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Norii T, Igarashi Y, Yoshino Y, Nakao S, Yang M, Albright D, Sklar DP, Crandall C. The effects of bystander interventions for foreign body airway obstruction on survival and neurological outcomes: Findings of the MOCHI registry. Resuscitation 2024:110198. [PMID: 38582443 DOI: 10.1016/j.resuscitation.2024.110198] [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: 02/11/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Foreign body airway obstruction (FBAO) is a life-threatening condition. We aimed to quantify the impact of bystander FBAO interventions on survival and neurological outcomes. METHODS We conducted a Japan-wide prospective, multi-center, observational study including all FBAO patients who presented to the Emergency Department from April 2020 to March 2023. Information on bystander FBAO interventions was collected through interviews with emergency medical services personnel. Primary outcomes included 1-month survival and favorable neurologic outcome defined as Cerebral Performance Category 1 or 2. We performed a multivariable logistic regression and a Cox proportional hazards modeling to adjust for confounders. RESULTS We analyzed a total of 407 patients in the registry who had the median age of 82 years old (IQR 73-88). The FBAO incidents were often witnessed (86.5%, n = 352/407) and the witnesses intervened in just over half of the cases (54.5%, n = 192/352). The incidents frequently occurred at home (54.3%, n = 221/407) and nursing home (21.6%, n = 88/407). Common first interventions included suction (24.8%, n = 101/407) and back blow (20.9%, n = 85/407). The overall success rate of bystander interventions was 48.4% (n = 93/192). About half (48.2%, n = 196/407) survived to 1-month and 23.8% patients (n = 97/407) had a favorable neurological outcome. Adjusting for pre-specified confounders, bystander interventions were independently associated with survival (hazard ratio, 0.55; 95% CI, 0.39-0.77) and a favorable neurological outcome (adjusted OR, 2.18; 95% CI, 1.23-3.95). CONCLUSION Bystander interventions were independently associated with survival and favorable neurological outcome, however, they were performed only in the half of patients.
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Affiliation(s)
- Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico, USA; Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital Tokyo, Japan.
| | - Yudai Yoshino
- Department of Emergency Medicine, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan.
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - MingAn Yang
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Danielle Albright
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - David P Sklar
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
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Norii T, Igarashi Y, Kogure T. Initial cardiac rhythms of out-of-hospital cardiac arrest victims with foreign body airway obstruction. Resuscitation 2024; 197:110143. [PMID: 38364968 DOI: 10.1016/j.resuscitation.2024.110143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/10/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico, Albuquerque, USA.
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
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Igarashi Y, Nakahara K, Norii T, Miyake N, Tagami T, Yokobori S. Performance of a large language model on Japanese emergency medicine board certification examinations. J NIPPON MED SCH 2024:JNMS.2024_91-205. [PMID: 38432929 DOI: 10.1272/jnms.jnms.2024_91-205] [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] [Indexed: 03/05/2024]
Abstract
Background Emergency physicians need a broad range of knowledge and skills to address critical medical, traumatic, and environmental conditions. Artificial intelligence (AI), including large language models (LLMs), has potential applications in healthcare settings; however, the performance of LLMs in emergency medicine remains unclear.Methods To evaluate the reliability of information provided by ChatGPT, an LLM was given the questions set by the Japanese Association of Acute Medicine in its board certification examinations over a period of 5 years (2018-2022) and programmed to answer them twice. Statistical analysis was used to assess agreement of the two responses.Results The LLM successfully answered 465 of the 475 text-based questions, achieving an overall correct response rate of 62.3%. For questions without images, the rate of correct answers was 65.9%. For questions with images that were not explained to the LLM, the rate of correct answers was only 52.0%. The annual rates of correct answers to questions without images ranged from 56.3% to 78.8%. Accuracy was better for scenario-based questions (69.1%) than for stand-alone questions (62.1%). Agreement between the two responses was substantial (kappa = 0.70). Factual error accounted for 82% of the incorrectly answered questions.Conclusion An LLM performed satisfactorily on an emergency medicine board certification examination in Japanese and without images. However, factual errors in the responses highlight the need for physician oversight when using LLMs.
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Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Kyoichi Nakahara
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico
| | - Nodoka Miyake
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi-Kosugi Hospital
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
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Kamei J, Kanamoto M, Igarashi Y, Suzuki K, Fujita K, Kuwana T, Ogura T, Mochizuki K, Banshotani Y, Ishikura H, Nakamura Y. Blood Purification in Patients with Sepsis Associated with Acute Kidney Injury: A Narrative Review. J Clin Med 2023; 12:6388. [PMID: 37835031 PMCID: PMC10573845 DOI: 10.3390/jcm12196388] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Sepsis leads to organ dysfunction. Acute kidney injury, a common type of organ dysfunction, is associated with a high mortality rate in patients with sepsis. Kidney replacement therapy can correct the metabolic, electrolyte, and fluid imbalances caused by acute kidney injury. While this therapy can improve outcomes, evidence of its beneficial effects is lacking. Herein, we review the indications for blood purification therapy, including kidney replacement therapy, and the current knowledge regarding acute kidney injury in terms of renal and non-renal indications. While renal indications have been well-documented, indications for blood purification therapy in sepsis (non-renal indications) remain controversial. Excessive inflammation is an important factor in the development of sepsis; blood purification therapy has been shown to reduce inflammatory mediators and improve hemodynamic instability. Given the pathophysiology of sepsis, blood purification therapy may decrease mortality rates in these patients. Further trials are needed in order to establish the effectiveness of blood purification therapy for sepsis.
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Affiliation(s)
- Jun Kamei
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan;
| | - Masafumi Kanamoto
- Department of Anesthesiology, Gunma Prefectural Cardiovascular Center, 3-12, Kameizumi, Gunma 371-0004, Japan;
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo 1138603, Japan;
| | - Kodai Suzuki
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan;
| | - Kensuke Fujita
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Tochigi 321-0974, Japan; (K.F.); (T.O.)
| | - Tsukasa Kuwana
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan;
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Tochigi 321-0974, Japan; (K.F.); (T.O.)
| | - Katsunori Mochizuki
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Osaka 569-8686, Japan;
| | - Yuki Banshotani
- Tajima Emergency & Critical Care Medical Center, Toyooka Hospital, Hyogo 668-8501, Japan;
| | - Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka 814-0180, Japan;
| | - Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka 814-0180, Japan;
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Furuhama A, Kitazawa A, Yao J, Matos Dos Santos CE, Rathman J, Yang C, Ribeiro JV, Cross K, Myatt G, Raitano G, Benfenati E, Jeliazkova N, Saiakhov R, Chakravarti S, Foster RS, Bossa C, Battistelli CL, Benigni R, Sawada T, Wasada H, Hashimoto T, Wu M, Barzilay R, Daga PR, Clark RD, Mestres J, Montero A, Gregori-Puigjané E, Petkov P, Ivanova H, Mekenyan O, Matthews S, Guan D, Spicer J, Lui R, Uesawa Y, Kurosaki K, Matsuzaka Y, Sasaki S, Cronin MTD, Belfield SJ, Firman JW, Spînu N, Qiu M, Keca JM, Gini G, Li T, Tong W, Hong H, Liu Z, Igarashi Y, Yamada H, Sugiyama KI, Honma M. Evaluation of QSAR models for predicting mutagenicity: outcome of the Second Ames/QSAR international challenge project. SAR QSAR Environ Res 2023; 34:983-1001. [PMID: 38047445 DOI: 10.1080/1062936x.2023.2284902] [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: 09/11/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023]
Abstract
Quantitative structure-activity relationship (QSAR) models are powerful in silico tools for predicting the mutagenicity of unstable compounds, impurities and metabolites that are difficult to examine using the Ames test. Ideally, Ames/QSAR models for regulatory use should demonstrate high sensitivity, low false-negative rate and wide coverage of chemical space. To promote superior model development, the Division of Genetics and Mutagenesis, National Institute of Health Sciences, Japan (DGM/NIHS), conducted the Second Ames/QSAR International Challenge Project (2020-2022) as a successor to the First Project (2014-2017), with 21 teams from 11 countries participating. The DGM/NIHS provided a curated training dataset of approximately 12,000 chemicals and a trial dataset of approximately 1,600 chemicals, and each participating team predicted the Ames mutagenicity of each trial chemical using various Ames/QSAR models. The DGM/NIHS then provided the Ames test results for trial chemicals to assist in model improvement. Although overall model performance on the Second Project was not superior to that on the First, models from the eight teams participating in both projects achieved higher sensitivity than models from teams participating in only the Second Project. Thus, these evaluations have facilitated the development of QSAR models.
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Affiliation(s)
- A Furuhama
- Division of Genetics and Mutagenesis (DGM), National Institute of Health Sciences (NIHS), Kawasaki, Japan
| | - A Kitazawa
- Division of Genetics and Mutagenesis (DGM), National Institute of Health Sciences (NIHS), Kawasaki, Japan
| | - J Yao
- Key Laboratory of Fluorine and Nitrogen Chemistry and Advanced Materials (Chinese Academy of Sciences), Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences (SIOC, CAS), Shanghai, China
| | - C E Matos Dos Santos
- Department of Computational Toxicology and In Silico Innovations, Altox Ltd, São Paulo-SP, Brazil
| | - J Rathman
- MN-AM, Nuremberg, Germany/Columbus, OH, USA
| | - C Yang
- MN-AM, Nuremberg, Germany/Columbus, OH, USA
| | | | - K Cross
- In Silico Department, Instem, Conshohocken, PA, USA
| | - G Myatt
- In Silico Department, Instem, Conshohocken, PA, USA
| | - G Raitano
- Laboratory of Environmental Toxicology and Chemistry, Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Milano, Italy
| | - E Benfenati
- Laboratory of Environmental Toxicology and Chemistry, Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Milano, Italy
| | | | | | | | | | - C Bossa
- Environment and Health Department, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - C Laura Battistelli
- Environment and Health Department, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - R Benigni
- Environment and Health Department, Istituto Superiore di Sanità (ISS), Rome, Italy
- Alpha-PreTox, Rome, Italy
| | - T Sawada
- Faculty of Regional Studies, Gifu University, Gifu, Japan
- xenoBiotic Inc, Gifu, Japan
| | - H Wasada
- Faculty of Regional Studies, Gifu University, Gifu, Japan
| | - T Hashimoto
- Faculty of Regional Studies, Gifu University, Gifu, Japan
| | - M Wu
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - R Barzilay
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - P R Daga
- Simulations Plus, Lancaster, CA, USA
| | - R D Clark
- Simulations Plus, Lancaster, CA, USA
| | | | | | | | - P Petkov
- LMC - Bourgas University, Bourgas, Bulgaria
| | - H Ivanova
- LMC - Bourgas University, Bourgas, Bulgaria
| | - O Mekenyan
- LMC - Bourgas University, Bourgas, Bulgaria
| | - S Matthews
- Computational Pharmacology & Toxicology Laboratory, Discipline of Pharmacology, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - D Guan
- Computational Pharmacology & Toxicology Laboratory, Discipline of Pharmacology, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - J Spicer
- Computational Pharmacology & Toxicology Laboratory, Discipline of Pharmacology, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - R Lui
- Computational Pharmacology & Toxicology Laboratory, Discipline of Pharmacology, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Y Uesawa
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Tokyo, Japan
| | - K Kurosaki
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Tokyo, Japan
| | - Y Matsuzaka
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Tokyo, Japan
| | - S Sasaki
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Tokyo, Japan
| | - M T D Cronin
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - S J Belfield
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - J W Firman
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - N Spînu
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - M Qiu
- Evergreen AI, Inc, Toronto, Canada
| | - J M Keca
- Evergreen AI, Inc, Toronto, Canada
| | - G Gini
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - T Li
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration (NCTR/FDA), Jefferson, AR, USA
| | - W Tong
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration (NCTR/FDA), Jefferson, AR, USA
| | - H Hong
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration (NCTR/FDA), Jefferson, AR, USA
| | - Z Liu
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration (NCTR/FDA), Jefferson, AR, USA
- Integrative Toxicology, Nonclinical Drug Safety, Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
| | - Y Igarashi
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Osaka, Japan
| | - H Yamada
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Osaka, Japan
| | - K-I Sugiyama
- Division of Genetics and Mutagenesis (DGM), National Institute of Health Sciences (NIHS), Kawasaki, Japan
| | - M Honma
- Division of Genetics and Mutagenesis (DGM), National Institute of Health Sciences (NIHS), Kawasaki, Japan
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Miyake N, Igarashi Y, Nakae R, Mizobuchi T, Masuno T, Yokobori S. Ventilator management and risk of air leak syndrome in patients with SARS-CoV-2 pneumonia: a single-center, retrospective, observational study. BMC Pulm Med 2023; 23:251. [PMID: 37430221 DOI: 10.1186/s12890-023-02549-7] [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: 03/11/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is reportedly associated with air leak syndrome (ALS), including mediastinal emphysema and pneumothorax, and has a high mortality rate. In this study, we compared values obtained every minute from ventilators to clarify the relationship between ventilator management and risk of developing ALS. METHODS This single-center, retrospective, observational study was conducted at a tertiary care hospital in Tokyo, Japan, over a 21-month period. Information on patient background, ventilator data, and outcomes was collected from adult patients with SARS-CoV-2 pneumonia on ventilator management. Patients who developed ALS within 30 days of ventilator management initiation (ALS group) were compared with those who did not (non-ALS group). RESULTS Of the 105 patients, 14 (13%) developed ALS. The median positive-end expiratory pressure (PEEP) difference was 0.20 cmH2O (95% confidence interval [CI], 0.20-0.20) and it was higher in the ALS group than in the non-ALS group (9.6 [7.8-20.2] vs. 9.3 [7.3-10.2], respectively). For peak pressure, the median difference was -0.30 cmH2O (95% CI, -0.30 - -0.20) (20.4 [17.0-24.4] in the ALS group vs. 20.9 [16.7-24.6] in the non-ALS group). The mean pressure difference of 0.0 cmH2O (95% CI, 0.0-0.0) (12.7 [10.9-14.6] vs. 13.0 [10.3-15.0], respectively) was also higher in the non-ALS group than in the ALS group. The difference in single ventilation volume per ideal body weight was 0.71 mL/kg (95% CI, 0.70-0.72) (8.17 [6.79-9.54] vs. 7.43 [6.03-8.81], respectively), and the difference in dynamic lung compliance was 8.27 mL/cmH2O (95% CI, 12.76-21.95) (43.8 [28.2-68.8] vs. 35.7 [26.5-41.5], respectively); both were higher in the ALS group than in the non-ALS group. CONCLUSIONS There was no association between higher ventilator pressures and the development of ALS. The ALS group had higher dynamic lung compliance and tidal volumes than the non-ALS group, which may indicate a pulmonary contribution to ALS. Ventilator management that limits tidal volume may prevent ALS development.
