Acute Medicine & Surgery最新文献

{"title":"Critique on Machine Learning Model for Predicting Short-Term Outcomes After Rapid Response System Activation","authors":"Hamza Tahir, Ahmed Raza","doi":"10.1002/ams2.70146","DOIUrl":"https://doi.org/10.1002/ams2.70146","url":null,"abstract":"<p>We read with great interest the article by Naito et al., “A machine learning model for predicting short-term outcomes after rapid response system activation” [<span>1</span>], which addresses an important and timely issue in acute care medicine. The authors should be commended for their efforts to apply advanced machine learning approaches to improve early identification of critically ill patients and to enhance the effectiveness of rapid response systems. Their contribution is valuable in highlighting the potential of artificial intelligence to support clinical decision-making in emergency contexts, where timely intervention can make the difference between survival and adverse outcomes. However, despite the significance of this work, the study has the following additional limitations that warrant consideration.</p><p>Lack of temporal data (only single-point data at RRS activation used). By relying only on static measurements at the time of RRS activation, the model ignores the dynamic trajectory of vital signs. This reduces sensitivity in predicting patient deterioration, since trends over time (e.g., progressive hypotension or hypoxia) are often more predictive than a single reading. Churpek et al. [<span>2</span>] showed that incorporating longitudinal vital sign trends significantly improved prediction of clinical deterioration compared to static values.</p><p>Model interpretability not addressed (black-box predictions). A lack of explainability may reduce clinician trust and hinder bedside adoption, particularly in critical care where rapid decisions demand transparent reasoning. Predictions without explanations risk being ignored, limiting clinical utility. Singh and Rabinstein [<span>3</span>] emphasized that AI systems in acute neurology face adoption barriers when predictions lack transparency.</p><p>Small and narrowly defined patient dataset. Restricting analysis to a small, registry-based sample risks underrepresenting patient diversity. This limits the robustness and stability of the predictive model, making it prone to bias and unreliable for broader clinical use. Li et al. [<span>4</span>] demonstrated that small sample size and restricted patient inclusion significantly limited the reliability of ML models predicting coagulation outcomes.</p><p>Patient heterogeneity not fully captured. Different hospitals and patient profiles introduce variability in disease presentation and care. Ignoring this heterogeneity may lead to inaccurate predictions, as the model cannot adapt to diverse patient subgroups. Dellinger and Bartock [<span>5</span>] discussed how failing to address patient heterogeneity undermines ML prediction in sepsis, leading to inconsistent performance. Future studies should leverage time-series EHR data with advanced models (e.g., RNNs and transformers) to capture patient trajectories and improve prediction accuracy. Incorporating explainable AI with intuitive visualizations will boost clinician trust, while larger mul","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467400","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 “Evaluating the Efficacy of Hyperbaric Oxygen Therapy for Acute Carbon Monoxide Poisoning: A Systematic Review and Meta-Analysis”","authors":"Kishankumar Mahida, Snehal Rajendra Jagtap","doi":"10.1002/ams2.70142","DOIUrl":"10.1002/ams2.70142","url":null,"abstract":"<p>We read with great interest the systematic review and meta analysis by Fujita and colleagues assessing hyperbaric oxygen therapy for acute carbon monoxide poisoning [<span>1</span>]. The authors should be acknowledged for restricting inclusion to randomized controlled trials and for undertaking a prespecified subgroup analysis based on treatment pressures of at least 2.5 atm absolute, an issue of ongoing mechanistic and clinical debate. The effort to align evidence synthesis with guideline development priorities in neuroresuscitation is timely. Several interpretive and translational considerations, however, warrant closer examination.</p><p>A central issue relates to the clinical hierarchy of outcomes selected for synthesis. Mortality, favorable neurological outcome, delayed neurological sequelae, and neuropsychiatric sequelae are treated as parallel endpoints, yet they do not carry equivalent decision weight in acute care [<span>2</span>]. In carbon monoxide poisoning, early neurological recovery and prevention of delayed cognitive decline often drive treatment escalation more than short term mortality risk [<span>3</span>]. Pooling these outcomes without an explicit prioritization framework may dilute clinically meaningful signals. A structured outcome hierarchy or composite endpoint anchored to patient centered functional recovery could better reflect real world decision making at the bedside.