in the caliber of the inferior vena cava (IVC) during multiphasic contrast-enhanced computed tomography (CT) has not been reported. Here, we report the computed tomographic findings in three cases of hypovolemic shock caused by an anaphylactic reaction to an NICM. We suspect that a decrease in caliber of the IVC during multiphasic contrast-enhanced CT may be a predictor of an allergic-like reaction to an NICM. Patients in whom physicians and radiographers detect a rapid caliber change in the IVC during multiphasic contrast-enhanced CT should be managed carefully.

DOI： 10.1016/j.radcr.2018.07.002

高度救命救急センターにおけるCRRT膜のlifetimeに関する検討

岡田真澄, 平山隆浩, 末永健二, 藤原宏成, 落葉佑昌, 岩藤晋, 内藤宏道, 中尾篤典, 廣畑聡

日本急性血液浄化学会雑誌 9 ( Suppl. ) 139 - 139 2018.9

Usefulness of 3-D computed tomography for diagnosis of abusive head trauma. International journal

Kazumasa Zensho, Hirotsugu Yamamoto, Kohei Tsukahara, Takaaki Osako, Atsunori Nakao

Pediatrics international : official journal of the Japan Pediatric Society 60 ( 9 ) 889 - 891 2018.9

Ictal Cardiorespiratory Arrest Associated with Status Epilepticus in Panayiotopoulos Syndrome

Hirotsugu Yamamoto, Hiromichi Naito, Takaaki Osako, Kohei Tsukahara, Taihei Yamada, Tetsuya Yumoto, Atsuyoshi Iida, Yoshinori Kosaki, Makio Oka, Fumika Endo, Akira Gochi, Atsunori Nakao

ACTA MEDICA OKAYAMA 72 ( 3 ) 297 - 300 2018.6

Language：English Publishing type：Research paper (scientific journal) Publisher：OKAYAMA UNIV MED SCHOOL

A healthy 10-year-old boy vomited during sleep and later complained of abdominal pain; he became drowsy and uncommunicative. At the nearby hospital E.R., he deteriorated rapidly, and his respiratory movements were absent with cardiac arrest. He was immediately resuscitated. Brain MRI showed no abnormalities. EEG revealed an abnormal pattern with recurrent multifocal epileptiform activity over the bilateral occipital and frontal regions during sleep. Based on the clinical/radiological findings we diagnosed Panayiotopoulos syndrome (PS), a benign form of early-onset pediatric epilepsy characterized by autonomic symptoms. Life-threating cardiopulmonary arrest is rare in PS, but long seizure duration of PS may associate with apnea and bradycardia.

Ictal Cardiorespiratory Arrest Associated with Status Epilepticus in Panayiotopoulos Syndrome.

Hirotsugu Yamamoto, Hiromichi Naito, Takaaki Osako, Kohei Tsukahara, Taihei Yamada, Tetsuya Yumoto, Atsuyoshi Iida, Yoshinori Kosaki, Makio Oka, Fumika Endo, Akira Gochi, Atsunori Nakao

Acta medica Okayama 72 ( 3 ) 297 - 300 2018.6

Language：English

A healthy 10-year-old boy vomited during sleep and later complained of abdominal pain; he became drowsy and uncommunicative. At the nearby hospital E.R., he deteriorated rapidly, and his respiratory movements were absent with cardiac arrest. He was immediately resuscitated. Brain MRI showed no abnormalities. EEG revealed an abnormal pattern with recurrent multifocal epileptiform activity over the bilateral occipital and frontal regions during sleep. Based on the clinical/radiological findings we diagnosed Panayiotopoulos syndrome (PS), a benign form of early-onset pediatric epilepsy characterized by autonomic symptoms. Lifethreating cardiopulmonary arrest is rare in PS, but long seizure duration of PS may associate with apnea and bradycardia.

DOI： 10.18926/AMO/56076

Delayed hydronephrosis due to retroperitoneal hematoma after a seatbelt injury

Tetsuya Yumoto, Yoshitaka Kondo, Kento Kumon, Yoshihisa Masaoka, Takao Hiraki, Taihei Yamada, Hiromichi Naito, Atsunori Nakao

Medicine 97 ( 23 ) e11022 - e11022 2018.6

下部尿路損傷を伴う骨盤輪損傷の治療戦略

山川泰明, 小崎吉訓, 湯本哲也, 飯田淳義, 山田太平, 内藤宏道, 野田知之, 中尾篤典

日本外傷学会雑誌 32 ( 2 ) 300 - 300 2018.6

鈍的体幹部外傷における大腰筋血腫と造影剤の血管外漏出像の意義についての検討

湯本哲也, 内藤宏道, 山川泰明, 小崎吉訓, 飯田淳義, 山田太平, 中尾篤典

日本外傷学会雑誌 32 ( 2 ) 284 - 284 2018.6

前頸部熱傷のため気管切開前に同部の植皮を先行させた4例についての検討

高見優男, 飯田淳義, 小崎吉訓, 山川泰明, 湯本哲也, 山田太平, 山本浩継, 塚原紘平, 尾迫貴章, 内藤宏道, 中尾篤典

熱傷 44 ( 2 ) 103 - 103 2018.6

Trauma IVRにより救命し得た肺動脈損傷の1症例

山田太平, 小崎吉訓, 山川泰明, 湯本哲也, 飯田淳義, 内藤宏道, 中尾篤典

日本外傷学会雑誌 32 ( 2 ) 324 - 324 2018.6

Raoultella planticola bacteremia-induced fatal septic shock following burn injury. International journal

Tetsuya Yumoto, Hiromichi Naito, Hiromi Ihoriya, Kohei Tsukahara, Tomoyuki Ota, Toshiyuki Watanabe, Atsunori Nakao

Annals of clinical microbiology and antimicrobials 17 ( 1 ) 19 - 19 2018.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Raoultella planticola, a Gram-negative, aerobic bacillus commonly isolated from soil and water, rarely causes invasive infections in humans. Septic shock from R. planticola after burn injury has not been previously reported. CASE PRESENTATION: A 79-year-old male was admitted to the emergency intensive care unit after extensive flame burn injury. He accidently caught fire while burning trash and plunged into a nearby tank filled with contaminated rainwater to extinguish the fire. The patient developed septic shock on day 10. The blood culture detected R. planticola, which was identified using the VITEK-2 biochemical identification system. Although appropriate antibiotic treatment was continued, the patient died on day 12. CONCLUSIONS: Clinicians should be aware of fatal infections in patients with burn injury complicated by exposure to contaminated water.

DOI： 10.1186/s12941-018-0270-0

Portal Venous Gas Following Ingestion of Hydrogen Peroxide Successfully Treated with Hyperbaric Oxygen Therapy

Chika Tsuboi, Hiromichi Naito, Shingo Hagioka, Hiroaki Hanafusa, Takahiro Hirayama, Yoshinori Kosaki, Atsuyoshi Iida, Tetsuya Yumoto, Kohei Tsukahara, Naoki Morimoto, Atsunori Nakao

ACTA MEDICA OKAYAMA 72 ( 2 ) 181 - 183 2018.4

Language：English Publishing type：Research paper (scientific journal) Publisher：OKAYAMA UNIV MED SCHOOL

The primary toxicity of hydrogen peroxide results from its interaction with catalase, which liberates water and oxygen. We report the case of a 14-year-old Japanese girl with portal venous gas that was caused by oxygen liberated from intentionally ingested hydrogen peroxide. Although she had a past history of atrial septal defect, recovery without cardiac or neurological sequelae was achieved using hyperbaric oxygen therapy. Emergency physicians must be aware of the danger of liberated oxygen due to hydrogen peroxide ingestion.

Portal Venous Gas Following Ingestion of Hydrogen Peroxide Successfully Treated with Hyperbaric Oxygen Therapy.

Chika Tsuboi, Hiromichi Naito, Shingo Hagioka, Hiroaki Hanafusa, Takahiro Hirayama, Yoshinori Kosaki, Atsuyoshi Iida, Tetsuya Yumoto, Kohei Tsukahara, Naoki Morimoto, Atsunori Nakao

Acta medica Okayama 72 ( 2 ) 181 - 183 2018.4

Language：English Publishing type：Research paper (scientific journal)

The primary toxicity of hydrogen peroxide results from its interaction with catalase, which liberates water and oxygen. We report the case of a 14-year-old Japanese girl with portal venous gas that was caused by oxygen liberated from intentionally ingested hydrogen peroxide. Although she had a past history of atrial septal defect, recovery without cardiac or neurological sequelae was achieved using hyperbaric oxygen therapy. Emergency physicians must be aware of the danger of liberated oxygen due to hydrogen peroxide ingestion.

DOI： 10.18926/AMO/55859

臨床工学技士の活躍の場の開拓、発展のためにミャンマーとの関わり

平山隆浩, 林久美子, 岩藤晋, 山川泰明, 湯本哲也, 山田太平, 内藤宏道, 木股敬裕, 岡田茂, 氏家良人, 中尾篤典

日本臨床工学技士会会誌 ( 63 ) 149 - 149 2018.4

Hyperammonemic encephalopathy in a patient receiving fluorouracil/oxaliplatin chemotherapy. Reviewed International journal

Hiromi Ihoriya, Hirotsugu Yamamoto, Taihei Yamada, Kohei Tsukahara, Kanae Inoue, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao

Clinical case reports 6 ( 4 ) 603 - 605 2018.4

Cushing's sign and severe traumatic brain injury in children after blunt trauma: a nationwide retrospective cohort study in Japan. International journal

Tetsuya Yumoto, Hiromichi Naito, Takashi Yorifuji, Hiroki Maeyama, Yoshinori Kosaki, Hirotsugu Yamamoto, Kohei Tsukahara, Takaaki Osako, Atsunori Nakao

BMJ open 8 ( 3 ) e020781 2018.3

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: We tested whether Cushing's sign could predict severe traumatic brain injury (TBI) requiring immediate neurosurgical intervention (BI-NSI) in children after blunt trauma. DESIGN: Retrospective cohort study using Japan Trauma Data Bank. SETTING: Emergency and critical care centres in secondary and tertiary hospitals in Japan. PARTICIPANTS: Children between the ages of 2 and 15 years with Glasgow Coma Scale motor scores of 5 or less at presentation after blunt trauma from 2004 to 2015 were included. A total of 1480 paediatric patients were analysed. PRIMARY OUTCOME MEASURES: Patients requiring neurosurgical intervention within 24 hours of hospital arrival and patients who died due to isolated severe TBI were defined as BI-NSI. The combination of systolic blood pressure (SBP) and heart rate (HR) on arrival, which were respectively divided into tertiles, and its correlation with BI-NSI were investigated using a multiple logistic regression model. RESULTS: In the study cohort, 297 (20.1%) exhibited BI-NSI. After adjusting for sex, age category and with or without haemorrhage shock, groups with higher SBP and lower HR (SBP ≥135 mm Hg; HR ≤92 bpm) were significantly associated with BI-NSI (OR 2.84, 95% CI 1.68 to 4.80, P<0.001) compared with the patients with normal vital signs. In age-specific analysis, hypertension and bradycardia were significantly associated with BI-NSI in a group of 7-10 and 11-15 years of age; however, no significant association was observed in a group of 2-6 years of age. CONCLUSIONS: Cushing's sign after blunt trauma was significantly associated with BI-NSI in school-age children and young adolescents.

DOI： 10.1136/bmjopen-2017-020781

Traumatic Globe Luxation with Complete Optic Nerve Transection Caused by Heavy Object Compression

Yoshinori Kosaki, Tetsuya Yumoto, Hiromichi Naito, Nobushige Tsuboi, Masahiro Kameda, Masayuki Hirano, Yuki Morizane, Takaya Senoo, Eijirou Tokuyama, Atsunori Nakao

ACTA MEDICA OKAYAMA 72 ( 1 ) 85 - 88 2018.2

Language：English Publishing type：Research paper (scientific journal) Publisher：OKAYAMA UNIV MED SCHOOL

Traumatic eyeball luxation is a rare clinical condition with a dramatic presentation. Here, we describe a unique case of traumatic globe luxation and complete optic nerve transection caused by heavy object compression. A 45-year-old male automobile mechanic was injured when a truck slipped from its supports, crushing his head and face. On arrival, his right eyeball was obviously displaced anteriorly and he had no light perception. Computed tomography revealed complex frontal bone and facial fractures with underlying brain contusion in addition to complete transection of the right optic nerve. The patient was successfully treated using a multidisciplinary approach.

院外心停止患者の搬送先病院と予後の検討

内藤宏道, 小崎吉訓, 山川泰明, 飯田淳義, 湯本哲也, 山本浩継, 山田太平, 塚原紘平, 尾迫貴章, 中尾篤典

日本集中治療医学会雑誌 25 ( Suppl. ) [O85 - 2] 2018.2

Penetrating thoracic ice pick injury extending into pulmonary artery: Report of a case. International journal

Marina Kawaguchi, Hirotsugu Yamamoto, Taihei Yamada, Tetsuya Yumoto, Toshiyuki Aokage, Hiromi Ihoriya, Koki Eto, Takanori Suezawa, Hiromichi Naito, Atsunori Nakao

International journal of surgery case reports 52 63 - 66 2018

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Penetrating thoracic traumas have a wide spectrum, ranging from mild traumas to life-threatening injuries. PRESENTATION OF CASE: This paper illustrates a 40-year-old male with a penetrating pulmonary artery injury that was successfully treated with emergency surgery. The patient visited local hospital by foot complaining of moving object on his chest and was found that an ice pick was penetrating the man's left chest. An ambulance took the patient to our emergency department. Computed tomography of the chest showed linear metallic density in the pulmonary trunk and a small amount of pericardial fluid. Emergency surgery for removal of the object and repair of the pulmonary artery was performed. The ice pick had been stuck in the main pulmonary artery through the pericardium without any injury to the left lung or internal thoracic artery. Postoperative course was uneventful. DISCUSSION: A multidisciplinary team designed our treatment strategy, enabling us to select the optimal treatment, including diagnostic techniques and surgical approach. A successful trauma management depends on whether a life-threatening conditionexists. Major vascular injury should be rapidly assessed in these cases. Psychiatric aspects of the case are also discussed. CONCLUSION: Early removal of the foreign body is recommended to prevent further damage to the heart.

DOI： 10.1016/j.ijscr.2018.09.052

Acute Agitation as an Initial Manifestation of Neuro-Behçet's Disease. International journal

Yuki Otsuka, Tetsuya Yumoto, Hiromi Ihoriya, Namiko Matsumoto, Kota Sato, Koji Abe, Hiromichi Naito, Atsunori Nakao

Case reports in emergency medicine 2018 5437027 - 5437027 2018

Language：English

Managing acutely agitated or violent patients in the emergency department (ED) represents a significant challenge. Acute agitation as an initial manifestation of neuro-Behcet's disease (NBD) is an extremely rare clinical entity. A 44-year-old male, who had been complaining about a severe headache and fever for several days, was admitted to our ED due to acutely presented incontinence and agitation. On admission, physical restraint and sedation with sevoflurane and propofol were required for his combative and violent behavior. Cerebrospinal fluid examination revealed increased cell count. Fluid attenuated inversion recovery magnetic resonance imaging showed a high intensity signal in the left parietal lobe and bilateral occipital lobe. As infectious meningoencephalitis was suspected, empirical therapy was immediately started. He recovered uneventfully without neurological defect in seven days. Based on positive human leukocyte antigen B-51 and clinical manifestations, the diagnosis of NBD was made and remitted by steroid therapy. Although acute NBD commonly presents with focal neurological symptoms, psychiatric symptoms could be considered the first manifestation. A focused and thorough examination coupled with appropriate management strategies can assist emergency clinicians safely and effectively manage these patients.