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Affiliation(s)
- Nodoka Miyake
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Taiki Mizobuchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
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Matsumoto Y, Nakae R, Sekine T, Kodani E, Warnock G, Igarashi Y, Tagami T, Murai Y, Suzuki K, Yokobori S. Rapidly progressive cerebral atrophy following a posterior cranial fossa stroke: Assessment with semiautomatic CT volumetry. Acta Neurochir (Wien) 2023; 165:1575-1584. [PMID: 37119319 DOI: 10.1007/s00701-023-05609-3] [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: 01/31/2023] [Accepted: 04/25/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND The effect of posterior cranial fossa stroke on changes in cerebral volume is not known. We assessed cerebral volume changes in patients with acute posterior fossa stroke using CT scans, and looked for risk factors for cerebral atrophy. METHODS Patients with cerebellar or brainstem hemorrhage/infarction admitted to the ICU, and who underwent at least two subsequent inpatient head CT scans during hospitalization were included (n = 60). The cerebral volume was estimated using an automatic segmentation method. Patients with cerebral volume reduction > 0% from the first to the last scan were defined as the "cerebral atrophy group (n = 47)," and those with ≤ 0% were defined as the "no cerebral atrophy group (n = 13)." RESULTS The cerebral atrophy group showed a significant decrease in cerebral volume (first CT scan: 0.974 ± 0.109 L vs. last CT scan: 0.927 ± 0.104 L, P < 0.001). The mean percentage change in cerebral volume between CT scans in the cerebral atrophy group was -4.7%, equivalent to a cerebral volume of 46.8 cm3, over a median of 17 days. The proportions of cases with a history of hypertension, diabetes mellitus, and median time on mechanical ventilation were significantly higher in the cerebral atrophy group than in the no cerebral atrophy group. CONCLUSIONS Many ICU patients with posterior cranial fossa stroke showed signs of cerebral atrophy. Those with rapidly progressive cerebral atrophy were more likely to have a history of hypertension or diabetes mellitus and required prolonged ventilation.
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Affiliation(s)
- Yoshiyuki Matsumoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
| | - Eigo Kodani
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
| | | | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
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Norii T, Igarashi Y. An unbroken ring of the chain of survival. Resuscitation 2023; 187:109803. [PMID: 37088271 PMCID: PMC10122547 DOI: 10.1016/j.resuscitation.2023.109803] [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: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
This is a commentary on the study conducted by Kennedy et al. from Victoria, Australia, that analyzed the cohort of all adult EMS-witnessed out-of-hospital cardiac arrest (OHCA) patients in the region and compared patients treated during the COVID-19 period to a historical comparator period. The commentary summarizes the study findings and discusses the importance of the study in the context of the chain of survival and changes in airway management for OHCA patients during the COVID-19 pandemic.
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Affiliation(s)
- Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico, USA.
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan.
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Norii T, Igarashi Y, Akaiwa M, Yoshino Y, Kamimura H, Albright D, Sklar DP, Crandall C. Food choking incidents in the hospital: incidents, characteristics, effectiveness of interventions, and mortality and morbidity outcomes. Resuscitation 2023:109806. [PMID: 37088269 DOI: 10.1016/j.resuscitation.2023.109806] [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: 02/15/2023] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
AIM Foreign body airway obstruction (FBAO) due to food can occur wherever people eat, including in hospitals. We characterized in-hospital FBAO incidents and their outcomes. METHODS We searched the Japan Council for Quality Health Care nationwide in-hospital adverse events database for relevant events from 1,549 institutions. We included all patients with FBAO incidents due to food in the hospital from January 2010 to June 2021 and collected data on the characteristics, interventions, and outcomes. FBAO from non-food materials were excluded. Our primary outcomes were mortality and morbidity from FBAO incidents. RESULTS We identified 300 patients who had a FBAO incident from food. The most common age group was 80 - 89 years old (32.3%, n = 97/300). One-half (50.0%, n = 150/300) were witnessed events. Suction was the most common first intervention (31.3%, n = 94/300) and resulted in successful removal of foreign body in 17.0% of cases (n = 16/94). Back blows (16.0%, n = 48/300) and abdominal thrusts (8.1%, n = 24/300) were less frequently performed as the first intervention and the success rates were 10.4% (n = 5/48) and 20.8% (n = 5/24), respectively. About one-third of the patients (31%, n = 93/300) died and 26.7% (n = 80/300) had a high potential of residual disability from the incidents. CONCLUSION FBAO from food in the hospital is an uncommon but life-threatening event. The majority of patients who suffered from the in-hospital FBAO incidents did not receive effective interventions initially and many of them died or suffered residual disability.
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Affiliation(s)
- Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico, USA.
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan.
| | - Mari Akaiwa
- School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Yudai Yoshino
- Department of Emergency Medicine, Aizu Chuo Hospital, Fukushima, Japan.
| | - Hiroki Kamimura
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan.
| | - Danielle Albright
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
| | - David P Sklar
- Senior Advisor and Professor, College of Health Solutions, Arizona State University, Phoenix, AZ.
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
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10
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Igarashi Y, Akazawa N, Maeda S. Effects of Changes in Body Fat Mass as a Result of Regular Exercise on Hemoglobin A1c in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis. Int J Sport Nutr Exerc Metab 2023:1-13. [PMID: 37076246 DOI: 10.1123/ijsnem.2022-0217] [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: 10/25/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 04/21/2023]
Abstract
An increase in visceral fat is associated with an increase in insulin resistance, so reducing body fat mass through exercise may help alleviate type 2 diabetes mellitus (T2DM). The current meta-analysis evaluated the effect of changes in body fat via an intervention of regular exercise on hemoglobin A1c (HbA1c) in patients with T2DM. The inclusion criteria were randomized controlled trials involving adults with T2DM, intervention involving exercise alone, an overall duration of intervention ≥12 weeks, and reporting HbA1c and body fat mass. The mean differences (MDs) were defined as the MD between the exercise group and the control group, and the MDs in HbA1c (in percentage) and body fat mass (in kilograms) were calculated. All MDs in HbA1c were pooled as overall effects. A meta-regression analysis was performed to evaluate the relationship between the MD in the body fat mass (in kilograms) and the MD in HbA1c. Twenty studies (1,134 subjects) were analyzed. The pooled MD in HbA1c (in percentage) decreased significantly (-0.4; 95% confidence interval [-0.5, -0.3]) but contained significant heterogeneity (Q = 52.7, p < .01; I2 = 41.6%). A meta-regression analysis showed that a decrease in the MD in body fat mass was significantly associated with a decrease in the MD in HbA1c (R2 = 80.0%) and heterogeneity decreased (Q = 27.3, p = .61; I2 = 11.9%), and a reduction in body fat mass of 1 kg was estimated to decrease the HbA1c (%) by approximately 0.2. The current study suggested that a decrease in HbA1c due to regular exercise depends on a reduction in body fat mass in patients with T2DM.
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Affiliation(s)
| | | | - Seiji Maeda
- Faculty of Sport Sciences, Waseda University, Tokorozawa,Japan
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11
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Kitano S, Ogawa K, Igarashi Y, Nishimura K, Osawa S, Suzuki K, Fujimoto K, Harada S, Narikawa K, Tagami T, Ohwada H, Yokobori S, Ogawa S, Yokota H. Development of a Machine Learning Model for Predicting Cardiac Arrest During Transport for Trauma Patients. J NIPPON MED SCH 2023. [PMID: 36823128 DOI: 10.1272/jnms.jnms.2023_90-206] [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] [Indexed: 02/22/2023]
Abstract
BACKGROUND Trauma is a serious medical and economic problem worldwide, and patients with trauma injuries have a poor survival rate following cardiac arrest. This study aimed to create a prediction model specific to prehospital trauma care and to achieve greater accuracy with techniques of machine learning. METHODS This retrospective observational study investigated data of patients who had blunt trauma injuries due to traffic accident and fall trauma from January 1, 2018, to December 31, 2019, using the National Emergency Medical Services Information System, which stores emergency medical service activity records nationwide in the United States. Random forest was used to develop a machine learning model. RESULTS Per the prediction model, the area under the curve of the predictive model was 0.95 and negative predictive value was 0.99. The feature importance of the predictive model was the highest for the AVPU scale (an acronym from "Alert, Verbal, Pain, Unresponsive"), followed by oxygen saturation (SpO2). Among patients who were progressing to cardiac arrest, the cutoff value was 89% for SpO2 in unalert patients. CONCLUSIONS Patients whose conditions did not progress to cardiac arrest could be identified with high accuracy by machine learning model techniques.
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Affiliation(s)
- Shinnosuke Kitano
- Graduate School of Medical and Health Science, Nippon Sport Science University.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tama Nagayama Hospital
| | - Kei Ogawa
- Department of Industrial Administration, Tokyo University of Science
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Kan Nishimura
- Department of Industrial Administration, Tokyo University of Science
| | - Shuichiro Osawa
- Department of Industrial Administration, Tokyo University of Science
| | - Kensuke Suzuki
- Graduate School of Medical and Health Science, Nippon Sport Science University
| | - Kenji Fujimoto
- Graduate School of Medical and Health Science, Nippon Sport Science University
| | - Satoshi Harada
- Graduate School of Medical and Health Science, Nippon Sport Science University
| | - Kenji Narikawa
- Graduate School of Medical and Health Science, Nippon Sport Science University
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Hayato Ohwada
- Department of Industrial Administration, Tokyo University of Science
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Satoo Ogawa
- Graduate School of Medical and Health Science, Nippon Sport Science University
| | - Hiroyuki Yokota
- Graduate School of Medical and Health Science, Nippon Sport Science University
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12
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Namatame K, Igarashi Y, Nakae R, Suzuki G, Shiota K, Miyake N, Ishii H, Yokobori S. Cerebral edema associated with diabetic ketoacidosis: Two case reports. Acute Med Surg 2023; 10:e860. [PMID: 37346084 PMCID: PMC10280603 DOI: 10.1002/ams2.860] [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: 01/24/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
Background Diabetic ketoacidosis (DKA) is associated with a high mortality rate, especially if cerebral edema develops during the disease course. It is rarer and more severe in adults than in children. We present cases of two patients with cerebral edema-related DKA. Case presentation The first patient was a 38-year-old man with diabetes mellitus who presented with DKA-related disturbed consciousness. Although glycemic correction was performed slowly, he showed pupil dilation 11 h later. He underwent emergency ventricular drainage, but died of cerebral herniation. The second patient was a 25-year-old woman who presented with impaired consciousness secondary to DKA. Head computed tomography showed subarachnoid hemorrhage and cerebral edema. No related intraoperative findings were observed; it was concluded that the first computed tomography scan revealed pseudo-subarachnoid hemorrhage. Conclusion Diabetic ketoacidosis-related cerebral edema develops despite treatment according to guidelines and is difficult to predict. Therefore, adult patients should be treated cautiously during DKA management.
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Affiliation(s)
- Kaoru Namatame
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Ryuta Nakae
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Go Suzuki
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
- Department of Emergency and Critical Care MedicineKawaguchi Municipal Medical CenterSaitamaJapan
| | - Kohei Shiota
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Nodoka Miyake
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Hirotomo Ishii
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Shoji Yokobori
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
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13
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Bunya N, Hirofumi O, Igarashi Y, Norii T, Katayama Y, Kasai T, Sawamoto K, Narimatsu E. Effect of prehospital advanced airway management on out-of-hospital cardiac arrest due to asphyxia: A JAAM-OHCA registry-based observational study in Japan. Acute Med Surg 2023; 10:e912. [PMID: 38152160 PMCID: PMC10751225 DOI: 10.1002/ams2.912] [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: 05/06/2023] [Revised: 11/17/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023] Open
Abstract
Aim To investigate the relationship between prehospital advanced airway management (AAM) and neurological outcomes in patients with asphyxia-related out-of-hospital cardiac arrest (OHCA). Methods We retrospectively analyzed data from the Japanese Association for Acute Medicine OHCA registry between June 2014 and December 2017. Patients with asphyxia-related cardiac arrest aged ≥18 years were included. The primary outcome was a 1-month favorable neurological outcome (cerebral performance category [CPC] 1-2). Results Of the 34,754 patients in the 2014-2017 JAAM-OHCA Registry, 1956 were included in our analysis. Cerebral performance category 1-2 was observed in 31 patients (1.6%), while CPC 3-5 was observed in 1925 patients (98.4%). Although prehospital AAM was associated with unfavorable neurological outcomes (odds ratio [OR], 0.269; 95% confidence interval [CI], 0.114-0.633; p = 0.003) in the univariate analysis, the association was not significant in the multivariate analysis. Compared with the AAM group, the non-AAM group showed increased rates of cardiac arrest after emergency medical service contact (4.3 vs. 7.2%, p = 0.009) and Glasgow Coma Scale ≥4 at hospital admission (1.9% vs. 4.7%, p = 0.004). Among the 903 patients for whom the time to return of spontaneous circulation (ROSC) could be calculated, the time from witnessed cardiac arrest to ROSC was significantly shorter (median, 8.5 vs. 37.0 min; p < 0.001) for those with favorable neurological outcomes than for those without. Conclusion Prehospital AAM is not associated with improved neurological outcomes among those with asphyxia-related OHCA. However, the time from cardiac arrest to the first ROSC was significantly shorter among those with favorable outcomes.
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Affiliation(s)
- Naofumi Bunya
- Department of Emergency MedicineSapporo Medical UniversitySapporoJapan
| | - Ohnishi Hirofumi
- Department of Public HealthSapporo Medical UniversitySapporoJapan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School HospitalTokyoJapan
| | - Tatsuya Norii
- Department of Emergency MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Yoichi Katayama
- Department of Emergency MedicineSapporo Medical UniversitySapporoJapan
| | - Takehiko Kasai
- Department of Emergency MedicineSapporo Medical UniversitySapporoJapan
| | - Keigo Sawamoto
- Department of Emergency MedicineSapporo Medical UniversitySapporoJapan
| | - Eichi Narimatsu
- Department of Emergency MedicineSapporo Medical UniversitySapporoJapan
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14
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Kanda J, Wakasugi M, Kondo Y, Ueno S, Kaneko H, Okada Y, Okano Y, Kishihara Y, Hamaguchi J, Ishihara T, Igarashi Y, Nakae R, Miyamoto S, Yamada E, Ikechi D, Yamazaki M, Tanaka D, Sawada Y, Suda C, Yoshimura S, Onodera R, Kano K, Hongo T, Endo K, Iwasaki Y, Kodaira H, Yasuo S, Seki N, Okuda H, Nakajima S, Nagato T, Terazumi K, Nakamura S, Yokobori S. Heat stroke management during the COVID-19 pandemic: Recommendations from the experts in Japan (2nd edition). Acute Med Surg 2023; 10:e827. [PMID: 37056485 PMCID: PMC10086676 DOI: 10.1002/ams2.827] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/08/2023] [Indexed: 04/15/2023] Open
Abstract
Both coronavirus disease 2019 (COVID-19) and heat stroke have symptoms of fever or hyperthermia and the difficulty in distinguishing them could lead to a strain on emergency medical care. To mitigate the potential confusion that could arise from actions for preventing both COVID-19 spread and heat stroke, particularly in the context of record-breaking summer season temperatures, this work offers new knowledge and evidence that address concerns regarding indoor ventilation and indoor temperatures, mask wearing and heat stroke risk, and the isolation of older adults. Specifically, the current work is the second edition to the previously published guidance for handling heat stroke during the COVID-19 pandemic, prepared by the "Working group on heat stroke medical care during the COVID-19 epidemic," composed of members from four organizations in different medical and related fields. The group was established by the Japanese Association for Acute Medicine Heatstroke and Hypothermia Surveillance Committee. This second edition includes new knowledge, and conventional evidence gleaned from a primary selection of 60 articles from MEDLINE, one article from Cochrane, 13 articles from Ichushi, and a secondary/final selection of 56 articles. This work summarizes the contents that have been clarified in the prevention and treatment of infectious diseases and heat stroke to provide guidance for the prevention, diagnosis, and treatment of heat stroke during the COVID-19 pandemic.
