Acute Medicine & Surgery最新文献

{"title":"mRNA–miRNA integration analysis of T-cell exhaustion in sepsis from community-acquired pneumonia","authors":"Sayaka Oda,&nbsp;Hisatake Matsumoto,&nbsp;Yuki Togami,&nbsp;Jumpei Yoshimura,&nbsp;Hiroshi Ito,&nbsp;Shinya Onishi,&nbsp;Arisa Muratsu,&nbsp;Yumi Mitsuyama,&nbsp;Daisuke Okuzaki,&nbsp;Hiroshi Ogura,&nbsp;Susumu Tanaka,&nbsp;Jun Oda","doi":"10.1002/ams2.70054","DOIUrl":"https://doi.org/10.1002/ams2.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Community-acquired pneumonia is an acute lung infection in patients without recent healthcare exposure that can progress to severe sepsis. Despite the well-established influence of miRNAs on inflammation, their specific roles in pneumonia-associated sepsis remain underexplored. In this pilot study, we aimed to provide insights into the pathogenesis of community-acquired pneumonia-associated sepsis by performing an integrative mRNA–miRNA analysis to identify key cellular signaling pathways and potential molecular targets for future research and treatment development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective, observational, single-center study including 14 critically ill patients with community-acquired pneumonia-associated sepsis and 15 healthy controls (median age: 78 [interquartile range 67.3–83.5] and 55 [interquartile range 40.5–59.0] years, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eleven patients required ventilatory support, and six met the diagnostic criteria for septic shock. All patients survived. RNA sequencing revealed 1209 upregulated and 1461 downregulated differentially expressed genes for mRNAs (false discovery rate &lt; 0.05, |log₂ fold change| &gt;1.2), 51 upregulated and 21 downregulated genes for miRNAs, and 646 upregulated and 1274 downregulated for mRNA related to miRNAs. Canonical pathway analysis revealed activation of the programmed death-1/programmed death-ligand-1 cancer immunotherapy pathway and suppression of the Th1 pathway, indicating T-cell exhaustion in the acute phase of community-acquired pneumonia-associated sepsis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study provides valuable insights into the molecular mechanisms underlying CAP-associated sepsis, confirming the occurrence of immune dysregulation, particularly T-cell exhaustion. Our findings suggest that specific miRNAs and signaling pathways identified here may serve as potential therapeutic targets or biomarkers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of blood carboxyhemoglobin levels with mortality and neurological outcomes in out-of-hospital cardiac arrest","authors":"Takashi Hongo,&nbsp;Tetsuya Yumoto,&nbsp;Hiromichi Naito,&nbsp;Tomohiro Hiraoka,&nbsp;Yuya Murakami,&nbsp;Takafumi Obara,&nbsp;Tsuyoshi Nojima,&nbsp;Toshiyuki Aokage,&nbsp;Atsunori Nakao","doi":"10.1002/ams2.70053","DOIUrl":"https://doi.org/10.1002/ams2.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Carbon monoxide (CO), produced endogenously by heme oxygenase-1, plays a crucial role in the immune system by mitigating cellular damage under stress. However, the significance of carboxyhemoglobin (COHb) levels after out-of-hospital cardiac arrest (OHCA) is not well understood. This study aimed to explore the association between COHb levels at hospital arrival and within the first 24 h post-arrival with 30-day mortality and neurological outcomes in patients who experienced OHCA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, retrospective study analyzed data from adult patients who experienced OHCA seen at Okayama University Hospital from 2019 to 2023. The patients were assigned to one of two study groups based on COHb levels (0.0% or ≥0.1%) upon hospital arrival. The primary outcome was 30-day mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 560 eligible patients who experienced OHCA, 284 (50.7%) were in the COHb 0.0% group and 276 (49.3%) were in the COHb ≥ 0.1% group. The 30-day mortality was significantly higher in the COHb 0.0% group compared to the COHb ≥ 0.1% group (264 [92.9%] vs. 233 [84.4%]). Multivariable logistic regression showed that the COHb 0.0% group was associated with 30-day mortality (adjusted ORs: 2.24, 95% CIs: 1.10–4.56). Non-survivors at 30 days who were admitted to the intensive care unit had lower COHb levels at hospital arrival (0.0% vs. 0.2%) and lower mean COHb levels during the first 24 h post-arrival (0.7% vs. 0.9%) compared to survivors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>COHb levels of 0.0% were linked to worse outcomes in patients experiencing OHCA, warranting further research on the prognostic implications of COHb in this context.