DOI： 10.1155/2018/5437027

Staphylococcus aureus Bacteremia Complicated by Psoas Abscess and Infective Endocarditis in a Patient with Atopic Dermatitis. Reviewed

Tsuboi I, Yumoto T, Toyokawa T, Matsueda K, Horii J, Naito H, Nakao A.

Case Rep Infect Dis 2017 2017.12

Venous thromboembolism in major trauma patients: a single-center retrospective cohort study of the epidemiology and utility of D-dimer for screening

Tetsuya Yumoto, Hiromichi Naito, Yasuaki Yamakawa, Atsuyoshi Iida, Kohei Tsukahara, Atsunori Nakao

Acute Medicine & Surgery 4 ( 4 ) 394 - 400 2017.10

Occult Sources of Bleeding in Blunt Trauma : A Narrative Review.

Tetsuya Yumoto, Yoshinori Kosaki, Yasuaki Yamakawa, Atsuyoshi Iida, Hirotsugu Yamamoto, Taihei Yamada, Kohei Tsukahara, Hiromichi Naito, Takaaki Osako, Atsunori Nakao

Acta medica Okayama 71 ( 5 ) 363 - 368 2017.10

Language：English Publishing type：Research paper (scientific journal)

Worldwide, hemorrhagic shock in major trauma remains a major potentially preventable cause of death. Controlling bleeding and subsequent coagulopathy is a big challenge. Immediate assessment of unidentified bleeding sources is essential in blunt trauma patients with hemorrhagic shock. Chest/pelvic X-ray in conjunction with ultrasonography have been established classically as initial diagnostic imaging modalities to identify the major sources of internal bleeding including intra-thoracic, intra-abdominal, or retroperitoneal hemorrhage related to pelvic fracture. Massive soft tissue injury, regardless of whether isolated or associated with multiple injuries, occasionally causes extensive hemorrhage and acute traumatic coagulopathy. Specific types of injuries, including soft tissue injury or retroperitoneal hemorrhage unrelated to pelvic fracture, can potentially be overlooked or be considered "occult" causes of bleeding because classical diagnostic imaging often cannot exclude such injuries. The purpose of this narrative review article is to describe "occult" or unusual sources of bleeding associated with blunt trauma.

DOI： 10.18926/AMO/55433

確定診断に時間を要したStanford A型急性大動脈解離患者の特徴

華房宏成, 内藤宏道, 小崎吉訓, 塚原紘平, 尾迫貴章, 溝上良一, 川西進, 萩岡信吾, 繁光薫, 中尾篤典, 森本直樹

日本救急医学会雑誌 28 ( 9 ) 512 - 512 2017.9

マムシ咬傷における入院期間にかかわる因子の検討

小崎吉訓, 内藤宏道, 山田太平, 塚原紘平, 尾迫貴章, 溝上良一, 川西進, 萩岡信吾, 繁光薫, 中尾篤典, 森本直樹

日本救急医学会雑誌 28 ( 9 ) 726 - 726 2017.9

クモ膜下出血術後、スパイナルドレナージの合併症として、血腫による急性閉塞性水頭症を発症した1例

内藤宏道, 山川泰明, 塚原紘平, 湯本哲也, 飯田淳義, 小崎吉訓, 山本浩継, 山田太平, 尾迫貴章, 中尾篤典

日本救急医学会雑誌 28 ( 9 ) 625 - 625 2017.9

過酸化水素摂取後の門脈内ガスに対する高圧酸素療法による治療の成功(Portal venous gas following ingestion of hydrogen peroxide successfully treated with hyperbaric oxygen therapy)

高尾賢一朗, 内藤宏道, 湯本哲也, 小崎吉訓, 飯田淳義, 塚原紘平, 山本浩継, 山川泰明, 山田太平, 尾迫貴章, 中尾篤典

日本救急医学会雑誌 28 ( 9 ) 526 - 526 2017.9

指切創処置時における私の工夫

山川泰明, 小崎吉訓, 山本浩継, 飯田淳義, 湯本哲也, 山田太平, 塚原紘平, 尾迫貴章, 内藤宏道, 中尾篤典

日本救急医学会雑誌 28 ( 9 ) 502 - 502 2017.9

救急医として地域、社会全体でリーダーになるということ(To be a regional and global leader as an emergency physician)

湯本哲也, 小崎吉訓, 山川泰明, 飯田淳義, 山本浩継, 山田太平, 塚原紘平, 内藤宏道, 尾迫貴章, 中尾篤典

日本救急医学会雑誌 28 ( 9 ) 471 - 471 2017.9

重度呼吸性アシドーシスを合併したPanayiotopoulos syndrome(Panayiotopoulos syndrome associated with severe respiratory acidosis)

西野貴大, 飯田淳義, 塚原紘平, 内藤宏道, 山田太平, 湯本哲也, 尾迫貴章, 小崎吉訓, 山本浩継, 山川泰明, 中尾篤典

日本救急医学会雑誌 28 ( 9 ) 518 - 518 2017.9

Intracranial Pressure Monitoring for Pediatric Acute Encephalopathy.

Nobuyuki Nosaka, Kohei Tsukahara, Emily Knaup, Toshihiko Yabuuchi, Tomonobu Kikkawa, Yosuke Fujii, Masato Yashiro, Takao Yasuhara, Ayumi Okada, Toyomu Ugawa, Atsunori Nakao, Hirokazu Tsukahara, Isao Date

Acta medica Okayama 71 ( 2 ) 179 - 180 2017.4

Language：English Publishing type：Research paper (scientific journal)

Newly published clinical practice guidelines recommend intracranial pressure (ICP) monitoring in critical care for the management of pediatric acute encephalopathy (pAE), but the utility of ICP monitoring for pAE has been poorly studied. We recently performed direct ICP monitoring for two patients. We observed that although the direct ICP monitoring had clinical benefits with less body weight gain and no vasopressor use in both cases, this monitoring technique is still invasive. Future studies should determine the utility of non-invasive ICP monitoring systems in pAE to further improve the quality of intensive-care management.

DOI： 10.18926/AMO/54987

Pneumatosis cystoides intestinalis presenting as pneumoperitoneum in a patient with chronic obstructive pulmonary disease: a case report Reviewed

Atsuyoshi Iida, Hiromichi Naito, Kohei Tsukahara, Tetsuya Yumoto, Nobuyuki Nosaka, Shinnichi Kawana, Keiji Sato, Nobuhiro Takeuchi, Jyunichi Soneda, Atsunori Nakao

Journal of Medical Case Reports 11 ( 1 ) 1 - 10 2017.2

Successfully-treated asymptomatic celiac artery aneurysm: A case report Reviewed

Nobuhiro Takeuchi, Junichi Soneda, Hiromichi Naito, Atsuyoshi Iida, Tetsuya Yumoto, Kohei Tsukahara, Atsunori Nakao

International Journal of Surgery Case Reports 33 115 - 118 2017.2

Intraocular silicone oil masquerading as eye hemorrhage. Reviewed

Yamakawa Y, Naito H, Tsukahara K, Iida A, Yumoto T, Yamada T, Osako T, Nakao A.

J Trauma Treat 6 ( 1 ) 360 - 361 2017.2

AN69ST膜はナファモスタットメシル酸塩のほとんどを吸着する

平山隆浩, 大川恭昌, 鵜川豊世武, 林久美子, 野坂宜之, 湯本哲也, 塚原紘平, 内藤宏道, 佐藤圭路, 中尾篤典

日本集中治療医学会雑誌 24 ( Suppl. ) AW - 2 2017.2

早期リハビリテーションを始めようチームビルディングの実際高度救命救急センターにおける理学療法士の関わり方

大塚貴久, 塚原紘平, 湯本哲也, 佐藤圭路, 鵜川豊世武, 中尾篤典

日本集中治療医学会雑誌 24 ( Suppl. ) PD7 - 6 2017.2

Intracranial pressure monitoring for pediatric acute encephalopathy Reviewed

Nobuyuki Nosaka*,Kohei Tsukahara*,Emily Knaup ,Toshihiko Yabuuchi,Tomonobu Kikkawa,Yosuke Fujii*,Masato Yashiro*,Takao Yasuhara*,Ayumi Okada*,Toyomu Ugawa*,Atsunori Nakao*,Hirokazu Tsukahara*,Isao Date*

Acta Medica Okayama, Acta. Medica Okayama, Acta medicinae Okayama, Acta medica Okayama 71 ( 2 ) 179 - 180 2017.1

Inhaled hydrogen ameliorates endotoxin-induced bowel dysfunction

Hiroyuki Sakata, Ayana Okamoto, Michiko Aoyama-Ishikawa, Hayato Yamashita, Keisuke Kohama, Noritomo Fujisaki, Taihei Yamada, Joji Kotani, Kohei Tsukahara, Atsuyoshi Iida, Atsunori Nakao

Acute Medicine & Surgery 4 ( 1 ) 38 - 45 2017.1

Staphylococcus aureus Bacteremia Complicated by Psoas Abscess and Infective Endocarditis in a Patient with Atopic Dermatitis

Ichiro Tsuboi, Tetsuya Yumoto, Tatsuya Toyokawa, Katsunori Matsueda, Joichiro Horii, Hiromichi Naito, Atsunori Nakao

Case Reports in Infectious Diseases 2017 1 - 4 2017

Publishing type：Research paper (scientific journal) Publisher：Hindawi Limited

The close relationship between atopic dermatitis (AD) and infective endocarditis (IE) has been implicated. <italic>Staphylococcus aureus</italic> colonization is frequently seen observed in AD patients’ skin lesions. Although a case of IE due to <italic>S. aureus</italic> bacteremia in an AD patient has been sporadically reported, a case of <italic>S. aureus</italic> bacteremia complicated by psoas abscess and IE has not been previously reported. A 42-year-old man with a history of AD presented to our hospital complaining of fever, fatigue, chills, lower right back pain, and poor appetite for a week. His blood cultures showed growth of <italic>S. aureus</italic>. On day 3, the patient presented acute cardiac failure and was diagnosed with IE based on echocardiogram examination. Since the patient’s cardiac failure did not respond to medication, an emergency surgery was performed on the fourth day of hospitalization. The patient underwent successful surgical treatment of the heart lesions and subsequent percutaneous drainage of psoas abscess and received intensive antibiotics, which successfully improved his condition. Our report emphasizes awareness of the association between AD and invasive <italic>S. aureus</italic> infections.

DOI： 10.1155/2017/4920182

Other Link： http://downloads.hindawi.com/journals/criid/2017/4920182.xml

Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study Reviewed

Tetsuya Yumoto, Toshiharu Mitsuhashi, Yasuaki Yamakawa, Atsuyoshi Iida, Nobuyuki Nosaka, Kohei Tsukahara, Hiromichi Naito, Atsunori Nakao

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 24 ( 1 ) 2016.12

Case of necrotizing fasciitis from streptococcus pyogenes (group A) treated successfully with negative-pressure wound therapy. Reviewed

Inaba M, Nozaki S, Fujiwara T, Hongou T, Uozumi M, Nakahara T, Akagi Y, Kojima T, Naito H, Nakao A.

Surgical Infections Case Reports. 1 142 - 145 2016.11

Donor pretreatment with carbon monoxide prevents ischemia/reperfusion injury following he Recurrent apnea art transplantation in rats. Reviewed

Fujisaki N, Kohama K, Nishimura T, Yamashita H, Ishikawa M, Kanematsu A, Yamada T, Lee S, Yumoto T, Tsukahara K, Kotani J, Nakao A.

Med Gas Res. 14 ( 6 ) 122 - 129 2016.10

Case of 24-week Fetus Delivered from Mother on Life Support with Brain-death from Suicide Attempt: Ethical Issues Associated with Severe Complications Reviewed

Nishimura Takeshi, Kohama Keisuke, Osako Takaaki, Yamada Taihei, Tanaka Hiroyuki, Nakao Atsunori, Kotani Joji

Acta Medica Okayama 70 ( 5 ) 389 - 399 2016.10

The Clinical Application of Hydrogen as a Medical Treatment Reviewed

Iida Atsuyoshi, Nosaka Nobuyuki, Yumoto Tetsuya, Knaup Emily, Naito Hiromichi, Nishiyama Chihiro, Yamakawa Yasuaki, Tsukahara Kohei, Terado Michihisa, Sato Keiji, Ugawa Toyomu, Nakao Atsunori

Acta Medica Okayama 70 ( 5 ) 331 - 337 2016.10

Donor pretreatment with carbon monoxide prevents ischemia/reperfusion injury following heart transplantation in rats Reviewed

Atsunori Nakao, Noritomo Fujisaki, Keisuke Kohama, Takeshi Nishimura, Hayato Yamashita, Michiko Ishikawa, Akihiro Kanematsu, Taihei Yamada, Sungsoo Lee, Tetsuya Yumoto, Kohei Tsukahara, Joji Kotani

Medical Gas Research 6 ( 3 ) 122 - 129 2016.7

外科的侵襲と代謝 Orthodox & Serendipity 危篤患者の栄養管理エビデンスと臨床(Surgical stress and metabolism: Orthodox & Serendipity Nutrition Management of Critically Ill patients: Evidences and Practice)

小谷穣治, 山田勇, 西村健, 寺嶋真理子, 中尾篤典

日本消化器外科学会総会 71回 SY1 - 5 2016.7

当院における腹部刺創46例における検討

西村健, 坂田寛之, 山田太平, 寺嶋真理子, 白井邦博, 山田勇, 中尾篤典, 小谷穣治

日本外傷学会雑誌 30 ( 2 ) 214 - 214 2016.5

Ileum perforation due to cytomegalovirus infection in a patient with adult T-cell leukemia International journal

Takeshi Nishimura, Atsunori Nakao, Ayana Okamoto, Takako Kihara, Seiichi Hirota, Noritomo Fujisaki, Joji Kotani

Acute Medicine & Surgery 3 ( 2 ) 178 - 181 2016.4

Language：English Publishing type：Research paper (scientific journal) Publisher：Wiley

Case: A 73-year-old woman was transferred to our department due to severe abdominal pain with peritonitis. Her laboratory data showed that her white blood cell count was elevated to more than 50,000/mm3. Antibodies to HTLV-I were positive and we made the diagnosis of adult T-cell leukemia (ATL). Outcome: Emergency laparotomy was performed and revealed two separate small perforations of the ileum, requiring bowel resection. Immunohistochemistry for cytomegalovirus (CMV) antigen revealed positive staining in the intestinal stromal cells. Despite surgery and antiviral therapy with ganciclovir, she died after 28 days. Conclusion: Adult T-cell leukemia patients may present acute abdominal pain due to intestinal perforation caused by CMV infection. We should be aware of CMV infection as one of the pathogens causing acute abdominal crises such as massive hemorrhage or visceral perforation.

