Acute Medicine & Surgery最新文献

{"title":"Response to “Remifentanil-Induced Chest Wall Rigidity in an Infant With Hepatic Failure”","authors":"Hiromu Okano, Hiroshi Okamoto","doi":"10.1002/ams2.70104","DOIUrl":"https://doi.org/10.1002/ams2.70104","url":null,"abstract":"<p>We thank the authors for sharing an instructive case of remifentanil-induced chest wall rigidity (“wooden chest syndrome”) in a 4-month-old infant with hepatic failure [<span>1</span>]. Terzi and Gün highlight a rare but clinically critical phenomenon that may emerge abruptly, compromise ventilation, and require immediate recognition and intervention [<span>1</span>].</p><p>As we noted in our review, remifentanil's organ-independent metabolism can be advantageous when hepatic function is impaired [<span>2</span>]. At the same time, as the authors illustrate, chest wall rigidity can occur even at modest doses in neonates and young infants—populations with unique pharmacodynamic vulnerability (heightened μ-opioid sensitivity and limited respiratory reserve). These practical bedside cues—sudden increases in peak inspiratory pressure, reduced tidal volumes, poor chest excursion, and rapid desaturation—should prompt consideration of opioid-induced rigidity alongside bronchospasm, endotracheal tube obstruction, or ventilator circuit problems.</p><p>Prevention is paramount. We would emphasize four key strategies: (1) avoiding bolus dosing when feasible; (2) starting infusions slowly at the lowest effective rate; (3) ensuring thoughtful sequencing with hypnotics/sedatives (adequate hypnosis before opioid up-titration); and (4) maintaining vigilant monitoring of airway pressures and ventilation, especially during induction, painful procedures, and dose changes. At present, which infants should be considered “high risk” remains insufficiently defined; plausible risk factors include very young age or prematurity, bolus exposure or rapid up-titration, co-administration of potent hypnotics, underlying respiratory or neurologic vulnerability, and metabolic/organ dysfunction, but these require confirmation. In high-risk infants, it is prudent to pre-plan an escalation pathway and ensure immediate availability of airway adjuncts, naloxone, and short-acting neuromuscular blockade.</p><p>When rigidity occurs, management should be decisive and stepwise: promptly stop or reduce the opioid; optimize oxygenation and ventilation; administer naloxone if clinically appropriate; and, if ventilation remains inadequate, consider a short-acting neuromuscular blocker. The authors' successful re-initiation of remifentanil at a lower infusion rate after stabilization is clinically reassuring and consistent with careful, protocolized titration under close monitoring.</p><p>Importantly, much of the available remifentanil evidence comes from adult intensive care unit (ICU) populations [<span>3</span>]. Pediatric ICU data remain comparatively limited, particularly for infants and for those with organ dysfunction. This case therefore underscores the need for standardized prevention, monitoring, and rescue bundles tailored to infants, and for multicenter, prospective studies clarifying age-specific dosing, bolus exposure risks, co-administration strategies, and early warning thres","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/ams2.70104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145581241","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":"Remifentanil-Induced Chest Wall Rigidity in an Infant With Hepatic Failure","authors":"Kıvanç Terzi,&nbsp;Emrah Gün","doi":"10.1002/ams2.70101","DOIUrl":"https://doi.org/10.1002/ams2.70101","url":null,"abstract":"<p>We read with interest the recent article, “Remifentanil use in intensive care units: Current evidence and future perspectives” by Okano et al. The article suggests that remifentanil should be preferred for analgesia in patients with hepatic failure because plasma esterases metabolise it [<span>1</span>]. We wish to share a related pediatric case. A 4-month-old boy with acute hepatic failure was admitted to the pediatric intensive care unit and intubated. We chose remifentanil infusion (0.25 μg/kg/min) for sedation and analgesia. After ~5 h on remifentanil, the patient acutely desaturated (SpO₂ ≈ 80%), and tidal volume fell to 2 mL/kg. Endotracheal tube position was confirmed using end-tidal carbon dioxide monitoring. However, bag ventilation produced <i>no chest movement</i>. We suspected opioid-induced chest wall rigidity. Remifentanil was immediately stopped, and naloxone (0.1 mg/kg IV) was administered. Chest wall excursion promptly returned, and SpO₂ normalised; tidal volume improved to ~6 mL/kg on mechanical ventilation. Remifentanil was then restarted at a reduced rate (0.15 μg/kg/min) without recurrence of rigidity. As shown by Sivak and Davis, remifentanil's clearance is unaffected by end-stage hepatic or renal failure, making it suitable for use in patients with hepatic failure [<span>2</span>]. However, clinicians must be aware of the rare but serious risk of opioid-induced chest wall rigidity, which can also occur in intubated patients under mechanical ventilation. In such cases, warning signs include a sudden rise in peak airway pressures, reduced tidal volumes despite adequate ventilator settings, poor chest wall expansion, and unexplained oxygen desaturation [<span>3</span>]. Chest wall rigidity may occur with small doses, especially in neonates and infants. A recent systematic review similarly noted that chest wall rigidity is a common side effect of remifentanil in neonates and infants, emphasising prevention by slow infusion and minimal dosing [<span>4</span>]. Our experience is consistent with previous reports: even small opioid doses may induce rigidity in neonates and infants [<span>3</span>].