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Hisamune R, Kobayashi M, Nakasato K, Yamazaki T, Ushio N, Mochizuki K, Takasu A, Yamakawa K. A meta-analysis and trial sequential analysis of randomised controlled trials comparing nonoperative and operative management of chest trauma with multiple rib fractures. World J Emerg Surg 2024; 19:11. [PMID: 38504282 PMCID: PMC10949653 DOI: 10.1186/s13017-024-00540-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/15/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Operative treatment of traumatic rib fractures for better outcomes remains under debate. Surgical stabilization of rib fractures has dramatically increased in the last decade. This study aimed to perform a systematic review and meta-analysis of randomised controlled trials (RCTs) to assess the effectiveness and safety of operative treatment compared to conservative treatment in adult patients with traumatic multiple rib fractures. METHODS A systematic literature review was performed according to the preferred reporting items for systematic reviews and meta-analyses guidelines. We searched MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials and used the Cochrane Risk-of-Bias 2 tool to evaluate methodological quality. Relative risks with 95% confidence interval (CI) were calculated for outcomes: all-cause mortality, pneumonia incidence, and number of mechanical ventilation days. Overall certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, with trial sequential analysis performed to establish implications for further research. RESULTS From 719 records, we included nine RCTs, which recruited 862 patients. Patients were assigned to the operative group (received surgical stabilization of chest wall injury, n = 423) or control group (n = 439). All-cause mortality was not significantly different (RR = 0.53; 95% CI 0.21 to 1.38, P = 0.35, I2 = 11%) between the two groups. However, in the operative group, duration of mechanical ventilation (mean difference -4.62; 95% CI -7.64 to -1.60, P < 0.00001, I2 = 94%) and length of intensive care unit stay (mean difference -3.05; 95% CI -5.87 to -0.22; P < 0.00001, I2 = 96%) were significantly shorter, and pneumonia incidence (RR = 0.57; 95% CI 0.35 to 0.92; P = 0.02, I2 = 57%) was significantly lower. Trial sequential analysis for mortality indicated insufficient sample size for a definitive judgment. GRADE showed this meta-analysis to have very low to low confidence. CONCLUSION Meta-analysis of large-scale trials showed that surgical stabilization of multiple rib fractures shortened the duration of mechanical ventilation and reduced the incidence of pneumonia but lacked clear evidence for improvement of mortality compared to conservative treatment. Trial sequential analysis suggested the need for more cases, and GRADE highlighted low certainty, emphasizing the necessity for further targeted RCTs, especially in mechanically ventilated patients. SYSTEMATIC REVIEW REGISTRATION UMIN Clinical Trials Registry UMIN000049365.
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Affiliation(s)
- Ryo Hisamune
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Mako Kobayashi
- Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Karin Nakasato
- Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Taiga Yamazaki
- Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Noritaka Ushio
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Katsunori Mochizuki
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Akira Takasu
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
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Ota K, Nitta M, Komeya T, Matsuoka T, Takasu A. Influence of the COVID-19 Outbreak in Vulnerable Patients (Pediatric Patients, Pregnant Women, and Elderly Patients) on an Emergency Medical Service System: A Pre- and Post-COVID-19 Pandemic Comparative Study Using the Population-Based ORION Registry. Medicina (Kaunas) 2024; 60:345. [PMID: 38399632 PMCID: PMC10890565 DOI: 10.3390/medicina60020345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/09/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
Background and Objective: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread all over the world. To assess the influence of the COVID-19 pandemic on emergency medical services (EMS) for vulnerable patients transported by ambulance. Materials and Methods: This study was a retrospective, descriptive study with a study period from 1 January 2019 to 31 December 2021 using the Osaka Emergency Information Research Intelligent Operation Network (ORION) system. We included all pediatric patients, pregnant women, and elderly patients ≥ 65 years of age transported by ambulance in Osaka Prefecture. The main outcome of this study was difficult-to-transport cases. We calculated the rate of difficult-to-transport cases under several conditions. Results: For the two year-long periods of 1 January 2019 to 31 December 2019 and 1 January 2021 to 31 December 2021, a total of 887,647 patients were transported to hospital by ambulance in Osaka Prefecture. The total number of vulnerable patients was 579,815 (304,882 in 2019 and 274,933 in 2021). Multivariate logistic regression analysis showed that difficult-to-transport cases were significantly more frequent in 2021 than in 2019. Difficult-to-transport cases were significantly less frequent in the vulnerable population than in the non-vulnerable population (adjusted odds ratio 0.81, 95% confidence interval 0.80-0.83; p < 0.001). Conclusion: During the pandemic (2021), difficult-to-transport cases were more frequent compared to before the pandemic (2019); however, vulnerable patients were not the cause of difficulties in obtaining hospital acceptance for transport.
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Affiliation(s)
- Koshi Ota
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.N.); (A.T.)
- Working Group for Analysis of the Emergency Medical Care System in Osaka Prefecture, Osaka 530-0000, Japan;
| | - Masahiko Nitta
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.N.); (A.T.)
| | | | - Tetsuya Matsuoka
- Working Group for Analysis of the Emergency Medical Care System in Osaka Prefecture, Osaka 530-0000, Japan;
| | - Akira Takasu
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (M.N.); (A.T.)
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Fujii K, Yamakawa K, Takeda Y, Okuda N, Takasu A, Ono F. Understanding the pathophysiology of acute critical illness: translational lessons from zebrafish models. Intensive Care Med Exp 2024; 12:8. [PMID: 38291192 PMCID: PMC10828313 DOI: 10.1186/s40635-024-00595-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024] Open
Abstract
The models used to investigate the pathophysiological mechanisms of acute critical illness are not limited to mammalian species. The zebrafish (Danio rerio) is a popular model organism for studying diseases due to its transparency and rapid development. The genes and signaling pathways involved in acute critical illness appear highly conserved among zebrafish and humans. Forward genetics such as random mutagenesis by a chemical mutagen or reverse genetics methods represented by CRISPR/Cas9 allowed researchers to reveal multiple novel aspects of pathological processes in areas including infection, immunity, and regeneration. As a model of sepsis, transgenic zebrafish allowed the visualization of lipopolysaccharide (LPS)-induced vascular leakage in vivo and the demonstration of changes in the expression of cellular junction proteins. Other transgenic zebrafish visualizing the extravascular migration of neutrophils and macrophages have demonstrated a decrease in neutrophil numbers and an increased expression of an inflammatory gene, which replicates a phenomenon observed in humans in clinically encountered sepsis. The regenerative potential and the visibility of zebrafish organs also enabled clarification of important mechanisms in wound healing, angiogenesis, and neurogenesis. After spinal cord injury (SCI), a marker gene expressed in glial bridging was discovered. Furthermore, localized epithelial-to-mesenchymal transition (EMT) and molecular mechanisms leading to spinal cord repair were revealed. These translational studies using zebrafish show the potential of the model system for the treatment of acute critical illnesses such as sepsis, organ failure, and trauma.
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Affiliation(s)
- Kensuke Fujii
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Yuriko Takeda
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Natsuko Okuda
- Department of Physiology, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Akira Takasu
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Fumihito Ono
- Department of Physiology, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
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Ota K, Nishioka D, Hamada E, Ota K, Shibata Y, Takasu A. Sites of blood collection and topical disinfectants associated with contaminated cultures: An ambidirectional cohort study. J Gen Fam Med 2024; 25:45-52. [PMID: 38239999 PMCID: PMC10792313 DOI: 10.1002/jgf2.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/31/2023] [Accepted: 11/26/2023] [Indexed: 01/22/2024] Open
Abstract
Background We aimed to determine whether puncture sites for blood sampling and topical disinfectants are associated with rates of contaminated blood cultures in the emergency department (ED) of a single institution. Methods This single-center, ambidirectional cohort study of 548 consecutive patients ≥20 years of age was performed in the ED of a university hospital in Japan over a 13-month period. Pairs of blood samples were collected for aerobic and anaerobic cultures from patients in the ED. Physicians selected puncture sites and topical disinfectants according to their personal preference. Results Potential contamination was identified in 110 of the 548 patients (20.1%). One hundred fourteen (20.8%) patients showed true-positive results for bacteremia, and 324 (59.1%) patients showed true-negative results. Multivariate analysis revealed more frequent contamination when puncture sites were disinfected with povidone-iodine (PVI) than with alcohol/chlorhexidine (ACHX) (adjusted risk difference, 19.1%; 95% confidence interval [CI]), 15.7-22.6; p < 0.001). In terms of blood collection sites, femoral and central venous (CV) catheter with PVI disinfection showed more frequent contamination than venous sites with ACHX (adjusted risk differences: 26.6%, 95% CI 21.3-31.9, p < 0.001 and 41.1%, 95% CI 22.2-59.9, p < 0.001, respectively). Conclusion Rates of contaminated blood cultures were significantly higher when blood was collected from the CV catheter or femoral sites with PVI as the topical disinfectant.
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Affiliation(s)
- Koshi Ota
- Department of Emergency MedicineOsaka Medical and Pharmaceutical UniversityTakatsuki CityJapan
| | - Daisuke Nishioka
- Research and Development CenterOsaka Medical and Pharmaceutical UniversityTakatsuki CityJapan
| | - Emi Hamada
- Department of NursingOsaka Medical and Pharmaceutical University HospitalTakatsuki CityJapan
| | - Kanna Ota
- Department of Emergency MedicineOsaka Medical and Pharmaceutical UniversityTakatsuki CityJapan
| | - Yuriko Shibata
- Department of Clinical LaboratoryOsaka Medical and Pharmaceutical University HospitalTakatsuki CityJapan
| | - Akira Takasu
- Department of Emergency MedicineOsaka Medical and Pharmaceutical UniversityTakatsuki CityJapan
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Sohn P, McLaughlin MR, Krishnan P, Wu W, Slak Rupnik M, Takasu A, Senda T, Lee CC, Kono T, Evans-Molina C. Stromal Interaction Molecule 1 Maintains β-Cell Identity and Function in Female Mice Through Preservation of G-Protein-Coupled Estrogen Receptor 1 Signaling. Diabetes 2023; 72:1433-1445. [PMID: 37478155 PMCID: PMC10545557 DOI: 10.2337/db22-0988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 07/07/2023] [Indexed: 07/23/2023]
Abstract
Altered endoplasmic reticulum (ER) Ca2+ signaling has been linked with β-cell dysfunction and diabetes development. Store-operated Ca2+ entry replenishes ER Ca2+ through reversible gating of plasma membrane Ca2+ channels by the ER Ca2+ sensor, stromal interaction molecule 1 (STIM1). For characterization of the in vivo impact of STIM1 loss, mice with β-cell-specific STIM1 deletion (STIM1Δβ mice) were generated and challenged with high-fat diet. Interestingly, β-cell dysfunction was observed in female, but not male, mice. Female STIM1Δβ mice displayed reductions in β-cell mass, a concomitant increase in α-cell mass, and reduced expression of markers of β-cell maturity, including MafA and UCN3. Consistent with these findings, STIM1 expression was inversely correlated with HbA1c levels in islets from female, but not male, human organ donors. Mechanistic assays demonstrated that the sexually dimorphic phenotype observed in STIM1Δβ mice was due, in part, to loss of signaling through the noncanonical 17-β estradiol receptor (GPER1), as GPER1 knockdown and inhibition led to a similar loss of expression of β-cell maturity genes in INS-1 cells. Together, these data suggest that STIM1 orchestrates pancreatic β-cell function and identity through GPER1-mediated estradiol signaling. ARTICLE HIGHLIGHTS Store-operated Ca2+ entry replenishes endoplasmic reticulum (ER) Ca2+ through reversible gating of plasma membrane Ca2+ channels by the ER Ca2+ sensor, stromal interaction molecule 1 (STIM1). β-Cell-specific deletion of STIM1 results in a sexually dimorphic phenotype, with β-cell dysfunction and loss of identity in female but not male mice. Expression of the noncanonical 17-β estradiol receptor (GPER1) is decreased in islets of female STIM1Δβ mice, and modulation of GPER1 levels leads to alterations in expression of β-cell maturity genes in INS-1 cells.
