1
|
Shin M, Fujita M, Hifumi T, Koga Y, Yagi T, Nakahara T, Todani M, Kaneda K, Tsuruta R. Rapid rewarming rate associated with favorable neurological outcomes in patients with post-cardiac arrest syndrome patients treated with targeted temperature management. Acute Med Surg 2023; 10:e897. [PMID: 37841965 PMCID: PMC10568044 DOI: 10.1002/ams2.897] [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: 07/05/2023] [Revised: 09/09/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023] Open
Abstract
Aim To determine whether the rewarming rate is associated with neurological outcomes in patients with post-cardiac arrest syndrome treated with targeted temperature management (TTM) at 34°C. Methods We conducted a retrospective analysis of a nationwide cohort study of out-of-hospital cardiac arrest in Japan. Adult patients who experienced a return of spontaneous circulation and completed TTM at 34°C between June 2014 and December 2019 were divided equally into three groups (slow, moderate, and rapid) according to their rewarming rates from 34°C to 36°C. The rates of favorable neurological outcomes (Cerebral Performance Category of 1-2 after 30 days) were compared among the groups, and the adjusted odds ratios for a favorable neurological outcome were calculated for the groups. Results We analyzed 348, 357, and 358 patients in the slow, moderate, and rapid groups, respectively. The periods of rewarming from 34°C to 36°C were 41.9 ± 10.5, 22.4 ± 1.8, and 12.2 ± 3.6 h, respectively. The number of favorable neurological outcomes after 30 days was 121 (34.8%), 125 (35.0%), and 147 (41.1%), respectively, with no significant differences among the three groups (p = 0.145). Rapid rewarming was independently associated with a favorable neurological outcome compared with slow rewarming (adjusted odds ratio 1.57 [95% confidence interval 1.04-2.37]; p = 0.031). Conclusions Rapid rewarming after TTM at 34°C was associated with a more favorable neurological outcome than slow rewarming.
Collapse
Affiliation(s)
- Masaru Shin
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalUbeJapan
| | - Motoki Fujita
- Acute and General MedicineYamaguchi University Graduate School of MedicineUbeJapan
| | - Toru Hifumi
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalTokyoJapan
| | - Yasutaka Koga
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalUbeJapan
| | - Takeshi Yagi
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalUbeJapan
| | - Takashi Nakahara
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalUbeJapan
| | - Masaki Todani
- Acute and General MedicineYamaguchi University Graduate School of MedicineUbeJapan
| | - Kotaro Kaneda
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalUbeJapan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalUbeJapan
- Acute and General MedicineYamaguchi University Graduate School of MedicineUbeJapan
| |
Collapse
|
2
|
Inoue T, Kaneda K, Ise N, Koga Y, Yagi T, Todani M, Nakahara T, Fujita M, Tsuruta R. Effects of cardiopulmonary resuscitation instructions on the outcomes of out-of-hospital cardiac arrest: An analysis of the JAAM-OHCA registry. Acute Med Surg 2023; 10:e892. [PMID: 37753227 PMCID: PMC10518302 DOI: 10.1002/ams2.892] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/27/2023] [Indexed: 09/28/2023] Open
Abstract
Aim To determine whether dispatcher-provided cardiopulmonary resuscitation (CPR) instructions improve the outcomes of out-of-hospital cardiac arrest (OHCA). Methods Cases registered in the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest (JAAM-OHCA) Registry between June 2014 and December 2019 were included. Cases in which the dispatcher provided CPR instructions to the bystander were included in the "Instructions" group", and cases without CPR instructions were included in the "No Instructions" group. The primary outcome was the proportion of patients with a favorable neurological outcome, defined as a Glasgow-Pittsburgh cerebral performance category scale of 1 to 2 at 1 month after OHCA. Results Overall, 51,199 patients with OHCA were registered in the JAAM-OHCA Registry during the study period. Of these, 33,745 were eligible for the study, with 16,509 in the Instructions group and 17,236 in the No Instructions group. The proportion of patients with a favorable neurological outcome at 1 month after OHCA was inferior in the Instructions group than in the No Instructions group (2.3% versus 3.0%, p < 0.001). After adjustment for patient background characteristics, no association was found between CPR instructions provided by a dispatcher and favorable neurological outcomes at 1 month after OHCA (adjusted odds ratio, 1.000; 95% confidence interval, 0.869-1.151, p = 0.996). Conclusion The present study found no clear clinical benefit of dispatcher-provided CPR instructions on the neurological outcomes of cases with OHCA.
