451 results on '"Shigeki Kushimoto"'
Search Results
152. Disseminated Nocardiosis that Mimicked Polypyomyositis: A Case Report
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Temma Soga, Takeaki Sato, So Sampei, and Shigeki Kushimoto
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0301 basic medicine ,03 medical and health sciences ,medicine.medical_specialty ,business.industry ,030106 microbiology ,Nocardiosis ,Disseminated nocardiosis ,Medicine ,business ,medicine.disease ,Dermatology ,Myositis - Published
- 2018
153. Ventral Herniorrhaphy with the Combined Use of Component Separation Technique and Negative Pressure Wound Therapy in Patient with Complex Abdominal Wall Hernia Complicated with Parastomal Hernia: A Case Report
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Takeaki Sato, Motoo Fujita, and Shigeki Kushimoto
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medicine.medical_specialty ,business.industry ,Incisional hernia ,medicine.medical_treatment ,Combined use ,030230 surgery ,medicine.disease ,Parastomal hernia ,Surgery ,Abdominal wall ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Negative-pressure wound therapy ,Ventral herniorrhaphy ,medicine ,In patient ,Hernia ,business - Published
- 2018
154. Mortality Effects of Prolonged Hemoperfusion Therapy Using a Polymyxin B-Immobilized Fiber Column for Patients with Septic Shock: A Sub-Analysis of the DESIRE Trial
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Hitoshi Yamamura, Takeshi Morimoto, Kyohei Miyamoto, Shigeki Kushimoto, Yu Kawazoe, Yoshinori Ohta, Yuta Yokokawa, Tetsuya Sato, and Noriko Miyagawa
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Male ,Time Factors ,medicine.drug_class ,medicine.medical_treatment ,Polymyxin ,030204 cardiovascular system & hematology ,Polymyxin b immobilized fiber ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,In patient ,Aged ,Polymyxin B ,Aged, 80 and over ,business.industry ,Septic shock ,030208 emergency & critical care medicine ,Hematology ,General Medicine ,Middle Aged ,Hemoperfusion ,medicine.disease ,Shock, Septic ,Survival Rate ,Nephrology ,Anesthesia ,Female ,lipids (amino acids, peptides, and proteins) ,business - Abstract
Background/Aims: The optimal duration of hemoperfusion therapy with a polymyxin B-immobilized fiber column has not yet been verified. Methods: This analysis examined whether hemoperfusion therapy with a polymyxin B-immobilized fiber column lasting longer than 2 h (prolonged polymyxin) improved outcomes for patients with septic shock compared to 2-h polymyxin therapy (sub-analysis of data from the DESIRE trial). Results: The 2-h and prolonged polymyxin groups contained 22 and 14 patients, respectively. Both groups had similar characteristics. The polymyxin duration per session in the prolonged polymyxin group was significantly longer (median, 5.5 h) than in the 2-h polymyxin group (p < 0.01). The 28-day mortality rate was significantly higher in the 2-h polymyxin group (7, 31.8%) than in the prolonged polymyxin group (0, 0%; p = 0.019). Conclusion: Prolonged polymyxin therapy might be associated with better clinical outcomes than 2-h polymyxin therapy in patients with septic shock. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=491744.
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- 2018
155. Trends in sepsis care in Japan: comparison of two sepsis cohort studies conducted by the Japanese Association for Acute Medicine
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Satoshi Fujimi, Toshikazu Abe, Kohji Okamoto, Kazuma Yamakawa, Tomohiko Masuno, Seitaro Fujishima, Yutaka Umemura, Kiyotsugu Takuma, Toshihiko Mayumi, Yasuhiro Otomo, Yuichiro Sakamoto, Shigeki Kushimoto, Naoshi Takeyama, Masashi Ueyama, Yasukazu Shiino, Hiroto Ikeda, Atsushi Shiraishi, Akiyoshi Hagiwara, Toru Hifumi, Shin-Ichiro Shiraishi, Junichi Sasaki, Taka-aki Nakada, Ryosuke Tsuruta, Joji Kotani, Satoshi Gando, Norio Yamashita, Hiroshi Ogura, Takehiko Tarui, and Daizoh Saitoh
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0301 basic medicine ,medicine.medical_specialty ,RC86-88.9 ,business.industry ,030106 microbiology ,General Engineering ,MEDLINE ,Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,Acute medicine ,medicine.disease ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Emergency medicine ,medicine ,business ,Letter to the Editor ,Cohort study - Abstract
Our analysis showed that improved compliance with sepsis bundles was associated with lower in-hospital mortality over a 7-year period in Japan, confirming that the SSC has been executed correctly in our country.
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- 2019
156. Clinical features of patients with candidemia in sepsis
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Gautam A. Deshpande, Shigeki Kushimoto, Akira Komori, Atsushi Shiraishi, Satoshi Gando, Toshihiko Mayumi, Seitaro Fujishima, Toshikazu Abe, Daizoh Saitoh, and Hiroshi Ogura
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medicine.medical_specialty ,lcsh:R5-920 ,business.industry ,MEDLINE ,medicine.disease ,Sepsis ,Text mining ,Internal Medicine ,medicine ,Geriatrics and Gerontology ,Family Practice ,Intensive care medicine ,business ,lcsh:Medicine (General) ,Letters to the Editor ,Letter to the Editor - Published
- 2019
157. Clinical characteristics and relationship between rate of sodium correction and outcomes in patients with primary polydipsia: retrospective observational analysis
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Noriko Miyagawa, Shigeki Kushimoto, Yoshitaro Yoshida, Masakazu Kobayashi, and Hajime Furukawa
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Pediatrics ,medicine.medical_specialty ,chemistry ,business.industry ,Sodium ,Observational analysis ,medicine ,chemistry.chemical_element ,Primary polydipsia ,In patient ,business ,medicine.disease - Published
- 2021
158. Assessment of mortality by qSOFA in patients with sepsis outside ICU: A post hoc subgroup analysis by the Japanese Association for Acute Medicine Sepsis Registry Study Group
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Kiyotsugu Takuma, Daizoh Saitoh, Koichiro Suzuki, Shin-Ichiro Shiraishi, Seitaro Fujishima, Atsushi Shiraishi, Shigeki Kushimoto, Yoshihiro Yamaguchi, Naoki Aikawa, Yutaka Umemura, Hiroto Ikeda, Satoshi Gando, Ryosuke Tsuruta, Norio Yamashita, Hiroshi Ogura, Toshikazu Abe, Joji Kotani, Yasuo Miki, Toshihiko Mayumi, Yasushi Suzuki, and Naoshi Takeyama
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Male ,Microbiology (medical) ,medicine.medical_specialty ,Organ Dysfunction Scores ,Subgroup analysis ,Hypothermia ,Logistic regression ,law.invention ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Predictive Value of Tests ,law ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Hospital Mortality ,Prospective Studies ,Registries ,Survivors ,030212 general & internal medicine ,Intensive care medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Receiver operating characteristic ,business.industry ,030208 emergency & critical care medicine ,Middle Aged ,Prognosis ,medicine.disease ,Intensive care unit ,Systemic inflammatory response syndrome ,Infectious Diseases ,ROC Curve ,Female ,SOFA score ,business - Abstract
Quick sequential organ failure assessment (qSOFA) was proposed in the new sepsis definition (Sepsis-3). Although qSOFA was created to identify patients with suspected infection and likely to have poor outcomes, the clinical utility of qSOFA to screen sepsis has not been fully evaluated. We investigated the number of patients diagnosed as having severe sepsis who could not be identified by the qSOFA criteria and what clinical signs could complement the qSOFA score. This retrospective analysis of a multicenter prospective registry included adult patients with severe sepsis diagnosed outside the intensive care unit (ICU) by conventional criteria proposed in 2003. We conducted receiver operating characteristic (ROC) analyses to assess the predictive value for in-hospital mortality and compared clinical characteristics between survivors and non-survivors with qSOFA score ≤ 1 point (qSOFA-negative). Among 387 eligible patients, 63 (16.3%) patients were categorized as qSOFA-negative, and 10 (15.9%) of these patients died. The area under the ROC curve for the qSOFA score was 0.615, which was superior to that for the systemic inflammatory response syndrome score (0.531, P = 0.019) but inferior to that for the SOFA score (0.702, P = 0.005). Multivariate logistic regression analysis showed that hypothermia might be associated with poor outcome independently of qSOFA criteria. Our findings suggested that qSOFA had a suboptimal level of predictive value outside the ICU and could not identify 16.3% of patients who were once actually diagnosed with sepsis. Hypothermia might be associated with an increased risk of death that cannot be identified by qSOFA.
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- 2017
159. Primary blast-induced traumatic brain injury: lessons from lithotripsy
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Kiyonobu Ohtani, Shigeki Kushimoto, Rocco A. Armonda, H. Tomita, Atsuhiro Nakagawa, Teiji Tominaga, A. Sakuma, Kazuyoshi Takayama, and Shunji Mugikura
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Blast induced traumatic brain injury ,Traumatic brain injury ,business.industry ,Mechanical Engineering ,medicine.medical_treatment ,General Physics and Astronomy ,Neurointensive care ,030208 emergency & critical care medicine ,Brain tissue ,Lithotripsy ,medicine.disease ,Blast injury ,03 medical and health sciences ,0302 clinical medicine ,Traumatic injury ,medicine ,business ,Neuroscience ,030217 neurology & neurosurgery ,Blast wave - Abstract
Traumatic injury caused by explosive or blast events is traditionally divided into four mechanisms: primary, secondary, tertiary, and quaternary blast injury. The mechanisms of blast-induced traumatic brain injury (bTBI) are biomechanically distinct and can be modeled in both in vivo and in vitro systems. The primary bTBI injury mechanism is associated with the response of brain tissue to the initial blast wave. Among the four mechanisms of bTBI, there is a remarkable lack of information regarding the mechanism of primary bTBI. On the other hand, 30 years of research on the medical application of shock waves (SWs) has given us insight into the mechanisms of tissue and cellular damage in bTBI, including both air-mediated and underwater SW sources. From a basic physics perspective, the typical blast wave consists of a lead SW followed by shock-accelerated flow. The resultant tissue injury includes several features observed in primary bTBI, such as hemorrhage, edema, pseudo-aneurysm formation, vasoconstriction, and induction of apoptosis. These are well-described pathological findings within the SW literature. Acoustic impedance mismatch, penetration of tissue by shock/bubble interaction, geometry of the skull, shear stress, tensile stress, and subsequent cavitation formation are all important factors in determining the extent of SW-induced tissue and cellular injury. In addition, neuropsychiatric aspects of blast events need to be taken into account, as evidenced by reports of comorbidity and of some similar symptoms between physical injury resulting in bTBI and the psychiatric sequelae of post-traumatic stress. Research into blast injury biophysics is important to elucidate specific pathophysiologic mechanisms of blast injury, which enable accurate differential diagnosis, as well as development of effective treatments. Herein we describe the requirements for an adequate experimental setup when investigating blast-induced tissue and cellular injury; review SW physics, research, and the importance of engineering validation (visualization/pressure measurement/numerical simulation); and, based upon our findings of SW-induced injury, discuss the potential underlying mechanisms of primary bTBI.
