5 results on '"Yasuhiro Otomo"'
Search Results
2. Impact of Lactate Clearance on Clinical and Neurological Outcomes of Patients With Out-of-Hospital Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation: A Secondary Data Analysis.
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Momoko Sugimoto, Wataru Takayama, Akihiko Inoue, Toru Hifumi, Tetsuya Sakamoto, Yasuhiro Kuroda, and Yasuhiro Otomo
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CARDIOPULMONARY resuscitation , *SECONDARY analysis , *CARDIAC arrest , *CARDIAC patients , *BYSTANDER CPR , *LACTATES - Abstract
OBJECTIVES: Serial evaluations of lactate concentration may be more useful in predicting outcomes in patients with out-of-hospital cardiac arrest (OHCA) than a single measurement. This study aimed to evaluate the impact of lactate clearance (LC) on clinical and neurologic outcomes in patients with OHCA who underwent extracorporeal cardiopulmonary resuscitation (ECPR). DESIGN: Retrospective multicenter observational study. SETTING: Patients with OHCA receiving ECPR at 36 hospitals in Japan between January 1, 2013, and December 31, 2018. PATIENTS: This study evaluated 1227 patients, with lactateinitial assessed upon emergency department admission and lactatesecond measured subsequently. To adjust for the disparity in the time between lactate measurements, the modified 6-hour LC was defined as follows: ([lactateinitial--lactatesecond]/lactateinitial) x 100 x (6/the duration between the initial and second measurements [hr]). The patients were divided into four groups according to the modified 6-hour LC with an equivalent number of patients among LC quartiles: Q1 (LC < 18.8), Q2 (18.8 < LC < 59.9), Q3 (60.0 < LC < 101.2), and Q4 (101.2 < LC). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The 30-day survival rates increased as the 6-hour LC increased (Q1, 21.2%; Q2, 36.8%; Q3, 41.4%; Q4, 53.6%; p for trend < 0.001). In the multivariate analysis, the modified 6-hour LC was significantly associated with a 30-day survival rate (adjusted odds ratio [AOR], 1.003; 95% CI, 1.001-1.005; p < 0.001) and favorable neurologic outcome (AOR, 1.002; 95% CI, 1.000-1.004; p = 0.027). CONCLUSIONS: In patients with OHCA who underwent ECPR, an increase in the modified 6-hour LC was associated with favorable clinical and neurologic outcome. Thus, LC can be a criterion to assess whether ECPR should be continued. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Apple-shaped obesity: A risky soil for cytokine-accelerated severity in COVID-19.
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Tadashi Hosoya, Seiya Oba, Yoji Komiya, Daisuke Kawata, Mari Kamiya, Hideyuki Iwai, Sho Miyamoto, Michiyo Kataoka, Minoru Tobiume, Takayuki Kanno, Akira Ainai, Hiroyuki Sato, Akihiro Hirakawa, Yuichi Mitsui, Takashi Satoh, Kenji Wakabayashi, Tetsuya Yamada, Yasuhiro Otomo, Yasunari Miyazaki, and Hideki Hasegawa
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COVID-19 , *JAPANESE people , *RATES , *VIRAL proteins , *COVID-19 treatment , *PREVENTION of obesity , *LEPTIN receptors , *OVERWEIGHT persons - Abstract
Obesity has been recognized as one of the most significant risk factors for the deterioration and mortality associated with COVID-19, but the significance of obesity itself differs among ethnicity. Multifactored analysis of our single institute-based retrospective cohort revealed that high visceral adipose tissue (VAT) burden, but not other obesity-associated markers, was related to accelerated inflammatory responses and the mortality of Japanese COVID-19 patients. To elucidate the mechanisms how VAT-dominant obesity induces severe inflammation after severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, we infected two different strains of obese mice, C57BL/6JHamSlc-ob/ob (ob/ob), C57BLKS/J-db/db (db/db), genetically impaired in the leptin ligand and receptor, respectively, and control C57BL/6 mice with mouse-adapted SARS-CoV-2. Here, we revealed that VAT-dominant ob/ob mice were extremely more vulnerable to SARS-CoV-2 due to excessive inflammatory responses when compared to SAT-dominant db/db mice. In fact, SARS-CoV-2 genome and proteins were more abundant in the lungs of ob/ob mice, engulfed in macrophages, resulting in increased cytokine production including interleukin (IL)-6. Both an anti-IL-6 receptor antibody treatment and the prevention of obesity by leptin replenishment improved the survival of SARS-CoV-2-infected ob/ob mice by reducing the viral protein burden and excessive immune responses. Our results have proposed unique insights and clues on how obesity increases the risk of cytokine storm and death in patients with COVID-19. Moreover, earlier administration of antiinflammatory therapeutics including anti-IL-6R antibody to VAT-dominant patients might improve clinical outcome and stratification of the treatment for COVID-19, at least in Japanese patients. [ABSTRACT FROM AUTHOR]
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- 2023
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4. Development of Novel Criteria of the "Lethal Triad" as an Indicator of Decision Making in Current Trauma Care: A Retrospective Multicenter Observational Study in Japan.