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Affiliation(s)
- Jun Kanda
- Department of Emergency MedicineTeikyo University School of MedicineItabashiJapan
| | - Masahiro Wakasugi
- Department of Emergency and Disaster MedicineUniversity of ToyamaToyamaJapan
| | - Yutaka Kondo
- Department of Emergency and Critical Care MedicineJuntendo University Urayasu HospitalUrayasuJapan
| | - Satoru Ueno
- Japan Organisation of Occupational Health and SafetyNational Institute of Occupational Safety and HealthKiyoseJapan
| | - Hitoshi Kaneko
- Department of Trauma and Emergency MedicineTokyo Metropolitan Tama Medical CenterFuchuJapan
| | - Yohei Okada
- Department of Public Health Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Yuichi Okano
- Department of Emergency MedicineKumamoto Sekijuji HospitalKumamotoJapan
| | - Yuki Kishihara
- Department of Urology, Emergency Room, Jichi Medical University Saitama Medical CenterJichi Medical UniversityShimotsukeJapan
| | - Jun Hamaguchi
- Department of Emergency and Critical Care MedicineTokyo Metropolitan Tama Medical CenterFuchuJapan
| | - Tadashi Ishihara
- Department of Emergency and Critical Care MedicineJuntendo University Urayasu HospitalUrayasuJapan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care MedicineNippon Medical SchoolBunkyo CityJapan
| | - Ryuta Nakae
- Department of Emergency and Critical Care MedicineNippon Medical SchoolBunkyo CityJapan
| | - Sohma Miyamoto
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalChuo CityJapan
| | - Eri Yamada
- Advanced Medical Emergency Department and Critical Care CenterMaebashi Red Cross HospitalMaebashiJapan
| | - Daisuke Ikechi
- Department of Emergency and Critical Care MedicineHitachi General HospitalHitachiJapan
| | - Maiko Yamazaki
- Department of Emergency MedicineTeikyo University School of MedicineItabashiJapan
| | - Daiki Tanaka
- Department of Emergency MedicineTeikyo University School of MedicineItabashiJapan
| | - Yusuke Sawada
- Department of Emergency MedicineGunma University Graduate School of MedicineMaebashiJapan
| | - Chiaki Suda
- Department of Emergency and Critical Care MedicineSaku Central Hospital Advanced Care CenterSakuJapan
| | | | - Ryuta Onodera
- Department of Preventive ServicesKyoto University School of Public HealthKyotoJapan
| | - Kenichi Kano
- Emergency and Critical Care MedicineKokuritsu Byoin Kiko Kyoto Iryo CenterKyotoJapan
| | - Takashi Hongo
- Emergency DepartmentOkayama Saiseikai General HospitalOkayamaJapan
| | - Kaori Endo
- Orthopaedic Surgery, Sapporo Tokushukai HospitalHokkaido UniversitySapporoJapan
| | - Yohei Iwasaki
- Trauma and Acute Critical Care CenterTokyo Medical and Dental University HospitalTokyoJapan
| | | | | | - Nozomu Seki
- Department of Emergency and Critical Care MedicineJapanese Red Cross Saitama HospitalSaitamaJapan
| | - Hiroshi Okuda
- Division of Comprehensive MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Satoshi Nakajima
- Department of Emergency MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Tadashi Nagato
- Department of Respiratory MedicineJCHO Tokyo Yamate Medical CenterKyotoJapan
| | - Keiko Terazumi
- Trauma and Critical CareJapanese Red Cross Kumamoto HospitalKumamotoJapan
| | - Satoshi Nakamura
- Department of Emergency MedicineAsahi General HospitalAsahiJapan
| | - Shoji Yokobori
- Department of Emergency and Critical Care MedicineNippon Medical SchoolBunkyo CityJapan
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15
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Igarashi Y. Effects of Differences in Exercise Programs With Regular Resistance Training on Resting Blood Pressure in Hypertensive Adults: A Systematic Review and Meta-Analysis. J Strength Cond Res 2023; 37:253-263. [PMID: 35442242 DOI: 10.1519/jsc.0000000000004236] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACT Igarashi, Y. Effects of differences in exercise programs with regular resistance training on resting blood pressure in hypertensive adults: A systematic review and meta-analysis. J Strength Cond Res 37(1): 253-263, 2023-This systematic review and meta-analysis aimed to evaluate changes in resting blood pressure (RBP) with differences in regular resistance training (RT) programs. Inclusion criteria were randomized controlled trials involving hypertensive adults and interventions involving only RT of both the upper and lower limbs for ≥7 weeks. The weighted mean difference (WMD) was defined as the mean difference between the exercise and control groups, weighted by the inverse of the squared standard error for each study, and all WMDs in RBP were pooled as overall effects. A simple meta-regression analysis was performed to evaluate the relationship between RT variables (percentage 1 repetition maximum [1RM], number of repetitions, number of sets, and weekly frequency) and changes in RBP. Seventeen studies (646 subjects) were analyzed. The pooled WMDs in the resting systolic blood pressure (RSBP) and resting diastolic blood pressure (RDBP) decreased significantly but contained significant heterogeneity {RSBP, -4.7 mm Hg (95% confidence interval [CI], -6.7 to -2.8; I2 = 46.6%); RDBP, -3.5 mm Hg (95% CI, -4.9 to -2.1; I2 = 39.1%)}. Meta-regression analysis revealed that an increase in % 1RM was significantly associated with a decrease in the RSBP (γ = -0.25x 0 + 10.85, where γ represents the mean difference in RSBP, and x 0 represents % 1RM [%]), and heterogeneity was alleviated ( I2 = 0.0%). For reducing RSBP, regular RT with moderate or heavy loads may be more beneficial than regular RT with light loads.
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16
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Kameno R, Igarashi Y, Hirai K, Yoshino Y, Mizobuchi T, Yokobori S. Letter to the Editor: A Compact and Lightweight X-Ray Unit in a Mountain Clinic. High Alt Med Biol 2022; 23:377-379. [PMID: 36480807 DOI: 10.1089/ham.2022.0074] [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] [Indexed: 12/13/2022] Open
Affiliation(s)
- Rikiya Kameno
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.,Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Fukushima, Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Kunio Hirai
- Department of Radiology, Division of Radiological Technology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yudai Yoshino
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Taiki Mizobuchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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17
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Igarashi Y, Suzuki K, Norii T, Motomura T, Yoshino Y, Kitagoya Y, Ogawa S, Yokobori S, Yokota H. Do Video Calls Improve Dispatcher-Assisted First Aid for Infants with Foreign Body Airway Obstruction? A Randomized Controlled Trial/Simulation Study. J NIPPON MED SCH 2022; 89:526-532. [DOI: 10.1272/jnms.jnms.2022_89-513] [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] [Indexed: 11/11/2022]
Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Kensuke Suzuki
- Department of Emergency Medical Science, Nippon Sport Science University
| | - Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico
| | - Tomokazu Motomura
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Yudai Yoshino
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | | | - Satoo Ogawa
- Department of Emergency Medical Science, Nippon Sport Science University
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hiroyuki Yokota
- Department of Emergency Medical Science, Nippon Sport Science University
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18
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Igarashi Y, Mizobuchi T, Nakae R, Yokobori S. Trends in the number of patients from traffic accidents and the state of emergency. Acute Med Surg 2022; 9:e799. [PMID: 36248914 PMCID: PMC9548511 DOI: 10.1002/ams2.799] [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: 07/04/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Aim During the coronavirus disease 2019 pandemic, the number of traffic accidents and injured patients was reported to be lower than that before the pandemic. However, little is known regarding the relationship between periods of the state of emergency and the number of patients who met with traffic accidents. Methods The numbers of trauma patients and deaths due to traffic accidents in Tokyo and Osaka were collected monthly from the statistics published by the police department. A state of emergency was declared four times in both cities. The number of trauma patients and deaths was compared between the emergency and other periods. Results The number of monthly patients per 100,000 due to traffic accidents during the state of emergency was significantly lower than that during other periods in Tokyo (16.56 versus 18.20; P = 0.008) and Osaka (24.12 versus 28.79; P = 0.002). However, the monthly number of deaths during the state of emergency was not significantly different compared with those during the other periods in Tokyo (0.08 versus 0.08; P = 0.65) and Osaka (0.10 versus 0.14; P = 0.082). A decrease in the number of trauma patients was observed before the emergency period; however, the reduction rate dropped as the period passed. Conclusion There were significantly fewer trauma patients due to traffic accidents during the state of emergency than during the other periods, with no significant difference in the number of deaths.
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Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Taiki Mizobuchi
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Ryuta Nakae
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Shoji Yokobori
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
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19
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Igarashi Y, Ogawa K, Nishimura K, Osawa S, Ohwada H, Yokobori S. Machine learning for predicting successful extubation in patients receiving mechanical ventilation. Front Med (Lausanne) 2022; 9:961252. [PMID: 36035403 PMCID: PMC9403066 DOI: 10.3389/fmed.2022.961252] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Ventilator liberation is one of the most critical decisions in the intensive care unit; however, prediction of extubation failure is difficult, and the proportion thereof remains high. Machine learning can potentially provide a breakthrough in the prediction of extubation success. A total of seven studies on the prediction of extubation success using machine learning have been published. These machine learning models were developed using data from electronic health records, 8–78 features, and algorithms such as artificial neural network, LightGBM, and XGBoost. Sensitivity ranged from 0.64 to 0.96, specificity ranged from 0.73 to 0.85, and area under the receiver operating characteristic curve ranged from 0.70 to 0.98. The features deemed most important included duration of mechanical ventilation, PaO2, blood urea nitrogen, heart rate, and Glasgow Coma Scale score. Although the studies had limitations, prediction of extubation success by machine learning has the potential to be a powerful tool. Further studies are needed to assess whether machine learning prediction reduces the incidence of extubation failure or prolongs the duration of ventilator use, thereby increasing tracheostomy and ventilator-related complications and mortality.
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Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
- *Correspondence: Yutaka Igarashi
| | - Kei Ogawa
- Department of Industrial Administration, Tokyo University of Science, Chiba, Japan
| | - Kan Nishimura
- Department of Industrial Administration, Tokyo University of Science, Chiba, Japan
| | - Shuichiro Osawa
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hayato Ohwada
- Department of Industrial Administration, Tokyo University of Science, Chiba, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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20
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Igarashi Y, Toya A, Okazaki K. The influence of regular exercise with differences of exercise mode and environment during exercise on core temperature: a meta‐analysis. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r3367] [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] [Indexed: 11/11/2022]
Affiliation(s)
- Yutaka Igarashi
- Research Center for Urban Health and SportsOsaka City UniversityOsaka
| | - Atsuya Toya
- Department of Environmental Physiology for ExerciseOsaka City University Graduate School of MedicineOsaka
| | - Kazunobu Okazaki
- Research Center for Urban Health and SportsOsaka City UniversityOsaka
- Department of Environmental Physiology for ExerciseOsaka City University Graduate School of MedicineOsaka
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21
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Igarashi Y, Norii T, Sung‐Ho K, Nagata S, Yoshino Y, Hamaguchi T, Nagaosa R, Nakao S, Tagami T, Yokobori S. Airway obstruction time and outcomes in patients with foreign body airway obstruction: multicenter observational choking investigation. Acute Med Surg 2022; 9:e741. [PMID: 35309267 PMCID: PMC8918414 DOI: 10.1002/ams2.741] [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: 11/15/2021] [Revised: 02/03/2022] [Accepted: 02/18/2022] [Indexed: 11/26/2022] Open
Abstract
Aim Foreign body airway obstruction (FBAO) is a major public health concern worldwide for infants and older adults. This study determines the association between airway obstruction time and neurological outcomes to plan an effective response for patients with FBAO. Methods This multicenter retrospective observational study was carried out among patients with life‐threatening FBAO in Japan over a period of 4 years. The duration of airway obstruction was calculated from the time of the accident to the time of foreign body removal. The study examined the relationship between airway obstruction time and outcome. The primary outcome was vegetative state or death at hospital discharge. Results Among 119 patients, 68 were in the category of vegetative state or death. Logistic regression analysis showed that longer airway obstruction time (adjusted odds ratio 1.04; 95% confidence interval 1.01–1.07) was associated with vegetative state or death. When the cut‐off value was set at 10, the sensitivity was 0.88, the specificity 0.47, with the area under the curve 0.69. Using the other cut‐off value of 4 min, the negative predictive value was 1.00. Conclusion Longer airway obstruction time was associated with vegetative state or death for patients with FBAO. The incidence of vegetative state or death increased when the airway obstruction time exceeded 10 min. Meanwhile, 4 min or less may be set as a target time for foreign body removal in order to prevent vegetative state or death and plan an effective response.
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Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Tatsuya Norii
- Department of Emergency Medicine University of New Mexico Albuquerque New Mexico USA
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Kim Sung‐Ho
- Senshu Trauma and Critical Care Center Rinku General Medical Center Osaka Japan
| | - Shimpei Nagata
- Department of Clinical Epidemiology and Health Economics The University of Tokyo Tokyo Japan
| | - Yudai Yoshino
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
- Department of Emergency and Critical Care Medicine Nippon Medical School Musashi Kosugi Hospital Kanagawa Japan
| | - Takuro Hamaguchi
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Riko Nagaosa
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
- Department of Emergency and Critical Care Medicine Nippon Medical School Musashi Kosugi Hospital Kanagawa Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
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22
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Igarashi Y, Akazawa N, Maeda S. The relationship between the level of exercise and hemoglobin A 1c in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Endocrine 2021; 74:546-558. [PMID: 34296390 DOI: 10.1007/s12020-021-02817-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of the study was to evaluate the relationship between changes in hemoglobin A1c (HbA1c) and exercise levels in type 2 diabetes mellitus (T2DM) patients when performing various types of exercise. METHODS The inclusion criteria were randomized controlled trials involving adults with T2DM, intervention involving exercise alone, the overall duration of intervention ≥12 weeks, and reporting HbA1c. Weighted mean difference (WMD) was defined as the mean difference between the intervention group and the control group weighted by the inverse of the squared standard error for each study, and all WMDs were pooled as overall effects. A meta-regression analysis was performed to evaluate the relationship between the exercise level and the WMD in HbA1c. RESULTS Forty-eight studies (2395 subjects) were analyzed. The pooled WMD in HbA1c decreased significantly (-0.5% [95% confidence intervals: -0.6 to -0.4]) but contained significant heterogeneity (Q = 103.8, P < 0.01; I2 = 36.6%). A meta-regression analysis showed that the intensity (metabolic equivalents [METs]), time (min/session), or frequency (sessions/week) of the exercise was not associated with the HbA1c. However, the overall duration of exercise (weeks) was significantly associated with the WMD in HbA1c (meta-regression coefficient: 0.01 [95% confidence intervals: 0.002-0.016]; R2 = 70.0%), and that result did not contain significant heterogeneity (P > 0.05; I2 = 14.7%). CONCLUSIONS The exercise intervention decreases HbA1c in T2DM patients. In addition, exercise for an extended duration was associated with an increase in HbA1c, so the effects of exercise may be evident early on, but results suggested that exercise for a prolonged period alone may increase HbA1c.