</p><p>Another consideration concerns the temporal alignment between intervention delivery and outcome assessment. Hyperbaric oxygen therapy is hypothesized to exert time sensitive effects on oxidative injury, mitochondrial dysfunction, and neuroinflammation. The included trials evaluate outcomes across heterogeneous follow up intervals, ranging from weeks to months. Synthesizing these time points assumes biological equivalence that may not hold. Time stratified analyses separating early neurological stabilization from later cognitive trajectories could offer clearer insight into when hyperbaric exposure is most likely to confer benefit.</p><p>The subgroup analysis based on treatment pressure also merits careful interpretation. Pressure is used as a surrogate for biological dose, yet total oxygen exposure is jointly determined by pressure, session duration, number of sessions, and intersession timing [<span>4</span>]. Treating pressure alone as the defining variable risks oversimplifying dose response relationships [<span>5</span>]. A cumulative oxygen dose model integrating these parameters may be more informative than threshold-based subgrouping when evaluating therapeutic efficacy.</p><p>There are also implications for guideline translation. The review concludes with equipoise regarding benefit, but does not explicitly address how clinicians should integrate this uncertainty into triage pathways, particularly in systems where hyperbaric chamber access is limited. Decision analytic frameworks incorporating patient risk profiles, exposure severity, an","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417785","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":"Syphilitic Alopecia as a Clinical Clue to Syphilitic Meningitis","authors":"Natsuki Moriya,&nbsp;Manami Fujinaga,&nbsp;Akari Nakabayashi,&nbsp;Katsuki Nomura,&nbsp;Kei Suzuki","doi":"10.1002/ams2.70138","DOIUrl":"10.1002/ams2.70138","url":null,"abstract":"<p>A 25-year-old man presented with a 1-week history of progressively worsening headache. Physical examination was unremarkable except for a low-grade fever and alopecia of the scalp in a “moth-eaten” pattern (Figure 1A). The hair loss had developed abruptly 1 month previously. He denied any associated scalp pruritus or pain but reported having experienced a generalized rash approximately 2 years earlier that had resolved spontaneously.</p><p>Because the patient had a history of a generalized rash and the alopecia showed a characteristic “moth-eaten” pattern suggestive of syphilitic alopecia [<span>1</span>], syphilis was suspected, and serologic testing was performed. Both the <i>Treponema pallidum</i> hemagglutination assay and rapid plasma reagin tests were positive, with titers of 5090 TU and 420 RU, respectively. HIV testing was negative. Given the patient's persistent headache lasting for 1-week, cerebrospinal fluid analysis was performed, demonstrating pleocytosis (total protein level, 65 mg/dL; glucose level, 53 mg/dL; total cell count, 51 cells/μL, including 1 polymorphonuclear cell/μL and 50 mononuclear cells/μL) and a positive semiquantitative fluorescent treponemal antibody absorption test at a titer of 1:16, confirming the diagnosis of neurosyphilis. The patient reported a history of multiple sexual contacts. He was treated with intravenous penicillin G at 24 million units per day for 14 days, followed by oral amoxicillin at 1500 mg daily for another 14 days. Four months after treatment initiation, the alopecia showed marked improvement (Figure 1B).</p><p>The incidence of syphilis has recently increased in Japan. However, its protean manifestations can delay diagnosis [<span>2</span>], which is why syphilis is known as the “great imitator.” A characteristic “moth-eaten” alopecia accompanied by headache may serve as an important clinical clue to neurosyphilis in emergency medicine practice.</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The patient provided consent for publication of this report.</p><p>The authors declare no conflicts of interest.</p><p>The data that support the findings of this study are available from the corresponding author upon reasonable request.