Collapse
Affiliation(s)
- Tomoaki Inoue
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalYamaguchiJapan
| | - Kotaro Kaneda
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalYamaguchiJapan
| | - Natsu Ise
- Yamaguchi University School of MedicineYamaguchiJapan
| | - Yasutaka Koga
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalYamaguchiJapan
| | - Takeshi Yagi
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalYamaguchiJapan
| | - Masaki Todani
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalYamaguchiJapan
| | - Takashi Nakahara
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalYamaguchiJapan
| | - Motoki Fujita
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalYamaguchiJapan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care CenterYamaguchi University HospitalYamaguchiJapan
| |
Collapse
|
3
|
Fujita M, Todani M, Kaneda K, Suzuki S, Wakai S, Kikuta S, Sasaki S, Hattori N, Yagishita K, Kuwata K, Tsuruta R. Use of hyperbaric oxygen therapy for preventing delayed neurological sequelae in patients with carbon monoxide poisoning: A multicenter, prospective, observational study in Japan. PLoS One 2021; 16:e0253602. [PMID: 34143855 PMCID: PMC8213185 DOI: 10.1371/journal.pone.0253602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 06/08/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The purpose of this study was to clarify the practical clinical treatment for acute carbon monoxide (CO) poisoning in Japan and to investigate the efficacy of hyperbaric oxygen (HBO2) therapy in preventing delayed neurological sequelae (DNS) in the acute phase of CO poisoning. METHODS We conducted a multicenter, prospective, observational study of acute CO poisoning in Japan. Patients with acute CO poisoning were enrolled and their treatment details were recorded. The primary endpoint was the onset of DNS within 2 months of CO exposure. Factors associated with DNS were assessed with logistic regression analysis. RESULTS A total of 311 patients from 57 institutions were registered and 255 were analyzed: 171 received HBO2 therapy (HBO2 group) and 84 did not (normobaric oxygen [NBO2] group). HBO2 therapy was performed zero, once, twice, or three times within the first 24 h in 1.8%, 55.9%, 30.9%, and 11.3% of the HBO2 group, respectively. The treatment pressure in the first HBO2 session was 2.8 ATA (47.9% of the HBO2 group), 2.0 ATA (41.8%), 2.5 ATA (7.9%), or another pressure (2.4%). The incidence of DNS was 13/171 (7.6%) in the HBO2 group and 3/84 (3.6%) in the NBO2 group (P = 0.212). The number of HBO2 sessions in the first 24 h was one of the factors associated with the incidence of DNS (odds ratio, 2.082; 95% confidence interval, 1.101-3.937; P = 0.024). CONCLUSIONS The practical clinical treatment for acute CO poisoning, including HBO2 therapy, varied among the institutions participating in Japan. HBO2 therapy with inconsistent protocols showed no advantage over NBO2 therapy in preventing DNS. Multiple HBO2 sessions was associated with the incidence of DNS.
Collapse
Affiliation(s)
- Motoki Fujita
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
- * E-mail:
| | - Masaki Todani
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Japan
| | - Kotaro Kaneda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Japan
| | - Shinya Suzuki
- Department of Emergency Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Shinjiro Wakai
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Shota Kikuta
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Satomi Sasaki
- Advanced Medical Emergency Department and Critical Care Center, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Noriyuki Hattori
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuyoshi Yagishita
- Hyperbaric Medical Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Kuwata
- Division of Medicine, Japan Self Defense Forces Hospital Yokosuka, Yokosuka, Japan
| | - Ryosuke Tsuruta
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Japan
| | | |
Collapse
|
4
|
Sakaguchi K, Koga Y, Yagi T, Nakahara T, Todani M, Fujita M, Tsuruta R. Severe Fever with Thrombocytopenia Syndrome Complicated with Pseudomembranous Aspergillus Tracheobronchitis in a Patient without Apparent Risk Factors for Invasive Aspergillosis. Intern Med 2019; 58:3589-3592. [PMID: 31366803 PMCID: PMC6949450 DOI: 10.2169/internalmedicine.3257-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/13/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne infectious disease. A 91-year-old woman was admitted to our intensive-care unit with SFTS, and she developed dyspnea with wheezes 5 days after admission. Bronchoscopy showed scattered white mold in her central airway. An airway tissue biopsy and culture of bronchial lavage fluid revealed fungal hyphae in the necrotic tissue, confirmed as Aspergillus fumigatus. She was thus diagnosed with pseudomembranous aspergillus tracheobronchitis. She had no common risk factors for invasive aspergillosis (IA). Patients with SFTS, even those without apparent risk factors for IA, may be at risk of developing IA.
