Acute Medicine & Surgery最新文献

{"title":"Rupture of a Hepatic Abscess After Prolonged Asymptomatic Penetration of a Fish Bone","authors":"Ryosuke Yamasaki,&nbsp;Takahiro Oishi,&nbsp;Fumiko Nakamura,&nbsp;Yoshihiro Nakamura,&nbsp;Atsunori Onoe,&nbsp;Mari Nakajima,&nbsp;Kazuhito Sakuramoto,&nbsp;Yasuyuki Kuwagata","doi":"10.1002/ams2.70113","DOIUrl":"10.1002/ams2.70113","url":null,"abstract":"<p>Six months after a CT scan showed a linear hyperdense focus within the liver, an 81-year-old man was diagnosed with a hepatic abscess. Emergency laparotomy with abscess drainage was performed. A foreign body was extracted from the hepatic penetration site and identified as a fish bone.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145964822","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":"Fatal Outcome due to Disseminated Cryptococcosis in a Patient With HIVrequiring Veno-Arterial Extracorporeal Membrane Oxygenation: A Case Report","authors":"Taisei Sasamoto,&nbsp;Naoki Kawahara,&nbsp;Hiroki Matsui,&nbsp;Koji Morishita","doi":"10.1002/ams2.70112","DOIUrl":"10.1002/ams2.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Disseminated cryptococcosis is a severe, high-mortality opportunistic infection with systemic effects, particularly in immunocompromised patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>Herein, we report a rare case of fulminant disseminated cryptococcosis in a 32-year-old male with undiagnosed advanced human immunodeficiency virus/acquired immune deficiency syndrome who rapidly developed multi-organ failure, refractory shock, and cardiac arrest within 21 h of admission, necessitating veno-arterial extracorporeal membrane oxygenation. Despite resuscitative efforts, the patient died on Day 6.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case highlights the accelerated progression of disseminated cryptococcosis in patients with profound immunosuppression and the unique autopsy findings of extensive myocardial cryptococcal infiltration and microemboli, suggesting a contribution to acute refractory shock.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12783911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951018","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":"Pulmonary Alveolar Proteinosis Complicated by Invasive Streptococcus pneumoniae Infection Requiring Extracorporeal Membrane Oxygenation: A Case Report","authors":"Utaho Mizusawa,&nbsp;Shinichiro Ohshimo,&nbsp;Kazuya Kikutani,&nbsp;Momoko Nakamura,&nbsp;Mitsuaki Nishikimi,&nbsp;Takeshi Namba,&nbsp;Yuki Masuka,&nbsp;Takahiro Inagawa,&nbsp;Nobuaki Shime","doi":"10.1002/ams2.70110","DOIUrl":"10.1002/ams2.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There have been no previously reported cases of pulmonary alveolar proteinosis (PAP) complicated by invasive pneumococcal infection requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 44-year-old man was transferred to our hospital under V-V ECMO for severe respiratory failure. Chest computed tomography showed bilateral crazy-paving patterns, and milky bronchoalveolar lavage fluid confirmed PAP. On day 3, he developed septic shock due to <i>Streptococcus pneumoniae</i>. After stabilization, right-sided whole lung lavage was performed on day 7, yielding yellow-brown fluid atypical for PAP. Bilateral segmental lavages on days 12 and 13 improved oxygenation. ECMO was discontinued on day 10, and the patient was extubated on day 14.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this rare case of PAP complicated by invasive pneumococcal infection, timely therapeutic interventions were successfully performed under V-V ECMO support.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12741192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145848728","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":"Psychological Sequelae of Injuries Caused by Asiatic Black Bear Attacks: A Follow-Up Study","authors":"Hideomi Tsuchida,&nbsp;Kasumi Satoh,&nbsp;Hajime Nakae","doi":"10.1002/ams2.70111","DOIUrl":"10.1002/ams2.70111","url":null,"abstract":"&lt;p&gt;We previously described patients with Asiatic black bear–related trauma treated at a tertiary emergency and critical care center in Akita Prefecture, Japan, and highlighted the high burden of craniofacial injury in this population (facial trauma in 90% and unilateral blindness in 15.8% of cases) [&lt;span&gt;1&lt;/span&gt;]. Amid a nationwide surge in bear attacks, with Akita repeatedly recording the highest number of victims, we examined long-term psychological sequelae in this population.