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- 2017
160. Azidothymidine-triphosphate impairs mitochondrial dynamics by disrupting the quality control system
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Jeffrey A. Medin, Teruyuki Yanagisawa, Ryosuke Nomura, Shigeki Kushimoto, Takeya Sato, and Yuka Sato
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WT, wild type ,0301 basic medicine ,Mitochondrial fission factor ,viruses ,GAPDH, glyceraldehyde 3-phosphate dehydrogenase ,Clinical Biochemistry ,Mitochondrion ,Biochemistry ,Mfn, mitofusin ,GTP Phosphohydrolases ,NRTI, nucleoside reverse transcriptase inhibitor ,0302 clinical medicine ,GTP, guanosine triphosphate ,JC-1, 5, 5′, 6, 6ꞌ-tetrachloro-1, 1ꞌ, 3, 3ꞌ-tetraethybenzimidazolcarbocyanin iodide ,MA-5, mitochonic asid-5 ,immune system diseases ,FACS, fluorescence-activated cell sorting ,Metabolites ,OCR, oxygen consumption rate ,heterocyclic compounds ,TMPK, thymidylate kinase ,HAART, highly active antiretrovirus therapy ,lcsh:QH301-705.5 ,p-Drp1, phosphorylated Drp1 ,lcsh:R5-920 ,HRP, horseradish peroxidase ,virus diseases ,Mitochondria ,HIV, human immunodeficiency virus ,AZT, 3ꞌ-azido-3ꞌ-deoxythymidine ,GTPase, guanosine triphosphate hydrolase ,030220 oncology & carcinogenesis ,Opa1, optic atrophy 1 ,Optic Atrophy 1 ,Mitochondrial fission ,lcsh:Medicine (General) ,AZT-MP, AZT monophosphate ,Zidovudine ,Research Paper ,medicine.drug ,Dynamins ,Programmed cell death ,Mitochondrial DNA ,ATP, adenosine triphosphate ,mPTP, mitochondrial permeability transition pore ,Anti-HIV Agents ,Cardiomyopathy ,IgG, immunoglobulin G ,PBS, phosphate-buffered saline ,calcein-AM, calcein acetoxymethyl ester ,pol-γ, DNA polymerase-gamma ,DMEM, Dulbecco's Modified Eagle Medium ,Biology ,Cell Line ,cDNA, complementary DNA ,03 medical and health sciences ,ROS, reactive oxygen species ,FBS, fetal bovine serum ,Downregulation and upregulation ,medicine ,Animals ,Oxidative phosphorylation ,AZT-TP, AZT-triphosphate ,AZT-DP, AZT diphosphate ,Organic Chemistry ,biochemical phenomena, metabolism, and nutrition ,medicine.disease ,Virology ,Cardiotoxicity ,mtDNA, mitochondrial DNA ,Rats ,030104 developmental biology ,lcsh:Biology (General) ,Oxidative stress ,Mff, mitochondrial fission factor ,Drp1, dynamin related protein-1 ,HPLC, high-performance liquid chromatography ,Mitochondrial dynamics ,Cancer research ,nDNA, nuclear DNA ,Mitochondrial function ,DHE, dihydroethidium - Abstract
Highly active anti-retrovirus therapy (HAART) has been used to block the progression and symptoms of human immunodeficiency virus infection. Although it decreases morbidity and mortality, clinical use of HAART has also been linked to various adverse effects such as severe cardiomyopathy resulting from compromised mitochondrial functioning. However, the mechanistic basis for these effects remains unclear. Here, we demonstrate that a key component of HAART, 3ꞌ-azido-3ꞌ-deoxythymidine (AZT), particularly, its active metabolite AZT-triphosphate (AZT-TP), caused mitochondrial dysfunction, leading to induction of cell death in H9c2 cells derived from rat embryonic myoblasts, which serve as a model for cardiomyopathy. Specifically, treatment with 100 µM AZT for 48 h disrupted the mitochondrial tubular network via accumulation of AZT-TP. The mRNA expression of dynamin-related protein (Drp)1 and the Drp1 receptor mitochondrial fission factor (Mff) was upregulated whereas that of optic atrophy 1 (Opa1) was downregulated following AZT treatment. Increased mitochondrial translocation of Drp1, Mff upregulation, and decreased functional Opa1 expression induced by AZT impaired the balance of mitochondrial fission vs. fusion. These data demonstrate that AZT-TP causes cell death by altering mitochondrial dynamics., Highlights • TMPK mutants efficiently converted AZT to its active metabolite AZT-TP. • Accumulated AZT-TP impaired mitochondrial network structure and dynamics. • AZT-TP but not AZT-MP caused mitochondrial dysfunction and ROS production. • Mitochondrial DNA copy number was unaffected by AZT-TP accumulation. • TMPK-expressing H9c2 cells are a suitable model for evaluating AZT toxicity.
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- 2017
161. Efficacy and safety of a 4-factor prothrombin complex concentrate for rapid vitamin K antagonist reversal in Japanese patients presenting with major bleeding or requiring urgent surgical or invasive procedures: a prospective, open-label, single-arm phase 3b study
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Shigeki Kushimoto, Thomas Chung, Kazunori Toyoda, Toshio Fukuoka, Amy Harman, Masahiro Yasaka, Akio Kimura, and Andres Brainsky
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Male ,medicine.medical_specialty ,Vitamin K ,medicine.drug_class ,Hemorrhage ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Asian People ,Japan ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,International Normalized Ratio ,Prospective Studies ,Adverse effect ,Aged ,Aged, 80 and over ,Hematology ,business.industry ,Anticoagulant ,Middle Aged ,Vitamin K antagonist ,Prothrombin complex concentrate ,Blood Coagulation Factors ,Surgery ,Anesthesia ,Hemostasis ,Female ,business ,030217 neurology & neurosurgery ,Major bleeding ,medicine.drug - Abstract
Rapid vitamin K antagonist (VKA) reversal is required in patients experiencing major bleeding or requiring urgent surgery. Four-factor prothrombin complex concentrate (4F-PCC; Beriplex®/Kcentra®) was shown in two large randomized controlled, international phase 3b trials to be an effective alternative to plasma for urgent VKA reversal. In the present prospective, open-label, single-arm phase 3b trial, we evaluate the efficacy and safety of 4F-PCC in Japanese patients. Eleven patients [international normalized ratio (INR) ≥2] requiring rapid VKA reversal owing to major bleeding (n = 6) or before urgent surgical/invasive procedures (n = 5) were administered 4F-PCC dosed based on INR and weight. INR reduction (≤1.3 0.5 h postinfusion; primary endpoint) was achieved in 81.8% of patients (major bleeding, 83.3%; surgical/invasive procedures, 80.0%). Effective hemostasis (main secondary endpoint) was met in 60.0% (major bleeding) and 100% (surgical/invasive procedure) of evaluable patients. Adverse events (AEs) and serious AEs were reported in 90.9 and 45.5% of patients, respectively. Two AEs were considered treatment-related; thromboembolic events rated mild and not clinically relevant by investigators. There were no deaths, fluid overload events, or viral transmission cases. Consistent with the previous results, 4F-PCC may be an effective and well-tolerated treatment for rapid VKA reversal in Japanese patients experiencing major bleeding or requiring urgent surgical/invasive procedures.
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- 2017
162. Early evaluation of severity in patients with severe sepsis: a comparison with 'septic shock' - subgroup analysis of the Japanese Association for Acute Medicine Sepsis Registry (JAAM-SR)
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Shin-Ichiro Shiraishi, Yoshihiro Yamaguchi, Yasuo Miki, Joji Kotani, Takehiko Tarui, Ryosuke Tsuruta, Koichiro Suzuki, Shigeki Kushimoto, Naoki Aikawa, Hiroto Ikeda, Satoshi Gando, Seitaro Fujishima, Yasushi Suzuki, Kiyotsugu Takuma, Naoshi Takeyama, Toshihiko Mayumi, Norio Yamashita, and Hiroshi Ogura
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medicine.medical_specialty ,Resuscitation ,Subgroup analysis ,Acute medicine ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,In patient ,030212 general & internal medicine ,Severe sepsis ,lactate ,business.industry ,Septic shock ,Mortality rate ,General Engineering ,030208 emergency & critical care medicine ,Original Articles ,prediction ,medicine.disease ,mortality ,Surgery ,outcome ,Original Article ,Hypotension ,business - Abstract
Aim The purpose of this subgroup analysis of a Japanese multicenter registry, the Japanese Association for Acute Medicine Sepsis Registry Advanced (JAAM-SR-Advanced), was to identify early outcome indicators for severe sepsis that are useful and more objective than “septic shock.” Methods Among 624 patients with severe sepsis registered in JAAM-SR-Advanced, 554 with valid serum lactate data were retrospectively studied. Hypotension before and after fluid resuscitation and the highest lactate values over the initial 24 h were compared for their ability to predict in-hospital mortality. Results Of the study group, 155 (28.0%) patients were non-survivors and had significantly lower systolic blood pressures and higher lactate peaks. The mortality of 364 patients with initial hypotension was higher than those patients without it (32.7% versus 19.1%, P
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- 2017
163. Decreased a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 activity and neurologic outcome in patients with successful resuscitation of out-of-hospital cardiac arrest: A prospective observational study
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Shigeki Kushimoto, Daisuke Kudo, Hiroyuki Ohbe, and Satoshi Yamanouchi
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Male ,Brain Death ,medicine.medical_specialty ,Resuscitation ,Organ Dysfunction Scores ,ADAMTS13 Protein ,Enzyme-Linked Immunosorbent Assay ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Severity of Illness Index ,Gastroenterology ,Monocytes ,03 medical and health sciences ,0302 clinical medicine ,hemic and lymphatic diseases ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,HMGB1 Protein ,Interleukin 6 ,Aged ,Thrombospondin ,Metalloproteinase ,biology ,Interleukin-6 ,business.industry ,Persistent Vegetative State ,Monocyte ,030208 emergency & critical care medicine ,HLA-DR Antigens ,Middle Aged ,Flow Cytometry ,Prognosis ,Cardiopulmonary Resuscitation ,Pathophysiology ,ADAMTS13 ,Surgery ,Survival Rate ,Treatment Outcome ,medicine.anatomical_structure ,ROC Curve ,biology.protein ,Female ,Observational study ,business ,Biomarkers ,Out-of-Hospital Cardiac Arrest - Abstract
Purpose The purpose of this study is to investigate the association between a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 (ADAMTS13) and neurologic outcome in patients with resuscitation of out-of-hospital cardiac arrest (R-OHCA). Materials and Methods A prospective observational study of adult patients with R-OHCA was conducted. Plasma activity of ADAMTS13 and inflammatory markers, an immunologic marker, and a marker of endothelial damage were measured on admission and day 2. Neurologic outcome was evaluated using the Cerebral Performance Categories on day 90. Results Plasma activity of ADAMTS13 on day 2 was lower in patients with poor neurologic outcome (n = 18) than that in those with good neurologic outcome (n = 16; P = .008). It was also lower in 28-day nonsurvivors (n = 12) than in survivors (n = 21; P = .019). Soluble thrombomodulin showed a strong correlation with ADAMTS13 ( P = .021). Furthermore, ADAMTS13 activity was negatively correlated with the Sequential Organ Failure Assessment score ( P P = .028), and levels of interleukin 6 ( P = .047) but positively correlated with the monocyte expression of human leukocyte antigen DR ( P = .023). Conclusion Decreased ADAMTS13 activity was associated with poor neurologic outcome, high mortality, and worsened immune-inflammatory status in patients with R-OHCA. These results suggest that ADAMTS13 may have pathophysiologic relevance in postcardiac arrest syndrome.
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- 2017
164. Switching Therapy from Intravenous Landiolol to Transdermal Bisoprolol in a Patient with Thyroid Storm Complicated by Decompensated Heart Failure and Gastrointestinal Dysfunction
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Daisuke Kudo, Shigeo Godo, Hiroshi Ozaki, Shigeki Kushimoto, Ryosuke Nomura, Motoo Fujita, Yu Kawazoe, and Hiroaki Shimokawa
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Adult ,medicine.medical_specialty ,acute heart failure ,Gastrointestinal Diseases ,Transdermal patch ,Morpholines ,Adrenergic beta-Antagonists ,Case Report ,030204 cardiovascular system & hematology ,Administration, Cutaneous ,thyroid storm ,03 medical and health sciences ,0302 clinical medicine ,bisoprolol transdermal patch ,Internal medicine ,Atrial Fibrillation ,Internal Medicine ,medicine ,Bisoprolol ,Humans ,Urea ,Thyroid storm ,030212 general & internal medicine ,landiolol ,Transdermal ,Heart Failure ,business.industry ,Thyroid ,Atrial fibrillation ,General Medicine ,Landiolol ,medicine.disease ,critical care ,Treatment Outcome ,medicine.anatomical_structure ,Heart failure ,Anesthesia ,Cardiology ,Administration, Intravenous ,Female ,Thyroid Crisis ,business ,medicine.drug - Abstract
Thyroid storm is a life-threatening disorder that remains a therapeutic challenge. Although β-blockers are the mainstay for treatment, their use can be challenging in cases complicated by rapid atrial fibrillation and decompensated heart failure. We present a case of thyroid storm-associated atrial fibrillation and decompensated heart failure complicated by gastrointestinal dysfunction secondary to diffuse peritonitis that was successfully managed by a switching therapy, in which the continuous intravenous administration of landiolol was changed to bisoprolol via transdermal patch, in the acute phase treatment. This switching therapy may offer a promising therapeutic option for this potentially lethal disorder.
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- 2017
165. The Dramatic Recovery of a Patient with Biguanide-associated Severe Lactic Acidosis Following Thiamine Supplementation
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Yoshitaro Yoshida, Daisuke Kudo, Hiroaki Shimokawa, Ryosuke Nomura, Motoo Fujita, Shigeo Godo, and Shigeki Kushimoto
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Drug ,medicine.medical_specialty ,medicine.drug_class ,media_common.quotation_subject ,Biguanides ,Case Report ,biguanide ,030204 cardiovascular system & hematology ,Gastroenterology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Hypoglycemic Agents ,Thiamine ,030212 general & internal medicine ,Thiamine deficiency ,Aged ,media_common ,thiamine deficiency ,Biguanide ,business.industry ,Incidence (epidemiology) ,food and beverages ,Type 2 Diabetes Mellitus ,General Medicine ,medicine.disease ,lactic acidosis ,Diabetes Mellitus, Type 2 ,chemistry ,Biochemistry ,Lactic acidosis ,Dietary Supplements ,buformin ,Acidosis, Lactic ,Female ,Severe lactic acidosis ,business ,human activities - Abstract
Biguanides are a drug of choice for the treatment of type 2 diabetes mellitus. Although they can cause lactic acidosis in susceptible patients with predisposing risk factors, the incidence of lactic acidosis is reported to be very low when they are used properly. We herein present a case of biguanide-associated severe lactic acidosis complicated with thiamine deficiency that was provoked without predisposing factors for thiamine deficiency. Diabetic patients taking biguanide may be predisposed to thiamine deficiency, even when there is no evidence of risk factors, and the high-dose administration of thiamine may be essential in the treatment of this otherwise under-recognized disorder.