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429573","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":"Response to Comments on “Evaluating the Efficacy of Hyperbaric Oxygen Therapy for Acute Carbon Monoxide Poisoning”","authors":"Motoki Fujita,&nbsp;Masaki Todani,&nbsp;Yasuhiko Ajimi,&nbsp;Tomoaki Yatabe,&nbsp;Shoji Yokobori,&nbsp;Manabu Araki,&nbsp;Norio Chihara,&nbsp;Masao Nagayama,&nbsp;Tetsuya Samkamoto,&nbsp;Ryosuke Tsuruta","doi":"10.1002/ams2.70147","DOIUrl":"10.1002/ams2.70147","url":null,"abstract":"&lt;p&gt;We sincerely thank the authors of the Letter for their thoughtful and constructive comments on our systematic review and meta-analysis of hyperbaric oxygen (HBO) therapy for acute carbon monoxide (CO) poisoning [&lt;span&gt;1, 2&lt;/span&gt;]. We appreciate their emphasis on methodological rigor, clinical interpretability, and implementation relevance.&lt;/p&gt;&lt;p&gt;We agree that additional analytical approaches—such as hierarchical prioritization of outcomes, time-stratified effect evaluation, and exposure-oriented modeling beyond treatment pressure alone—would improve clinical interpretability. These are important and welcome suggestions.&lt;/p&gt;&lt;p&gt;Our key point, however, is feasibility. These analyses could not be performed robustly in the current review because the underlying evidence base remains limited. Only a small number of randomized controlled trials (RCTs) met eligibility criteria, and major intervention and outcome variables were incompletely and inconsistently reported across studies [&lt;span&gt;1, 3&lt;/span&gt;]. Under these conditions, extensive secondary modeling would have introduced substantial fragility. Therefore, our conclusions should be interpreted as reflecting limitations of currently available RCT evidence, rather than definitive proof of no treatment effect.&lt;/p&gt;&lt;p&gt;A related issue is outcome hierarchy. We agree that mortality, favorable neurological outcome, delayed neurological sequelae (DNS), and neuropsychiatric sequelae do not necessarily carry equal decision weight, and that relative importance may vary across patients. In our review, we broadened outcomes beyond neuropsychiatric sequelae alone to provide a more clinically inclusive perspective. However, this meta-analysis did not include primary elicitation of patient values and preferences, nor formal EtD-based value judgments [&lt;span&gt;4&lt;/span&gt;]. In addition, CO-specific evidence on patient preferences appears limited [&lt;span&gt;4, 5&lt;/span&gt;]. We therefore consider development of a patient-centered hierarchical outcome framework an important priority for future evidence synthesis and guideline translation.&lt;/p&gt;&lt;p&gt;Temporal heterogeneity is another major limitation. Follow-up timing varied substantially across trials, and pooling across different windows may have obscured time-dependent effects. Early neurological stabilization and later neurocognitive trajectories likely represent distinct processes. Future studies should use harmonized early/late follow-up windows with prespecified temporal analyses.&lt;/p&gt;&lt;p&gt;Treatment-intensity modeling also requires improvement. Pressure alone is an incomplete proxy for biological oxygen dose; session duration, number of sessions, and interval structure also determine cumulative exposure. Our a priori subgroup analysis at ≥ 2.5 ATA addressed a clinically plausible threshold question, but cumulative exposure modeling would be preferable once adequately detailed trial-level data become available [&lt;span&gt;1, 3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Clinical translation must also consider real-worl","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417842","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 Epidemiological Characteristics of Suspected Child Maltreatment Reported After Caregiver Emergency Department Visits in Japan","authors":"Natsumi Hata,&nbsp;Yasunori Nagai,&nbsp;Takateru Ihara","doi":"10.1002/ams2.70144","DOIUrl":"10.1002/ams2.70144","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Child maltreatment is a major public health concern, yet identification in emergency department settings remains challenging. Caregiver-focused approaches may help identify families at risk. We describe cases reported to a hospital-based Child Protection Team following caregiver emergency department visits in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-center retrospective observational study at an urban tertiary hospital. We included caregiver emergency department visits between January 2022 and December 2024 when the presenting adult was 18 years or older, the visit was reported to the Child Protection Team regarding at least one child under 18 years in that adult's care, and the team subsequently judged that involvement was required. We extracted medical record variables and used descriptive analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 79 index caregivers and 101 emergency department visits. A documented history of mental health conditions was present in 53% of caregivers. Common diagnoses included drug intoxication, alcohol-related disorders, somatic symptom-related or dissociation-related diagnoses, injuries related to domestic violence, and self-inflicted injuries. Neglect was the most common reason for notification. Fifty-seven percent of caregivers had prior involvement with the Child Protection Team or the Council for Children Requiring Care and Support, and 30% required new registration or temporary child protection after the team review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study describes a selected group of caregiver emergency department visits that were reported to a hospital-based Child Protection Team and subsequently judged to require team involvement. Further studies with defined caregiver denominators and comparison groups are needed to evaluate caregiver-focused emergency department assessment pathways.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417743","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":"Response to “Comment on ‘Utility of Plasma Myostatin as a Predictive Biomarker for Post-Intensive Care Syndrome in Patients With Sepsis’”","authors":"Ayaki Shirahata,&nbsp;Nobuto Nakanishi,&nbsp;Yuko Ono,&nbsp;Shigeaki Inoue,&nbsp;Joji Kotani","doi":"10.1002/ams2.70141","DOIUrl":"10.1002/ams2.70141","url":null,"abstract":"&lt;p&gt;We sincerely thank Drs. Haq and Shoaib for their thoughtful and constructive comments on our article, “Utility of Plasma Myostatin as a Predictive Biomarker for Post Intensive Care Syndrome (PICS) in Patients with Sepsis.” We appreciate their recognition of the clinical value of biomarker-guided stratification in patients with sepsis and the opportunity to clarify and elaborate on key aspects of our study.&lt;/p&gt;&lt;p&gt;First, we agree with Drs. Haq and Shoaib that the interpretation of plasma myostatin levels should be understood within the context of sepsis survivors rather than the entire sepsis population. Our study was not designed to predict acute mortality but to identify patients who survived severe sepsis and were at risk of developing PICS after discharge. As we noted in our original paper, lower plasma myostatin levels during the subacute phase were significantly associated with subsequent physical and cognitive impairments, suggesting that sustained suppression of myostatin reflects an ongoing catabolic state and delayed recovery from critical illness [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Second, we fully agree that the temporal dynamics of myostatin are essential for interpretation. In our study, measurements on day 1 and day 6–7 appeared to represent distinct biological phases—early inflammation and later metabolic adaptation. Previous research has shown that plasma and muscular myostatin concentrations remain suppressed during critical illness and increase gradually during recovery, correlating with improved muscle strength [&lt;span&gt;2&lt;/span&gt;]. Thus, serial assessment of myostatin may help characterize the transition from catabolism to anabolism after sepsis more precisely.&lt;/p&gt;&lt;p&gt;Third, we acknowledge that the AUC values (0.70–0.76) indicate fair discrimination. According to established interpretive criteria, AUC values between 0.70 and 0.79 represent fair accuracy, 0.80–0.89 good, and ≥ 0.90 excellent [&lt;span&gt;3&lt;/span&gt;]. We intended not to propose myostatin as a stand-alone diagnostic tool but as a complementary biomarker to enhance multimodal assessment. Combining myostatin kinetics with inflammatory or neuronal markers such as interleukin-6 (IL-6) or neurofilament light chain (NfL) may improve predictive accuracy for post-sepsis outcomes [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Finally, the lack of association between myostatin and mental health outcomes indicates that its relevance lies primarily in the physical and cognitive domains of PICS. This aligns with the biological characteristics of myostatin (GDF-8), which is predominantly expressed in skeletal muscle and the central nervous system, where it regulates muscle growth and may influence neurocognitive recovery [&lt;span&gt;5&lt;/span&gt;]. Thus, myostatin appears to reflect musculoskeletal and neurocognitive recovery rather than mental health sequelae.