Acute Medicine & Surgery最新文献

{"title":"Treatment strategy for severe trauma patients requiring aortic occlusion for impending cardiopulmonary arrest in the hybrid emergency room","authors":"Shuhei Maruyama,&nbsp;Daiki Wada,&nbsp;Tomoyuki Yoshihara,&nbsp;Fukuki Saito,&nbsp;Kazuhisa Yoshiya,&nbsp;Yasushi Nakamori,&nbsp;Yasuyuki Kuwagata","doi":"10.1002/ams2.928","DOIUrl":"10.1002/ams2.928","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Computed tomography (CT) is useful in trauma care. Severely ill trauma patients may not tolerate whole-body CT even without patient transfer. This study examined clinical flow of severe trauma patients requiring aortic occlusion (AO) such as resuscitative thoracotomy or REBOA in the hybrid emergency room (ER) and investigated patient clinical courses prioritizing CT first versus resuscitation including AO first.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective, single-center observational study included consecutive trauma patients visiting our ER between May 2016 and February 2023. Patients were divided into the CT first group (whole-body CT preceded AO) and AO first group (AO preceded whole-body CT) and into two subgroups: AO after CT (AO/interventions for hemorrhage performed just after CT in the CT first group), and CT after AO (CT or damage control surgery performed after AO in the AO first group). We investigated 28-day survival rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Survival probability by TRISS method was 49% (range: 3.3–94) in the CT first group (<i>n</i> = 6) and 20% (range: 0.7–45) in the AO first group (<i>n</i> = 7). Actual 28-day survival rates were 50% and 57%, respectively. Survival rates of the AO after CT subgroup (CT first group) were 75% (3/4) and 0% (0/2), respectively, and those of the CT after AO subgroup (AO first group) were 25% (1/4) and 100% (3/3), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In severe trauma patients with low predicted probability of survival treated in the hybrid ER, survival rates might be better if resuscitation including AO is performed before CT and if damage control surgery is performed first before CT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10825068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139641434","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":"Reviewer Summary for Acute Medicine & Surgery","authors":"","doi":"10.1002/ams2.927","DOIUrl":"https://doi.org/10.1002/ams2.927","url":null,"abstract":"<p><i>Score Completion Date Range</i>: Between Jan 1, 2023 and Dec 31, 2023.</p><p>The publication of invaluable papers in the Acute Medicine &amp; Surgery depends on the prompt, careful review of submitted manuscripts. We would like to thank the Editorial Board members, and the following experts for reviewing manuscripts from January 1, 2023, to December 31, 2023.</p><p>Abe, Ryuzo</p><p>Abe, Yoshinobu</p><p>Akahoshi, Tomohiko</p><p>Amagasa, Shunsuke</p><p>Anan, Hideaki</p><p>Aokage, Toshiyuki</p><p>Aoki, Makoto</p><p>Aoki, Yoshihiro</p><p>Araki, Takashi</p><p>Arimoto, Hideki</p><p>Atsumi, Takahiro</p><p>Azuma, Kazunari</p><p>Banerjee, Pushpal</p><p>Boran, Maruf</p><p>Doi, Kent</p><p>Doi, Tomoaki</p><p>Ebihara, Takayuki</p><p>Egi, Moritoki</p><p>Endo, Tomoyuki</p><p>Enomoto, Yuki</p><p>Fujii, Tomoko</p><p>Fujiogi, Michimasa</p><p>Fujisaki, Noritomo</p><p>Fujishima, Seitaro</p><p>Fujita, Motoki</p><p>Fujita, Satoshi</p><p>Fujizuka, Kenji</p><p>Fukuda, Tatsuma</p><p>Fukushima, Hidetada</p><p>Funabiki, Tomohiro</p><p>Funakoshi, Hiraku</p><p>Funazaki, Toshikazu</p><p>Furukawa, Makoto</p><p>Gando, Satoshi</p><p>Goto, Tadahiro</p><p>Goto, Yoshikazu</p><p>Grensemann, Jörn</p><p>Hagiwara, Yusuke</p><p>Hanada, Hiroyuki</p><p>Hanajima, Tasuku</p><p>Hanaki, Nao</p><p>Harada, Masahiro</p><p>Hatakeyama, Junji</p><p>Hattori, Noriyuki</p><p>Hayakawa, Koichi</p><p>Hayakawa, Mineji</p><p>Hayashi, Yasuyuki</p><p>Hayashida, Kazuyuki</p><p>Hibino, Seikei</p><p>Hifumi, Toru</p><p>Hirose, Tomoya</p><p>Homma, Hiroshi</p><p>Homma, Yosuke</p><p>Hongo, Takashi</p><p>Hosomi, Sanae</p><p>Hoyt, David B.