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early lymphopenia as a predictor of COVID-19 outcomes: A multicenter cohort study","authors":"Kazuhiro Okada,&nbsp;Takashi Tagami,&nbsp;Takanobu Otaguro,&nbsp;Mineji Hayakawa,&nbsp;Kazuma Yamakawa,&nbsp;Akira Endo,&nbsp;Takayuki Ogura,&nbsp;Atsushi Hirayama,&nbsp;Hideo Yasunaga,&nbsp;Yoshiaki Hara","doi":"10.1002/ams2.70044","DOIUrl":"https://doi.org/10.1002/ams2.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Lymphopenia is recognized as a biomarker for predicting outcomes in coronavirus disease (COVID-19). However, the optimal timing for its observation remains uncertain. We investigated the association between early lymphopenia and COVID-19 prognosis, as well as the relationship between lymphocyte count trends and disease outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the J-RECOVER study, a multicenter retrospective cohort study in Japan, encompassing patients with COVID-19 between January and September 2020. The patients were categorized into lymphopenia (LP) (&lt;800 cells/μL) and non-lymphopenia (NL) (≥800 cells/μL) groups based on the lymphocyte counts between days 1 and 4 post-onset. They were further divided into “persistent,” “recovered,” “exacerbated,” and “stable” groups based on lymphocyte counts between days 7 and 10. The primary outcome was the in-hospital mortality. The Cox proportional hazard regression was used for the analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 995 enrolled patients, 212 patients (21.3%) were classified into the LP group. LP was significantly associated with in-hospital mortality (hazard ratio [HR] 2.32, [95% CI 1.39 to 3.87], <i>p</i>-value 0.001). In both the LP and NL groups, lower lymphocyte counts between 7 and 10 days—categorized as the “persistent” and “exacerbated” groups—was associated with in-hospital mortality (HR 4.65, [95% CI 2.07 to 10.47], <i>p</i>-value &lt;0.001, and HR 5.59, [95% CI 2.24 to 13.97], <i>p</i>-value &lt;0.001, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early lymphopenia is predictive of poor prognosis in patients with COVID-19. A declining lymphocyte count trend post-onset further indicates disease deterioration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric pharyngeal foreign body with a difficult diagnosis","authors":"Hisataka Ominato,&nbsp;Tomoki Yoshizaki,&nbsp;Yui Hirata-Nozaki,&nbsp;Shota Sakaue,&nbsp;Miki Takahara","doi":"10.1002/ams2.70052","DOIUrl":"https://doi.org/10.1002/ams2.70052","url":null,"abstract":"<p>A 1-year-old boy with Down syndrome visited the emergency department of our hospital with complaints of displeasure and suspicion of pharyngeal foreign body obstruction. The parents noticed that a clothing price tag was missing at home. At the time of the initial examination, no foreign bodies were detected in the oral cavity of the patient. In addition, computed tomography did not reveal any foreign bodies (Figure 1A). The patient was referred to our department the next day. Endoscopic examination revealed a plastic foreign body at the posterior pharyngeal wall (Figure 1B). We could observe the foreign body from the oral cavity, and the foreign body was removed from the oral cavity using forceps, avoiding the huge tongue (Figure 1C).</p><p>Pharyngeal foreign body obstruction usually manifests as dysphagia, vomiting, and drooling.<span>¹</span> Typical pharyngeal foreign bodies include food, toys, balloons, and plastic bags. The patient had Down syndrome, and consequently, his enlarged tongue posed difficulties for oral observation. The foreign body was plastic and transparent, and it is difficult to see the foreign body in the emergency department. This case was characterized by the difficulty of diagnosis due to the presence of a transparent plastic foreign body and a large tongue, and there was a risk of the foreign body blocking and moving to the larynx. It was suggested that this case showed the need for early intervention by an otolaryngologist in the emergency outpatient department and the importance of performing an endoscopy as soon as possible. In addition, we should consider the possibility of performing an endoscopy before a CT scan to avoid radiation exposure.