DOI： 10.1002/ams2.145

Intraperitoneally administered, hydrogen-rich physiologic solution protects against postoperative ileus and is associated with reduced nitric oxide production Reviewed

Ayana Okamoto, Keisuke Kohama, Michiko Aoyama-Ishikawa, Hayato Yamashita, Noritomo Fujisaki, Taihei Yamada, Tetsuya Yumoto, Nobuyuki Nosaka, Hiromichi Naito, Kohei Tsukahara, Atsuyoshi Iida, Keiji Sato, Joji Kotani, Atsunori Nakao

Surgery 160 ( 3 ) 623 - 631 2016.1

Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism Reviewed

Kohei Tsukahara, Keiji Sato, Tetsuya Yumoto, Atsuyoshi Iida, Nobuyuki Nosaka, Michihisa Terado, Hiromichi Naito, Yorihisa Orita, Tomoyuki Naito, Kentaro Miki, Mayu Sugihara, Satoko Nagao, Toyomu Ugawa, Atsunori Nakao

International Journal of Surgery Case Reports 26 217 - 220 2016.1

A case of traumatic abdominal wall hernia with delayed bowel obstruction

Takeshi Nishimura, Atsunori Nakao, Ayana Okamoto, Noritomo Fujisaki, Joji Kotani

Surgical Case Reports 1 ( 1 ) 2015.12

A case of traumatic abdominal wall hernia with delayed bowel obstruction. International journal

Takeshi Nishimura, Atsunori Nakao, Ayana Okamoto, Noritomo Fujisaki, Joji Kotani

Surgical case reports 1 ( 1 ) 15 - 15 2015.12

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Traumatic abdominal hernia is rare and difficult to diagnose from physical symptoms. PATIENT: A 60-year-old woman was admitted to the emergency department with complaints of vomiting after falling off a bicycle and hitting her abdomen against one of the handlebars 2 days earlier. Computed tomography (CT) demonstrated abdominal wall hernia from blunt trauma to the left upper abdomen. The patient underwent exploratory laparotomy, and the herniated bowel loop was not found to be perforated or gangrenous. Primary hernia repair without resection of the bowel loop was performed. RESULTS: Postoperative course was uneventful. CONCLUSION: Surgical exploration with primary repair of the defect is the definitive treatment in the present case, as the hernia contained an incarcerated loop of small bowel. The use of abdominal CT to confirm the diagnosis before operative repair of the hernia appears to be a safe and efficacious adjunct to physical examination.

DOI： 10.1186/s40792-015-0023-7

Hydrogen inhalation protects against acute lung injury induced by hemorrhagic shock and resuscitation Reviewed

Keisuke Kohama, Hayato Yamashita, Michiko Aoyama-Ishikawa, Toru Takahashi, Timothy R. Billiar, Takeshi Nishimura, Joji Kotani, Atsunori Nakao

SURGERY 158 ( 2 ) 399 - 407 2015.8

Language：English Publishing type：Research paper (scientific journal) Publisher：MOSBY-ELSEVIER

Introduction. Hemorrhagic shock followed by fluid resuscitation (HS/R) triggers an inflammatory response and causes pulmonary inflammation that can lead to acute lung injury (ALI). Hydrogen, a therapeutic gas, has potent cytoprotective, antiinflammatory, and antioxidant effects. This study examined the effects of inhaled hydrogen on ALI caused by HS/R.
Methods. Rats were subjected to hemorrhagic shock by withdrawing blood to lower blood pressure followed by resuscitation with shed blood and saline to restore blood pressure. After HS/R, the rats were maintained in a control gas of similar composition to room air or exposed to 1.3% hydrogen.
Results. HS/R induced ALL as demonstrated by significantly impaired gas exchange, congestion, edema, cellular infiltration, and hemorrhage in the lungs. Hydrogen inhalation mitigated lung injury after HS/R, as indicated by significantly improved gas exchange and reduced cellular infiltration and hemorrhage. Hydrogen inhalation did not affect hemodynamic status during HS/R Exposure to 1.3% hydrogen significantly attenuated the upregulation of the messenger RNAs for several proinflammatory mediators induced by HS/R Lipid peroxidation was reduced significantly in the presence of hydrogen, indicating antioxidant effects.
Conclusion. Hydrogen, administered through inhalation, may exert potent therapeutic effects against ALI induced by HS/R and attenuate the activation of inflammatory cascades.

DOI： 10.1016/j.surg.2015.03.038

Endogenous interleukin 18 regulates testicular germ cell apoptosis during endotoxemia Reviewed

Taketo Inoue, Michiko Aoyama-Ishikawa, Shingo Kamoshida, Satoshi Nishino, Maki Sasano, Nobuki Oka, Hayato Yamashita, Motoki Kai, Atsunori Nakao, Joji Kotani, Makoto Usami

REPRODUCTION 150 ( 2 ) 105 - 114 2015.8

Language：English Publishing type：Research paper (scientific journal) Publisher：BIOSCIENTIFICA LTD

Orchitis (testicular swelling) often occurs during systemic inflammatory conditions, such as sepsis. Interleukin 18 (IL18) is a proinflammatory cytokine and is an apoptotic mediator during endotoxemia, but the role of IL18 in response to inflammation in the testes was unclear. WT and IL18 knockout (KO) mice were injected lipopolysaccharide (LPS) to induce endotoxemia and examined 12 and 48 h after LPS administration to model the acute and recovery phases of endotoxemia. Caspase activation was assessed using immunohistochemistry. Protein and mRNA expression were examined by western blot and quantitative real-time RT-PCR respectively. During the acute phase of endotoxemia, apoptosis (as indicated by caspase-3 cleavage) was increased in WT mice but not in IL18 KO mice. The death receptor-mediated and mitochondrial-mediated apoptotic pathways were both activated in the WT mice but not in the KO mice. During the recovery phase of endotoxemia, apoptosis was observed in the IL18 KO mice but not in the WT mice. Activation of the death-receptor mediated apoptotic pathway could be seen in the IL18 KO mice but not the WT mice. These results suggested that endogenous IL18 induces germ cell apoptosis via death receptor mediated- and mitochondrial-mediated pathways during the acute phase of endotoxemia and suppresses germ cell apoptosis via death-receptor mediated pathways during recovery from endotoxemia. Taken together, IL18 could be a new therapeutic target to prevent orchitis during endotoxemia.

DOI： 10.1530/REP-14-0427

A Case of Perianal Impalement Rectal Injury Presenting Pneumoperitoneum

39 ( 2 ) 132 - 134 2015.2

Endogenous Interleukin 18 Suppresses Hyperglycemia and Hyperinsulinemia during the Acute Phase of Endotoxemia in Mice Reviewed

Hayato Yamashita, Michiko Aoyama-Ishikawa, Miki Takahara, Chisato Yamauchi, Taketo Inoue, Makoto Miyoshi, Noriaki Maeshige, Makoto Usami, Atsunori Nakao, Joji Kotani

SURGICAL INFECTIONS 16 ( 1 ) 90 - 96 2015.2

Language：English Publishing type：Research paper (scientific journal) Publisher：MARY ANN LIEBERT, INC

Background: Hyperglycemia associated with insulin resistance is common among critically ill patients. Interleukin (IL)-18 has been linked with hyperglycemia and insulin resistance in chronic disease, but the relation between IL-18 and insulin resistance during critical illness was unexplored. This study investigated whether IL-18 modulates hyperglycemia and insulin resistance during acute inflammation.
Methods: We injected lipopolysaccharide (LPS) 40 mg/kg into wild-type (WT) and IL-18 knockout (KO) mice to induce endotoxemia and examined insulin resistance and insulin-dependent signaling pathways during the acute phase.
Results: During the first hour after LPS treatment, IL-18 KO mice showed higher blood glucose and insulin and less insulin receptor substrate-1 and less phosphorylated Akt in the liver compared with WT mice. Interleukin-18 KO mice exhibited better survival after LPS treatment.
Conclusions: The findings suggest that endogenous IL-18 may attenuate hyperglycemia and modulate insulin signaling in liver. Accordingly, IL-18 may modulate glucose tolerance during acute inflammation.

DOI： 10.1089/sur.2013.269

A Case of Traumatic Carotid Cavernous Fistula after the Head Injury Which Healed Spontaneously

39 ( 1 ) 62 - 64 2015.1

High Frequency Oscillatory Ventilation(HFOV)が奏功したインフルエンザ重症呼吸不全の1症例

藤崎宣友, 岡本彩那, 満保直美, 寺嶋真理子, 中尾篤典, 小谷穣治

日本集中治療医学会雑誌 22 ( Suppl. ) [DP109 - 2] 2015.1

To remove or not remove? Twenty or more sewing needles in the gastrointestinal tract

Yoshimichi Yamaguchi, Mariko Terashima, Atsunori Nakao, Norichika Yoshie, Noritomo Fujisaki, Taihei Yamada, Ayana Okamoto, Atsunori Hashimoto, Joji Kotani

Acute Medicine & Surgery 1 ( 4 ) 250 - 251 2014.10

Successful treatment of panton-valentine leukocidin-expressing staphylococcus aureus-Associated pneumonia co-infected with influenza using extracorporeal membrane oxygenation

Noritomo Fujisaki, Azusa Takahashi, Takahiro Arima, Tomoya Mizushima, Katsuki Ikeda, Hiroyuki Kakuchi, Atsunori Nakao, Joji Kotani, Koji Sakaida

In Vivo 28 ( 5 ) 961 - 966 2014.9

Language：English Publishing type：Research paper (scientific journal) Publisher：International Institute of Anticancer Research

Background: Panton-Valentine leukocidin (PVL) is a cytotoxin that causes leukocyte destruction and lung necrosis. Managing respiratory failure and acute respiratory distress syndrome secondary to PVL-expressing Staphylococcus aureus pneumonia and its associated lung necrosis with mechanical ventilation is challenging. We report a patient with lifethreatening PVL-expressing S. aureus-Associated pneumonia who was rescued using extracorporeal membrane oxygenation (ECMO). Case Report: We examined the case of a woman who presented to our Emergency Department with septic shock due to PVL-expressing S. aureus-Associated pneumonia. A 27-yearold Filipino woman was transferred to our hospital due to severe dyspnea, hemosputum, and high-grade fever. She had a medical history of osteosarcoma of the leg and hyperthyroidism. On arrival, her vital signs indicated septic shock, with a white blood cell count of 3.5×103/μl. Because a Gram stain of her sputum indicated SA, therapy with antibiotics, including meropenem and vancomycin, was started. Hypoxemia necessitated intubation and ventilation. Because the patient's PaO2/FiO2 remained less than 60 mmHg and her blood pressure was unstable despite aggressive conventional management, venoarterial ECMO was administered approximately 11 h after her arrival. The ECMO circuit was changed to veno-venous ECMO on day 7 and the patient was successfully weaned off ECMO after 12 days of treatment. She was discharged from the hospital 104 days after admission. Conclusion: This case demonstrates that early induction of ECMO support can be a reasonable therapeutic option for PVL-S. aureus-Associated pneumonia. This patient's successful outcome might be attributable to early establishment of ECMO to prevent ventilation-induced lung injury.

頭部外傷後に内頸動脈海綿静脈洞瘻を来し自然治癒した1症例

岡本彩那, 坂田寛之, 松田健一, 満保直美, 西村健, 藤崎宣友, 山田太平, 寺嶋真理子, 中尾篤典, 久保山一敏, 小谷穣治

日本救急医学会雑誌 25 ( 8 ) 543 - 543 2014.8

Application of carbon monoxide for treatment of acute kidney injury

Atsunori Nakao, Taihei Yamada, Keisuke Kohama, Norichika Yoshie, Noritomo Fujisaki, Joji Kotani

Acute Medicine & Surgery 1 ( 3 ) 127 - 134 2014.7

Flail Chestの治療経験観血的整復固定術と陽圧換気管理

山田太平, 坂田寛之, 尾迫貴章, 寺嶋真理子, 宮脇淳志, 中尾篤典, 小谷穣治

日本外傷学会雑誌 28 ( 2 ) 225 - 225 2014.5

IL18 Production and IL18 Promoter Polymorphisms Correlate with Mortality in ICU Patients Reviewed

Taihei Yamada, Michiko Aoyama-Ishikawa, Hayato Yamashita, Mayu Fujiwara, Makoto Usami, Takahiro Ueda, Mariko Terashima, Keisuke Kohama, Atsunori Nakao, Joji Kotani

IN VIVO 28 ( 3 ) 391 - 396 2014.5

Language：English Publishing type：Research paper (scientific journal) Publisher：INT INST ANTICANCER RESEARCH

Background: Single nucleotide polymorphisms in the promoter of interleukin (IL)-18 (-607C/A and -137G/C) may affect the clinical course of inflammatory diseases. This study examined the relationship between the plasma IL18 levels, IL18 promoter polymorphism, and outcomes in the intensive care unit (ICU) setting. Patients and Methods: Plasma IL18 levels, IL18 promoter genotype, clinical variables, including APACHE II score, and mortality were examined in 70 ICU patients. Results: Plasma IL18 levels were significantly higher in patients who did not survive the ICU stay than in patients who survived, and were correlated with APACHE II score. When examined by IL18 promoter genotype, only patients with the -607CA genotype exhibited differences in IL18 expression between survivors and non-survivors. Conclusion: Plasma IL18 levels may predict outcome in patients with sepsis. IL18 promoter polymorphism, especially at -607, may increase IL18 production in some patients and might be useful in predicting the outcome of patients with sepsis in the ICU.

Supplementation of parenteral nutrition with fish oil attenuates acute lung injury in a rat model Reviewed

Keisuke Kohama, Atsunori Nakao, Mariko Terashima, Michiko Aoyama-Ishikawa, Takayuki Shimizu, Daisuke Harada, Mitsuo Nakayama, Hayato Yamashita, Mayu Fujiwara, Joji Kotani

JOURNAL OF CLINICAL BIOCHEMISTRY AND NUTRITION 54 ( 2 ) 116 - 121 2014.3

Language：English Publishing type：Research paper (scientific journal) Publisher：JOURNAL CLINICAL BIOCHEMISTRY & NUTRITION

Fish oil rich in n-3 polyunsaturated fatty acids has diverse immunomodulatory properties and attenuates acute lung injury when administered in enternal nutrition. However, enteral nutrition is not always feasible. Therefore, we investigated the ability of parenteral nutrition supplemented with fish oil to ameliorate acute lung injury. Rats were infused with parenteral nutrition solutions (without lipids, with soybean oil, or with soybean oil and fish oil) for three days. Lipopolysaccharide (15 mg/kg) was then administered intratracheally to induce acute lung injury, characterized by impaired lung function, polymorphonuclear leukocyte recruitment, parenchymal tissue damage, and upregulation of mRNAs for inflammatory mediators. Administration of parenteral nutrition supplemented with fish oil prior to lung insult improved gas exchange and inhibited neutrophil recruitment and upregulation of mRNAs for inflammatory mediators. Parenteral nutrition supplemented with fish oil also prolonged survival. To investigate the underlying mechanisms, leukotriene B4 and B5 leukotriene secretion was measured in neutrophils from the peritoneal cavity. The neutrophils from rats treated with fish oil-rich parenteral nutrition released significantly more leukotriene B5, an anti-inflammatory eicosanoid, than neutrophils isolated from rats given standard parenteral nutrition. Parenteral nutrition with fish oil significantly reduced lipopolysaccharide-induced lung injury in rats in part by promoting the synthesis of anti-inflammatory eicosanoids.

