Acute Medicine & Surgery最新文献_第7页

Unilateral temporal lobe atrophy after massive caffeine overdose 咖啡因过量后单侧颞叶萎缩

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-04-24 DOI: 10.1002/ams2.70060

Yasuyoshi Miyamura, Tetsuhiro Takei, Taketo Suzuki, Kunihiko Okada

A 24-year-old man with autism spectrum disorder (ASD) and no history of seizures was admitted to the emergency department after ingesting 800 mg/kg of caffeine in a suicide attempt. He initially presented with generalized tonic–clonic seizures that lasted at least 40 min, which progressed to status epilepticus, necessitating continuous midazolam infusion for 4 days. Thereafter, he had no further convulsive seizures. On Day 8, fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) of the brain revealed a high-intensity signal in the left temporal lobe, suggestive of partial cerebral edema (Figure 1A–C). He resumed oral clonazepam for ASD from Day 12.

Two years after the caffeine overdose, the patient was admitted due to the recurrence of convulsive seizures. A subsequent brain MRI revealed marked atrophy of the left temporal lobe, especially the superior temporal and parahippocampal gyri, as observed on FLAIR (Figure 1D–F arrows and arrowheads). Clinically, he exhibited symptoms of depression, irritability, and dysmnesia.

In the rat hippocampal models, caffeine induced persistent neuronal bursting even after drug washout.¹ Also, caffeine deteriorated epileptiform discharges in the hippocampal and parahippocampal gyrus in a patient with temporal lobe epilepsy.² This case suggests that nonconvulsive status epilepticus, following a massive caffeine overdose, can cause unilateral temporal lobe atrophy.

The authors declare no conflicts of interest.

Approval of the research protocol: N/A.

Informed consent: Informed consent was obtained from the patient.

Registry and registration no. of the study/trial: N/A.

Animal studies: N/A.

一名24岁的患有自闭症谱系障碍（ASD）且无癫痫发作史的男子在试图自杀时摄入了800毫克/公斤的咖啡因，被送进了急诊室。患者最初表现为全身性强直-阵挛性发作，持续至少40分钟，发展为癫痫持续状态，需要连续输注咪达唑仑4天。此后，他再也没有抽搐发作。第8天，脑液体衰减反转恢复（FLAIR）磁共振成像（MRI）显示左侧颞叶高强度信号，提示部分脑水肿（图1A-C）。他从第12天开始口服氯硝西泮治疗ASD。服用过量咖啡因两年后，患者因抽搐发作复发而入院。随后的脑部MRI显示左侧颞叶明显萎缩，尤其是颞上回和海马旁回，如FLAIR所示（图1D-F箭头和箭头）。临床表现为抑郁、易怒和记忆障碍。在大鼠海马模型中，即使在药物冲洗后，咖啡因也会引起持续的神经元破裂此外，咖啡因恶化了颞叶癫痫患者海马和海马旁回的癫痫样放电本病例提示非惊厥性癫痫持续状态，在大量咖啡因过量后，可引起单侧颞叶萎缩。作者声明无利益冲突。研究方案的批准：无。知情同意：获得患者的知情同意。登记处及注册号研究/试验：无。动物研究：无。

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引用次数: 0

Bronchiolitis obliterans due to toxic epidermal necrolysis with structural evaluation using computed tomography bronchography: A case report 中毒性表皮坏死松解所致闭塞性细支气管炎的计算机断层支气管造影结构评价：1例报告

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-04-14 DOI: 10.1002/ams2.70046

Hidemasa Kudo, Ken Katsuta, Shigeki Kushimoto

Background

Toxic epidermal necrolysis (TEN) can lead to various extracutaneous complications, including respiratory involvement. We present a case of a patient who developed bronchiolitis obliterans (BO) after the acute phase of TEN, with computed tomography (CT) bronchography revealing bronchial tree structural changes.

