71 results on '"Atagi K"'
Search Results
2. Mortality related to respiratory failure among pediatric hematology patients requiring intensive care
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Okuno, H, Atagi, K, and Shimaoka, H
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- 2013
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3. Educational effectiveness of introductory training for the Rapid Response System in Japan
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Kodama, T, Nakagawa, M, Kawamoto, E, Fujiwara, S, Imai, H, Fujitani, S, and Atagi, K
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- 2013
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4. Efficacy of endotoxin absorption therapy on sepsis by polymyxin B-attached fibers
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Atagi, K
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- 2011
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5. ABSTRACT 725
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Ujiro, A., primary, Atagi, K., additional, Otsuka, Y., additional, Okumura, M., additional, and Wada, S., additional
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- 2014
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6. Champagne bottle neck sign with Moyamoya disease.
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Takemoto, K and Atagi, K
- Subjects
- *
MOYAMOYA disease , *INTERNAL carotid artery , *NECK , *CHAMPAGNE , *MAGNETIC resonance angiography - Abstract
In the present case, subsequent magnetic resonance angiography revealed a rapid reduction of the diameter in the proximal right ICA, and cerebral angiography revealed an abnormal vascular network (Moyamoya vessels) at the right middle cerebral artery (Figure 1C and D). Graph: Figure 1. class="chapter-para">(A, B; color doppler) Carotid artery ultrasonography revealed a rapid reduction of the diameter at the proximal portion of the right internal carotid artery. A 50-year-old man with a history of hypertension was presented to our hospital because of carotid artery stenosis indicated by a medical checkup. [Extracted from the article]
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- 2022
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7. Artery tortuosity in Marfan syndrome.
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Takemoto, K and Atagi, K
- Subjects
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MARFAN syndrome , *TORTUOSITY , *INTERNAL carotid artery , *ARTERIES , *MAGNETIC resonance angiography - Abstract
A 32-year-old woman with Marfan syndrome was presented to our hospital for a pre-operative examination of a thoracic aortic aneurysm. Magnetic resonance angiography of extracranial vessels revealed abnormal meandering of the right internal carotid and bilateral vertebral arteries (Figure 1). Magnetic resonance angiography of neck revealed the right internal carotid artery redundancy creating an S-shaped curve and bilateral vertebral arteries with S- and C-shaped elongation. [Extracted from the article]
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- 2023
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8. EFFECTIVENESS OF DEXMEDETOMIDINE ADMINISTRATION IN FONTAN-TYPE OPERATION
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Tokuhira, N, primary, Atagi, K, additional, Ujiro, A, additional, and Shimaoka, H, additional
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- 2006
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9. Prognostic factors of percutaneous cardiopulmonary support therapy at Osaka City General Hospital, Japan
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Yoshida, T, Satani, M, Rinka, H, Tamiya, H, Murai, T, Atagi, K, Shimadzu, K, Ujino, H, Miyaichi, T, Kan, M, Kaji, A, and Haze, K
- Subjects
Poster Presentation - Published
- 2005
10. Preventing IR interference between infrared waves emitted by high-frequency fluorescent lighting systems and infrared remote controls
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Kataoka, S., primary and Atagi, K., additional
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- 1997
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11. Comparison of optic laryngoscope Airtraq((R)) and Miller laryngoscope for tracheal intubation during infant cardiopulmonary resuscitation.
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Komasawa N, Atagi K, Ueki R, Nishi S, Kaminoh Y, and Tashiro C
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- 2011
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12. Dexmedetomidine sedation for pediatric post-Fontan procedure patients.
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Tokuhira N, Atagi K, Shimaoka H, Ujiro A, Otsuka Y, and Ramsay M
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- 2009
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13. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)
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Egi M, Ogura H, Yatabe T, Atagi K, Inoue S, Iba T, Kakihana Y, Kawasaki T, Kushimoto S, Kuroda Y, Kotani J, Shime N, Taniguchi T, Tsuruta R, Doi K, and Nishida O
14. Prevention of IR interference from high frequency fluorescent lighting to IR remote-control systems
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Kataoka, S., primary and Atagi, K., additional
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15. Prevention of IR interference from high frequency fluorescent lighting to IR remote-control systems.
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Kataoka, S. and Atagi, K.
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- 1995
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16. Comparison of air-Q((R)) and Soft Seal((R)) laryngeal mask for airway management by novice doctors during infant chest compression: A manikin study.
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Komasawa N, Ueki R, Yamamoto N, Atagi K, Nishi S, Kaminoh Y, and Tashiro C
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- 2012
17. Blue Liver.
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Takemoto K, Ko S, and Atagi K
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- Humans, Liver diagnostic imaging
- Abstract
Competing Interests: Conflict of interest None declared.
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- 2024
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18. Machine learning algorithm for predicting 30-day mortality in patients receiving rapid response system activation: A retrospective nationwide cohort study.
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Kurita T, Oami T, Tochigi Y, Tomita K, Naito T, Atagi K, Fujitani S, and Nakada TA
- Abstract
This study investigated the accuracy of a machine learning algorithm for predicting mortality in patients receiving rapid response system (RRS) activation. This retrospective cohort study used data from the In-Hospital Emergency Registry in Japan, which collects nationwide data on patients receiving RRS activation. The missing values in the dataset were replaced using multiple imputations (mode imputation, BayseRidge sklearn. linear model, and K-nearest neighbor model), and the enrolled patients were randomly assigned to the training and test cohorts. We established prediction models for 30-day mortality using the following four types of machine learning classifiers: Light Gradient Boosting Machine (LightGBM), eXtreme Gradient Boosting, random forest, and neural network. Fifty-two variables (patient characteristics, details of RRS activation, reasons for RRS initiation, and hospital capacity) were used to construct the prediction algorithm. The primary outcome was the accuracy of the prediction model for 30-day mortality. Overall, the data from 4,997 patients across 34 hospitals were analyzed. The machine learning algorithms using LightGBM demonstrated the highest predictive value for 30-day mortality (area under the receiver operating characteristic curve, 0.860 [95 % confidence interval, 0.825-0.895]). The SHapley Additive exPlanations summary plot indicated that hospital capacity, site of incidence, code status, and abnormal vital signs within 24 h were important variables in the prediction model for 30-day mortality., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)
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- 2024
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19. Autologous rectus abdominis fascia sling surgery following unsuccessful synthetic midurethral sling.