DOI： 10.3164/jcbn.13-90

A simple scoring system based on neutrophil count in sepsis patients Reviewed

Takahiro Ueda, Michiko Aoyama-Ishikawa, Atsunori Nakao, Taihei Yamada, Makoto Usami, Joji Kotani

MEDICAL HYPOTHESES 82 ( 3 ) 382 - 386 2014.3

Language：English Publishing type：Research paper (scientific journal) Publisher：CHURCHILL LIVINGSTONE

Background: The assessment of critically ill patients is often a challenge for clinicians. There are a number of scoring systems such as Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and C-reactive protein test (CRP), which have been shown to correlate with outcome in a variety of Intensive Care Unit (ICU) patients. Therefore, use of repeated measures of these preexisting scores over time is a reasonable attempt to assess the severity of organ dysfunction and predict outcome in critically ill patients. Several reports suggest that the neutrophil is a useful marker of sepsis. However, since both a large number and a small number of neutrophils indicate a severe situation, neutrophil count is difficult to use to directly predict patients'.
The hypothesis: We proposed a novel scoring system identify predictive factors using a simple blood cell count that may be associated with mortality in ICU patients. Our novel scoring system (n-score) was calculated as follows: ranges of neutrophils of 0-4999 cells/mm(3) and 5000-9999 cells/mm(3) were defined as 3 and 1 points, respectively. When the neutrophil count was over 10,000 cells/mm(3), the score was calculated by dividing the number of cells by 10,000. Then, 1 or 2 points were added when patients were female or male, respectively. We hypothesize that n-score may be a simple and easy scoring system to estimate mortality of the patients with sepsis and severe sepsis/septic shock without requirement of special methods or special measuring equipment, and may be as reliable as the APACHE II score or SOFA score.
Evaluation of the hypothesis: The retrospective evaluation was conducted at the Department of Emergency, Disaster and Critical Care Medicine at the Hyogo College of Medicine. Seventy-seven patients who were admitted to the emergency center and diagnosed sepsis or severe sepsis/septic shock between June 2007 and December 2012 and gave informed consent were enrolled. The n-score was significantly higher in non-survivors of sepsis and severe sepsis/septic shock (p < 0.01, t-test) than in survivors. The ROC curve showed a sensitivity of 61.5% and a specificity of 80.4% at an n-score of 3.8 points; the area under the curve was 0.736. In addition, n-score correlated with APACHE II score (p < 0.01, R = 0.378) and SOFA score (p < 0.05, R = 0.256) on admission.
Conclusion: Based on these preliminary evaluations, we hypothesize that n-score may be a useful scoring system to detect risk of death in sepsis and severe sepsis/septic shock. (C) 2014 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.mehy.2014.01.007

Recipient hyperbilirubinaemia protects cardiac graft in rat heterotopic heart transplantation Reviewed

Sungsoo Lee, Taihei Yamada, Takaaki Osako, Donna B. Stolz, Masanori Abe, Kenneth R. McCurry, Noriko Murase, Joji Kotani, Atsunori Nakao

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY 45 ( 3 ) 481 - 488 2014.3

Language：English Publishing type：Research paper (scientific journal) Publisher：OXFORD UNIV PRESS INC

OBJECTIVES: Since bilirubin is a known powerful antioxidant, this study examined whether recipient hyperbilirubinaemia protected heart grafts from ischaemia/reperfusion (I/R) injury and chronic rejection associated with rat cardiac transplantation.
METHODS: Heterotopic heart transplantation (HTx) was performed using congenitally hyperbilirubinaemic GUNN (j/j) and normobilirubinaemic GUNN (+/+) rats. Syngenic grafts from +/+ rats were transplanted into +/+ or j/j rats with 6 or 18 h cold storage in University of Wisconsin solution to study I/R injury. To evaluate the effect on chronic rejection, Brown Norway rat heart grafts were transplanted into +/+ or j/j rats under short-course tacrolimus immunosuppression.
RESULTS: The +/+ grafts in j/j rats demonstrated significantly lower serum creatine phosphokinase and higher left ventricular developed pressures and had smaller infarct areas than +/+ rats at 3 h after reperfusion. Graft survival with 18 h cold storage increased from 0% in +/+ rats to 41.7% in j/j rats. Malondialdehyde (a marker of lipid peroxidation), mRNA of the inflammatory mediators and phosphorylation of ERK1/2 were significantly decreased in the grafts transplanted into j/j rats compared with those transplanted into +/+ rats 1-3 h after reperfusion. The mean allograft survival in j/j recipients was prolonged to a median survival of 150 days from 84 days in +/+ recipients and was associated with less macrophage infiltrates and less intragraft inflammatory cytokine mRNA at d60. In vitro T-cell proliferation was significantly inhibited in the presence of bilirubin.
CONCLUSIONS: Recipient hyperbilirubinaemia ameliorated cardiac I/R injury, as well as chronic allograft rejection following HTx via regulation of inflammatory responses or T-cell proliferation.

DOI： 10.1093/ejcts/ezt402

Intravenous Immunoglobulin-Induced Neutrophil Apoptosis in the Lung during Murine Endotoxemia Reviewed

Michiko Aoyama-Ishikawa, Ayumi Seishu, Saori Kawakami, Noriaki Maeshige, Makoto Miyoshi, Takahiro Ueda, Makoto Usami, Atsunori Nakao, Joji Kotani

SURGICAL INFECTIONS 15 ( 1 ) 36 - 42 2014.2

Language：English Publishing type：Research paper (scientific journal) Publisher：MARY ANN LIEBERT, INC

Background: The pathophysiologic features of acute respiratory distress syndrome (ARDS) are attributed to neutrophil accumulation and over-activation. Low blood immunoglobulin G concentrations in septic shock patients are associated with higher risk of developing ARDS. This study showed the effects of intravenous immunoglobulin (IVIg) on neutrophil apoptosis and accumulation in the lung during murine endotoxemia. Methods: Male C57BL/6J mice were injected with saline or 7mg/kg of lipopolysaccharide (LPS), and 3h later also were injected with saline, IVIg 300mg/kg, or IVIg 1000mg/kg intraperitoneally. At 12h after LPS injection, mice were sacrificed and peripheral blood and lungs were collected. The lung messenger ribonucleic acid expression (tumor necrosis factor- [TNF-], inducible nitric oxide synthase [iNOS], and intercellular adhesion molecule-1 [ICAM-1]) was determined using quantitative realtime reverse transcriptase-polymerase chain reaction. Lungs were immersed in 4% paraformaldehyde and then embedded in paraffin. Tissue slices were prepared and stained with naphthol AS-D chloroacetate esterase to detect neutrophils. The numbers of neutrophils (characterized by the segment number of their nuclei) were counted. Peripheral neutrophil apoptosis was detected by annexin V using flow cytometry and lung neutrophil apoptosis was detected by cleaved caspase-3 using immunohistochemistry. Results: The survival rates of the saline group, LPS group, and IVIg group were all 100%. Apoptosis of peripheral blood neutrophils was inhibited by LPS. Neutrophil accumulation in the lung was decreased by both IVIg 300mg/kg and 1000mg/kg. Segmented neutrophils were reduced by IVIg during endotoxemia. However, IVIg 300mg/kg and 1000mg/kg had no influence on the lung messenger ribonucleic acid expression of TNF-, iNOS, or ICAM-1. Cleaved-caspase-3-positive neutrophils were increased in the IVIg 300mg/kg group during endotoxemia. The 1000mg/kg IVIG dose reduced the number of segmented neutrophils, but did not induce cleaved-caspase 3-positive neutrophils. Conclusion: A therapeutic IVIg dose can attenuate neutrophil accumulation and regulate neutrophil apoptosis in the lung during endotoxemia. It is possible that the pathways by which IVIG induces neutrophil apoptosis may differ depending on the IVIg concentration.

DOI： 10.1089/sur.2012.227

血栓溶解療法中に腹腔内出血が出現した経口避妊薬内服患者の一症例

寺嶋真理子, 中尾篤典, 橋本篤徳, 満保直美, 高杉遥, 村上裕亮, 山田勇, 小谷穣治

日本集中治療医学会雑誌 21 ( Suppl. ) [DP - 5] 2014.1

Role of endogenous IL-18 in the lung during endotoxin-induced systemic inflammation. Reviewed International journal

Miki Takahara, Michiko Aoyama-Ishikawa, Katsuhito Shuno, Chisato Yamauhi, Makoto Miyoshi, Noriaki Maeshige, Makoto Usami, Taihei Yamada, Takaaki Osako, Atsunori Nakao, Joji Kotani

Acute medicine & surgery 1 ( 1 ) 23 - 30 2014.1

Language：English Publishing type：Research paper (scientific journal)

Background: Overactivated neutrophils are causes of acute lung injury, which is a major clinical problem with significant morbidity and mortality in sepsis. Serum interleukin (IL)-18 levels correspond to severity of systemic inflammation. Aim: To elucidate the roles of endogenous IL-18 in lung injury during endotoxin-induced systemic inflammation. Methods: Wild-type (WT) and IL-18 gene knockout (KO) mice were injected with lipopolysaccharide (40 mg/kg) intraperitoneally and killed. Lungs were collected at 0 and 12 h to assess mRNA for intercellular adhesion molecule (ICAM)-1, inducible nitric oxide synthase, myeloperoxidase, immunohistochemistry (cleaved caspase-3, 8-hydroxy-2-deoxyguanosine), and wet/dry ratio. Blood was collected at 0, 1, 12, 18, and 24 h to assess plasma cytokine levels. Results: The survival rates at 24 h were approximately 43% and 76% in the WT and KO mice, respectively. Plasma IL-18 levels were induced time-dependently only in the WT mice. Plasma interferon-γ levels were significantly higher in the WT than in the KO mice at 12 h, but IL-6 and tumor necrosis factor-α levels did not differ between the WT and KO mice. At 12 h, the WT mice showed higher myeloperoxidase activity (P < 0.05), ICAM-1, and wet/dry ratios than KO mice. Cleaved caspase-3 positive neutrophils, which migrated in the lung interstitium, were lower in WT mice than in KO mice. Conclusions: Endogenous IL-18 induced neutrophil accumulation, accompanied by induction of ICAM-1 expression, inhibition of neutrophil apoptosis, and increased inducible nitric oxide synthase-induced oxidative tissue injury in the lung, leading to lung edema and poor outcome during endotoxemia.

DOI： 10.1002/ams2.6

Can carbon monoxide-poisoned victims be organ donors? International journal

Noritomo Fujisaki, Atsunori Nakao, Takaaki Osako, Takeshi Nishimura, Taihei Yamada, Keisuke Kohama, Hiroyuki Sakata, Michiko Ishikawa-Aoyama, Joji Kotani

Medical gas research 4 13 - 13 2014

Language：English Publishing type：Research paper (scientific journal)

The increasing demand for organ allografts to treat end-stage organ failure has driven changes in traditional donor criteria. Patients who have succumbed to carbon monoxide (CO) poisoning, a common cause of toxicological mortality, are usually rejected as organ donors. To fulfill the increasing demand, selection criteria must be expanded to include CO-poisoned donors. However, the use of allografts exposed to high CO concentrations is still under debate. Basic research and literature review data suggest that patients with brain death caused by CO poisoning should be considered appropriate organ donors. Accepting organs from CO-poisoned victims could increase the number of potential donors and lower the death rate of patients on the waiting lists. This review and reported cases may increase awareness among emergency department physicians, as well as transplant teams, that patients dying of CO exposure may be acceptable organ donors.

DOI： 10.1186/2045-9912-4-13

Can carbon monoxide-poisoned victims be organ donors?

Noritomo Fujisaki, Atsunori Nakao, Takaaki Osako, Takeshi Nishimura, Taihei Yamada, Keisuke Kohama, Hiroyuki Sakata, Michiko Ishikawa-Aoyama, Joji Kotani

Medical Gas Research 4 ( 1 ) 13 - 13 2014

Gastrointestinal symptoms and food/nutrition concerns after the great east japan earthquake in march 2011: Survey of evacuees in a temporary shelter Reviewed

Tomoko Inoue, Atsunori Nakao, Kazutoshi Kuboyama, Atsunori Hashimoto, Motomaru Masutani, Takahiro Ueda, Joji Kotani

Prehospital and Disaster Medicine 29 ( 3 ) 303 - 306 2014

Language：English Publishing type：Research paper (scientific journal) Publisher：Cambridge University Press

On March 11, 2011, a 9.1 magnitude earthquake occurred in the eastern Pacific Ocean off the coast of northern Japan. A resulting tsunami struck the Japan Pacific coast, causing &gt
20,000 deaths, injuries and missing persons. Survivors' post-tsunami health and nutritional status were surveyed one month after the disaster in a school shelter in Ishinomaki City. Hyogo College of Medicine's disaster relief team observations and survivors' questionnaires were used to assess the disaster's effects on survivors' lifestyles and gastrointestinal symptoms while residing in temporary shelters. Of 236 disaster evacuees 9-88 years of age (mean age 52 years), 23% lost weight and 28% reported decreased food intake one month after the earthquake. Up to 25% of the participants presented with gastrointestinal symptoms, including constipation (10%), appetite loss (6.4%), vomiting (6.4%), and nausea (2.1%). Although the victims preferred more vegetables (44%) or fruit (33%), most food aid received, such as rice balls or bread, was carbohydrate-based, possibly because of easy provision and abundance in emergency food pantries. The authors asked the volunteers and the Japan Self-Defense Forces to provide a more balanced diet, including vegetables and fruit. Consumption of imbalanced diets may have caused more gastrointestinal symptoms for the survivors. Because of the victims' hesitation to request more balanced diets, and because of poorly controlled existing chronic disease and mental stress, professional public health providers should assure emergency food nutrition after disasters.

DOI： 10.1017/S1049023X14000533

開放性気胸合併フレイルチェストに対し、肋骨ピンによる観血的骨接合術が奏功した1症例

寺嶋真理子, 山田太平, 橋本篤徳, 中尾篤典, 山田勇, 小谷穣治

日本Acute Care Surgery学会学術集会プログラム・抄録 5回 53 - 53 2013.11

急性虫垂炎症状を呈し生前には診断困難であった劇症型アメーバ赤痢の一例

満保直美, 寺嶋真理子, 橋本篤徳, 和田恭直, 山田勇, 中尾篤典, 小谷穣治

日本外科感染症学会雑誌 10 ( 5 ) 705 - 705 2013.10

敗血症性ショックを呈した、壊死性筋膜炎の1例

寺嶋真理子, 宮脇敦志, 満保直美, 中尾篤典, 橋本篤徳, 松田健一, 坂田寛之, 岡本彩那, 上田敬博, 小谷穣治

日本外科感染症学会雑誌 10 ( 5 ) 701 - 701 2013.10

Successful treatment of a 14-year-old patient with intestinal malrotation with laparoscopic Ladd procedure: case report and literature review. Reviewed International journal

Yuka Nakajima, Hiroyuki Sakata, Tomohiro Yamaguchi, Norichika Yoshie, Taihei Yamada, Takaaki Osako, Mariko Terashima, Naomi Mambo, Ryuta Saka, Satoko Nose, Takashi Sasaki, Hiroomi Okuyama, Atsunori Nakao, Joji Kotani

World journal of emergency surgery : WJES 8 ( 1 ) 19 - 19 2013.5

Language：English Publishing type：Research paper (scientific journal)

Midgut malrotation is an anomaly of intestinal rotation that occurs during fetal development and usually presents in the neonatal period. We present a rare case of malrotation in a 14-year-old patient who presented with cramping, generalized right abdominal pain, and vomiting for a duration of one day. A computed tomography abdominal scan and upper gastrointestinal contrast studies showed malrotation of the small bowel without volvulus. Laparoscopy revealed typical Ladd's bands and a distended flabby third and fourth duodenal portion extrinsically obstructing the misplaced duodeno-jejunal junction. The Ladd procedure, including widening of the mesenteric base and appendectomy, was performed. Symptoms completely resolved in a half-year follow up period. Patients with midgut malrotation may present with vague abdominal pain, intestinal obstruction, or intestinal ischemia. The laparoscopic Ladd procedure is feasible and safe, and it appears to be as effective as the standard open Ladd procedure in the diagnosis and treatment of teenage or adult patients with intestinal malrotation.