Case Presentation

A 60-year-old woman presented with a rash and hoarseness 2 days after taking ibuprofen and was diagnosed with TEN. While her cutaneous symptoms improved by day 20, the flow-volume loop indicated obstructive respiratory failure. CT bronchography revealed bead-like changes and mural irregularities in the bronchi; thus, BO was diagnosed. Despite treatment with bronchodilators and steroids, she required long-term mechanical ventilation with persistent bronchial alterations.

Conclusion

Extracutaneous complications of TEN are crucial, particularly in BO development following the acute phase. In this case, CT bronchography showed treatment-refractory bead-like changes and mural irregularities in the bronchioles.

背景中毒性表皮坏死溶解症（TEN）可导致各种皮肤外并发症，包括呼吸系统受累。我们报告了一例在 TEN 急性期后发展为阻塞性支气管炎（BO）的患者，其计算机断层扫描（CT）支气管造影显示支气管树结构发生了变化。病例介绍一位 60 岁的妇女在服用布洛芬 2 天后出现皮疹和声音嘶哑，被诊断为 TEN。虽然她的皮肤症状在第 20 天时有所改善，但血流-容积循环显示她出现了阻塞性呼吸衰竭。CT 支气管造影显示支气管内有珠状改变和壁状不规则，因此诊断为 BO。尽管使用了支气管扩张剂和类固醇治疗，她仍需要长期机械通气，支气管病变持续存在。结论 TEN 的皮肤外并发症至关重要，尤其是在急性期后出现 BO 时。在该病例中，CT 支气管造影显示了难治性珠状改变和支气管壁不规则。

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引用次数: 0

mRNA–miRNA integration analysis of T-cell exhaustion in sepsis from community-acquired pneumonia 社区获得性肺炎败血症中t细胞耗竭的mRNA-miRNA整合分析

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-04-02 DOI: 10.1002/ams2.70054

Sayaka Oda, Hisatake Matsumoto, Yuki Togami, Jumpei Yoshimura, Hiroshi Ito, Shinya Onishi, Arisa Muratsu, Yumi Mitsuyama, Daisuke Okuzaki, Hiroshi Ogura, Susumu Tanaka, Jun Oda

Aim

Community-acquired pneumonia is an acute lung infection in patients without recent healthcare exposure that can progress to severe sepsis. Despite the well-established influence of miRNAs on inflammation, their specific roles in pneumonia-associated sepsis remain underexplored. In this pilot study, we aimed to provide insights into the pathogenesis of community-acquired pneumonia-associated sepsis by performing an integrative mRNA–miRNA analysis to identify key cellular signaling pathways and potential molecular targets for future research and treatment development.

Methods

We conducted a prospective, observational, single-center study including 14 critically ill patients with community-acquired pneumonia-associated sepsis and 15 healthy controls (median age: 78 [interquartile range 67.3–83.5] and 55 [interquartile range 40.5–59.0] years, respectively).

Results

Eleven patients required ventilatory support, and six met the diagnostic criteria for septic shock. All patients survived. RNA sequencing revealed 1209 upregulated and 1461 downregulated differentially expressed genes for mRNAs (false discovery rate < 0.05, |log₂ fold change| >1.2), 51 upregulated and 21 downregulated genes for miRNAs, and 646 upregulated and 1274 downregulated for mRNA related to miRNAs. Canonical pathway analysis revealed activation of the programmed death-1/programmed death-ligand-1 cancer immunotherapy pathway and suppression of the Th1 pathway, indicating T-cell exhaustion in the acute phase of community-acquired pneumonia-associated sepsis.

Conclusion

This study provides valuable insights into the molecular mechanisms underlying CAP-associated sepsis, confirming the occurrence of immune dysregulation, particularly T-cell exhaustion. Our findings suggest that specific miRNAs and signaling pathways identified here may serve as potential therapeutic targets or biomarkers.