</p><p>Iba, Toshiaki</p><p>Ichiba, Shingo</p><p>Ichiba, Toshihisa</p><p>Ikeda, Hiroto</p><p>Ikezoe, Takayuki</p><p>Imai, Yoshiro</p><p>Imamoto, Toshiro</p><p>Imamura, Hiroshi</p><p>Inaba, Mototaka</p><p>Inamasu, Joji</p><p>Inokuchi, Koichi</p><p>Inoue, Akihiko</p><p>Inoue, Shigeaki</p><p>Inoue, Yoshiaki</p><p>Ishida, Kenichiro</p><p>Ishihara, Satoshi</p><p>Ishikura, Hiroyasu</p><p>Isokawa, Shutaro</p><p>Iwase, Hiroaki</p><p>Iwashita, Yoshiaki</p><p>Izawa, Yoshimitsu</p><p>Jörres, Achim</p><p>Kaita, Yasuhiko</p><p>Kajino, Kentaro</p><p>Kanda, Jun</p><p>Kaneko, Tadashi</p><p>Kasaoka, Shunji</p><p>Kashiura, Masahiro</p><p>Kasugai, Daisuke</p><p>Katayama, Yusuke</p><p>Kawazoe, Yu</p><p>Kikutani, Kazuya</p><p>Kinoshita, Takahiro</p><p>Kiriu, Nobuaki</p><p>Kiyota, Kazuya</p><p>Koami, Hiroyuki</p><p>Kobata, Hitoshi</p><p>Kondo, Hiroshi</p><p>Kondo, Yutaka</p><p>Kudo, Daisuke</p><p>Kurihara, Tomohiro</p><p>Kuroda, Yasuhiro</p><p>Kurozumi, Taketo</p><p>Matsumura, Yosuke</p><p>Matsushima, Asako</p><p>Matsushima, Hisao</p><p>Matsuyama, Shigenari</p><p>Matsuyama, Tasuku</p><p>Mayumi, Toshihiko</p><p>Mitsunaga, Toshiya</p><p>Miyamichi, Ryosuke</p><p>Miyamoto, Kyohei</p><p>Mizushima, Yasuaki</p><p>Mohara, Jun</p><p>Morimura, Naoto</p><p>Morishita, Koji</p><p>Moriya, Takashi</p><p>Muronoi, Tomohiro</p><p>Muroya, Takashi</p><p>Nagashima, Futoshi</p><p>Naito, Hiromichi</p><p>Nakada, Taka-aki</","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.927","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139655194","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":"Long-term psychiatric disorders in families of severe COVID-19 patients","authors":"Kasumi Shirasaki,&nbsp;Toru Hifumi,&nbsp;Moe Sekiguchi,&nbsp;Shutaro Isokawa,&nbsp;Yusuke Nakao,&nbsp;Shinobu Tanaka,&nbsp;Shinsuke Hashiuchi,&nbsp;Ryosuke Imai,&nbsp;Norio Otani","doi":"10.1002/ams2.926","DOIUrl":"10.1002/ams2.926","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The present study aimed to describe in detail the changes to and assess the risk factors for poor long-term outcomes of psychiatric disorders in families of COVID-19 patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single-center, retrospective study using questionnaires. Family members of patients admitted to the intensive care unit (ICU) with severe COVID-19 participated. Psychiatric disorders refer to the psychological distress such as anxiety, depression, and posttraumatic stress disorder (PTSD) experienced by the patient's family.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-six family members completed the survey and were analyzed. Anxiety, depression, and PTSD occurred in 24%, 33%, and 2% of family members, respectively, and psychiatric disorders occurred in 39%. On multivariable analysis, living in the same house with the patient was independently associated with a lower risk of psychiatric disorders in families of COVID-19 patients (OR, 0.180; 95% CI, 0.036–0.908; <i>p</i> = 0.038). Furthermore, four family members overcame psychiatric disorders, and six family members newly developed psychiatric disorders during the one-year follow-up period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Approximately 40% of family members had long-term psychiatric disorders, and some of them overcame the psychiatric disorders, and some newly developed psychiatric disorders over the one-year follow-up. Living in the same house with the patient was possibly significantly associated with the reduction of long-term symptoms of psychiatric disorders, but this result must be interpreted with care. Further large studies are needed to examine the factors associated with the long-term mental status of family members.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10813578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139568875","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 multiple organ injury resuscitated by collaboration of damage control surgery and interventional radiology in hybrid emergency room","authors":"Ryosuke Omoto,&nbsp;Yutaka Umemura,&nbsp;Masanari Kato,&nbsp;Yasutaka Nakahori,&nbsp;Satoshi Fujimi","doi":"10.1002/ams2.925","DOIUrl":"https://doi.org/10.1002/ams2.925","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hybrid emergency room systems, namely hybrid ER (HER), enable us to perform computed tomography (CT), surgery, and interventional radiology (IVR) without patient transfer. HER significantly shortened the time to CT after arrival and allowed us to achieve early intervention, resulting in reduced mortality from exsanguination in patients with severe blunt trauma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>We encountered a patient diagnosed with left common iliac artery occlusion and dissection caused by blunt traumatic compressive abdominal injury with transection of the small intestine, kidney, and adrenal and pelvic ring fractures. Although the patient experienced cardiopulmonary arrest (CPA) immediately after CT, we performed damage control surgery (DCS) and IVR after temporary aortic occlusion in the HER and resuscitated the patient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The present case, in which rapid diagnosis and intervention were performed and the patient was successfully resuscitated, supports the efficacy of the HER system for managing severe blunt trauma.