DOI： 10.1186/1749-7922-8-19

NOMI(非閉塞性腸管虚血症)に伴う結腸壊死を合併した重症急性膵炎の1例

山田勇, 寺嶋真理子, 橋本篤典, 中尾篤典, 上田敬博, 小谷穣治

日本外科系連合学会誌 38 ( 3 ) 693 - 693 2013.5

Hydrogen gas reduces hyperoxic lung injury via the Nrf2 pathway in vivo

Tomohiro Kawamura, Nobunao Wakabayashi, Norihisa Shigemura, Chien-Sheng Huang, Kosuke Masutani, Yugo Tanaka, Kentaro Noda, Ximei Peng, Toru Takahashi, Timothy R. Billiar, Meinoshin Okumura, Yoshiya Toyoda, Thomas W. Kensler, Atsunori Nakao

AMERICAN JOURNAL OF PHYSIOLOGY-LUNG CELLULAR AND MOLECULAR PHYSIOLOGY 304 ( 10 ) L646 - L656 2013.5

Language：English Publishing type：Research paper (scientific journal) Publisher：AMER PHYSIOLOGICAL SOC

Hyperoxic lung injury is a major concern in critically ill patients who receive high concentrations of oxygen to treat lung diseases. Successful abrogation of hyperoxic lung injury would have a huge impact on respiratory and critical care medicine. Hydrogen can be administered as a therapeutic medical gas. We recently demonstrated that inhaled hydrogen reduced transplant-induced lung injury and induced heme oxygenase (HO)-1. To determine whether hydrogen could reduce hyperoxic lung injury and investigate the underlying mechanisms, we randomly assigned rats to four experimental groups and administered the following gas mixtures for 60 h: 98% oxygen (hyperoxia), 2% nitrogen; 98% oxygen (hyperoxia), 2% hydrogen; 98% balanced air (normoxia), 2% nitrogen; and 98% balanced air (normoxia), 2% hydrogen. We examined lung function by blood gas analysis, extent of lung injury, and expression of HO-1. We also investigated the role of NF-E2-related factor (Nrf) 2, which regulates HO-1 expression, by examining the expression of Nrf2-dependent genes and the ability of hydrogen to reduce hyperoxic lung injury in Nrf2-deficient mice. Hydrogen treatment during exposure to hyperoxia significantly improved blood oxygenation, reduced inflammatory events, and induced HO-1 expression. Hydrogen did not mitigate hyperoxic lung injury or induce HO-1 in Nrf2-deficient mice. These findings indicate that hydrogen gas can ameliorate hyperoxic lung injury through induction of Nrf2-dependent genes, such as HO-1. The findings suggest a potentially novel and applicable solution to hyperoxic lung injury and provide new insight into the molecular mechanisms and actions of hydrogen.

DOI： 10.1152/ajplung.00164.2012

重症胸部外傷による呼吸不全に対し体外式肺補助(ECMO)管理した1症例

山田太平, 小谷穣治, 久保山一敏, 上田敬博, 尾迫貴章, 中島有香, 吉江範親, 松田健一, 中尾篤典, 寺嶋真理子, 小濱圭祐, 橋本篤徳, 満保直美

日本外傷学会雑誌 27 ( 2 ) 225 - 225 2013.4

肝損傷修復術後の腹腔内膿瘍がプレジェットにより遷延、十二指腸穿孔に至った一例

小濱圭祐, 寺嶋真理子, 橋本篤徳, 山田勇, 中尾篤典, 山田太平, 満保直美, 宮脇淳志, 久保山一敏, 小谷穣治

日本外傷学会雑誌 27 ( 2 ) 242 - 242 2013.4

Linezolid-induced lactic acidosis followed by severe hypophosphatemia after discontinuation of linezolid. Reviewed International journal

Atsushi Miyawaki, Takahiro Ueda, Atsunori Nakao, Masaru Adachi, Munehiko Ohya, Isamu Yamada, Yoshio Takesue, Joji Kotani

Surgical infections 14 ( 2 ) 229 - 30 2013.4

The effects of n-3 polyunsaturated fatty acid-rich total parenteral nutrition on neutrophil apoptosis in a rat endotoxemia Reviewed

Mariko Terashima, Michiko Aoyama-Ishikawa, Takahiro Ueda, Akifumi Hagi, Makoto Usami, Atsunori Nakao, Joji Kotani

JOURNAL OF CLINICAL BIOCHEMISTRY AND NUTRITION 52 ( 2 ) 154 - 159 2013.3

Language：English Publishing type：Research paper (scientific journal) Publisher：JOURNAL CLINICAL BIOCHEMISTRY & NUTRITION

Although recruited neutrophils function as first-line defense to remove bacteria, delayed apoptosis is implicated in persistent inflammation leading to organ injury. Leukotrien B-4, n-6 polyunsaturated fatty acids (PUFAs) product, is one of the mediators that delay neutrophil apoptosis. The mechanism of the beneficial effects of supplementation of fish oil-based long-chain n-3 PUFAs in parenteral nutrition for critically ill patients has not been fully understood. One possible mechanism is the less inflammatory n-3 PUFAs products can compete with proinflammatory n-6 PUFAs products for access to the enzymes. The aim of this study was to determine whether n-3 PUFA rich parenteral nutrition may alter the composition of fatty acids in the neutrophil membrane and restore delay of neutrophil apoptosis during endotoxin-induced systemic inflammation in rats. The animals in group 1 were treated with 20% Hicaliq NC-N in Neoparen-2 for three days. The animals in group 2 (referred to as n-6 PUFA-rich parenteral nutrition) were given parenteral nutrition solutions containing 20% soybean oil in Neoparen-2 (n-6/n-3 = 10). The animals in group 3 (referred to as n-3 PUFA-rich parenteral nutrition) were administered parenteral nutrition consisting of 10% soybean oil and 10% fish oil emulsion (n-6/n-3 = 1.3). The n-3/n-6 ratio of the neutrophil membrane was significantly increased in group 3 and was associated with restored lipopolysaccharide-delayed-apoptosis of neutrophils in bone marrow cells and increased production of leukotriene B-5 from peritoneal neutrophils stimulated by lipopolysaccharide. Our preliminary results showed that n-3 PUFA-rich parenteral nutrition regulated neutrophil apoptosis and prevented synthesis of pro-inflammatory eicosanoids, explaining the protective effects seen in the clinical setting.

DOI： 10.3164/jcbn.12-86

重症急性膵炎の集計から発覚した、難病疾患登録とDPC登録病名の盲点

橋本篤徳, 井上朋子, 山田太平, 小濱圭祐, 寺嶋真理子, 中尾篤典, 山田勇, 小谷穣治

日本腹部救急医学会雑誌 33 ( 2 ) 492 - 492 2013.2

Inhalation of carbon monoxide following resuscitation ameliorates hemorrhagic shock-induced lung injury Reviewed

Susumu Kawanishi, Toru Takahashi, Hiroshi Morimatsu, Hiroko Shimizu, Emiko Omori, Kenji Sato, Masaki Matsumi, Shigeru Maeda, Atsunori Nakao, Kiyoshi Morita

MOLECULAR MEDICINE REPORTS 7 ( 1 ) 3 - 10 2013.1

Language：English Publishing type：Research paper (scientific journal) Publisher：SPANDIDOS PUBL LTD

Even after successful resuscitation, hemorrhagic shock frequently causes pulmonary inflammation that induces acute lung injury (ALI). We previously demonstrated that when CO is inhaled at a low concentration both prior to and following hemorrhagic shock and resuscitation (HSR) it ameliorates HSR-induced ALI in rats due to its anti-inflammatory effects. In the present study, we administered CO to the same model of ALI only after resuscitation and examined whether it exerted a therapeutic effect without adverse events on HSR-induced ALI, since treatment of animals with CO prior to HSR did not prevent lung injury. HSR were induced by bleeding animals to achieve a mean arterial pressure of 30 mmHg for I h followed by resuscitation with the removed blood. HSR resulted in the upregulation of inflammatory gene expression and increased the rate of apoptotic cell death in the lungs. This was determined from an observed increase in the number of cells positive for transferase-mediated dUTP-fluorescein isothiocyanate (FITC), nick-end labeling staining and activated caspase-3. HSR also resulted in prominent histopathological damage, including congestion, edema, cellular infiltration and hemorrhage. By contrast, CO inhalation for 3 h following resuscitation significantly ameliorated these inflammatory events, demonstrated by reduced histological damage, inflammatory mediators and apoptotic cell death. The protective effects of CO against lung injury were notably associated with an increase in the protein expression level of peroxisome proliferator-activated receptor (PPAR)-gamma, an anti-inflammatory transcriptional regulator in the lung. Moreover, CO inhalation did not affect the hemodynamic status or tissue oxygenation during HSR. These findings suggest that inhalation of CO at a low concentration exerts a potent therapeutic effect against HSR-induced ALI and attenuates the inflammatory cascade by increasing PPAR-gamma protein expression.

DOI： 10.3892/mmr.2012.1173

Application of a first impression triage in the Japan railway west disaster. Reviewed

Atsunori Hashimoto, Takahiro Ueda, Kazutoshi Kuboyama, Taihei Yamada, Mariko Terashima, Atsushi Miyawaki, Atsunori Nakao, Joji Kotani

Acta medica Okayama 67 ( 3 ) 171 - 6 2013

Language：English Publishing type：Research paper (scientific journal)

On April 25, 2005, a Japanese express train derailed into a building, resulting in 107 deaths and 549 injuries. We used "First Impression Triage (FIT)", our new triage strategy based on general inspection and palpation without counting pulse/respiratory rates, and determined the feasibility of FIT in the chaotic situation of treating a large number of injured people in a brief time period. The subjects included 39 patients who required hospitalization among 113 victims transferred to our hospital. After initial assessment with FIT by an emergency physician, patients were retrospectively reassessed with the preexisting the modified Simple Triage and Rapid Treatment (START) methodology, based on Injury Severity Score, probability of survival, and ICU stay. FIT resulted in shorter waiting time for triage. FIT designations comprised 11 red (immediate), 28 yellow (delayed), while START assigned six to red and 32 to yellow. There were no statistical differences between FIT and START in the accuracy rate calculated by means of probability of survival and ICU stay. Overall validity and reliability of FIT determined by outcome assessment were similar to those of START. FIT would be a simple and accurate technique to quickly triage a large number of patients.

DOI： 10.18926/AMO/50410

Lung transplantation in rats

Tomohiro Kawamura, Yugo Tanaka, Norihisa Shigemura, Yoshiya Toyoda, Atsunori Nakao

Experimental Organ Transplantation 159 - 173 2013

Language：English Publishing type：Part of collection (book) Publisher：Nova Science Publishers, Inc.

This chapter describes a unilateral, orthotopic lung transplantation (LTx) model using the cuff technique in rats. The advantage of this model over the suture technique includes a decrease in operation time, prevention of bleeding from the vascular anastomosis site, and shorter training period with stable outcomes. The rat LTx model has been proven valid for understanding physiological/pathological events occurring in lung grafts, as well as evaluating graft injuries due to inflammation or rejection, as seen in clinical lung transplant.&amp
copy 2013 Nova Science Publishers, Inc.

【外科領域における嫌気性菌感染症】ガス壊疽デブリドマン後の広範囲軟部組織欠損の症例にβ-ヒドロキシ-β-メチルブチレート(HMB)、アルギニン(Arg)、グルタミン(Gln)配合飲料を用いた1例

寺嶋真理子, 中尾篤典, 橋本篤徳, 山田太平, 満保直美, 小谷穣治

日本外科感染症学会雑誌 9 ( 6 ) 691 - 696 2012.12

Language：Japanese Publisher：(一社)日本外科感染症学会

β-ヒドロキシルβ-メチルブチレート・アルギニン・グルタミン(HMB/Arg/Gln)配合飲料は蛋白の合成を促進し、分解を抑制するといわれている。今回、臀部の褥瘡感染を契機に発症したガス壊疽部のデブリドマン後の皮膚軟部組織欠損部加療中に、HMB/Arg/Gln配合飲料を経口投与した症例を経験したので報告する。症例は67歳女性。仙骨、右坐骨部褥瘡に感染を伴い右臀部から大腿部にガス壊疽が出現したため当センターに搬入となった。同日創部の開放、デブリドマンを行い、2日目よりHMB/Arg/Gln配合飲料の摂取を開始し、良好な創閉鎖につながった。ガス壊疽などの壊死性軟部組織感染症の治療として、感染壊死組織のデブリドマンと同時に欠損部の修復も重要である。HMB/Arg/Gln配合飲料を用いた代謝栄養学的アプローチは容易で有用な方法と思われた。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J04188&link_issn=&doc_id=20130128230009&doc_link_id=%2Fdg9srgif%2F2012%2F000906%2F010%2F0691-0696%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg9srgif%2F2012%2F000906%2F010%2F0691-0696%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Preservation solution supplemented with biliverdin prevents lung cold ischaemia/reperfusion injury. Reviewed International journal

Ryujiro Sugimoto, Yugo Tanaka, Kentaro Noda, Tomohiro Kawamura, Yoshiya Toyoda, Timothy R Billiar, Kenneth R McCurry, Atsunori Nakao

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 42 ( 6 ) 1035 - 41 2012.12

Language：English Publishing type：Research paper (scientific journal) Publisher：OXFORD UNIV PRESS INC

OBJECTIVES: Biliverdin (BV), one of the byproducts of heme catalysis through the heme oxygenase system, is a known scavenger of the reactive oxygen species. We hypothesized that adding BV to the perfusate and cold storage solution could protect rat lung grafts from oxidative injuries via its antioxidant efficacies. METHODS: Orthotopic left lung transplantation was performed in a syngenic Lewis-to-Lewis rat combination under 100% oxygen. Grafts were preserved in low-potassium dextran (LPD; Perfadex) at 4°C for 6 h with or without supplementation of 1 or 10 μM of BV into LPD. RESULTS: Prolonged cold storage and reperfusion resulted in a considerable deterioration of graft functions associated with massive apoptosis in the grafts after reperfusion. The untreated grafts exhibited the early up-regulations of mRNA for inflammatory mediators and an increase in a marker of lipid peroxidation, showing oxidative injuries. Although BV supplementation of LPD at a lower concentration (1 μM) did not improve the graft gas exchange, the grafts treated with BV (10 μM) showed a significant improvement of oxygenation and less inflammatory responses as well as reduced lipid peroxidation and apoptosis. Although the rapid activations of mitogen-activated protein kinases (MAPKs) were seen 30 min after reperfusion in the grafts stored in control LPD, BV treatment significantly reduced phosphorylated-MAPK protein expression. CONCLUSIONS: This study demonstrates that the exposure of the lung grafts to BV during cold storage can impart potent cytoprotective effects to lung cold ischaemia/reperfusion injury and significantly improve the lung graft function following extended cold preservation and transplantation by the mechanism of a reduction in oxidative injury and following inflammatory events.