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Akira Endo, Atsushi Shiraishi, Yasuhiro Otomo, Shigeki Kushimoto, Daizoh Saitoh, Mineji Hayakawa, Hiroshi Ogura, Kiyoshi Murata, Akiyoshi Hagiwara, Junichi Sasaki, Tetsuya Matsuoka, Toshifumi Uejima, Naoto Morimura, Hiroyasu Ishikura, Munekazu Takeda, Naoyuki Kaneko, Hiroshi Kato, Daisuke Kudo, Takashi Kanemura, and Takayuki Shibusawa
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ACIDOSIS , *BLOOD coagulation disorders , *RESUSCITATION , *CRITICAL care medicine , *PROTHROMBIN time , *WOUND care , *BLOOD coagulation tests , *BODY temperature , *COMPARATIVE studies , *RESEARCH methodology , *PATIENT-family relations , *MEDICAL cooperation , *HEALTH outcome assessment , *PROGNOSIS , *PSYCHOLOGICAL tests , *RESEARCH , *WOUNDS & injuries , *EVALUATION research , *PREDICTIVE tests , *RETROSPECTIVE studies , *TRAUMA severity indices - Abstract
Objectives: To evaluate the utility of the conventional lethal triad in current trauma care practice and to develop novel criteria as indicators of treatment strategy.Design: Retrospective observational study.Settings: Fifteen acute critical care medical centers in Japan.Patients: In total, 796 consecutive trauma patients who were admitted to emergency departments with an injury severity score of greater than or equal to 16 from January 2012 to December 2012.Interventions: None.Measurements and Main Results: All data were retrospectively collected, including laboratory data on arrival. Sensitivities to predict trauma death within 28 days of prothrombin time international normalized ratio greater than 1.50, pH less than 7.2, and body temperature less than 35°C were 15.7%, 17.5%, and 15.9%, respectively, and corresponding specificities of these were 96.4%, 96.6%, and 93.6%, respectively. The best predictors associated with hemostatic disorder and acidosis were fibrin/fibrinogen degradation product and base excess (the cutoff values were 88.8 µg/mL and -3.05 mmol/L). The optimal cutoff value of hypothermia was 36.0°C. The impact of the fibrin/fibrinogen degradation product and base excess abnormality on the outcome were approximately three- and two-folds compared with those of hypothermia. Using these variables, if the patient had a hemostatic disorder alone or a combined disorder with acidosis and hypothermia, the sensitivity and specificity were 80.7% and 66.8%.Conclusions: Because of the low sensitivity and high specificity, conventional criteria were unsuitable as prognostic indicators. Our revised criteria are assumed to be useful for predicting trauma death and have the potential to be the objective indicators for activating the damage control strategy in early trauma care. [ABSTRACT FROM AUTHOR]- Published
- 2016
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5. Severe COVID-19 Pneumonia in a 30-Year-Old Woman in the 36th Week of Pregnancy Treated with Postpartum Extracorporeal Membrane Oxygenation.
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Wataru Takayama, Akira Endo, Junichiro Yoshii, Hirokuni Arai, Keiji Oi, Eiki Nagaoka, Satoshi Toyama, Hiroto Yamamoto, Tokujiro Uchida, and Yasuhiro Otomo
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COVID-19 , *EXTRACORPOREAL membrane oxygenation , *PREMATURE rupture of fetal membranes , *WOMEN'S health services , *PNEUMONIA , *REPORTING of diseases - Abstract
Objective: Unusual clinical course. Background: There are few reports of coronavirus disease 2019 (COVID-19) in pregnant women. Although coagulation dysfunction was reported to affect the severity of COVID-19, the association between pregnancy, which is usually accompanied by changes in coagulation function, and the worsening of COVID-19 is unknown. We present a case of a 30-year-old woman in the 36th week of pregnancy who was diagnosed with severe COVID-19 pneumonia and required postpartum extracorporeal membrane oxygenation (ECMO) therapy. Case Report: A 30-year-old, 36-weeks pregnant woman presented to our hospital and was diagnosed with severe COVID-19 pneumonia soon after she had undergone a cesarean section. Her respiratory failure could not be managed by conventional therapeutic approaches. Therefore, ECMO was administered on day 7. Controlling coagulation function to maintain ECMO therapy was challenging. Nafamostat mesylate and cryoprecipitate were administered to treat the hypercoagulative status and severe hypofibrinogenemia, respectively. Since coagulopathy and her respiratory state improved, the ECMO therapy was terminated on day 15. Conclusions: We report a case of severe COVID-19 pneumonia in a pregnant woman urgently treated with ECMO in the postpartum period. Thus, this case highlights the importance of close monitoring and appropriate medical care for pregnant women with severe COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]
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- 2020
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