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.925","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139474056","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":"Dysbiosis of gut microbiota in patients with severe COVID-19","authors":"Kentaro Shimizu,&nbsp;Haruhiko Hirata,&nbsp;Natsuko Tokuhira,&nbsp;Daisuke Motooka,&nbsp;Shota Nakamura,&nbsp;Akiko Ueda,&nbsp;Jotaro Tachino,&nbsp;Moe Koide,&nbsp;Akinori Uchiyama,&nbsp;Hiroshi Ogura,&nbsp;Jun Oda","doi":"10.1002/ams2.923","DOIUrl":"https://doi.org/10.1002/ams2.923","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Altered gut microbiota has been proposed as one of the causes of exacerbation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) from the perspective of the gut–lung axis. We aimed to evaluate gut microbiota in mechanically ventilated patients with COVID-19 prior to using antibiotics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively selected for enrollment COVID-19 patients who required mechanical ventilation on admission but who had not used antibiotics before admission to observe the influence of SARS-Cov-2 on gut microbiota. Fecal samples were collected serially on admission and were evaluated by 16S rRNA gene deep sequencing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The phylum of Bacteroidetes decreased, and those of Firmicutes and Actinobacteria increased in COVID-19 patients compared with those in healthy controls (<i>p</i> &lt; 0.001). The main commensals of <i>Bacteroides</i>, <i>Faecalibacterium</i>, and <i>Blautia</i> at the genus level were significantly decreased in the COVID-19 patients, and opportunistic bacteria including <i>Corynebacterium</i>, <i>Anaerococcus</i>, <i>Finegoldia Peptoniphilus</i>, <i>Actinomyces</i>, and <i>Enterococcus</i> were increased (<i>p</i> &lt; 0.001). α-Diversity and β-diversity in COVID-19 patients significantly changed compared with those in the healthy controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The commensal gut microbiota were altered, and opportunistic bacteria increased in patients with severe COVID-19 who required mechanical ventilation on admission.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.923","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139419770","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 fatal septic shock caused by Capnocytophaga gingivalis potentially associated with COVID-19: A case report","authors":"Dai Miyazaki,&nbsp;Chika Kunishige,&nbsp;Shigeru Sano,&nbsp;Kahoru Urakawa,&nbsp;Kana Okamoto,&nbsp;Naomi Morishita,&nbsp;Kentaro Iwata","doi":"10.1002/ams2.922","DOIUrl":"https://doi.org/10.1002/ams2.922","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p><i>Capnocytophaga</i> spp. is associated with fulminant sepsis, particularly in those with immunosuppression. We here report a rare case of fatal fulminant septic shock caused by <i>C. gingivalis</i>, concurrent with COVID-19.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A Japanese woman developed septic shock, which led to her death. Polymerase chain reaction (PCR) testing of the respiratory specimen was positive for SARS-CoV-2, and a CT scan of the chests revealed bilateral ground glass opacities. The blood cultures identified <i>C. gingivalis</i>. The patient had rheumatoid arthritis and was taking prednisone orally. There were no splenic abnormalities shown on the CT scan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A rare case of fulminant septic shock caused by <i>C. gingivalis</i>, together with COVID-19 was identified. The precise pathogenesis of this combination, together with the best treatment option should be sought by further studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.922","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139400183","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":"Delayed diagnosis of Morel-Lavallee lesion after multiple injuries","authors":"Taketomo Soga,&nbsp;Hiroyuki Kakuchi,&nbsp;Hiroshi Toriumi,&nbsp;Takeshi Miura,&nbsp;Moe Oguchi,&nbsp;Mayuko Ikeda,&nbsp;Takafumi Yoshioka,&nbsp;Hikaru Odera,&nbsp;Sei Yano","doi":"10.1002/ams2.924","DOIUrl":"https://doi.org/10.1002/ams2.924","url":null,"abstract":"<p>Morel–Lavallee lesion (MLL) is a post-trauma degloving cyst, usually filled with blood, lymph, or necrotic tissue, which mostly develops in the area around greater trochanter. MLL is associated with the potential risk of infection and progressive expansion of untreated lesions can cause pressure necrosis of overlying skin.