社区获得性肺炎是一种急性肺部感染，发生在近期没有医疗保健暴露的患者中，可发展为严重败血症。尽管mirna对炎症的影响已经得到证实，但它们在肺炎相关败血症中的具体作用仍未得到充分探讨。在这项初步研究中，我们旨在通过进行综合mRNA-miRNA分析来确定关键的细胞信号通路和潜在的分子靶点，为未来的研究和治疗开发提供深入了解社区获得性肺炎相关败血症的发病机制。方法：我们进行了一项前瞻性、观察性、单中心研究，纳入了14例社区获得性肺炎相关败血症危重患者和15例健康对照(中位年龄分别为78岁（67.3-83.5岁）和55岁（40.5-59.0岁）。结果11例患者需要呼吸支持，6例符合脓毒性休克诊断标准。所有患者都存活了下来。RNA测序结果显示，mRNA差异表达基因上调1209个，下调1461个（错误发现率<； 0.05， |log2倍变化| >；1.2）， miRNAs差异表达基因上调51个，下调21个，miRNAs相关mRNA上调646个，下调1274个。典型途径分析显示程序性死亡-1/程序性死亡配体-1癌症免疫治疗途径的激活和Th1途径的抑制，表明在社区获得性肺炎相关败血症的急性期t细胞衰竭。本研究为cap相关脓毒症的分子机制提供了有价值的见解，证实了免疫失调，特别是t细胞衰竭的发生。我们的研究结果表明，这里确定的特定mirna和信号通路可能作为潜在的治疗靶点或生物标志物。

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引用次数: 0

Association of blood carboxyhemoglobin levels with mortality and neurological outcomes in out-of-hospital cardiac arrest 院外心脏骤停患者血碳氧血红蛋白水平与死亡率和神经系统预后的关系

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-03-23 DOI: 10.1002/ams2.70053

Takashi Hongo, Tetsuya Yumoto, Hiromichi Naito, Tomohiro Hiraoka, Yuya Murakami, Takafumi Obara, Tsuyoshi Nojima, Toshiyuki Aokage, Atsunori Nakao

Background

Carbon monoxide (CO), produced endogenously by heme oxygenase-1, plays a crucial role in the immune system by mitigating cellular damage under stress. However, the significance of carboxyhemoglobin (COHb) levels after out-of-hospital cardiac arrest (OHCA) is not well understood. This study aimed to explore the association between COHb levels at hospital arrival and within the first 24 h post-arrival with 30-day mortality and neurological outcomes in patients who experienced OHCA.

Methods

This single-center, retrospective study analyzed data from adult patients who experienced OHCA seen at Okayama University Hospital from 2019 to 2023. The patients were assigned to one of two study groups based on COHb levels (0.0% or ≥0.1%) upon hospital arrival. The primary outcome was 30-day mortality.

Results

Among the 560 eligible patients who experienced OHCA, 284 (50.7%) were in the COHb 0.0% group and 276 (49.3%) were in the COHb ≥ 0.1% group. The 30-day mortality was significantly higher in the COHb 0.0% group compared to the COHb ≥ 0.1% group (264 [92.9%] vs. 233 [84.4%]). Multivariable logistic regression showed that the COHb 0.0% group was associated with 30-day mortality (adjusted ORs: 2.24, 95% CIs: 1.10–4.56). Non-survivors at 30 days who were admitted to the intensive care unit had lower COHb levels at hospital arrival (0.0% vs. 0.2%) and lower mean COHb levels during the first 24 h post-arrival (0.7% vs. 0.9%) compared to survivors.

Conclusions

COHb levels of 0.0% were linked to worse outcomes in patients experiencing OHCA, warranting further research on the prognostic implications of COHb in this context.

一氧化碳（CO）由血红素加氧酶-1内源性产生，在免疫系统中通过减轻应激下的细胞损伤起着至关重要的作用。然而，院外心脏骤停（OHCA）后碳氧血红蛋白（COHb）水平的意义尚不清楚。本研究旨在探讨OHCA患者入院时和入院后24小时内COHb水平与30天死亡率和神经预后之间的关系。方法本单中心回顾性研究分析了2019年至2023年在冈山大学医院就诊的成年OHCA患者的数据。患者根据到达医院时的COHb水平（0.0%或≥0.1%）被分配到两个研究组之一。主要终点为30天死亡率。结果560例符合条件的OHCA患者中，COHb 0.0%组284例（50.7%），COHb≥0.1%组276例（49.3%）。COHb 0.0%组的30天死亡率明显高于COHb≥0.1%组（264[92.9%]对233[84.4%]）。多变量logistic回归显示，COHb 0.0%组与30天死亡率相关（调整后的or: 2.24, 95% ci: 1.10-4.56）。与幸存者相比，30天入住重症监护病房的非幸存者在到达医院时的COHb水平较低（0.0%对0.2%），并且在到达后的前24小时内的平均COHb水平较低（0.7%对0.9%）。结论：COHb水平0.0%与OHCA患者预后较差相关，值得进一步研究COHb在此背景下对预后的影响。