DOI： 10.1093/ejcts/ezs298

A secure "double-check" technique of bedside post pyloric feeding tube placement using transnasal endoscopy. Reviewed

Atsunori Hashimoto, Munehiko Oya, Mika Iwano, Chisako Fuse, Tomoko Inoue, Taihei Yamada, Mariko Terashima, Takaaki Osako, Takahiro Ueda, Isamu Yamada, Atsunori Nakao, Joji Kotani

Journal of clinical biochemistry and nutrition 51 ( 3 ) 213 - 5 2012.11

Language：English Publishing type：Research paper (scientific journal) Publisher：JOURNAL CLINICAL BIOCHEMISTRY & NUTRITION

Enteral feeding has become an important means of providing nutritional support to seriously ill patients. Placement of the feeding tube through the pyloric ring and past the ligament of Treitz into the proximal jejunum is critical to reduce the risk of gastroesophageal regurgitation and microaspiration. We started utilizing transnasal endoscopy for intestinal feeding tube placement, placing enteral tubes for 40 patients between March 2008 and February 2009. Although we achieved a high success rate comparable to previous reports, we experienced several cases of failure, which was corrected with repeated endoscopy. Based on these experiences, we modified our method by adding a "double-check" transnasal endoscopy through the other nasal passage. After April 2010, we have placed the feeding tube by "double-check" method for all patients (more than 40 patients) who required transnasal endoscopic feeding tube placement. We have not experienced any misplacement in all these patients after 24 h later with 100% successful rate since the introduction of "double-check" procedure. We describe our experience with "double-check" transnasal endoscopic feeding tube placement, which we found to be a helpful adjunct, for patients in intensive care unit.

DOI： 10.3164/jcbn.12-35

The effect of donor treatment with hydrogen on lung allograft function in rats

Tomohiro Kawamura, Chien-Sheng Huang, Ximei Peng, Kosuke Masutani, Norihisa Shigemura, Timothy R. Billiar, Meinoshin Okumura, Yoshiya Toyoda, Atsunori Nakao

SURGERY 150 ( 2 ) 240 - 249 2011.8

Language：English Publishing type：Research paper (scientific journal) Publisher：MOSBY-ELSEVIER

Background. Because inhaled hydrogen provides potent anti-inflammatory and antiapoptotic effects against acute lung injury, we hypothesized that treatment of organ donors with inhaled hydrogen during mechanical ventilation would decrease graft injury after lung transplantation.
Methods. Orthotopic left lung transplants were performed using a fully allogeneic Lewis to Brown Norway rat model. The donors were exposed to mechanical ventilation with 98% oxygen plus 2% nitrogen or 2% hydrogen for 3 h prior to harvest, and the lung grafts underwent 4 h of cold storage in Perfadex (Vitrolife, Goteborg, Sweden). The graft function, histomorphologic changes, and inflammatory reactions were assessed.
Results. The combination of mechanical ventilation and prolonged cold ischemia resulted in marked deterioration of gas exchange when the donors were ventilated with 2% nitrogen/98% oxygen, which was accompanied by upregulation of proinflammatory cytokines and proapoptotic molecules. These lung injuries were attenuated significantly by ventilation with 2% hydrogen. Inhaled hydrogen induced heme oxygenase-1, an antioxidant enzyme, in the lung grafts prior to implantation, which might contribute to protective effects afforded by hydrogen.
Conclusion. Preloaded hydrogen gas during ventilation prior to organ procurement protected lung grafts effectively from ischemia/reperfusion-induced injury in a rat lung transplantation model. (Surgery 2011;150:240-9.)

DOI： 10.1016/j.surg.2011.05.019

Effects of drinking hydrogen-rich water on the quality of life of patients treated with radiotherapy for liver tumors Invited Reviewed

Ki-Mun Kang, Young-Nam Kang, Ihil-Bong Choi, Yeunhwa Gu, Tomohiro Kawamura, Yoshiya Toyoda, Atsunori Nakao

Medical Gas Research 1 ( 1 ) 1 - 11 2011

Language：English Publishing type：Research paper (scientific journal) Publisher：BioMed Central Ltd.

Background: Cancer patients receiving radiotherapy often experience fatigue and impaired quality of life (QOL). Many side effects of radiotherapy are believed to be associated with increased oxidative stress and inflammation due to the generation of reactive oxygen species during radiotherapy. Hydrogen can be administered as a therapeutic medical gas, has antioxidant properties, and reduces inflammation in tissues. This study examined whether hydrogen treatment, in the form of hydrogen-supplemented water, improved QOL in patients receiving radiotherapy. Methods. A randomized, placebo-controlled study was performed to evaluate the effects of drinking hydrogen-rich water on 49 patients receiving radiotherapy for malignant liver tumors. Hydrogen-rich water was produced by placing a metallic magnesium stick into drinking water (final hydrogen concentration
0.55∼0.65 mM). The Korean version of the European Organization for Research and Treatment of Cancer's QLQ-C30 instrument was used to evaluate global health status and QOL. The concentration of derivatives of reactive oxidative metabolites and biological antioxidant power in the peripheral blood were assessed. Results: The consumption of hydrogen-rich water for 6 weeks reduced reactive oxygen metabolites in the blood and maintained blood oxidation potential. QOL scores during radiotherapy were significantly improved in patients treated with hydrogen-rich water compared to patients receiving placebo water. There was no difference in tumor response to radiotherapy between the two groups. Conclusions: Daily consumption of hydrogen-rich water is a potentially novel, therapeutic strategy for improving QOL after radiation exposure. Consumption of hydrogen-rich water reduces the biological reaction to radiation-induced oxidative stress without compromising anti-tumor effects. © 2011 Kang et al
licensee BioMed Central Ltd.

DOI： 10.1186/2045-9912-1-11

Inhaled hydrogen gas therapy for prevention of lung transplant-induced ischemia/reperfusion injury in rats

Tomohiro Kawamura, Chien-Sheng Huang, Naobumi Tochigi, Sungsoo Lee, Norihisa Shigemura, Timothy R. Billiar, Meinoshin Okumura, Atsunori Nakao, Yoshiya Toyoda

Transplantation 90 ( 12 ) 1344 - 1351 2010.12

Language：English Publishing type：Research paper (scientific journal)

Background. Successful abrogation of ischemia/reperfusion (I/R) injury of lung grafts could significantly improve short- and long-term outcomes for lung transplant (LTx) recipients. Hydrogen gas has potent antioxidant and antiapoptotic properties and has been recently used in number of experimental and clinical studies. The purpose of this research was to investigate whether inhaled hydrogen gas could reduce graft I/R injury during lung transplantation. Methods. Orthotopic left LTxs were performed in syngenic Lewis rats. Grafts were perfused with and stored in low potassium dextran solution at 4°C for 6 hr. The recipients received 100% O2 or 98% O2 with 2% N 2, 2% He, or 2% H2 during surgery and 1 hr after reperfusion. The effects of hydrogen were assessed by functional, pathologic, and molecular analysis. Results. Gas exchange was markedly impaired in animals exposed to 100% O2, 2% N2, or 2% He. Hydrogen inhalation attenuated graft injury as indicated by significantly improved gas exchange 2 hr after reperfusion. Graft lipid peroxidation was significantly reduced in the presence of hydrogen, demonstrating antioxidant effects of hydrogen in the transplanted lungs. Lung cold I/R injury causes the rapid production and release of several proinflammatory mediators and epithelial apoptosis. Exposure to 2% H2 significantly blocked the production of several proinflammatory mediators and reduced apoptosis with induction of the antiapoptotic molecules B-cell lymphoma-2 and B-cell lymphoma-extra large. Conclusion. Treatment of LTx recipients with inhaled hydrogen can prevent lung I/R injury and significantly improve the function of lung grafts after extended cold preservation, transplant, and reperfusion. © 2010 by Lippincott Williams &amp
Wilkins.

DOI： 10.1097/TP.0b013e3181fe1357

Protective Effect of Carbon Monoxide Inhalation on Lung Injury After Hemorrhagic Shock/Resuscitation in Rats Reviewed

Fumitoshi Kanagawa, Toru Takahashi, Kazuyoshi Inoue, Hiroko Shimizu, Emiko Omori, Hiroshi Morimatsu, Shigeru Maeda, Hiroshi Katayama, Atsunori Nakao, Kiyoshi Morita

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE 69 ( 1 ) 185 - 194 2010.7

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

Background: Hemorrhagic shock and resuscitation (HSR) induces pulmonary inflammation that leads to acute lung injury. Carbon monoxide (CO), a by-product of heme catalysis, was shown to have potent cytoprotective and anti-inflammatory effects. The aim of this study was to examine the effects of CO inhalation at low concentration on lung injury induced by HSR in rats.
Methods: Rats were subjected to HSR by bleeding to achieve mean arterial pressure of 30 mm Hg for 60 minutes followed by resuscitation with shed blood and saline as needed to restore blood pressure. HSR animals were either maintained in room air or were exposed to CO at 250 ppm for 1 hour before and 3 hours after HSR.
Results: HSR caused an increase in the DNA binding activity of nuclear factor-kappa B and activator protein-1 in the lung followed by the up-regulation of pulmonary gene expression of tumor necrosis factor-alpha, inducible nitric oxide synthase, and interleukin (IL)-10. HSR also resulted in an increase in myeloperoxidase activity and wet weight to dry weight ratio in the lung, and more prominent histopathologic changes including congestion, edema, cellular infiltration, and hemorrhage. In contrast, CO inhalation significantly ameliorated these inflammatory events as judged by fewer histologic changes, less up-regulation of inflammatory mediators, and less activation of nuclear factor-kappa B and activator protein-1. Interestingly, the protective effects against lung injury afforded by CO were associated with further increases in mRNA expression of IL-10 in the lung.
Conclusions: These findings suggest that inhaled CO at a low concentration ameliorated HSR-induced lung injury and attenuated inflammatory cascades by up-regulation of anti-inflammatory IL-10.

DOI： 10.1097/TA.0b013e3181bbd516

Amelioration of rat cardiac cold ischemia/reperfusion injury with inhaled hydrogen or carbon monoxide, or both. Reviewed International journal

Atsunori Nakao, David J Kaczorowski, Yinna Wang, Jon S Cardinal, Bettina M Buchholz, Ryujiro Sugimoto, Kimimasa Tobita, Sungsoo Lee, Yoshiya Toyoda, Timothy R Billiar, Kenneth R McCurry

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 29 ( 5 ) 544 - 53 2010.5

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

BACKGROUND: Recent advances in novel medical gases, including hydrogen and carbon monoxide (CO), have demonstrated significant opportunities for therapeutic use. This study was designed to evaluate the effects of inhaled hydrogen or CO, or both, on cold ischemia/reperfusion (I/R) injury of the myocardium. METHODS: Syngeneic heterotopic heart transplantation was performed in rats after 6 or 18 hours of cold ischemia in Celsior solution. Survival, morphology, apoptosis and marker gene expression were assessed in the grafts after in vivo inhalation of hydrogen (1% to 3%), CO (50 to 250 ppm), both or neither. Both donors and recipients were treated for 1 hour before and 1 hour after reperfusion. RESULTS: After 6-hour cold ischemia, inhalation of hydrogen (>2%) or CO (250 ppm) alone attenuated myocardial injury. Prolonged cold ischemia for 18 hours resulted in severe myocardial injury, and treatment with hydrogen or CO alone failed to demonstrate significant protection. Dual treatment with hydrogen and CO significantly attenuated I/R graft injury, reducing the infarcted area and decreasing in serum troponin I and creatine phosphokinase (CPK). Hydrogen treatment alone significantly reduced malondialdehyde levels and serum high-mobility group box 1 protein levels as compared with air-treated controls. In contrast, CO only marginally prevented lipid peroxidation, but it suppressed I/R-induced mRNA upregulation for several pro-inflammatory mediators and reduced graft apoptosis. CONCLUSIONS: Combined therapy with hydrogen and CO demonstrated enhanced therapeutic efficacy via both anti-oxidant and anti-inflammatory mechanisms, and may be a clinically feasible approach for preventing cold I/R injury of the myocardium.

DOI： 10.1016/j.healun.2009.10.011

Oral hydrogen water prevents chronic allograft nephropathy in rats. Reviewed International journal

Jon S Cardinal, Jianghua Zhan, Yinna Wang, Ryujiro Sugimoto, Allan Tsung, Kenneth R McCurry, Timothy R Billiar, Atsunori Nakao

Kidney international 77 ( 2 ) 101 - 9 2010.1

Language：English Publishing type：Research paper (scientific journal) Publisher：NATURE PUBLISHING GROUP

Reactive oxygen species (ROS) contribute to the development of interstitial fibrosis and tubular atrophy seen in chronic allograft nephropathy (CAN). As molecular hydrogen gas can act as a scavenger of ROS, we tested the effect of treatment with hydrogen water (HW) in a model of kidney transplantation, in which allografts from Lewis rats were orthotopically transplanted into Brown Norway recipients that had undergone bilateral nephrectomy. Molecular hydrogen was dissolved in water and recipients were given HW from day 0 until day 150. Rats that were treated with regular water (RW) gradually developed proteinuria and their creatinine clearance declined, ultimately leading to graft failure secondary to CAN. In contrast, treatment with HW improved allograft function, slowed the progression of CAN, reduced oxidant injury and inflammatory mediator production, and improved overall survival. Inflammatory signaling pathways, such as mitogen-activated protein kinases, were less activated in renal allografts from HW-treated rats as compared with RW-treated rats. Hence, oral HW is an effective antioxidant and antiinflammatory agent that prevented CAN, improved survival of rat renal allografts, and may be of therapeutic value in the setting of transplantation.

DOI： 10.1038/ki.2009.421

Orally administered nitrite attenuates cardiac allograft rejection in rats. Reviewed International journal

Jianghua Zhan, Atsunori Nakao, Ryujiro Sugimoto, Rajeev Dhupar, Yinna Wang, Zhiliang Wang, Timothy R Billiar, Kenneth R McCurry

Surgery 146 ( 2 ) 155 - 65 2009.8

Language：English Publishing type：Research paper (scientific journal) Publisher：MOSBY-ELSEVIER

BACKGROUND: Recent studies have shown that nitrite serves as an endogenous reservoir of nitric oxide (NO), particularly in the presence of hypoxia and ischemia. We hypothesized that exogenous nitrite supplementation would protect cardiac allografts. METHODS: Fully allogeneic heterotopic heart transplantation was performed in LEW to BN combination under tacrolimus. Animals were given either regular or nitrite/nitrate (NOx)-low chow combined with regular water or water containing nitrite (50 mg/L) for 120 days continuously beginning 7 days before transplant. RESULTS: Serum nitrite/nitrate levels were significantly higher in animals given nitrite water for 30 days, and lower in the animals fed with NOx-low diet than those in animals who received standard diet. Supplementation of drinking water with nitrite enhanced heart graft survival to a median of >120 days from 49.5 days in animals fed a standard diet. In contrast, dietary NOx insufficiency resulted in significantly earlier rejection of allografts (30.5 days). In correlation with graft survival, mRNA levels for interferon-gamma in the spleen or tumor necrosis factor-alpha in the grafts were significantly less when animals were fed nitrite water compared with those without nitrite supplementation. CONCLUSION: These data demonstrate that dietary nitrite supplementation was significantly effective in preventing development of allograft rejection.