</p><p>When rigidity occurs, it must be recognized and treated immediately. As in our patient, chest rigidity is rapidly reversible with naloxone. In our case, naloxone promptly restored adequate ventilation without needing paralysis. This pediatric case supports the use of remifentanil in hepatic failure (extrahepatic metabolism ensures predictable clearance) while highlighting “wooden chest syndrome” as a rare but critical complication. Clinicians should be alert for chest wall rigidity during opioid infusions in intubated patients and be prepared to intervene (naloxone or paralysis) to prevent hypoxemia.</p><p>The authors declare no conflicts of interest.</p><p>This article is linked to Okano et al. paper. To view this article, visit https://doi.org/10.1002/ams2.70087.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145581136","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":"Critical Appraisal of “Increased Incidence of Secondary PPH From Placental Site Subinvolution and Role of Interventional Radiology”","authors":"Raihan Mohammed Mohiuddin,&nbsp;Mohammed Misbah Ul Haq","doi":"10.1002/ams2.70103","DOIUrl":"10.1002/ams2.70103","url":null,"abstract":"&lt;p&gt;We read with great interest the study by Ito et al. [&lt;span&gt;1&lt;/span&gt;]. This study examined the rising incidence of secondary postpartum hemorrhage (PPH) attributed to subinvolution of the placental site (SIPS) and the therapeutic role of uterine artery embolization (UAE). The authors should be commended for providing a rare contemporary dataset from Japan and emphasizing interventional radiology as a minimally invasive treatment option for this condition.&lt;/p&gt;&lt;p&gt;The description of SIPS as a frequently overlooked cause of late bleeding is clinically meaningful because misclassification can delay definitive treatment. Moreover, the reported 100% procedural success rate for UAE is noteworthy and supports its inclusion in modern obstetric emergency protocols. These contributions advance the recognition of an underappreciated clinical entity.&lt;/p&gt;&lt;p&gt;However, we wish to raise two points that affect the diagnostic interpretation and treatment decisions. First, successful embolization was defined as the absence of subsequent hemostatic intervention without accounting for rebleeding risk or functional outcomes. For patients desiring future pregnancies, uterine integrity is as important as achieving immediate hemostasis. By not stratifying embolization success according to subsequent reproductive outcomes, clinicians may overestimate the net clinical benefits when counseling patients. A relative risk reduction in acute bleeding is clinically reassuring, but the absolute trade-off in terms of potential placenta accreta spectrum disorders in future pregnancies remains unquantified. This is critical for shared decision-making at the bedside [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Second, the analytic strategy interprets the apparent increase in secondary PPH as an increase in the incidence of SIPS. However, this temporal association may partly reflect the greater availability of angiography and lower thresholds for imaging rather than a true epidemiological shift. This distinction is clinically significant; if the incidence is overestimated due to detection bias, guidelines may prematurely prioritize angiography over conservative measures, such as uterotonics or curettage, in stable patients. The downstream consequence is possible overtreatment with invasive embolization in cases where non-invasive management would suffice [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Therefore, a clinically tethered interpretation of these findings is essential for improving patient outcomes. When SIPS is suspected, clinicians should consider whether imaging-defined abnormalities represent pathology requiring embolization or physiologic vascular remodeling that may resolve with conservative therapy. Overreliance on angiographic patterns risks unnecessary interventions with implications for fertility, patient anxiety, and long-term obstetric outcomes [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Despite these concerns, this study makes an important contribution by reinforcing the role of the UAE in controlling hemorrhage refractory to","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12628010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562340","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 Increased Incidence of Secondary Postpartum Hemorrhage due to SIPS”","authors":"Chikao Ito","doi":"10.1002/ams2.70100","DOIUrl":"10.1002/ams2.70100","url":null,"abstract":"<p>We sincerely thank Dr. Raihan Mohammed Mohiuddin and Dr. Mohammed Misbah Ul Haq for their insightful and thoughtful comments on our study. We greatly appreciate their careful appraisal, which highlights important clinical considerations regarding diagnostic interpretation and treatment selection for secondary postpartum hemorrhage (PPH) associated with subinvolution of the placental site (SIPS).