Collapse
Affiliation(s)
- Kento Sakaguchi
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
- Department of Emergency and Critical Care Medicine, Yamagata University Faculty of Medicine, Japan
| | - Yasutaka Koga
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Takeshi Yagi
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Takashi Nakahara
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Masaki Todani
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Motoki Fujita
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Japan
| |
Collapse
|
5
|
Kaneda K, Yagi T, Todani M, Nakahara T, Fujita M, Kawamura Y, Oda Y, Tsuruta R. Impact of type of emergency department on the outcome of out-of-hospital cardiac arrest: a prospective cohort study. Acute Med Surg 2019; 6:371-378. [PMID: 31592321 PMCID: PMC6773652 DOI: 10.1002/ams2.423] [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: 12/08/2018] [Accepted: 04/02/2019] [Indexed: 11/16/2022] Open
Abstract
Aim To assess whether the outcomes of out‐of‐hospital cardiac arrest (OHCA) differ between patients treated at tertiary or secondary emergency medical facilities. Methods Data from the Japanese Association for Acute Medicine Out‐of‐Hospital Cardiac Arrest (JAAM‐OHCA) registry between June 2014 and December 2015 were analyzed and compared between patients treated at tertiary (tertiary group) and secondary (secondary group) emergency medical facilities. The primary outcome of this study was a favorable neurological outcome at 1 and 3 months after OHCA, defined as a Glasgow–Pittsburgh cerebral performance category of 1 or 2. Results Between June 2014 and December 2015, a total of 13,491 patients with OHCA were registered in the JAAM‐OHCA registry. Of these, 12,836 were eligible in the present analysis, with 11,583 in the tertiary group and 1,253 in the secondary group. The proportions of patients with favorable neurological outcomes in the tertiary group were significantly higher than those in the secondary group at 1 (4.7% versus 2.0%, P < 0.001) and 3 (3.5% versus 1.6%, P < 0.001) months after OHCA. Even after adjusting for baseline characteristics of patients, treatment at a tertiary emergency medical facility was independently associated with favorable neurological outcomes at 1 (odds ratio, 2.856, 95% confidence interval, 1.429–5.710; P = 0.003) and 3 (odds ratio, 2.462, 95% confidence interval, 1.203–5.042; P = 0.014) months after OHCA. Conclusion The neurological outcomes of patients with OHCA treated at tertiary emergency medical facilities were better than those of patients treated at secondary emergency medical facilities.
Collapse
Affiliation(s)
- Kotaro Kaneda
- Advanced Medical Emergency and Critical Care Center Yamaguchi University Hospital Ube Yamaguchi Japan
| | - Takeshi Yagi
- Advanced Medical Emergency and Critical Care Center Yamaguchi University Hospital Ube Yamaguchi Japan
| | - Masaki Todani
- Advanced Medical Emergency and Critical Care Center Yamaguchi University Hospital Ube Yamaguchi Japan
| | - Takashi Nakahara
- Advanced Medical Emergency and Critical Care Center Yamaguchi University Hospital Ube Yamaguchi Japan
| | - Motoki Fujita
- Advanced Medical Emergency and Critical Care Center Yamaguchi University Hospital Ube Yamaguchi Japan
| | - Yoshikatsu Kawamura
- Advanced Medical Emergency and Critical Care Center Yamaguchi University Hospital Ube Yamaguchi Japan
| | - Yasutaka Oda
- Advanced Medical Emergency and Critical Care Center Yamaguchi University Hospital Ube Yamaguchi Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center Yamaguchi University Hospital Ube Yamaguchi Japan
| |
Collapse
|
6
|
Fujita M, Oda Y, Kaneda K, Kawamura Y, Nakahara T, Todani M, Yagi T, Koga Y, Tsuruta R. Variability in Treatment for Carbon Monoxide Poisoning in Japan: A Multicenter Retrospective Survey. Emerg Med Int 2018; 2018:2159147. [PMID: 30627443 PMCID: PMC6304618 DOI: 10.1155/2018/2159147] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/07/2018] [Accepted: 11/22/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The aim of this study was to identify practice differences in the treatment of carbon monoxide (CO) poisoning with or without hyperbaric oxygen (HBO2) therapy in Japan. MATERIALS AND METHODS Using an online survey website (Google form), we created a questionnaire and invited interested institutions to join the COP-J Study, a prospective observational study of CO poisoning in Japan. RESULTS Forty-eight (63%) of 76 institutions replied to the questionnaire. Thirty-three institutions (69%) administered HBO2 therapy to patients with CO poisoning, and 15 institutions (31%) did not. Consciousness disturbance on arrival, exposure to CO for a long time, and elevation of arterial carboxyhemoglobin (CO-Hb) were the major indications for HBO2 therapy. The maximum therapeutic pressures were 2.0, 2.5, and 2.8 atmospheres absolute (ATA) at 19 (58%), 6 (18%), and 8 (24%) institutions, respectively. The number of HBO2 sessions on the first day was 1-3, and 1-7 sessions were administered on days 2-7. Seventeen (35%) institutions treated patients with delayed neurological sequelae (DNS) and 15 of them used HBO2 therapy for DNS. CONCLUSIONS This survey indicates that HBO2 therapy for CO poisoning was varied in both the indications and practice regimens used in Japan.