DOI： 10.1016/j.surg.2009.05.002

Mechanisms of Toll-like receptor 4 (TLR4)-mediated inflammation after cold ischemia/reperfusion in the heart. Reviewed International journal

David J Kaczorowski, Atsunori Nakao, Raghuveer Vallabhaneni, Kevin P Mollen, Ryujiro Sugimoto, Junichi Kohmoto, Brian S Zuckerbraun, Kenneth R McCurry, Timothy R Billiar

Transplantation 87 ( 10 ) 1455 - 63 2009.5

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

BACKGROUND: Toll-Like Receptor 4 (TLR4) signaling mediates early inflammation after cold ischemia-reperfusion (I/R). We hypothesized that the TLR4 coreceptor CD14, the intracellular adaptor proteins myeloid differentiation factor 88 (MyD88) and TIR domain-containing-adaptor inducing IFNbeta (TRIF) would be required for cold I/R induced inflammation. High mobility group box 1 (HMGB1) is a putative endogenous activator of TLR4. Therefore, we also assessed the contribution of HMGB1 in cold I/R induced inflammation. METHODS: Syngeneic heart transplants were performed in mice deficient in CD14, MyD88, TRIF, or wild-type mice. In other experiments, anti-HMGB1 neutralizing antibody or control IgG was administered at reperfusion. Donor hearts were subjected to 2 hr of cold ischemia and retrieved after 3 hr of reperfusion. RESULTS: After cold I/R, grafts revealed striking translocation of HMGB1 out of the nucleus in cardiac myocytes. Administration of an anti-HMGB1 neutralizing antibody resulted in reduced systemic interleukin (IL)-6, tumor necrosis factor alpha (TNFalpha), and intercellular adhesion molecule-1 (ICAM-1) messenger RNA (mRNA) levels (P< or =0.05). Compared with controls, CD14 knock-out (KO) mice exhibited significantly lower (P< or =0.05) systemic IL-6 and JE/monocyte chemotractant protein-1 levels after cold I/R. Intragraft TNFalpha and IL-1beta mRNA levels were also significantly lower (P< or =0.05) in CD14 KO grafts. MyD88 KO mice exhibited significantly lower (P< or=0.05) systemic IL-6 levels compared with control mice after cold I/R. Intragraft TNFalpha, IL-6, and ICAM-1 mRNA levels were also significantly lower (P< or =0.05) in MyD88 KO grafts. Significantly lower levels (P< or =0.05) of serum IL-6, monocyte chemotractant protein-1 as well as intragraft TNFalpha, IL-6, IL-1beta, and ICAM-1 were observed after cold I/R in TRIF deficient animals compared with controls. CONCLUSIONS: CD14, MyD88, TRIF, and HMGB1 contribute to the inflammatory response that occurs after cold I/R. These results provide insight into the mechanisms of TLR4-mediated inflammation after cold I/R.

DOI： 10.1097/TP.0b013e3181a36e5e

Therapeutic antioxidant medical gas. Reviewed

Atsunori Nakao, Ryujiro Sugimoto, Timothy R Billiar, Kenneth R McCurry

Journal of clinical biochemistry and nutrition 44 ( 1 ) 1 - 13 2009.1

Language：English Publishing type：Research paper (scientific journal) Publisher：JOURNAL CLINICAL BIOCHEMISTRY & NUTRITION

Medical gases are pharmaceutical gaseous molecules which offer solutions to medical needs and include traditional gases, such as oxygen and nitrous oxide, as well as gases with recently discovered roles as biological messenger molecules, such as carbon monoxide, nitric oxide and hydrogen sulphide. Medical gas therapy is a relatively unexplored field of medicine; however, a recent increasing in the number of publications on medical gas therapies clearly indicate that there are significant opportunities for use of gases as therapeutic tools for a variety of disease conditions. In this article, we review the recent advances in research on medical gases with antioxidant properties and discuss their clinical applications and therapeutic properties.

DOI： 10.3164/jcbn.08-193R

Experimental orthotopic lung transplantation model in rats with cold storage. Reviewed

Ryujiro Sugimoto, Atsunori Nakao, Itaru Nagahiro, Junichi Kohmoto, Seiichiro Sugimoto, Mikio Okazaki, Masaomi Yamane, Hidetoshi Inokawa, Takahiro Oto, Kazunori Tahara, Jianghua Zhan, Yoshifumi Sano, Kenneth R McCurry

Surgery today 39 ( 7 ) 641 - 5 2009

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

This report describes a new experimental procedure, a rat unilateral, orthotopic lung transplantation with cold storage, and evaluates its relevancy and reliability to study the early events during cold ischemia/reperfusion (I/R) injury. This model, using the cuff technique, does not require extensive training and is relatively easy to be established. The model can induce reproducible degrees of pulmonary graft injury including impaired gas exchange, proinflammatory cytokine upregulation, or inflammatory infiltrates, depending on the preservation time. The results are consistent with the previous clinical evidence, thus suggesting that this model is a valid and reliable animal model of cold I/R injury.

DOI： 10.1007/s00595-008-3929-x

Oral Administration of Hydrogen Water Prevents Chronic Allograft Nephropathy. Reviewed

Atsunori Nakao, Jianghua Zhan, Yinna Wang, Ryujiro Sugimoto, Jon Cardinal, Kenneth R. McCurry

AMERICAN JOURNAL OF TRANSPLANTATION 9 660 - 661 2009

Carbon monoxide-saturated preservation solution protects lung grafts from ischemia-reperfusion injury

Junichi Kohmoto, Atsunori Nakao, Ryujiro Sugimoto, Yinna Wang, JiangHua Zhan, Hideo Ueda, Kenneth R. McCurry

Journal of Thoracic and Cardiovascular Surgery 136 ( 4 ) 1067 - 1075 2008.10

Language：English Publishing type：Research paper (scientific journal)

Objectives: In previous work we have demonstrated that delivery of low concentrations (250 ppm) of carbon monoxide by means of inhalation to donors, recipients, or both protects transplanted lungs from ischemia-reperfusion injury (improved gas exchange, diminished intragraft and systemic inflammation, and retention of graft vascular endothelial cell ultrastructure). In this study we examined whether delivery of carbon monoxide to lung grafts in the preservation solution could protect against lung ischemia-reperfusion injury. Methods: Orthotopic left lung transplantation was performed in syngeneic Lewis to Lewis rats. Grafts were preserved in University of Wisconsin solution with or without (control solution) carbon monoxide at 4°C for 6 hours. Carbon monoxide gas (5% or 100%) was bubbled into University of Wisconsin solution at 4°C for 5 minutes before use. Results: In control animals, ischemia-reperfusion injury resulted in significant deterioration of graft function and was associated with a massive cellular infiltrate 2 hours after reperfusion. Grafts stored in University of Wisconsin solution with carbon monoxide (5%), however, demonstrated significantly better gas exchange and significantly reduced intragraft inflammation (reduced inflammatory mediators and cellular infiltrate). Experiments demonstrated that the protective effects afforded by 100% University of Wisconsin solution with carbon monoxide were not as potent as those of 5% University of Wisconsin solution with carbon monoxide. Conclusions: This study demonstrates that 5% carbon monoxide as an additive to the cold flush/preservation solution can impart potent anti-inflammatory and cytoprotective effects after cold preservation and transplantation of lung grafts. Such ex vivo treatment of lung grafts with carbon monoxide can minimize concerns associated with carbon monoxide inhalation and might offer the opportunity to significantly advance the application of carbon monoxide in the clinical setting. © 2008 The American Association for Thoracic Surgery.

DOI： 10.1016/j.jtcvs.2008.06.026

Ex vivo carbon monoxide prevents cytochrome P450 degradation and ischemia/reperfusion injury of kidney grafts. Reviewed International journal

Atsunori Nakao, Gaetano Faleo, Hiroko Shimizu, Kiichi Nakahira, Junichi Kohmoto, Ryujiro Sugimoto, Augustine M K Choi, Kenneth R McCurry, Toru Takahashi, Noriko Murase

Kidney international 74 ( 8 ) 1009 - 16 2008.10

Language：English Publishing type：Research paper (scientific journal) Publisher：NATURE PUBLISHING GROUP

Renal ischemia/reperfusion injury is a major complication of kidney transplantation. We tested if ex vivo delivery of carbon monoxide (CO) to the kidney would ameliorate the renal injury of cold storage that can complicate renal transplantation. Orthotopic syngeneic kidney transplantation was performed in Lewis rats following 24 h of cold preservation in University of Wisconsin solution equilibrated without or with CO (soluble CO levels about 40 microM). Ischemia/reperfusion injury in control grafts resulted in an early upregulation of inflammatory mediator mRNAs and progressive deterioration of graft function. In contrast, the grafts preserved with CO had significantly less oxidative injury and this was associated with improved recipient survival compared to the control group. Renal injury in the control group showed considerable degradation of cytochrome P450 heme proteins, active heme metabolism and increased detrimental intracellular free heme levels. Kidney grafts preserved in CO-equilibrated solution maintained their cytochrome P450 protein levels, had normal intracellular heme levels and had less lipid peroxidation. Our results show that CO-mediated suppression of injurious heme-derived redox reactions offers protection of kidney grafts from cold ischemia/reperfusion injury.

DOI： 10.1038/ki.2008.342

Sirolimus amelioration of clinical symptoms of recurrent lymphangioleiomyomatosis after living-donor lobar lung transplantation. Reviewed International journal

Ryujiro Sugimoto, Atsunori Nakao, Masaomi Yamane, Shinichi Toyooka, Megumi Okazaki, Motoi Aoe, Kuniaki Seyama, Hiroshi Date, Takahiro Oto, Yoshifumi Sano

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 27 ( 8 ) 921 - 4 2008.8

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

In this study we report the case of a 28-year-old female patient with recurrent lymphangioleiomyomatosis (LAM) in the allografts after bilateral living-donor lobar lung transplantation. Although her post-operative course under immunosuppression with tacrolimus and prednisolone had been uneventful without rejection episodes, she had developed shortness of breath and a progressive chylous effusion with diffuse cystic changes in both lungs 5 years after transplantation. In spite of a diagnosis of having a recurrence of LAM based on radiologic findings and deteriorating pulmonary function, her clinical symptoms, which included dyspnea and chylothorax, were significantly improved after treatment with sirolimus. Although a beneficial effect of sirolimus in the treatment of LAM has not been definitively determined, this report may provide useful information for management of recurrent LAM after lung transplantation.

DOI： 10.1016/j.healun.2008.05.012

Carbon monoxide ameliorates renal cold ischemia-reperfusion injury with an upregulation of vascular endothelial growth factor by activation of hypoxia-inducible factor. Reviewed International journal

Gaetano Faleo, Joao Seda Neto, Junichi Kohmoto, Koji Tomiyama, Hiroko Shimizu, Toru Takahashi, Yinna Wang, Ryujiro Sugimoto, Augustine M K Choi, Donna B Stolz, Giuseppe Carrieri, Kenneth R McCurry, Noriko Murase, Atsunori Nakao

Transplantation 85 ( 12 ) 1833 - 40 2008.6

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

BACKGROUND: We have previously shown that carbon monoxide (CO) inhalation at a low concentration provides protection against cold ischemia-reperfusion (I/R) injury after kidney transplantation. As vascular endothelial growth factor (VEGF) may promote the recovery process of impaired vascular endothelial cells during I/R injury, we examined whether protective effects of CO involved VEGF induction and its upstream hypoxia-inducible factor (HIF)-1 activation. METHODS: Lewis rat kidney graft, preserved in University of Wisconsin at 4 degrees C for 24 hr, was orthotopically transplanted into syngeneic recipient. Recipients were continuously maintained in air or exposed to CO (250 ppm) for 1 hr before and 24 hr after transplant. RESULTS: Prolonged cold preservation resulted in progressive impairment of kidney graft function with early inflammatory responses. Carbon monoxide significantly protected kidney grafts from cold I/R injury, improved renal function and enhanced recipient survival. Real-time reverse transcriptase-polymerase chain reaction revealed upregulation of HIF-1alpha and VEGF in the CO-treated kidney grafts as early as 1 hr after reperfusion. Western blot showed CO significantly upregulated VEGF expression 1 to 3 hr after kidney transplantation. Considerably more VEGF-positive cells were observed mainly in tubular epithelial cells in CO-treated, but not air-exposed, kidney grafts at 3 hr after reperfusion. YC-1, HIF-1alpha inhibitor, completely abrogated the actions of CO on VEGF induction and reversed the protective effects afforded by CO. Nitric oxide production in the grafts was increased by CO, however, abolished by YC-1. CONCLUSION: These results demonstrate that the protective effect of CO against renal cold I/R injury may involve VEGF upregulation through its upstream signal, HIF-1 activation.

DOI： 10.1097/TP.0b013e31817c6f63

The Oldest Patient with Gallstone Ileus: Report of a Case and Review of 176 Cases in Japan

NAKAO ATSUNORI, OKAMOTO YASUHISA, SUNAMI MASATAKA, FUJITA TAKUJI, TSUJI TAKAO

Kurume Med. J. 55 ( 1 ) 29 - 33 2008.5

Authorship：Lead author Language：English Publishing type：Research paper (bulletin of university, research institution) Publisher：Kurume University School of Medicine

We report a 91-year-old woman presenting bowel obstruction due to impacted gallstone, who was the oldest patient which has been reported in Japanese scientific literature. The patient was referred to our hospital due to vomiting and abdominal pain. Computed tomography and abdominal X-ray showed dilated loops of small intestine associated with air-fluid levels, pneumobilia, and a calcified mass in the left iliac fossa. After the diagnosis of bowel obstruction due to gallstone was made, an enterotomy and lithotomy was performed under spinal anesthesia. The postoperative recovery was uneventful. We also reviewed 176 cases of gallstone ileus which were reported in the Japanese literature in the past 20 years. The retrospective analysis demonstrated that one-stage enterolithotomy alone may be acceptable as the first choice of operative treatment. The gallstone ileus is a rare, but important disease because urgent and appropriate surgical therapy is required.