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Kurano Y, Shimizu N, Yoshimura R, Iga R, Atagi K, Nao T, Fukuhara H, Fukata S, Ashida S, and Inoue K
- Abstract
Introduction: We performed autologous rectus abdominis fascia sling surgery using Advantage™ following an unsuccessful synthetic midurethral sling., Case Presentation: At the age of 76 years, the patient experienced stress urinary incontinence recurrence. A 1-h pad test resulted in 259 g of leakage. A pressure flow study verified urine leakage while coughing and straining without detrusor overactivity. Abdominal leak point pressure was 10 cmH
2 O. Autologous rectus abdominis fascia sling surgery was performed using Advantage™. One month postoperatively, a 1-h pad test resulted in 0 g of leakage., Conclusion: We believe that this method will allow the fascia sling procedure to be performed reliably even if one is unfamiliar with conventional autologous rectus abdominis fascia sling surgery., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Urological Association.)- Published
- 2024
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20. Clinical significance of cerebrospinal fluid presepsin as adjunctive biomarker for postneurosurgical meningitis: A single-center prospective observational study.
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Takemoto K, Yamamoto T, Hashimoto H, Matsuyama T, and Atagi K
- Abstract
Background: Postneurosurgical meningitis (PNM) is a serious complication in neurocritical care patients, leading to clinical deterioration and worsening outcomes. Accurate diagnosis of PNM is often difficult due to the lack of definitive diagnostic criteria. This study investigates the potential utility of cerebrospinal fluid (CSF) presepsin (PSP), blood PSP, and the CSF/blood PSP ratio as adjunctive biomarkers for the diagnosis of PNM., Methods: We conducted a single-center prospective observational study at Nara Prefecture General Medical Center in Nara, Japan, from April 2020 to March 2022. The postoperative neurosurgical patients with suspected PNM were included in the study and divided into PNM and non-PNM groups. We evaluated the sensitivity, specificity, area under curves (AUCs), positive predictive value (PPV), and negative predictive value (NPV) for the diagnosis of PNM with CSF PSP, blood PSP, and CSF/blood PSP ratio compared in the two groups., Results: We screened 241 consecutive patients with postoperative neurosurgery. Diagnosis of PNM was suspected in 27 patients, and the clinical diagnosis was confirmed in nine patients. The results of CSF PSP (cutoff: 736 pg/mL) for the diagnosis of PNM were sensitivity 89%, specificity 78%, PPV 67%, NPV 93%, AUC 0.81 (95% confidence interval [CI], 0.60-1.00), blood PSP (cut-off: 264 pg/mL) was 56%, 78%, 56%, and 78%, 0.65 (95% CI, 0.42-0.88), and those of CSF/blood PSP ratio (cutoff: 3.45) was 89%, 67%, 57%, and 92%, 0.83 (95% CI, 0.65-1.00)., Conclusion: Elevated CSF PSP and CSF/blood PSP ratio may be associated with PNM and could serve as valuable adjunctive biomarkers for improving diagnostic accuracy., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Surgical Neurology International.)
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- 2024
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21. COVID-19 vaccine effectiveness against severe COVID-19 requiring oxygen therapy, invasive mechanical ventilation, and death in Japan: A multicenter case-control study (MOTIVATE study).
- Author
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Arashiro T, Miwa M, Nakagawa H, Takamatsu J, Oba K, Fujimi S, Kikuchi H, Iwasawa T, Kanbe F, Oyama K, Kanai M, Ogata Y, Asakura T, Asami T, Mizuno K, Sugita M, Jinta T, Nishida Y, Kato H, Atagi K, Higaki T, Nakano Y, Tsutsumi T, Doi K, Okugawa S, Ueda A, Nakamura A, Yoshida T, Shimada-Sammori K, Shimizu K, Fujita Y, Okochi Y, Tochitani K, Nakanishi A, Rinka H, Taniyama D, Yamaguchi A, Uchikura T, Matsunaga M, Aono H, Hamaguchi M, Motoda K, Nakayama S, Yamamoto K, Oka H, Tanaka K, Inoue T, Kobayashi M, Fujitani S, Tsukahara M, Takeda S, Stucky A, Suzuki T, Smith C, Hibberd M, Ariyoshi K, Fujino Y, Arima Y, Takeda S, Hashimoto S, and Suzuki M
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- Humans, Oxygen therapeutic use, Japan epidemiology, Respiration, Artificial, Case-Control Studies, Vaccine Efficacy, SARS-CoV-2, COVID-19 Vaccines, COVID-19 prevention & control
- Abstract
Introduction: Since the SARS-CoV-2 Omicron variant became dominant, assessing COVID-19 vaccine effectiveness (VE) against severe disease using hospitalization as an outcome became more challenging due to incidental infections via admission screening and variable admission criteria, resulting in a wide range of estimates. To address this, the World Health Organization (WHO) guidance recommends the use of outcomes that are more specific to severe pneumonia such as oxygen use and mechanical ventilation., Methods: A case-control study was conducted in 24 hospitals in Japan for the Delta-dominant period (August-November 2021; "Delta") and early Omicron (BA.1/BA.2)-dominant period (January-June 2022; "Omicron"). Detailed chart review/interviews were conducted in January-May 2023. VE was measured using various outcomes including disease requiring oxygen therapy, disease requiring invasive mechanical ventilation (IMV), death, outcome restricting to "true" severe COVID-19 (where oxygen requirement is due to COVID-19 rather than another condition(s)), and progression from oxygen use to IMV or death among COVID-19 patients., Results: The analysis included 2125 individuals with respiratory failure (1608 cases [75.7%]; 99.2% of vaccinees received mRNA vaccines). During Delta, 2 doses provided high protection for up to 6 months (oxygen requirement: 95.2% [95% CI:88.7-98.0%] [restricted to "true" severe COVID-19: 95.5% {89.3-98.1%}]; IMV: 99.6% [97.3-99.9%]; fatal: 98.6% [92.3-99.7%]). During Omicron, 3 doses provided high protection for up to 6 months (oxygen requirement: 85.5% [68.8-93.3%] ["true" severe COVID-19: 88.1% {73.6-94.7%}]; IMV: 97.9% [85.9-99.7%]; fatal: 99.6% [95.2-99.97]). There was a trend towards higher VE for more severe and specific outcomes., Conclusion: Multiple outcomes pointed towards high protection of 2 doses during Delta and 3 doses during Omicron. These results demonstrate the importance of using severe and specific outcomes to accurately measure VE against severe COVID-19, as recommended in WHO guidance in settings of intense transmission as seen during Omicron., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Takeshi Arashiro is an unpaid consultant for the World Health Organization. The other authors declare no conflicts of interest., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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22. Recurrent Guillain-Barré Syndrome Associated with the Second Episode of Campylobacter jejuni Infection.