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Affiliation(s)
| | - Nobuhiko Akazawa
- Japan Institute of Sports Sciences, Tokyo, 115-0056, Japan
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, 305-8574, Japan
| | - Seiji Maeda
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, 305-8574, Japan
- Faculty of Sport Sciences, Waseda University, Saitama, 359-1192, Japan
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23
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Igarashi Y, Yabuki M, Norii T, Yokobori S, Yokota H. Quantitative analysis of the impact of COVID-19 on the emergency medical services system in Tokyo. Acute Med Surg 2021; 8:e709. [PMID: 34824859 PMCID: PMC8604116 DOI: 10.1002/ams2.709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/09/2021] [Revised: 10/14/2021] [Accepted: 10/31/2021] [Indexed: 11/10/2022] Open
Abstract
Aim The coronavirus disease 2019 (COVID‐19) pandemic has imposed a heavy burden on emergency medical services (EMS) systems. Therefore, we quantitatively analyzed impacts of COVID‐19 on the EMS system in Tokyo. Methods In this retrospective observational study, we used publicly available data, including the daily number of newly diagnosed patients with COVID‐19, the weekly number of transport difficulties, and the field activity time, from March 2, 2020, to January 25, 2021. Data for the same period in the previous year were used as controls. Results The total number of EMS calls decreased by 12.7% in 2020 compared with that in 2019. The number of daily transport difficulties significantly increased in 2020 compared with that in 2019 (89 [72–120] vs 57 [49–63]; P < 0.001). Additionally, the field activity time significantly increased in 2020 compared with that in 2019 (22.7 [22.3–23.8] min vs 20.7 [20.6–21.2] min; P < 0.001). Furthermore, the daily number of new patients with COVID‐19 was positively correlated with the number of transport difficulties (R = 0.76) and the field activity time on the scene (R = 0.74). With an increase in the number of people infected with COVID‐19 by 1,000, the number of daily transport difficulties increased by 86.4. Per 1,000 infected patients per day, the field activity time increased by 3.48 min. Conclusion This study revealed that the increase in the number of patients with COVID‐19 indirectly affected the EMS system in Tokyo.
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Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Mio Yabuki
- Faculty of Medicine Nippon Medical School Tokyo Japan
| | - Tatsuya Norii
- Department of Emergency Medicine University of New Mexico Albuquerque NM USA
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Hiroyuki Yokota
- Department of Emergency Medical Science Nippon Sport Science University Yokohama Kanagawa Japan
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24
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Igarashi Y, Ikeda S, Hirai K, Tominaga N, Mizobuchi T, Shigeta K, Ishii H, Yokobori S. A Risk Reduction Technique for Five Invasive Procedures in the Emergency Room Using a Compact and Lightweight X-ray Unit. J NIPPON MED SCH 2021; 89:555-561. [PMID: 34526472 DOI: 10.1272/jnms.jnms.2022_89-504] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many invasive procedures are performed in the emergency room (ER), which have potential risks and complications. Due to limitations, especially with respect to size, portable X-ray devices are generally not used during such procedures. However, they have been miniaturized, enabling physicians to capture X-ray images by themselves.. METHODS We developed a safe, compact, and lightweight X-ray unit and performed five invasive procedures in the ER. In all the procedures, a chest X-ray image was taken to confirm its utility. RESULTS Case 1 (central venous catheter placement): After needle and guidewire insertion and the placement of the catheter, the location of catheter could be confirmed. Case 2 (chest tube insertion): During the insertion of the chest tube into the pleural space, it was observed that the tip of the thoracic tube was at the appropriate location. Case 3 (percutaneous tracheostomy or cricothyroidotomy): After needle and guidewire insertion, it was visualized that the guidewire was in the right main bronchus and that the tube was inserted into the trachea. Case 4 (resuscitative endovascular aortic balloon of the aorta): The captured image revealed that the catheter was located in zone I before balloon inflation. Case 5 (Sengstaken-Blakemore tube): The image revealed that the balloon was located in the stomach. CONCLUSIONS The devised portable X-ray unit could contribute medical safety during invasive procedures frequently performed in the ER.
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Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Shimpei Ikeda
- Department of Emergency and Critical Care Medicine, Nippon Medical School.,Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital
| | - Kunio Hirai
- Division of Radiological Technology, Nippon Medical School Hospital
| | - Naoki Tominaga
- Department of Emergency and Critical Care Medicine, Nippon Medical School.,Department of Emergency and Critical Care Medicine, Saitama City Hospital
| | - Taiki Mizobuchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Kenta Shigeta
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hiromoto Ishii
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
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25
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Igarashi Y, Nishimura K, Ogawa K, Miyake N, Mizobuchi T, Shigeta K, Obinata H, Takayama Y, Tagami T, Seike M, Ohwada H, Yokobori S. Machine Learning Prediction for Supplemental Oxygen Requirement in Patients with COVID-19. J NIPPON MED SCH 2021; 89:161-168. [PMID: 34526457 DOI: 10.1272/jnms.jnms.2022_89-210] [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] [Indexed: 01/08/2023]
Abstract
BACKGROUND The coronavirus disease (COVID-19) poses an urgent threat to global public health and is characterized by rapid disease progression even in mild cases. In this study, we investigated whether machine learning can be used to predict which patients will have a deteriorated condition and require oxygenation in asymptomatic or mild cases of COVID-19. METHODS This single-center, retrospective, observational study included COVID-19 patients admitted to the hospital from February 1, 2020, to May 31, 2020, and who were either asymptomatic or presented with mild symptoms and did not require oxygen support on admission. Data on patient characteristics and vital signs were collected upon admission. We used seven machine learning algorithms, assessed their capability to predict exacerbation, and analyzed important influencing features using the best algorithm. RESULTS In total, 210 patients were included in the study. Among them, 43 (19%) required oxygen therapy. Of all the models, the logistic regression model had the highest accuracy and precision. Logistic regression analysis showed that the model had an accuracy of 0.900, precision of 0.893, and recall of 0.605. The most important parameter for predictive capability was SpO2, followed by age, respiratory rate, and systolic blood pressure. CONCLUSION In this study, we developed a machine learning model that can be used as a triage tool by clinicians to detect high-risk patients and disease progression earlier. Prospective validation studies are needed to verify the application of the tool in clinical practice.
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Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Kan Nishimura
- Department of Industrial Administration, Tokyo University of Science
| | - Kei Ogawa
- Department of Industrial Administration, Tokyo University of Science
| | - Nodoka Miyake
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Taiki Mizobuchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Kenta Shigeta
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hirofumi Obinata
- Department of Emergency and Critical Care Medicine, Nippon Medical School.,Department of Anesthesiology, Self-Defense Forces Central Hospital
| | - Yasuhiro Takayama
- Department of Emergency and Critical Care Medicine, Nippon Medical School.,Emergency Department, Flowers and Forest Tokyo Hospital
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School.,Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Nippon Medical School
| | - Hayato Ohwada
- Department of Industrial Administration, Tokyo University of Science
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
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26
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Egi M, Ogura H, Yatabe T, Atagi K, Inoue S, Iba T, Kakihana Y, Kawasaki T, Kushimoto S, Kuroda Y, Kotani J, Shime N, Taniguchi T, Tsuruta R, Doi K, Doi M, Nakada TA, Nakane M, Fujishima S, Hosokawa N, Masuda Y, Matsushima A, Matsuda N, Yamakawa K, Hara Y, Sakuraya M, Ohshimo S, Aoki Y, Inada M, Umemura Y, Kawai Y, Kondo Y, Saito H, Taito S, Takeda C, Terayama T, Tohira H, Hashimoto H, Hayashida K, Hifumi T, Hirose T, Fukuda T, Fujii T, Miura S, Yasuda H, Abe T, Andoh K, Iida Y, Ishihara T, Ide K, Ito K, Ito Y, Inata Y, Utsunomiya A, Unoki T, Endo K, Ouchi A, Ozaki M, Ono S, Katsura M, Kawaguchi A, Kawamura Y, Kudo D, Kubo K, Kurahashi K, Sakuramoto H, Shimoyama A, Suzuki T, Sekine S, Sekino M, Takahashi N, Takahashi S, Takahashi H, Tagami T, Tajima G, Tatsumi H, Tani M, Tsuchiya A, Tsutsumi Y, Naito T, Nagae M, Nagasawa I, Nakamura K, Nishimura T, Nunomiya S, Norisue Y, Hashimoto S, Hasegawa D, Hatakeyama J, Hara N, Higashibeppu N, Furushima N, Furusono H, Matsuishi Y, Matsuyama T, Minematsu Y, Miyashita R, Miyatake Y, Moriyasu M, Yamada T, Yamada H, Yamamoto R, Yoshida T, Yoshida Y, Yoshimura J, Yotsumoto R, Yonekura H, Wada T, Watanabe E, Aoki M, Asai H, Abe T, Igarashi Y, Iguchi N, Ishikawa M, Ishimaru G, Isokawa S, Itakura R, Imahase H, Imura H, Irinoda T, Uehara K, Ushio N, Umegaki T, Egawa Y, Enomoto Y, Ota K, Ohchi Y, Ohno T, Ohbe H, Oka K, Okada N, Okada Y, Okano H, Okamoto J, Okuda H, Ogura T, Onodera Y, Oyama Y, Kainuma M, Kako E, Kashiura M, Kato H, Kanaya A, Kaneko T, Kanehata K, Kano KI, Kawano H, Kikutani K, Kikuchi H, Kido T, Kimura S, Koami H, Kobashi D, Saiki I, Sakai M, Sakamoto A, Sato T, Shiga Y, Shimoto M, Shimoyama S, Shoko T, Sugawara Y, Sugita A, Suzuki S, Suzuki Y, Suhara T, Sonota K, Takauji S, Takashima K, Takahashi S, Takahashi Y, Takeshita J, Tanaka Y, Tampo A, Tsunoyama T, Tetsuhara K, Tokunaga K, Tomioka Y, Tomita K, Tominaga N, Toyosaki M, Toyoda Y, Naito H, Nagata I, Nagato T, Nakamura Y, Nakamori Y, Nahara I, Naraba H, Narita C, Nishioka N, Nishimura T, Nishiyama K, Nomura T, Haga T, Hagiwara Y, Hashimoto K, Hatachi T, Hamasaki T, Hayashi T, Hayashi M, Hayamizu A, Haraguchi G, Hirano Y, Fujii R, Fujita M, Fujimura N, Funakoshi H, Horiguchi M, Maki J, Masunaga N, Matsumura Y, Mayumi T, Minami K, Miyazaki Y, Miyamoto K, Murata T, Yanai M, Yano T, Yamada K, Yamada N, Yamamoto T, Yoshihiro S, Tanaka H, Nishida O. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020). J Intensive Care 2021; 9:53. [PMID: 34433491 PMCID: PMC8384927 DOI: 10.1186/s40560-021-00555-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [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: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 02/08/2023] Open
Abstract
The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.
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Affiliation(s)
- Moritoki Egi
- Department of Surgery Related, Division of Anesthesiology, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, Japan.
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Medical School, Yamadaoka 2-15, Suita, Osaka, Japan.