&lt;/p&gt;&lt;p&gt;We performed a single-center descriptive follow-up study of all patients admitted with bear-related injuries between January and December 2023. Eligible patients survived to discharge and could provide written informed consent. The study protocol was approved by the Ethics Committee of Akita University School of Medicine (approval no. 3131), and demographic and clinical variables, including Injury Severity Score (ISS) and injured anatomical regions, were abstracted from the medical record.&lt;/p&gt;&lt;p&gt;In July 2024, approximately 8–14 months after injury, we mailed a structured questionnaire to eligible survivors and sent one reminder in December 2024. Patients reported persistent physical sequelae, and psychological symptoms were assessed with the validated Japanese version of the Impact of Event Scale-Revised (IES-R-J) [&lt;span&gt;2&lt;/span&gt;]; total scores range from 0 to 88, and scores ≥ 25 were interpreted as indicating clinically significant post-traumatic stress symptoms.&lt;/p&gt;&lt;p&gt;Of 20 eligible patients, 11 (8 men and 3 women) returned completed questionnaires (response rate 55%). Median age was 74 years, median time from injury to follow-up was 343 days, and median ISS was 8; four patients required intensive care.&lt;/p&gt;&lt;p&gt;Two respondents (18.2%) had IES-R scores ≥ 25, and nine (81.8%) reported at least one persistent physical sequela such as facial dysfunction or problematic scarring. In exploratory analyses, no significant correlations were observed between IES-R scores and clinical variables, and these null findings should be regarded as hypothesis-generating in view of the small sample.&lt;/p&gt;&lt;p&gt;These preliminary data suggest that a notable proportion of survivors of Asiatic black bear attacks have persistent PTSD-like symptoms about one year after injury, despite modest median ISS. Visible disfigurement and sensory loss, the sudden and life-threatening nature of attacks, and the older age of many victims may together contribute to sustained distress. The lack of an apparent relationship between ISS and IES-R scores is consistent with longitudinal work indicating that physical injury per se has only a negligible effect on PTSD trajectories, whereas perceived life threat and peritraumatic dissociation are more strongly related to symptom severity [&lt;span&gt;3&lt;/span&gt;]. This pattern accords with cognitive models of PTSD, which emphasize perceived life threat and negative interpretations of the trauma and its consequences as central in maintaining symptoms [&lt;span&gt;4&lt;/span&gt;]. This sm","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145814790","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":"Periorbital Necrotizing Soft Tissue Infection Caused by Streptococcus pyogenes","authors":"Yuko Ono,&nbsp;Chiharu Kato,&nbsp;Ryuhei Yoneda,&nbsp;Kazuaki Shinohara,&nbsp;Joji Kotani","doi":"10.1002/ams2.70105","DOIUrl":"10.1002/ams2.70105","url":null,"abstract":"<p>An illustrative image of periorbital necrotizing soft tissue infection. In any patient presenting with severe facial pain and systemic signs of infection, this rare but life-threatening condition must be considered.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766816","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":"Hydrogen Gas Insufficiency in Mitigating Intestinal Mucosal Injury in NOMI Without Transmural Necrosis: A Critical Swine Model Assessment","authors":"Raihan Mohammed Mohiuddin,&nbsp;Mohammed Misbah Ul Haq","doi":"10.1002/ams2.70108","DOIUrl":"https://doi.org/10.1002/ams2.70108","url":null,"abstract":"<p>We read with great interest the study by Tanaka et al. [<span>1</span>]. Investigated hydrogen inhalation therapy in a swine model of non-occlusive mesenteric ischemia (NOMI). The authors should be commended for establishing a reproducible model combining hemorrhagic shock and vasopressor administration and for being the first to evaluate hydrogen therapy in this setting. Given the poor prognosis of NOMI and the absence of widely effective therapies, this study is timely and valuable.</p><p>The reported findings that hydrogen inhalation did not significantly mitigate histological ischemic injury in the absence of transmural necrosis are important, as they suggest that hydrogen therapy alone may not be sufficient for NOMI treatment. However, we wish to highlight two issues that influence clinical interpretation.</p><p>First, the model design may not have allowed for the assessment of the potential benefits of hydrogen. The study was terminated at 4 h without the development of transmural necrosis; however, clinical NOMI typically evolves over days with progressive microcirculatory compromise. In this relatively early phase, mucosal changes may be subtle and below the threshold at which antioxidant effects translate into measurable histological benefits. Therefore, the absence of an effect within this time frame may reflect the study design rather than true therapeutic inefficacy. From a clinical standpoint, this distinction matters [<span>2</span>]; clinicians may wrongly conclude that hydrogen therapy has no role at any stage of NOMI when, in fact, its impact may emerge under longer observation or more severe ischemic injury.