Collapse
Affiliation(s)
- Motoki Fujita
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Yasutaka Oda
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Kotaro Kaneda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Yoshikatsu Kawamura
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Takashi Nakahara
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Masaki Todani
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Takeshi Yagi
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Yasutaka Koga
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Ryosuke Tsuruta
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| |
Collapse
|
7
|
Koga Y, Fujita M, Yagi T, Todani M, Nakahara T, Kawamura Y, Kaneda K, Oda Y, Tsuruta R. Reply to the letter to the editor. J Crit Care 2018; 49:193-194. [PMID: 30391114 DOI: 10.1016/j.jcrc.2018.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/26/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Yasutaka Koga
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan.
| | - Motoki Fujita
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Takeshi Yagi
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Masaki Todani
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Takashi Nakahara
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Yoshikatsu Kawamura
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Kotaro Kaneda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Yasutaka Oda
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan; Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| |
Collapse
|
8
|
Yamamoto T, Fujita M, Oda Y, Todani M, Hifumi T, Kondo Y, Shimazaki J, Shiraishi S, Hayashida K, Yokobori S, Takauji S, Wakasugi M, Nakamura S, Kanda J, Yagi M, Moriya T, Kawahara T, Tonouchi M, Yokota H, Miyake Y, Shimizu K, Tsuruta R. Evaluation of a Novel Classification of Heat-Related Illnesses: A Multicentre Observational Study (Heat Stroke STUDY 2012). Int J Environ Res Public Health 2018; 15:ijerph15091962. [PMID: 30205551 PMCID: PMC6165559 DOI: 10.3390/ijerph15091962] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 01/09/2023]
Abstract
The Japanese Association for Acute Medicine Committee recently proposed a novel classification system for the severity of heat-related illnesses. The illnesses are simply classified into three stages based on symptoms and management or treatment. Stages I, II, and III broadly correspond to heat cramp and syncope, heat exhaustion, and heat stroke, respectively. Our objective was to examine whether this novel severity classification is useful in the diagnosis by healthcare professionals of patients with severe heat-related illness and organ failure. A nationwide surveillance study of heat-related illnesses was conducted between 1 June and 30 September 2012, at emergency departments in Japan. Among the 2130 patients who attended 102 emergency departments, the severity of their heat-related illness was recorded for 1799 patients, who were included in this study. In the patients with heat cramp and syncope or heat exhaustion (but not heat stroke), the blood test data (alanine aminotransferase, creatinine, blood urea nitrogen, and platelet counts) for those classified as Stage III were significantly higher than those of patients classified as Stage I or II. There were no deaths among the patients classified as Stage I. This novel classification may avoid underestimating the severity of heat-related illness.
Collapse
Affiliation(s)
- Takahiro Yamamoto
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Motoki Fujita
- Department of Acute and General Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Yasutaka Oda
- Department of Acute and General Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Masaki Todani
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Toru Hifumi
- Emergency and Critical Care medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan.
| | - Yutaka Kondo
- Department of Emergency Medicine and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba 279-0021, Japan.
| | - Junya Shimazaki
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Shinichiro Shiraishi
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, 1-1 Tsuruga-machi, Aizuwakamatsu, Fukushima 965-8611, Japan.
| | - Kei Hayashida
- Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
| | - Shuhei Takauji
- Department of Emergency Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido 078-8510, Japan.
| | - Masahiro Wakasugi
- Emergency and Critical Care Center, Toyama University Hospital, 2630, Sugitani, Toyama City, Toyama 930-0152, Japan.
| | - Shunsuke Nakamura
- Department of Emergency Medicine, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama City, Wakayama 640-8505, Japan.
| | - Jun Kanda
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8606, Japan.
| | - Masaharu Yagi
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, 4-16-1 Iso, Urasoe, Okinawa 901-2132, Japan.
| | - Takashi Moriya
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama 330-8503, Japan.
| | - Takashi Kawahara
- Japan Sport Council, 2-8-35 Kita-Aoyama, Minato-ku, Tokyo 107-0061, Japan.
| | - Michihiko Tonouchi
- Japan Meteorological Business Support Center, To-nen Bld, 3-17 Kanda-Nishikicho, Chiyoda-ku, Tokyo 101-0054, Japan.