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Affiliation(s)
- Paul Sohn
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN
| | - Madeline R. McLaughlin
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Preethi Krishnan
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
- Department of Chemical and Biological Engineering, University of British Columbia, Vancouver, Canada
| | - Wenting Wu
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Marjan Slak Rupnik
- Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
- Institute of Physiology, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Akira Takasu
- Structural Biology Research Center, Institute of Materials Structure Science, High Energy Accelerator Research Organization, Ibaraki, Japan
| | - Toshiya Senda
- Structural Biology Research Center, Institute of Materials Structure Science, High Energy Accelerator Research Organization, Ibaraki, Japan
| | - Chih-Chun Lee
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Tatsuyoshi Kono
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
- Richard L. Roudebush Veterans' Administration Medical Center, Indianapolis, IN
| | - Carmella Evans-Molina
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
- Richard L. Roudebush Veterans' Administration Medical Center, Indianapolis, IN
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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Ota K, Kobata H, Hamada Y, Mizutani S, Okuyama T, Ota K, Takeda Y, Takasu A. Anisocoria without extraocular muscle impairment due to moderate traumatic brain injury with midbrain contusion: a case report. BMC Neurol 2023; 23:270. [PMID: 37454064 DOI: 10.1186/s12883-023-03331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 07/12/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND New-onset anisocoria is an important clinical clue to life-threatening intracranial injury. Anisocoria alone without impairment of extraocular muscles is a rare presentation of moderate traumatic brain injury (TBI). CASE PRESENTATION A 79-year-old woman was transported to hospital soon after falling off a bicycle. Glasgow Coma Scale score on arrival was 11 (E3V3M5). On examination at admission, she was found to be drowsy. Bruising was seen around the right eye and pupil diameters differed (right, 4.5 mm; left, 3.0 mm; both reactive to light). Computed tomography of the head revealed hemorrhagic contusion in the left temporal lobe and left pretectal area of the midbrain, right clavicular fracture, and pulmonary contusion with fractures of the 3rd and 4th ribs. Magnetic resonance imaging confirmed hemorrhagic contusion of the midbrain. The patient achieved full recovery of motor and mental functions with conservative treatment and was discharged on hospital day 17. CONCLUSION We encountered a case of anisocoria without major extraocular muscle impairment due to moderate TBI with midbrain contusion.
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Affiliation(s)
- Koshi Ota
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, 596-8686, Osaka, Japan.
| | - Hitoshi Kobata
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, 596-8686, Osaka, Japan
| | - Yoshisuke Hamada
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, 596-8686, Osaka, Japan
| | - Saki Mizutani
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, 596-8686, Osaka, Japan
| | - Terunari Okuyama
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, 596-8686, Osaka, Japan
| | - Kanna Ota
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, 596-8686, Osaka, Japan
| | - Yuriko Takeda
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, 596-8686, Osaka, Japan
| | - Akira Takasu
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, 596-8686, Osaka, Japan
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Tsunekawa E, Otsubo Y, Yamada Y, Ikeda A, Adachi N, Kawasaki M, Takasu A, Aramaki S, Senda T, Sato S, Yoshida S, Fujita M, Sawada T. X-ray and Electron Diffraction Observations of Steric Zipper Interactions in Metal-Induced Peptide Cross-β Nanostructures. J Am Chem Soc 2023. [PMID: 37435991 DOI: 10.1021/jacs.3c04710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
The steric zipper is a common hydrophobic packing structure of peptide side chains that forms between two adjacent β-sheet layers in amyloid and related fibrils. Although previous studies have revealed that peptide fragments derived from native protein sequences exhibit steric zipper structures, their de novo designs have rarely been studied. Herein, steric zipper structures were artificially constructed in the crystalline state by metal-induced folding and assembly of tetrapeptide fragments Boc-3pa-X1-3pa-X2-OMe (3pa: β-(3-pyridyl)-l-alanine; X1 and X2: hydrophobic amino acids). Crystallographic studies revealed two types of packing structures, interdigitation and hydrophobic contact, that result in a class 1 steric zipper geometry when the X1 and X2 residues contain alkyl side chains. Furthermore, a class 3 steric zipper geometry was also observed for the first time among any reported steric zippers when using tetrapeptide fragments with (X1, X2) = (Thr, Thr) and (Phe, Leu). The system could also be extended to a knob-hole-type zipper using a pentapeptide sequence.
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Affiliation(s)
- Eisuke Tsunekawa
- Department of Applied Chemistry, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Yusuke Otsubo
- Department of Applied Chemistry, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Yusuke Yamada
- Structural Biology Research Center, Institute of Materials Structure Science, High Energy Accelerator Research Organization (KEK), Oho 1-1, Tsukuba, Ibaraki 305-0801, Japan
| | - Akihito Ikeda
- Structural Biology Research Center, Institute of Materials Structure Science, High Energy Accelerator Research Organization (KEK), Oho 1-1, Tsukuba, Ibaraki 305-0801, Japan
| | - Naruhiko Adachi
- Structural Biology Research Center, Institute of Materials Structure Science, High Energy Accelerator Research Organization (KEK), Oho 1-1, Tsukuba, Ibaraki 305-0801, Japan
| | - Masato Kawasaki
- Structural Biology Research Center, Institute of Materials Structure Science, High Energy Accelerator Research Organization (KEK), Oho 1-1, Tsukuba, Ibaraki 305-0801, Japan
| | - Akira Takasu
- Structural Biology Research Center, Institute of Materials Structure Science, High Energy Accelerator Research Organization (KEK), Oho 1-1, Tsukuba, Ibaraki 305-0801, Japan
- Life Science Center for Survival Dynamics, Tsukuba Advanced Research Alliance (TARA), University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
| | - Shinji Aramaki
- Structural Biology Research Center, Institute of Materials Structure Science, High Energy Accelerator Research Organization (KEK), Oho 1-1, Tsukuba, Ibaraki 305-0801, Japan
- Life Science Center for Survival Dynamics, Tsukuba Advanced Research Alliance (TARA), University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
- Tietz Video and Image Processing Systems Japan G.K., Level 14, Hibiya Central Building, 1-2-9 Nishi Shimbashi, Minato-ku, Tokyo 105-1003, Japan
| | - Toshiya Senda
- Structural Biology Research Center, Institute of Materials Structure Science, High Energy Accelerator Research Organization (KEK), Oho 1-1, Tsukuba, Ibaraki 305-0801, Japan
| | - Sota Sato
- Department of Applied Chemistry, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- Division of Advanced Molecular Science, Institute for Molecular Science, National Institutes of Natural Sciences, 5-1 Higashiyama, Myodaiji-cho, Okazaki, Aichi 444-8787, Japan
| | - Satoshi Yoshida
- Department of Applied Chemistry, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Makoto Fujita
- Department of Applied Chemistry, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- Division of Advanced Molecular Science, Institute for Molecular Science, National Institutes of Natural Sciences, 5-1 Higashiyama, Myodaiji-cho, Okazaki, Aichi 444-8787, Japan
| | - Tomohisa Sawada
- Laboratory for Chemistry and Life Science, Institute of Innovative Research, Tokyo Institute of Technology, 4259 Nagatsuta, Midori-ku, Yokohama 226-8503, Japan
- Precursory Research for Embryonic Science and Technology (PRESTO), Japan Science and Technology Agency (JST), 4-1-8 Honcho, Kawaguchi, Saitama 332-0012, Japan
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Kyo D, Tokuoka S, Katano S, Hisamune R, Yoshimoto H, Murao S, Umemura Y, Takasu A, Yamakawa K. Comparison of Nutrition Indices for Prognostic Utility in Patients with Sepsis: A Real-World Observational Study. Diagnostics (Basel) 2023; 13:diagnostics13071302. [PMID: 37046520 PMCID: PMC10093319 DOI: 10.3390/diagnostics13071302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Nutritional status of critically ill patients is an important factor affecting complications and mortality. This study aimed to investigate the impact of three nutritional indices, the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT), on mortality in patients with sepsis in Japan. Methods: This retrospective observational study used the Medical Data Vision database containing data from 42 acute-care hospitals in Japan. We extracted data on baseline characteristics on admission. GNRI, PNI, and CONUT scores on admission were also calculated. To evaluate the significance of these three nutritional indices on mortality, we used logistic regression to fit restricted cubic spline models and constructed Kaplan–Meier survival curves. Results: We identified 32,159 patients with sepsis according to the inclusion criteria. Of them, 1804 patients were treated in intensive care units, and 3461 patients were non-survivors. When the GNRI dropped below 100, the risk of mortality rose sharply, as did that when the PNI dropped below about 40. An increased CONUT score was associated with increased mortality in an apparent linear manner. Conclusion: In sepsis management, GNRI and PNI values may potentially be helpful in identifying patients with a high risk of death.
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Affiliation(s)
- Django Kyo
- Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan; (D.K.)
| | - Shiho Tokuoka
- Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan; (D.K.)
| | - Shunsuke Katano
- Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan; (D.K.)
| | - Ryo Hisamune
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan
| | - Hidero Yoshimoto
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan
- Department of Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan
| | - Shuhei Murao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita 565-0871, Japan
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi 558-8558, Japan
| | - Akira Takasu
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Japan
- Correspondence: ; Tel.: +81-72-683-1221
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9
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Ota K, Nishioka D, Katayama Y, Kitamura T, Masui J, Ota K, Nitta M, Matsuoka T, Takasu A. Epidemiology of patients with dizziness over a 3-year period, requiring utilization of the emergency medical serviced system: A pre- and post-COVID pandemic comparative study using the population-based ORION registry. J Vestib Res 2023; 33:127-136. [PMID: 36641704 DOI: 10.3233/ves-220024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE We aimed to identify the proportion of each medical condition or disease contributing to dizziness and their disposition in the Emergency Department (ED). METHODS This retrospective, descriptive study examined data from the Osaka Emergency Information Research Intelligent Operation Network system in Japan for the period from January 1, 2018 to December 31, 2020. The inclusion criteria were patients with presumptive ICD-10 codes including "dizziness" or "vertigo". Patient demographics were compared using the χ2 test and Kruskal-Wallis test. Logistic regression analysis was performed to calculate disposition from ED (emergency admission or discharge) over the 3-year study period. The adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated using multivariate analyses. RESULTS During the 3-year study period, a total of 1,346,457 patients (462,773 in 2018, 468,697 in 2019, and 414,987 in 2020; P < 0.001), including 53,190 patients with dizziness (18,396 in 2018, 18,649 in 2019, and 16,145 in 2020; P = 0.058), were identified as having been transported to hospitals by ambulance in Osaka Prefecture. Dizziness and giddiness (R42) was the most common form of dizziness, in 27,075 cases (9,570 in 2018, 9,613 in 2019, and 7,892 in 2020; P < 0.001; Gender composition showed 10,483 males and 16,592 females.) Vestibular Neuronitis (H81.2) showed significant increase in 2020 compared to the two preceding years (91 in 2018, 119 in 2019, and 130 in 2020, P = 0.003; including 174 males and 167 females, respectively). Of the 53,190 patients with dizziness, 11,862 (22.3%; 4,323 males, 7,539 females) were admitted to hospital. The odds ratio (OR) for emergency admission for dizziness in 2020 during the COVID-19 pandemic was 0.98 (95% confidence interval (CI), 0.93- 1.03) with reference to 2018. CONCLUSION Patients with dizziness accounted approximately 4% of ED transportations, with about 20% requiring hospital admission, irrespective of the COVID-19 pandemic. Vestibular neuronitis was significantly increased in 2020.
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Affiliation(s)
- Koshi Ota
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | - Daisuke Nishioka
- Research and Development Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yusuke Katayama
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | - Tetsuhisa Kitamura
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | - Jun Masui
- Osaka Prefectural Government, Osaka, Japan
| | - Kanna Ota
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | - Tetsuya Matsuoka
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
| | - Akira Takasu
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
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10
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Takeda Y, Ota K, Kondo A, Nishii T, Onishi N, Yokoyama H, Yamakawa K, Takasu A. A case of necrotizing fasciitis caused by Bifidobacterium breve. IDCases 2022; 31:e01667. [PMID: 36636462 PMCID: PMC9830150 DOI: 10.1016/j.idcr.2022.e01667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/10/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Bifidobacterium breve is an obligate anaerobic gram-positive bacillus mainly found in the gastrointestinal tract of human infants. Few cases of necrotizing fasciitis caused by B. breve have been reported. Case presentation A 42-year-old Japanese man with type 2 diabetes mellitus, obesity, cellulitis of the back, and subcutaneous abscess of the right inguinal region presented with rapidly developing erythema, swelling and severe pain in the right inguinal region. Computed tomography showed widespread gas in the right leg region. Cultures of blood and a swab of the wound abscess grew gram-positive bacilli. Mass spectrography and 16 S rDNA analysis confirmed the gram-positive bacilli as B. breve. The patient recovered following extensive debridement and antibacterial therapy. Conclusion Unidentified necrotizing fasciitis can be caused by B. breve, especially in compromised hosts.
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Affiliation(s)
| | - Koshi Ota
- Correspondence to: Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka 596-8686, Japan.