</p><p>Second, the sample size was insufficient to detect modest differences. The power calculation indicated that 64 animals per group were needed, yet only four were studied. While practical constraints are understandable in large-animal research, a small cohort increases the risk of type II error. A nonsignificant result should not be interpreted as the absence of an effect, but rather as inconclusive. Translating this into clinical terms, the current findings should temper enthusiasm for hydrogen inhalation as a standalone therapy but should not dismiss its potential contribution as part of a multimodal approach, for example, combined with early vasodilator infusion or optimized hemodynamic support [<span>3</span>].</p><p>Despite these limitations, this study makes a valuable contribution by demonstrating the safety and feasibility of hydrogen inhalation in a critical illness model. This is an essential prerequisite for further translational studies. Importantly, this opens the door for future investigations into whether hydrogen might synergize with other therapies in NOMI, particularly at later disease stages, where oxidative stress is more pronounced.</p><p>No funding was received.</p><p>Not Applicable.</p><p>Not Applicable.</p><p>The authors declare that they have no conflicts of interest.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686137","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 “Critical Appraisal on Hydrogen Inhalation Therapy Alone May Not Alleviate Intestinal Mucosal Damage in NOMI Without Total-Layer Necrosis: An Experimental Swine Model Study”","authors":"Yasutaka Tanaka,&nbsp;Yosuke Matsumura,&nbsp;Yoshimitsu Izawa","doi":"10.1002/ams2.70107","DOIUrl":"10.1002/ams2.70107","url":null,"abstract":"<p>We sincerely thank Dr. Mishba Ur Haq et al. for their thoughtful comments, which provided valuable insight and critical appraisal of our publication “Hydrogen inhalation therapy alone may not alleviate intestinal mucosal damage in NOMI without total-layer necrosis: An experimental swine model study”. We would like to address two key comments raised.</p><p>First, we agree that both the 4-h observation period and treatment intensity are areas for future consideration. Previous studies [<span>1-3</span>] implemented hydrogen inhalation therapy for only a few hours. Therefore, extending the duration of hydrogen inhalation could potentially yield.</p><p>Unlike conditions characterized by complete ischemia–reperfusion injury, such as cardiac arrest, large-vessel occlusive stroke, or coronary artery occlusion, our NOMI model did not involve superior mesenteric artery occlusion and did not induce full-thickness necrosis. Under these conditions, a lower quantity of reactive oxygen species (ROS) potentially attenuated the measurable effects of hydrogen as an antioxidant adjunct. This interpretation aligns with our findings showing no intergroup differences in 8-OHdG levels and similar progression of histological injury grades over time. We also note that achieving uniform intensity was technically challenging due to variations in individual responses to vasopressors. While macroscopic serosal images occasionally suggested transmural necrosis, histological confirmation consistently revealed only partial layer injury. Given the limited number of animals, comprehensive histological sampling at multiple time points was not feasible.</p><p>Second, we acknowledge that the limited sample size, imposed by ethical constraints of large-animal research, restricted statistical power. This study was designed as a pilot feasibility experiment, intended to generate preliminary data for subsequent investigations with adequate power and longer observation periods.</p><p>In conclusion, we appreciate the reviewers' constructive criticism and share the goal of improving outcomes in NOMI. We believe that further studies exploring hydrogen therapy, as part of a multifaceted strategy, under optimized timing and dosage conditions, represent the most promising path. We hope that our preliminary findings, together with such academic dialogue, will contribute to future translational research in this challenging field.</p><p>The Committee for Animal Ethics at Jichi Medical University approved the present experimental study (Approval number: 21054-01).