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- 2017
166. Pharmacokinetics of recombinant human soluble thrombomodulin in disseminated intravascular coagulation patients with acute renal dysfunction
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Jun Tagawa, Eizo Watanabe, Mineji Hayakawa, Yasushi Suzuki, Fumiyo Komatsu, Satoshi Gando, Shigeki Kushimoto, Koji Goto, Tomoaki Yatabe, Toru Kotani, and Takeyuki Kiguchi
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Male ,Thrombomodulin ,030204 cardiovascular system & hematology ,Kidney ,Severity of Illness Index ,Gastroenterology ,sepsis ,0302 clinical medicine ,Japan ,Prospective Studies ,Plasma concentration ,Aged, 80 and over ,Disseminated intravascular coagulation ,Anticoagulant ,Hematology ,Middle Aged ,Recombinant Proteins ,Treatment Outcome ,Renal Elimination ,medicine.anatomical_structure ,Area Under Curve ,Acute Disease ,Female ,Kidney Diseases ,pharmacokinetics ,Half-Life ,Coagulation and Fibrinolysis ,medicine.medical_specialty ,Metabolic Clearance Rate ,medicine.drug_class ,Renal function ,Hemorrhage ,Models, Biological ,03 medical and health sciences ,Pharmacokinetics ,renal dysfunction ,Internal medicine ,medicine ,Humans ,Adverse effect ,disseminated intravascular coagulation ,Aged ,business.industry ,Anticoagulants ,030208 emergency & critical care medicine ,medicine.disease ,Surgery ,business - Abstract
SummaryRecombinant human soluble thrombomodulin (ART-123) is a novel anticoagulant for patients with disseminated intravascular coagulation (DIC). It is widely used in clinical settings throughout Japan. Furthermore, a global Phase 3 study is currently being conducted. In healthy subjects, ART-123 is excreted mainly via the kidneys. Therefore, ART-123 dose decrease was recommended in DIC patients with severe renal dysfunction. However, the pharmacokinetics of ART-123 in DIC patients with severe acute renal dysfunction has not been elucidated. In an open-label, multicentre, prospective, clinical pharmacological study, we investigated the pharmacokinetics and safety of ART-123 upon repeated administration to DIC patients. ART-123 was administered to patients at a dose of 130 or 380 U/kg/day for six consecutive days. Plasma concentrations of ART-123 were measured at 21 time points until eight days after the final administration. Urinary excretion rates during the first 24 hours (h) were calculated. Patient renal functions were evaluated by measuring 24-h creatinine clearance (Ccr). Forty-three patients were enrolled in the present study. The urinary excretion rates of ART-123 correlated closely with 24-h Ccr. Total body clearance of ART-123 was also weakly related with 24-h Ccr. However, the plasma concentrations of ART-123 were not considerably different among patients with different renal function. Two patients had subcutaneous haemorrhage as an adverse event related to ART-123. In conclusion, plasma concentrations of ART-123 may not be different among patients with different renal functions. ART-123 was well tolerated in these patients.
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- 2017
167. Implementation of earlier antibiotic administration in patients with severe sepsis and septic shock in Japan: a descriptive analysis of a prospective observational study
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Toru Hifumi, Hiroto Ikeda, Satoshi Gando, Seitaro Fujishima, Kiyotsugu Takuma, Norio Yamashita, Hiroshi Ogura, Joji Kotani, Toshikazu Abe, Naoshi Takeyama, Akira Komori, Kohji Okamoto, Yuichiro Sakamoto, Ryosuke Tsuruta, Yasuhiro Otomo, Toshio Naito, Toshihiko Mayumi, Hiroki Iriyama, Takehiko Tarui, Atsushi Shiraishi, Andrew Rhodes, Taka-aki Nakada, Takehiro Sugiyama, Shigeki Kushimoto, Shin Ichiro Shiraishi, Junichi Sasaki, Yutaka Umemura, Gary Phillips, Masashi Ueyama, Yasuharu Tokuda, Yasukazu Shiino, Daizoh Saitoh, Akiyoshi Hagiwara, Kazuma Yamakawa, and Tomohiko Masuno
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medicine.medical_specialty ,Acute coronary syndrome ,business.industry ,Septic shock ,Mortality rate ,Antibiotic ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,Emergency department ,Critical Care and Intensive Care Medicine ,medicine.disease ,Bundle ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,Intensive care ,medicine ,030212 general & internal medicine ,Outcomes research ,business ,Protocols - Abstract
Background Time to antibiotic administration is a key element in sepsis care; however, it is difficult to implement sepsis care bundles. Additionally, sepsis is different from other emergent conditions including acute coronary syndrome, stroke, or trauma. We aimed to describe the association between time to antibiotic administration and outcomes in patients with severe sepsis and septic shock in Japan. Methods This prospective observational study enrolled 1184 adult patients diagnosed with severe sepsis based on the Sepsis-2 criteria and admitted to 59 intensive care units (ICUs) in Japan between January 1, 2016, and March 31, 2017, as the sepsis cohort of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) study. We compared the characteristics and in-hospital mortality of patients administered with antibiotics at varying durations after sepsis recognition, i.e., 0–60, 61–120, 121–180, 181–240, 241–360, and 361–1440 min, and estimated the impact of antibiotic timing on risk-adjusted in-hospital mortality using the generalized estimating equation model (GEE) with an exchangeable, within-group correlation matrix, with “hospital” as the grouping variable. Results Data from 1124 patients in 54 hospitals were used for analyses. Of these, 30.5% and 73.9% received antibiotics within 1 h and 3 h, respectively. Overall, the median time to antibiotic administration was 102 min [interquartile range (IQR), 55–189]. Compared with patients diagnosed in the emergency department [90 min (IQR, 48–164 min)], time to antibiotic administration was shortest in patients diagnosed in ICUs [60 min (39–180 min)] and longest in patients transferred from wards [120 min (62–226)]. Overall crude mortality was 23.4%, where patients in the 0–60 min group had the highest mortality (28.0%) and a risk-adjusted mortality rate [28.7% (95% CI 23.3–34.1%)], whereas those in the 61–120 min group had the lowest mortality (20.2%) and risk-adjusted mortality rates [21.6% (95% CI 16.5–26.6%)]. Differences in mortality were noted only between the 0–60 min and 61–120 min groups. Conclusions We could not find any association between earlier antibiotic administration and reduction in in-hospital mortality in patients with severe sepsis.
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- 2019
168. Demographics, Treatments, and Outcomes of Acute Respiratory Distress Syndrome: the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) Study
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Joji Kotani, Seitaro Fujishima, Taka-aki Nakada, Atsushi Shiraishi, Shin Ichiro Shiraishi, Akiyoshi Hagiwara, Yasukazu Shiino, Toshikazu Abe, Toru Hifumi, Daizoh Saitoh, Norio Yamashita, Kiyotsugu Takuma, Kazuma Yamakawa, Hiroshi Ogura, Tomohiko Masuno, Toshihiko Mayumi, Satoshi Fujimi, Yasuhiro Otomo, Shigeki Kushimoto, Kohji Okamoto, Junichi Sasaki, Ryosuke Tsuruta, Yuichiro Sakamoto, Satoshi Gando, Naoshi Takeyama, Yutaka Umemura, Hiroto Ikeda, Masashi Ueyama, and Takehiko Tarui
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Adult ,Male ,ARDS ,medicine.medical_specialty ,Emergency Medical Services ,Critical Care ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Sepsis ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Epidemiology ,Outcome Assessment, Health Care ,Emergency medical services ,medicine ,Humans ,Prospective cohort study ,Cause of death ,Aged ,Respiratory Distress Syndrome ,business.industry ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,Logistic Models ,Emergency medicine ,Emergency Medicine ,Wounds and Injuries ,Female ,Outcomes research ,business ,Cohort study - Abstract
Acute respiratory distress syndrome (ARDS) remains a major cause of death. Epidemiology should be continually examined to refine therapeutic strategies for ARDS. We aimed to elucidate demographics, treatments, and outcomes of ARDS in Japan.This is a prospective cohort study for ARDS. We included adult patients admitted to intensive care units through emergency and critical care departments who satisfied the American-European Consensus Conference (AECC) acute lung injury (ALI) criteria. In addition, the fulfillment of the Berlin definition was assessed. Logistic regression analyses were used to examine the association of independent variables with outcomes.Our study included 166 patients with AECC ALI from 34 hospitals in Japan; among them, 157 (94.6%) fulfilled the Berlin definition. The proportion of patients with PaO2/FIO2 ≤ 100, patients under invasive positive pressure ventilation (IPPV), and in-hospital mortality was 39.2%, 92.2%, and 38.0% for patients with AECC ALI and 38.9%, 96.8%, and 37.6% for patients with Berlin ARDS, respectively. The area of lung infiltration was independently associated with outcomes of ARDS. Low-mid-tidal volume ventilation was performed in 75% of patients under IPPV. Glucocorticoid use was observed in 54% patients, and it was positively associated with mortality.Our study included a greater percentage of patients with ARDS with high severity and found that the overall mortality was 38%. The management of ARDS in Japan was characterized by high the utilization rate of glucocorticoids, which was positively associated with mortality.
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- 2019
169. Significance of plasma fibrinogen level and antithrombin activity in sepsis: A multicenter cohort study using a cubic spline model
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Akiyoshi Hagiwara, Satoshi Gando, Hiroshi Ogura, Kazuma Yamakawa, Yutaka Umemura, Toshikazu Abe, Atsushi Shiraishi, Tsunehiro Matsubara, Satoshi Fujimi, Takehiko Tarui, Shigeki Kushimoto, and Yasuhiro Otomo
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Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Fibrinogen ,Gastroenterology ,Sepsis ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Intensive care ,medicine ,Coagulopathy ,Humans ,Prospective cohort study ,Aged ,Disseminated intravascular coagulation ,Aged, 80 and over ,business.industry ,Septic shock ,Thrombosis ,Hematology ,Disseminated Intravascular Coagulation ,Middle Aged ,medicine.disease ,030220 oncology & carcinogenesis ,Female ,business ,Cohort study ,medicine.drug - Abstract
Sepsis leads to coagulopathy by the activation of inflammatory mediators and vascular endothelial cell injury. A number of biomarkers are used to evaluate coagulopathy on sepsis. Fibrinogen and antithrombin activity have been reported as biomarkers of coagulopathy; however, the utility of these two markers has not been well established. This study aimed to evaluate the detailed association between these two markers and clinical outcomes in sepsis patients.This was a post hoc analysis of a multicenter, prospective cohort study conducted in 59 intensive care units throughout Japan from January 2016 to March 2017. We included 1103 adult patients with severe sepsis based on the Sepsis-2 criteria. The associations between the coagulation markers and in-hospital mortality were examined using linear and non-linear logistic regression analyses. We also evaluated the associations between the coagulation markers and disseminated intravascular coagulation (DIC) scores. The International Society on Thrombosis and Haemostasis overt DIC score was calculated after subtracting the fibrinogen component.The decreased levels of the fibrinogen and antithrombin activity were significantly associated with an increase in mortality (P = 0.011 and 0.002, respectively). In addition, cubic spline regression demonstrated that mortality sharply increased at a fibrinogen level of approximately200 mg/dL and at an antithrombin activity of approximately50%. Similarly, the decreased levels of the two markers non-linearly correlated with the elevation of DIC score.The fibrinogen level and antithrombin activity should be reconsidered as unique biomarkers for sepsis and sepsis-induced DIC.
