Acute Medicine & Surgery最新文献

{"title":"Association Between Hour-by-Hour ICU Admission Timing and 24-h Mortality: A Single-Center Retrospective Observational Study","authors":"Kazuhiro Shirakawa,&nbsp;Yoshihiro Katsura,&nbsp;Hiroaki Watanabe,&nbsp;Ryutaro Seo,&nbsp;Koichi Ariyoshi","doi":"10.1002/ams2.70163","DOIUrl":"10.1002/ams2.70163","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Prior studies of ICU admission timing often use broad categories (day vs. night), potentially masking hour-level effects. We examined hour-by-hour ICU admission timing and mortality, with attention to nighttime periods and routine handovers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-center retrospective observational study in a closed ICU with 24/7 on-site intensivist coverage, using prospectively registered data from the Japanese Intensive Care Patient Database. Adults (≥ 18 years) admitted to the E-ICU between April 2017 and July 2025 were included. Admission hour (0–23) was modeled as a continuous exposure using restricted cubic splines (reference 14:00). The primary outcome was 24-h mortality and the secondary outcome was ICU mortality. Multivariable logistic regression was adjusted for demographics, APACHE II, invasive mechanical ventilation at admission, comorbidities, diagnostic categories, admission source, and post-cardiac arrest status. Bootstrap resampling was used to estimate 95% confidence intervals. Additional analyses examined handover, nighttime, and 24-h periodic patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 5724 patients, 24-h and ICU mortality were 3.4% and 10.6%, respectively. Compared with 14:00, adjusted odds of 24-h mortality were higher in the early morning. The early-evening estimate was imprecise, with the 95% CI including unity. In contrast, ICU mortality showed no clear temporal pattern. Handover comparisons showed no clear mortality association; nighttime admission was not associated with higher mortality, and cosinor analysis was nonsignificant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hour-by-hour analysis showed higher adjusted odds of 24-h mortality in the early morning, whereas evidence of an increase in the early evening was inconclusive. Direct comparisons of handover periods showed no clear association with mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102358","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":"Isolated Scalp Laceration in the Elderly: Association Between Age and Red Blood Cell Transfusion Despite Anatomically Minor Injury","authors":"Hidemasa Okumura,&nbsp;Hiroto Chiba,&nbsp;Daiki Nakaji,&nbsp;Hiroka Hosaka,&nbsp;Nobuyuki Hattori,&nbsp;Tomohiko Takeuchi,&nbsp;Ayumi Tomonaga,&nbsp;Takuro Endo,&nbsp;Masayuki Iwashita,&nbsp;Taichiro Tsunoyama,&nbsp;Takashi Suzuki","doi":"10.1002/ams2.70164","DOIUrl":"10.1002/ams2.70164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Scalp lacerations without intracranial injury are generally considered anatomically minor traumas. However, elderly patients may experience unexpected clinical deterioration due to persistent bleeding after trivial injury. Such cases may represent clinically urgent conditions when physiological deterioration is taken into consideration. Evidence of the outcomes of isolated scalp lacerations in elderly patients remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of data from the Japan Trauma Data Bank (2019–2023) was conducted. Patients with isolated scalp lacerations, identified using Abbreviated Injury Scale codes, were included. Patients with intracranial injuries or injuries to other body regions were excluded. Patients were categorized into elderly (≥ 65 years) and non-elderly (&lt; 65 years) groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 304 patients were included, of whom 181 (59.5%) were elderly. Elderly patients required red blood cell (RBC) transfusion within 24 h more frequently than non-elderly patients (14.0% vs. 2.6%, <i>p</i> = 0.001). Furthermore, the rate of interhospital transfer after acute trauma management was significantly higher in elderly patients than in non-elderly patients (13.1% vs. 3.4%, <i>p</i> = 0.004). Multivariable logistic regression analyses were performed to identify factors independently associated with RBC transfusion. These analyses demonstrated that age ≥ 65 years (OR 4.540, 95% CI 1.272–16.204) and systolic blood pressure &lt; 90 mmHg on arrival (OR 6.124, 95% CI 2.182–17.186) were independently associated with RBC transfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Advanced age is independently associated with RBC transfusion in patients with isolated scalp lacerations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102609","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":"Unexplained Acute Life-Threatening Right Heart Failure During Hip Surgery","authors":"Hiroshi Araki,&nbsp;Motohiro Sekino,&nbsp;Shohei Kaneko,&nbsp;Naoya Iwasaki,&nbsp;Tetsuya Hara","doi":"10.1002/ams2.70165","DOIUrl":"10.1002/ams2.70165","url":null,"abstract":"<p>An 87-year-old woman underwent internal fixation for a right femoral neck fracture under general anesthesia. Intraoperatively, she developed sudden hypoxemia, shock, and severe right ventricular dilatation, necessitating the introduction of venoarterial extracorporeal membrane oxygenation. Pulmonary thromboembolism was excluded by dedicated computed tomography pulmonary angiography (Figure 1A,B).