<span>^{1, 2}</span> However, MLL may be missed because it is not visible on the body surface, and the signs of MLL may not be initially apparent. We report a case of delayed diagnosis of MLL after multiple injuries. A 37-year-old man was run over by a truck. Pelvic fractures were detected, and transcatheter arterial embolization and fixation were performed. On the 10th day, delayed sigmoid colon perforation was diagnosed, and emergency surgery was performed. Postoperative hemoglobin level was 10.6 g/dL, but anemia gradually progressed. On day 28, the hemoglobin level was 6.9 g/dL and a blood transfusion was required. In addition, subcutaneous hematoma remained in the left buttock and thigh, and skin necrosis was found on the left buttock and thigh. Therefore, on day 30, plain CT was performed. Plain CT showed an extensive low-density area in the subcutaneous soft tissues of the low lumbar and the left buttocks extending caudally to the left lower thigh and the right greater trochanter (asterisks) (Figure 1A), a finding consistent with a MLL. Needle aspiration was performed, and 1020 mL of old blood was collected from the lesion. However, contrast-enhanced CT on day 47 showed an encapsulated, subcutaneous lesion in the same area (asterisks) (Figure 1B). MRI on day 51 showed an encapsulated, abnormal-intensity lesion in the subcutaneous soft tissues of the low lumbar and the left buttocks extending caudally to the left lower thigh and the right greater trochanter (asterisks). Within this lesion, T1-weighted images appeared isointense to hypointense, and T2-weighted images appeared predominantly hyperintense. MRI coronal STIR shows no fat suppression (Figure 1C). MRI also showed a partial injury to the muscles of the left buttocks (white arrow). In some places within these muscles, T2-weighted images and STIR appeared hyperintense, and T1-weighted images not appeared hyperintense (Figure 1C). Treatment was based on clinical symptoms, lesion size, severity, age, and co-morbidities.<span>^{1, 2}</span> In this case, surgical excision was performed on day 55 because of the size of the fluid retention. We opened the lesion widely and debrided the interior, and three drainage tubes were inserted. Negative pressure wound therapy was performed thereafter. The wound was healed at 3 months after the trauma. MLL became more marginated as they aged and the chronic lesions were encapsulated. The majority shape of MLL was lenticular and oval, and there was a trend toward an increase in the size of lesion from the acute to the subacute stage and a decrease in size from the subacute to the chronic stage.<span>³</spa","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.924","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139400030","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":"Future directions of lung-protective ventilation strategies in acute respiratory distress syndrome","authors":"Taiki Hoshino,&nbsp;Takeshi Yoshida","doi":"10.1002/ams2.918","DOIUrl":"10.1002/ams2.918","url":null,"abstract":"<p>Acute respiratory distress syndrome (ARDS) is characterized by the heterogeneous distribution of lung aeration along a gravitational direction due to increased lung density. Therefore, the lung available for ventilation is usually limited to ventral, nondependent lung regions and has been called the “baby” lung. In ARDS, ventilator-induced lung injury is known to occur in nondependent “baby” lungs, as ventilation is shifted to ventral, nondependent lung regions, increasing stress and strain. To protect this nondependent “baby” lung, the clinician targets and limits global parameters such as tidal volume and plateau pressure. In addition, positive end-expiratory pressure (PEEP) is used to prevent dorsal, dependent atelectasis and, if successful, increases the size of the baby lung and lessens its susceptibility to injury from inspiratory stretch. Although many clinical trials have been performed in patients with ARDS over the last two decades, there are few successfully showing benefits on mortality (ie, prone positioning and neuromuscular blocking agents). These disappointing results contrast with other medical disciplines, especially in oncology, where the heterogeneity of diseases is recognized widely and precision medicine has been promoted. Thus, lung-protective ventilation strategies need to take an innovative approach that accounts for the heterogeneity of injured lungs. This article summarizes ventilator-induced lung injury and ARDS and discusses how to implement precision medicine in the field of ARDS. Potentially useful methods to individualize PEEP with esophageal balloon manometry, lung recruitability, and electrical impedance tomography were discussed.