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- 2019
170. Prognostic Accuracy of Quick SOFA is different according to the severity of illness in infectious patients
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Kazuma Yamakawa, Tomohiko Masuno, Satoshi Gando, Shin-Ichiro Shiraishi, Hiroto Ikeda, Norio Yamashita, Takehiko Tarui, Atsushi Shiraishi, Shigeki Kushimoto, Ryosuke Tsuruta, Yasuhiro Otomo, Yutaka Umemura, Junichi Sasaki, Toru Hifumi, Kiyotsugu Takuma, Akiyoshi Hagiwara, Toshikazu Abe, Seitato Fujishima, Masashi Ueyama, Kohji Okamoto, Daizoh Saitoh, Toshihiko Mayumi, Hiroshi Ogura, Yuichiro Sakamoto, Naoshi Takeyama, Yasukazu Shiino, Joji Kotani, and Taka-aki Nakada
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0301 basic medicine ,Microbiology (medical) ,Male ,medicine.medical_specialty ,Organ Dysfunction Scores ,030106 microbiology ,Subgroup analysis ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,Intensive care ,Sepsis ,Severity of illness ,Post-hoc analysis ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Hospital Mortality ,Prospective Studies ,Aged ,Receiver operating characteristic ,business.industry ,Emergency department ,Middle Aged ,Prognosis ,Intensive Care Units ,Infectious Diseases ,ROC Curve ,Cohort ,SOFA score ,Female ,business ,Emergency Service, Hospital - Abstract
Background Sepsis-3 proposed the quick Sequential Organ Failure Assessment (qSOFA) to identify sepsis patients likely to have poor outcome. The clinical utility of qSOFA still remains controversial because its predictive accuracy for mortality is quite different across the validation studies. We hypothesized that one of the major causes for these controversial findings was the heterogeneity in severity across the studies, and evaluated the association between severity of illness and the prognostic accuracy of qSOFA. Materials and methods This was a post hoc analysis of a prospective nationwide cohort of consecutive adult patients with sepsis in 59 intensive care units in Japan. Regression trees analysis for survival was used to classify patients according to severity of illness as determined by SOFA score on registration. We conducted receiver operating characteristic (ROC) analyses and evaluated the differences in the area under the ROC curve (AUROC). As a subgroup analysis, we conducted the above evaluations in emergency department (ED) and non-ED patients separately. Results We included 1114 patients fulfilling the criteria and classified them into three subsets according to severity. The AUROC for mortality was significantly different according to the severity of illness (p = 0.007), with the highest AUROC being in the low-severity subset (patients with SOFA score ≤ 7). Interestingly, our subgroup analysis revealed that a significant difference in the AUROC of qSOFA was observed only in ED patients. Conclusion This study suggested that lower severity of illness was associated with the relatively higher prognostic accuracy of qSOFA, especially in ED patients.
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- 2019
171. Heterotopic ossification with fever of unknown origin
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Shigeki Kushimoto and Shigeo Godo
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Male ,Pediatrics ,medicine.medical_specialty ,health care facilities, manpower, and services ,Persistent fever ,030209 endocrinology & metabolism ,Fever of Unknown Origin ,law.invention ,03 medical and health sciences ,Alkaline phosphatase blood ,0302 clinical medicine ,law ,medicine ,Humans ,Fever of unknown origin ,Coma ,Practice ,Ossification ,business.industry ,Ossification, Heterotopic ,General Medicine ,Middle Aged ,medicine.disease ,Alkaline Phosphatase ,Intensive care unit ,Thalamic hemorrhage ,Heterotopic ossification ,medicine.symptom ,business ,Tomography, X-Ray Computed ,030217 neurology & neurosurgery - Abstract
A 52-year-old man was admitted to hospital with coma from thalamic hemorrhage. He developed a persistent fever of unknown origin during his stay in the intensive care unit (ICU). A tentative diagnosis of central fever was made based on the unremarkable findings of an extensive fever workup. The
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- 2019
172. Endovascular resuscitation and Trauma Management (EVTM) in the Hybrid Emergency Room System (HERS)
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Kazuma Yamakawa, Junichi Matsumoto, Yosuke Matsumura, Tomohiro Funabiki, Takahiro Kinoshita, Satoshi Fujimi, Kei Hayashida, Kaori Ito, Shigeki Kushimoto, and Hiroyuki Ohbe
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medicine.medical_specialty ,Resuscitation ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,Critical Care and Intensive Care Medicine ,Trauma care ,Resuscitation room ,Operating table ,Trauma management ,Radiological weapon ,Emergency Medicine ,Medicine ,Surgery ,Endovascular treatment ,business ,Intensive care medicine - Abstract
The concept of EndoVascular resuscitation and Trauma Management (EVTM) has recently been proposed to refer to the use of endovascular techniques for resuscitation, haemorrhage control, and definitive trauma management. Although the popularity of resuscitative endovascular balloon occlusion of the aorta (REBOA) has been growing, the use of the EVTM or CT imaging is still limited in hemodynamically unstable patients. To overcome the current limitations, the Hybrid Emergency Room System (HERS) was introduced in 2011. HERS consists of an operating table with an angiographic C-arm and a sliding CT scanner system in the resuscitation area, which allows all emergency diagnostic and therapeutic interventions without relocating the patient. This paper deals with current limitations of EVTM and proposes solutions with HERS. In the HERS environment, patients can undergo IR in the resuscitation room, which may expand the indications of IR to include hemodynamically unstable patients. HERS can also reduce CT scanning time to identify unexpected injuries or traumatic brain injury. It also allows prompt neurosurgical intervention simultaneously with haemorrhage control. REBOA is a viable adjunct treatment for refractory haemorrhagic shock but its procedure-related complications must be considered. REBOA can be performed more safely, rapidly, and accurately in HERS, followed by immediate definitive haemostasis. In addition, HERS may safely extend the application of REBOA-CT to identify accurate injury site. HERS may be an ideal EVTM solution for the trinity of surgery, endovascular treatment, and imaging in trauma care. We will continue to explore the most radical and safest EVTM in the HERS environment.
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- 2019
173. Role of disseminated intravascular coagulation in severe sepsis
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Satoshi Gando, Atsushi Shiraishi, Kazuma Yamakawa, Hiroshi Ogura, Daizoh Saitoh, Seitaro Fujishima, Toshihiko Mayumi, Shigeki Kushimoto, Toshikazu Abe, Yasukazu Shiino, Taka-aki Nakada, Takehiko Tarui, Toru Hifumi, Yasuhiro Otomo, Kohji Okamoto, Yutaka Umemura, Joji Kotani, Yuichiro Sakamoto, Junichi Sasaki, Shin-ichiro Shiraishi, Kiyotsugu Takuma, Ryosuke Tsuruta, Akiyoshi Hagiwara, Tomohiko Masuno, Naoshi Takeyama, Norio Yamashita, Hiroto Ikeda, Masashi Ueyama, Satoshi Fujimi, Osamu Tasaki, Yasumitsu Mizobata, Hiraku Funakoshi, Toshiro Okuyama, Iwao Yamashita, Toshio Kanai, Yasuo Yamada, Mayuki Aibiki, Keiji Sato, Susumu Yamashita, Kenichi Yoshida, Shunji Kasaoka, Akihide Kon, Hiroshi Rinka, Hiroshi Kato, Hiroshi Okudera, Eichi Narimatsu, Toshifumi Fujiwara, Manabu Sugita, Yasuo Shichinohe, Hajime Nakae, Ryouji Iiduka, Yuji Murata, Mitsunobu Nakamura, Yoshitake Sato, Hiroyasu Ishikura, Yasuhiro Myojo, Yasuyuki Tsujita, Kosaku Kinoshita, Hiroyuki Yamaguchi, Toshihiro Sakurai, Satoru Miyatake, Takao Saotome, Susumu Yasuda, and Yasuaki Mizushima
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Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Aged ,Retrospective Studies ,Disseminated intravascular coagulation ,Aged, 80 and over ,Septic shock ,business.industry ,Mortality rate ,Incidence (epidemiology) ,Organ dysfunction ,Hematology ,Disseminated Intravascular Coagulation ,Middle Aged ,medicine.disease ,Log-rank test ,030220 oncology & carcinogenesis ,Female ,medicine.symptom ,Multiple organ dysfunction syndrome ,business ,circulatory and respiratory physiology - Abstract
Background Disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome (MODS) plays pivotal roles in severe sepsis. Objectives We performed a multicenter, prospective data collection study and retrospectively analyzed the data to confirm the role of DIC in severe sepsis. Methods Eligible patients were ICU patients who met the definitions of severe sepsis, and 1013 patients were included. DIC scores as well as disease severity and the development of MODS on the day of the diagnosis of severe sepsis (day 0) and at day 3 were evaluated. The primary outcome was hospital mortality, and MODS on days 0 and 3 was the secondary outcomes. Results The overall mortality rate of severe sepsis was 21.5%, and the prevalence of DIC was 50.9% (516/1013). DIC patients were more seriously ill and exhibited a higher prevalence of MODS (32.0% vs. 13.1%) on day 0 and worse mortality rate (24,8% vs. 17.5%) than non-DIC patients. DIC patients also showed a lower survival probability than non-DIC patients (Log rank p = 0.028). Logistic regression analyses after propensity score adjustment for potential confounders confirmed a significant association between DIC and MODS and hospital death in the patients with severe sepsis. The new development of DIC and persistent DIC from days 0 to 3 were associated with a high incidence of MODS and low survival probability. Conclusions The mortality rate of severe sepsis has been improved; however, DIC is still associated with the poor prognosis of these patients. Evaluating the dynamic changes in the DIC status may improve the prediction capability.
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- 2019
174. Intensive care unit model and in-hospital mortality among patients with severe sepsis and septic shock
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Shigeki Kushimoto, Toshikazu Abe, Seitaro Fujishima, Isao Nagata, Satoshi Gando, and Hiroshi Ogura
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medicine.medical_specialty ,health care facilities, manpower, and services ,Observational Study ,Severity of Illness Index ,law.invention ,sepsis ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Clinical Protocols ,law ,medicine ,Humans ,Hospital Mortality ,Prospective Studies ,030212 general & internal medicine ,business.industry ,Septic shock ,Incidence (epidemiology) ,General Medicine ,Odds ratio ,medicine.disease ,Combined Modality Therapy ,Shock, Septic ,Intensive care unit ,Confidence interval ,Intensive Care Units ,sepsis care bundle ,030220 oncology & carcinogenesis ,Emergency medicine ,Propensity score matching ,Observational study ,business ,ICU model ,Patient Care Bundles ,Research Article ,in-hospital mortality - Abstract
We aimed to determine the association between the intensive care unit (ICU) model and in-hospital mortality of patients with severe sepsis and septic shock. This was a secondary analysis of a multicenter prospective observational study conducted in 59 ICUs in Japan from January 2016 to March 2017. We included adult patients (aged ≥16 years) with severe sepsis and septic shock based on the sepsis-2 criteria who were admitted to an ICU with a 1:2 nurse-to-patient ratio per shift. Patients were categorized into open or closed ICU groups, according to the ICU model. The primary outcome was in-hospital mortality. A total of 1018 patients from 45 ICUs were included in this study. Patients in the closed ICU group had a higher severity score and higher organ failure incidence than those in the open ICU group. The compliance rate for the sepsis care 3-h bundle was higher in the closed ICU group than in the open ICU group. In-hospital mortality was not significantly different between the closed and open ICU groups in a multilevel logistic regression analysis (odds ratio = 0.83, 95% confidence interval; 0.52–1.32, P = .43) and propensity score matching analysis (closed ICU, 21.2%; open ICU, 25.7%, P = .22). In-hospital mortality between the closed and open ICU groups was not significantly different after adjusting for ICU structure and compliance with the sepsis care bundle.
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- 2021
175. COVID-19 Transmission at Schools in Japan.
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Tetsuya Akaishi, Shigeki Kushimoto, Yukio Katori, Noriko Sugawara, Kaoru Igarashi, Motoo Fujita, Shigeo Kure, Shin Takayama, Michiaki Abe, Junichi Tanaka, Akiko Kikuchi, Yoshiko Abe, Hiroyuki Imai, Yohei Inaba, Yoko Iwamatsu-Kobayashi, Takashi Nishioka, Ko Onodera, and Tadashi Ishii
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The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remains a global public health concern in 2021. However, the risk of attending schools during the pandemic remains unevaluated. This study estimated the secondary transmission rate at schools using the results of a real-time reverse transcription-polymerase chain reaction (RT-PCR) screening test performed between July 2020 and April 2021, before starting the nationwide mass vaccination. A total of 1,924 students (20 RT-PCR-positive; 1.0%) from 52 schools or preschools were evaluated, together with 1,379 non-adults (95 RT-PCR-positive; 6.9%) exposed to SARS-CoV-2 in non-school environments. Assuming that the infectious index cases were asymptomatic and the transmission at schools followed a Bernoulli process, we estimated the probability of transmission after each contact at school as approximately 0.005 (0.5% per contact) with the current infection prevention measures at schools in Japan (i.e., hand hygiene, physical distancing, wearing masks, and effective ventilation). Furthermore, assuming that all children are capable of carrying the infection, then contact between an index case and 20-30 students per day at schools would yield the expected value for secondary cases of = 1.0, during the 10 days of the infectious period. In conclusion, with the current infection prevention measures at schools in Japan, secondary transmission at schools would occur in approximately every 200 contacts. When considering this rate, compliance with the current infection prevention measures at schools and early detection and quarantine of the index cases would be effective in preventing the spread of COVID-19 at schools. [ABSTRACT FROM AUTHOR]
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- 2021
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176. INCIDENCE AND IMPACT OF DYSGLYCEMIA IN PATIENTS WITH SEPSIS UNDER MODERATE GLYCEMIC CONTROL.