&lt;/p&gt;&lt;p&gt;In conclusion, we concur that plasma myostatin represents a dynamic, recovery-related biomarker in sepsis survivors. Future multicenter studies incorporating longitudi","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13334364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434701","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":"How to Write Clear and Clinically Meaningful Manuscripts for Acute Medicine and Surgery","authors":"Masaru Suzuki","doi":"10.1002/ams2.70140","DOIUrl":"https://doi.org/10.1002/ams2.70140","url":null,"abstract":"&lt;p&gt;This letter is based on a lecture entitled “Let's Submit to AMS (Acute Medicine and Surgery): How Editors and Reviewers Read Manuscripts” that was delivered at the 53rd Annual Meeting of the Japanese Association for Acute Medicine. The lecture posed a deceptively simple question: What does it mean to write a scientific manuscript that is truly complete?&lt;/p&gt;&lt;p&gt;In science education, we learn early on that scientific knowledge is founded on demonstrability, reproducibility, and objectivity. In clinical research, these principles correspond to distinct roles: the researcher provides evidence, the reviewer assesses reproducibility, and the journal establishes objectivity by incorporating validated findings into the collective scientific record. Publication is therefore not merely the reporting of results; it is the act through which science is completed.&lt;/p&gt;&lt;p&gt;Reviewers typically do not begin by reading every line, but instead examine three key elements: the abstract, the stated objective, and the conclusion [&lt;span&gt;1&lt;/span&gt;]. If these do not align, the manuscript's logic is considered unstable from the outset. Misalignment between purpose and conclusion is therefore the most common cause of rejection. The next question that reviewers must ask is: Can this study be reproduced as written? [&lt;span&gt;2&lt;/span&gt;]. This is why statistical research becomes unusable not because the studies themselves are flawed, but because reporting is incomplete, methods are unclear, decisions are omitted and results are expressed impressionistically rather than numerically; complexity is not synonymous with scientific rigor. A study that requires complex modeling to extract meaning often indicates a design issue rather than analytical depth. A simple study analyzed simply is stronger than a complicated study defended with statistical acrobatics. In AMS, clarity precedes complexity. Ultimately, the important thing in AMS is whether the manuscript enables readers to understand, evaluate and apply its findings. Accepted manuscripts therefore share a clarity of intention: they state a specific clinical question, describe methods transparently, present results as evidence rather than impressions, interpret findings within the limits of the data and conclude by clarifying what those findings mean for clinical practice. When a manuscript is rejected, it is rarely because the research lacks clinical importance; rather, it is because the writing does not allow the reviewer to judge reproducibility. Reviewer uncertainty is structurally equivalent to rejection by a reviewer.&lt;/p&gt;&lt;p&gt;Therefore, to complete the scientific process in emergency medicine, we must write manuscripts that are clearly written, can be faithfully reproduced, and objectively contribute to shared clinical knowledge. AMS does require clarity, reproducibility, clinical meaning, and honesty. Researchers demonstrate this. Reviewers verify. The journal provides objectivity. Together, we advance science.&lt;/p&gt;&lt;p&gt;The author d","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381152","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":"Comparison of the Effectiveness and Safety of 20% Versus 50% Glucose Solutions Administered by Paramedics to Patients With Hypoglycemia","authors":"Mamoru Tomida,&nbsp;Yasuo Miki,&nbsp;Ryota Matsuoka,&nbsp;Norio Kanamori,&nbsp;Nobuaki Kaki,&nbsp;Hideaki Sonoi,&nbsp;Haruhiko Inada","doi":"10.1002/ams2.70139","DOIUrl":"10.1002/ams2.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We aimed to compare the effectiveness and safety of 50% and 20% glucose solutions administered to patients with hypoglycemia in prehospital settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study analyzed cases of hypoglycemia treated by paramedics with either 50% or 20% glucose solution (40 mL) between 2016 and 2023 in the Shida-Haibara district of Shizuoka Prefecture, Japan. The primary outcome was the degree of improvement in the Japan Coma Scale (JCS). Secondary outcomes were the blood glucose level at hospital arrival and the proportion of patients exhibiting JCS improvement, rebound hypoglycemia, need for in-hospital glucose administration, and adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 242 patients met the inclusion criteria (131 and 111 in the 50% and 20% groups, respectively). The median initial blood glucose levels were similar (31 