</p><p>None.</p><p>The authors declare no conflicts of interest.</p><p>Approval of the research protocol: N/A.</p><p>Informed consent: Informed consent was obtained from the patient's family.</p><p>Registry and the registration number of the study/trial: N/A.</p><p>Animal studies: N/A.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143632901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of near-infrared spectroscopy in diagnosing skin and soft tissue infections: A single-center retrospective study","authors":"Marina Oi,&nbsp;Takaaki Maruhashi,&nbsp;Yasushi Asari","doi":"10.1002/ams2.70041","DOIUrl":"https://doi.org/10.1002/ams2.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Skin and soft tissue infection (SSTI) is classified as necrotizing fasciitis (NF) or cellulitis based on the invasion depth of the lesion. Cellulitis has a good prognosis and improves with conservative treatment, whereas NF has a poor prognosis with rapid progression requiring prompt debridement of the wound and intensive care control. Therefore, they should be differentiated quickly and accurately; however, a useful diagnostic method, except for the surgical test incision, remains to be established. This study aimed to verify the usefulness of near-infrared spectroscopy (NIRS) to measure regional oxygen saturation (rSO2) in diagnosing SSTI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single-center, retrospective, observational study. SSTI cases from October 2019 to April 2024 (4.5 years) were selected from medical records, and their characteristics, rSO2 levels, computed tomography findings, and Laboratory Risk Indicator for Necrotizing Fasciitis scores were collected. The primary endpoint was the rSO2 between cellulitis and NF lesions measured using NIRS, and the affected and unaffected sides in the same patient were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen patients were included: six with NF and 12 with cellulitis. There were no significant differences in patient characteristics between the groups. The primary endpoint of NIRS on the affected/unaffected side was significantly lower in patients with NF (0.6 [interquartile range, 0.5–0.7] vs. 1.4 [1.2–1.6]; <i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NIRS has the potential to be a non-invasive and quantitative diagnostic tool for SSTI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143602530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and outcomes of patients with out-of-hospital cardiac arrest treated by repeated extracorporeal cardiopulmonary resuscitation: A multicenter retrospective cohort study","authors":"Akira Suekane,&nbsp;Wataru Takayama,&nbsp;Koji Morishita,&nbsp;Akihiko Inoue,&nbsp;Toru Hifumi,&nbsp;Tetsuya Sakamoto,&nbsp;Yasuhiro Kuroda,&nbsp;the Save-J II Study Group","doi":"10.1002/ams2.70051","DOIUrl":"https://doi.org/10.1002/ams2.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Retrospective analysis of clinical characteristics and outcomes of patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) requiring extracorporeal membrane oxygenation (ECMO) reinsertion or not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in the Japan II database were reviewed. Patients who received ECPR after OHCA between January 2015 and July 2021 and underwent ECPR weaning were divided into reinsertion and no-reinsertion groups. The primary outcome was the 30-day survival rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data from 1011 patients who underwent ECMO weaning ≥1 time and survived were analyzed (12 [1.2%], reinsertion; 999 [98.8%] no-reinsertion). The reinsertion group had a longer time to first ECMO weaning (median [interquartile range, IQR]: 3.0 [2.0–5.0] vs. 4.5 [3.2–6.8] days; <i>p</i> = 0.02). The survival rates at 30 days (25.0% vs. 55.1%; <i>p</i> = 0.08) and favorable neurological outcomes at discharge (8.3% vs. 30.5%; <i>p</i> = 0.18) tended to be lower in the reinsertion group. Among patients who died within 30 days, medical costs were significantly higher in the reinsertion group (median [IQR]: $36,628.2 [26,012.9–45,885.6] vs. $16,456.6 [9341.2–24,880.6]; <i>p</i> &lt; 0.01). Intensive care unit (ICU) stay and mechanical ventilation duration were significantly longer in the reinsertion group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients requiring ECMO reinsertion tended to have poor clinical outcomes and higher healthcare