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
| | - Yasufumi Miyake
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8606, Japan.
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Centre, 2-8-29 Musashidai, Fuchu-shi, Tokyo 183-8524, Japan.
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
- Department of Acute and General Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| |
Collapse
|
9
|
Lafrenaye AD, Todani M, Walker SA, Povlishock JT. Microglia processes associate with diffusely injured axons following mild traumatic brain injury in the micro pig. J Neuroinflammation 2015; 12:186. [PMID: 26438203 PMCID: PMC4595283 DOI: 10.1186/s12974-015-0405-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [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: 07/27/2015] [Accepted: 09/23/2015] [Indexed: 01/08/2023] Open
Abstract
Background Mild traumatic brain injury (mTBI) is an all too common occurrence that exacts significant personal and societal costs. The pathophysiology of mTBI is complex, with reports routinely correlating diffuse axonal injury (DAI) with prolonged morbidity. Progressive chronic neuroinflammation has also recently been correlated to morbidity, however, the potential association between neuroinflammatory microglia and DAI is not well understood. The majority of studies exploring neuroinflammatory responses to TBI have focused on more chronic phases of injury involving phagocytosis associated with Wallerian change. Little, however, is known regarding the neuroinflammatory response seen acutely following diffuse mTBI and its potential relationship to early DAI. Additionally, while inflammation is drastically different in rodents compared to humans, pigs and humans share very similar inflammatory profiles and responses. Methods In the current study, we employed a modified central fluid percussion model in micro pigs. Using this model of diffuse mTBI, paired with various immunohistological endpoints, we assessed the potential association between acute thalamic DAI and neuroinflammation 6 h following injury. Results Injured micro pigs displayed substantial axonal damage reflected in the presence of APP+ proximal axonal swellings, which were particularly prominent in the thalamus. In companion, the same thalamic sites displayed extensive neuroinflammation, which was observed using Iba-1 immunohistochemistry. The physical relationship between microglia and DAI, assessed via confocal 3D analysis, revealed a dramatic increase in the number of Iba-1+ microglial processes that contacted APP+ proximal axonal swellings compared to uninjured myelinated thalamic axons in sham animals. Conclusions In aggregate, these studies reveal acute microglial process convergence on proximal axonal swellings undergoing DAI, an interaction not previously recognized in the literature. These findings transform our understanding of acute neuroinflammation following mTBI and may suggest its potential as a diagnostic and/or a therapeutic target. Electronic supplementary material The online version of this article (doi:10.1186/s12974-015-0405-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Audrey D Lafrenaye
- Department of Anatomy and Neurobiology, Virginia Commonwealth University Medical Center, P.O. Box 980709, Richmond, VA, 23298, USA.
| | - Masaki Todani
- Department of Anatomy and Neurobiology, Virginia Commonwealth University Medical Center, P.O. Box 980709, Richmond, VA, 23298, USA. .,Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan.
| | - Susan A Walker
- Department of Anatomy and Neurobiology, Virginia Commonwealth University Medical Center, P.O. Box 980709, Richmond, VA, 23298, USA.
| | - John T Povlishock
- Department of Anatomy and Neurobiology, Virginia Commonwealth University Medical Center, P.O. Box 980709, Richmond, VA, 23298, USA.