</p><p>Twelve hours postoperatively, conjunctival petechiae appeared (Figure 1C, white arrow). Brain magnetic resonance imaging after 5 weeks revealed diffuse small, low-signal spots (starfield pattern) on susceptibility-weighted imaging (Figure 1D, yellow arrow heads), confirming the clinical diagnosis of fulminant fat embolism syndrome (FES).</p><p>Although the classical FES triad (respiratory distress, neurological abnormalities, and petechial rash) is well recognized, it is frequently incomplete or absent at presentation [<span>1, 2</span>]. Especially, fulminant FES can manifest as sudden cardiovascular collapse, which may precede these classical features [<span>3</span>]. Notably, while FES is classically associated with younger patients, it also peaks in the elderly sustaining proximal femoral fractures [<span>4</span>]. During instrumentation, high intramedullary pressure forces marrow fat into the venous system [<span>1, 3</span>]; in elderly patients with reduced cardiopulmonary reserve, this leads to acute right heart failure [<span>2-4</span>].</p><p>This case highlights that FES should be considered in elderly patients presenting with unexplained acute right heart failure during orthopedic surgery.</p><p>The authors have nothing to report.</p><p>The patient's daughter gave written consent for the publication of this report. Ethics approval for this case report was waived by the Institutional Review Board of our Institution.</p><p>The patient's daughter gave written consent for the publication of this report.</p><p>The authors declare no conflicts of interest.</p><p>Data sharing not applicable to this article as no datasets were generated or analysed during the current study.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102588","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":"Cost-Effectiveness of Rule-Guided Head Computed Tomography for Pediatric Head Injury: An Economic Modeling Study Using a Nationwide Claims Database","authors":"Ryotaro Nagashima,&nbsp;Satoshi Funada,&nbsp;Yutaka Shigemori,&nbsp;Rei Goto","doi":"10.1002/ams2.70158","DOIUrl":"10.1002/ams2.70158","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the cost-effectiveness of applying the Pediatric Emergency Care Applied Research Network (PECARN) head injury clinical decision rules versus usual care in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We developed a public payer-perspective decision tree model by comparing PECARN rule-guided and usual-care computed tomography (CT) strategies for children aged 0–15 years with head injuries. The model captured short-term pathways (clinically important traumatic brain injury [ciTBI], CT use, admission or discharge, and surgery) and lifetime radiation-induced intracranial malignancy risk. Transition probabilities for the PECARN rule were obtained from a multicenter Japanese validation study, and usual-care transitions and costs were estimated from the Japan Medical Data Center (JMDC) nationwide claims database (2012–2019). Life-years were assessed over a lifetime. Uncertainty was explored using one-way and probabilistic sensitivity analyses, and scenario analyses assessed parameters, facility type, short-term hospitalization, and baseline CT utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the base-case analysis, the PECARN rule resulted in lower costs (¥11,391 vs. ¥12,148) and slightly higher effectiveness (39.41303 vs. 39.41296 life-years) than usual care. In probabilistic sensitivity analysis, the PECARN rule was cost-effective in 99.98% of simulations at a willingness-to-pay threshold of ¥5,000,000 per life-year. CT rates among children without ciTBI influenced the net monetary benefit most. Scenario analyses showed that the findings varied by facility type and baseline CT utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In average hospital-based usual care in Japan, use of the PECARN rule was associated with lower expected healthcare costs without meaningful loss of effectiveness and may support efficient resource use and reduced radiation exposure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149035590","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":"Day-Specific