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引用次数: 0

Early lymphopenia as a predictor of COVID-19 outcomes: A multicenter cohort study 早期淋巴细胞减少作为COVID-19结局的预测因子：一项多中心队列研究

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-03-21 DOI: 10.1002/ams2.70044

Kazuhiro Okada, Takashi Tagami, Takanobu Otaguro, Mineji Hayakawa, Kazuma Yamakawa, Akira Endo, Takayuki Ogura, Atsushi Hirayama, Hideo Yasunaga, Yoshiaki Hara

Introduction

Lymphopenia is recognized as a biomarker for predicting outcomes in coronavirus disease (COVID-19). However, the optimal timing for its observation remains uncertain. We investigated the association between early lymphopenia and COVID-19 prognosis, as well as the relationship between lymphocyte count trends and disease outcomes.

Methods

We analyzed data from the J-RECOVER study, a multicenter retrospective cohort study in Japan, encompassing patients with COVID-19 between January and September 2020. The patients were categorized into lymphopenia (LP) (<800 cells/μL) and non-lymphopenia (NL) (≥800 cells/μL) groups based on the lymphocyte counts between days 1 and 4 post-onset. They were further divided into “persistent,” “recovered,” “exacerbated,” and “stable” groups based on lymphocyte counts between days 7 and 10. The primary outcome was the in-hospital mortality. The Cox proportional hazard regression was used for the analysis.

Results

Of 995 enrolled patients, 212 patients (21.3%) were classified into the LP group. LP was significantly associated with in-hospital mortality (hazard ratio [HR] 2.32, [95% CI 1.39 to 3.87], p-value 0.001). In both the LP and NL groups, lower lymphocyte counts between 7 and 10 days—categorized as the “persistent” and “exacerbated” groups—was associated with in-hospital mortality (HR 4.65, [95% CI 2.07 to 10.47], p-value <0.001, and HR 5.59, [95% CI 2.24 to 13.97], p-value <0.001, respectively).

Conclusions

Early lymphopenia is predictive of poor prognosis in patients with COVID-19. A declining lymphocyte count trend post-onset further indicates disease deterioration.

淋巴细胞减少症被认为是预测冠状病毒病（COVID-19）预后的生物标志物。然而，观测它的最佳时间仍然不确定。我们研究了早期淋巴细胞减少与COVID-19预后的关系，以及淋巴细胞计数趋势与疾病结局的关系。方法我们分析了J-RECOVER研究的数据，这是一项日本的多中心回顾性队列研究，包括2020年1月至9月期间的COVID-19患者。根据发病后第1 ~ 4天淋巴细胞计数将患者分为淋巴细胞减少（LP）组（≤800个细胞/μL）和非淋巴细胞减少（NL）组（≥800个细胞/μL）。根据第7天至第10天的淋巴细胞计数，他们被进一步分为“持续”、“恢复”、“恶化”和“稳定”组。主要终点是住院死亡率。采用Cox比例风险回归进行分析。结果995例入组患者中，LP组212例（21.3%）。LP与住院死亡率显著相关（危险比[HR] 2.32, [95% CI 1.39 ~ 3.87]， p值0.001）。在LP组和NL组中，7 - 10天内较低的淋巴细胞计数（被归类为“持续性”组和“加重”组）与住院死亡率相关（相对危险度4.65,[95% CI 2.07 - 10.47]， p值<；0.001；相对危险度5.59,[95% CI 2.24 - 13.97]， p值<；0.001）。结论早期淋巴细胞减少可预测COVID-19患者预后不良。发病后淋巴细胞计数下降趋势进一步表明疾病恶化。