| |
Collapse
|
10
|
Yamamoto T, Todani M, Oda Y, Kaneko T, Kaneda K, Fujita M, Miyauchi T, Tsuruta R. Predictive Factors for Hospitalization of Patients with Heat Illness in Yamaguchi, Japan. Int J Environ Res Public Health 2015; 12:11770-80. [PMID: 26393633 PMCID: PMC4586706 DOI: 10.3390/ijerph120911770] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/01/2015] [Accepted: 09/11/2015] [Indexed: 11/24/2022]
Abstract
The objective of the study was to investigate the predictive factors for the hospitalization of patients who presented with mild to moderate heat illness at an emergency department. We conducted a retrospective survey of hospitals with an emergency department in Yamaguchi Prefecture, Japan. The survey questionnaire entries included patient age, sex, use of an ambulance, vital signs, blood examination conducted at the emergency department, the length of hospitalization, and outcome. We analyzed the predictive factors for hospitalization in patients with heat illness. A total of 127 patients were analyzed. Of these, 49 (37%) were admitted, with 59% discharged on the day following admission. In univariate analysis, the following inpatient characteristics were predictive for hospitalization: old age, low Glasgow Coma Scale score, elevated body temperature, increased serum C-reactive protein, and increased blood urea nitrogen. In logistic regression multivariate analysis, the following were predictive factors for hospitalization: age of ≥ 65 years (odds ratio (OR) 4.91; 95% confidence interval (CI) 1.42–17.00), body temperature (OR 1.97; 95% CI 1.14–3.41), Glasgow Coma Scale (OR 0.40; 95% CI 0.16–0.98), and creatinine (OR 2.92; 95% CI 1.23–6.94). The results suggest that the elderly with hyperthermia, disturbance of consciousness, and elevated serum creatinine have an increased risk for hospitalization with heat illness.
Collapse
Affiliation(s)
- Takahiro Yamamoto
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Masaki Todani
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Yasutaka Oda
- Department of Acute and General Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Tadashi Kaneko
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Kotaro Kaneda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Motoki Fujita
- Department of Acute and General Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Takashi Miyauchi
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
- Department of Acute and General Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| |
Collapse
|
11
|
Otsuka Y, Kasaoka S, Oda Y, Nakahara T, Tanaka R, Todani M, Miyauchi T, Kaneda K, Kawamura Y, Tsuruta R. Effects of uninterrupted chest compressions on the rescuer's physical condition. Am J Emerg Med 2014; 32:909-12. [PMID: 24929774 DOI: 10.1016/j.ajem.2014.05.008] [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: 10/06/2013] [Revised: 05/01/2014] [Accepted: 05/05/2014] [Indexed: 11/17/2022] Open
Abstract
STUDY OBJECTIVE Recent guidelines have emphasized the need for uninterrupted chest compressions. The purpose of this study was to evaluate the rescuer's tolerability of uninterrupted chest compressions. METHODS Twenty-five healthy subjects performed uninterrupted chest compressions for 7 minutes at a rate of 100 compressions per minute using a training manikin. The quality of chest compressions was assessed in terms of the total number and percentage of chest compressions, compression depth, recoil distance, and duty cycle. Correct chest compression was defined as a depth of 38 to 51 mm. Physiological and laboratory parameters were measured before and after the procedure. Fatigue was measured using a numerical rating scale. Data were compared before and after the procedure. RESULTS The participants were 10 emergency physicians and 15 medical students. The compression rate was nearly 100 compressions per minute. The number and percentage of correct compressions decreased gradually after 3 minutes. The compression depth decreased significantly after 2 minutes. The recoil distance and duty cycle were unchanged over 7 minutes. Systolic blood pressure, pulse rate, respiratory rate, numerical rating scale, serum lactate, adrenalin, and noradrenalin increased significantly after the procedure. Noradrenalin levels measured before the procedure were significantly and negatively correlated with the total number and percentage of correct compressions (r = -0.587, P = .004; r = -0.549, P = .008, respectively). CONCLUSIONS Performing uninterrupted chest compressions for 7 minutes is an arduous procedure. Higher noradrenalin levels before the procedure might be associated with incorrect chest compressions.
Collapse
Affiliation(s)
- Yohei Otsuka
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
| | - Shunji Kasaoka
- Department of Stress and Bio-response Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Yasutaka Oda
- Department of Stress and Bio-response Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan.
| | - Takashi Nakahara
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
| | - Ryo Tanaka
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
| | - Masaki Todani
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
| | - Takashi Miyauchi
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
| | - Kotaro Kaneda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
| | - Yoshikatsu Kawamura
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan; Department of Stress and Bio-response Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| |
Collapse
|
12
|
Tsuruta R, Todani M. [Predictive prognostic factors in severe patients]. Nihon Rinsho 2012; 70:976-980. [PMID: 22690603] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
International classification of heat illness including heat stroke, heat exhaustion, the others is well known. However, the new classification from the grade III(severe) to the grade I(mild) is more common in Japan. There is a good correlation between the two classifications. The Heatstroke Surveillance Committee of the Japanese Association for Acute Medicine has collected the data using the new classification. The outcome of patients who were mechanically ventilated due to heat illness was not affected by cooling procedures but independently associated with systolic blood pressure and SpO2 at the scene, and arterial base excess on admission.