Associations of Serum Phosphate With 90-Day Mortality in Adult Patients With sepsis: A Landmark Analysis","authors":"Yugo Matsumoto,&nbsp;Tomoki Tanaka,&nbsp;Kazunori Fujino,&nbsp;Yuka Segoe,&nbsp;Mitsuhiro Fujino,&nbsp;Hidemitsu Miyatake,&nbsp;Naoto Mizumura,&nbsp;Junji Shimizu,&nbsp;Takuma Kishimoto,&nbsp;Yasuyuki Tsujita,&nbsp;Naoto Shiomi","doi":"10.1002/ams2.70161","DOIUrl":"10.1002/ams2.70161","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Serum phosphate abnormalities are common in sepsis, yet associations with outcomes remain inconsistent. We examined day-specific associations between serum phosphate levels during the first week after intensive care unit (ICU) admission and 90-day mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective study included adults meeting Sepsis-3 criteria admitted to the ICU between April 2011 and March 2021 with at least one serum phosphate measurement on Days 1–7. Phosphate was categorized as low (≤ 0.84 mmol/L [≤ 2.6 mg/dL]), normal (0.87–1.45 mmol/L [2.7–4.5 mg/dL]), or high (≥ 1.49 mmol/L [≥ 4.6 mg/dL]). Day-specific landmark Cox models assessed 90-day mortality using the normal group as reference and adjusted for age, sex, body mass index, arterial pH, daily Sequential Organ Failure Assessment (SOFA) score excluding the central nervous system component, renal replacement therapy status, and previous-day phosphate supplementation on Days 2–7. Day-specific logistic models evaluated factors associated with phosphate abnormalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 480 patients, hyperphosphatemia was consistently associated with higher 90-day mortality across Days 1–7 after adjustment. Hypophosphatemia showed phase-dependent associations that attenuated after adjustment. Arterial pH was most strongly associated with phosphate abnormalities early, whereas SOFA score showed more consistent associations later.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hyperphosphatemia during the first ICU week was consistently associated with increased 90-day mortality, whereas associations with hypophosphatemia were weaker after adjustment. The prevalence and clinical correlates of phosphate abnormalities varied across days, supporting interpretation by measurement timing and clinical severity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987655","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":"Correction to “Evaluating the Efficacy of Hyperbaric Oxygen Therapy for Acute Carbon Monoxide Poisoning: A Systematic Review and Meta-Analysis”","authors":"","doi":"10.1002/ams2.70162","DOIUrl":"10.1002/ams2.70162","url":null,"abstract":"<p>\u0000 <span>M. Fujita</span>, <span>M. Todani</span>, <span>Y. Ajimi</span>, et al., “ <span>Evaluating the Efficacy of Hyperbaric Oxygen Therapy for Acute Carbon Monoxide Poisoning: A Systematic Review and Meta-Analysis</span>,” <i>Acute Medicine &amp; Surgery</i> <span>13</span>, no. <span>1</span> (<span>2026</span>): e70114, https://doi.org/10.1002/ams2.70114.\u0000 </p><p>\u0000 <span>M. Fujita</span>, <span>M. Todani</span>, <span>Y. Ajimi</span>, et al., “ <span>Response to Comments on “Evaluating the Efficacy of Hyperbaric Oxygen Therapy for Acute Carbon Monoxide Poisoning”</span>,” <i>Acute Medicine &amp; Surgery</i> <span>13</span>, no. <span>1</span> (<span>2026</span>): e70147, https://doi.org/10.1002/ams2.70147.\u0000 </p><p>The name of the ninth author was misspelled and has been updated from Tetsuya Samkamoto to Tetsuya Sakamoto.</p><p>The online versions of these articles have been corrected accordingly.</p><p>We apologize for this error.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148965932","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":"Prophylactic Antibiotics and 30-Day Survival in Out-Of-Hospital Cardiac Arrest Patients Undergoing VA-ECMO: A Multicenter Observational Study","authors":"Toko Hirano,&nbsp;Takashi Tagami,&nbsp;Tomoko Ogasawara,&nbsp;Yudai Yoshino,&nbsp;Akihito Watanabe,&nbsp;Nobuya Kitamura,&nbsp;Yosuke Homma,&nbsp;Junichi Inoue,&nbsp;Shoji Yokobori","doi":"10.1002/ams2.70150","DOIUrl":"10.1002/ams2.70150","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with out-of-hospital cardiac arrest (OHCA) undergoing extracorporeal cardiopulmonary resuscitation with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are at high risk of nosocomial infections, and prophylactic antibiotics may reduce the infections, but there is limited evidence. This study evaluated the effectiveness of prophylactic antibiotic administration on survival and neurological outcomes in patients with OHCA receiving VA-ECMO.