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引用次数: 0

Pediatric pharyngeal foreign body with a difficult diagnosis 小儿咽部异物诊断困难

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-03-17 DOI: 10.1002/ams2.70052

Hisataka Ominato, Tomoki Yoshizaki, Yui Hirata-Nozaki, Shota Sakaue, Miki Takahara

A 1-year-old boy with Down syndrome visited the emergency department of our hospital with complaints of displeasure and suspicion of pharyngeal foreign body obstruction. The parents noticed that a clothing price tag was missing at home. At the time of the initial examination, no foreign bodies were detected in the oral cavity of the patient. In addition, computed tomography did not reveal any foreign bodies (Figure 1A). The patient was referred to our department the next day. Endoscopic examination revealed a plastic foreign body at the posterior pharyngeal wall (Figure 1B). We could observe the foreign body from the oral cavity, and the foreign body was removed from the oral cavity using forceps, avoiding the huge tongue (Figure 1C).

Pharyngeal foreign body obstruction usually manifests as dysphagia, vomiting, and drooling.¹ Typical pharyngeal foreign bodies include food, toys, balloons, and plastic bags. The patient had Down syndrome, and consequently, his enlarged tongue posed difficulties for oral observation. The foreign body was plastic and transparent, and it is difficult to see the foreign body in the emergency department. This case was characterized by the difficulty of diagnosis due to the presence of a transparent plastic foreign body and a large tongue, and there was a risk of the foreign body blocking and moving to the larynx. It was suggested that this case showed the need for early intervention by an otolaryngologist in the emergency outpatient department and the importance of performing an endoscopy as soon as possible. In addition, we should consider the possibility of performing an endoscopy before a CT scan to avoid radiation exposure.

None.

The authors declare no conflicts of interest.

Approval of the research protocol: N/A.

Informed consent: Informed consent was obtained from the patient's family.

Registry and the registration number of the study/trial: N/A.

Animal studies: N/A.

1例1岁唐氏综合症男童，主诉不愉快，怀疑咽部异物梗阻来我院急诊科就诊。父母发现家里少了一个衣服的价签。初次检查时，患者口腔内未发现异物。此外，计算机断层扫描未发现任何异物（图1A）。病人第二天被转介到我们科。内镜检查显示咽后壁有一塑料异物（图1B）。我们可以从口腔中观察到异物，并使用镊子将异物从口腔中取出，避开了巨大的舌（图1C）。咽部异物阻塞通常表现为吞咽困难、呕吐、流口水典型的咽异物包括食物、玩具、气球和塑料袋。病人患有唐氏综合症，因此，他的舌头肿大给口腔观察带来了困难。异物具有可塑性和透明性，在急诊科很难看到异物。该病例的特点是由于存在透明的塑料异物和大舌头而难以诊断，并且存在异物阻塞和移动到喉部的风险。我们认为，这个病例表明急诊门诊部的耳鼻喉科医生需要进行早期干预，以及尽快进行内窥镜检查的重要性。此外，我们应该考虑在CT扫描之前进行内窥镜检查的可能性，以避免辐射暴露。研究方案的批准：无。知情同意：获得患者家属的知情同意。注册中心和研究/试验的注册号：无。动物研究：无。

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引用次数: 0

Efficacy of near-infrared spectroscopy in diagnosing skin and soft tissue infections: A single-center retrospective study 近红外光谱诊断皮肤和软组织感染的有效性：一项单中心回顾性研究

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-03-13 DOI: 10.1002/ams2.70041

Marina Oi, Takaaki Maruhashi, Yasushi Asari

Aim

Skin and soft tissue infection (SSTI) is classified as necrotizing fasciitis (NF) or cellulitis based on the invasion depth of the lesion. Cellulitis has a good prognosis and improves with conservative treatment, whereas NF has a poor prognosis with rapid progression requiring prompt debridement of the wound and intensive care control. Therefore, they should be differentiated quickly and accurately; however, a useful diagnostic method, except for the surgical test incision, remains to be established. This study aimed to verify the usefulness of near-infrared spectroscopy (NIRS) to measure regional oxygen saturation (rSO2) in diagnosing SSTI.