</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12665115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653101","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":"Successful Embolization for Lumbar Fracture Bleeding in Diffuse Idiopathic Skeletal Hyperostosis","authors":"Nobu Fukumoto,&nbsp;Sadao Kawasaki,&nbsp;Naoaki Shibata,&nbsp;Shigeki Nemoto,&nbsp;Shigeaki Inoue","doi":"10.1002/ams2.70106","DOIUrl":"https://doi.org/10.1002/ams2.70106","url":null,"abstract":"<p>Successful embolization controlled active bleeding in a 76-year-old woman with diffuse idiopathic skeletal hyperostosis (DISH) [<span>1</span>] after a lumbar fracture. She originally presented with back pain following a fall. Initial computed tomography (CT) revealed fractures of the first and second lumbar vertebrae (L1, L2) with DISH extending from T8 to L2 (Figure 1A). Two days later, she was pale in complexion with hypotension (92/60 mmHg) and tachycardia (130 bpm). Contrast-enhanced CT revealed extravasation within the L2 vertebral body, indicative of left L2 and L3 arteries' involvement (Figure 1B). Emergency transcatheter arterial embolization was performed. To prevent reflux of embolic material into the aorta and spinal arteries including Adamkiewicz, the microcatheter was advanced beyond the vertebral limbus under fluoroscopic guidance. Selective angiography confirmed extravasation from the left L2 and L3 arteries (Figure 1C), which were embolized using a 1:2 mixture of <i>N</i>-butyl cyanoacrylate that achieved hemostasis after confirming absence of spinal arteries (Figure 1D).</p><p>Patients with DISH have an elevated risk of vertebral fracture compared to the general population due to rigidity and ossification [<span>2</span>]. The condition may cause various complications including injuries to intercostal and lumbar arteries, leading to active bleeding within relatively loose tissue spaces [<span>3, 4</span>]. This case demonstrates the importance of prompt intervention in DISH-related fractures with vascular complications, and it highlights the efficacy of embolization for controlling vertebral body bleeding.</p><p>The authors have nothing to report.</p><p>Written informed consent was obtained from the patient's family for the publication.</p><p>The authors declare no conflicts of interest.</p><p>The data that supports the findings of this study is available from the corresponding author upon reasonable request.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619304","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 “Predictive Effects of the Lactate/Albumin Ratio on Neurological Outcomes in Patients After Out-of-Hospital Cardiac Arrest”","authors":"Shyam Sundar Sah,&nbsp;Abhishek Kumbhalwar","doi":"10.1002/ams2.70102","DOIUrl":"https://doi.org/10.1002/ams2.70102","url":null,"abstract":"&lt;p&gt;We read with great interest Nakada et al.'s large, nationwide analysis of the lactate/albumin ratio (LAR) measured on hospital arrival and its association with neurological outcomes after out-of-hospital cardiac arrest (OHCA) [&lt;span&gt;1&lt;/span&gt;]. The authors should be commended for leveraging the Japanese Association for Acute Medicine (JAAM-OHCA) registry to test a biologically plausible composite biomarker across a broad population (&lt;i&gt;n&lt;/i&gt; = 28,098) and for performing subgroup analyses addressing admission status and receipt of active post-resuscitation therapies. Their finding that LAR improved discrimination over lactate or albumin alone and modestly enhanced a reference model is relevant to early risk stratification in a condition where timely prognostic information is valuable. Nevertheless, several issues temper the translational value of the results.&lt;/p&gt;&lt;p&gt;First, the timing and selection for blood sampling were not standardized and depended on clinicians' discretion. This introduces selection bias, as patients undergoing longer evaluation or surviving slightly longer were more likely to have albumin measured, while albumin assays typically require more processing time than lactate [&lt;span&gt;2&lt;/span&gt;]. Such variability may exaggerate LAR's prognostic value and likely contributed to the diminished incremental effect observed in admitted patients. Standardized, early sampling protocols would strengthen future validation.&lt;/p&gt;&lt;p&gt;Second, although discrimination metrics such as area under the curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were reported, the clinical impact remains unclear. An AUC of 0.83 is encouraging, yet the absolute gain over the reference model and its effect on decision thresholds were not quantified. Reporting predictive values, calibration, and net clinical benefit would clarify whether LAR provides practical guidance rather than only statistical improvement [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Third, residual confounding is possible. Albumin levels are influenced by chronic liver disease, nutritional status, and fluid balance [&lt;span&gt;4&lt;/span&gt;], while lactate is affected by sepsis, epinephrine dosing, and prehospital variables [&lt;span&gt;5&lt;/span&gt;]. These were not accounted for in the models, which may bias associations. Adjustment for comorbidity burden or sensitivity analyses excluding patients with advanced chronic disease would improve robustness.