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>As a prespecified research question within the Survey of Survivors after Cardiac Arrest in the Kanto Area in 2017 (SOS-KANTO 2017) study, we conducted a multicenter observational study analyzing 153 patients with OHCA who underwent VA-ECMO between September 2019 and March 2021. Patients were categorized into the prophylactic antibiotic group (<i>n</i> = 106) or control group (<i>n</i> = 47). The primary endpoint was 30-day survival, and the secondary endpoints were ECMO-free days and a 30-day cerebral performance category of 1 or 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After Inverse Probability of Treatment Weighting (IPTW), the 30-day survival was significantly higher in the antibiotic group than in the control group (42.8% vs. 20.3%; <i>p</i> &lt; 0.001) and also ECMO-free days were higher in the antibiotic group (7.1 days vs. 1.4 days; <i>p</i> &lt; 0.001). However, there was no significant difference in neurological outcomes (13.2% vs. 11.1%; <i>p</i> = 0.584).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prophylactic antibiotic administration during VA-ECMO was associated with improved 30-day survival in patients with OHCA. Although these findings suggest a potential benefit, further randomized controlled trials are required to establish clinical recommendations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904957","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 and Microbiological Characteristics of Invasive Group A Streptococcus Infection: Four Case Series of Re-Emerging Pathogens","authors":"Shuji Okahara,&nbsp;Shinnosuke Fukushima,&nbsp;Yuto Hamaguchi,&nbsp;Masanobu Hishiike,&nbsp;Yohei Motoi,&nbsp;Kazuyoshi Gotoh,&nbsp;Shuma Tsuji,&nbsp;Koji Iio,&nbsp;Hideharu Hagiya","doi":"10.1002/ams2.70160","DOIUrl":"10.1002/ams2.70160","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Group A <i>Streptococcus</i> (GAS), particularly the M1UK lineage, has re-emerged as a major global public health concern following the COVID-19 pandemic, with a rise in invasive GAS (iGAS) and streptococcal toxic shock syndrome (STSS). Although STSS is under national surveillance in Japan, comprehensive molecular monitoring of iGAS infections remains limited, and the clinical characteristics of M1UK-associated iGAS have not been fully elucidated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed four consecutive iGAS cases requiring intensive care between March and May 2024. Detailed clinical, microbiological, and genomic investigations were performed to characterize the causative strains and their associated virulence profiles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All patients required respiratory and/or circulatory support with surgical debridement. Three cases involved necrotizing fasciitis, and one involved intra-abdominal infection secondary to ovarian tumor rupture. All four patients received penicillin G and clindamycin as definitive antimicrobial therapy, with two developing severe drug-related adverse events. Genotypic analysis identified three isolates as <i>emm</i>1 strains, including two M1UK lineage strains. The two M1UK isolates commonly harbored multiple superantigen genes. All isolates remained susceptible to β-lactam, clindamycin, and macrolide antibiotics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case series documents the identification of the M1UK lineage among critically ill patients with iGAS infections in Japan. Our findings support the need for continued molecular surveillance while reinforcing the importance of prompt surgical source control and appropriate antimicrobial therapy in the management of severe iGAS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896263","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":"Profile and Data Quality of DataVerse Japan: A Multi-Institutional Clinical Data Platform for Emergency and Critical Care Research","authors":"Takeshi Ebihara,&nbsp;Shunichiro Nakao,&nbsp;Ryota Nukiwa,&nbsp;Hiroshi Matsuura,&nbsp;Koichi Inukai,&nbsp;Kazuhiro Yoneda,&nbsp;Shigeto Seno,&nbsp;Jun Oda","doi":"10.1002/ams2.70159","DOIUrl":"10.1002/ams2.70159","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>DataVerse Japan is a multi-institutional clinical data platform that retains all exportable clinical information from each participating center's information systems and generates analysis-ready datasets for each research question. This study aimed to describe its design, participating centers, data composition, and patient profile, and to characterize its data quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The platform captures clinical information from each center's information systems, currently the electronic health record (EHR), which incorporates patient data management system (PDMS) data and claims data; reshapes the records into a common