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11
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Yoshimoto H, Fukui S, Higashio K, Endo A, Takasu A, Yamakawa K. Optimal target blood pressure in critically ill adult patients with vasodilatory shock: A systematic review and meta-analysis. Front Physiol 2022; 13:962670. [PMID: 36051909 PMCID: PMC9424848 DOI: 10.3389/fphys.2022.962670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
While the Surviving Sepsis Campaign guidelines recommend an initial target value of 65 mmHg as the mean arterial pressure (MAP) in patients with septic shock, the optimal MAP target for improving outcomes remains controversial. We performed a meta-analysis to evaluate the optimal MAP for patients with vasodilatory shock, which included three randomized controlled trials that recruited 3,357 patients. Between the lower (60–70 mmHg) and higher (>70 mmHg) MAP target groups, there was no significant difference in all-cause mortality (risk ratio [RR], 1.06; 95% confidence intervals [CI], 0.98–1.16) which was similar in patients with chronic hypertension (RR, 1.10; 95% CI, 0.98–1.24) and patients aged ≥65 years (RR, 1.10; 95% CI, 0.99–1.21). No significant difference in adverse events was observed between the different MAP groups (RR, 1.04; 95% CI, 0.87–1.24); however, supraventricular arrhythmia was significantly higher in the higher MAP group (RR, 1.73; 95% CI, 1.15–2.60). Renal replacement therapy was reduced in the higher MAP group of patients with chronic hypertension (RR, 0.83; 95% CI, 0.71–0.98). Though the higher MAP control did not improve the mortality rate, it may be beneficial in reducing renal replacement therapy in patients with chronic hypertension. Systematic review registration: UMIN Clinical Trials Registry, identifier UMIN000042624
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Affiliation(s)
- Hidero Yoshimoto
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
- Department of Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Satoshi Fukui
- Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Koki Higashio
- Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Akira Takasu
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
- *Correspondence: Kazuma Yamakawa,
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12
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Ota K, Nishioka D, Katayama Y, Kitamura T, Masui J, Ota K, Nitta M, Matsuoka T, Takasu A. Influence of the -19 outbreak on transportation of pregnant women in an emergency medical service system: Population-based, ORION registry. Int J Gynaecol Obstet 2022; 157:366-374. [PMID: 35122253 PMCID: PMC9087768 DOI: 10.1002/ijgo.14128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/15/2021] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
Background The coronavirus disease 2019 (COVID‐19), caused by Severe Acute Respiratory Syndrome Coronavirus 2, has spread rapidly across the world. Objective To assess the influence of the COVID‐19 pandemic on the emergency medical service (EMS) for transportation of pregnant women by ambulance. Methods This study was a retrospective, descriptive study using the Osaka Emergency Information Research Intelligent Operation Network system, and included pregnant women transported by ambulance in Osaka Prefecture between January 1, 2018 and December 31, 2020. The main outcome of the study was difficulty in obtaining hospital acceptance for transfer of patients (difficult‐to‐transfer cases). We calculated the rates of difficult‐to‐transfer cases using univariate and multivariate analyses. Results Of the 1 346 457 total patients transported to hospitals by ambulance in Osaka Prefecture during the study period, pregnant women accounted for 2586 (909, 943, and 734, in 2018, 2019, and 2020, respectively). Logistic regression analysis revealed that pregnant women were negatively associated with difficult‐to‐transfer cases (adjusted OR 0.36, 95% CI 0.26–0.50). Compared with 2018, 2020 was significantly associated with difficult‐to‐transfer cases (adjusted OR 1.27, 95% CI 1.24–1.30). Conclusion Pregnant women were consistently associated with reduced odds for being difficult‐to‐transfer cases. The COVID‐19 pandemic might have influenced difficult‐to‐transfer cases in 2020. This study showed that pregnancy was consistently associated with reduced odds for difficult‐to‐transfer cases in 2020 even during the COVID‐19 outbreak.
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Affiliation(s)
- Koshi Ota
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University.,The Working Group to analyze the emergency medical care system in Osaka Prefecture
| | - Daisuke Nishioka
- Research and Development Center, Osaka Medical and Pharmaceutical University
| | - Yusuke Katayama
- The Working Group to analyze the emergency medical care system in Osaka Prefecture
| | - Tetsuhisa Kitamura
- The Working Group to analyze the emergency medical care system in Osaka Prefecture
| | | | - Kanna Ota
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University.,The Working Group to analyze the emergency medical care system in Osaka Prefecture
| | - Tetsuya Matsuoka
- The Working Group to analyze the emergency medical care system in Osaka Prefecture
| | - Akira Takasu
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University
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13
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Kawakami A, Yamakawa K, Nishioka D, Ota K, Kusaka Y, Umegaki O, Ito Y, Takasu A.
PaO
2
/
FiO
2
ratio responsiveness to prone positioning in intubated patients with severe
COVID
‐19: a retrospective observational study. Acute Med Surg 2022; 9:e765. [PMID: 35677680 PMCID: PMC9167425 DOI: 10.1002/ams2.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/15/2022] [Indexed: 12/15/2022] Open
Abstract
Aim Prone positioning of coronavirus disease 2019 (COVID‐19) patients could improve oxygenation. However, clinical data on prone positioning of intubated COVID‐19 patients are limited. We investigated trends of PaO2 / FiO2 ratio values in patients during prone positioning to identify a predictive factor for early detection of patients requiring advanced therapeutic intervention such as extracorporeal membrane oxygenation (ECMO). Methods This retrospective, observational cohort study was undertaken between April 2020 and May 2021 in a tertiary referral hospital for COVID‐19 in Osaka, Japan. We included intubated adult COVID‐19 patients treated with prone positioning within the first 72 h of admission to the intensive care unit and followed them until hospital discharge or death. Primary outcomes were in‐hospital mortality and escalation of care to ECMO. We used unsupervised k‐means clustering modeling to categorize COVID‐19 patients by PaO2 / FiO2 ratio responsiveness to prone positioning. Results The final study cohort comprised 54 of 155 consecutive severe COVID‐19 patients. Three clusters were generated according to trends in PaO2 / FiO2 ratios during prone positioning (cluster A, n = 16; cluster B, n = 24; cluster C, n = 14). Baseline characteristics of all clusters were almost similar. Cluster A (no increase in PaO2 / FiO2 ratio during prone positioning) had a significantly higher proportion of patients placed on ECMO or who died (6/16, 37.5%). Numbers of patients with ECMO and with in‐hospital death were significantly different between the three groups (p = 0.017). Conclusion In Japanese patients intubated due to COVID‐19, clinicians should consider earlier escalation of treatment, such as facility transfer or ECMO, if the PaO2 / FiO2 ratio does not increase during initial prone positioning.
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Affiliation(s)
- Akiko Kawakami
- Department of Emergency and Critical Care Medicine Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Daisuke Nishioka
- Department of Medical Statistics, Research and Development Center Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Koshi Ota
- Department of Emergency and Critical Care Medicine Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Yusuke Kusaka
- Department of Anesthesiology Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Osamu Umegaki
- Intensive Care Unit Osaka Medical and Pharmaceutical University Hospital Takatsuki Japan
| | - Yuri Ito
- Department of Medical Statistics, Research and Development Center Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Akira Takasu
- Department of Emergency and Critical Care Medicine Osaka Medical and Pharmaceutical University Takatsuki Japan
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14
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Yoshimoto H, Yamakawa K, Umemura Y, Fujii K, Nakamura E, Taniguchi K, Tanaka K, Takasu A, Uchiyama K. Seasonal Variation and Severity of Acute Abdomen in Japan: A Nine-Year Retrospective Analysis. J Pers Med 2021; 11:1346. [PMID: 34945818 PMCID: PMC8709094 DOI: 10.3390/jpm11121346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022] Open
Abstract
The seasonal incidence of acute abdomens, such as appendicitis, is reportedly more common in summer but is reported less frequently in Asia. Additionally, seasonal variations in the severity of acute abdomens have been evaluated insufficiently. This study evaluated the seasonal variations in the incidence and severity of acute abdomens in Japan. This retrospective observational study used a multicenter database containing data from 42 acute hospitals in Japan. We included all patients diagnosed with acute appendicitis, diverticulitis, cholecystitis, and cholangitis between January 2011 and December 2019. Baseline patient data included admission date, sequential organ failure assessment score, presence of sepsis, and disseminated intravascular coagulation. We enrolled 24,708 patients with acute abdomen. Seasonal admissions for all four acute abdominal diseases were the highest in summer [acute appendicitis, (OR = 1.35; 95% CI = 1.28-1.43); diverticulitis, (OR = 1.23; 95% CI = 1.16-1.31; cholecystitis (OR = 1.23; 95% CI = 1.11-1.36); and cholangitis (OR = 1.23; 95% CI = 1.12-1.36)]. The proportion of patients with sepsis and disseminated intravascular coagulation as well as the total SOFA score for each disease, did not differ significantly across seasons. Seasonal variations in disease severity were not observed.
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Affiliation(s)
- Hidero Yoshimoto
- Department of Surgery, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (H.Y.); (K.F.); (K.T.); (K.T.); (K.U.)
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (E.N.); (A.T.)
| | - Yutaka Umemura
- Osaka General Medical Center, Division of Trauma and Surgical Critical Care, Osaka 558-8558, Japan;
| | - Kensuke Fujii
- Department of Surgery, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (H.Y.); (K.F.); (K.T.); (K.T.); (K.U.)
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (E.N.); (A.T.)
- Department of Surgery, Kasaoka Daiichi Hospital, Kasaoka 714-0043, Japan
| | - Eriko Nakamura
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (E.N.); (A.T.)
| | - Kohei Taniguchi
- Department of Surgery, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (H.Y.); (K.F.); (K.T.); (K.T.); (K.U.)
- Translational Research Program, Osaka Medical and Pharmaceutical University, Osaka 569-8686, Japan
| | - Keitaro Tanaka
- Department of Surgery, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (H.Y.); (K.F.); (K.T.); (K.T.); (K.U.)
| | - Akira Takasu
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (E.N.); (A.T.)
| | - Kazuhisa Uchiyama
- Department of Surgery, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan; (H.Y.); (K.F.); (K.T.); (K.T.); (K.U.)
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15
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Ota K, Yokoyama H, Takasu A. Removal of a Pencil Embedded in a Child’s Foot: A Case Report. Cureus 2021; 13:e20033. [PMID: 34987918 PMCID: PMC8716160 DOI: 10.7759/cureus.20033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/21/2022] Open
Abstract
The foot is the most common anatomic site for foreign body embedment in both children and adults. An 11-year-old boy boy with a history of autism spectrum disorder (ASD), learning disorder, and attention-deficit hyperactivity disorder (ADHD) was brought to our ED with a pencil deeply embedded in his right foot. The broken portion of the pencil was completely embedded in his right foot, with mild bleeding and it could not be extracted easily. The pencil was eventually mobilized via gentle back-and-forth twisting motion, which allowed successful removal of a significant portion of the embedded pencil. To establish the presence of a foreign body, as in each X-ray, the affected body part should be imaged in at least two directions. Based on the density of the embedded foreign body, ultrasound imaging should be considered.
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16
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Ota K, Nishii T, Fujii K, Oishi Y, Onishi N, Ota K, Yokoyama H, Takasu A. Altered consciousness with transient abnormal signals in the hippocampus: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211054644. [PMID: 34707870 PMCID: PMC8543701 DOI: 10.1177/2050313x211054644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022] Open
Abstract
Hippocampal infarction is relatively rare. Many different diseases can mimic hippocampal
infarction including transient global amnesia, Alzheimer’s disease, epilepsy,
encephalitis, and encephalopathies. An 89-year-old man was transported to our hospital for
altered consciousness. Diffusion-weighted magnetic resonance imaging revealed slightly
intense signals in the hippocampus with a mildly decreased apparent diffusion coefficient.
Serial magnetic resonance imaging revealed features of hippocampal infarction. Symptoms
and cognitive function gradually improved with rehabilitation, and he was transferred to a
rehabilitation facility on Hospital Day 38. Hippocampal infarction is rare in patients
with altered mental status, but should be considered when magnetic resonance imaging shows
findings suggestive of this condition. Other differential diseases should be ruled out by
serial magnetic resonance imaging and observation of the clinical course.
