研究者詳細 - 小﨑　吉訓

論文 - 小﨑　吉訓

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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年12月

記述言語：日本語出版者・発行元：(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)

Management of Obesity Hypoventilation Syndrome in Extreme Obesity: A Case Study. 査読国際誌

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

The American journal of case reports 25 e945112 2024年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

Association between signs of life and survival in traumatic cardiac arrest patients: A nationwide, retrospective cohort study. 査読国際誌

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年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

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. 査読国際誌

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年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

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年9月

Prognostic Performance of Gray-White Matter Ratio in Adult Out-of-Hospital Cardiac Arrest Patients after Receiving Extracorporeal Cardiopulmonary Resuscitation. 査読国際誌

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年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

日本における医学生の情報リテラシー能力の検討

三好智子, 小崎吉訓, 越智可奈子, 松川昭博

医学教育 55 ( Suppl. ) 351 - 351 2024年7月

医学生の医療面接における表情解析AIを用いた検討

越智可奈子, 三好智子, 大塚勇輝, 小崎吉訓, 山下範之, 伊野英男, 大塚文男

医学教育 55 ( Suppl. ) 292 - 292 2024年7月

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年7月

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年7月

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

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年1月

記述言語：英語

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

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

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年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

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年12月

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

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

Resuscitation plus 15 100418 - 100418 2023年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.1016/j.resplu.2023.100418

The Restrictive Red Blood Cell Transfusion Strategy for Critically Injured Patients (RESTRIC) trial: a cluster-randomized, crossover, non-inferiority multicenter trial of restrictive transfusion in trauma. 査読国際誌

Mineji Hayakawa, Takashi Tagami, Daisuke Kudo, Kota Ono, Makoto Aoki, Akira Endo, Tetsuya Yumoto, Yosuke Matsumura, Shiho Irino, Kazuhiko Sekine, Noritaka Ushio, Takayuki Ogura, Sho Nachi, Yuhei Irie, Katsura Hayakawa, Yusuke Ito, Yuko Okishio, Tomohiro Muronoi, Yoshinori Kosaki, Kaori Ito, Keita Nakatsutsumi, Yutaka Kondo, Taichiro Ueda, Hiroshi Fukuma, Yuichi Saisaka, Naoki Tominaga, Takeo Kurita, Fumihiko Nakayama, Tomotaka Shibata, Shigeki Kushimoto

Journal of intensive care 11 ( 1 ) 34 - 34 2023年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The efficacies of fresh frozen plasma and coagulation factor transfusion have been widely evaluated in trauma-induced coagulopathy management during the acute post-injury phase. However, the efficacy of red blood cell transfusion has not been adequately investigated in patients with severe trauma, and the optimal hemoglobin target level during the acute post-injury and resuscitation phases remains unclear. Therefore, this study aimed to examine whether a restrictive transfusion strategy was clinically non-inferior to a liberal transfusion strategy during the acute post-injury phase. METHODS: This cluster-randomized, crossover, non-inferiority multicenter trial was conducted at 22 tertiary emergency medical institutions in Japan and included adult patients with severe trauma at risk of major bleeding. The institutions were allocated a restrictive or liberal transfusion strategy (target hemoglobin levels: 7-9 or 10-12 g/dL, respectively). The strategies were applied to patients immediately after arrival at the emergency department. The primary outcome was 28-day survival after arrival at the emergency department. Secondary outcomes included transfusion volume, complication rates, and event-free days. The non-inferiority margin was set at 3%. RESULTS: The 28-day survival rates of patients in the restrictive (n = 216) and liberal (n = 195) strategy groups were 92.1% and 91.3%, respectively. The adjusted odds ratio for 28-day survival in the restrictive versus liberal strategy group was 1.02 (95% confidence interval: 0.49-2.13). Significant non-inferiority was not observed. Transfusion volumes and hemoglobin levels were lower in the restrictive strategy group than in the liberal strategy group. No between-group differences were noted in complication rates or event-free days. CONCLUSIONS: Although non-inferiority of the restrictive versus liberal transfusion strategy for 28-day survival was not statistically significant, the mortality and complication rates were similar between the groups. The restrictive transfusion strategy results in a lower transfusion volume. TRIAL REGISTRATION NUMBER: umin.ac.jp/ctr: UMIN000034405, registration date: 8 October 2018.