| | - Tomoaki Yatabe
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuaki Atagi
- Department of Intensive Care Unit, Nara Prefectural General Medical Center, Nara, Japan
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University, Tokyo, Japan
| | - Yasuyuki Kakihana
- Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tatsuya Kawasaki
- Department of Pediatric Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster, and Critical Care Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Joji Kotani
- Department of Surgery Related, Division of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takumi Taniguchi
- Department of Anesthesiology and Intensive Care Medicine, Kanazawa University, Kanazawa, Japan
| | - Ryosuke Tsuruta
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Matsuyuki Doi
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masaki Nakane
- Department of Emergency and Critical Care Medicine, Yamagata University Hospital, Yamagata, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan
| | - Naoto Hosokawa
- Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Japan
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Asako Matsushima
- Department of Advancing Acute Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Naoyuki Matsuda
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical College, Osaka, Japan
| | - Yoshitaka Hara
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshitaka Aoki
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mai Inada
- Member of Japanese Association for Acute Medicine, Tokyo, Japan
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, Toyoake, Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Hiroki Saito
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Support and Practice, Hiroshima University Hospital, Hiroshima, Japan
| | - Chikashi Takeda
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Takero Terayama
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | | | - Hideki Hashimoto
- Department of Emergency and Critical Care Medicine/Infectious Disease, Hitachi General Hospital, Hitachi, Japan
| | - Kei Hayashida
- The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Tomoya Hirose
- Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan
| | - Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tomoko Fujii
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
| | - Shinya Miura
- The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Kohkichi Andoh
- Division of Anesthesiology, Division of Intensive Care, Division of Emergency and Critical Care, Sendai City Hospital, Sendai, Japan
| | - Yuki Iida
- Department of Physical Therapy, School of Health Sciences, Toyohashi Sozo University, Toyohashi, Japan
| | - Tadashi Ishihara
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Kentaro Ide
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kenta Ito
- Department of General Pediatrics, Aichi Children's Health and Medical Center, Obu, Japan
| | - Yusuke Ito
- Department of Infectious Disease, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Yu Inata
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Akemi Utsunomiya
- Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
| | - Koji Endo
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Akira Ouchi
- College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Masayuki Ozaki
- Department of Emergency and Critical Care Medicine, Komaki City Hospital, Komaki, Japan
| | - Satoshi Ono
- Gastroenterological Center, Shinkuki General Hospital, Kuki, Japan
| | | | | | - Yusuke Kawamura
- Department of Rehabilitation, Showa General Hospital, Tokyo, Japan
| | - Daisuke Kudo
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenji Kubo
- Department of Emergency Medicine and Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Kiyoyasu Kurahashi
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare School of Medicine, Narita, Japan
| | | | - Akira Shimoyama
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Takeshi Suzuki
- Department of Anesthesiology, Tokai University School of Medicine, Isehara, Japan
| | - Shusuke Sekine
- Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan
| | - Motohiro Sekino
- Division of Intensive Care, Nagasaki University Hospital, Nagasaki, Japan
| | - Nozomi Takahashi
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sei Takahashi
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Hiroshi Takahashi
- Department of Cardiology, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
| | - Goro Tajima
- Nagasaki University Hospital Acute and Critical Care Center, Nagasaki, Japan
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masanori Tani
- Division of Critical Care Medicine, Saitama Children's Medical Center, Saitama, Japan
| | - Asuka Tsuchiya
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Yusuke Tsutsumi
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Takaki Naito
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaharu Nagae
- Department of Intensive Care Medicine, Kobe University Hospital, Kobe, Japan
| | | | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Tetsuro Nishimura
- Department of Traumatology and Critical Care Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shin Nunomiya
- Department of Anesthesiology and Intensive Care Medicine, Division of Intensive Care, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yasuhiro Norisue
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Satoru Hashimoto
- Department of Anesthesiology and Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daisuke Hasegawa
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Naoki Hara
- Department of Pharmacy, Yokohama Rosai Hospital, Yokohama, Japan
| | - Naoki Higashibeppu
- Department of Anesthesiology and Nutrition Support Team, Kobe City Medical Center General Hospital, Kobe City Hospital Organization, Kobe, Japan
| | - Nana Furushima
- Department of Anesthesiology, Kobe University Hospital, Kobe, Japan
| | - Hirotaka Furusono
- Department of Rehabilitation, University of Tsukuba Hospital/Exult Co., Ltd., Tsukuba, Japan
| | - Yujiro Matsuishi
- Doctoral program in Clinical Sciences. Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Minematsu
- Department of Clinical Engineering, Osaka University Hospital, Suita, Japan
| | - Ryoichi Miyashita
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yuji Miyatake
- Department of Clinical Engineering, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Megumi Moriyasu
- Division of Respiratory Care and Rapid Response System, Intensive Care Center, Kitasato University Hospital, Sagamihara, Japan
| | - Toru Yamada
- Department of Nursing, Toho University Omori Medical Center, Tokyo, Japan
| | - Hiroyuki Yamada
- Department of Primary Care and Emergency Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Yoshida
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuhei Yoshida
- Nursing Department, Osaka General Medical Center, Osaka, Japan
| | - Jumpei Yoshimura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | | | - Hiroshi Yonekura
- Department of Clinical Anesthesiology, Mie University Hospital, Tsu, Japan
| | - Takeshi Wada
- Department of Anesthesiology and Critical Care Medicine, Division of Acute and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Eizo Watanabe
- Department of Emergency and Critical Care Medicine, Eastern Chiba Medical Center, Togane, Japan
| | - Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Japan
| | - Takakuni Abe
- Department of Anesthesiology and Intensive Care, Oita University Hospital, Yufu, Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Naoya Iguchi
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masami Ishikawa
- Department of Anesthesiology, Emergency and Critical Care Medicine, Kure Kyosai Hospital, Kure, Japan
| | - Go Ishimaru
- Department of General Internal Medicine, Soka Municipal Hospital, Soka, Japan
| | - Shutaro Isokawa
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Ryuta Itakura
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hisashi Imahase
- Department of Biomedical Ethics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Imura
- Department of Infectious Diseases, Rakuwakai Otowa Hospital, Kyoto, Japan
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | | | - Kenji Uehara
- Department of Anesthesiology, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Noritaka Ushio
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Takeshi Umegaki
- Department of Anesthesiology, Kansai Medical University, Hirakata, Japan
| | - Yuko Egawa
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
| | - Yuki Enomoto
- Department of Emergency and Critical Care Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kohei Ota
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshifumi Ohchi
- Department of Anesthesiology and Intensive Care, Oita University Hospital, Yufu, Japan
| | - Takanori Ohno
- Department of Emergency and Critical Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - Nobunaga Okada
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yohei Okada
- Department of Primary care and Emergency medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Okano
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Jun Okamoto
- Department of ER, Hashimoto Municipal Hospital, Hashimoto, Japan
| | - Hiroshi Okuda
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Takayuki Ogura
- Tochigi prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai, Utsunomiya Hospital, Utsunomiya, Japan
| | - Yu Onodera
- Department of Anesthesiology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yuhta Oyama
- Department of Internal Medicine, Dialysis Center, Kichijoji Asahi Hospital, Tokyo, Japan
| | - Motoshi Kainuma
- Anesthesiology, Emergency Medicine, and Intensive Care Division, Inazawa Municipal Hospital, Inazawa, Japan
| | - Eisuke Kako
- Department of Anesthesiology and Intensive Care Medicine, Nagoya-City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hiromi Kato
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Akihiro Kanaya
- Department of Anesthesiology, Sendai Medical Center, Sendai, Japan
| | - Tadashi Kaneko
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Keita Kanehata
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Ken-Ichi Kano
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Hiroyuki Kawano
- Department of Gastroenterological Surgery, Onga Hospital, Fukuoka, Japan
| | - Kazuya Kikutani
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hitoshi Kikuchi
- Department of Emergency and Critical Care Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takahiro Kido
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Sho Kimura
- Division of Critical Care Medicine, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroyuki Koami
- Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, USA
| | - Daisuke Kobashi
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Iwao Saiki
- Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan
| | - Masahito Sakai
- Department of General Medicine Shintakeo Hospital, Takeo, Japan
| | - Ayaka Sakamoto
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tetsuya Sato
- Tohoku University Hospital Emergency Center, Sendai, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Center for Advanced Joint Function and Reconstructive Spine Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Manabu Shimoto
- Department of Primary care and Emergency medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinya Shimoyama
- Department of Pediatric Cardiology and Intensive Care, Gunma Children's Medical Center, Shibukawa, Japan
| | - Tomohisa Shoko
- Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Yoh Sugawara
- Department of Anesthesiology, Yokohama City University, Yokohama, Japan
| | - Atsunori Sugita
- Department of Acute Medicine, Division of Emergency and Critical Care Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Intensive Care, Okayama University Hospital, Okayama, Japan
| | - Yuji Suzuki
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Suhara
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Sonota
- Department of Intensive Care Medicine, Miyagi Children's Hospital, Sendai, Japan
| | - Shuhei Takauji
- Department of Emergency Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Kohei Takashima
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Sho Takahashi
- Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan
| | - Yoko Takahashi
- Department of General Internal Medicine, Koga General Hospital, Koga, Japan
| | - Jun Takeshita
- Department of Anesthesiology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Yuuki Tanaka
- Fukuoka Prefectural Psychiatric Center, Dazaifu Hospital, Dazaifu, Japan
| | - Akihito Tampo
- Department of Emergency Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Taichiro Tsunoyama
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Kenichi Tetsuhara
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Kentaro Tokunaga
- Department of Intensive Care Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshihiro Tomioka
- Department of Anesthesiology and Intensive Care Unit, Todachuo General Hospital, Toda, Japan
| | - Kentaro Tomita
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Tominaga
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Mitsunobu Toyosaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukitoshi Toyoda
- Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Isao Nagata
- Intensive Care Unit, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Tadashi Nagato
- Department of Respiratory Medicine, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Yoshimi Nakamura
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Yuki Nakamori
- Department of Clinical Anesthesiology, Mie University Hospital, Tsu, Japan
| | - Isao Nahara
- Department of Anesthesiology and Critical Care Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Hiromu Naraba
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Chihiro Narita
- Department of Emergency Medicine and Intensive Care Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoya Nishimura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Kei Nishiyama
- Division of Emergency and Critical Care Medicine Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Taiki Haga
- Department of Pediatric Critical Care Medicine, Osaka City General Hospital, Osaka, Japan
| | - Yoshihiro Hagiwara
- Department of Emergency and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Katsuhiko Hashimoto
- Research Associate of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Takeshi Hatachi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Toshiaki Hamasaki
- Department of Emergency Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Takuya Hayashi
- Division of Critical Care Medicine, Saitama Children's Medical Center, Saitama, Japan
| | - Minoru Hayashi
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Atsuki Hayamizu
- Department of Emergency Medicine, Saitama Saiseikai Kurihashi Hospital, Kuki, Japan
| | - Go Haraguchi
- Division of Intensive Care Unit, Sakakibara Heart Institute, Tokyo, Japan
| | - Yohei Hirano
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Ryo Fujii
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Imperial Foundation Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Motoki Fujita
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Naoyuki Fujimura
- Department of Anesthesiology, St. Mary's Hospital, Our Lady of the Snow Social Medical Corporation, Kurume, Japan
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Masahito Horiguchi
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Jun Maki
- Department of Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Naohisa Masunaga
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Matsumura
- Department of Intensive Care, Chiba Emergency Medical Center, Chiba, Japan
| | - Takuya Mayumi
- Department of Internal Medicine, Kanazawa Municipal Hospital, Kanazawa, Japan
| | - Keisuke Minami
- Ishikawa Prefectual Central Hospital Emergency and Critical Care Center, Kanazawa, Japan
| | - Yuya Miyazaki
- Department of Emergency and General Internal Medicine, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Kazuyuki Miyamoto
- Department of Emergency and Disaster Medicine, Showa University, Tokyo, Japan
| | - Teppei Murata
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Machi Yanai
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takao Yano
- Department of Critical Care and Emergency Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Kohei Yamada
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Naoki Yamada
- Department of Emergency Medicine, University of Fukui Hospital, Fukui, Japan
| | - Tomonori Yamamoto
- Department of Intensive Care Unit, Nara Prefectural General Medical Center, Nara, Japan
| | - Shodai Yoshihiro
- Pharmaceutical Department, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Hiroshi Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
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Nakae R, Fujiki Y, Takayama Y, Kanaya T, Igarashi Y, Suzuki G, Naoe Y, Yokobori S. Time course of coagulation and fibrinolytic parameters in pediatric traumatic brain injury. J Neurosurg Pediatr 2021; 28:526-532. [PMID: 34416724 DOI: 10.3171/2021.5.peds21125] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Coagulopathy is a well-recognized risk factor for poor outcomes in patients with traumatic brain injury (TBI). Differences in the time courses of coagulation and fibrinolytic parameters between pediatric and adult patients with TBI have not been defined. METHODS Patients with TBI and an Abbreviated Injury Scale of the head score ≥ 3, in whom the prothrombin time (PT)-international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen concentration, and plasma D-dimer levels were measured on arrival and at 3, 6, and 12 hours after injury, were retrospectively analyzed. Propensity score-matched analyses were performed to adjust baseline characteristics between pediatric patients (aged < 16 years) and adult patients (aged ≥ 16 years). RESULTS A total of 468 patients (46 children and 422 adults) were included. Propensity score matching resulted in a matched cohort of 46 pairs. Higher PT-INR and APTT values at 1 to 12 hours after injury and lower fibrinogen concentrations at 1 to 6 hours after injury were observed in the pediatric group compared with the adult group. Plasma levels of D-dimer were elevated in both groups at 1 to 12 hours after injury, but no significant differences were seen between the groups. Multivariate logistic regression analysis of the initial coagulation and fibrinolytic parameters in the pediatric group revealed no prognostic significance of the coagulation parameter values, but elevation of the fibrinolytic parameter D-dimer was an independent negative prognostic factor. CONCLUSIONS In the acute phase of TBI, pediatric patients were characterized by prolongation of PT-INR and APTT and lower fibrinogen concentrations compared with adult patients, but these did not correlate with outcome. D-dimer was an independent prognostic outcome factor in terms of the Glasgow Outcome Scale in pediatric patients with TBI.
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Affiliation(s)
- Ryuta Nakae
- 11Department of Emergency and Critical Care Medicine, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo; and
| | - Yu Fujiki
- 2Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, Kawaguchi-shi, Saitama, Japan
| | - Yasuhiro Takayama
- 11Department of Emergency and Critical Care Medicine, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo; and
| | - Takahiro Kanaya
- 11Department of Emergency and Critical Care Medicine, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo; and
| | - Yutaka Igarashi
- 11Department of Emergency and Critical Care Medicine, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo; and
| | - Go Suzuki
- 2Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, Kawaguchi-shi, Saitama, Japan
| | - Yasutaka Naoe
- 2Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, Kawaguchi-shi, Saitama, Japan
| | - Shoji Yokobori
- 11Department of Emergency and Critical Care Medicine, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo; and
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Igarashi Y, Akazawa N, Maeda S. The form of exercise to decrease resting blood pressure in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2021; 96:104431. [PMID: 34082273 DOI: 10.1016/j.archger.2021.104431] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/08/2021] [Accepted: 05/03/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES The current systematic review and meta-analysis evaluated the relationship between the form of exercise and changes in resting blood pressure (RBP) in older adults and the overall level of evidence. METHODS The inclusion criteria were studies involving intervention with only regular exercise limited to subjects ≥65 years old. The combined changes in RBP in each study were calculated and the relationship between the form of exercise and changes in the RBP were evaluated. The overall evidence was assessed using the GRADE approach. RESULTS Nineteen studies (1081 subjects) were analyzed. The combined changes in the RBP decreased as a result of aerobic exercise or resistance exercise. The intensity of resistance exercise (METs) was related to the change in the RBP of systolic (meta-regression coefficient, -2.5 [95% confidence interval, -4.7 to -0.4]; R2=35.4%). When excluding studies with high overall risk of bias, the overall duration of aerobic exercise (weeks) was related to the change in the RBP of systolic (meta-regression coefficient, -0.6 [95% confidence interval, -1.0 to -0.2]; R2=93.2%). In addition, there was a low level of evidence overall for a decrease in RBP as a result of aerobic exercise, but there was a moderate level of evidence for a decrease in RBP as a results of resistance exercise. CONCLUSION A decrease in the RBP of systolic may be associated with active exercise in older adults. However, there may be insufficient evidence for the decrease in RBP as a result of aerobic exercise.
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Affiliation(s)
- Yutaka Igarashi
- Osaka City University, 3‑3‑138 Sugimoto, Sumiyoshi‑ku, Osaka 558-8585, Japan.
| | - Nobuhiko Akazawa
- Japan Institute of Sports Sciences, 3-15-1 Nishiga-oka, Kita-ku, Tokyo 115-0056, Japan; Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8574, Japan
| | - Seiji Maeda
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama 359-1192, Japan; Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8574, Japan
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Aguilar-Arevalo A, Aoki M, Blecher M, Britton D, vom Bruch D, Bryman D, Chen S, Comfort J, Cuen-Rochin S, Doria L, Gumplinger P, Hussein A, Igarashi Y, Ito S, Kettell S, Kurchaninov L, Littenberg L, Malbrunot C, Mischke R, Numao T, Protopopescu D, Sher A, Sullivan T, Vavilov D. Search for three body pion decays
π+→l+νX. Int J Clin Exp Med 2021. [DOI: 10.1103/physrevd.103.052006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Otaguro T, Tanaka H, Igarashi Y, Tagami T, Masuno T, Yokobori S, Matsumoto H, Ohwada H, Yokota H. Machine learning for the prediction of successful extubation among patients with mechanical ventilation in the intensive care unit: A retrospective observational study. J NIPPON MED SCH 2021; 88:408-417. [PMID: 33692291 DOI: 10.1272/jnms.jnms.2021_88-508] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ventilator weaning protocols are commonly implemented for patients receiving mechanical ventilation. However, the rate of extubation failure remains high despite the protocols. This study investigated the usefulness and accuracy of ventilator weaning through machine learning to predict successful extubation. METHODS We retrospectively evaluated the data of patients who underwent intubation for respiratory failure and received mechanical ventilation in the intensive care unit (ICU). Data on 57 factors including patient demographics, vital signs, laboratory data, and data from ventilator were extracted. Extubation failure was defined as re-intubation within 72 hours of extubation. For supervised learning, the data were labeled requirement of intubation or not. We used three learning algorithms (Random Forest, XGBoost, and LightGBM) to predict successful extubation. We also analyzed important features and evaluated the area under curve (AUC) and prediction metrics. RESULTS Overall, 13 of the 117 included patients required re-intubation. LightGBM had the highest AUC (0.950), followed by XGBoost (0.946) and Random Forest (0.930). The accuracy, precision, and recall performance were 0.897, 0.910, and 0.909, for Random Forest; 0.910, 0.912, and 0.931 for XGBoost; and 0.927, 0.915, and 0.960 for LightGBM, respectively. The most important feature was the duration of mechanical ventilation followed by the fraction of inspired oxygen, positive end-expiratory pressure, maximum and mean airway pressures, and Glasgow Coma Scale. CONCLUSIONS Machine learning could predict successful extubation among patients on mechanical ventilation in the ICU. LightGBM has the highest overall performance. The duration of mechanical ventilation was the most important feature in all models.