Methods

This was a single-center, retrospective, observational study. SSTI cases from October 2019 to April 2024 (4.5 years) were selected from medical records, and their characteristics, rSO2 levels, computed tomography findings, and Laboratory Risk Indicator for Necrotizing Fasciitis scores were collected. The primary endpoint was the rSO2 between cellulitis and NF lesions measured using NIRS, and the affected and unaffected sides in the same patient were compared.

Results

Eighteen patients were included: six with NF and 12 with cellulitis. There were no significant differences in patient characteristics between the groups. The primary endpoint of NIRS on the affected/unaffected side was significantly lower in patients with NF (0.6 [interquartile range, 0.5–0.7] vs. 1.4 [1.2–1.6]; p < 0.01).

Conclusion

NIRS has the potential to be a non-invasive and quantitative diagnostic tool for SSTI.

目的根据皮肤软组织感染的浸润深度，将其分为坏死性筋膜炎（NF）和蜂窝织炎。蜂窝织炎预后良好，保守治疗可改善，而NF预后差，进展迅速，需要及时清创和重症监护控制。因此，要快速准确地进行区分；然而，一种有用的诊断方法，除了手术试验切口，仍有待建立。本研究旨在验证近红外光谱（NIRS）测量区域氧饱和度（rSO2）在SSTI诊断中的有效性。方法采用单中心、回顾性、观察性研究。选择2019年10月至2024年4月（4.5年）的SSTI病例，收集其特征、rSO2水平、计算机断层扫描表现和坏死性筋膜炎实验室风险指标评分。主要终点是使用近红外光谱测量蜂窝织炎和NF病变之间的rSO2，并比较同一患者中受影响和未受影响的侧。结果18例患者：NF 6例，蜂窝织炎12例。两组患者特征无显著差异。NF患者受影响侧/未受影响侧NIRS的主要终点明显较低(0.6[四分位数间距，0.5-0.7]vs. 1.4 [1.2-1.6]；p < 0.01)。结论近红外光谱有可能成为一种无创、定量的SSTI诊断工具。

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引用次数: 0

Clinical characteristics and outcomes of patients with out-of-hospital cardiac arrest treated by repeated extracorporeal cardiopulmonary resuscitation: A multicenter retrospective cohort study 反复体外心肺复苏治疗院外心脏骤停患者的临床特征和结果：一项多中心回顾性队列研究

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-03-13 DOI: 10.1002/ams2.70051

Akira Suekane, Wataru Takayama, Koji Morishita, Akihiko Inoue, Toru Hifumi, Tetsuya Sakamoto, Yasuhiro Kuroda, the Save-J II Study Group

Aim

Retrospective analysis of clinical characteristics and outcomes of patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) requiring extracorporeal membrane oxygenation (ECMO) reinsertion or not.

Methods

Data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in the Japan II database were reviewed. Patients who received ECPR after OHCA between January 2015 and July 2021 and underwent ECPR weaning were divided into reinsertion and no-reinsertion groups. The primary outcome was the 30-day survival rate.

Results

Data from 1011 patients who underwent ECMO weaning ≥1 time and survived were analyzed (12 [1.2%], reinsertion; 999 [98.8%] no-reinsertion). The reinsertion group had a longer time to first ECMO weaning (median [interquartile range, IQR]: 3.0 [2.0–5.0] vs. 4.5 [3.2–6.8] days; p = 0.02). The survival rates at 30 days (25.0% vs. 55.1%; p = 0.08) and favorable neurological outcomes at discharge (8.3% vs. 30.5%; p = 0.18) tended to be lower in the reinsertion group. Among patients who died within 30 days, medical costs were significantly higher in the reinsertion group (median [IQR]: $36,628.2 [26,012.9–45,885.6] vs. $16,456.6 [9341.2–24,880.6]; p < 0.01). Intensive care unit (ICU) stay and mechanical ventilation duration were significantly longer in the reinsertion group.