five-column long-format (Code, Day, Time, Variable, Value); and stores them as relationally linked. rds objects. We summarized admissions to the participating centers between January 2016 and December 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four emergency and critical care centers contributed 41,173 admissions from 38,287 individuals and 644,838 patient-days. The platform contains approximately 45 million vital sign records, 30 million laboratory records, and 32 million claims records. Median patient age was 70 years (IQR 49–81), and in-hospital mortality was 16.3%. Admission-level presence coverage, defined as the proportion of admissions with at least one record in a category, varied substantially by category, center, and year and improved after EHR and PDMS upgrades.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>DataVerse Japan provides a continuously updated multi-institutional clinical data platform that expands its participating centers over time. The coverage and validation metrics reported here allow investigators to judge whether the platform is suitable for a specific research question in emergency and critical care medicine in Japan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878802","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":"Comment on “Utility of Plasma Myostatin as a Predictive Biomarker for Post-Intensive Care Syndrome in Patients With Sepsis”","authors":"Mohammed Misbah Ul Haq,&nbsp;Shaik Mohd Shoaib","doi":"10.1002/ams2.70152","DOIUrl":"10.1002/ams2.70152","url":null,"abstract":"&lt;p&gt;We read with great interest the study by Shirahata et al. [&lt;span&gt;1&lt;/span&gt;]. Examining plasma myostatin as a predictive biomarker for post–intensive care syndrome in patients with sepsis. The authors addressed an unmet clinical need by seeking an early, biologically grounded signal to stratify survivors for targeted follow-up and rehabilitation. Their prospective design and time-resolved sampling add value to fields dominated by cross-sectional associations.&lt;/p&gt;&lt;p&gt;This analytical framework links discrete sampling windows to domain-specific outcomes, which advances clinical interpretability beyond single-timepoint biomarkers. Nevertheless, the inference that early versus late measurements map to cognitive versus physical trajectories depends on stable exposure classification across survivors. Given substantial post–intensive care attrition before outcome ascertainment, the predictive construct functions primarily within a survivor-enriched cohort [&lt;span&gt;2&lt;/span&gt;]. In this context, clinical interpretation benefits from the explicit positioning of myostatin as a stratifier among survivors rather than a universal prognostic tool across the septic population.&lt;/p&gt;&lt;p&gt;The reported discrimination metrics reached moderate ranges for the selected domains. From a clinical standpoint, such performance supports risk enrichment, but not standalone decision-making [&lt;span&gt;3&lt;/span&gt;]. The dichotomization strategy anchored to data-derived thresholds enhances internal consistency; however, bedside adoption requires the calibration of actionable pathways. Linking threshold crossing to concrete changes in rehabilitation intensity, nutrition delivery, or follow-up cadence would strengthen translation and reduce ambiguity in how clinicians should act on a given value [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Myostatin biology plausibly integrates muscle and neurocognitive pathways, which supports the authors' mechanistic rationale. Simultaneously, circulating concentrations during acute sepsis reflect a composite of catabolic stress, organ support, and recovery kinetics. For clinicians, this means that serial trends or isolated values carry the most interpretive weight. Framing myostatin as a dynamic recovery marker aligns better with practice patterns that reassess risk during de-escalation phases and discharge planning.&lt;/p&gt;&lt;p&gt;The study's strongest contribution lies in identifying a window late in the acute course that aligns with functional outcomes. This timing coincides with decisions regarding step-down care and rehabilitation referrals. Integrating myostatin trajectories with established clinical indicators could refine individualized strategies without adding a procedural burden. Importantly, the absence of association with mental health outcomes delineates the biomarker's scope and prevents overextension into domains where different pathophysiologies likely dominate.&lt;/p&gt;&lt;p&gt;Overall, this study advances biomarker-guided survivorship care by anchoring predictions to biologically in","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872592","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}