</p><p>We fully share their concern that an increased rate of diagnostic imaging, particularly computed tomography (CT), may contribute to potentially excessive angiographic procedures and hemostatic interventions. While uterine artery embolization (UAE) remains a highly reliable and life-saving therapy for hemodynamically unstable cases, its use in stable patients with SIPS requires more nuanced evaluation. Current evidence, though still limited, suggests that <i>uterotonics and curettage</i> constitute the standard initial management for stable SIPS [<span>1</span>].</p><p>As noted in our paper, the concept of SIPS has not yet been widely recognized in Japan. Consequently, curettage has seldom been selected as a first-line treatment. Furthermore, the ready availability of CT in Japan has facilitated early imaging; once contrast extravasation is visualized, clinicians often proceed to angiography because of its high procedural success rate and low short-term complication risk. Nevertheless, considering the potential for increased hemorrhagic complications in subsequent pregnancies, UAE should not be chosen indiscriminately.</p><p>We agree that broader awareness of SIPS and the establishment of evidence-based management algorithms are essential. In particular, for hemodynamically stable patients, a diagnostic and therapeutic pathway that begins with ultrasonography and proceeds to <i>uterotonics and curettage</i>—rather than immediate embolization—should be further studied and systematically implemented in Japan.</p><p>We again thank the authors for their valuable perspectives, which contribute to advancing a balanced and patient-centered approach to managing secondary PPH due to SIPS.</p><p>Sincerely.</p><p>This study conformed to the provisions of the Declaration of Helsinki (revised in Fortaleza, Brazil in October 2013).</p><p>The author has nothing to report.</p><p>The author declares no conflicts of interest.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12623147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555993","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":"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/ams2.70098","DOIUrl":"https://doi.org/10.1002/ams2.70098","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Post intensive care syndrome (PICS) is a critical issue in postsepsis care; however, no reliable biomarker exists to predict PICS. We hypothesized that plasma myostatin, a cytokine involved in muscle and brain function, could serve as a predictive biomarker for PICS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center prospective observational study included adult patients with sepsis admitted to the intensive care unit (ICU). Plasma myostatin concentrations were measured using enzyme-linked immunosorbent assay on days 1, 3–4, and 6–7 after sepsis diagnosis and ICU admission. PICS was assessed 6 months post-ICU discharge via telephone interviews using the Barthel Index, Short-Memory Questionnaire score, and Hospital Anxiety and Depression Scale. Multivariable logistic regression analysis was conducted to determine whether myostatin levels independently predicted PICS. Predictive performance was evaluated using the area under the curve (AUC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-seven patients were enrolled (mean age: 71 ± 14 years; median SOFA score 7 [IQR: 6–11]). Plasma myostatin concentrations were 544 (311–1015) pg/mL on day 1, 495 (302–651) pg/mL on days 3–4, and 536 (385–817) pg/mL on days 6–7. Decreased plasma myostatin levels on day 1 and on days 6–7 contributed to identifying patients with cognitive and physical impairments, respectively (<i>p</i> = 0.04). A decreased plasma myostatin level on day 1 yielded an AUC of 0.70 for predicting cognitive impairment, whereas the day 6–7 level yielded an AUC of 0.76 for predicting physical impairment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lower plasma myostatin concentrations in the acute phase of sepsis may serve as a biomarker for predicting PICS-related physical and cognitive impairments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145529747","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":"External Validation of the Traumatic Bleeding Severity Score for the Predictive Accuracy of the Need for Massive Transfusion","authors":"Kei Kimoto,&nbsp;Akira Endo,&nbsp;Atsushi Shiraishi,&nbsp;Kensuke Fujita,&nbsp;Takuya Kimura,&nbsp;Yoshihiro Hagiwara,&nbsp;Takayuki Ogura,&nbsp;J-OCTET 2 Study Group","doi":"10.1002/ams2.70095","DOIUrl":"10.1002/ams2.70095","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Traumatic Bleeding Severity Score (TBSS), developed