vs. 30 mg/dL), but they were significantly higher in the 50% group upon hospital arrival (151 vs. 81 mg/dL). The degree of JCS improvement did not differ significantly (4 vs. 3 grades). However, the proportion of patients with JCS improvement was higher in the 50% group (92% vs. 82%). Rebound hypoglycemia occurred in 15% and 9.0% of the patients, respectively (not statistically significant). In-hospital glucose administration was less frequent in the 50% group (42% vs. 75%). No soft tissue injuries were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The degree of JCS improvement did not differ significantly between the two groups; however, the 50% glucose solution was superior in some secondary outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13323162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374043","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":"A Case of Acute Poisoning Due to Ortho-Dichlorobenzene Diagnosed Using Biological Volatile Gas Analysis","authors":"Eiji Kawamoto,&nbsp;Kazuo Umezawa,&nbsp;Yoshika Sekine,&nbsp;Atsuya Hane,&nbsp;Ryo Esumi,&nbsp;Yohei Ieki,&nbsp;Satomi Asai,&nbsp;Takeshi Saito,&nbsp;Keisuke Jinno,&nbsp;Yasuhiro Kuroda,&nbsp;Hiroshi Imai","doi":"10.1002/ams2.70136","DOIUrl":"https://doi.org/10.1002/ams2.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>“Human skin gas,” the trace amounts of bio-volatile gases emitted from the surface of human skin, contains a variety of biological information and can be used in diagnosing several diseases. Herein, we described a case of the identification of the causative agent in a patient with acute poisoning using human skin gas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 52-year-old man cut his wrists and neck and crashed his car into a tunnel wall. The patient informed the paramedics that he had taken paraquat dimethyl sulfate and was transported to our emergency medical center. Since paraquat was not found in the home, the skin gas was measured, and ortho-dichlorobenzene was detected. An insecticide containing ortho-dichlorobenzene was found in the home, and he was strongly suggested with ortho-dichlorobenzene poisoning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The human skin gas assay was used to identify intoxicants and is useful for the diagnosis of poisoning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148324800","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":"The Association Between Signs of Life and Outcomes in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis","authors":"Naofumi Bunya,&nbsp;Nobuaki Himuro,&nbsp;Hiroaki Taniguchi,&nbsp;Kenshiro Wada,&nbsp;Fumito Kato,&nbsp;Ryuichi Nakayama,&nbsp;Makoto Aoki,&nbsp;Takero Terayama,&nbsp;Hirofumi Ohnishi,&nbsp;Eichi Narimatsu","doi":"10.1002/ams2.70133","DOIUrl":"10.1002/ams2.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Out-of-hospital cardiac arrest (OHCA) carries a poor prognosis despite advances in cardiopulmonary resuscitation (CPR). Traditional prognostic factors have limited accuracy, and “signs of life,” including gasping, pupillary light reflex (PLR), and CPR-induced consciousness (CPRIC), have been proposed as prognostic markers. We conducted a systematic review and meta-analysis to evaluate the association between signs of life and outcomes in OHCA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, MEDLINE, and Web of Science were systematically searched. Eligible studies included adult patients with OHCA of presumed medical origin reporting survival or neurological outcomes in relation to signs of life. Study quality was assessed using the Newcastle–Ottawa Scale. Pooled odds ratios with 95% confidence intervals were calculated using a random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight cohort studies, including 4,862 patients, were analyzed. All studies were of good methodological quality. The presence of signs of life was associated with higher survival and favorable neurological outcomes within 30 days after cardiac arrest (CA). Similar associations were observed for longer-term survival, although evidence for longer-term neurological outcomes was limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Signs of life during CA or CPR were consistently associated with improved survival and favorable neurological outcomes in patients with OHCA, both within 30 days and beyond 90 days. These findings suggest that signs of life may have prognostic value; however, their applicability may vary depending on clinical context. Systematic documentation of signs of life may be considered in standardized reporting frameworks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262741","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}