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10761614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139085426","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":"Obstructive azoospermia caused by epididymis injury with testicle rupture on the other side","authors":"Takayuki Ueda,&nbsp;Masato Yanagi,&nbsp;Akifumi Katsu,&nbsp;Hiroyoshi Kono,&nbsp;Ryoji Kimata,&nbsp;Tsutomu Hamasaki,&nbsp;Yukihiro Kondo","doi":"10.1002/ams2.919","DOIUrl":"10.1002/ams2.919","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Epididymal injuries without ipsilateral injuries of the testicles are rare. We report a case of a solitary right epididymal injury complicated by left testicular rupture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 21-year-old man experienced scrotal trauma caused by a motorcycle accident. Bilateral swelling and tenderness of the scrotum were observed. Ultrasonography and computed tomography revealed a ruptured left testicle; therefore, surgery was performed. During surgery, the left testicle was excised because it was completely ruptured, and the right testicle and epididymis were evaluated to identify the cause of swelling of the right scrotum. The right testis was not injured; however, the right epididymis was lacerated. Subsequently, the lacerated right epididymis was repaired using sutures. A semen analysis performed at 1, 4, and 7 months after surgery revealed the absence of sperm in the semen.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Epididymal injuries should be considered as differential diagnoses for scrotal trauma.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10757826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139072551","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":"Demographic profiles and risk factors for mortality in acute meningitis: A nationwide population-based observational study","authors":"Tetsuya Akaishi,&nbsp;Kunio Tarasawa,&nbsp;Kiyohide Fushimi,&nbsp;Nobuo Yaegashi,&nbsp;Masashi Aoki,&nbsp;Kenji Fujimori","doi":"10.1002/ams2.920","DOIUrl":"10.1002/ams2.920","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Acute meningitis encompasses bacterial, viral (aseptic), fungal, tuberculous, and carcinomatous meningitis. The rate and risks of mortality in each type remain uncertain. This study aimed to elucidate these aspects in each type of meningitis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study utilized Japan's nationwide administrative Diagnosis Procedure Combination (DPC) database. Patients with acute meningitis, treated at 1132 DPC-covered hospitals from 2016 to 2022, were enrolled.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 47,366,222 cumulative hospitalized patients, 48,758 (0.10%) were hospitalized with acute meningitis. The types of meningitis were as follows: 10,338 with bacterial, 29,486 with viral/aseptic, 965 with fungal, 678 with tuberculous, and 3790 with carcinomatous meningitis. Bacterial and viral meningitis exhibited bimodal age distributions, with the first peak occurring at 0–9 years. The median onset age was below 50 years only in viral meningitis. The mortality rate was the highest in carcinomatous meningitis (39%), followed by fungal meningitis (21%), and the lowest in viral meningitis (0.61%). Mortality rates increased with age across all meningitis types, but this trend was less prominent in carcinomatous meningitis. The duration from admission to mortality was longer in fungal and tuberculous meningitis compared with other types. <i>Staphylococcus aureus</i> in bacterial meningitis (adjusted odds ratio 1.71; <i>p</i> = 0.0016) and herpes simplex virus in viral meningitis (adjusted odds ratio 1.53; <i>p</i> = 0.0467) exhibited elevated mortality rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Distinct demographic profiles and mortality rates were observed among different meningitis types. The high mortality rates in less common types of meningitis emphasize the necessity to further optimize the required diagnostic and treatment strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10756990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139072992","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}