DOI： 10.1186/s40560-023-00682-3

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

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

Cureus 15 ( 2 ) e35440 2023年2月

記述言語：英語

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

DOI： 10.7759/cureus.35440

Successfully treated case of severe hypothermia secondary to myxedema coma. 査読国際誌

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年

記述言語：英語

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

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年11月

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

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

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

記述言語：英語掲載種別：研究論文（学術雑誌）

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

DOI： 10.18926/AMO/63720

Burnout of Healthcare Workers Amid the COVID-19 Pandemic: A Follow-Up Study 査読国際誌

Yoshito Nishimura, Tomoko Miyoshi, Asuka Sato, Kou Hasegawa, Hideharu Hagiya, Yoshinori Kosaki, Fumio Otsuka

INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 18 ( 21 ) 2021年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：MDPI

The coronavirus disease 2019 (COVID-19) pandemic has posed a significant challenge to the modern healthcare system and led to increased burnout among healthcare workers (HCWs). We previously reported that HCWs who engaged in COVID-19 patient care had a significantly higher prevalence of burnout (50.0%) than those who did not in November 2020 (period 1). We performed follow-up surveys in HCWs in a Japanese national university hospital, including basic demographics, whether a participant engaged in care of COVID-19 patients in the past 2 weeks, and the Maslach Burnout Inventory in February 2021 (period 2) and May 2021 (period 3). Periods 1 and 3 were amid the surges of COVID-19 cases, and period 2 was a post-surge period with a comparatively small number of COVID-19 patients requiring hospitalization. Response rates to the surveys were 33/130 (25.4%) in period 1, 36/130 (27.7%) in period 2, and 56/162 (34.6%) in period 3, respectively. While no consistent tendency in the prevalence of burnout based on variables was observed throughout the periods, the prevalence of burnout tends to be higher in periods 1 and 3 in those who engaged in COVID-19 patient care in the last 2 weeks (50.0%, 30.8%, 43.1% in period 1, 2, and 3, respectively). Given the prolonged pandemic causing stigmatization and hatred against HCWs leading to increased prevalence of burnout, high-level interventions and supports are warranted.

DOI： 10.3390/ijerph182111581

Carbon monoxide poisoning during pregnancy treated with hyperbaric oxygen. 査読国際誌

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

Clinical case reports 9 ( 5 ) e04138 2021年5月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：WILEY

Acute carbon monoxide (CO) intoxication during pregnancy causes fetal death and teratogenic effects. Hyperbaric oxygen (HBO2) therapy has the potential to improve them. HBO2 therapy should be considered to treat CO intoxication during pregnancy.

DOI： 10.1002/ccr3.4138

Burnout of Healthcare Workers amid the COVID-19 Pandemic: A Japanese Cross-Sectional Survey 査読国際誌

Yoshito Nishimura, Tomoko Miyoshi, Hideharu Hagiya, Yoshinori Kosaki, Fumio Otsuka

INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 18 ( 5 ) 2021年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：MDPI

The coronavirus disease 2019 (COVID-19) global pandemic has drastically changed how we live and work. Amid the prolonged pandemic, burnout of the frontline healthcare professionals has become a significant concern. We conducted a cross-sectional survey study to provide data about the relationship between the COVID-19 pandemic and the prevalence of burnout in healthcare professionals in Japan. Healthcare workers in a single Japanese national university hospital participated in the survey, including basic demographics, whether a participant engaged in care of COVID-19 patients in the past 2 weeks and the Maslach Burnout Inventory. Of those, 25.4% fully answered the survey; 33.3% were doctors and 63.6% were nurses, and 36.3% engaged in care of COVID-19 patients in the past 2 weeks. Compared to those belonging to General Medicine, those in Emergency Intensive Care Unit were at higher risk of burnout (odds ratio (OR), 6.7; 95% CI, 1.1-42.1; p = 0.031). Of those who engaged in care of COVID-19 patients, 50% reported burnout while 6.1% did not (OR 8.5, 95% CI; 1.3-54.1; p = 0.014). The burnout of healthcare workers is a significant concern amid the pandemic, which needs to be addressed for sustainable healthcare delivery.