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Takemoto K, Kawahara M, and Atagi K
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- Male, Humans, Young Adult, Adult, Antibodies, Gangliosides, Guillain-Barre Syndrome diagnosis, Campylobacter jejuni, Campylobacter Infections complications
- Abstract
Guillain-Barré syndrome (GBS) cases are generally monophasic, and recurrence is rare. However, the pathogenesis and pathophysiology of recurrent GBS remain to be fully elucidated. There are few detailed reports of patients who have been infected twice with Campylobacter jejuni and have developed GBS twice. We herein report a case of recurrent GBS in a 21-year-old man with a history of GBS caused by C. jejuni infection at 19 years old. Although our patient was reinfected with C. jejuni, several different anti-ganglioside antibodies were identified, and the clinical manifestations were more severe than those in the first GBS episode. We compared the anti-ganglioside antibodies and nerve conduction studies findings between the two GBS episodes. This case suggested that different antibodies are involved and produce different symptoms even when C. jejuni infection is the trigger in recurrent episodes.
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- 2023
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23. Lidocaine as a potential therapeutic option for super-refractory status epilepticus: A case report.
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Sugata M, Kataoka H, Uchihara Y, Shimada D, Atagi K, Nakamura M, Hara M, Kawahara M, and Sugie K
- Abstract
New-onset refractory status epilepticus (NORSE) is a rare and devastating condition and the prognosis is often poor, with half to two-thirds of survivors experiencing drug-resistant epilepsy, residual cognitive impairment, or functional disability, and the mortality rate is 16% to 27% for adults. We describe a patient with cryptogenic NORSE and favorable recovery from drug-resistant super-refractory SE after the use of intravenous lidocaine. The patient experienced fever and presented with refractory generalized tonic-clonic seizures. The cause was not found by performing extensive examinations, including cell surface autoantibodies and rat brain immunohistochemistry evaluations. The refractory SE with unresponsiveness to multiple anti-epileptic and prolonged sedative medications, which are necessary for prolonged mechanical ventilation, were ameliorated by additive treatment with intravenous lidocaine initiating at 1 mg/kg/h and maintaining at 2 mg/kg/h for 40 days, which led to freedom from intravenous sedative medication and mechanical ventilation. The patient was able to return to school. Lidocaine may be an optional treatment for cryptogenic NORSE., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)
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- 2023
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24. Rectus Sheath Hematoma Attributable to Coronavirus Disease 2019.
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Takemoto K and Atagi K
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- Humans, Hematoma diagnostic imaging, Hematoma etiology, Fascia, Rectus Abdominis diagnostic imaging, COVID-19 complications, Muscular Diseases
- Published
- 2023
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25. Response to Implication of Collaboration between Intensivists and Cardiologists to Manage Acute Myocardial Infarction in the Intensive-care Unit.
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Takemoto K, Nakamura M, Yamamoto T, Kawata H, and Atagi K
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- Humans, Intensive Care Units, Cardiologists, Myocardial Infarction therapy
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- 2023
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26. Aortic Artery Thrombosis Associated with Inherited Thrombophilia.
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Takemoto K and Atagi K
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- Humans, Arteries, Risk Factors, Thrombophilia complications, Thrombosis complications, Thrombosis diagnostic imaging, Protein S Deficiency complications
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- 2023
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27. The Efficacy of Acute Myocardial Infarction Intensive Care Unit Management with a Collaborative Intensivists and Cardiologists in Japan: A Retrospective Observational Study.
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Takemoto K, Nakamura M, Yamamoto T, Kawata H, and Atagi K
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- Humans, Japan epidemiology, Intensive Care Units, Critical Care, Length of Stay, Hospital Mortality, Retrospective Studies, Cardiologists, Myocardial Infarction therapy
- Abstract
Objective Dedicated intensive care unit (ICU) physician staffing is associated with a reduction in ICU mortality rates in general medical and surgical ICUs. However, limited data are available on the role of intensivists in ICU for cardiac disease, especially in Japan. This study investigated the association of collaborative intensivists and cardiologist care with clinical outcomes in patients with acute myocardial infarction (AMI) admitted to the ICU. Methods This study analyzed 106 patients admitted to the ICU at Nara Prefecture General Medical Center in Nara, Japan, from April 2017 to April 2019. Eligible patients were divided into either the high-intensity ICU management group (n=51) or the low-intensity ICU management group (n=55). The primary outcome of in-hospital mortality was compared in the two groups. Results The high-intensity ICU group was found to be associated with a lower mortality rate in a multivariate analysis than the low-intensity group [7.8% vs. 16.4%; odds ratio (OR): 0.07; 95% confidence interval (CI): 0.01-0.54; p=0.01]. There were no significant differences in the length of either the ICU stay or hospital stay or the hospital costs between the two groups. A subgroup analysis revealed that the in-hospital mortality rate was lower in the high-intensity ICU group than in the low-intensity ICU group among patients with Killip class IV (16.7% vs. 34.6%; OR, 0.08; 95% CI, 0.01-0.67; p=0.02). Conclusion The presence of dedicated intensivists in high-intensity ICU collaborating with cardiologists might reduce in-hospital mortality in patients with Killip class IV AMI who require critical care.
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- 2023
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28. Inferior Vena Cava Thrombosis with Veno-arterial Extracorporeal Membrane Oxygenation.
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Takemoto K and Atagi K
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- Humans, Vena Cava, Inferior diagnostic imaging, Extracorporeal Membrane Oxygenation, Venous Thrombosis complications, Venous Thrombosis diagnostic imaging, Venous Thrombosis therapy
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- 2023
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29. Primary adrenal Ewing's sarcoma family of tumors with tumor thrombus of the inferior vena cava: a case report.
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Atagi K, Karashima T, Mizutani K, Fukuhara H, Fukata S, Miura Y, Mitsuishi A, Hanazaki K, Uemura S, Miyazaki R, Anayama T, Yamane M, Sakai M, Iguchi M, Yorita K, and Inoue K
- Subjects
- Female, Humans, Young Adult, Adult, Vena Cava, Inferior diagnostic imaging, Vena Cava, Inferior surgery, Chemotherapy, Adjuvant, Abdomen, Sarcoma, Ewing diagnostic imaging, Sarcoma, Ewing surgery, Thrombosis drug therapy
- Abstract
Background: Ewing's sarcoma is a malignant neoplasm that mainly occurs in skeletal tissue but can rarely arise in soft tissues. Recently, small round cell tumors (including Ewing's sarcoma) caused by chromosomal translocations have been collectively termed Ewing's sarcoma family of tumors. We report a rare case of primary adrenal Ewing's sarcoma family of tumors with tumor thrombus., Case Presentation: A 22-year-old Asian woman was referred to our hospital with a left retroperitoneal tumor 19 cm in diameter. Tumor thrombus was identified from the left adrenal vein to the inferior vena cava, infiltrating the right atrium. Total tumor excision with left adrenalectomy, nephrectomy, and thrombectomy was performed under hypothermic circulatory arrest, followed by seven courses of adjuvant chemotherapy. The patient has shown no signs of recurrence as of 26 months postoperatively., Conclusion: Radical surgery combined with systemic chemotherapy may contribute to good prognosis in patients with primary adrenal Ewing's sarcoma family of tumors., (© 2023. The Author(s).)