Conclusion

Patients requiring ECMO reinsertion tended to have poor clinical outcomes and higher healthcare costs, highlighting the need for large-scale studies to develop ECPR protocols and optimize clinical benefits and resource allocation.

目的回顾性分析院外心脏骤停（OHCA）患者行体外心肺复苏（ECPR）治疗是否需要体外膜氧合（ECMO）的临床特点和结局。方法对日本ⅱ数据库中室性颤动体外循环晚期生命支持研究资料进行回顾性分析。2015年1月至2021年7月期间，OHCA后接受ECPR并进行ECPR脱机的患者分为重新插入组和未重新插入组。主要观察指标为30天生存率。结果分析了1011例接受ECMO脱机≥1次并存活的患者的数据(12例[1.2%]，重新插入；999例（98.8%）无插拔)。重新插入组到首次ECMO脱机的时间更长(中位数[四分位数间距，IQR]: 3.0 [2.0-5.0] vs. 4.5[3.2-6.8]天；p = 0.02)。30天存活率(25.0% vs. 55.1%；P = 0.08)和出院时良好的神经预后(8.3% vs. 30.5%；P = 0.18)，再插入组有降低的趋势。在30天内死亡的患者中，重新插入组的医疗费用明显更高(中位数[IQR]: 36,628.2美元[26,012.9-45,885.6美元]vs. 16,456.6美元[9341.2-24,880.6美元]；p < 0.01)。重插组重症监护病房（ICU）住院时间和机械通气时间均明显延长。结论需要重新置入ECMO的患者往往临床结果较差，医疗费用较高，需要进行大规模的研究来制定ECPR方案，优化临床效益和资源分配。

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引用次数: 0

Medical validity and layperson interpretation of emergency visit recommendations by the GPT model: A cross-sectional study GPT模型对急诊就诊建议的医学效度和外行人解释：一项横断面研究

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-03-12 DOI: 10.1002/ams2.70042

Chie Tanaka, Takahiro Kinoshita, Yohei Okada, Kasumi Satoh, Yosuke Homma, Kensuke Suzuki, Shoji Yokobori, Jun Oda, Yasuhiro Otomo, Takashi Tagami, Special Committee on the Utilization of Advanced Technology in Emergency Medicine, Japanese Association for Acute Medicine

Aim

In Japan, emergency ambulance dispatches involve minor cases requiring outpatient services, emphasizing the need for improved public guidance regarding emergency care. This study evaluated both the medical plausibility of the GPT model in aiding laypersons to determine the need for emergency medical care and the laypersons' interpretations of its outputs.

Methods

This cross-sectional study was conducted from December 10, 2023, to March 7, 2024. We input clinical scenarios into the GPT model and evaluated the need for emergency visits based on the outputs. A total of 314 scenarios were labeled with red tags (emergency, immediate emergency department [ED] visit) and 152 with green tags (less urgent). Seven medical specialists assessed the outputs' validity, and 157 laypersons interpreted them via a web-based questionnaire.

Results

Experts reported that the GPT model accurately identified important information in 95.9% (301/314) of red-tagged scenarios and recommended immediate ED visits in 96.5% (303/314). However, only 43.0% (135/314) of laypersons interpreted those outputs as indicating urgent hospital visits. The model identified important information in 99.3% (151/152) of green-tagged scenarios and advised against immediate visits in 88.8% (135/152). However, only 32.2% (49/152) of laypersons considered them routine follow-ups.

Conclusions

Expert evaluations revealed that the GPT model could be highly accurate in advising on emergency visits. However, laypersons frequently misinterpreted its recommendations, highlighting a substantial gap in understanding AI-generated medical advice.