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Seitaro Fujishima, Satoshi Gando, Daizoh Saitoh, Shigeki Kushimoto, Hiroshi Ogura, Toshikazu Abe, Atsushi Shiraishi, Toshihiko Mayumi, Junichi Sasaki, Joji Kotani, Naoshi Takeyama, Ryosuke Tsuruta, Kiyotsugu Takuma, Norio Yamashita, Shin-ichiro Shiraishi, Hiroto Ikeda, Yasukazu Shiino, Takehiko Tarui, Taka-aki Nakada, and Toru Hifumi
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- 2021
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177. Discriminatory Value of Self-reported Olfactory Dysfunction in the Prediction of Coronavirus Disease 2019.
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Tetsuya Akaishi, Shigeki Kushimoto, Yukio Katori, Shigeo Kure, Kaoru Igarashi, Motoo Fujita, Shin Takayama, Michiaki Abe, Akiko Kikuchi, Junichi Tanaka, Yoshiko Abe, Hiroyuki Imai, Yohei Inaba, Yoko Iwamatsu-Kobayashi, Takashi Nishioka, Ko Onodera, and Tadashi Ishii
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- 2021
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178. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)
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Kazuma Yamakawa, Takeshi Unoki, Yoh Sugawara, Hiroyuki Kawano, Ayaka Sakamoto, Kenji Uehara, Yasuyuki Kakihana, Eizo Watanabe, Hiromu Okano, Yukitoshi Toyoda, Goro Tajima, Ryuichi Yotsumoto, Hiroshi Ogura, Asako Matsushima, Motoshi Kainuma, Ryo Fujii, Takuya Mayumi, Tomonori Yamamoto, Masaaki Sakuraya, Yuuki Tanaka, Toshikazu Abe, Tomoko Fujii, Daisuke Kobashi, Naoki Yamada, Yoshiki Masuda, Satoru Hashimoto, Atsunori Sugita, Kazuaki Atagi, Yutaka Igarashi, Akira Shimoyama, Tomohisa Nomura, Tasuku Matsuyama, Jun Maki, Akemi Utsunomiya, Kazuya Kikutani, Kei Nishiyama, Joji Kotani, Megumi Moriyasu, Yasuhiro Kuroda, Hiromi Kato, Ryuta Itakura, Seitaro Fujishima, Yusuke Kawamura, Kazuyuki Oka, Hiroyuki Koami, Asuka Tsuchiya, Jun Okamoto, Yasuhiro Shiga, Hiroki Saito, Masaharu Nagae, Hiroyuki Ohbe, Kenji Sonota, Kentaro Tomita, Yutaka Kondo, Sho Kimura, Haruki Imura, Taiki Haga, Satoshi Ono, Tomoaki Yatabe, Yuki Enomoto, Yohei Hirano, Yuji Suzuki, Jun Takeshita, Kentaro Ide, Junji Hatakeyama, Kazuyuki Miyamoto, Naoki Tominaga, Masanori Tani, Hideo Tohira, Yuhta Oyama, Toru Hifumi, Yuji Miyatake, Kohei Yamada, Yoshimi Nakamura, Hiromu Naraba, Hideki Asai, Daisuke Kudo, Mitsunobu Toyosaki, Yuhei Yoshida, Takaki Naito, Hideaki Sakuramoto, Naoto Hosokawa, Takao Yano, Shutaro Isokawa, Hiroshi Yonekura, Masaki Nakane, Shusuke Sekine, Hiroshi Takahashi, Atsuki Hayamizu, Masami Ishikawa, Ryo Yamamoto, Tomoya Nishimura, Iwao Saiki, Hiromichi Naito, Go Haraguchi, Kenichi Tetsuhara, Hideki Hashimoto, Toru Yamada, Yosuke Matsumura, Yuko Egawa, Daisuke Hasegawa, Noritaka Ushio, Takanori Ohno, Teppei Murata, Mai Inada, Osamu Nishida, Motoki Fujita, Masahito Horiguchi, Jumpei Yoshimura, Nobunaga Okada, Hitoshi Kikuchi, Nana Furushima, Koji Endo, Yasuhiro Norisue, Yuya Miyazaki, Chikashi Takeda, Shinya Shimoyama, Takumi Taniguchi, Tadashi Kaneko, Takuya Hayashi, Kenji Kubo, Toshiaki Iba, Yutaka Umemura, Chihiro Narita, Tadashi Nagato, Hiroomi Tatsumi, Takeshi Yoshida, Satoshi Suzuki, Isao Nahara, Takashi Tagami, Akihito Tampo, Tatsuya Kawasaki, Kensuke Nakamura, Shuhei Takauji, Shin Nunomiya, Yujiro Matsuishi, Yusuke Tsutsumi, Kent Doi, Katsuhiko Hashimoto, Norihiro Nishioka, Shigeki Kushimoto, Keita Kanehata, Naoki Higashibeppu, Kohkichi Andoh, Go Ishimaru, Nozomi Takahashi, Takeshi Umegaki, Isao Nagata, Ryosuke Tsuruta, Keisuke Minami, Yoko Takahashi, Hirotaka Furusono, Yusuke Kawai, Naoya Iguchi, Takero Terayama, Hisashi Imahase, Akira Ouchi, Hiroshi Tanaka, Yoshihiro Tomioka, Motohiro Sekino, Yoshihiro Hagiwara, Takayuki Ogura, Hiraku Funakoshi, Tomoya Hirose, Hiroshi Okuda, Morihiro Katsura, Takeshi Wada, Shinya Miura, Sho Takahashi, Yu Inata, Sei Takahashi, Shigeaki Inoue, Hiroyuki Yamada, Takeshi Suzuki, Kiyoyasu Kurahashi, Yoshitaka Aoki, Yuki Nakamori, Moritoki Egi, Toshiaki Hamasaki, Minoru Hayashi, Naoki Hara, Ichiro Nagasawa, Naoyuki Fujimura, Shunsuke Taito, Tetsuro Nishimura, Shodai Yoshihiro, Yoshifumi Ohchi, Yu Onodera, Tomohiro Suhara, Machi Yanai, Naoyuki Matsuda, Masayuki Ozaki, Yohei Okada, Takeshi Hatachi, Tomohisa Shoko, Naohisa Masunaga, Masahiro Kashiura, Yoshitaka Hara, Ryoichi Miyashita, Matsuyuki Doi, Kentaro Tokunaga, Kenta Ito, Akihiro Kanaya, Eisuke Kako, Taichiro Tsunoyama, Tadashi Ishihara, Makoto Aoki, Nobuaki Shime, Tatsuma Fukuda, Kohei Ota, Kei Hayashida, Ken ichi Kano, Masahito Sakai, Takashi Irinoda, Taka-aki Nakada, Atsushi Kawaguchi, Takakuni Abe, Manabu Shimoto, Yuki Iida, Takahiro Kido, Tetsuya Sato, Yusuke Minematsu, Kohei Takashima, Yusuke Ito, Shinichiro Ohshimo, and Hideto Yasuda
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medicine.medical_specialty ,Weakness ,Acute medicine ,Guideline ,Critical Care and Intensive Care Medicine ,Sepsis ,sepsis ,systematic review ,Multidisciplinary approach ,Medicine ,guidelines ,Intensive care medicine ,Treatment system ,evidence‐based medicine ,RC86-88.9 ,business.industry ,Septic shock ,General Engineering ,Medical emergencies. Critical care. Intensive care. First aid ,Evidence-based medicine ,medicine.disease ,Clinical Practice ,GRADE ,septic shock ,medicine.symptom ,business ,evidence-based medicine - 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., other authors: Satoru Hashimoto,Daisuke Hasegawa,Junji Hatakeyama,Naoki Hara,Naoki Higashibeppu,Nana Furushima,Hirotaka Furusono,Yujiro Matsuishi,Tasuku Matsuyama,Yusuke Minematsu,Ryoichi Miyashita,Yuji Miyatake,Megumi Moriyasu,Toru Yamada,Hiroyuki Yamada,Ryo Yamamoto,Takeshi Yoshida,Yuhei Yoshida,Jumpei Yoshimura,Ryuichi Yotsumoto,Hiroshi Yonekura,Takeshi Wada,Eizo Watanabe,Makoto Aoki,Hideki Asai,Takakuni Abe,Yutaka Igarashi,Naoya Iguchi,Masami Ishikawa,Go Ishimaru,Shutaro Isokawa,Ryuta Itakura,Hisashi Imahase,Haruki Imura,Takashi Irinoda,Kenji Uehara,Noritaka Ushio,Takeshi Umegaki,Yuko Egawa,Yuki Enomoto,Kohei Ota,Yoshifumi Ohchi,Takanori Ohno,Hiroyuki Ohbe,Kazuyuki Oka,Nobunaga Okada,Yohei Okada,Hiromu Okano,Jun Okamoto,Hiroshi Okuda,Takayuki Ogura,Yu Onodera,Yuhta Oyama,Motoshi Kainuma,Eisuke Kako,Masahiro Kashiura,Hiromi Kato,Akihiro Kanaya,Tadashi Kaneko,Keita Kanehata,Ken-ichi Kano,Hiroyuki Kawano,Kazuya Kikutani,Hitoshi Kikuchi,Takahiro Kido,Sho Kimura,Hiroyuki Koami,Daisuke Kobashi,Iwao Saiki,Masahito Sakai,Ayaka Sakamoto,Tetsuya Sato,Yasuhiro Shiga,Manabu Shimoto,Shinya Shimoyama,Tomohisa Shoko,Yoh Sugawara,Atsunori Sugita,Satoshi Suzuki,Yuji Suzuki,Tomohiro Suhara,Kenji Sonota,Shuhei Takauji,Kohei Takashima,Sho Takahashi,Yoko Takahashi,Jun Takeshita,Yuuki Tanaka,Akihito Tampo,Taichiro Tsunoyama,Kenichi Tetsuhara,Kentaro Tokunaga,Yoshihiro Tomioka,Kentaro Tomita,Naoki Tominaga,Mitsunobu Toyosaki,Yukitoshi Toyoda,Hiromichi Naito,Isao Nagata,Tadashi Nagato,Yoshimi Nakamura,Yuki Nakamori,Isao Nahara,Hiromu Naraba,Chihiro Narita,Norihiro Nishioka,Tomoya Nishimura,Kei Nishiyama,Tomohisa Nomura,Taiki Haga,Yoshihiro Hagiwara,Katsuhiko Hashimoto,Takeshi Hatachi,Toshiaki Hamasaki,Takuya Hayashi,Minoru Hayashi,Atsuki Hayamizu,Go Haraguchi,Yohei Hirano,Ryo Fujii,Motoki Fujita,Naoyuki Fujimura,Hiraku Funakoshi,Masahito Horiguchi,Jun Maki,Naohisa Masunaga,Yosuke Matsumura,Takuya Mayumi,Keisuke Minami,Yuya Miyazaki,Kazuyuki Miyamoto,Teppei Murata,Machi Yanai,Takao Yano,Kohei Yamada,Naoki Yamada,Tomonori Yamamoto,Shodai Yoshihiro,Hiroshi Tanaka,Osamu Nishida, Guidelines
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- 2021
179. Development of Novel Criteria of the 'Lethal Triad' as an Indicator of Decision Making in Current Trauma Care
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Arino Yaguchi, Kiyoshi Murata, Daizoh Saitoh, Kazutaka Nishiyama, Toshifumi Uejima, Munekazu Takeda, Yasushi Hagiwara, Daisuke Kudo, Yasuhiro Otomo, Akira Endo, Takashi Kanemura, Yoshihiko Nakamura, Atsushi Shiraishi, Akiyoshi Hagiwara, Hiroshi Ogura, Naoto Morimura, Osamu Takasu, Tetsuya Matsuoka, Naoyuki Kaneko, Junichi Sasaki, Gou Mayama, Shiei Kim, Hiroyasu Ishikura, Shintaro Furugori, Kunihiko Maekawa, Mineji Hayakawa, Takayuki Shibusawa, Hiroshi Kato, and Shigeki Kushimoto
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Clinical Decision-Making ,MEDLINE ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Body Temperature ,03 medical and health sciences ,Triad (sociology) ,Injury Severity Score ,0302 clinical medicine ,Japan ,Predictive Value of Tests ,Outcome Assessment, Health Care ,Health care ,Humans ,Medicine ,Child ,Intensive care medicine ,Aged ,Retrospective Studies ,Blood coagulation test ,business.industry ,030208 emergency & critical care medicine ,Retrospective cohort study ,Middle Aged ,Prognosis ,Child, Preschool ,Predictive value of tests ,Wounds and Injuries ,Female ,Observational study ,Blood Coagulation Tests ,business - Abstract
To evaluate the utility of the conventional lethal triad in current trauma care practice and to develop novel criteria as indicators of treatment strategy.Retrospective observational study.Fifteen acute critical care medical centers in Japan.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.None.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%.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.