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- 2023
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30. Intramural Esophageal Hematoma with Herpes Esophagitis.
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Takemoto K and Atagi K
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- Hematoma diagnosis, Hematoma diagnostic imaging, Humans, Esophageal Diseases diagnosis, Esophageal Diseases diagnostic imaging, Esophagitis diagnosis, Esophagitis diagnostic imaging
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- 2022
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31. Non-occlusive mesenteric ischemia during acute stroke management: three case reports.
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Fujii K, Seki T, Nakata Y, Atagi K, and Matsuyama T
- Abstract
Background: There are many reports of non-occlusive mesenteric ischemia in patients on maintenance hemodialysis and following cardiac surgery. However, there are few reports of non-occlusive mesenteric ischemia in patients with acute stroke., Case Presentation: We report three cases of non-occlusive mesenteric ischemia with onset during treatment for acute stroke. All of the patients were undergoing strict blood-pressure control, and two patients developed NOMI soon after tracheostomy when enteral nutrition had been resumed., Conclusion: Many stroke patients are older adults with risk factors such as arteriosclerosis. Thus, during acute stroke management, there is a possibility that patients may develop non-occlusive mesenteric ischemia due to decreased intestinal blood flow secondary to strict blood-pressure control. This case report implicates early enteral nutrition as a potential etiopathogenic factor of non-occlusive mesenteric ischemia in patients with acute stroke., (© 2022. The Author(s).)
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- 2022
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32. Eosinophilic pleural effusion due to lung cancer has a better prognosis than non-eosinophilic malignant pleural effusion.
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Takeuchi E, Okano Y, Machida H, Atagi K, Kondou Y, Kadota N, Hatakeyama N, Naruse K, and Shinohara T
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- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pleural Effusion pathology, Pleural Effusion therapy, Pleural Effusion, Malignant pathology, Pleural Effusion, Malignant therapy, Prognosis, Retrospective Studies, Survival Rate, Eosinophils pathology, Lymphocytes pathology, Neutrophils pathology, Pleural Effusion mortality, Pleural Effusion, Malignant mortality
- Abstract
Objective: Tumor-related eosinophilia may have extended survival benefits for some cancer patients. However, there has been no report on the prognosis difference between eosinophilic pleural effusion (EPE) and non-EPE in lung cancer patients. Our study aimed to investigate the prognosis difference between EPE and non-EPE due to lung cancer., Patients and Methods: We retrospectively reviewed patients diagnosed with lung cancer who presented with malignant pleural effusion (MPE) between May 2007 and September 2020 at the National Hospital Organization Kochi Hospital. EPE is defined as pleural fluid with a nucleated cell count containing 10% or more eosinophils., Results: A total of 152 patients were included: 89 were male (59%). The median age was 74.4 years (range 37-101), and all patients were pathologically shown to have MPE. Most patients (140; 92%) had an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 0/1. Twenty patients had EPE. The median overall survival (OS) of all 152 lung cancer patients with MPE was 298 days. The median OS of the patients with EPE was 766 days, and the median OS of the patients with non-EPE was 252 days. Kaplan-Meier univariate analysis showed that lung cancer patients with EPE had a significantly better prognosis than patients with non-EPE (P < 0.05). Cox proportional regression analysis showed that EPE, ECOG PS, sex, and the neutrophil-to-lymphocyte ratio in the serum (sNLR) may be independent prognostic factors affecting survival in patients with MPE., Conclusion: Lung cancer patients with EPE have a better prognosis than those with non-EPE., (© 2021. The Author(s).)
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- 2022
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33. Concomitant acute pulmonary embolism, myocardial infarction and ischemic stroke due to paradoxical embolism from a patent foramen ovale: a case report.
- Author
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Takemoto K, Nakamura M, and Atagi K
- Abstract
A patent foramen ovale (PFO) is a cause of paradoxical embolism. Although most patients with a PFO are asymptomatic, various clinical manifestations may be associated with PFO. The most important is a cryptogenic stroke. Concomitant acute pulmonary embolism (APE), acute myocardial infarction (AMI) and acute ischemic stroke (AIS) due to paradoxical embolism from a PFO are extremely rare. We describe a 77-year-old woman with a past medical history of hypertension who was transferred due to a sudden onset of dyspnea followed by cardiopulmonary arrest. Based on the patient's medical history, transthoracic and transesophageal echocardiography, coronary angiography, and a whole-body contrasted computed tomography, we diagnosed concomitant APE, AMI and AIS caused by a paradoxical embolism from a PFO. Appropriate knowledge of the pathophysiology of this rare critical illness is important for prompt diagnosis and treatment., (© The Author(s) 2021. Published by Oxford University Press.)
- Published
- 2021
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34. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020).