目的在日本，紧急救护车调度涉及需要门诊服务的小病例，强调需要改进关于紧急护理的公共指导。本研究评估了GPT模型在帮助外行人确定紧急医疗护理需求方面的医学合理性，以及外行人对其输出的解释。方法横断面研究时间为2023年12月10日至2024年3月7日。我们将临床情景输入GPT模型，并根据输出评估紧急访问的需求。共有314种情况被标记为红色标签（紧急情况，立即急诊部门[ED]就诊），152种被标记为绿色标签（不太紧急）。7名医学专家评估了产出的有效性，157名外行人通过基于网络的问卷对产出进行了解读。结果专家报告，GPT模型在95.9%（301/314）的红色标记场景中准确识别了重要信息，并在96.5%（303/314）的情况下建议立即就诊。然而，只有43.0%（135/314）的非专业人员将这些产出解释为表明紧急医院就诊。该模型在99.3%（151/152）的绿色标记场景中识别出重要信息，并在88.8%（135/152）的场景中建议不要立即访问。然而，只有32.2%（49/152）的外行人认为他们是常规随访。结论专家评价表明，GPT模型在急诊就诊建议中具有较高的准确性。然而，外行经常误解其建议，突出表明在理解人工智能生成的医疗建议方面存在巨大差距。

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引用次数: 0

Association between neurological outcomes and prehospital time in patients with out-of-hospital cardiopulmonary arrest 院外心肺骤停患者的神经预后与院前时间的关系

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-03-06 DOI: 10.1002/ams2.70025

Kazuhide Yoshikawa, Akira Endo, Wataru Takayama, Tomohisa Shoko, Yasuhiro Otomo, Koji Morishita

Introduction

Out-of-hospital cardiac arrest (OHCA) remains an important health care issue. Considering the importance of such a time course after cardiac arrest, detailed evaluation of the prehospital time (i.e., time from EMS contact to a patient to hospital arrival) is essential to improve the mortality and neurologic outcome of OHCA. In this study, we aimed to evaluate the impact of prehospital time on neurological outcomes in patients with OHCA.

Methods

This retrospective observational study included adult non-traumatic OHCA patients who were transported to 2 emergency centers in Tokyo from January 2015 to December 2020. The following data were obtained retrospectively from medical records.

Results

Of the 3120 OHCA patients who were transported during the study period, 2215 patients were evaluated via the inclusion and exclusion criteria. Sixty-nine patients were alive at hospital discharge with a good neurological outcome (i.e., CPC 1 or 2). The multivariate logistic regression model showed that prehospital time (time from EMS contact to hospital arrival) was an independent predictor for hospital discharge with good neurological outcome, in addition to age, bystander CPR, initial rhythm, and cause of cardiac arrest. The GAM plot showed that the adjusted odds ratio of prehospital time for the good neurological outcome was decreased linearly according to time, and the threshold was approximately 30 min.

Conclusion

The threshold of allowable prehospital time, including field activity and transport, for OHCA patients might be 30 min at least in a Japanese urban setting.

院外心脏骤停（OHCA）仍然是一个重要的卫生保健问题。考虑到心脏骤停后这一时间过程的重要性，详细评估院前时间（即从EMS接触患者到到达医院的时间）对于改善OHCA的死亡率和神经系统预后至关重要。在本研究中，我们旨在评估院前时间对OHCA患者神经预后的影响。方法本回顾性观察研究纳入2015年1月至2020年12月在东京2个急救中心就诊的成年非创伤性OHCA患者。以下资料是回顾性地从医疗记录中获得的。结果在研究期间被转移的3120例OHCA患者中，通过纳入和排除标准对2215例患者进行了评估。出院时69例患者存活，神经系统预后良好（即CPC 1或2）。多因素logistic回归模型显示，院前时间（从EMS接触到医院到达的时间）是出院时神经系统预后良好的独立预测因子，此外还有年龄、旁观者CPR、初始心律和心脏骤停原因。GAM图显示院前时间对神经系统良好预后的校正优势比随时间线性下降，阈值约为30 min。结论在日本城市环境中，OHCA患者允许的院前时间阈值，包括现场活动和运输，可能至少为30分钟。

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引用次数: 0