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Affiliation(s)
- Takanobu Otaguro
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hidenori Tanaka
- Department of Industrial Administration, Tokyo University of Science
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hisashi Matsumoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hayato Ohwada
- Department of Industrial Administration, Tokyo University of Science
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School
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Norii T, Igarashi Y, Braude D, Sklar DP. Airway foreign body removal by a home vacuum cleaner: Findings of a multi-center registry in Japan. Resuscitation 2021; 162:99-101. [PMID: 33600858 DOI: 10.1016/j.resuscitation.2021.02.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico, MSC11 6025 Lomas Blvd NE, Albuquerque, NM, 87131-0001, USA; Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan.
| | - Darren Braude
- Department of Emergency Medicine & Department of Anesthesiology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - David P Sklar
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
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Egi M, Ogura H, Yatabe T, Atagi K, Inoue S, Iba T, Kakihana Y, Kawasaki T, Kushimoto S, Kuroda Y, Kotani J, Shime N, Taniguchi T, Tsuruta R, Doi K, Doi M, Nakada T, Nakane M, Fujishima S, Hosokawa N, Masuda Y, Matsushima A, Matsuda N, Yamakawa K, Hara Y, Sakuraya M, Ohshimo S, Aoki Y, Inada M, Umemura Y, Kawai Y, Kondo Y, Saito H, Taito S, Takeda C, Terayama T, Tohira H, Hashimoto H, Hayashida K, Hifumi T, Hirose T, Fukuda T, Fujii T, Miura S, Yasuda H, Abe T, Andoh K, Iida Y, Ishihara T, Ide K, Ito K, Ito Y, Inata Y, Utsunomiya A, Unoki T, Endo K, Ouchi A, Ozaki M, Ono S, Katsura M, Kawaguchi A, Kawamura Y, Kudo D, Kubo K, Kurahashi K, Sakuramoto H, Shimoyama A, Suzuki T, Sekine S, Sekino M, Takahashi N, Takahashi S, Takahashi H, Tagami T, Tajima G, Tatsumi H, Tani M, Tsuchiya A, Tsutsumi Y, Naito T, Nagae M, Nagasawa I, Nakamura K, Nishimura T, Nunomiya S, Norisue Y, Hashimoto S, Hasegawa D, Hatakeyama J, Hara N, Higashibeppu N, Furushima N, Furusono H, Matsuishi Y, Matsuyama T, Minematsu Y, Miyashita R, Miyatake Y, Moriyasu M, Yamada T, Yamada H, Yamamoto R, Yoshida T, Yoshida Y, Yoshimura J, Yotsumoto R, Yonekura H, Wada T, Watanabe E, Aoki M, Asai H, Abe T, Igarashi Y, Iguchi N, Ishikawa M, Ishimaru G, Isokawa S, Itakura R, Imahase H, Imura H, Irinoda T, Uehara K, Ushio N, Umegaki T, Egawa Y, Enomoto Y, Ota K, Ohchi Y, Ohno T, Ohbe H, Oka K, Okada N, Okada Y, Okano H, Okamoto J, Okuda H, Ogura T, Onodera Y, Oyama Y, Kainuma M, Kako E, Kashiura M, Kato H, Kanaya A, Kaneko T, Kanehata K, Kano K, Kawano H, Kikutani K, Kikuchi H, Kido T, Kimura S, Koami H, Kobashi D, Saiki I, Sakai M, Sakamoto A, Sato T, Shiga Y, Shimoto M, Shimoyama S, Shoko T, Sugawara Y, Sugita A, Suzuki S, Suzuki Y, Suhara T, Sonota K, Takauji S, Takashima K, Takahashi S, Takahashi Y, Takeshita J, Tanaka Y, Tampo A, Tsunoyama T, Tetsuhara K, Tokunaga K, Tomioka Y, Tomita K, Tominaga N, Toyosaki M, Toyoda Y, Naito H, Nagata I, Nagato T, Nakamura Y, Nakamori Y, Nahara I, Naraba H, Narita C, Nishioka N, Nishimura T, Nishiyama K, Nomura T, Haga T, Hagiwara Y, Hashimoto K, Hatachi T, Hamasaki T, Hayashi T, Hayashi M, Hayamizu A, Haraguchi G, Hirano Y, Fujii R, Fujita M, Fujimura N, Funakoshi H, Horiguchi M, Maki J, Masunaga N, Matsumura Y, Mayumi T, Minami K, Miyazaki Y, Miyamoto K, Murata T, Yanai M, Yano T, Yamada K, Yamada N, Yamamoto T, Yoshihiro S, Tanaka H, Nishida O. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020). Acute Med Surg 2021; 8:e659. [PMID: 34484801 PMCID: PMC8390911 DOI: 10.1002/ams2.659] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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] [Indexed: 12/16/2022] Open
Abstract
The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.
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Hida S, Fujita Y, Igarashi Y, Hatano T, Morishima T, Yamashita J, Murata N, Ito R, Chikamori T. Prediction of the improvement of left ventricular wall motion after acute myocardial infarction by simultaneous dual-isotope imaging with 99mTc-sestamibi/123I-BMIPP using cadmium-zinc-telluride SPECT. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0281] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Although both the presence of 99mTc-sestamibi/123I-BMIPP mismatch and the reverse redistribution of 99mTc-sestamibi in patients with acute myocardial infarction (AMI) are known to significant markers for predicting the improvement of left ventricular (LV) wall motion in the infarcted territory in chronic phase, few studies evaluated them by simultaneous dual-isotope (99mTc-sestamibi/123I-BMIPP) imaging using cadmium-zinc-telluride (CZT) SPECT system.
Purpose
The purpose of this study was to evaluate whether the presence of 99mTc-sestamibi/123I-BMIPP mismatch or the reverse redistribution of 99mTc-sestamibi make better prediction of the improvement of LV wall motion in the infarcted territory.
Methods
We evaluated 30 consecutive patients with AMI who had undergone both dual-isotope (99mTc-sestamibi/123I-BMIPP) SPECT in acute phase and stress myocardial SPECT using 99mTc-tracers in chronic phase by Discovery NM530c. Both 99mTc-sestamibi/123I-BMIPP mismatch and reverse redistribution of 99mTc-sestamibi were determined using traditional definition. The improvement of LV wall motion in the infarcted territory from acute phase to chronic phase was assessed using QGS.
Results
Of 30 patients, the improvement of LV wall motion in the infarcted territory from acute phase to chronic phase was found in 20 patients. Both the presence of 99mTc-sestamibi/123I-BMIPP mismatch and reverse redistribution of 99mTc-sestamibi were significantly linked to predict the improvement of LV wall motion (p=0.0001, p=0.011, respectively). The respective sensitivities, specificities and accuracies in the prediction of the improvement of LV wall motion in the infarcted territory were 90%, 90% and 90% with 99mTc-sestamibi/123I-BMIPP mismatch, and 60%, 90%, 70% with reverse redistribution of 99mTc-sestamibi.
Conclusions
In the simultaneous 99mTc-sestamibi/123I-BMIPP dual-isotope imaging using CZT SPECT system, both the presence of 99mTc-sestamibi/123I-BMIPP mismatch and the reverse redistribution of 99mTc-sestamibi in acute phase are useful for predicting the improvement of LV wall motion in chronic phase, but the presence of 99mTc-sestamibi/123I-BMIPP mismatch is superior to the reverse redistribution of 99mTc-sestamibi for it.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Hida
- Tokyo Medical University, Tokyo, Japan
| | - Y Fujita
- Tokyo Medical University, Tokyo, Japan
| | | | - T Hatano
- Tokyo Medical University, Tokyo, Japan
| | | | | | - N Murata
- Tokyo Medical University, Tokyo, Japan
| | - R Ito
- Tokyo Medical University, Tokyo, Japan
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Fujita Y, Hida S, Igarashi Y, Hatano T, Morishima T, Yamashita J, Murata N, Ito R, Chikamori T. Prediction of myocardial viability in chronic phase in patients with acute myocardial infarction by simultaneous dual-isotope imaging with 99mTc-sestamibi/123I-BMIPP SPECT using CZT camera system. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0277] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The objective of this study was to determine the optimal cut-off value of % uptake of simultaneous dual-isotope (99mTc-sestamibi/123I-BMIPP) SPECT in patients with acute myocardial infarction (AMI) for prediction of myocardial viability in chronic phase.
Methods
We evaluated 30 consecutive patients with AMI who had undergone both dual-SPECT in acute phase and stress myocardial SPECT using 99mTc-tracers in chronic phase by Discovery NM530c. Regional % uptake with a 17-segment model was obtained using QPS software. The presence of myocardial viability was defined when regional % uptake ≥50% in 99mTc SPECT at rest in chronic phase was observed. Receiver operating characteristic (ROC) curves were analyzed to determine the optimal cutoff values of regional % uptake in both left anterior descending artery (LAD) territory and non-LAD coronary territory in acute phase to predict the myocardial viability in chronic phase.
Results
The cutoff values for prediction of viable myocardium were %uptake ≥47% for 99mTc-sestamibi, %uptake ≥31% for 123I-BMIPP in acute phase in LAD territory and %uptake ≥52% for 99mTc-sestamibi, %uptake ≥48% for 123I-BMIPP in non-LAD territory. The respective sensitivities, specificities and the area under the ROC curve (AUC) values in the prediction of myocardial viability were 92%, 92% and 0.94 with 99mTc-sestamibi, 90%, 85%, 0.92 with 123I-BMIPP in LAD territory, and 81%, 93% and 0.92 with 99mTc-sestamibi, 81%, 90%, 0.92 with 123I-BMIPP in non-LAD territory. There were no significant differences in AUC values between 99mTc-sestamibi and 123I-BMIPP in both LAD territory and non-LAD coronary territory.
Conclusions
In the simultaneous 99mTc-sestamibi/123I-BMIPP dual-isotope imaging in patients with AMI, these results suggest that not only 99mTc-sestamibi SPECT, but also 123I-BMIPP SPECT may be possible to predict the presence of myocardial viability in chronic phase. But it should be noted that the optimal cutoff values of regional % uptake in acute phase to predict the myocardial viability may differ for LAD territory and non-LAD coronary territory.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Fujita
- Tokyo Medical University, Tokyo, Japan
| | - S Hida
- Tokyo Medical University, Tokyo, Japan
| | | | - T Hatano
- Tokyo Medical University, Tokyo, Japan
| | | | | | - N Murata
- Tokyo Medical University, Tokyo, Japan
| | - R Ito
- Tokyo Medical University, Tokyo, Japan
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Obinata H, Yokobori S, Shibata Y, Takiguchi T, Nakae R, Igarashi Y, Shigeta K, Matsumoto H, Aiyagari V, Olson DM, Yokota H. Early automated infrared pupillometry is superior to auditory brainstem response in predicting neurological outcome after cardiac arrest. Resuscitation 2020; 154:77-84. [DOI: 10.1016/j.resuscitation.2020.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/12/2020] [Accepted: 06/01/2020] [Indexed: 12/16/2022]
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Obinata H, Yokobori S, Ogawa K, Takayama Y, Kawano S, Ito T, Takiguchi T, Igarashi Y, Nakae R, Masuno T, Ohwada H. Indicators of Acute Kidney Injury as Biomarkers to Differentiate Heatstroke from Coronavirus Disease 2019: A Retrospective Multicenter Analysis. J NIPPON MED SCH 2020; 88:80-86. [PMID: 32863339 DOI: 10.1272/jnms.jnms.2021_88-107] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) and heat-related illness are systemic febrile diseases. These illnesses must be differentiated during a COVID-19 pandemic in summer. However, no studies have compared and distinguished heat-related illness and COVID-19. We compared data from patients with early heat-related illness and those with COVID-19. METHODS This retrospective observational study included 90 patients with early heat-related illness selected from the Heatstroke STUDY 2017-2019 (nationwide registries of heat-related illness in Japan) and 86 patients with laboratory-confirmed COVID-19 who had fever or fatigue and were admitted to one of two hospitals in Tokyo, Japan. RESULTS Among vital signs, systolic blood pressure (119 vs. 125 mm Hg, p = 0.02), oxygen saturation (98% vs. 97%, p < 0.001), and body temperature (36.6°C vs. 37.6°C, p<0.001) showed significant between-group differences in the heatstroke and COVID-19 groups, respectively. The numerous intergroup differences in laboratory findings included disparities in white blood cell count (10.8 × 103/μL vs. 5.2 × 103/μL, p<0.001), creatinine (2.2 vs. 0.85 mg/dL, p<0.001), and C-reactive protein (0.2 vs. 2.8 mg/dL, p<0.001), although a logistic regression model achieved an area under the curve (AUC) of 0.966 using these three factors. A Random Forest machine learning model achieved an accuracy, precision, recall, and AUC of 0.908, 0.976, 0.842, and 0.978, respectively. Creatinine was the most important feature of this model. CONCLUSIONS Acute kidney injury was associated with heat-related illness, which could be essential in distinguishing or evaluating patients with fever in the summer during a COVID-19 pandemic.
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Affiliation(s)
- Hirofumi Obinata
- Department of Emergency and Critical Care Medicine, Nippon Medical School.,Self-Defense Forces Central Hospital
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School.,Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee
| | - Kei Ogawa
- Department of Industrial Administration, Tokyo University of Science
| | | | | | | | - Toru Takiguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hayato Ohwada
- Department of Industrial Administration, Tokyo University of Science
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Nakae R, Fujiki Y, Takayama Y, Kanaya T, Igarashi Y, Suzuki G, Naoe Y, Yokobori S. Age-Related Differences in the Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury. Int J Mol Sci 2020; 21:ijms21165613. [PMID: 32764459 PMCID: PMC7460662 DOI: 10.3390/ijms21165613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 12/04/2022] Open
Abstract
Coagulopathy and older age are common and well-recognized risk factors for poorer outcomes in traumatic brain injury (TBI) patients; however, the relationships between coagulopathy and age remain unclear. We hypothesized that coagulation/fibrinolytic abnormalities are more pronounced in older patients and may be a factor in poorer outcomes. We retrospectively evaluated severe TBI cases in which fibrinogen and D-dimer were measured on arrival and 3–6 h after injury. Propensity score-matched analyses were performed to adjust baseline characteristics between older patients (the “elderly group,” aged ≥75 y) and younger patients (the “non-elderly group,” aged 16–74 y). A total of 1294 cases (elderly group: 395, non-elderly group: 899) were assessed, and propensity score matching created a matched cohort of 324 pairs. Fibrinogen on admission, the degree of reduction in fibrinogen between admission and 3–6 h post-injury, and D-dimer levels between admission and 3–6 h post-injury were significantly more abnormal in the elderly group than in the non-elderly group. On multivariate logistic regression analysis, independent risk factors for poor prognosis included low fibrinogen and high D-dimer levels on admission. Posttraumatic coagulation and fibrinolytic abnormalities are more severe in older patients, and fibrinogen and D-dimer abnormalities are negative predictive factors.