- Author
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Egi M, Ogura H, Yatabe T, Atagi K, Inoue S, Iba T, Kakihana Y, Kawasaki T, Kushimoto S, Kuroda Y, Kotani J, Shime N, Taniguchi T, Tsuruta R, Doi K, Doi M, Nakada TA, Nakane M, Fujishima S, Hosokawa N, Masuda Y, Matsushima A, Matsuda N, Yamakawa K, Hara Y, Sakuraya M, Ohshimo S, Aoki Y, Inada M, Umemura Y, Kawai Y, Kondo Y, Saito H, Taito S, Takeda C, Terayama T, Tohira H, Hashimoto H, Hayashida K, Hifumi T, Hirose T, Fukuda T, Fujii T, Miura S, Yasuda H, Abe T, Andoh K, Iida Y, Ishihara T, Ide K, Ito K, Ito Y, Inata Y, Utsunomiya A, Unoki T, Endo K, Ouchi A, Ozaki M, Ono S, Katsura M, Kawaguchi A, Kawamura Y, Kudo D, Kubo K, Kurahashi K, Sakuramoto H, Shimoyama A, Suzuki T, Sekine S, Sekino M, Takahashi N, Takahashi S, Takahashi H, Tagami T, Tajima G, Tatsumi H, Tani M, Tsuchiya A, Tsutsumi Y, Naito T, Nagae M, Nagasawa I, Nakamura K, Nishimura T, Nunomiya S, Norisue Y, Hashimoto S, Hasegawa D, Hatakeyama J, Hara N, Higashibeppu N, Furushima N, Furusono H, Matsuishi Y, Matsuyama T, Minematsu Y, Miyashita R, Miyatake Y, Moriyasu M, Yamada T, Yamada H, Yamamoto R, Yoshida T, Yoshida Y, Yoshimura J, Yotsumoto R, Yonekura H, Wada T, Watanabe E, Aoki M, Asai H, Abe T, Igarashi Y, Iguchi N, Ishikawa M, Ishimaru G, Isokawa S, Itakura R, Imahase H, Imura H, Irinoda T, Uehara K, Ushio N, Umegaki T, Egawa Y, Enomoto Y, Ota K, Ohchi Y, Ohno T, Ohbe H, Oka K, Okada N, Okada Y, Okano H, Okamoto J, Okuda H, Ogura T, Onodera Y, Oyama Y, Kainuma M, Kako E, Kashiura M, Kato H, Kanaya A, Kaneko T, Kanehata K, Kano KI, Kawano H, Kikutani K, Kikuchi H, Kido T, Kimura S, Koami H, Kobashi D, Saiki I, Sakai M, Sakamoto A, Sato T, Shiga Y, Shimoto M, Shimoyama S, Shoko T, Sugawara Y, Sugita A, Suzuki S, Suzuki Y, Suhara T, Sonota K, Takauji S, Takashima K, Takahashi S, Takahashi Y, Takeshita J, Tanaka Y, Tampo A, Tsunoyama T, Tetsuhara K, Tokunaga K, Tomioka Y, Tomita K, Tominaga N, Toyosaki M, Toyoda Y, Naito H, Nagata I, Nagato T, Nakamura Y, Nakamori Y, Nahara I, Naraba H, Narita C, Nishioka N, Nishimura T, Nishiyama K, Nomura T, Haga T, Hagiwara Y, Hashimoto K, Hatachi T, Hamasaki T, Hayashi T, Hayashi M, Hayamizu A, Haraguchi G, Hirano Y, Fujii R, Fujita M, Fujimura N, Funakoshi H, Horiguchi M, Maki J, Masunaga N, Matsumura Y, Mayumi T, Minami K, Miyazaki Y, Miyamoto K, Murata T, Yanai M, Yano T, Yamada K, Yamada N, Yamamoto T, Yoshihiro S, Tanaka H, and Nishida O
- 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., Competing Interests: Financial and academic COIs as well as the role(s) of each committee member are disclosed in the additional file 1 (https://www.jsicm.org/pdf/guidelineEN/Additionalfile1.pdf). Financial COIs were disclosed in accordance with the standards used by the Japanese Association of Medical Sciences from 2017 through 2019., (© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)
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- 2021
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35. Successful treatment with DCF chemotherapy and radiotherapy for primary squamous cell carcinoma of the prostate.
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Atagi K, Fukuhara H, Ishiguro M, Osakabe H, Satoshi F, Tamura K, Karashima T, and Inoue K
- Abstract
Introduction: Primary squamous cell carcinoma of the prostate is an extremely rare tumor with poor prognosis. Squamous cell carcinoma of the prostate is estimated to comprise less than 1% of all prostate carcinomas. We report herein a case with clinical response to docetaxel, cisplatin, and 5-fluorouracil chemotherapy with radiotherapy, in a patient with metastatic squamous cell carcinoma of the prostate., Case Presentation: A 74-year-old man consulted with frequent urination. The prostate-specific antigen level was 1.62 ng/mL. Multiparametric magnetic resonance imaging showed prostate imaging and reporting and data system category 5 for the whole prostate and biopsy was performed. The pathological diagnosis was pure squamous cell carcinoma of the prostate. fluorodeoxyglucose positron emission tomography showed fluorodeoxyglucose accumulation in the whole prostate and multiple pelvic lymph nodes. Four cycles of docetaxel, cisplatin, and 5-fluorouracil regimen were administrated along with radiotherapy. The patient showed a marked response with no major adverse events., Conclusion: The present case suggests the potential of docetaxel, cisplatin, and 5-fluorouracil chemotherapy with radiotherapy for squamous cell carcinoma of the prostate., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors. IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Urological Association.)
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- 2021
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36. Early detection of large-vessel occlusion stroke after cardiac surgery using CT angiography leading to early recanalization with endovascular thrombectomy.
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Takemoto K, Sakuraya M, Nakamura M, Maekawa H, Yamanaka K, and Atagi K
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CT angiography may be useful for early diagnosis of ischemic stroke after cardiac surgery. When patients diagnosed with large-vessel occlusion, endovascular thrombectomy may be a therapeutic option and may improve their neurological complications., Competing Interests: None declared., (© 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)
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- 2021
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37. The characteristics, types of intervention, and outcomes of postoperative patients who required rapid response system intervention: a nationwide database analysis.
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Sento Y, Arai M, Yamamori Y, Fujiwara S, Tamashiro M, Kawamoto E, Naito T, Atagi K, Fujitani S, Osaga S, and Sobue K
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- Hospital Mortality, Humans, Japan epidemiology, Postoperative Period, Retrospective Studies, Hospital Rapid Response Team
- Abstract
Purpose: Improving the safety of general wards is a key to reducing serious adverse events in the postoperative period. We investigated the characteristics, treatment, and outcomes of postoperative patients managed by a rapid response system (RRS) in Japan to improve postoperative management., Methods: This retrospective study analyzed cases requiring RRS intervention that were included in the In-Hospital Emergency Registry in Japan. We analyzed data reported by 34 Japanese hospitals between January 2014 and March 2018, mainly focusing on postoperative patients for whom the RRS was activated within 7 days of surgery. Non-postoperative patients, for whom the RRS was activated in all other settings, were used for comparison as necessary., Results: There were 609 (12.7%) postoperative patients among the total patients in the registry. The major criteria were staff concerns (30.2%) and low oxygen saturation (29.7%). Hypotension, tachycardia, and inability to contact physicians were observed as triggers significantly more frequently in postoperative patients when compared with non-postoperative patients. Among RRS activations within 7 days of surgery, 68.9% of activations occurred within postoperative day 3. The ordering of tests (46.8%) and fluid bolus (34.6%) were major interventions that were performed significantly more frequently in postoperative patients when compared with non-postoperative patients. The rate of RRS activations resulting in ICU care was 32.8%. The mortality rate at 1 month was 16.2%., Conclusion: Approximately, 70% of the RRS activations occurred within postoperative day 3. Circulatory problems were a more frequent cause of RRS activation in the postoperative group than in the non-postoperative group.