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- 2016
180. Modified traumatic bleeding severity score: early determination of the need for massive transfusion
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Alan Kawarai Lefor, Takayuki Ogura, Mamoru Masuda, and Shigeki Kushimoto
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Adult ,Male ,Resuscitation ,Blood transfusion ,medicine.medical_treatment ,Hemorrhage ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Injury Severity Score ,0302 clinical medicine ,Predictive Value of Tests ,Humans ,Medicine ,Blood Transfusion ,Aged ,Retrospective Studies ,Aged, 80 and over ,Receiver operating characteristic ,business.industry ,030208 emergency & critical care medicine ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Blood pressure ,ROC Curve ,Predictive value of tests ,Anesthesia ,Emergency Medicine ,Pelvic fracture ,Wounds and Injuries ,Female ,business ,Needs Assessment - Abstract
Background Determination of the need for massive transfusion (MT) is essential for early activation of a MT protocol. The Traumatic Bleeding Severity Score (TBSS) predicts the need for MT accurately, but takes time to determine because systolic blood pressure after a 1000mL of crystalloid infusion is used. The aim of this study is to determine the how well the Modified TBSS (age, sonography, pelvic fracture, serum lactate and systolic blood pressure on arrival) predicts the need for MT (accuracy). Methods This is a single-center retrospective study of trauma patients (Injury Severity Score ≧16) admitted between 2010 and 2014. The TBSS, the Trauma Associated Severe Hemorrhage (TASH) Score, and the Modified TBSS were calculated. MT is defined as ≧10 U packed red blood cell transfusion within 24hours of injury, and the predictive value of the need for MT was compared by area under the receiver operating characteristic curve (AUC) analysis among three scores. Results Three hundred patients were enrolled, and MT given to 25% of patients. Although the AUC of the TBSS was higher than that of the TASH score (0.956 vs 0.912, P =.006) and the Modified TBSS (0.956 vs 0.915, P =.001), there was no difference between the AUC of the Modified TBSS and the TASH score. The Modified TBSS has high accuracy, within an AUC >0.9. Conclusion The predictive value of the Modified TBSS of the need for MT is still high and is equivalent to the TASH score. The Modified TBSS is calculated earlier in resuscitation than the original TBSS.
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- 2016
181. Severe sepsis caused by Capnocytophaga canimorsus complicated by thrombotic microangiopathy in an immunocompetent patient
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Shigeki Kushimoto, Keiichiro Asanuma, Daisuke Takekoshi, Shota Maezawa, Daisuke Kudo, and Ryuichiro Egashira
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Hemolytic anemia ,medicine.medical_specialty ,Thrombotic microangiopathy ,Renal function ,Case Report ,Case Reports ,030204 cardiovascular system & hematology ,dog bite ,Gastroenterology ,sepsis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Coagulopathy ,Capnocytophaga canimorsus ,Medical history ,Platelet ,Blood culture ,030212 general & internal medicine ,biology ,medicine.diagnostic_test ,business.industry ,General Engineering ,biology.organism_classification ,medicine.disease ,Surgery ,Acute kidney injury ,thrombotic microangiopathy ,business - Abstract
Case A 61-year-old man with an unremarkable medical history was admitted with fever 7 days after being bitten by his dog. On day 3, he showed altered mental status, and laboratory data showed progressive hemolytic anemia, thrombocytopenia, hyperbilirubinemia, renal dysfunction, coagulopathy, and schistocytosis. Severe sepsis complicated with thrombotic microangiopathy caused by Capnocytophaga canimorsus was suspected. Outcome Plasma exchange was applied to treat the thrombotic microangiopathy and resulted in platelet count increase and improved renal function, hyperbilirubinemia, and schistocytosis. Blood culture results confirmed the presence of C. canimorsus. The patient was discharged in good condition. Conclusion Capnocytophaga canimorsus is rare cause of severe sepsis, and should be suspected even in immunocompetent patients with dog-bite history. Capnocytophaga canimorsus infection may be complicated by thrombotic microangiopathy, for which plasma exchange should be considered prior to definitive diagnosis of thrombotic microangiopathy.
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- 2016
182. Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock
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Satoshi Gando, Yoshihiro Yamaguchi, Yasushi Suzuki, Tsunetoshi Araki, Naoshi Takeyama, Shin-Ichiro Shiraishi, Joji Kotani, Seitaro Fujishima, Toshihiko Mayumi, Kiyotsugu Takuma, Shigeki Kushimoto, Naoki Aikawa, Yasuo Miki, Norio Yamashita, Hiroshi Ogura, Koichiro Suzuki, Saitoh Daizoh, Hiroto Ikeda, and Ryosuke Tsuruta
- Subjects
Pulmonary and Respiratory Medicine ,Disseminated intravascular coagulation ,Resuscitation ,medicine.medical_specialty ,Septic shock ,business.industry ,animal diseases ,030208 emergency & critical care medicine ,respiratory system ,Lung injury ,Focal infection theory ,medicine.disease ,respiratory tract diseases ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Internal medicine ,medicine ,Multiple organ dysfunction syndrome ,business ,Prospective cohort study ,Intensive care medicine - Abstract
Background and objective Sepsis is a leading cause of acute lung injury (ALI); however, the characteristics and outcome of sepsis-associated ALI are poorly understood. We aimed to elucidate factors that predict patient outcome in sepsis-associated ALI. Methods Secondary analysis of a multicenter, prospective, observational study was performed. Results Among 624 patients with severe sepsis and septic shock, 251 (40.2%) fulfilled the definition of American–European Consensus Conference definition of ALI. All-cause 28-day and in-hospital mortalities were 30.7% and 38.6%, respectively. More than 40% of ALI patients had neurological, cardiovascular and haematological dysfunctions or disseminated intravascular coagulation, all of which were associated with higher mortality. We report a significant correlation between infection site and mortality in patients with ALI, but not in those without ALI. The proportion of ALI was significantly higher in pulmonary sepsis; further, a complication of ALI was associated with higher mortality in sepsis from pulmonary and other sources, but not in abdominal sepsis. Among the other sepsis sites, urinary tract, central nervous system, catheter-related and undetermined foci of infection had worse outcomes when associated with ALI. None of the individual severe sepsis bundles, including fluid resuscitation and early antibiotic administration, correlated with mortality. Compliance with a set of sepsis management bundles was associated with better outcomes. Conclusion In severe sepsis and septic shock, the proportion and effect on outcome was not uniform among infection sites. The infection site was predictive of outcome in patients with ALI but not in those without ALI.
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- 2016
183. High D-Dimer Levels Predict a Poor Outcome in Patients with Severe Trauma, Even with High Fibrinogen Levels on Arrival
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Shiei Kim, Hiroshi Kato, Shigeki Kushimoto, Takayuki Shibusawa, Kunihiko Maekawa, Naoyuki Kaneko, Yoshihiko Nakamura, Atsushi Shiraishi, Hiroshi Ogura, Hiroyasu Ishikura, Arino Yaguchi, Daizoh Saitoh, Shintaro Furugori, Akiyoshi Hagiwara, Osamu Takasu, Junichi Sasaki, Munekazu Takeda, Gou Mayama, Kazutaka Nishiyama, Toshifumi Uejima, Tetsuya Matauoka, Mineji Hayakawa, Takashi Kanemura, Naoto Morimura, Daisuke Kudo, and Kiyoshi Murata
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Adult ,Male ,medicine.medical_specialty ,Critical Care and Intensive Care Medicine ,Fibrinogen ,Gastroenterology ,Disease-Free Survival ,coagulopathy ,Fibrin Fibrinogen Degradation Products ,Mice ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,D-dimer ,medicine ,Coagulopathy ,Animals ,Humans ,030212 general & internal medicine ,Survival rate ,disseminated intravascular coagulation ,transfusion ,Aged ,Retrospective Studies ,Disseminated intravascular coagulation ,Trauma Severity Indices ,business.industry ,030208 emergency & critical care medicine ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Hyperfibrinolysis ,Survival Rate ,Immunology ,Emergency Medicine ,Wounds and Injuries ,Injury Severity Score ,fibrinolysis ,multiple trauma ,Erythrocyte Transfusion ,business ,medicine.drug - Abstract
Elevated D-dimer level in trauma patients is associated with tissue damage severity and is an indicator of hyperfibrinolysis during the early phase of trauma. To investigate the interacting effects of fibrinogen and D-dimer levels on arrival at the emergency department for massive transfusion and mortality in severe trauma patients in a multicentre retrospective study. This study included 519 adult trauma patients with an injury severity score ≥16. Patients with ≥10 units of red cell concentrate transfusion and/or death during the first 24 hours were classified as having a poor outcome. Receiver operating characteristic curve analysis for predicting poor outcome showed the optimal cut-off fibrinogen and D-dimer values to be 190 mg/dL and 38 mg/L, respectively. Based on these values, patients were divided into four groups: (1) low D-dimer (190 mg/dL), (2) low D-dimer (190 mg/dL), and (4) high D-dimer (≥38 mg/L)/low fibrinogen (≤190 mg/dL). The survival rate was lower in the high D-dimer/low fibrinogen group than in the other groups. Moreover, the survival rate was lower in the high D-dimer/high fibrinogen group than in the low D-dimer/high fibrinogen and low D-dimer/low fibrinogen groups. High D-dimer level on arrival is a strong predictor of early death or requirement for massive transfusion in severe trauma patients, even with high fibrinogen levels.
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- 2016
184. Delayed autonomic neuropathy in a patient with diethylene glycol poisoning: a case report
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Hiroki Kamada, Shigeki Kushimoto, Saori Yamamoto, Hideaki Suzuki, and Ryosuke Nomura
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Artificial ventilation ,medicine.medical_treatment ,Case Report ,Case Reports ,Acetamiprid ,03 medical and health sciences ,Orthostatic vital signs ,chemistry.chemical_compound ,0302 clinical medicine ,Sensorimotor neuropathy ,medicine ,Tilt test ,030212 general & internal medicine ,business.industry ,diethylene glycol ,General Engineering ,Diethylene glycol ,Muscle weakness ,delayed neuropathy ,Sympathetic activity ,poisoning ,chemistry ,Anesthesia ,medicine.symptom ,Autonomic neuropathy ,business ,autonomic neuropathy ,030217 neurology & neurosurgery - Abstract
Case A 72-year-old man presented to our hospital after ingesting insecticide containing approximately 2 mL/kg diethylene glycol, which exceeded the lethal dose of 1 mL/kg. The patient recovered from critical symptoms on acute phase until day 3, but received artificial ventilation for muscle weakness secondary to sensorimotor neuropathy on days 11–54. Outcome Even after marked improvement from sensorimotor neuropathy, the patient continued to complain of orthostatic hypotension. Autonomic neuropathy was identified by positive result of a head-up tilt test, and reduction in coefficient of variation of R-R intervals and cardiac iodine-123-metaiodobenzylguanidine uptake for the assessment of cardiac sympathetic activity. The patient's symptoms fully recovered 2 years after the exposure to diethylene glycol. Conclusion This case shows the first report of delayed autonomic neuropathy after recovery from severe sensorimotor neuropathy, and suggests the importance of continuous monitoring for late-onset neurological complications.
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- 2017
185. Association of frailty on treatment outcomes among patients with suspected infection treated at emergency departments.
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Shigeto Ishikawa, Ippei Miyagawa, Masashi Kusanaga, Toshikazu Abe, Atsushi Shiraishi, Seitaro Fujishima, Hiroshi Ogura, Daizoh Saitoh, Shigeki Kushimoto, Yasukazu Shiino, Toru Hifumi, Yasuhiro Otomo, Kohji Okamoto, Joji Kotani, Yuichiro Sakamoto, Junichi Sasaki, Shin-ichiro Shiraishi, Kiyotsugu Takuma, Akiyoshi Hagiwara, and Kazuma Yamakawa
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- 2021
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186. Impacts of Natural Environmental Factors and Prevalence of Airway Symptoms on the Local Spread of COVID-19: A Time- Series Analysis in Regional COVID-19 Epidemics.