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Affiliation(s)
- Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (Y.T.); (T.K.); (Y.I.); (S.Y.)
- Correspondence: ; Tel.: +81-3-3822-2131
| | - Yu Fujiki
- Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi-shi, Saitama 333-0833, Japan; (Y.F.); (G.S.); (Y.N.)
| | - Yasuhiro Takayama
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (Y.T.); (T.K.); (Y.I.); (S.Y.)
| | - Takahiro Kanaya
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (Y.T.); (T.K.); (Y.I.); (S.Y.)
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (Y.T.); (T.K.); (Y.I.); (S.Y.)
| | - Go Suzuki
- Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi-shi, Saitama 333-0833, Japan; (Y.F.); (G.S.); (Y.N.)
| | - Yasutaka Naoe
- Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi-shi, Saitama 333-0833, Japan; (Y.F.); (G.S.); (Y.N.)
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (Y.T.); (T.K.); (Y.I.); (S.Y.)
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Norii T, Igarashi Y, Sung-Ho K, Nagata S, Tagami T, Yoshino Y, Hamaguchi T, Maejima R, Nakao S, Albright D, Yokobori S, Yokota H, Shimazu T, Crandall C. Protocol for a nationwide prospective, observational cohort study of foreign-body airway obstruction in Japan: the MOCHI registry. BMJ Open 2020; 10:e039689. [PMID: 32690753 PMCID: PMC7375623 DOI: 10.1136/bmjopen-2020-039689] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Foreign body airway obstruction (FBAO) is a major public health issue worldwide. In 2017, there were more than 5000 fatal choking cases in the USA alone, and it was the fourth leading cause of preventable injury-related death in the home and community. In Japan, FBAO is the leading cause of accidental death and with almost 9000 fatalities annually. However, research on FBAO is limited, particularly on the impact of a foreign body (FB) removal manoeuvres by bystanders. The primary objective of this study is to determine the impact of bystander FB removal manoeuvres on 1 month neurological outcome. Our secondary objectives include (1) evaluating the efficacy of a variety of FB removal manoeuvres; (2) identifying risk factors for unsuccessful removal and (3) evaluating the impact of time intervals from incidents of FBAO to FB removal on neurological outcome. METHODS AND ANALYSIS We will conduct a nationwide multi-centre prospective cohort study of patients with FBAO who present to approximately 100 emergency departments in both urban and rural areas in Japan. Research personnel at each participating site will collect variables including patient demographics, type of FB and prehospital variables, such as bystander FB removal manoeuvres, medical interventions by prehospital personnel, advanced airway management and diagnostic findings. Our primary outcome is 1 month favourable neurological outcome defined as cerebral performance category 1 or 2. Our secondary outcomes include success of FB removal manoeuvres and complications from the manoeuvres. We hypothesise that bystander FB removal manoeuvres improve patient survival with a favourable neurological outcome. ETHICS AND DISSEMINATION This study received research ethics approval from Nippon Medical School Hospital (B-2019-019). Research ethics approval will be obtained from all participating sites before entering patients into the registry. The study was registered at the University Hospital Medical Information Network (UMIN) Clinical Trials Registry. TRIAL REGISTRATION NUMBER UMIN 000039907.
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Affiliation(s)
- Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kim Sung-Ho
- Department of Critical Care Medicine, Osaka Habikino Medical Center, Habikino, Osaka, Japan
| | - Shimpei Nagata
- Department of Emergency Medicine, Osaka Police Hospital, Osaka, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Yudai Yoshino
- Department of Emergency Medicine, Aidu Chuo Hospital, Aizuwakamatsu, Fukushima, Japan
| | - Takuro Hamaguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Riko Maejima
- Department of Emergency Medicine, Japanese Red Cross Ashikaga Hospital, Ashikaga, Tochigi, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Danielle Albright
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
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Yokobori S, Saito K, Sasaki K, Kanaya T, Fujiki Y, Yamaguchi M, Satoh S, Watanabe A, Igarashi Y, Suzuki G, Kaneko J, Nakae R, Onda H, Ishinokami S, Takayama Y, Naoe Y, Sato H, Unemoto K, Fuse A, Yokota H. Treatment of Geriatric Traumatic Brain Injury: A Nationwide Cohort Study. J NIPPON MED SCH 2020; 88:194-203. [PMID: 32612015 DOI: 10.1272/jnms.jnms.2021_88-404] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Because of the aging of the Japanese population, traumatic brain injuries (TBI) have increased in elderly adults. However, the effectiveness and prognosis of intensive treatment for geriatric TBI have not yet been determined. Thus, we used nationwide data from the Japan Neurotrauma Data Bank (JNTDB) projects to analyze prognostic factors for intensive and aggressive treatments. METHODS We analyzed 1,879 geriatric TBI cases (age ≥65 years) registered in four JNTDB projects: Project 1998 (P1998) to Project 2015 (P2015). Clinical features, use of aggressive treatment, and 6-month outcomes on the Glasgow Outcome Scale (GOS) were compared among study projects. Logistic regression was used to identify prognostic factors in aggressively treated patients. RESULTS The percentage of geriatric TBI cases significantly increased with time-P1998: 30.1%; Project 2004 (P2004): 34.6%; Project 2009 (P2009): 43.9%; P2015: 53.6%, p<0.0001). Use of aggressive treatment also significantly increased, from 67.0% in P1998 to 69.3% in P2015 (p<0.0001). Less invasive methods, such as trepanation and normothermic targeted temperature management, were more often chosen for geriatric patients. These efforts resulted in a significant decrease in the 6-month mortality rate, from 76.2% in P1998 to 63.1% in P2015 (p=0.0003), although the percentage of severely disabled patients increased, from 8.9% in P1998 to 11.1% in P2015 (p=0.0003). Intraventricular hemorrhage was the factor most strongly associated with unfavorable 6-month outcomes (OR 3.79, 95% CI 1.78-8.06, p<0.0001). CONCLUSIONS Less invasive treatments reduced mortality in geriatric TBI but did not improve functional outcomes. Patient age was not the strongest prognostic factor; thus, physicians should consider characteristics other than age.
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Affiliation(s)
- Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Ken Saito
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Kazuma Sasaki
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Takahiro Kanaya
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Yu Fujiki
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Masahiro Yamaguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Shin Satoh
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Akihiro Watanabe
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Go Suzuki
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hidetaka Onda
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Saori Ishinokami
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Yasuhiro Takayama
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Yasutaka Naoe
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hidetaka Sato
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Akira Fuse
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School
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Kurihara T, Igarashi Y, Kobai K, Mizobuchi T, Ishii H, Matsumoto N, Yokobori S, Yokota H. Diagnosis and prediction of prognosis for Bickerstaff's brainstem encephalitis using auditory brainstem response: a case report. Acute Med Surg 2020; 7:e517. [PMID: 32685172 PMCID: PMC7266809 DOI: 10.1002/ams2.517] [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: 03/25/2020] [Revised: 04/13/2020] [Accepted: 04/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background It is difficult to diagnose Bickerstaff’s brainstem encephalitis (BBE) in the acute phase, and emergency physicians could diagnose BBE as an unknown cause of consciousness disturbance. Case presentation A 75‐year‐old woman presented with dizziness and weakness in both arms 1 week after an upper respiratory infection. She experienced gradual worsening of consciousness, had dilated pupils and no light reflex. She was suspected of brainstem dysfunction at the upper part of the brainstem; however, there were not significant findings on magnetic resonance imaging, cerebrospinal fluid, or electroencephalography. The auditory brainstem response demonstrated a low voltage, but there was no prolonged latency. At a later date, she was diagnosed with BBE based on serum immunoglobulin G anti‐GQ1b antibody. She was discharged home without any neurological sequelae. Conclusion It is necessary to analyze serum immunoglobulin G anti‐GQ1b antibodies to diagnose BBE. Auditory brainstem response would be helpful in detecting lesions and predicting functional recovery.
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Affiliation(s)
- Toru Kurihara
- Department of Emergency and Critical Care Medicine Nippon Medical School Hospital Tokyo Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine Nippon Medical School Hospital Tokyo Japan
| | - Kaori Kobai
- Department of Anesthesiology Wakayama Medical University Wakayama Japan
| | - Taiki Mizobuchi
- Department of Emergency and Critical Care Medicine Nippon Medical School Hospital Tokyo Japan
| | - Hiromoto Ishii
- Department of Emergency and Critical Care Medicine Nippon Medical School Hospital Tokyo Japan
| | - Noriko Matsumoto
- Department of Neurology Nippon Medical School Hospital Tokyo Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine Nippon Medical School Hospital Tokyo Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine Nippon Medical School Hospital Tokyo Japan
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Igarashi Y, Norii T, Sung-Ho K, Nagata S, Yokota H. Seasonal choking in Japan: Japanese rice cake (mochi), ehomaki, and beans for Setsubun. Resuscitation 2020; 150:90-91. [PMID: 32244007 DOI: 10.1016/j.resuscitation.2020.03.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
| | - Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico, Albuquerque, USA.
| | - Kim Sung-Ho
- Department of Intensive Care Medicine, Osaka Habikino Medical Center, Osaka, Japan.
| | - Shimpei Nagata
- Department of Emergency Medicine, Osaka Police Hospital, Osaka, Japan.
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan.
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Nakae R, Yokobori S, Takayama Y, Kanaya T, Fujiki Y, Igarashi Y, Suzuki G, Naoe Y, Fuse A, Yokota H. A retrospective study of the effect of fibrinogen levels during fresh frozen plasma transfusion in patients with traumatic brain injury. Acta Neurochir (Wien) 2019; 161:1943-1953. [PMID: 31309303 DOI: 10.1007/s00701-019-04010-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 02/15/2019] [Accepted: 07/09/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The association between traumatic brain injury (TBI) and coagulopathy is well established. While coagulopathy prophylaxis in TBI involves replenishing coagulation factors with fresh frozen plasma (FFP), its effectiveness is controversial. We investigated the relationship between plasma fibrinogen concentration 3 h after initiating FFP transfusion and outcomes and evaluated the correlation with D-dimer levels at admission. METHODS We retrospectively examined data from 380 patients with severe isolated TBI with blood samples collected a maximum of 1 h following injury. Plasma fibrinogen and D-dimer concentrations were obtained at admission, and plasma fibrinogen concentration was again assessed 3-4 h following injury. The patients were divided into two groups based on whether or not they received FFP transfusion. Patients were also divided into subgroups according their fibrinogen level: ≥ 150 mg/dL (high-fibrinogen subgroup) or < 150 mg/dL (low-fibrinogen subgroup) 3 h after injury. Demographic, clinical, radiological and laboratory data were compared between these subgroups. RESULTS Glasgow Outcome Scale (GOS) scores at discharge and 3 months after injury were significantly lower in the FFP transfusion group than in the FFP non-transfusion group. Among patients who received FFP, GOS scores at discharge and 3 months after injury were significantly higher in the high-fibrinogen subgroup than in the low-fibrinogen subgroup. Elevated admission D-dimer predicted subsequent fibrinogen decrease. CONCLUSIONS In FFP transfusion, fibrinogen level ≥ 150 mg/dL 3 h after injury was associated with better outcomes in TBI patients. Assessing the admission D-dimer and tracking the fibrinogen are crucial for optimal coagulopathy prophylaxis in TBI patients.
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Affiliation(s)
- Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yasuhiro Takayama
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Takahiro Kanaya
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yu Fujiki
- Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Go Suzuki
- Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Yasutaka Naoe
- Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Akira Fuse
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Igarashi Y, Norii T, Sung-Ho K, Nagata S, Tagami T, Femling J, Mizushima Y, Yokota H. New classifications for Life-threatening foreign body airway obstruction. Am J Emerg Med 2019; 37:2177-2181. [PMID: 30880041 DOI: 10.1016/j.ajem.2019.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 12/13/2018] [Revised: 02/27/2019] [Accepted: 03/09/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Foreign body airway obstruction (FBAO) is a common medical emergency; however, few studies of life-threatening FBAO have been reported and no standard classification system is available. METHODS We retrospectively evaluated patients who presented to the emergency departments of two hospitals and were diagnosed with FBAO. The primary outcome was cerebral performance category (CPC) score at discharge. To establish a new classification system for FBAO, FBAO was classified into three types based on the anatomical and physiological characteristics of the obstructed airway. RESULTS A total of 137 patients were enrolled. Median age was 79.0 years. The most common cause of FBAO was meat, followed by bread, rice cake, and rice. Of all patients, 65.7% suffered cardiac arrest and 51.1% died. In contrast, 28.5% had favorable neurological outcomes, defined as CPC 1 and 2. Upper airway obstruction (type 1) was the most common (type 1, 78.1%), while trachea and/or bilateral main bronchus obstruction (type 2, 12.4%) showed significantly higher mortality than type 1 obstruction (82.4% vs 47.7%, P = 0.0078). Patients with unilateral bronchus and/or distal bronchus obstruction (type 3, 9.5%) were significantly more likely to consume a dysphagia diet than type 1 patients (23.1% vs 0%, P < 0.0001). CONCLUSION The majority of patients with life-threatening FBAO were elderly and had poor neurological outcomes. Our new classification system divides FBAO into three types, and revealed that mortality was significantly higher with type 2 than type 1 obstruction. This classification system may improve the management of patients with FBAO and assessment of patient outcomes.