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Affiliation(s)
- Koshi Ota
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Tomonobu Nishii
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Kensuke Fujii
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Yasuo Oishi
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Naoya Onishi
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Kanna Ota
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Hiroki Yokoyama
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Akira Takasu
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
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17
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Ota K, Yokoyama H, Fujii K, Nakamura E, Oka M, Ota K, Sano Y, Takasu A. Severe hypokalemia due to Kampo medicine (Shakuyakukanzoto): A report of two cases. J Herb Med 2021. [DOI: 10.1016/j.hermed.2021.100467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Ota K, Oba K, Ito Y, Cheng J, Ota K, Takasu A. Focused Assessment with Sonography for Trauma (FAST) training for first-year resident physicians at a university hospital in Japan: A longitudinal, observational study. SAGE Open Med 2021; 9:20503121211044367. [PMID: 34504709 PMCID: PMC8422809 DOI: 10.1177/20503121211044367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 08/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Ultrasound training is an essential part of residency programs during emergency medicine rotations for first-year trainees (postgraduate year 1). The Focused Assessment with Sonography for Trauma examination used to assess for internal bleeding in trauma patients is one of the essential skills postgraduate year 1 residents must acquire during the emergency medicine rotation. Method: A prospective, longitudinal, observational study of postgraduate year 1 residents during a 2-month long emergency medicine rotation conducted from 1 April 2019 to 31 May 2021. The primary outcome was the mean difference between the hands-on Focused Assessment with Sonography for Trauma examination scores of the first week of the emergency medicine rotation and the same hands-on Focused Assessment with Sonography for Trauma examination scores of the last week of the emergency medicine rotation. All postgraduate year 1 residents had open access to the ultrasound machine to practice examining on other postgraduate year 1 residents or could use it on real patients under supervision of emergency medicine physicians. Result: A total of 91 postgraduate year 1 residents (65 male and 26 female) were recruited and submitted to the hands-on Focused Assessment with Sonography for Trauma test in both the first and last weeks of the rotation. The mean test score for the postgraduate year 1 residents in the first week was 7.81 (standard deviation = 2.11). The mean test score in the last week was 16.17 (standard deviation = 2.60). The primary outcome of this study was the score difference between the first and last weeks (mean = 8.35, 95% confidence interval = 7.73 to 8.94, p < 0.001, paired t-test). Conclusion: Hands-on practical Focused Assessment with Sonography for Trauma training for postgraduate year 1 residents during emergency medicine rotations significantly improved their Focused Assessment with Sonography for Trauma test scores.
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Affiliation(s)
- Koshi Ota
- Department of Emergency Medicine, Osaka Medical College, Osaka, Japan
| | - Koji Oba
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuri Ito
- Research and Development Center, Osaka Medical College, Osaka, Japan
| | - Jacky Cheng
- Department of Obstetrics and Gynecology, United States Naval Hospital Yokosuka, Yokosuka, Japan
| | - Kanna Ota
- Department of Emergency Medicine, Osaka Medical College, Osaka, Japan
| | - Akira Takasu
- Department of Emergency Medicine, Osaka Medical College, Osaka, Japan
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19
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Ota K, Oba K, Fukui K, Ito Y, Hamada E, Mori N, Oka M, Ota K, Shibata Y, Takasu A. Sites of blood collection and topical antiseptics associated with contaminated cultures: prospective observational study. Sci Rep 2021; 11:6211. [PMID: 33737624 PMCID: PMC7973780 DOI: 10.1038/s41598-021-85614-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/26/2021] [Indexed: 11/14/2022] Open
Abstract
We aimed to determine whether puncture sites for blood sampling and topical disinfectants are associated with rates of contaminated blood cultures in the emergency department (ED) of a single institution. This single-center, prospective observational study of 249 consecutive patients aged ≥ 20 years proceeded in the ED of a university hospital in Japan during 6 months. Pairs of blood samples were collected for aerobic and anaerobic culture from all patients in the ED. Physicians selected puncture sites and topical disinfectants according to their personal preference. We found 50 (20.1%) patients with potentially contaminated blood cultures. Fifty-six (22.5%) patients were true bacteremia and 143 (57.4%) patients were true negatives. Multivariate analysis associated more frequent contamination when puncture sites were disinfected with povidone-iodine than with alcohol/chlorhexidine (adjusted risk difference, 12.9%; 95% confidence interval [CI] 8.8–16.9; P < 0.001). Sites of blood collection were also associated with contamination. Femoral and central venous with other sites were associated with contamination more frequently than venous sites (adjusted risk difference), 13.1% (95% CI 8.2–17.9; P < 0.001]) vs. 17.3% (95% CI 3.6–31.0; P = 0.013). Rates of contaminated blood cultures were significantly higher when blood was collected from femoral sites and when povidone-iodine was the topical antiseptic.
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Affiliation(s)
- Koshi Ota
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan.
| | - Koji Oba
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keisuke Fukui
- Research and Development Center, Osaka Medical College, Osaka, Japan
| | - Yuri Ito
- Research and Development Center, Osaka Medical College, Osaka, Japan
| | - Emi Hamada
- Department of Nursing, Osaka Medical College Hospital, Osaka, Japan
| | - Naomi Mori
- Department of Nursing, Osaka Medical College Hospital, Osaka, Japan
| | - Masahiro Oka
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan
| | - Kanna Ota
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan
| | - Yuriko Shibata
- Department of Clinical Laboratory, Osaka Medical College Hospital, Osaka, Japan
| | - Akira Takasu
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan
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Ota K, Yokoyama H, Takasu A. Discovery of decades-old acupuncture needle fragments during routine care for an arm injury. Acute Med Surg 2020; 7:e588. [PMID: 33173588 PMCID: PMC7642608 DOI: 10.1002/ams2.588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/16/2020] [Accepted: 09/29/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Koshi Ota
- Department of Emergency Medicine Osaka Medical College Takatsuki City Japan
| | - Hiroki Yokoyama
- Department of Emergency Medicine Osaka Medical College Takatsuki City Japan
| | - Akira Takasu
- Department of Emergency Medicine Osaka Medical College Takatsuki City Japan
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21
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Ota K, Onishi N, Fujii K, Nakamura E, Oishi Y, Oka M, Ota K, Sano Y, Yokoyama H, Takasu A. Tachyarrhythmia improved by management of low back pain in a patient with delayed diagnosis of infective spondylodiscitis: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20952996. [PMID: 32922798 PMCID: PMC7448131 DOI: 10.1177/2050313x20952996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 08/05/2020] [Indexed: 11/15/2022] Open
Abstract
A 77-year-old man presented to the emergency room with a 1-month history of persistent low back pain with the absence of vital sign abnormalities. On several previous orthopedic surgery clinic visits, pathological back pain had not been considered and pain killers had been prescribed because he had low back pain due to lumbar spinal canal stenosis. He was admitted to the intensive care unit for infectious spondylodiscitis and infective endocarditis with disseminated abscess caused by methicillin-resistant Staphylococcus aureus. Shock refractory tachyarrhythmia could not be managed with antiarrhythmic agent in the intensive care unit. Intractable low back pain and persistent tachyarrhythmia were adequately managed by pain control with fentanyl in the intensive care unit. Infectious spondylodiscitis and infective endocarditis were effectively managed with anti-methicillin-resistant Staphylococcus aureus drugs, initially in rotational usage, but the patient died of extended-spectrum beta-lactamase-producing Escherichia coli pneumonia on day 50 of hospitalization. Infectious spondylodiscitis should have been considered for persistent low back pain with hemodialysis, fever, and a history of device implantation. Pain management may be necessary for persistent tachycardia that proves unresponsive to usual antiarrhythmic medications.
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Affiliation(s)
- Koshi Ota
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Naoya Onishi
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Kensuke Fujii
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Eriko Nakamura
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Yasuo Oishi
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Masahiro Oka
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | | | - Yohei Sano
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Hiroki Yokoyama
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Akira Takasu
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
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Ota K, Fukui K, Nakamura E, Oka M, Ota K, Sakaue M, Sano Y, Takasu A. Effect of Shakuyaku-kanzo-to in patients with muscle cramps: A systematic literature review. J Gen Fam Med 2020; 21:56-62. [PMID: 32489757 PMCID: PMC7260166 DOI: 10.1002/jgf2.302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/15/2020] [Accepted: 01/27/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Previous clinical studies have reported that Shakuyaku-kanzo-to (SKT) has a therapeutic effect on muscle cramps, but few studies have clarified how SKT acts to treat muscle cramps. The aim of this study was to perform an updated systematic review of clinical trials for SKT in patients with muscle cramps. METHODS The literature was systematically reviewed to assess the effects of SKT in patients with muscle cramps. PubMed, Web of Science, Cochrane Library, Google Scholar, and Ichushi-Web were searched using the terms "Shakuyaku-kanzo-to" ("shakuyakukanzoto", etc), "clinical trials" and "muscle cramps". Two quality assessments were conducted independently by three authors. Data were extracted using a standardized extraction tool, and a qualitative synthesis of evidence was performed. RESULTS Three randomized controlled articles were identified and enrolled in this study. A systematic review, but not a meta-analysis, was performed because of the high heterogeneity and limited number of studies. In patients with liver cirrhosis, the odds ratio (OR) for improvement with SKT compared to placebo was 1.27 (95% confidence interval [CI], 0.445-2.086) and compared to Goshajinkigan was 0.81 (95%CI, -1.734-0.114). The OR for improvement with SKT compared with eperisone hydrochloride in patients with lumbar spinal stenosis was 2.86 (95%CI, 0.980-4.744). CONCLUSIONS Current evidence appears insufficient to allow a meta-analysis of the effects of SKT, but SKT might show efficacy in treating muscle cramps in patients with cirrhosis or lumbar spinal stenosis.
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Affiliation(s)
- Koshi Ota
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Keisuke Fukui
- Research and Development CenterOsaka Medical CollegeTakatsukiJapan
| | - Eriko Nakamura
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Masahiro Oka
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Kanna Ota
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Masahide Sakaue
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Yohei Sano
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Akira Takasu
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
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23
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Ota K, Sano Y, Takasu A. Bilateral hydroureteronephrosis with infection due to uterine prolapse. J Gen Fam Med 2020; 21:23-24. [PMID: 32161699 PMCID: PMC7060291 DOI: 10.1002/jgf2.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Koshi Ota
- Department of Emergency Medicine Osaka Medical College Takatsuki City Osaka Japan
| | - Yohei Sano
- Department of Emergency Medicine Osaka Medical College Takatsuki City Osaka Japan
| | - Akira Takasu
- Department of Emergency Medicine Osaka Medical College Takatsuki City Osaka Japan
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Imai Y, Taniguchi K, Iida R, Nitta M, Uchiyma K, Takasu A. Diagnostic accuracy of presepsin in predicting bacteraemia in elderly patients admitted to the emergency department: prospective study in Japan. BMJ Open 2019; 9:e030421. [PMID: 31843822 PMCID: PMC6924853 DOI: 10.1136/bmjopen-2019-030421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Early prediction of bacteraemia in the elederly is needed in the emergency department (ED). DESIGN, SETTING AND PARTICIPANTS A prospective study in Japan; single-centre trial in patients who satisfied the sepsis criteria was conducted between September 2014 and March 2016. Forty-six elderly patients aged ≥70 years were included. The study protocol was approved by the ethics committee of Osaka Medical College. Ethics Committee approval number was 1585. INTERVENTIONS Blood sampling to evaluate C-reactive protein (CRP), procalcitonin (PCT) and presepsin plasma levels; two sets of blood sampling for bacterial cultures; and evaluations of the Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation scores were performed on arrival at the ED. The results were compared between patients with bacteraemia and those without bacteraemia. MAIN OUTCOME MEASURE The accuracy of detecting bacteraemia. RESULTS The presepsin value was significantly higher in the bacteraemia group than in the non-bacteraemia group (866.6±184.6 vs 639.9±137.1 pg/mL, p=0.03). The PCT and CRP did not significantly differ between the groups. The area under the receiver operating characteristic curve values were not significantly different among presepsin (0.69), PCT (0.61) and CRP (0.53). Multivariate analysis showed that presepsin was independently associated with bacteraemia (OR 8.84; 95% CI 0.95 to 81.79; p=0.02). CONCLUSION Presepsin could be a good biomarker to predict bacteraemia in elderly patients with sepsis criteria admitted to the ED.
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Affiliation(s)
- Yoshiro Imai
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
| | - Kohei Taniguchi
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
| | - Ryo Iida
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Kazuhisa Uchiyma
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
| | - Akira Takasu
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
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25
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Sakaue M, Ota K, Nakamura E, Nitta M, Oka M, Oishi Y, Sano Y, Yonogi S, Takasu A. Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report. BMC Infect Dis 2019; 19:719. [PMID: 31416426 PMCID: PMC6694550 DOI: 10.1186/s12879-019-4350-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/01/2019] [Indexed: 02/07/2023] Open
Abstract
Background Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and fasciitis. C. perfringens septicemia is rare, but is a known cause of hemolysis by damaging red blood cell, and often proves rapidly fatal in emergency department (ED) situations. Case presentation A previously healthy 76-year-old man presented to the ED 8 h after onset of acute abdominal pain and diarrhea. Laboratory examination revealed a large discrepancy between the red blood cell count of 1.91 × 106/mm3 and the hemoglobin level of 10.3 g/dL, suggesting massive intravascular hemolysis. Computed tomography revealed liver abscesses with gas. During ED treatment, the state of the patient rapidly deteriorated and he entered cardiopulmonary arrest. Blood cultures finally identified C. perfringens. Conclusion Intravascular hemolysis and red blood cell (RBC) / hemoglobin (Hb) discrepancy in the presence of infection should prompt ED physicians to consider C. perfringens septicemia and to act quickly to provide appropriate treatment.