costs, highlighting the need for large-scale studies to develop ECPR protocols and optimize clinical benefits and resource allocation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical validity and layperson interpretation of emergency visit recommendations by the GPT model: A cross-sectional study","authors":"Chie Tanaka,&nbsp;Takahiro Kinoshita,&nbsp;Yohei Okada,&nbsp;Kasumi Satoh,&nbsp;Yosuke Homma,&nbsp;Kensuke Suzuki,&nbsp;Shoji Yokobori,&nbsp;Jun Oda,&nbsp;Yasuhiro Otomo,&nbsp;Takashi Tagami,&nbsp;Special Committee on the Utilization of Advanced Technology in Emergency Medicine, Japanese Association for Acute Medicine","doi":"10.1002/ams2.70042","DOIUrl":"https://doi.org/10.1002/ams2.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>In Japan, emergency ambulance dispatches involve minor cases requiring outpatient services, emphasizing the need for improved public guidance regarding emergency care. This study evaluated both the medical plausibility of the GPT model in aiding laypersons to determine the need for emergency medical care and the laypersons' interpretations of its outputs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study was conducted from December 10, 2023, to March 7, 2024. We input clinical scenarios into the GPT model and evaluated the need for emergency visits based on the outputs. A total of 314 scenarios were labeled with red tags (emergency, immediate emergency department [ED] visit) and 152 with green tags (less urgent). Seven medical specialists assessed the outputs' validity, and 157 laypersons interpreted them via a web-based questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Experts reported that the GPT model accurately identified important information in 95.9% (301/314) of red-tagged scenarios and recommended immediate ED visits in 96.5% (303/314). However, only 43.0% (135/314) of laypersons interpreted those outputs as indicating urgent hospital visits. The model identified important information in 99.3% (151/152) of green-tagged scenarios and advised against immediate visits in 88.8% (135/152). However, only 32.2% (49/152) of laypersons considered them routine follow-ups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Expert evaluations revealed that the GPT model could be highly accurate in advising on emergency visits. However, laypersons frequently misinterpreted its recommendations, highlighting a substantial gap in understanding AI-generated medical advice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between neurological outcomes and prehospital time in patients with out-of-hospital cardiopulmonary arrest","authors":"Kazuhide Yoshikawa,&nbsp;Akira Endo,&nbsp;Wataru Takayama,&nbsp;Tomohisa Shoko,&nbsp;Yasuhiro Otomo,&nbsp;Koji Morishita","doi":"10.1002/ams2.70025","DOIUrl":"https://doi.org/10.1002/ams2.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Out-of-hospital cardiac arrest (OHCA) remains an important health care issue. Considering the importance of such a time course after cardiac arrest, detailed evaluation of the prehospital time (i.e., time from EMS contact to a patient to hospital arrival) is essential to improve the mortality and neurologic outcome of OHCA. In this study, we aimed to evaluate the impact of prehospital time on neurological outcomes in patients with OHCA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study included adult non-traumatic OHCA patients who were transported to 2 emergency centers in Tokyo from January 2015 to December 2020. The following data were obtained retrospectively from medical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 3120 OHCA patients who were transported during the study period, 2215 patients were evaluated via the inclusion and exclusion criteria. Sixty-nine patients were alive at hospital discharge with a good neurological outcome (i.e., CPC 1 or 2). The multivariate logistic regression model showed that prehospital time (time from EMS contact to hospital arrival) was an independent predictor for hospital discharge with good neurological outcome, in addition to age, bystander CPR, initial rhythm, and cause of cardiac arrest. The GAM plot showed that the adjusted odds ratio of prehospital time for the good neurological outcome was decreased linearly according to time, and the threshold was approximately 30 min.