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Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan.
| | - Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico, Albuquerque, USA
| | - Kim Sung-Ho
- Department of Critical Care Medicine, Osaka Habikino Medical Center, Osaka, Japan
| | - Shimpei Nagata
- Department of Emergency Medicine, Osaka Police Hospital, Osaka, Japan
| | - Takashi Tagami
- Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Jon Femling
- Department of Emergency Medicine, University of New Mexico, Albuquerque, USA
| | - Yasuaki Mizushima
- Department of Emergency Medicine, Osaka Police Hospital, Osaka, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
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Yokobori S, Sasaki K, Kanaya T, Igarashi Y, Nakae R, Onda H, Masuno T, Suda S, Sowa K, Nakajima M, Spurlock MS, Onn Chieng L, Hazel TG, Johe K, Gajavelli S, Fuse A, Bullock MR, Yokota H. Feasibility of Human Neural Stem Cell Transplantation for the Treatment of Acute Subdural Hematoma in a Rat Model: A Pilot Study. Front Neurol 2019; 10:82. [PMID: 30809187 PMCID: PMC6379455 DOI: 10.3389/fneur.2019.00082] [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: 03/23/2018] [Accepted: 01/21/2019] [Indexed: 12/20/2022] Open
Abstract
Human neural stem cells (hNSCs) transplantation in several brain injury models has established their therapeutic potential. However, the feasibility of hNSCs transplantation is still not clear for acute subdural hematoma (ASDH) brain injury that needs external decompression. Thus, the aim of this pilot study was to test feasibility using a rat ASDH decompression model with two clinically relevant transplantation methods. Two different methods, in situ stereotactic injection and hNSC-embedded matrix seating on the brain surface, were attempted. Athymic rats were randomized to uninjured or ASDH groups (F344/NJcl-rnu/rnu, n = 7-10/group). Animals in injury group were subjected to ASDH, and received decompressive craniectomy and 1-week after decompression surgery were transplanted with green fluorescent protein (GFP)-transduced hNSCs using one of two approaches. Histopathological examinations at 4 and 8 weeks showed that the GFP-positive hNSCs survived in injured brain tissue, extended neurite-like projections resembling neural dendrites. The in situ transplantation group had greater engraftment of hNSCs than matrix embedding approach. Immunohistochemistry with doublecortin, NeuN, and GFAP at 8 weeks after transplantation showed that transplanted hNSCs remained as immature neurons and did not differentiate toward to glial cell lines. Motor function was assessed with rotarod, compared to control group (n = 10). The latency to fall from the rotarod in hNSC in situ transplanted rats was significantly higher than in control rats (median, 113 s in hNSC vs. 69 s in control, P = 0.02). This study first demonstrates the robust engraftment of in situ transplanted hNSCs in a clinically-relevant ASDH decompression rat model. Further preclinical studies with longer study duration are warranted to verify the effectiveness of hNSC transplantation in amelioration of TBI induced deficits.
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Affiliation(s)
- Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuma Sasaki
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takahiro Kanaya
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hidetaka Onda
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Satoshi Suda
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kota Sowa
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masataka Nakajima
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Markus S Spurlock
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lee Onn Chieng
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Tom G Hazel
- Neuralstem, Inc., Germantown, MD, United States
| | - Karl Johe
- Neuralstem, Inc., Germantown, MD, United States
| | - Shyam Gajavelli
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Akira Fuse
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - M Ross Bullock
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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Igarashi Y, Akazawa N, Maeda S. Effects of Aerobic Exercise Alone on Lipids in Healthy East Asians: A Systematic Review and Meta-Analysis. J Atheroscler Thromb 2018; 26:488-503. [PMID: 30381613 PMCID: PMC6514176 DOI: 10.5551/jat.45864] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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] [Indexed: 12/21/2022] Open
Abstract
AIM The purpose of the current work was to review the effects of regular aerobic exercise on serum lipid and lipoprotein levels in East Asians using meta-analysis. METHODS The randomized controlled trials analyzed involved healthy adults who were East Asians with a mean age ≥40 years, an exercise group that only performed regular aerobic exercise, and a control group that did not carry out exercise-related intervention; the trials indicated mean high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), or triglyceride (TG). The mean difference (MD) was defined as the difference (mean value at post-intervention in the exercise group-mean value at baseline in the exercise group)-(mean value at post-intervention in the control group-mean value at baseline in the control group) in HDL-C, LDL-C, TC, and TG and was calculated for each trial. The weighted MD was calculated with a random-effects model. RESULTS The meta-analysis examined 994 subjects in 25 studies. The weighted MD in HDL-C, TC, and TG improved significantly (HDL-C, 2.2 mg/dL; TC, -5.8 mg/dL; TG, -13.7 mg/dL). The weighted MD in HDL-C and TC contained significant heterogeneity (HDL-C, I2=45.1%; TC, I2=56.2%). When trials were limited to those involving moderate-intensity exercise (55%-69% of the maximum heart rate) or an exercise volume ≥150 min/week, the weighted MD in HDL-C, LDL-C, TC, and TG improved significantly and did not contain significant heterogeneity. CONCLUSIONS The findings suggest that the ideal form of exercise to improve lipid and lipoprotein levels in East Asians is exercise of moderate-intensity and in a volume ≥150 min/week.
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Affiliation(s)
- Yutaka Igarashi
- Graduate School of Sport and Exercise Sciences, Osaka University of Health and Sport Sciences
| | - Nobuhiko Akazawa
- Japan Institute of Sports Sciences.,Faculty of Health and Sport Sciences, University of Tsukuba
| | - Seiji Maeda
- Faculty of Health and Sport Sciences, University of Tsukuba
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Yokobori S, Wang KKK, Yang Z, Zhu T, Tyndall JA, Mondello S, Shibata Y, Tominaga N, Kanaya T, Takiguchi T, Igarashi Y, Hagiwara J, Nakae R, Onda H, Masuno T, Fuse A, Yokota H. Quantitative pupillometry and neuron-specific enolase independently predict return of spontaneous circulation following cardiogenic out-of-hospital cardiac arrest: a prospective pilot study. Sci Rep 2018; 8:15964. [PMID: 30374189 PMCID: PMC6206016 DOI: 10.1038/s41598-018-34367-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 07/19/2018] [Accepted: 10/11/2018] [Indexed: 11/18/2022] Open
Abstract
This study aimed to identify neurological and pathophysiological factors that predicted return of spontaneous circulation (ROSC) among patients with out-of-hospital cardiac arrest (OHCA). This prospective 1-year observational study evaluated patients with cardiogenic OHCA who were admitted to a tertiary medical center, Nippon Medical School Hospital. Physiological and neurological examinations were performed at admission for quantitative infrared pupillometry (measured with NPi-200, NeurOptics, CA, USA), arterial blood gas, and blood chemistry. Simultaneous blood samples were also collected to determine levels of neuron-specific enolase (NSE), S-100b, phosphorylated neurofilament heavy subunit, and interleukin-6. In-hospital standard advanced cardiac life support was performed for 30 minutes.The ROSC (n = 26) and non-ROSC (n = 26) groups were compared, which a revealed significantly higher pupillary light reflex ratio, which was defined as the percent change between maximum pupil diameter before light stimuli and minimum pupil diameter after light stimuli, in the ROSC group (median: 1.3% [interquartile range (IQR): 0.0–2.0%] vs. non-ROSC: (median: 0%), (Cut-off: 0.63%). Furthermore, NSE provided the great sensitivity and specificity for predicting ROSC, with an area under the receiver operating characteristic curve of 0.86, which was created by plotting sensitivity and 1-specificity. Multivariable logistic regression analyses revealed that the independent predictors of ROSC were maximum pupillary diameter (odds ratio: 0.25, 95% confidence interval: 0.07–0.94, P = 0.04) and NSE at admission (odds ratio: 0.96, 95% confidence interval: 0.93–0.99, P = 0.04). Pupillary diameter was also significantly correlated with NSE concentrations (r = 0.31, P = 0.027). Conclusively, the strongest predictors of ROSC among patients with OHCA were accurate pupillary diameter and a neuronal biomarker, NSE. Quantitative pupillometry may help guide the decision to terminate resuscitation in emergency departments using a neuropathological rationale. Further large-scale studies are needed.
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Affiliation(s)
- Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
| | - Kevin K K Wang
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Psychiatry, University of Florida, Gainesville, Florida, USA
| | - Zhihui Yang
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Psychiatry, University of Florida, Gainesville, Florida, USA
| | - Tian Zhu
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Psychiatry, University of Florida, Gainesville, Florida, USA.,Department of Pediatrics, Daping Hospital, Chongqing, Third Military Medical University, No. 10 Changjigang Zhilu, Chongqing, 400042, China
| | - Joseph A Tyndall
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Oasi Research Institute-IRCCS, Troina, Italy
| | - Yasushi Shibata
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.,Department of Clinical Laboratory, Nippon Medical School Hospital, Tokyo, Japan
| | - Naoki Tominaga
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takahiro Kanaya
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Toru Takiguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Jun Hagiwara
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hidetaka Onda
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Akira Fuse
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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Hida S, Igarashi Y, Hirose K, Saitoh T, Hatano T, Morishima T, Yamashita J, Murata N, Goto M, Itoh R, Chikamori T. 2459Diagnostic value of simultaneous dual-isotope imaging with 99mTc-sestamibi and 123I-BMIPP using cadmium-zinc-telluride SPECT system in patients with acute myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2459] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Hida
- Tokyo Medical University, Tokyo, Japan
| | | | - K Hirose
- Tokyo Medical University, Tokyo, Japan
| | - T Saitoh
- Tokyo Medical University, Tokyo, Japan
| | - T Hatano
- Tokyo Medical University, Tokyo, Japan
| | | | | | - N Murata
- Tokyo Medical University, Tokyo, Japan
| | - M Goto
- Tokyo Medical University, Tokyo, Japan
| | - R Itoh
- Tokyo Medical University, Tokyo, Japan
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Igarashi Y, Yokobori S, Yamana H, Nagakura K, Hagiwara J, Masuno T, Yokota H. Overview of doctor-staffed ambulance use in Japan: a nationwide survey and 1-week study. Acute Med Surg 2018; 5:316-320. [PMID: 30338076 PMCID: PMC6167388 DOI: 10.1002/ams2.347] [Citation(s) in RCA: 6] [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: 10/31/2017] [Accepted: 04/24/2018] [Indexed: 11/06/2022] Open
Abstract
Aim In Japan, standard prehospital care is provided by emergency medical services teams. Doctor-staffed ambulances play a role in facilitating the immediate treatment of critically ill patients to increase the survival rates. However, little is known about their activities. We revealed the present situation of doctor-staffed ambulances in Japan. Methods First, we surveyed all the fire departments in Japan and determined whether a doctor-staffed ambulance was present within their district boundary. Second, we surveyed hospitals that operate doctor-staffed ambulances in their system to list their activities during a 1-week period. Results Of 133 hospitals that operated a doctor-staffed ambulance, 73 (55%) replied to our questionnaire. Only 26 (36%) of them provided 24-h ambulance deployment. Additionally, 51 (70%) of hospitals bore the operational costs of ambulances. Within 1 week, 345 doctor-staffed ambulances were dispatched, but 97 (28%) were cancelled. In total, 62 patients (28%) were diagnosed with cardiac arrest, 48 (19%) with trauma or burns, 36 (15%) with stroke, and 22 (9%) with acute coronary syndrome; 159 (58%) were transferred to a tertiary emergency medical center. Conclusions Doctor-staffed ambulances have the advantage of deployment at night and in urban areas compared to doctor-staffed helicopters. Among the 73 hospitals that responded to the questionnaire, doctor-staffed ambulances were dispatched almost as frequently as doctor-staffed helicopters. However, doctor-staffed ambulances did not receive adequate funding. Future data collection is necessary to determine the efficacy of doctor-staffed ambulances among hospitals that operate this service.
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Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Hidetoshi Yamana
- Emergency Department Tsukuba Medical Center Hospital Tsukuba Japan
| | | | - Jun Hagiwara
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
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Igarashi Y, Yokobori S, Onda H, Masuno T, Yokota H. Relation between extracellular Chemistry and Patient Outcome for Severe Traumatic Brain Injury within the First 24 hours: A Microdialysis Study. IJNT 2018. [DOI: 10.1055/s-0038-1649283] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Abstract
Object Many studies have reported that extracellular chemistry is related to the outcome of patients with traumatic brain injury (TBI). No study has reported that extracellular chemistry predicts outcome in less than 3 days. Moreover, in other studies, both focal brain and diffuse brain injuries have been often discussed. The authors focused on the relationship between extracellular chemistry in a shorter period and the outcome of patients with focal brain injury.
Methods By using intracerebral microdialysis monitoring, extracellular fluid concentrations of glucose, lactate, glycerol, glutamate, lactate/pyruvate (L/P), and lactate/glucose (L/G) were determined in 30 patients with severe TBI for initial 24 hours. The results were analyzed between favorable and unfavorable, and between survival and mortality.
Results The medians of glycerol and L/P in the favorable group were significantly lower than those in the unfavorable group (124 µmol/L vs. 808 µmol/L, p = 0.002; 31 vs. 48, p = 0.021, respectively). All parameters apart from glutamate differed significantly between the survival and mortality groups (glucose, 25 mmol/L vs. 77 mmol/L, p = 0.035; lactate, 38 mmol/L vs. 73 mmol/L, p = 0.018; glycerol, 168 µmol/L vs. 1462 µmol/L, p = 0.002; glutamate, 14 µmol/L vs. 95 µmol/L, p = 0.019; L/P, 32 vs. 124, p < 0.001; L/G, 1.46 vs. 4.52, p = 0.004).
Conclusion Cerebral extracellular glycerol and L/P was the most reliable predictor of outcomes in patients with focal brain injury and can discriminate between favorable and unfavorable outcomes for the first 24 hours, using the threshold of 200 and 40, respectively.
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Affiliation(s)
- Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Hidetaka Onda
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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Igarashi Y, Nogami Y. Response of Lipids and Lipoproteins to Regular Aquatic Endurance Exercise: A Meta-Analysis of Randomized Controlled Trials. J Atheroscler Thromb 2018; 26:14-30. [PMID: 29743386 PMCID: PMC6308265 DOI: 10.5551/jat.42937] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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] [Indexed: 01/20/2023] Open
Abstract
Aim: No meta-analysis has examined the effect of regular aquatic endurance exercise on lipid and lipoprotein levels. The purpose of the current work was to perform a meta-analysis to evaluate the effects of regular aquatic endurance exercise on lipid and lipoprotein levels. Methods: The inclusion criteria of the randomized controlled trials were healthy adults in an exercise group performing regular aquatic exercise and a control group not exercising, with a description of the serum high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, or triglyceride levels provided. The net change in the lipid and lipoprotein levels was calculated from each trial, and the changes in the lipid and lipoprotein levels were pooled using a random effects model. Results: The meta-analysis examined 10 trials involving aquatic endurance exercise and 327 subjects. The pooled net changes in HDL-C, LDL-C, and total cholesterol improved significantly (HDL-C, 4.6 mg/dL; LDL-C, −10.1 mg/dL; total cholesterol, −8.5 mg/dL). When trials were limited to those involving only women, the pooled net changes in HDL-C, LDL-C, and total cholesterol improved significantly. When trials were limited to those involving subjects with a mean age < 60 years, the pooled net changes in HDL-C, total cholesterol, and triglyceride improved significantly. When trials were limited to those with dyslipidemia, the pooled net changes in HDL-C, LDL-C, total cholesterol, and triglyceride improved significantly. Conclusions: Aquatic endurance exercise improved the lipid and lipoprotein levels and benefited women, middle-aged subjects, and patients with dyslipidemia in particular.
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Affiliation(s)
- Yutaka Igarashi
- Graduate School of Sport and Exercise Sciences, Osaka University of Health and Sport Sciences
| | - Yoshie Nogami
- Faculty of Engineering, Department of Human Environmental Sciences, Shonan Institute of Technology
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