Collapse
Affiliation(s)
- Ryosuke Tsuruta
- Department of Emergency and Critical Care Medicine, Yamaguchi University Graduate School of Medicine
| | | |
Collapse
|
13
|
Kasaoka S, Todani M, Kaneko T, Kawamura Y, Oda Y, Tsuruta R, Maekawa T. Peak value of blood myoglobin predicts acute renal failure induced by rhabdomyolysis. J Crit Care 2010; 25:601-4. [DOI: 10.1016/j.jcrc.2010.04.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 03/25/2010] [Accepted: 04/04/2010] [Indexed: 12/18/2022]
|
14
|
Todani M, Fujita M, Tsuruta R, Nakahara T, Yagi T, Oshima C, Igarashi M, Takahashi K, Kasaoka S, Yuasa M, Maekawa T. Moderate hypothermia suppressed excessive generation of superoxide anion radical and inflammatory reactions in blood and liver in heatstroke: Laboratory study in rats. Free Radic Res 2010; 44:462-72. [DOI: 10.3109/10715761003610752] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
15
|
Kutsuna S, Tsuruta R, Fujita M, Todani M, Yagi T, Ogino Y, Igarashi M, Takahashi K, Izumi T, Kasaoka S, Yuasa M, Maekawa T. Cholinergic agonist physostigmine suppresses excessive superoxide anion radical generation in blood, oxidative stress, early inflammation, and endothelial injury in rats with forebrain ischemia/reperfusion. Brain Res 2009; 1313:242-9. [PMID: 19968973 DOI: 10.1016/j.brainres.2009.11.077] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 11/25/2009] [Accepted: 11/29/2009] [Indexed: 12/25/2022]
Abstract
The cholinergic anti-inflammatory pathway is reportedly important in modulating the inflammatory response in local and systemic diseases, including ischemia/reperfusion pathophysiology. In this study, we investigated the effects of the cholinergic agonist, physostigmine, on jugular venous superoxide radical (O(2)(-)) generation, oxidative stress, early inflammation, and endothelial activation during forebrain ischemia/reperfusion (FBI/R) in rats. Fourteen male Wistar rat were allocated to the control group (n=7) or physostigmine group (n=7). The physostigmine group received 80 ng/g physostigmine intraperitoneally 24 h and 1 h before forebrain ischemia was established. The jugular venous O(2)(-) current was measured for 10 min during forebrain ischemia and for 120 min after reperfusion. The O(2)(-) current increased gradually during forebrain ischemia in both groups. The current increased markedly immediately after reperfusion in the control group but was significantly attenuated in the physostigmine group after reperfusion. Brain and plasma malondialdehyde, high-mobility group box 1 (HMGB1) protein, and intercellular adhesion molecule 1 (ICAM1) were significantly attenuated in the physostigmine group compared with the control group, except for brain HMGB1. The amount of O(2)(-) generated during FBI/R correlated with malondialdehyde, HMGB1, and ICAM1 in both the brain and plasma. In conclusion, the cholinergic agonist physostigmine suppressed jugular venous O(2)(-) generation, oxidative stress, early inflammation, and endothelial activation in the brain and plasma in the acute phase of cerebral ischemia/reperfusion. Therefore, the suppression of O(2)(-) is a key mechanism of the cholinergic anti-inflammatory pathway in the pathophysiology of cerebral ischemia/reperfusion.