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The threshold of allowable prehospital time, including field activity and transport, for OHCA patients might be 30 min at least in a Japanese urban setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Difficult-to-transport cases and neurological outcomes of out-of-hospital cardiac arrest: A population-based nationwide study in Japan","authors":"Azusa Taguchi,&nbsp;Shotaro Aso,&nbsp;Hiroshi Yamagami,&nbsp;Hideo Yasunaga","doi":"10.1002/ams2.70050","DOIUrl":"https://doi.org/10.1002/ams2.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>In Japan, emergency medical service personnel often have difficulty obtaining hospitals' acceptance of emergency cases owing to congestion in the emergency unit; such cases are called difficult-to-transport cases. Increased difficult-to-transport cases at a regional level may be associated with the prognosis of out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the association between the proportion of difficult-to-transport cases at a regional level and neurological outcomes in patients with OHCA, using the nationwide Utstein database linked to ambulance records in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective cohort study from 2017 to 2021 in Japan, the proportion of difficult-to-transport cases was calculated as the number of difficult-to-transport cases divided by the number of emergency calls in each district on each day. Patients with OHCA were categorized into no, low, and high difficult-to-transport cases groups. The primary outcome was a Cerebral Performance Category 1 or 2 at 1 month. The secondary outcome was transportation time intervals. Multivariate regression analyses were conducted to assess the association between difficult-to-transport cases and patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 592,021 eligible patients, the no, low, and high difficult-to-transport case groups included 282,747 (48%), 155,167 (26%), and 154,107 (26%) patients, respectively. The high difficult-to-transport cases group was associated with decreased favorable neurological outcomes (adjusted odds ratio, 0.91; 95% confidence interval, 0.86–0.95) and longer total transportation time (difference, 4.1 min; 95% confidence interval, 3.8–4.4).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A higher proportion of difficult-to-transport cases was associated with poorer neurological outcomes and longer total transportation times in patients with OHCA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143533558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of aerosol generation and cooling effects of evaporative plus convective cooling in heat stroke treatment: A simulation study","authors":"Jun Kanda,&nbsp;Yasufumi Miyake,&nbsp;Yuzo Sakamoto,&nbsp;Shoichi Yoshiike,&nbsp;Tomohiko Takeuchi,&nbsp;Tomoki Kanda,&nbsp;Daiki Tanaka,&nbsp;Tadashi Umehara,&nbsp;Kaori Kono,&nbsp;Yasushi Mizutani,&nbsp;Ayumi Tomonaga,&nbsp;Masahiro Asami,&nbsp;Akifumi Yoshida,&nbsp;Maiko Yamazaki,&nbsp;Naoto Morimura,&nbsp;Tetsuya Sakamoto","doi":"10.1002/ams2.70023","DOIUrl":"https://doi.org/10.1002/ams2.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to experimentally verify the safety and effectiveness of evaporative plus convective cooling used in heat stroke treatment using a doll simulating a patient with heat stroke.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Evaporative plus convective cooling was simulated by blowing air through a fan (speed: approximately 1.0 or 2.5 m/s) and using normal (20°C) or slightly warm (40°C) water on a doll whose surface body temperature was set at 40°C. We measured the change in surface body temperature using a surface heater attached to the back of the doll's chest cover and observed aerosol generation (size: ≥5 μm) using a particulate visualization system. Three particle counters were placed to measure the generated particles that were not captured by the particulate visualization system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cooling effect of the 2.5 m/s wind speed was greater than that of the 1.0 m/s wind speed. No particles &gt;0.5 μm were observed, and no aerosol particles were generated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results thus suggested that wind force has a significant effect, and there was no risk of aerosol-related viral infection in evaporative plus convective cooling. However, this does not rule out the risk of droplet infection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}