DOI： 10.2739/kurumemedj.55.29

Other Link： http://search.jamas.or.jp/link/ui/2009121716

Biliverdin-supplemented preservation solution attenuates cold ischemia/reperfusion injury of the lung Reviewed

Ryujiro Sugimoto, Atsunori Nakao, Gaetano Faleo, Yinna Wang, Timothy R. Billiar, Kenneth R. McCurry

AMERICAN JOURNAL OF TRANSPLANTATION 8 497 - 497 2008.5

Nitrite protects rat lung grafts from ischemia/reperfusion injury via nitric oxide Reviewed

Ryujiro Sugimoto, Atsunori Nakao, Junichi Kohmoto, Yinna Wang, Mark T. Gladwin, Timothy R. Billiar, Kenneth R. McCurry

AMERICAN JOURNAL OF TRANSPLANTATION 8 498 - 498 2008.5

Hydrogen inhalation ameliorates cold ischemia/reperfusion injury of rat cardiac grafts Reviewed

Atsunori Nakao, David J. Kaczorowski, Ryujiro Sugimoto, Yinna Wang, Timothy R. Billiar, Kenneth R. McCurry

AMERICAN JOURNAL OF TRANSPLANTATION 8 501 - 501 2008.5

Application of heme oxygenase-1, carbon monoxide and biliverdin for the prevention of intestinal ischemia/reperfusion injury. Reviewed

Atsunori Nakao, David J Kaczorowski, Ryujiro Sugimoto, Timothy R Billiar, Kenneth R McCurry

Journal of clinical biochemistry and nutrition 42 ( 2 ) 78 - 88 2008.3

Language：English Publishing type：Research paper (scientific journal) Publisher：JOURNAL CLINICAL BIOCHEMISTRY & NUTRITION

Intestinal ischemia/reperfusion (I/R) injury occurs frequently in a variety of clinical settings, including mesenteric artery occlusion, abdominal aneurism surgery, trauma, shock, and small intestinal transplantation, and is associated with substantial morbidity and mortality. Although the exact mechanisms involved in the pathogenesis of intestinal I/R injury have not been fully elucidated, it is generally believed that polymorphonuclear neutrophils, pro-inflammatory cytokines, and mediators generated in the setting of oxidative stress, such as reactive oxygen species (ROS), play important roles. Heme oxygenase (HO) is the rate-limiting enzyme that catalyzes the degradation of heme into equimolar quantities of biliverdin and carbon monoxide (CO), while the central iron is released. An inducible form of HO (HO-1), biliverdin, and CO, have been shown to possess generalized endogenous anti-inflammatory activities and provide protection against intestinal I/R injury. Further, recent observations have demonstrated that exogenous HO-1 expression, as well as exogenously administered CO and biliverdin, have potent cytoprotective effects on intestinal I/R injury as well. Here, we summarize the currently available data regarding the role of the HO system in the prevention intestinal I/R injury.

DOI： 10.3164/jcbn.2008013

Reduction of cerebral infarction in rats by biliverdin associated with amelioration of oxidative stress Reviewed International journal

Kentaro Deguchi, Takeshi Hayashi, Shoko Nagotani, Yoshihide Sehara, Han Zhe Zhang, Atsushi Tsuchiya, Yasuyuki Ohta, Koji Tomiyama, Nobutoshi Morimoto, Masahiro Miyazaki, Nam ho Huh, Atsunori Nakao, Tatsushi Kamiya, Koji Abe

Brain Research 1188 ( 1 ) 1 - 8 2008.1

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER

Biliverdin (BV), one of the byproducts of heme catalysis through heme oxygenase (HO) system, is a scavenger of reactive oxygen species (ROS). We hypothesized that BV treatment could protect rat brain cells from oxidative injuries via its anti-oxidant efficacies. Cerebral infarction was induced by transient middle cerebral artery occlusion (tMCAO) for 90 min, followed by reperfusion. BV or vehicle was administered intraperitoneally immediately after reperfusion. The size of the cerebral infarction 2 days after tMCAO was evaluated by 2,3,5-triphenyltetrazolium chloride (TTC) stain. Superoxide generation 4 h after tMCAO was determined by detection of oxidized hydroethidine. In addition, the oxidative impairment of neurons were immunohistochemically assessed by stain for lipid peroxidation with 4-hydroxy-2-nonenal (4-HNE) and damaged DNA with 8-hydroxy-2′-deoxyguanosine (8-OHdG). BV treatment significantly reduced infarct volume of the cerebral cortices associated with less superoxide production and decreased oxidative injuries of brain cells. The present study demonstrated that treatment with BV ameliorated the oxidative injuries on neurons and decreased brain infarct size in rat tMCAO model. © 2007 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.brainres.2007.07.104

Toll-like receptor 4 mediates the early inflammatory response after cold ischemia/reperfusion. Reviewed International journal

David J Kaczorowski, Atsunori Nakao, Kevin P Mollen, Raghuveer Vallabhaneni, Ryujiro Sugimoto, Junichi Kohmoto, Kimimasa Tobita, Brian S Zuckerbraun, Kenneth R McCurry, Noriko Murase, Timothy R Billiar

Transplantation 84 ( 10 ) 1279 - 87 2007.11

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

BACKGROUND: Ischemia/reperfusion (I/R) injury leads to graft dysfunction and may contribute to alloimmune responses posttransplantation. The molecular mechanisms of cold I/R injury are only partially characterized but may involve toll-like receptor (TLR)-4 activation by endogenous ligands. We tested the hypothesis that TLR4 mediates the early inflammatory response in the setting of cold I/R in a murine cardiac transplant model. METHODS: Syngeneic heart transplants were performed in mutant mice deficient in TLR4 signaling (C3H/HeJ) and wild-type mice (C3H/HeOuJ). Transplants were also performed between the strains (mutant hearts into wild-type recipients and the converse). Donor hearts were subjected to 2 hr of cold ischemia. The grafts were retrieved at 3 and 24 hr after reperfusion. Serum samples were collected for cytokine analysis. Reverse-transcription polymerase chain reaction and histologic analysis were used to assess intra-graft inflammation. RESULTS: After transplant, serum tumor necrosis factor (TNF), interleukin (IL)-6, JE/monocyte chemotractant protein (MCP)-1, IL-1beta, and troponin I levels, as well as intragraft TNF, IL-1beta, IL-6, early growth response (EGR)-1, intercellular adhesion molecule (ICAM)-1, and inducible nitric oxide synthase (iNOS) mRNA levels, were significantly lower in the mutant-->mutant group compared to the wild-type-->wild-type group (P< or =0.05). Intermediate levels of serum IL-6, JE/MCP-1, as well as intragraft TNF, IL-1beta, IL-6, and ICAM-1 mRNA were observed after transplants in the mutant-->wild-type and wild-type-->mutant groups. Immunohistochemistry revealed less myocardial nuclear factor-kappaB nuclear translocation at and less neutrophil infiltration in the mutant-->mutant group compared to the wild-type-->wild-type group. CONCLUSIONS: These findings demonstrate that TLR4 signaling is central to both the systemic and intragraft inflammatory responses that occur after cold I/R in the setting of organ transplantation and that TLR4 signaling on both donor and recipient cells contributes to this response.

DOI： 10.1097/01.tp.0000287597.87571.17

Carbon monoxide differentially inhibits TLR signaling pathways by regulating ROS-induced trafficking of TLRs to lipid rafts. International journal

Kiichi Nakahira, Hong Pyo Kim, Xue Hui Geng, Atsunori Nakao, Xue Wang, Noriko Murase, Peter F Drain, Xiaomei Wang, Madhu Sasidhar, Elizabeth G Nabel, Toru Takahashi, Nicholas W Lukacs, Stefan W Ryter, Kiyoshi Morita, Augustine M K Choi

The Journal of experimental medicine 203 ( 10 ) 2377 - 89 2006.10

Language：English Publishing type：Research paper (scientific journal)

Carbon monoxide (CO), a byproduct of heme catabolism by heme oxygenase (HO), confers potent antiinflammatory effects. Here we demonstrate that CO derived from HO-1 inhibited Toll-like receptor (TLR) 2, 4, 5, and 9 signaling, but not TLR3-dependent signaling, in macrophages. Ligand-mediated receptor trafficking to lipid rafts represents an early event in signal initiation of immune cells. Trafficking of TLR4 to lipid rafts in response to LPS was reactive oxygen species (ROS) dependent because it was inhibited by diphenylene iodonium, an inhibitor of NADPH oxidase, and in gp91(phox)-deficient macrophages. CO selectively inhibited ligand-induced recruitment of TLR4 to lipid rafts, which was also associated with the inhibition of ligand-induced ROS production in macrophages. TLR3 did not translocate to lipid rafts by polyinosine-polycytidylic acid (poly(I:C)). CO had no effect on poly(I:C)-induced ROS production and TLR3 signaling. The inhibitory effect of CO on TLR-induced cytokine production was abolished in gp91(phox)-deficient macrophages, also indicating a role for NADPH oxidase. CO attenuated LPS-induced NADPH oxidase activity in vitro, potentially by binding to gp91(phox). Thus, CO negatively controlled TLR signaling pathways by inhibiting translocation of TLR to lipid rafts through suppression of NADPH oxidase-dependent ROS generation.

Heart allograft protection with low-dose carbon monoxide inhalation: effects on inflammatory mediators and alloreactive T-cell responses. Reviewed International journal

Atsunori Nakao, Hideyoshi Toyokawa, Masanori Abe, Tetsuma Kiyomoto, Kiichi Nakahira, Augustine M K Choi, Michael A Nalesnik, Angus W Thomson, Noriko Murase

Transplantation 81 ( 2 ) 220 - 30 2006.1

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Carbon monoxide (CO), a byproduct of heme catalysis, has lately received considerable attention as a regulatory molecule in cellular and biological processes. CO has been shown to provide potent protection against a variety of tissue injuries. We hypothesized in this study that low concentration CO would be beneficial for organ allografts, which frequently undergo several types of injury such as ischemia/reperfusion, alloimmune reaction, and inflammation METHODS: The efficacy of low-dose CO was examined in a fully allogeneic LEW to BN rat heterotopic heart transplantation (HHTx) model. Recipients were kept in air or exposed to low-dose CO (20 ppm) for 14, 28, or 100 days after HHTx under short-course tacrolimus RESULTS: CO treatment (d0-28, 0-100) was remarkably effective in prolonging heart allograft survival to a median of >100 from 45 days in the air-control group, with significant reductions of arteritis, fibrosis, and cellular infiltration, including macrophages and T cells. CO inhibited intragraft upregulation of Th1 type cytokines (IL-2, IFNgamma), proinflammatory mediators (IL-1beta, TNFalpha, IL-6, COX-2), and adhesion molecule. Shorter CO exposure in early (0-13d) and late (14-28d) posttransplant periods also prolonged graft survival, with a significant inhibition of inflammatory mediators CONCLUSIONS: These results show that low dose CO inhalation protects heart allografts and can considerably prolong their survival. CO appears to function via multiple mechanisms, including direct inhibition of Th1 type cytokine production and regulation of inflammatory responses.

DOI： 10.1097/01.tp.0000188637.80695.7f

Multiple hepatic adenomas caused by long-term administration of androgenic steroids for aplastic anemia in association with familial adenomatous polyposis

NAKAO Atsunori, SAKAGAMI Kenichi, NAKATA Yusei, KOMAZAWA Katsutaka, AMIMOTO Tatsuya, NAKASHIMA Koichiro, ISOZAKI Hiroshi, TAKAKURA Norihisa, TANAKA Noriaki

J Gastroenterol 35 ( 7 ) 557 - 562 2000.7

Generalized Peritonitis Due to Spontaneously Perforated Pyometra Presenting as Pneumoperitoneum : Report of a Case

NAKAO ATSUNORI, MIMURA HISASHI, FUJISAWA KENJI, EZAWA KAZUHIKO, OKAMOTO TAKAHIRO, IWAGAKI HIROMI, ISOZAKI HIROSHI, TAKAKURA NORIHISA, TANAKA NORIAKI

Surg Today 30 ( 5 ) 454 - 457 2000.5

Gastric Perforation Caused by a Bulimic Attack in an Anorexia Nervosa Patient : Report of a Case

NAKAO ATSUNORI, ISOZAKI HIROSHI, IWAGAKI HIROMI, KANAGAWA TAIICHIRO, TAKAKURA NORIHISA, TANAKA NORIAKI

Surg Today 30 ( 5 ) 435 - 437 2000.5

Gallbladder torsion : case report and review of 245 cases reported in the Japanese literature

NAKAO A

J Hepatobiliary Pancreat Surg 6 418 - 421 1999.12

Portal venous gas associated with splenic abscess secondary to colon cancer

NAKAO A

Anticancer Res 19 5641 - 5644 1999.12

Dermoid Cyst of the Spleen: Report of a Case

NAKAO Atsunori, SAITO Shinya, YAMANO Taketoshi, TAKAKURA Norihisa, ISOZAKI Hiroshi, NOTOHARA Kenji, TANAKA Noriaki

Surg Today 29 ( 7 ) 660 - 662 1999.7

Gastric carcinoma with predominant choriocarcinomatous component

NAKAO Atsunori, SAKAGAMI Kenichi, UDA Masashi, MITSUOKA Shintaro, YAMASHITA Naoto, ITO Hisao

3 ( 6 ) 403 - 405 1998.12

Benign Fibrous Mesothelioma Successfully Treated by Thoracoscope-Assisted Surgery : Report of a Case

NAKAO ATSUNORI, SAKAGAMI KENICHI, UDA MASASHI, MITSUOKA SHINTARO, ITO HISAO

Surg Today 28 ( 10 ) 1087 - 1090 1998.10

所属リンパ節にサルコイド反応がみられた胆管癌の1症例

中尾篤典

胆と膵 17 963 - 966 1996.12

Use of the Bobbin Threader^<【○!R】> for Cranioplasty

NAKAO Atsunori, HIROHATA Taizo, OBAYASHI Naohiko

Japanese journal of neurosurgery 5 ( 6 ) 470 - 471 1996.11

Authorship：Lead author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：The Japanese Congress of Neurological Surgeons

During cranioplasty, surgeons secure the cranial flap with thread or thin wire sutures by inserting them through holes made in the skull. we have devised a new insertion method using the Bobbin Threader^[○!R] . The major advantages of this technique are ease in suturing, shortened closure time, and minimal risk of dural injury.

粘膜内癌を伴った巨大な直腸villous tumorの1例??10cm以上の大腸villous tumor本邦報告15例の検討

中尾篤典

広島医学 49 970 - 972 1996.7

抗血小板療法中に起きた大腿神経麻痺を伴う腸腰筋血腫の1例

中尾篤典

外科診療 6 745 - 747 1996.6

肝癌術後の肺転移に対し, Epirubicinの少量頻回投与が有効であった2症例

中尾篤典

癌と化学療法 22 1831 - 1834 1995.10

腰背部に皮膚瘻を形成した原発性虫垂癌の1症例

中尾篤典

臨床外科 50 533 - 536 1995.4

外傷性十二指腸破裂の1治験例

中尾篤典

広島医学 48 113 - 115 1995.1

THE CHOLECYSTIC ARTERIAL ANATOMY FOR LAPAROSCOPIC CHOLECYSTECTOMY

SATO Shizo, NAKAJIMA Akira, NAKAO Atsunori, KAWASHIMA Ryuichi, KAI Kyohei, AOYAMA Masahiro, KAWAMATA Osamu, MORI Takashi, NABEYAMA Akira, OKADA Yasuo

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 55 ( 5 ) 1119 - 1123 1994.1

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Surgical Association

To accomplish laparoscopic cholecystectomy, the overall grasp of the clinical anatomy, especially cholecystic arterial anatomy is essential. In this study the cholecystic arterial anatomy was investigated in terms of the treatment of the arteries for laparascopic cholecystectomy.<br> Cholyecystic arteries were classified into 9 types from a viewpoint of the treatment. When compared with Michel's cholecystic arterial anatomy, each type appeared in a similar frequency. In treating the cholecystic arteries, "the long cholecystic arteries" could be easily maneuvered, however, "the short cholecystic arteries" could be safely treated especially at a portion near the gallbladder. In addition careful maneuvers were necessary for treating the artery running along the cystic duct. Even if a cholecystic artery is treated, a possible existence of another artery must be entertained.

DOI： 10.3919/ringe1963.55.1119

腎血管筋脂肪腫に選択的動脈塞栓術施行後dynamicCTで効果判定し得た１例

中尾篤典

腎と透析 34 135 - 138 1993.2

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