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Tadashi Ishii, Shigeki Kushimoto, Yukio Katori, Shigeo Kure, Kaoru Igarashi, Motoo Fujita, Noriko Sugawara, Shin Takayama, Michiaki Abe, Junichi Tanaka, Akiko Kikuchi, Yoshiko Abe, Hiroyuki Imai, Yohei Inaba, Yoko Iwamatsu-Kobayashi, Takashi Nishioka, Ko Onodera, and Tetsuya Akaishi
- Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the world's largest public health concern in 2021. This study evaluated the associations of the prevalence of airway symptoms among the tested individuals and data regarding the natural environmental factors with the weekly number of newly diagnosed COVID-19 patients in Sendai City (Nt). For the derivatives of the screening test results, data from individuals with a contact history who underwent nasopharyngeal swab reverse transcription-polymerase chain reaction (RT-PCR) testing between July 2020 and April 2021 (6,156 participants, including 550 test-positive patients) were used. The value of Nt correlated with the weekly RT-PCR test-positive rate after close contact, prevalence of cough symptoms in test-positive individuals or in test-negative individuals, lower air temperature, lower air humidity, and higher wind speed. The weekly test-positive rate correlated with lower air humidity and higher wind speed. In cross-correlation analyses, natural environmental factors correlated with the regional epidemic status on a scale of months, whereas the airway symptoms among non-COVID-19 population affected on a scale of weeks. When applying an autoregression model to the serial data of Nt, large-scale movements of people were suggested to be another factor to influence the local epidemics on a scale of days. In conclusion, the prevalence of cough symptoms in the local population, lower air humidity or higher wind speed, and largescale movements of people in the locality would jointly influence the local epidemic status of COVID-19. [ABSTRACT FROM AUTHOR]
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- 2021
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187. History of diabetes may delay antibiotic administration in patients with severe sepsis presenting to emergency departments
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Ryosuke Tsuruta, Takehiro Sugiyama, Kiyotsugu Takuma, Yutaka Umemura, Kazuma Yamakawa, Tomohiko Masuno, Atsushi Shiraishi, Masashi Ueyama, Yasukazu Shiino, Yuichiro Sakamoto, Shin-Ichiro Shiraishi, Junichi Sasaki, Akira Komori, Joji Kotani, Shigeki Kushimoto, Hiroto Ikeda, Kohji Okamoto, Tomoharu Suzuki, Toru Hifumi, Seitaro Fujishima, Yasuhiro Otomo, Hiroki Iriyama, Akiyoshi Hagiwara, Takehiko Tarui, Toshikazu Abe, Norio Yamashita, Masao Iwagami, Hiroshi Ogura, Daizoh Saitoh, Taka-aki Nakada, Satoshi Gando, Naoshi Takeyama, and Toshihiko Mayumi
- Subjects
Male ,medicine.medical_specialty ,Observational Study ,protocols ,Logistic regression ,Time-to-Treatment ,Sepsis ,sepsis ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Interquartile range ,Internal medicine ,Intensive care ,medicine ,Humans ,Hospital Mortality ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Septic shock ,Mortality rate ,Retrospective cohort study ,General Medicine ,Odds ratio ,medicine.disease ,Anti-Bacterial Agents ,comorbidity ,030220 oncology & carcinogenesis ,diabetes mellitus ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Female ,Emergency Service, Hospital ,business ,bundle ,Research Article - Abstract
Supplemental Digital Content is available in the text, Clinical manifestations of sepsis differ between patients with and without diabetes mellitus (DM), and these differences could influence the clinical behaviors of medical staff. Therefore, we aimed to investigate whether pre-existing DM was associated with the time to antibiotics or sepsis care protocols. This was a retrospective cohort study. It conducted at 53 intensive care units (ICUs) in Japan. Consecutive adult patients with severe sepsis admitted directly to ICUs form emergency departments from January 2016 to March 2017 were included. The primary outcome was time to antibiotics. Of the 619 eligible patients, 142 had DM and 477 did not have DM. The median times (interquartile ranges) to antibiotics in patients with and without DM were 103 minutes (60–180 minutes) and 86 minutes (45–155 minutes), respectively (P = .05). There were no significant differences in the rates of compliance with sepsis protocols or with patient-centred outcomes such as in-hospital mortality. The mortality rates of patients with and without DM were 23.9% and 21.6%, respectively (P = .55). Comparing patients with and without DM, the gamma generalized linear model-adjusted relative difference indicated that patients with DM had a delay to starting antibiotics of 26.5% (95% confidence intervals (95%CI): 4.6–52.8, P = .02). The gamma generalized linear model-adjusted relative difference with multiple imputation for missing data of sequential organ failure assessment was 19.9% (95%CI: 1.0–42.3, P = .04). The linear regression model-adjusted beta coefficient indicated that patients with DM had a delay to starting antibiotics of 29.2 minutes (95%CI: 6.8–51.7, P = .01). Logistic regression modelling showed that pre-existing DM was not associated with in-hospital mortality (odds ratio, 1.26; 95%CI: 0.72–2.19, P = .42). Pre-existing DM was associated with delayed antibiotic administration among patients with severe sepsis or septic shock; however, patient-centred outcomes and compliance with sepsis care protocols were comparable.
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- 2020
188. Prosthetic Valve Endocarditis Diagnosed by
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Shigeo, Godo and Shigeki, Kushimoto
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Male ,Prosthesis-Related Infections ,Endocarditis ,Fluorodeoxyglucose F18 ,Aortic Valve ,Heart Valve Prosthesis ,Positron Emission Tomography Computed Tomography ,Humans ,Aged - Published
- 2018
189. Analysis of risk factors for hyponatremia in patients with acute spinal cord injury: a retrospective single-institution study in Japan
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Tomoaki Koakutsu, Shigeki Kushimoto, and Hiroyuki Ohbe
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Adult ,Male ,030506 rehabilitation ,medicine.medical_specialty ,Traumatic brain injury ,Deep vein ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Spinal cord injury ,Spinal Cord Injuries ,Aged ,Retrospective Studies ,Abbreviated Injury Scale ,business.industry ,Trauma center ,nutritional and metabolic diseases ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Pneumonia ,medicine.anatomical_structure ,Neurology ,Acute Disease ,Female ,Neurology (clinical) ,0305 other medical science ,business ,Hyponatremia - Abstract
Retrospective single-institution observational study.Spinal cord injury (SCI) is associated with a high prevalence of hyponatremia, which can cause various clinical symptoms and increase mortality. We aimed to analyze the risk factors for hyponatremia in patients with acute SCI.Trauma Center, Tohoku University Hospital, Japan METHODS: We reviewed the medical records of patients with SCI admitted between January 2008 and November 2016. Least angle regression analyses was performed to assess the association between hyponatremia and other parameters.Of the 213 enrolled patients, 85 (40%) had hyponatremia (serum Na 135 mmol/L) whilst 19 (9%) had severe hyponatremia (serum Na 130 mmol/L). Least angle regression analyses revealed that hyponatremia was significantly associated with higher American Spinal Injury Association impairment scale, nosocomial pneumonia, deep vein thrombosis, bradycardia, and surgery for SCI before developing hyponatremia. Severe hyponatremia was significantly associated with traumatic brain injury with an abbreviated injury scale score ≥3, higher American Spinal Injury Association impairment scale, bradycardia, vasopressors, and nosocomial pneumonia.Various factors including traumatic brain injury with an abbreviated injury scale score ≥3 and higher American Spinal Injury Association impairment scale may be associated with hyponatremia in patients with acute SCI. These factors can help clinicians identify and monitor SCI patients with a higher hyponatremia risk, and potentially help patients to avoid severe complications.
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- 2018
190. Coagulation Factor Plasma Levels Following Administration of a 4-Factor Prothrombin Complex Concentrate for Rapid Vitamin K Antagonist Reversal in Japanese Patients
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Andres Brainsky, Peijin Zhang, Shigeki Kushimoto, and Masahiro Yasaka
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Vitamin ,medicine.medical_specialty ,medicine.drug_class ,Population ,030204 cardiovascular system & hematology ,Gastroenterology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Pharmacokinetics ,Internal medicine ,medicine ,Pharmacology (medical) ,education ,Adverse effect ,Pharmacology ,education.field_of_study ,business.industry ,lcsh:RM1-950 ,030208 emergency & critical care medicine ,Plasma levels ,Vitamin K antagonist ,Prothrombin complex concentrate ,lcsh:Therapeutics. Pharmacology ,Coagulation ,chemistry ,business ,medicine.drug - Abstract
Background: Four-factor prothrombin complex concentrates (4F-PCCs) have been approved for urgent vitamin K antagonist reversal in Western countries for many years. Ethnicity and genetic variations between populations may influence the pharmacokinetic profile of 4F-PCC treatments. Objective: To report plasma levels of vitamin K-dependent coagulation factors and proteins C and S in Japanese patients following administration of a 4F-PCC approved recently in Japan. Methods: This was a subanalysis of a prospective, open-label, Phase IIIb study in Japanese patients requiring rapid vitamin K antagonist reversal owing to major bleeding (n = 6) or need for urgent surgery (n = 5). International normalized ratio and plasma levels of factors II, VII, IX, and X, and proteins C and S were measured before PCC infusion and at specific time points for the next 24 hours. Adverse events and serious adverse events were recorded up to Day 14 and 45, respectively. Results: Rapid increases in plasma concentrations 30 minutes following 4F-PCC infusion were seen for all factors and proteins C and S, with median concentrations compared with baseline increasing by ≥100% and 70% in the bleeding and surgical groups, respectively. A concurrent decrease in international normalized ratio was observed. Plasma levels for each factor and protein remained within physiologic levels throughout the assessment period. No relationship between thromboembolic events and elevated plasma levels was identified. Conclusions: Administration of 4F-PCC in Japanese patients receiving vitamin K antagonist anticoagulation therapy resulted in rapid and sustained increases in plasma levels and was well tolerated, indicating that this treatment is effective for the urgent reversal of vitamin K antagonist therapy in this population. Key words: Coagulation factor, Hemorrhage, Prothrombin complex concentrate, Surgery, Vitamin K antagonist
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- 2018
191. Complementary Role of Hypothermia Identification to the Quick Sequential Organ Failure Assessment Score in Predicting Patients With Sepsis at High Risk of Mortality: A Retrospective Analysis From a Multicenter, Observational Study
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Kiyotsugu Takuma, Yutaka Umemura, Hiroto Ikeda, Naoshi Takeyama, Ryosuke Tsuruta, Koichiro Suzuki, Shigeki Kushimoto, Naoki Aikawa, Satoshi Gando, Toshihiko Mayumi, Daizoh Saitoh, Norio Yamashita, Yasushi Suzuki, Hiroshi Ogura, Seitaro Fujishima, Joji Kotani, Yoshihiro Yamaguchi, Atsushi Shiraishi, Shin Ichiro Shiraishi, Toshikazu Abe, and Yasuo Miki
- Subjects
Male ,medicine.medical_specialty ,Organ Dysfunction Scores ,Hypothermia ,Critical Care and Intensive Care Medicine ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk of mortality ,medicine ,Retrospective analysis ,Humans ,Hospital Mortality ,Prospective Studies ,Aged ,Retrospective Studies ,Aged, 80 and over ,Sequential organ failure assessment ,business.industry ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,Intensive Care Units ,030228 respiratory system ,Emergency medicine ,Observational study ,Female ,medicine.symptom ,business - Abstract
Background: Although the quick Sequential Organ Failure Assessment (qSOFA) has been recommended for identifying patients at higher risk of hospital death, it has only a 60% sensitivity for in-hospital mortality. On the other hand, hypothermia associates with increased mortality and organ failure in patients with sepsis. This study aimed to assess the predictive validity of qSOFA for identifying patients with sepsis at higher risk of multiple organ dysfunction or death and the complementary effect of hypothermia. Methods: Patients with severe sepsis admitted to intensive care units (ICUs) were retrospectively analyzed. The predictive validities of qSOFA (≥2, positive) and the complementary effect of hypothermia (body temperature ≤36.5°C) for the identification of death or multiorgan dysfunction were evaluated. Results: Of the 624 patients, 230 (36.9%) developed multiorgan dysfunction and 144 (23.1%) died within 28 days; 527 (84.5%) had a positive qSOFA. The 28-day mortality rates of patients with positive and negative qSOFA were 25.4% and 10.3%, respectively ( P = .001). The rate of positive qSOFA was higher in patients with multiorgan dysfunction (sensitivity, 0.896; specificity, 0.185) and among patients who died within 28 days (sensitivity, 0.931; specificity, 0.181); 10 (6.9%) of 144 deaths were not identified. In cases of positive qSOFA without hypothermia, positive qSOFA + hypothermia, or negative qSOFA with hypothermia, the predictive value for 28-day mortality improved (sensitivity, 0.979). Among the 144 patients who died, only 3 were not identified. Conclusion: A qSOFA score ≥2 may identify >90% of 28-day deaths among patients with severe sepsis; hypothermia may complement the predictive ability of qSOFA.