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Affiliation(s)
- Masahide Sakaue
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan.
| | - Koshi Ota
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan
| | - Eriko Nakamura
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan
| | - Masahiro Oka
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan
| | - Yasuo Oishi
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan
| | - Yohei Sano
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan
| | | | - Akira Takasu
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan
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26
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Ota K, Nakamura Y, Nakamura E, Takashima S, Oka M, Ota K, Sakaue M, Sano Y, Takasu A. Massive abscess with prolonged respiratory failure due to newly diagnosed myotonic dystrophy: A case report. Medicine (Baltimore) 2019; 98:e15427. [PMID: 31027145 PMCID: PMC6831368 DOI: 10.1097/md.0000000000015427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
RATIONALE Myotonic dystrophy is a progressive multisystem genetic heterogeneous disorder. General anesthesia with opioids increases the risk of prolonged postanesthetic respiratory recovery in myotonic dystrophy patients. PATIENT CONCERNS A 20-year-old previously healthy woman was transferred to our emergency department for further workup of respiratory failure, and massive ascites with abscess caused by endometriosis. Hypercapnic respiratory failure persisted under intensive care unit (ICU) management, but finally improved after cessation of fentanyl as a sedative agent. DIAGNOSIS Myotonic dystrophy type 1. INTERVENTIONS Massive ascites with abscess was accordingly managed by drainage, antibiotics, and an antifungal agent. Myotonic dystrophy type 1 was confirmed after molecular genetic testing revealed a cytosine-thymine-guanine repeat length of 400 to 450 in the DMPK gene. OUTCOMES The patient was discharged without complications on hospital day 69. LESSONS Myotonic dystrophy should be considered when hypercapnic respiratory failure persists in sedated ICU patients. Opioids should not be used for perioperative management of patients with myotonic dystrophy.
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Affiliation(s)
| | - Yoshitsugu Nakamura
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
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27
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Ota K, Fukui K, Oba K, Shimoda A, Oka M, Ota K, Sakaue M, Takasu A. The role of ultrasound imaging in adult patients with testicular torsion: a systematic review and meta-analysis. J Med Ultrason (2001) 2019; 46:325-334. [DOI: 10.1007/s10396-019-00937-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
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28
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Ota K, Onoe M, Oka M, Ota K, Taniguchi K, Sakaue M, Takasu A. Killian-Jamieson diverticulum mimicking a thyroid nodule: A case report. J Gen Fam Med 2019; 20:62-64. [PMID: 30873306 PMCID: PMC6399583 DOI: 10.1002/jgf2.222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 11/08/2022] Open
Abstract
Killian-Jamieson diverticulum (KJD) is a rare disease of the cervical esophagus, often misidentified as thyroid nodules on ultrasonography. We performed carotid artery ultrasonography for an asymptomatic 68-year-old man. The ultrasound showed an oval nodule with heterogeneous echogenicity surrounded by a multilayered rim in the posterior left thyroid gland. As endoscopy and computed tomography confirmed pharyngoesophageal diverticulum in the anterolateral wall of the esophagus, we reached a final diagnosis of KJD. In cases where a thyroid nodule is detected by ultrasound, physicians should be aware of the possibility of KJD before performing invasive procedures.
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Affiliation(s)
- Koshi Ota
- Department of Emergency MedicineOsaka Medical CollegeTakatsuki CityOsakaJapan
| | - Miyako Onoe
- Osaka Medical College Health Science ClinicTakatsuki CityOsakaJapan
| | - Masahiro Oka
- Department of Emergency MedicineOsaka Medical CollegeTakatsuki CityOsakaJapan
| | - Kanna Ota
- Department of Emergency MedicineOsaka Medical CollegeTakatsuki CityOsakaJapan
| | - Kohei Taniguchi
- Department of Emergency MedicineOsaka Medical CollegeTakatsuki CityOsakaJapan
| | - Masahide Sakaue
- Department of Emergency MedicineOsaka Medical CollegeTakatsuki CityOsakaJapan
| | - Akira Takasu
- Department of Emergency MedicineOsaka Medical CollegeTakatsuki CityOsakaJapan
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Taniguchi K, Iida R, Watanabe T, Nitta M, Tomioka M, Uchiyama K, Takasu A. Ileo-ileal knot: a rare case of acute strangulated intestinal obstruction. Nagoya J Med Sci 2018; 79:109-113. [PMID: 28303069 PMCID: PMC5346628 DOI: 10.18999/nagjms.79.1.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Strangulated intestinal obstruction is one of the most common types of acute abdomen and requires urgent surgical treatment. Herein, we report a very rare case of strangulated intestinal obstruction caused by an ileo-ileal knot. An 80-year-old woman was admitted to our hospital with suspicion of strangulation ileus and underwent emergency laparotomy after investigation by exploratory single-port laparoscopy. During surgery, a small bowel gangrene caused by an ileo-ileal knot was found. The gangrenous segment was resected, and primary anastomosis was performed. Post-operative recovery was uneventful except for a minor wound infection. Our extensive search of the literature found only 7 case reports of ileo-ileal knot including ours. An ileo-ileal knot should be considered in the differential diagnosis of acute intestinal obstruction, because this rare phenomenon requires urgent surgical treatment; and some complications should be considered during or after surgery.
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Affiliation(s)
- Kohei Taniguchi
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan ; Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
| | - Ryo Iida
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan ; Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
| | - Tomohiko Watanabe
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Masao Tomioka
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
| | - Akira Takasu
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
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30
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Taniguchi K, Asakuma M, Nagayabu K, Takashima S, Iida R, Hirokawa F, Umegaki O, Neo M, Takasu A, Uchiyama K. Exploring the use of single-port surgery in the conservative management of hepatic portal vein gas: A case report. Medicine (Baltimore) 2018; 97:e13368. [PMID: 30461657 PMCID: PMC6392919 DOI: 10.1097/md.0000000000013368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Hepatic portal vein gas (HPVG) is known as a sign of a lethal condition resulting from bowel necrosis. Recently, the detection rate of non-life-threatening cases of HPVG has increased due to the technological development of imaging, i.e., computed tomography (CT). However, it is difficult to determine accurately whether surgical treatment is necessary because of its lethal potential. PATIENT CONCERNS A 74-year-old woman suddenly complained about lower abdominal pain and vomiting after an operation for cervical spondylosis myelopathy. Her vital signs were slightly unstable and she was perspiring and exhibited pallor. Muscular defense was not clear, though her abdomen was tender and slightly distended. DIAGNOSIS CT results showed massive HPVG. However, laboratory investigation did not clearly indicate bowel necrosis. Also, a contrast-CT scan was not performed due to her chronic renal dysfunction and asthma. INTERVENTION Exploration was performed by single-port surgery (SPS) instead of exploratory laparotomy. OUTCOME This approach showed no ischemic bowel and so conservative therapies were undertaken with confidence. The HPVG disappeared 2 days later, and she recover completely from the illness. LESSONS HPVG requires immediate and reliable decision for management. However, unnecessary exploratory laparotomy should be avoided. Hence, a novel strategy should be considered in light of innovative surgical procedures. Our experience suggested that SPS was useful as an exploratory tool for the management of HPVG.
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Affiliation(s)
- Kohei Taniguchi
- Department of Emergency Medicine
- Department of General and Gastroenterological Surgery
| | | | | | | | - Ryo Iida
- Department of Emergency Medicine
- Department of General and Gastroenterological Surgery
| | | | | | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
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31
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Ota K, Fumimoto S, Iida R, Kataoka T, Ota K, Taniguchi K, Hanaoka N, Takasu A. Massive hemothorax due to two bleeding sources with minor injury mechanism: a case report. J Med Case Rep 2018; 12:291. [PMID: 30292243 PMCID: PMC6174063 DOI: 10.1186/s13256-018-1813-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/23/2018] [Indexed: 12/02/2022] Open
Abstract
Background Massive hemothorax resulting from a minor injury mechanism is considered to be rare particularly when the diaphragm is injured. We report a case of massive hemothorax with bleeding from the intercostal artery and diaphragmatic damage caused by minor blunt trauma. Case presentation An 83-year-old Japanese man was transported to our hospital 3 hours after falling out of bed. Computed tomography revealed hemothorax and multiple rib fractures. He underwent fluid resuscitation and a tube thoracostomy, but he became hemodynamically unstable. Contrast-enhanced computed tomography revealed worsening hemothorax with contrast extravasation 4 hours after arrival at the hospital. Emergency angiography indicated hemorrhage in the area supplied by the tenth intercostal artery. Transcatheter arterial embolization stabilized his vital signs for a short period. However, further hemodynamic stabilization required a thoracotomy, which revealed diaphragmatic trauma, which was removed and sutured before fixing his fractured ribs. His postoperative course was uneventful, and he was transferred to another hospital for rehabilitation without complications on hospital day 29. Conclusions Minor mechanisms of blunt trauma can cause rib fractures and massive hemothorax. Traumatic diaphragm injury should be considered a differential diagnosis if hemodynamic instability persists after transcatheter arterial embolization in patients with lower level rib fractures.
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Affiliation(s)
- Koshi Ota
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan.
| | - Satoshi Fumimoto
- Department of Thoracic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Ryo Iida
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Takayuki Kataoka
- Department of Thoracic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Kanna Ota
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Kohei Taniguchi
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Nobuharu Hanaoka
- Department of Thoracic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Akira Takasu
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
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Mihara R, Takasu A, Maemura K, Minami T. Prolonged severe hemorrhagic shock at a mean arterial pressure of 40 mmHg does not lead to brain damage in rats. Acute Med Surg 2018; 5:350-357. [PMID: 30338081 PMCID: PMC6167391 DOI: 10.1002/ams2.361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/24/2018] [Indexed: 11/17/2022] Open
Abstract
Aim To examine whether prolonged hemorrhagic shock (HS) at a mean arterial pressure (MAP) of 40 mmHg leads to brain damage. Methods Rats were anesthetized with sevoflurane. The HS model consisted of the following phases: I, pressure‐controlled HS at a MAP of 40 mmHg; II, fluid resuscitation to normalize blood pressure; III, observations with outcome evaluations in terms of survival, overall performance categories, and neurological deficit scores, as well as evaluation of apoptosis in the hippocampus at 96 h. Each group of six rats was randomized into 60 min (group 1) or 75 min (group 2) each of phases I and II. Three sham rats were anesthetized for 150 min, and then awakened during phase III. Results The three sham rats as well as five and two of the six rats in groups 1 and 2 (P < 0.05), respectively, survived for up to 96 h. All survivors were functionally normal with overall performance category = 1 and neurological deficit score = 0 at 96 h. Apoptotic neurons were not found in the hippocampus. Conclusions The higher mortality in group 2 suggested a more profound effect of HS compared with group 1. However, prolonged HS for 60 or 75 min did not cause functional damage or apoptosis in the hippocampus. These findings suggest that prolonged HS at a MAP of 40 mmHg, as a level at which cerebral blood flow seems preserved by autoregulatory mechanisms, does not lead to brain damage.
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Affiliation(s)
- Ryosuke Mihara
- Department of Emergency Medicine Osaka Medical College Osaka Japan.,Department of Anesthesiology Osaka Medical College Osaka Japan
| | - Akira Takasu
- Department of Emergency Medicine Osaka Medical College Osaka Japan
| | | | - Toshiaki Minami
- Department of Anesthesiology Osaka Medical College Osaka Japan
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33
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Ota K, Iida R, Ota K, Sakaue M, Taniguchi K, Tomioka M, Nitta M, Takasu A. An atypical case of atypical pneumonia. J Gen Fam Med 2018; 19:133-135. [PMID: 29998043 PMCID: PMC6030032 DOI: 10.1002/jgf2.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/30/2018] [Indexed: 11/07/2022] Open
Abstract
Atypical pneumonia has been thought to account for 7%-20% of community-acquired pneumonia (CAP). The treatment for the pathogens that cause atypical pneumonia is different from that of other bacterial pneumonia. Therefore, identification of the causative pathogen in a primary care situation is crucial for adequate treatment of CAP. Mycoplasma infection is prevalent in the general population, but Mycoplasma pneumoniae with extrapulmonary symptoms is relatively rare. Herein, we report a case of CAP because of M. pneumoniae that presented with a wide variety of extrapulmonary diseases. Delayed administration of appropriate antibiotics may contribute to development of extrapulmonary manifestations.