&lt;/p&gt;&lt;p&gt;Finally, operational considerations limit generalizability. Japan's emergency medical service (EMS) system, where field termination is rare, shapes the case mix and may not reflect other settings. External prospective validation with standardized sampling and serial biomarker kinetics will be essential to confirm clinical applicability.&lt;/p&gt;&lt;p&gt;In conclusion, Nakada et al. provide important large-scale evidence that LAR is associated with neurological outcomes after OHCA and improves prognostic discrimination beyond single biomarkers. F","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145581237","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 ‘Predictive Effects of the Lactate/Albumin Ratio on Neurological Outcomes in Patients After Out-Of-Hospital Cardiac Arrest’”","authors":"Koki Nakada,&nbsp;Yuki Miyamoto,&nbsp;Toshinari Kawama,&nbsp;Toshihiro Hatakeyama,&nbsp;Tetsuhisa Kitamura,&nbsp;Tasuku Matsuyama","doi":"10.1002/ams2.70099","DOIUrl":"https://doi.org/10.1002/ams2.70099","url":null,"abstract":"&lt;p&gt;We sincerely appreciate the constructive and thoughtful comments provided on our article, “Predictive effects of the lactate/albumin ratio on neurological outcomes in patients after out-of-hospital cardiac arrest,” published in &lt;i&gt;Acute Medicine &amp; Surgery&lt;/i&gt; [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;As Dr. Shyam Sundar Sah and Dr. Abhishek Kumbhalwar pointed out, the absence of a standardized protocol for the timing and implementation of blood tests may have introduced selection bias. Although both serum albumin and lactate levels are typically measured during the early resuscitation phase in Japanese clinical settings, some patients may have been excluded because resuscitation was terminated before albumin results became available, which could have introduced selection bias. Although these limitations were acknowledged in our manuscript, establishing a standardized blood sampling protocol remains important for future studies.&lt;/p&gt;&lt;p&gt;As the main objective of this observational study was to assess the association between lactate/albumin ratio and neurological outcomes, our analysis was limited to evaluating discrimination. Further research should address calibration and clinical usefulness to clarify whether prediction-guided interventions can improve patient outcomes [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We also agree that the lack of detailed data on comorbidities and baseline conditions affecting albumin and lactate is an important limitation. Nonetheless, serum albumin partially reflects long-term patient background, such as chronic illness and nutritional status [&lt;span&gt;3&lt;/span&gt;]. Although factors like epinephrine dose and sepsis were not directly adjusted for, they may influence neurological outcomes themselves. Thus, lactate may act as an intermediate factor, and the lactate/albumin ratio might capture the overall prognostic profile more comprehensively.&lt;/p&gt;&lt;p&gt;Finally, as you noted, in Japan, field termination of resuscitation is permitted only under specific circumstances, which may limit external generalizability compared with other countries [&lt;span&gt;4&lt;/span&gt;]. Therefore, we additionally performed a sensitivity analysis excluding patients who met the advanced life support termination-of-resuscitation rule, defined by five criteria: no emergency medical service-witnessed arrest, no bystander automated external defibrillator use or emergency medical service defibrillation, no prehospital return of spontaneous circulation, no bystander-witnessed arrest, and no bystander cardiopulmonary resuscitation [&lt;span&gt;5&lt;/span&gt;]. As a result, 6136 patients who met the termination-of-resuscitation rule were excluded, leaving 21,962 out-of-hospital cardiac arrest patients for analysis. When comparing the predictive performance for favorable neurological outcomes (cerebral performance category 1–2) at 30 days, we observed a similar trend to the main analysis, in which lactate/albumin ratio showed significantly better predictive ability than lactate or albumin (Figure 1). This finding","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145581242","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}