in Japan, has shown high predictive accuracy in internal validation; however, external validation has still not been performed. We conducted the first external validation of the TBSS in Japan and compared it with other massive transfusion (MT) prediction scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter retrospective study included severe trauma patients (aged ≥ 18 years, Injury Severity Score [ISS] ≥ 16) from 25 tertiary critical care centers (April 2018–March 2019), excluding those with isolated head injury or cardiac arrest on arrival. TBSS's accuracy for predicting MT was analyzed using the area under the curve (AUC). A complete case was the primary approach, with sensitivity analysis using multiple imputed datasets. The Trauma-Associated Severe Hemorrhage (TASH) score and Assessment of Blood Consumption (ABC) score were also evaluated for comparison.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1193 patients, 873 were eligible, and 365 patients were included in the complete case analysis. The median age was 63 (interquartile range [IQR]: 45–75) years, the median ISS was 25 (IQR: 20–34), 69.3% were male individuals, 98.1% experienced blunt trauma, and 24.7% received MT. TBSS' AUC was 0.86 (sensitivity: 70.1%; specificity: 88.4%). The TASH score showed a comparable AUC of 0.88 (<i>p</i> = 0.850), whereas the ABC score had a significantly lower AUC of 0.80 (<i>p</i> = 0.024). Sensitivity analysis confirmed these findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>TBSS' accuracy for predicting MT was comparable to that of the TASH score and superior to that of the ABC score. Further research is needed to determine its clinical utility and broader applicability in trauma care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12580833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145443704","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":"Validation of the Glasgow Admission Prediction Score in a Japanese Emergency Setting","authors":"Shigeto Horiuchi,&nbsp;Haruka Kamagata,&nbsp;Koichiro Nakano,&nbsp;Naoki Sawamura,&nbsp;Shunsaku Kohriki","doi":"10.1002/ams2.70097","DOIUrl":"https://doi.org/10.1002/ams2.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Glasgow Admission Prediction Score (GAPS) is a triage tool that was developed in the United Kingdom to predict hospital admission based on available patient data upon arrival at emergency departments (EDs). Despite being associated with length of hospital stay, 6-month mortality, and readmission, its validity has only been assessed in the UK. Its generalizability therefore remains unclear. This study aimed to assess the predictive performance of the GAPS for short- and intermediate-term outcomes in a Japanese ED setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of ambulance-transported ED visits between December 2020 and September 2023 at a Japanese general hospital. After excluding pediatric patients and those with missing or inconsistent data, 22,179 encounters were analyzed. GAPS scores were calculated upon ED arrival and stratified into tertiles. The outcomes included 30-day mortality, 30-day emergency re-transportation, 100-day hospital readmission, and length of inpatient stay. Kaplan–Meier and Cox proportional hazards analyses were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher GAPS scores were significantly associated with less favorable outcomes. Each 1-point increase was linked to a 10.3% increase in 30-day mortality risk (hazard ratio [HR] = 1.10; 95% confidence interval: 1.10–1.11), or a four-fold increase per 15-point rise (HR = 4.32). Similar associations were observed for re-transportation (HR = 1.03) and hospital readmission (HR = 1.09). Higher GAPS scores were also associated with longer hospital stays (HR for discharge = 0.98).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>GAPS presents a practical tool for predicting ambulance-transported ED encounter outcomes in Japan, although its broader applicability warrants further research.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70097","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145407329","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":"Status of Dispatcher-Provided Instructions to Bystanders of Out-of-Hospital Cardiac Arrest in Japan: An Analysis of the JAAM-OHCA Registry","authors":"Kayoko Harada,&nbsp;Kotaro Kaneda,&nbsp;Ryo Ayata,&nbsp;Tomoaki Inoue,&nbsp;Yasutaka Koga,&nbsp;Takeshi Yagi,&nbsp;Masaki Todani,&nbsp;Motoki Fujita,&nbsp;Ryosuke Tsuruta","doi":"10.1002/ams2.70096","DOIUrl":"https://doi.org/10.1002/ams2.