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- 2021
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38. Infected thoracoabdominal aortic aneurysm related to an implanted long-term arterial catheter for chemotherapy: a case report.
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Takemoto K, Nakamura M, Sakuraya M, Yamamoto T, Iwanaga W, Atagi K, Yamanaka K, and Matsuyama T
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- Aged, Catheters, Indwelling, Celiac Artery, Humans, Male, Neoplasm Recurrence, Local, Aneurysm, Infected diagnostic imaging, Aneurysm, Infected etiology, Aortic Aneurysm, Abdominal, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic etiology
- Abstract
Background: An infected aortic aneurysm is a rare and life-threatening vascular condition with a high incidence of arterial rupture and recurrence even after treatment. One of the most common causes of an infected aortic aneurysm is catheter-related bloodstream infection. Although infection due to indwelling catheters is possible, the incidence of this is rare, especially for long-term implanted arterial catheters., Case Presentation: A 78-year-old Japanese man with a past medical history of rectal cancer with metastasis to the liver presented to our hospital as a result of low back pain. Remission had been achieved following surgery and adjuvant chemotherapy via an implanted catheter for arterial infusion. However, the original catheter that was inserted from the femoral artery to the hepatic artery via the celiac artery was still present more than 10 years after diagnosis, without being replaced, in case of a recurrence. On the day of admission, computed tomography scan of the chest and abdomen with contrast revealed an irregularly shaped aortic aneurysm at the origin of the celiac artery and a partially expanded common hepatic artery with disproportionate fat stranding along the implanted arterial catheter without extravasation. Although the initial impression was an impending rupture of the acute thoracoabdominal aortic aneurysm, a catheter-related infection was considered as a differential diagnosis. Surgery was performed, which revealed a catheter-related infected aortic aneurysm based on images along the catheter, pus cultures, and tissue pathology examination results., Conclusions: This is an extremely rare case of an infectious aneurysm caused by prolonged implantation of an arterial catheter for chemotherapy. It should be noted that an indwelling arterial catheter not only causes bloodstream infections but can also cause an infection of a thoracoabdominal aortic aneurysm.
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- 2021
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39. Impact of increased calls to rapid response systems on unplanned ICU admission.
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Kurita T, Nakada TA, Kawaguchi R, Fujitani S, Atagi K, Naito T, Arai M, Arimoto H, Masuyama T, and Oda S
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- Aged, Aged, 80 and over, Critical Care, Female, Heart Arrest therapy, Hospitalization statistics & numerical data, Humans, Japan, Male, Middle Aged, Mortality, Multivariate Analysis, Retrospective Studies, Wounds and Injuries therapy, Critical Care Outcomes, Hospital Bed Capacity statistics & numerical data, Hospital Mortality, Hospital Rapid Response Team statistics & numerical data, Intensive Care Units statistics & numerical data
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Background: Whether hospital bed number and rapid response system (RRS) call rate is associated with the clinical outcomes of patients who have RRS activations is unknown. We test a hypothesis that hospital volume and RRS call rates are associated with the clinical outcomes of patients with RRSs., Methods: This is a retrospective chart analysis of an existing dataset associated with In-Hospital Emergency Registry in Japan. In the present study, 4818 patients in 24 hospitals from April 2014 to March 2018 were analyzed. Primary outcome variable was an unplanned intensive care unit (ICU) admission after RRS activation., Results: In the primary analysis of the study using a multivariate analysis adjusting potential confounding factors, higher RRS call rate was significantly associated with decreased unplanned ICU admissions (P < 0.0001, Odds ratio [OR] 0.95, 95% confidence interval [CI] 0.92-0.98), but there was no significant association of hospital volume with unplanned ICU admissions (P = 0.44). In the secondary analysis of the study, there was a non-significant trend of increased cardiac arrest on arrival at the location of the RRS provider at large-volume hospitals (P = 0.084, OR 1.16, 95% CI 0.98-1.38). Large-volume hospitals had a significantly higher 1-month mortality rate (P = 0.0040, OR 1.10, 95% CI 1.03-1.18)., Conclusion: Hospitals with increased RRS call rates had significantly decreased unplanned ICU admission in patients who had RRS activations. Patients who had RRS activations at large-volume hospitals had an increased 1-month mortality rate., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2020
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40. Synchronous bilateral renal cell carcinomas with differing histologies.
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Shigehisa R, Karashima T, Kobayashi S, Atagi K, Takemori D, Fukuhara H, Fukata S, Murakami I, Kuroda N, and Inoue K
- Abstract
Introduction: Bilateral renal cell carcinomas with different histological types are rare. We report herein the first description of bilateral renal carcinomas with clear cell renal cell carcinoma and mucinous tubular and spindle cell carcinoma occurring synchronously., Case Presentation: A 62-year-old man was referred to our hospital with bilateral renal tumors. The tumors on each side showed different findings from both contrast-enhanced computed tomography and magnetic resonance imaging. The tumors were partially resected. Histopathological and immunohistochemical examination of the left renal tumor diagnosed clear cell renal carcinoma. Histopathological and immunohistochemical examination of the right renal tumor diagnosed mucinous tubular and spindle cell carcinoma., Conclusion: We encountered a case with clear cell renal cell carcinoma and mucinous tubular and spindle cell carcinoma occurring simultaneously in bilateral kidneys., Competing Interests: The authors declare no conflict of interest., (© 2020 The Authors. IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Urological Association.)
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- 2020
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41. Relationship between epidermal growth factor receptor mutations and skin rash in non-small cell lung cancer patients.