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- 2018
192. Prosthetic Valve Endocarditis Diagnosed by 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography
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Shigeki Kushimoto and Shigeo Godo
- Subjects
Fluorodeoxyglucose positron emission tomography ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Medicine ,Computed tomography ,General Medicine ,Radiology ,business ,Prosthetic valve endocarditis - Published
- 2019
193. Streptococcus pneumoniae bacteremia in patients with the acute phase of severe acute pancreatitis: a case report
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Takeaki Sato, Yuta Yokokawa, and Shigeki Kushimoto
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medicine.medical_specialty ,business.industry ,Bacteremia ,Internal medicine ,Streptococcus pneumoniae ,Medicine ,Acute pancreatitis ,In patient ,business ,medicine.disease ,medicine.disease_cause ,Gastroenterology - Published
- 2019
194. Lumbar artery injury from which the Adamkiewicz artery originated associated with lumbar spine injury: successfully treated by transcatheter arterial embolization
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Shigeki Kushimoto, Toshimi Aizawa, Eiji Itoi, Tomoaki Koakutsu, and Hironao Yuzawa
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Male ,musculoskeletal diseases ,medicine.medical_specialty ,Collateral Circulation ,Hemorrhage ,Lumbar vertebrae ,Crush Injuries ,03 medical and health sciences ,0302 clinical medicine ,Psoas major muscle ,medicine.artery ,medicine ,Humans ,Orthopedics and Sports Medicine ,Lumbar Vertebrae ,business.industry ,Arterial Embolization ,Angiography ,030208 emergency & critical care medicine ,Arteries ,Middle Aged ,Collateral circulation ,Spinal cord ,Embolization, Therapeutic ,Surgery ,medicine.anatomical_structure ,Spine injury ,Radiology ,business ,Intercostal arteries ,030217 neurology & neurosurgery ,Lumbar arteries - Abstract
Lumbar artery injury associated with lumbar spine injury can be a cause of shock leading to life-threatening condition. The Adamkiewicz artery often bifurcates from a lumbar spine or an intercostal artery at the thoracolumbar junction, where spine injury most commonly occurs. However, in emergency transcatheter arterial embolization for lumbar artery injury, hemostasis has priority and blood supply to the Adamkiewicz artery is not frequently confirmed. The aim of this report is to present the case of lumbar spine injury with lumbar artery injury from which the Adamkiewicz artery bifurcated. Retrospective description of a case. A 58-year-old man was pinned under about 300-kg steel container that fell on his back. He was transported to our hospital presented with hemorrhagic shock. Contrast-enhanced computed tomography demonstrated L1–2 flexion-distraction injury and the left psoas major muscle swelling with extravasation of contrast medium, which suspected lumbar artery injury. Emergency angiography demonstrated the bilateral 2nd lumbar artery injury. Likewise, the Adamkiewicz artery originated from the distal part of the left 2nd lumbar artery. Fortunately, selective angiography of the left 1st lumbar artery depicted collateral circulation to the Adamkiewicz artery. Embolization of the bilateral 2nd lumbar artery was performed and massive hemorrhage was controlled successfully without spinal cord ischemia. Close attention must be paid to lumbar artery injury in the management of patients with lumbar spine injury. Once lumbar artery injury is found, transcatheter arterial embolization can be the choice of the treatment with careful attention to the Adamkiewicz artery.
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- 2015
195. Novel clinical grading of delayed neurologic sequelae after carbon monoxide poisoning and factors associated with outcome
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Shigeki Kushimoto, Kazuo Fujihara, Masashi Aoki, and Hiroshi Kuroda
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Poison control ,Fluid-attenuated inversion recovery ,Toxicology ,Risk Assessment ,Severity of Illness Index ,Carbon Monoxide Poisoning ,Young Adult ,Cerebrospinal fluid ,Japan ,Predictive Value of Tests ,Risk Factors ,Interquartile range ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Neurologic sequelae ,Grading (tumors) ,Aged ,Aged, 80 and over ,Carbon monoxide poisoning ,business.industry ,General Neuroscience ,fungi ,Age Factors ,Myelin Basic Protein ,Middle Aged ,Prognosis ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,Acute Disease ,Clinical value ,Female ,Neurotoxicity Syndromes ,business ,Biomarkers - Abstract
Delayed neurologic sequelae (DNS) after carbon monoxide (CO) poisoning manifest as a relapse of neurologic deficits. However, the long-term outcome of DNS has not been fully clarified. Myelin basic protein (MBP) levels in the cerebrospinal fluid (CSF) have been reported to be elevated in DNS. However, the precise timing and clinical value of the CSF examination have not been fully evaluated. We aimed to clarify the long-term outcome and the factors predicting the outcome of DNS and to evaluate the utility of CSF-MBP for predicting the development and severity of DNS.This work was designed as a single-center, prospective, observational study. We graded DNS severity as Grade 1 (consistent independence), Grade 2 (temporary dependence), or Grade 3 (persistent dependence). We analyzed the percentage categorized in each grade and the parameters associated with outcome.Of 100 patients experiencing acute CO poisoning (median age: 46 years; 69% male), 20 (20%) developed DNS, including six Grade 1 (30%), ten Grade 2 (50%), and four Grade 3 (20%) cases. The Grade 3 patients [median: 77 years; interquartile range (IQR): 76-82] were older than the Grade 1 patients [42; 30-46] (P0.01); the DNS onset of the Grade 1 patients [median interval after poisoning: 35 days; IQR: 32-56] occurred later than that of the Grade 3 patients [10; 9-13] P0.001) and the Grade 2 patients [25; 23-27] (P0.05). The CSF-MBP levels of the DNS patients were higher than those of the non-DNS patients (P0.0001). The 1-month CSF-MBP levels of the Grade 3 patients were higher than those of the Grade 1 patients (P0.05); the MBP index, defined as [(Age)×(1-month CSF-MBP)], was higher in the Grade 3 patients than in the Grade 1 patients (P0.01). Severe DNS were associated with advanced age (72.5 years), earlier onset (18 days), higher 1-month CSF-MBP (252 pg/ml), and higher MBP index (20.9 year × ng/ml).Poor DNS outcomes were associated with advanced age and earlier onset. CSF-MBP can serve as a sensitive predictor of both the development and outcomes of DNS.
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- 2015
196. Survey of Preventable Disaster Death at Medical Institutions in Areas Affected by the Great East Japan Earthquake: A Retrospective Preliminary Investigation of Medical Institutions in Miyagi Prefecture
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Yuzuru Ueki, Hisayoshi Kondo, Shigeki Kushimoto, Yasuhiro Otomo, Yoshitaka Kohayagawa, Satoshi Yamanouchi, Yuichi Koido, Hiroyuki Sasaki, and Miho Tsuruwa
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Adult ,Male ,Poison control ,Emergency Nursing ,Occupational safety and health ,Disaster area ,Japan ,Risk Factors ,Injury prevention ,Earthquakes ,Humans ,Medicine ,Hospital Mortality ,Aged ,Retrospective Studies ,Aged, 80 and over ,Geography ,business.industry ,Incidence ,Incidence (epidemiology) ,Medical record ,Middle Aged ,medicine.disease ,Hospitals ,Tsunamis ,Emergency Medicine ,Wounds and Injuries ,Female ,Medical emergency ,business ,Disaster medicine ,Disaster Victims - Abstract
ProblemThe 2011, magnitude (M) 9, Great East Japan Earthquake and massive tsunami caused widespread devastation and left approximately 18,500 people dead or missing. The incidence of preventable disaster death (PDD) during the Great East Japan Earthquake remains to be clarified; the present study investigated PDD at medical institutions in areas affected by the Great East Japan Earthquake in order to improve disaster medical systems.MethodsA total of 25 hospitals in Miyagi Prefecture (Japan) that were disaster base hospitals (DBHs), or had at least 20 patient deaths between March 11, 2011 and April 1, 2011, were selected to participate based on the results of a previous study. A database was created using the medical records of all patient deaths (n=868), and PDD was determined from discussion with 10 disaster health care professionals.ResultsA total of 102 cases of PDD were identified at the participating hospitals. The rate of PDD was higher at coastal hospitals compared to inland hospitals (62/327, 19.0% vs 40/541, 7.4%; PPConclusionPreventable disaster death at medical institutions in areas affected by the Great East Japan Earthquake occurred mainly at coastal hospitals. Insufficient resources (at GHs), environmental factors (at coastal hospitals), and delayed medical intervention (at all hospitals) constituted the major potential contributing factors. Further investigation of all medical institutions in Miyagi Prefecture, including those with fewer than 20 patient deaths, is required in order to obtain a complete picture of the details of PDD at medical institutions in the disaster area.YamanouchiS, SasakiH, TsuruwaM, UekiY, KohayagawaY, KondoH, OtomoY, KoidoY, KushimotoS. Survey of preventable disaster death at medical institutions in areas affected by the Great East Japan Earthquake: a retrospective preliminary investigation of medical institutions in Miyagi Prefecture. Prehosp Disaster Med. 2015;30(2):1-7.
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- 2015
197. Intensive care unit model and in-hospital mortality among patients with severe sepsis and septic shock: A secondary analysis of a multicenter prospective observational study.
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Isao Nagata, Toshikazu Abe, Hiroshi Ogura, Shigeki Kushimoto, Seitaro Fujishima, Satoshi Gando, Nagata, Isao, Abe, Toshikazu, Ogura, Hiroshi, Kushimoto, Shigeki, Fujishima, Seitaro, Gando, Satoshi, and JAAM FORECAST group
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- 2021
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198. Predictors of severe sepsis-related in-hospital mortality based on a multicenter cohort study: The Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma study.
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Akiyoshi Hagiwara, Noriko Tanaka, Yosuke Inaba, Satoshi Gando, Atsushi Shiraishi, Daizoh Saitoh, Yasuhiro Otomo, Hiroto Ikeda, Hiroshi Ogura, Shigeki Kushimoto, Joji Kotani, Yuichiro Sakamoto, Yasukazu Shiino, Shin-ichiro Shiraishi, Kiyotsugu Takuma, Takehiko Tarui, Ryosuke Tsuruta, Taka-aki Nakada, Toru Hifumi, and Kazuma Yamakawa
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- 2021
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199. Predictors of SARS-CoV-2 Positivity Based on RT-PCR Swab Tests at a Drive-Through Outpatient Clinic for COVID-19 Screening in Japan.
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Tadashi Ishii, Shigeki Kushimoto, Yukio Katori, Shigeo Kure, Kaoru Igarashi, Motoo Fujita, Shin Takayama, Michiaki Abe, Junichi Tanaka, Akiko Kikuchi, Yoshiko Abe, Hiroyuki Imai, Yohei Inaba, Yoko Iwamatsu-Kobayashi, Takashi Nishioka, Ko Onodera, and Tetsuya Akaishi
- Abstract
In response to the COVID-19 pandemic caused by SARS-CoV-2 in 2020, we conducted drive-through nasopharyngeal swab testing for COVID-19 in Sendai city, Japan, since April 2020. All tested individuals were judged in advance by public health centers for the necessity of undergoing the test with possible contact history and/or symptoms suggestive of COVID-19. In this study, to identify the predictors of SARS-CoV-2 test positivity for more efficient and evidenced selection of suspected individuals, we enrolled 3,540 consecutive individuals, tested in the first 7 months of the testing program, with data regarding to the history of close contact with COVID-19 patients, including those involved in cluster outbreaks. This cohort included 284 foreign students (257 males and 27 females) from a vocational school involved in the largest cluster outbreak in the area. Close contact history was present in 952 (26.9%) of the participants. The reverse transcription-polymerase chain reaction (RT-PCR) test results showed that 164 participants (4.6%) were positive and 3,376 participants (95.4%) were negative for the SARS-CoV-2 nucleocapsid gene (N2). In the univariate and multivariate analyses, history of close contact with COVID-19 patients, higher age, cough symptoms, and non-native ethnicity were predictors for SARS-CoV-2 test positivity. However, the significance of age and foreign nationality disappeared or declined upon excluding the foreign students from the aforementioned largest cluster outbreak. In conclusion, a history of close contact with COVID-19 patients and the presence of cough symptoms are significant predictors of SARS-CoV-2 test positivity. [ABSTRACT FROM AUTHOR]
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- 2021
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200. Association of Body Weight Change and Fluid Balance With Extubation Failure in Intensive Care Unit Patients: A Single-Center Observational Study.
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Shota Maezawa, Daisuke Kudo, Noriko Miyagawa, Satoshi Yamanouchi, and Shigeki Kushimoto
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BODY weight ,WATER-electrolyte balance (Physiology) ,INTENSIVE care patients ,VENTILATION ,EXTUBATION - Abstract
Purpose: To elucidate whether fluid balance and body weight change are associated with failed planned extubation. Materials and Methods: Patients who received invasive mechanical ventilation for over 24 hours were enrolled and divided into extubation success and extubation failure groups. Fluid balance and body weight fluctuation within 24 and 48 hours before extubation and from admission to planned extubation were calculated. The primary outcome was extubation failure (ie, all-cause reintubation within 72 hours). The association of extubation failure with fluid balance and body weight change was assessed via logistic regression analysis. Results: Extubation failure occurred in 12(7.4%)/161 patients. The extubation success group had a significantly lower fluid balance within 24 hours before extubation than did the extubation failure group (-276 mL [-1111 to 456] vs 1217 mL [503 to 1875], P = .002). However, fluid balance within 48 hours before extubation, cumulative fluid balance, and body weight change were not significantly different between the 2 groups. The sensitivity and specificity of water balance þ1000 mL within 24 hours before extubation for the extubation failure group were 0.54 and 0.84, respectively, based on the receiver operating characteristic curve. Logistic regression analysis showed that fluid balance within 24 hours before extubation was associated with extubation failure (odds ratio: 22.9, 95% confidence interval: 4.1-128.4). Conclusions: A larger fluid balance within 24 hours before extubation is associated with extubation failure. Thus, fluid balance may be a good indicator of extubation outcome. [ABSTRACT FROM AUTHOR]
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- 2021
- Full Text
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