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Affiliation(s)
- Koshi Ota
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Ryo Iida
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Kanna Ota
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Masahide Sakaue
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Kohei Taniguchi
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Masao Tomioka
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Masahiko Nitta
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
| | - Akira Takasu
- Department of Emergency MedicineOsaka Medical CollegeTakatsukiJapan
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Abstract
INTRODUCTION The abrupt onset of sensorimotor deficits is a neurologic emergency that requires immediate management. Acute spontaneous spinal cord infarction (SCI) is rare, but can cause the sudden onset of quadriplegia or quadriparesis. Magnetic resonance imaging (MRI) is an essential imaging modality to diagnose SCI. CASE PRESENTATION A 75-year-old man with a history of diabetes mellitus type 2, hypertension, and dyslipidemia was transferred to our facility for further workup of the sudden onset of quadriplegia. Diffusion-weighted contrast MRI (DWI) on hospital day 8 revealed hyperintense signals predominantly at the grey matter, and a contrast T2 signal abnormality with a decreased apparent diffusion coefficient (ADC). Steroid pulse therapy was initiated because myelitis could not be completely ruled out, but this did not improve the neurological deficits. Spontaneous SCI was finally diagnosed as an exclusion diagnosis. Symptoms were gradually recovered with rehabilitation, and he was transferred to a rehabilitation facility on hospital day 40. CONCLUSION MRI with DWI of the spine should be considered for an early diagnosis of SCI. A combination of DWI with ADC maps is recommended to distinguish SCI from other differential disorders.
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Taniguchi K, Iida R, Ota K, Asakuma M, Uchiyama K, Takasu A. Single-port surgery (SPS) strategy for small bowel obstruction (SBO) caused by postoperative internal hernia: A series case report. Medicine (Baltimore) 2018; 97:e0269. [PMID: 29595689 PMCID: PMC5895389 DOI: 10.1097/md.0000000000010269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Internal hernia due to postoperative adhesions sometimes causes small bowel obstruction (SBO) and requires emergency surgery. The difficulties in the management of SBO with internal hernia include accurate diagnosis and estimation of its ischemic degree and of the risk of SBO recurrences following the surgical procedure. Laparoscopic surgery is a noninvasive to reduce postoperative adhesions and therefore has been widely used recently. However, surgeons often tend to hesitate in applying laparoscopic surgery for SBO because of some situational disadvantages such as poor operating space or iatrogenic bowel injury. Hence, laparoscopic surgery is still not yet the standard procedure for SBO caused by internal hernia. Thus, the establishment of an appropriate procedure for SBO due to internal hernia is required. PATIENT CONCERNS We experienced 3 SBO cases caused by postoperative internal hernia. The first patient was a 59-year-old man who had temporary loop-ileostomy for a perforated sigmoid colon due to diverticulitis. Severe hypogastralgia and vomiting occurred suddenly on the 33rd postoperative day. The second patient was an 81-year-old man who had been hospitalized due to epigastralgia of unknown origin. He had a surgical history of omentum patching for a perforated duodenum 20 years ago. The third patient was a 72-year-old female who presented at our hospital after sudden and severe hypogastralgia. She had a surgical history of sigmoidectomy for her sigmoid colon cancer 22 years ago. DIAGNOSIS A contrast computed tomography (CT) revealed a suspected closed loop obstruction of their bowels and immediate surgical treatments were required. INTERVENTION We tried SPS using the surgical glove method as an initial approach for their SBO caused by postoperative internal hernia. OUTCOMES Two of these 3 cases completely underwent SPS treatment, which afforded accurate diagnosis of SBO. Laparotomy following SPS, which allowed accurate diagnosis, was judged to be appropriate and was performed in the third case. All the patients were discharged without any complications and SBO have not recurred after their discharge. Finally, we established a new strategy using SPS for SBO with internal hernia. LESSONS Our experience suggests that SPS is a promising strategy as an initial surgical approach for SBO with internal hernia.
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Affiliation(s)
- Kohei Taniguchi
- Department of Emergency Medicine
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Ryo Iida
- Department of Emergency Medicine
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | | | - Mitsuhiro Asakuma
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
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Taniguchi K, Takashima S, Iida R, Ota K, Nitta M, Sakane K, Fujisaka T, Ishizaka N, Umegaki O, Uchiyama K, Takasu A. Takotsubo cardiomyopathy caused by acute respiratory stress from extubation: A case report. Medicine (Baltimore) 2017; 96:e8946. [PMID: 29310390 PMCID: PMC5728791 DOI: 10.1097/md.0000000000008946] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONAL Takotsubo cardiomyopathy (TCM) is a transient systolic dysfunction of the left ventricular apex without stenosis of coronary arteries and is induced by various psychological and physical factors. TCM sometimes causes lethal complications such as arrhythmia, thrombogenesis, and even cardiac rupture, and thus it should be diagnosed appropriately and managed carefully. Intensive care unit (ICU) patients are exposed to overstress during the treatment process and therefore can are at potential risk for TCM. PATIENT CONCERNS The patient was diagnosed as having pneumonia because of influenza A virus mixed with bacteria and underwent intensive care with intubation and mechanical ventilation in the ICU. His respiratory condition soon improved, and so extubation was carried out; however, redeterioration with pulmonary edema occurred at half of a day following extubation. DIAGNOSIS The chest x-ray revealed pulmonary edema. The electrocardiogram pattern significantly changed with time, and the echocardiogram showed weakness of wall motion around the left ventricular apex. Hence, to confirm the diagnosis, we performed cardiac catheterization immediately, with the results showing a Takotsubo-like form at the systolic phase without significant stenosis of the coronary arteries. INTERVENTION The patient was reintubated with administration of catecholamine for decreasing blood pressure caused by left ventricular dysfunction. Also, diuretics for pulmonary edema and anticoagulants for prevention of thrombogenesis were administered. OUTCOMES As the respiratory condition improved with stabilization of cardiovascular hemodynamics, reextubation was done at ICU day 11 and was discharged from the ICU at ICU day 15. The patient was subsequently treated for pneumonia after leaving the ICU but suffered from repetitive aspiration pneumonia and was finally transferred to another hospital at hospital day 111. LESSONS TCM should be considered especially under the situation of intensive care, and prompt diagnosis should be followed by appropriate management.
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Affiliation(s)
- Kohei Taniguchi
- Department of Emergency Medicine
- Department of General and Gastroenterological Surgery
| | | | - Ryo Iida
- Department of Emergency Medicine
- Department of General and Gastroenterological Surgery
| | | | | | | | | | | | - Osamu Umegaki
- Department of Critical Care Medicine, Osaka Medical College, Osaka, Japan
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Taniguchi K, Iida R, Ota K, Nitta M, Tsujino T, Komura K, Inamoto T, Azuma H, Uchiyama K, Takasu A. Spontaneous rupture of the urinary bladder (SRUB): Recovery from cardiopulmonary arrest. Am J Emerg Med 2017; 35:1584.e5-1584.e7. [PMID: 28751042 DOI: 10.1016/j.ajem.2017.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/16/2017] [Indexed: 11/25/2022] Open
Abstract
Spontaneous rupture of the urinary bladder (SRUB) is rare and results in a lethal condition, i.e., pan peritonitis. However, early and accurate diagnosis of SRUB is very difficult. A 54-year-old woman was transported to our hospital with suspicion of pan peritonitis after spontaneous return of circulation with pulseless electrical activity. Laboratory investigation seemed to indicate acute renal failure. Namely, her serum urea and creatinine levels were grossly elevated. Exploratory laparotomy showed unexpected rupture of urinary bladder. Her recovery after surgery was relatively smooth. SRUB should be considered in the differential diagnosis of pan peritonitis, because urgent appropriate surgical intervention can rescue patients from this rare lethal disease.
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Affiliation(s)
- Kohei Taniguchi
- Department of Emergency Medicine, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan; Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
| | - Ryo Iida
- Department of Emergency Medicine, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan; Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Koshi Ota
- Department of Emergency Medicine, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Takuya Tsujino
- Department of Urology, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Kazumasa Komura
- Department of Urology, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Teruo Inamoto
- Department of Urology, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Akira Takasu
- Department of Emergency Medicine, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