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Tanaka H, Atagi K, Tatsumichi T, Yamaguchi K, Takahashi K, Kaji M, Kosaka S, and Houchi H
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- Age Factors, Aged, Aged, 80 and over, Body Surface Area, Female, Humans, Male, Middle Aged, Mutation, Retrospective Studies, Severity of Illness Index, Sex Factors, Carcinoma, Non-Small-Cell Lung drug therapy, ErbB Receptors genetics, Exanthema chemically induced, Lung Neoplasms drug therapy, Protein Kinase Inhibitors adverse effects
- Abstract
Several reports have investigated relationships between epidermal growth factor receptor ( EGFR ) mutations and the efficacy of EGFR-tyrosine kinase inhibitors (TKIs) in EGFR-mutant non-small cell lung cancer; however, there have been insufficient analyses of relationships between EGFR mutations and adverse reactions. This study investigated the relationships between EGFR mutations and skin rash. We first compared skin rash grades between different mutations, then tested factors possibly affecting skin rash by multivariate analysis. The main outcome measure was the significant difference in incidence of skin rash between each group with different mutations. Our study suggested that the risk of skin rash is low in patients with exon 19 deletion mutations who are taking EGFR-TKIs, whereas it is high in those with exon 21 point mutations. These results will be useful indicators for instructions regarding daily examinations, skin care, and use of oral antibiotics or topical steroids in patients taking EGFR-TKIs with skin rash.
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- 2020
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42. How to facilitate a rapid response system in Japan: a promotion course based on TeamSTEPPS.
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Fujiwara S, Atagi K, Moriyasu M, Naito T, Taneda K, Hsu HC, Lefor AK, and Fujitani S
- Abstract
Aim: In Japan, the number of facilities introducing a rapid response system (RRS) has been increasing. However, many institutions have had unsuccessful implementations. In order to implement RRS smoothly, a plan that meets the needs of each hospital is needed., Methods: Rapid response system teams from each hospital, including a physician and staff in charge of medical safety, from the RRS online registry were invited to attend a workshop. The workshop aimed to develop and implement RRS. The course curriculum was based on the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) developed in the USA. Participating facilities were required to formulate an RRS introduction plan referring to Kotter's 8-step change model to overcome barriers in the implementation of RRS. The change in medical emergency team activations comparing the intervention and control group hospitals was compared., Results: Sixteen institutions were eligible for this study. After participating in the workshop, there was a tendency toward more frequent activation of medical emergency teams in the intervention group ( P = 0.075). According to a self-evaluation from each facility, there is great difficulty in overcoming the 5th step of Kotter's model (empower people to act the vision)., Conclusion: This step-by-step evaluation clearly identified a problem with implementation and provided measures for resolution corresponding to each facility. There was a major barrier to overcome the 5th step of Kotter's model in leading change, which represents the attitude toward implementing RRS in institutions., Competing Interests: Approval of the research protocol: The protocol was approved by the Ethics Committee of NHO Ureshino Medical Center (13‐06). Informed consent: The requirement for informed consent of patients was waived. Registry and registration no. of the study/trial: This study was registered in UMIN‐CTR (UMIN000012045). Animal studies: N/A. Conflict of interest: None., (© 2020 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)
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- 2020
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43. First report based on the online registry of a Japanese multicenter rapid response system: a descriptive study of 35 institutions in Japan.
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Naito T, Fujiwara S, Kawasaki T, Sento Y, Nakada TA, Arai M, Atagi K, and Fujitani S
- Abstract
Aim: Although the concept of a rapid response system (RRS) has been gradually accepted in Japan, detailed information on the Japanese RRS is not well known. We provide the first report of the RRS epidemiological situation based on 4 years of RRS online registry data., Methods: This is a prospective observational study. All patients registered between January 2014 and March 2018 were eligible for this study. Data related to RRS including physiological measurements were recorded. The mortality rates after rapid response team/medical emergency team (RRT/MET) intervention and after 30 days were recorded as outcomes., Results: In total, 6,784 cases were registered at 35 facilities. Cancer (23.1%) was the most common existing comorbidity. Limitation of medical treatment was identified in 12.7% of the cases. The respiratory category was most frequently activated in 41.3% of the cases. Only two institutions had received more than 15 calls per 1,000 admissions. During RRT/MET intervention, death occurred in 3.6% and transfers to intensive care units occurred in 28.2% of the cases. After 30 days, the mortality rate was significantly higher in the night than in the day shift (30.7% versus 20.4%, respectively, P < 0.01)., Conclusions: We report the first epidemiological study of RRS in Japan. Japanese facilities had a very low rate of RRT/MET calls and a higher mortality rate in the night than in the day shift. Further promotion to increase the number of calls and implementation of a 24-h RRT/MET is required., (© 2019 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)
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- 2019
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44. Effect of simulation-based sedation training course for dentists on emergency response monitoring.
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Haba M, Komasawa N, Sanuki T, and Atagi K
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- Emergencies, Humans, Japan, Practice Guidelines as Topic, United States, Anesthesiology, Conscious Sedation standards, Dentists education, Education, Dental, Graduate methods, Monitoring, Physiologic methods, Simulation Training methods, Societies, Medical
- Published
- 2018
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45. Combination of video and manikin hybrid simulation for rapid response emergency airway management training in medical students.
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Komasawa N, Atagi K, and Minami T
- Subjects
- Airway Management instrumentation, Anesthesiology education, Emergency Treatment instrumentation, Humans, Manikins, Students, Medical statistics & numerical data, Surveys and Questionnaires statistics & numerical data, Airway Management methods, Clinical Competence, Education, Medical methods, Emergency Treatment methods, Simulation Training methods
- Published
- 2018
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46. Impact of mobilisation therapy on the haemodynamic and respiratory status of elderly intubated patients in an intensive care unit: A retrospective analysis.
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Umei N, Atagi K, Okuno H, Usuke S, Otsuka Y, Ujiro A, and Shimaoka H
- Subjects
- Aged, Female, Hemodynamics physiology, Humans, Intensive Care Units organization & administration, Intubation, Intratracheal adverse effects, Male, Patient Positioning nursing, Respiratory System physiopathology, Retrospective Studies, Health Status, Patient Positioning methods, Patient Positioning standards
- Abstract
Objectives: This study identified respiratory and haemodynamic parameters affected by limited mobilisation therapy in elderly, critically ill, intubated patients in an intensive care unit., Methods: Over 18 months, we retrospectively assessed physiological changes during 43 mobilisation therapy sessions in 23 patients requiring mechanical ventilation for >48h. We compared heart rate, mean arterial blood pressure, respiratory rate, partial pressure of oxygen in arterial blood/inspired fraction of oxygen and lactate before and after mobilisation therapy, which entailed sitting on the edge of a hospital bed without back support. We analysed baseline characteristics and therapy duration., Results: Patients' median age was 75 (interquartile range: 65-79) years, and the median Acute Physiology and Chronic Health Evaluation II score was 27 (26-31). Average therapy duration was 1h (0.5-2h). Therapy did not significantly modify heart rate or arterial blood pressure but increased the partial pressure of oxygen in arterial blood/inspired fraction of oxygen ratio significantly, from 218.8 (135.4-271.7) to 237.3 (167.2-284.9; p=0.007), indicating improved lung function., Conclusion: In this retrospective review, mobilisation therapy had no adverse effect on elderly, critically ill, intubated patients' haemodynamic status and appeared to improve the PaO2/FIO2 ratio; further research is required to confirm this finding., (Copyright © 2016 Elsevier Ltd. All rights reserved.)