Collapse
Affiliation(s)
- Satoshi Kutsuna
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Tsuruta R, Otsuka Y, Mutaguchi M, Oshima C, Todani M, Kaneko T, Kawamura Y, Kasaoka S, Maekawa T, Maekawa T. PATIENT-RELATED FACTORS IN THE DECISION TO FORGO LIFE-SUSTAINING TREATMENT IN COMATOSE PATIENTS RESUSCITATED FROM OUT-OF-HOSPITAL CARDIAC ARREST IN JAPAN. J Am Geriatr Soc 2009; 57:2368-9. [DOI: 10.1111/j.1532-5415.2009.02587.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
17
|
Koda Y, Tsuruta R, Fujita M, Miyauchi T, Kaneda K, Todani M, Aoki T, Shitara M, Izumi T, Kasaoka S, Yuasa M, Maekawa T. Moderate hypothermia suppresses jugular venous superoxide anion radical, oxidative stress, early inflammation, and endothelial injury in forebrain ischemia/reperfusion rats. Brain Res 2009; 1311:197-205. [PMID: 19931227 DOI: 10.1016/j.brainres.2009.11.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 11/09/2009] [Accepted: 11/11/2009] [Indexed: 10/20/2022]
Abstract
The aim of this study was to assess the effect of moderate hypothermia (MH) on generation of jugular venous superoxide radical (O2-.), oxidative stress, early inflammation, and endothelial injury in forebrain ischemia/reperfusion (FBI/R) rats. Twenty-one Wistar rats were allocated to a control group (n=7, 37 degrees C), a pre-MH group (n=7, 32 degrees C before ischemia), and a post-MH group (n=7, 32 degrees C after reperfusion). MH was induced before induction of ischemia in the pre-MH group and just after reperfusion in the post-MH group. Forebrain ischemia was induced by occlusion of bilateral common carotid arteries with hemorrhagic hypotension for 10 min, followed by reperfusion. O(2)(-)(.) in the jugular vein was measured from the produced current using a novel O2-. sensor. The O2-. current showed a gradual increase during forebrain ischemia in the control and post-MH groups but was attenuated in the pre-MH group. Following reperfusion, the current showed a marked increase in the control group but was strongly attenuated in the pre- and post-MH groups. Concentrations of malondialdehyde, high-mobility group box 1 (HMGB1) protein, and intercellular adhesion molecule-1 (ICAM-1) in the brain and plasma 120 min after reperfusion in the pre- and post-MH groups were significantly lower than those in the control group, except for plasma HMGB1 in the post-MH group. In conclusion, MH suppressed O2-. measured in the jugular vein, oxidative stress, early inflammation, and endothelial injury in FBI/R rats.
Collapse
Affiliation(s)
- Yoichi Koda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1, Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Todani M, Kaneko T, Hayashida H, Kaneda K, Tsuruta R, Kasaoka S, Maekawa T. [Acute poisoning with neonicotinoid insecticide acetamiprid]. Chudoku Kenkyu 2008; 21:387-390. [PMID: 19069132] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Acetamiprid belongs to a new class of insecticides called neonicotinoids, which have different effects from other insecticides. Neonicotinoids act as selective agonists at the nicotinic acetylcholine receptors, therefore their toxicity is higher to insect pests than to humans. Cases of acetamiprid poisoning are still rare, because neonicotinoids have been released in the market only within the last decade. We experienced a case of acute acetamiprid poisoning and measured the blood concentration of acetamiprid. A 79-year-old man had ingested acetamiprid and got medical attention two hours after ingestion. On arrival, he had consciousness disturbance (GCS-8), hypotension, nausea, vomiting and hyperglycemia, but had no constricted pupils nor mucous supersecretion which are characteristic in organophosphate poisoning. Gastric lavage was performed and activated charcoal and laxative were administered. Paroxysmal atrial fibrillation persisted until 11 hours after ingestion. The next day, his symptoms with regards to the effects of acetamiprid improved and he was discharged from the hospital without complication. Blood concentration of acetamiprid on arrival, approximately 2 hours after the ingestion, was 21.1 microg/ml.
Collapse
Affiliation(s)
- Masaki Todani
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | | | | | | | | | | | | |
Collapse
|
19
|
Todani M, Ryosuke T, Kaneko T, Kawamura Y, Kasaoka S, Maekawa T. Factors of hospitalization for mild heat illness. Crit Care 2008. [PMCID: PMC4088725 DOI: 10.1186/cc6575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
20
|
Hirata K, Gohra H, Todani M, Fujii M, Takahashi T, Furukawa S, Oda T, Hamano K. [Surgical repair of coarctation of the aorta in adults]. Kyobu Geka 2007; 60:825-9. [PMID: 17703622] [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] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
We report the surgical treatment of coarctation of the aorta (CoA) in 3 adults, 2 women and 1 man, aged between 18 and 32 years old. All of the patients had blood pressure gradients higher than 70 mmHg between the upper and lower limbs. In 2 patients, we simply clamped the aorta and excised the CoA: while in the other patient, we excised the CoA using partial extracorporeal circulation with a femoro-femoral (F-F) bypass. Reconstruction was done by an end to end anastomosis in 2 patients and with an artificial tube graft in 1 patient who regulred the extended aortic arch repair. Postoperatively, the pressure gradients between the upper and lower limbs dropped to below 20 mmHg in intensive care unit (ICU). Two of the patients have now stopped taking antihypertensive drugs and the other patient is taking half the preoperative dose.
Collapse
Affiliation(s)
- K Hirata
- Department of Surgery, Yamaguchi Saiseikai General Hospital, Yamaguchi, Japan
| | | | | | | | | | | | | | | |
Collapse
|