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Rob D, Špunda R, Lindner J, Šmalcová J, Šmíd O, Kovárník T, Linhart A, Bìlohlávek J, Marinoni MM, Cianchi G, Trapani S, Migliaccio ML, Gucci L, Bonizzoli M, Cramaro A, Cozzolino M, Valente S, Peris A, Grins E, Kort E, Weiland M, Shresta NM, Davidson P, Algotsson L, Fitch S, Marco G, Sturgill J, Lee S, Dickinson M, Boeve T, Khaghani A, Wilton P, Jovinge S, Ahmad AN, Loveridge R, Vlachos S, Patel S, Gelandt E, Morgan L, Butt S, Whitehorne M, Kakar V, Park C, Hayes M, Willars C, Hurst T, Best T, Vercueil A, Auzinger G, Adibelli B, Akovali N, Torgay A, Zeyneloglu P, Pirat A, Kayhan Z, Schmidbauer SS, Herlitz J, Karlsson T, Friberg H, Knafelj R, Radsel P, Duprez F, Bonus T, Cuvelier G, Mashayekhi S, Maka M, Ollieuz S, Reychler G, Mosaddegh R, Abbasi S, Talaee S, Zotzmann VZ, Staudacher DS, Wengenmayer TW, Dürschmied DD, Bode CB, Nelskylä A, Nurmi J, Jousi M, Schramko A, Mervaala E, Ristagno G, Skrifvars M, Ozsoy G, Kendirli T, Azapagasi E, Perk O, Gadirova U, Ozcinar E, Cakici M, Baran C, Durdu S, Uysalel A, Dogan M, Ramoglu M, Ucar T, Tutar E, Atalay S, Akar R, Kamps M, Leeuwerink G, Hofmeijer J, Hoiting O, Van der Hoeven J, Hoedemaekers C, Konkayev A, Kuklin V, Kondratyev T, Konkayeva M, Akhatov N, Sovershaev M, Tveita T, Dahl V, Wihersaari L, Skrifvars MB, Bendel S, Kaukonen KM, Vaahersalo J, Romppanen J, Pettilä V, Reinikainen M, Lybeck A, Cronberg T, Nielsen N, Friberg H, Rauber M, Steblovnik K, Jazbec A, Noc M, Kalasbail P, Garrett F, Kulstad E, Bergström DJ, Olsson HR, Schmidbauer S, Friberg H, Mandel I, Mikheev S, Podoxenov Y, Suhodolo I, Podoxenov A, Svirko J, Sementsov A, Maslov L, Shipulin V, Vammen LV, Rahbek SR, Secher NS, Povlsen JP, Jessen NJ, Løfgren BL, Granfeldt AG, Grossestreuer A, Perman S, Patel P, Ganley S, Portmann J, Cocchi M, Donnino M, Nassar Y, Fathy S, Gaber A, Mokhtar S, Chia YC, Lewis-Cuthbertson R, Mustafa K, Sabra A, Evans A, Bennett P, Eertmans W, Genbrugge C, Boer W, Dens J, De Deyne C, Jans F, Skorko A, Thomas M, Casadio M, Coppo A, Vargiolu A, Villa J, Rota M, Avalli L, Citerio G, Moon JB, Cho JH, Park CW, Ohk TG, Shin MC, Won MH, Papamichalis P, Zisopoulou V, Dardiotis E, Karagiannis S, Papadopoulos D, Zafeiridis T, Babalis D, Skoura A, Staikos I, Komnos A, Passos SS, Maeda F, Souza LS, Filho AA, Granjeia TAG, Schweller M, Franci D, De Carvalho Filho M, Santos TM, De Azevedo P, Wall R, Welters I, Tansuwannarat P, Sanguanwit P, Langer T, Carbonara M, Caccioppola A, Fusarini CF, Carlesso E, Paradiso E, Battistini M, Cattaneo E, Zadek F, Maiavacca R, Stocchetti N, Pesenti A, Ramos A, Acharta F, Toledo J, Perezlindo M, Lovesio L, Dogliotti A, Lovesio C, Schroten N, Van der Veen B, De Vries MC, Veenstra J, Abulhasan YB, Rachel S, Châtillon-Angle M, Alabdulraheem N, Schiller I, Dendukuri N, Angle M, Frenette C, Lahiri S, Schlick K, Mayer SA, Lyden P, Akatsuka M, Arakawa J, Yamakage M, Rubio J, Mateo-Sidron JAR, Sierra R, Celaya M, Benitez L, Alvarez-Ossorio S, Rubio J, Mateo-Sidron JAR, Sierra R, Fernandez A, Gonzalez O, Engquist H, Rostami E, Enblad P, Toledo J, Ramos A, Acharta F, Canullo L, Nallino J, Dogliotti A, Lovesio C, Perreault M, Talic J, Frenette AJ, Burry L, Bernard F, Williamson DR, Adukauskiene D, Cyziute J, Adukauskaite A, Malciene L, Luca L, Rogobete A, Bedreag O, Papurica M, Sarandan M, Cradigati C, Popovici S, Vernic C, Sandesc D, Avakov V, Shakhova I, Trimmel H, Majdan M, Herzer GH, Sokoloff CS, Albert M, Williamson D, Odier C, Giguère J, Charbonney E, Bernard F, Husti Z, Kaptás T, Fülep Z, Gaál Z, Tusa M, Donnelly J, Aries M, Czosnyka M, Robba C, Liu M, Ercole A, Menon D, Hutchinson P, Smielewski P, López R, Graf J, Montes JM, Kenawi M, Kandil A, Husein K, Samir A, Heijneman J, Huijben J, Abid-Ali F, Stolk M, Van Bommel J, Lingsma H, Van der Jagt M, Cihlar RC, Mancino G, Bertini P, Forfori F, Guarracino F, Pavelescu D, Grintescu I, Mirea L, Alamri S, Tharwat M, Kono N, Okamoto H, Uchino H, Ikegami T, Fukuoka T, Simoes M, Trigo E, Coutinho P, Pimentel J, Franci A, Basagni D, Boddi M, Cozzolino M, Anichini V, Cecchi A, Peris A, Markopoulou D, Venetsanou K, Papanikolaou I, Barkouri T, Chroni D, Alamanos I, Cingolani E, Bocci MG, Pisapia L, Tersali A, Cutuli SL, Fiore V, Palma A, Nardi G, Antonelli M, Coke R, Kwong A, Dwivedi DJ, Xu M, McDonald E, Marshall JC, Fox-Robichaud AE, Charbonney E, Liaw PC, Kuchynska I, Malysh IR, Zgrzheblovska LV, Mestdagh L, Verhoeven EF, Hubloue I, Ruel-laliberte J, Zarychanski R, Lauzier F, Bonaventure PL, Green R, Griesdale D, Fowler R, Kramer A, Zygun D, Walsh T, Stanworth S, Léger C, Turgeon AF, Baron DM, Baron-Stefaniak J, Leitner GC, Ullrich R, Tarabrin O, Mazurenko A, Potapchuk Y, Sazhyn D, Tarabrin P, Tarabrin O, Mazurenko A, Potapchuk Y, Sazhyn D, Tarabrin P, Pérez AG, Silva J, Artemenko V, Bugaev A, Tokar I, Konashevskaya S, Kolesnikova IM, Roitman EV, Kiss TR, Máthé Z, Piros L, Dinya E, Tihanyi E, Smudla A, Fazakas J, Ubbink R, Boekhorst te P, Mik E, Caneva L, Ticozzelli G, Pirrelli S, Passador D, Riccardi F, Ferrari F, Roldi EM, Di Matteo M, Bianchi I, Iotti GA, Zurauskaite G, Voegeli A, Meier M, Koch D, Haubitz S, Kutz A, Bargetzi M, Mueller B, Schuetz P, Von Meijenfeldt G, Van der Laan M, Zeebregts C, Christopher KB, Vernikos P, Melissopoulou T, Kanellopoulou G, Panoutsopoulou M, Xanthis D, Kolovou K, Kypraiou T, Floros J, Broady H, Pritchett C, Marshman M, Jannaway N, Ralph C, Lehane CL, Keyl CK, Zimmer EZ, Trenk DT, Ducloy-Bouthors AS, Jonard MJ, Fourrier F, Piza F, Correa T, Marra A, Guerra J, Rodrigues R, Vilarinho A, Aranda V, Shiramizo S, Lima MR, Kallas E, Cavalcanti AB, Donoso M, Vargas P, Graf J, McCartney J, Ramsay S, McDowall K, Novitzky-Basso I, Wright C, Medic MG, Bielen L, Radonic V, Zlopasa O, Vrdoljak NG, Gasparovic V, Radonic R, Narváez G, Cabestrero D, Rey L, Aroca M, Gallego S, Higuera J, De Pablo R, González LR, Chávez GN, Lucas JH, Alonso DC, Ruiz MA, Valarezo LJ, De Pablo Sánchez R, Real AQ, Wigmore TW, Bendavid I, Cohen J, Avisar I, Serov I, Kagan I, Singer P, Hanison J, Mirza U, Conway D, Takasu A, Tanaka H, Otani N, Ohde S, Ishimatsu S, Coffey F, Dissmann P, Mirza K, Lomax M, Dissmann P, Coffey F, Mirza K, Lomax M, Miner JR, Leto R, Markota AM, Gradišek PG, Aleksejev VA, Sinkovič AS, Romagnoli S, Chelazzi C, Zagli G, Benvenuti F, Mancinelli P, Boninsegni P, Paparella L, Bos AT, Thomas O, Goslar T, Knafelj R, Perreault M, Martone A, Sandu PR, Rosu VA, Capilnean A, Murgoi P, Frenette AJ, Lecavalier A, Jayaraman D, Rico P, Bellemare P, Gelinas C, Williamson D, Nishida T, Kinoshita T, Iwata N, Yamakawa K, Fujimi S, Maggi L, Sposato F, Citterio G, Bonarrigo C, Rocco M, Zani V, De Blasi RA, Alcorn D, Barry L, Riedijk MA, Milstein DM, Caldas J, Panerai R, Camara L, Ferreira G, Bor-Seng-Shu E, Lima M, Galas F, Mian N, Nogueira R, de Oliveira GQ, Almeida J, Jardim J, Robinson TG, Gaioto F, Hajjar LA, Zabolotskikh I, Musaeva T, Saasouh W, Freeman J, Turan A, Saseedharan S, Pathrose E, Poojary S, Messika J, Martin Y, Maquigneau N, Henry-Lagarrigue M, Puechberty C, Stoclin A, Martin-Lefevre L, Blot F, Dreyfuss D, Dechanet A, Hajage D, Ricard J, Almeida E, Almeida J, Landoni G, Galas F, Fukushima J, Fominskiy E, De Brito C, Cavichio L, Almeida L, Ribeiro U, Osawa E, Boltes R, Battistella L, Hajjar L, Fontela P, Lisboa T, Junior LF, Friedman GF, Abruzzi F, Primo JAP, Filho PM, de Andrade JS, Brenner KM, boeira MS, Leães C, Rodrigues C, Vessozi A, Machado AS, Weiler M, Bryce H, Hudson A, Law T, Reece-Anthony R, Molokhia A, Abtahinezhadmoghaddam F, Cumber E, Channon L, Wong A, Groome R, Gearon D, Varley J, Wilson A, Reading J, Wong A, Zampieri FG, Bozza FA, Ferez M, Fernandes H, Japiassú A, Verdeal J, Carvalho AC, Knibel M, Salluh JI, Soares M, Gao J, Ahmadnia E, Patel B, McCartney J, MacKay A, Binning S, Wright C, Pugh RJ, Battle C, Hancock C, Harrison W, Szakmany T, Mulders F, Vandenbrande J, Dubois J, Stessel B, Siborgs K, Ramaekers D, Soares M, Silva UV, Homena WS, Fernandes GC, Moraes AP, Brauer L, Lima MF, De Marco F, Bozza FA, Salluh JI, Maric N, Mackovic M, Udiljak N, Bosso CE, Caetano RD, Cardoso AP, Souza OA, Pena R, Mescolotte MM, Souza IA, Mescolotte GM, Bangalore H, Borrows E, Barnes D, Ferreira V, Azevedo L, Alencar G, Andrade A, Bierrenbach A, Buoninsegni LT, Bonizzoli M, Cecci L, Cozzolino M, Peris A, Lindskog J, Rowland K, Sturgess P, Ankuli A, Molokhia A, Rosa R, Tonietto T, Ascoli A, Madeira L, Rutzen W, Falavigna M, Robinson C, Salluh J, Cavalcanti A, Azevedo L, Cremonese R, Da Silva D, Dornelles A, Skrobik Y, Teles J, Ribeiro T, Eugênio C, Teixeira C, Zarei M, Hashemizadeh H, Eriksson M, Strandberg G, Lipcsey M, Larsson A, Lignos M, Crissanthopoulou E, Flevari K, Dimopoulos P, Armaganidis A, Golub JG, Markota AM, Stožer AS, Sinkovič AS, Rüddel H, Ehrlich C, Burghold CM, Hohenstein C, Winning J, Sellami W, Hajjej Z, Bousselmi M, Gharsallah H, Labbene I, Ferjani M, Sattler J, Steinbrunner D, Poppert H, Schneider G, Blobner M, Kanz KG, Schaller SJ, Apap K, Xuereb G, Xuereb G, Apap K, Massa L, Xuereb G, Apap K, Massa L, Delvau N, Penaloza A, Liistro G, Thys F, Delattre IK, Hantson P, Roy PM, Gianello P, Hadîrcă L, Ghidirimschi A, Catanoi N, Scurtov N, Bagrinovschi M, Sohn YS, Cho YC, Golovin B, Creciun O, Ghidirimschi A, Bagrinovschi M, Tabbara R, Whitgift JZ, Ishimaru A, Yaguchi A, Akiduki N, Namiki M, Takeda M, Tamminen JN, Reinikainen M, Uusaro A, Taylor CG, Mills ED, Mackay AD, Ponzoni C, Rabello R, Serpa A, Assunção M, Pardini A, Shettino G, Corrêa T, Vidal-Cortés PV, Álvarez-Rocha L, Fernández-Ugidos P, Virgós-Pedreira A, Pérez-Veloso MA, Suárez-Paul IM, Del Río-Carbajo L, Fernández SP, Castro-Iglesias A, Butt A, Alghabban AA, Khurshid SK, Ali ZA, Nizami IN, Salahuddin NS, Alshahrani M, Alsubaie AW, Alshamsy AS, Alkhiliwi BA, Alshammari HK, Alshammari MB, Telmesani NK, Alshammari RB, Asonto LP, Zampieri FG, Damiani LP, Bozza F, Salluh JI, Cavalcanti AB, El Khattate A, Bizrane M, Madani N, Belayachi J, Abouqal R, Ramnarain D, Gouw-Donders B, Benstoem C, Moza A, Meybohm P, Stoppe C, Autschbach R, Devane D, Goetzenich A, Taniguchi LU, Araujo L, Salgado G, Vieira JM, Viana J, Ziviani N, Pessach I, Lipsky A, Nimrod A, O´Connor M, Matot I, Segal E, Kluzik A, Gradys A, Smuszkiewicz P, Trojanowska I, Cybulski M, De Jong A, Sebbane M, Chanques G, Jaber S, Rosa R, Robinson C, Bessel M, Cavalheiro L, Madeira L, Rutzen W, Oliveira R, Maccari J, Falavigna M, Sanchez E, Dutra F, Dietrich C, Balzano P, Rezende J, Teixeira C, Sinha S, Majhi K, Gorlicki JG, Pousset FP, Kelly J, Aron J, Gilbert AC, Urankar NP, Knafelj R, Irazabal M, Bosque M, Manciño J, Kotsopoulos A, Jansen N, Abdo W, Casey ÚM, O’Brien B, Plant R, Doyle B. 37th International Symposium on Intensive Care and Emergency Medicine (part 2 of 3). Crit Care 2017. [PMCID: PMC5374552 DOI: 10.1186/s13054-017-1630-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Takasu A, Masui A, Hamada M, Imai T, Iwai S, Yura Y. Immunogenic cell death by oncolytic herpes simplex virus type 1 in squamous cell carcinoma cells. Cancer Gene Ther 2016; 23:107-13. [PMID: 26987291 DOI: 10.1038/cgt.2016.8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/15/2016] [Accepted: 02/19/2016] [Indexed: 02/06/2023]
Abstract
Molecules essential for the induction of immunogenic cell death (ICD) are called damage-associated molecular patterns (DAMPs). The effects of oncolytic herpes simplex virus type 1 (HSV-1) on the production of DAMPs were examined in squamous cell carcinoma (SCC) cells. The cytopathic effects of HSV-1 RH2 were observed in mouse SCCVII cells infected at a high multiplicity of infection (MOI), and the amounts of viable cells were decreased. After being infected with RH2, ATP and high mobility group box 1 (HMGB1) were released extracellulary, while calreticulin (CRT) translocated to the cell membrane. A flow-cytometric analysis revealed an increase in the number of annexin-V and propidium iodide (PI)-stained cells; and the amount of cleaved poly (ADP-ribose) polymerase (PARP) was increased. The killing effect of RH2 was reduced by pan-caspase inhibitor z-VAD-fmk and the caspase-1 inhibitor z-YVAD-fmk, suggesting the involvement of apoptosis and pyroptosis. In C3H mice bearing synergic SCCVII tumors, the growth of tumors injected with the supernatant of RH2-infected cells was less than that of tumors injected with phosphate-buffered saline (PBS). These results indicate that oncolytic HSV-1 RH2 produces DAMPs from SCC cells to induce cell death. This may contribute to the enhancement of tumor immunity by oncolytic HSV-1.