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Dispatcher-provided cardiopulmonary resuscitation (CPR) instructions are recommended in current resuscitation guidelines. However, the factors influencing whether dispatchers provide such instructions remain unclear. This study investigated the implementation of dispatcher-provided CPR instructions and identified associated factors using a nationwide registry in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective analysis of out-of-hospital cardiac arrest (OHCA) cases registered in the Japanese Association for Acute Medicine OHCA Registry between June 2014 and August 2023. The cases were categorized into two groups according to whether the dispatchers provided CPR instructions. Multivariable logistic regression was performed to identify factors that were independently associated with dispatcher-provided instructions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 59,407 eligible OHCA cases, the dispatcher provided CPR instructions to the bystander for 27,414 (46.1%). Multivariable analysis revealed that female sex, a closer bystander–patient relationship, and unwitnessed arrest were significantly associated with a higher likelihood of dispatcher-provided instructions. By contrast, certain non-medical causes, such as traffic accidents, falls, and poisoning, were associated with lower dispatcher-provided instruction rates. Age showed a nonlinear association. Substantial temporal and regional variability was also observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The likelihood of dispatcher-provided CPR instruction was influenced by a combination of patient, bystander, and system-level factors. These findings underscore the need for standardized dispatcher training and protocols to improve the recognition of OHCA and timely delivery of CPR instructions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145407116","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":"Significance of Serum Neuron-Specific Enolase in Patients With Sepsis and Its Association With Inflammatory Biomarkers","authors":"Umefumi Iguchi,&nbsp;Atsushi Sakurai,&nbsp;Katsuhiro Nakagawa,&nbsp;Toru Hosokawa,&nbsp;Tsukasa Kuwana,&nbsp;Nami Sawada,&nbsp;Shingo Ihara,&nbsp;Junko Yamaguchi,&nbsp;Yasuyoshi Kai,&nbsp;Kosaku Kinoshita","doi":"10.1002/ams2.70094","DOIUrl":"https://doi.org/10.1002/ams2.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although survival rates in sepsis cases have improved, functional outcomes remain poor in many cases. The aim of this study was to investigate the significance and interrelationship of serum neurological and inflammatory biomarkers in patients with sepsis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with sepsis who had good activities of daily living before admission were included. The following biomarkers were examined at 0, 1, and 3 days after admission: neuron-specific enolase (NSE); S100β; high mobility group box 1 (HMGB1); interleukins 1, 6, and 8 (IL-1, IL-6, and IL-8); interferon-gamma (IFN-γ); and tumor necrosis factor-alpha (TNF-α). Functional outcomes were defined using the modified Rankin Scale, with scores of 1 and 2 categorized as favorable outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 53 patients, 5 (9%) were non-survivors, and 8 (15%) were survivors with favorable outcomes. Biomarker analysis revealed significantly elevated levels of NSE, HMGB1, IL-1, IL-6, IL-8, and IFN-γ in non-survivors; however, no difference was observed in functional prognosis. On day 3, a significant association was observed between NSE and HMGB1, IL-1, IL-6, IL-8, and IFN-γ.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Elevated NSE levels were observed in non-surviving patients with sepsis, and NSE levels on day 3 were significantly correlated with the other inflammation-related biomarkers. These findings suggest that the progression of brain damage due to sepsis may be associated with inflammation, highlighting a potential target for future therapeutic strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145407294","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":"Incidental Detection of Asymptomatic Upper Extremity Deep Vein Thrombosis in an Elderly Patient With Pulmonary Embolism","authors":"Shuhei Uotani,&nbsp;Yoshihiro Aoki,&nbsp;Keita Iyama,&nbsp;Atsuko Tachikawa,&nbsp;Daisuke Sugawara,&nbsp;Kensuke Takahashi,&nbsp;Shuhei Yamano,&nbsp;Koichi Hayakawa,&nbsp;Osamu Tasaki","doi":"10.1002/ams2.70093","DOIUrl":"https://doi.org/10.1002/ams2.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Upper extremity deep vein thrombosis (UEDVT) is rare, accounting for 4%–10% of all DVT cases. Central venous catheterization and malignancy are primary risk factors, making cases without these factors uncommon.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 76-year-old woman with hypertension was admitted with sepsis. She had no history of central venous catheterization. Contrast-enhanced CT revealed asymptomatic UEDVT in the left subclavian and brachiocephalic veins, lower extremity DVT, and bilateral pulmonary embolism. D-dimer was elevated. Tests showed elevated homocysteine; other thrombophilic screening was negative. No malignancy was detected. Heparin followed by edoxaban achieved complete resolution on follow-up imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In elderly patients with elevated D-dimer and multiple DVT risk factors, particularly with sepsis or limited cardiopulmonary reserve, upper extremity imaging may be warranted even without UEDVT-specific symptoms. Asymptomatic UEDVT may have clinical implications for management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145317604","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}