- Published
- 2016
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47. A retrospective study of in-hospital cardiac arrest.
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Fujiwara S, Koike T, Moriyasu M, Nakagawa M, Atagi K, Lefor AK, Fujitani S, Ikeda T, Takamatsu Y, Hasegawa Y, Suzuki S, Komuro T, Kawamura N, and Yamada N
- Abstract
Aim: In-hospital cardiac arrest is an important issue in health care today. Data regarding in-hospital cardiac arrest in Japan is limited. In Australia and the USA, the Rapid Response System has been implemented in many institutions and data regarding in-hospital cardiac arrest are collected to evaluate the efficacy of the Rapid Response System. This is a multicenter retrospective survey of in-hospital cardiac arrest, providing data before implementing a Rapid Response System., Methods: Ten institutions planning to introduce a Rapid Response System were recruited to collect in-hospital cardiac arrest data. The Institutional Review Board at each participating institution approved this study. Data for patients admitted at each institution from April 1, 2011 until March 31, 2012 were extracted using the three keywords "closed-chest compression", "epinephrine", and "defibrillation". Patients under 18 years old, or who suffered cardiac arrest in the emergency room or the intensive care unit were excluded., Results: A total of 228 patients in 10 institutions were identified. The average age was 73 ± 13 years. Males represented 64% of the patients (82/146). Overall survival after in-hospital cardiac arrest was 7% (16/228). Possibly preventable cardiac arrests represented 15% (33/228) of patients, with medical safety issues identified in 8% (19/228). Vital sign abnormalities before cardiac arrest were observed in 63% (138/216) of patients., Conclusions: Approximately 60% of patients had abnormal vital signs before cardiac arrest. These patients may have an improved clinical outcome by implementing a Rapid Response System.
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- 2016
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48. [Change in Perioperative Hemostatic Function in Patients Undergoing Hepatic Resection for Primary and Metastatic Liver Cancer].
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Komasawa N, Ueki R, Atagi K, and Nishi S
- Subjects
- Aged, Hepatectomy, Humans, Liver Cirrhosis complications, Liver Cirrhosis surgery, Liver Neoplasms pathology, Liver Neoplasms secondary, Middle Aged, Perioperative Period, Retrospective Studies, Hemostasis, Liver Neoplasms surgery
- Abstract
Background: Patients undergoing primary hepatic resection often develop hemostatic dysfunction associated with cirrhosis., Methods: We retrospectively surveyed pre- and postoperative prothrombin time (PT) and the PT expressed as international normalized ratio (PT-INR) in 39 patients undergoing primary liver resection. We also compared PT changes between primary and metastatic cancer cases (8 cases)., Results: Postoperative PT-INR was 1.40 ± 0.38, which was significantly prolonged compared to preoperative PT-INR of 1.08 ± 0.07. Preoperative PT was over 70% in all 39 patients undergoing primary liver resection, whereas postoperative PT was less than 60% in 13 of 39 patients. No significant difference was found in preoperative PT-INR between primary and metastatic cancer cases, but postoperative PT-INR was significantly prolonged in primary cancer cases., Conclusions: Patients undergoing primary liver resection are susceptible to hemostatic dysfunction, even with preoperative PT levels within normal limits.
- Published
- 2015
49. Life-threatening check valve formation due to tracheobronchial aspergillosis.
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Matsuura H, Inoue S, Atagi K, and Kawaguchi M
- Abstract
A 12-year-old girl receiving chemotherapy for acute myeloid leukemia had a fever of unknown origin in spite of administration of micafungin. Her respiratory condition suddenly deteriorated. Her trachea was intubated, and positive pressure ventilation was initiated; however, her respiratory condition further deteriorated. Expiratory volume was considerably lower than inspiratory volume. Simultaneously, she developed severe hypotension and bradycardia, and tension pneumothorax was suspected. Emergent chest decompression was subsequently performed; however, her airway resistance was still high. Bronchoscopy was performed to remove a foreign body in the carina. Subsequently, her respiratory status improved. Histopathological examination revealed that the foreign body was a fibrinous blood clot mixed with fungal hyphae of Aspergillus niger . Life-threatening check valve formation due to tracheobronchial aspergillosis under positive-pressure ventilation may be rare; however, once it occurs, prompt establishment of an escape route for trapped air, such as thoracentesis, may be required.
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- 2015
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50. A case requiring tracheal stenting due to superior vena cava syndrome developing after craniotomy.
- Author
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Sonobe S, Inoue S, Atagi K, and Kawaguchi M
- Abstract
We report a patient who developed sustained hypotension during craniotomy; further, owing to a mediastinal mass, critical tracheal stenosis and brain edema were observed after craniotomy, despite the absence of preoperative symptomatic superior vena cava (SVC) syndrome. A 62-year-old man underwent removal of a suspected metastatic brain tumor. The main brain tumor was speculated to be a metastatic tumor from lung cancer. A subsequent chest CT revealed a large solid tumor in the mediastinum. The maximum reduction in the cross-sectional area of the trachea was estimated to be 50 %. In addition, bilateral innominate veins were completely obstructed, and the superior vena cava was involved in the mass and was completely compressed. The patient did not show any cardiopulmonary symptoms or upper body edema. Intravenous lines were secured at the right extremity. General anesthesia was induced without any complications and was maintained with sevoflurane, remifentanil, and rocuronium. During the surgery, hemodynamic status fluctuated and was unstable. To maintain systolic blood pressure, continuous, massive infusion of noradrenaline was required. After the surgery, the patient was turned to the supine position. Massive facial edema was apparent. In addition, the bilateral upper extremities were significantly swollen. Despite the removal of the main lesion, brain edema was still observed on head CT. Chest CT revealed that the maximum reduction in the cross-sectional area of the trachea was estimated to be >90 %, which necessitated mechanical ventilation with tracheal intubation. On the day following craniotomy, tracheal stenting was performed uneventfully. The patient's trachea was finally extubated, and his respiratory condition did not deteriorate. Although he did not develop SVC syndrome, the patient died from asphyxiation after coughing up blood at home 5 months after the procedure. It was suggested that fluid infusion from the upper extremities owing to the mediastinal tumor caused critical SVC syndrome.
- Published
- 2015
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