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Affiliation(s)
- A Takasu
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - A Masui
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - M Hamada
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - T Imai
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - S Iwai
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Y Yura
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
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Takajo D, Iwaya K, Katsurada Y, Miyai K, Takasu A, Matsubara O, Sakamoto T, Tamai S, Tsuda H. Community-acquired lobar pneumonia caused by Pseudomonas aeruginosa infection in Japan: a case report with histological and immunohistochemical examination. Pathol Int 2015; 64:224-30. [PMID: 24888776 DOI: 10.1111/pin.12162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 03/25/2014] [Indexed: 11/29/2022]
Abstract
Pseudomonas aeruginosa is a common pathogen in nosocomial and/or healthcare-associated pneumonia, but is rare in community-acquired pneumonia. A 50-year-old previously healthy woman was taken to the emergency department because of rapidly progressing dyspnea. Chest radiograph showed consolidation of the entire right upper lobe, a finding suggestive of lobar pneumonia. The patient died of respiratory failure with bronchial bleeding, on the same day of admission. Autopsy revealed that the alveoli throughout the upper right lobe were filled with dense inflammatory cells mainly consisting of macrophages and neutrophils. Immunoreactive bacilli by using an anti-P. aeruginosa antibody were localized within macrophages accumulated in the alveoli as well in the vessel walls. Lobar pneumonia composed of dense neutrophils and bacteria-laden macrophages with total lung congestion and edema may be characteristic for community-acquired P. aeruginosa pneumonia in a healthy adult.
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Affiliation(s)
- Daiji Takajo
- Student, National Defense Medical College, Tokorozawa, Saitama, Japan
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Yura Y, Okunaga S, Takasu A, Hamada M, Iwai S. Low-intensity ultrasound as a method to improve the effect of oncolytic virotherapy on oral cancer. J Oral Maxillofac Surg 2014. [DOI: 10.1016/j.joms.2014.06.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nishi K, Takasu A, Shinozaki H, Sakamoto K, Yamamoto Y, Sakamoto T. Hypothermia does not hasten death during uncontrolled hemorrhagic shock presenting as the "triad of death" in rats. Acute Med Surg 2014; 2:29-34. [PMID: 29123687 DOI: 10.1002/ams2.60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/19/2014] [Indexed: 11/05/2022] Open
Abstract
Aim The aim of this study was to investigate the effect of hypothermia on survival and coagulopathy in hemorrhagic shock presenting as the "triad of death". Methods Sixteen rats were lightly anesthetized with halothane while maintaining spontaneous breathing. The triad of death was simulated by inducing hypothermia (32.0°C) with surface body cooling and hemodilution with replacement of 20 mL blood with 50 mL normal saline. Then, rats were randomly assigned to one of two rectal temperature groups (n = 8/group: group 1, rewarming to 37.0°C; group 2, maintenance at 32.0°C) and subjected to hemorrhagic shock initiated by amputation of the tail at 75% of its length. The rats were then observed for survival time without fluid resuscitation. Blood coagulability with Sonoclot analysis was also assessed. Results The triad of death status was considered as being induced at a rectal temperature of 32°C, arterial pH of 7.22, and deteriorating coagulating values. At 45 min after randomization, Sonoclot analysis revealed prolonged activated clotting times of 355 ± 131 s and "time to peak" of 23 ± 9 min in group 2, compared to 228 ± 64 s and 12 ± 1 min (P < 0.05) in group 1, respectively. Kaplan-Meier curves showed longer survival in group 2 than group 1 (P = 0.06). Conclusions Compared to rewarming, hypothermia aggravates coagulation parameters, but does not hasten death during untreated hemorrhagic shock presenting as the triad of death.
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Affiliation(s)
- Kouichirou Nishi
- Department of Traumatology and Critical Care Medicine National Defense Medical College Tokorozawa Japan
| | - Akira Takasu
- Department of Emergency Medicine Osaka Medical College Takatsuki Japan
| | | | - Ken Sakamoto
- School of Bionics Tokyo University of Technology Tokyo Japan
| | | | - Toshihisa Sakamoto
- Department of Traumatology and Critical Care Medicine National Defense Medical College Tokorozawa Japan
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Nitta M, Kitamura T, Iwami T, Nadkarni VM, Berg RA, Topjian AA, Okamoto Y, Nishiyama C, Nishiuchi T, Hayashi Y, Nishimoto Y, Takasu A. Out-of-hospital cardiac arrest due to drowning among children and adults from the Utstein Osaka Project. Resuscitation 2013; 84:1568-73. [PMID: 23831805 PMCID: PMC4092116 DOI: 10.1016/j.resuscitation.2013.06.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 06/02/2013] [Accepted: 06/20/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children have better outcomes after out-of-hospital cardiac arrest (OHCA) than adults. However, little is known about the difference in outcomes between children and adults after OHCA due to drowning. OBJECTIVES The aim of this study is to assess the outcome after OHCA due to drowning between children and adults. Our hypothesis is that outcomes after OHCA due to drowning would be in better among children (<18 years old) compared with adults (≥18 years old). METHOD This prospective population-based, observational study included all emergency medical service-treated OHCA due to drowning in Osaka, Japan, between 1999 and 2010 (excluding 2004). Outcomes were evaluated between younger children (0-4 years old), older children (5-17 years old), and adults (≥18 years old). Major outcome measures were one-month survival and neurologically favorable one-month survival defined as cerebral performance category 1 or 2. Multivariate logistic regression analyses were used to account for potential confounders. RESULTS During the study period, 66,716 OHCAs were documented, and resuscitation was attempted for 62,048 patients (1300 children [2%] and 60,748 adults [98%]). Among these OHCAs, 1737 (3% of OHCAs) were due to drowning (36 younger children [2%], 32 older children [2%], and 1669 adults [96%]). The odds of one-month survival were significantly higher for younger children (28% [10/36]; adjusted odds ratio [AOR], 20.20 [95% confidence interval {CI} 7.45-54.78]) and older children (9% [3/32]; AOR, 4.47 [95% CI 1.04-19.27]) when compared with adults (2% [28/1669]). However, younger children (6% [2/36]; AOR, 5.23 [95% CI 0.52-51.73]) and older children (3% [1/32]; AOR, 2.53 [95% CI 0.19-34.07]) did not have a higher odds of neurologically favorable outcome than adults (1% [11/1669]). CONCLUSION In this large OHCA registry, children had better one-month survival rates after OHCA due to drowning compared with adults. Most survivors in all groups had unfavorable neurological outcomes.
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Affiliation(s)
- Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan; Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan.
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Meshii N, Takahashi G, Okunaga S, Hamada M, Iwai S, Takasu A, Ogawa Y, Yura Y. Enhancement of systemic tumor immunity for squamous cell carcinoma cells by an oncolytic herpes simplex virus. Cancer Gene Ther 2013; 20:493-8. [PMID: 23887644 DOI: 10.1038/cgt.2013.45] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/07/2013] [Accepted: 06/15/2013] [Indexed: 01/13/2023]
Abstract
RH2 is a neurovirulent γ134.5 gene-deficient herpes simplex virus type 1 (HSV-1) with a lytic ability in human squamous cell carcinoma (SCC) cells; it is related to spontaneously occurring HSV-1 mutant HF10. The effect of RH2 on SCC was examined using a syngeneic C3H mouse model. After infection of mouse SCCVII cells with RH2, cell viability was decreased at first, but recovered by prolonged culture, indicating the limited replication of RH2. The antitumor ability of RH2 was examined using a bilateral SCCVII tumor model. The growth of the RH2-injected tumors was suppressed compared with that of phosphate-buffered saline-injected tumors. Moreover, the growth of contralateral tumor of RH2-treated mice was also suppressed significantly. The splenocytes of C3H mice treated with RH2 lysed more SCCVII cells than NFSaY83 cells and YAC-1 cells. The cytotoxicity of the splenocytes on SCCVII cells was significantly greater than that of splenocytes from tumor-bearing mice. Removal of CD8(+) T cells from splenocytes decreased their cell killing activity remarkably. The antitumor effect of RH2 on SCCVII xenografts in nude mice was not demonstrated. These results indicate that RH2 exhibited a suppressive effect on mouse SCC, even if the replication of RH2 was limited. This is ascribed to the ability of RH2 to enhance existing tumor-specific cytotoxic T lymphocyte activity.
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Affiliation(s)
- N Meshii
- Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan
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Sato H, Mizutani S, Tsuge S, Ohtani H, Aoi K, Takasu A, Okada M, Kobayashi S, Kiyosada T, Shoda S. Determination of the degree of acetylation of chitin/chitosan by pyrolysis-gas chromatography in the presence of oxalic Acid. Anal Chem 2012; 70:7-12. [PMID: 21644594 DOI: 10.1021/ac9706685] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A new method to determine directly and rapidly the degree of acetylation of chitin/chitosan was developed based on reactive pyrolysis-gas chromatography in the presence of an oxalic acid aqueous solution. The degree of acetylation was precisely evaluated on the basis of peak intensities of the characteristic products such as acetonitrile, acetic acid, and acetamide originating from the N-acetyl group of N-acetyl-d-glucosamine units of chitin/chitosan. The observed values were in good agreement with those obtained by (1)H NMR and the other methods. Moreover, the proposed technique was applicable to any kinds of chitin/chitosan samples over the whole range of acetylation including insoluble chitin/chitosan and perfectly acetylated artificial chitin having higher crystallinity to which (1)H NMR had been inapplicable.
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Affiliation(s)
- H Sato
- Department of Applied Chemistry, Graduate School of Engineering, Nagoya University, Nagoya 464-01, Japan
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Nagashima F, Kitamura H, Miyajima K, Takasu A, Kasuga A, Furuse J, Onaya H, Ogawa A. Planning for Community-Based Coorperation at Kyorin University Hospital by Diagnostic Imaging and Comprehensive Assessment. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Terazumi K, Yanagawa Y, Takasu A, Sakamoto T. A case of degloving injury of the colon. Am J Emerg Med 2010; 30:250.e5-6. [PMID: 21159462 DOI: 10.1016/j.ajem.2010.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 09/24/2010] [Indexed: 10/18/2022] Open
Abstract
The left side of a truck driven by a 71-year-old man was hit by another car at an intersection, and his abdomen was compressed by the steering wheel. On arrival, he complained of severe lower abdominal pain; and physical examination demonstrated involuntary rigidity and rebound tenderness. Enhanced truncal computed tomography exhibited that the descending colon was shifted ventral and medial because of a low-density mass with contrast extravasation. An emergency laparotomy disclosed injuries of the descending colon, which could be mobile because of degloving of the colon, left mesenterium, spleen, and tail of pancreas. During resection of these injured organs, difficulty in controlling the bleeding from the degloving injury site resulted in the requirement of a “second look” operation. The postoperative course was eventful; however, the patient's physiologic condition stabilized, and he was discharged on foot on the 108th hospital day.
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Affiliation(s)
- Keiko Terazumi
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama Japan
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Sekizawa A, Yanagawa Y, Nishi K, Takasu A, Sakamoto T. A case of thoracic degloving injury with flail chest. Am J Emerg Med 2010; 29:841.e1-2. [PMID: 20934295 DOI: 10.1016/j.ajem.2010.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 06/17/2010] [Indexed: 10/19/2022] Open
Abstract
A 75-year-old male patient suffered a chest degloving injury when he fell on his back and was run over by a small farm tractor he was pulling. At the time of patient admission, the paradoxical motion of the right chest wall was remarkable; and he had an open fracture of the right humerus, a dislocation of the right ankle, and a laceration of the right forearm. Chest computed tomography revealed fractures of the fifth to seventh ribs and detachment of both the right pectoralis major muscle and serratus anterior muscle from the chest wall, with a disconnected right thoracic cavity. Because the right flail chest was severe and there was a large amount of air leakage that continued under positive-pressure ventilation for pneumatic stabilization, we performed surgical fixation of the ribs and repaired the lung injury on the fifth hospital day. The patient's postoperative course was uneventful.
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Affiliation(s)
- Akinori Sekizawa
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
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Nishikawa K, Takasu A, Morita K, Tsumori H, Sakamoto T. Deposits on the intraluminal surface and bacterial growth in central venous catheters. J Hosp Infect 2010; 75:19-22. [PMID: 20227135 DOI: 10.1016/j.jhin.2009.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 11/05/2009] [Indexed: 11/28/2022]
Abstract
Central venous catheter (CVC) tip and blood cultures are generally used to diagnose a catheter-related infection. Such methodology does not confirm the presence of bacterial colonisation on parts of CVCs other than the CVC tip. In order to assess the extent of bacterial colonisation, 10 catheters were examined in detail from patients admitted to intensive care unit. Swabs from the lumen at several sites (hub, indwelling and non-indwelling) were cultured and the intraluminal surface of the device subjected to scanning electron microscopy (SEM). Bacteria were detected on five out of 10 catheters (50%), and bacterial contamination of CVCs was common in the hub area of the device. Deposits (crystallisation) that differed from bacterial colonisation or biofilm were observed on the intraluminal surface of used CVCs. SEM showed bacteria firmly anchored to the deposits. Experimental flow studies demonstrated that deposits were more likely to appear after exposure to solutions such as total parenteral nutrition rather than distilled water. These deposits facilitated bacterial colonisation 30 times more than CVCs free from deposits.
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Affiliation(s)
- K Nishikawa
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
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