DOI： 10.3390/ijerph18052434

Glycogenic hepatopathy following attempted suicide by long-acting insulin overdose in patient with type 1 diabetes 査読国際誌

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年10月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：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

A family intoxicated by daffodil bulbs mistaken for onions 査読

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

ACUTE MEDICINE & SURGERY 7 ( 1 ) 2020年1月

Epileptic Seizure from Ginkgo Nut Intoxication in an Adult. 査読国際誌

Yoshinori Kosaki, Hiromichi Naito, Tsuyoshi Nojima, Atsunori Nakao

Case reports in emergency medicine 2020 5072954 - 5072954 2020年

記述言語：英語

The ginkgo tree is a well-known, highly adaptable urban plant. Ginkgo nuts are the product of the ginkgo tree. Interior ginkgo nuts are cooked and served in Asian countries; however, the potential toxicity of the gingko nuts is not commonly known. Herein, we report a 48-year-old male patient experiencing acute convulsions presumably due to overconsumption of gingko nuts. The patient was transferred to our department after several episodes of acute generalized tonicclonic seizures lasting approximately 30 seconds each and starting one hour before the visit. The patient also complained of vomiting, vertigo, diarrhea, and tremors in both upper limbs following the seizures. Elevated 4-O-methylpyridoxine (312 ng/mL), low blood pyridoxal phosphate (2.4 μg/L), and low vitamin B1 (20 ng/mL) levels were found in the blood analysis. No other remarkable abnormalities were detected. We diagnosed the patient with ginkgo nut intoxication, and he was orally administered 400 mg of pyridoxal phosphate. His symptoms resolved after treatment, and no seizures recurred thereafter. Our report may help raise awareness of the clinical presentation and management of this intoxication among emergency physicians.

DOI： 10.1155/2020/5072954

Caffeine Intoxication in Pregnancy; a case Report. 査読国際誌

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

Archives of academic emergency medicine 7 ( 1 ) e67 2019年

記述言語：英語

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.

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

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年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：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.

Ictal Cardiorespiratory Arrest Associated with Status Epilepticus in Panayiotopoulos Syndrome 査読

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年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：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. Lifethreating cardiopulmonary arrest is rare in PS, but long seizure duration of PS may associate with apnea and bradycardia.

DOI： 10.18926/AMO/56076

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

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年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：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.

DOI： 10.18926/AMO/55859

Cushing's sign and severe traumatic brain injury in children after blunt trauma: a nationwide retrospective cohort study in Japan. 査読国際誌

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

BMJ open 8 ( 3 ) e020781 2018年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

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 査読

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年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：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.

DOI： 10.18926/AMO/55669

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

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年10月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：OKAYAMA UNIV MED SCHOOL

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

右内頸静脈穿刺による脱血で体外膜型肺を併用し心肺蘇生を施行した4症例の検討査読

野島宏悦, 内藤宏道, 小崎吉訓, 大谷晋吉, 杉山淳一, 川西進, 萩岡信吾, 森本直樹

日本集中治療医学会雑誌 24 ( 2 ) 131 - 135 2017年

記述言語：日本語出版者・発行元：一般社団法人日本集中治療医学会

透視装置が使用できない状況下でも安全で短時間に送・脱血管を挿入するため，脱血管を右内頸静脈穿刺にて留置し，院外難治性心停止患者に対し体外膜型肺を併用した心肺蘇生法を行った。対象患者は4名，来院から体外循環開始までの時間は平均19.5（16［最小値］～23［最大値］）分で，ポンプ流量は2.5（1.2～3.7）l/minであった。導入に伴う出血，虚血，感染，送・脱血管先端の誤留置は認めなかった。心拍再開までは十分なポンプ流量を確保できた。自己心拍再開後，1例で脱血不良のため大腿静脈からの脱血管再留置を行った。2例が体外膜型肺を離脱，1例が独歩で退院，3例が死亡した。本4症例では脱血管に径の小さい送血用カニューレを代用し，右内頸静脈穿刺で留置したため，脱血に制限があったものの，院外心停止患者に対し，合併症なく迅速に体外膜型肺を導入できた。

DOI： 10.3918/jsicm.24_131

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