Most previous research on AI-based image diagnosis of acute cholecystitis (AC) has utilized ultrasound images. While these studies have shown promising outcomes, the results were based on still images captured by physicians, introducing inevitable selection bias. This study aims to develop a fully automated system for precise gallbladder detection among various abdominal structures, aiding clinicians in the rapid assessment of AC requiring cholecystectomy.
Methods
The dataset comprised images from 250 AC patients and 270 control participants. The VGG-16 architecture was employed for gallbladder recognition. Post-processing techniques such as the flood fill algorithm and centroid calculation were integrated into the model. U-Net was utilized for segmentation and features extraction. All models were combined to develop a fully automated AC detection system.
Results
The gallbladder identification accuracy among various abdominal organs was 95.3%, with the model effectively filtering out CT images lacking a gallbladder. In diagnosing AC, the model was tested on 120 cases, achieving an accuracy of 92.5%, sensitivity of 90.4%, and specificity of 94.1%. After integrating all components, the ensemble model achieved an overall accuracy of 86.7%. The automated process required 0.029 seconds of computation time per CT slice and 3.59 seconds per complete CT set.
Conclusions
The proposed system achieves promising performance in the automatic detection and diagnosis of gallbladder conditions in patients requiring cholecystectomy, with robust accuracy and computational efficiency. With further clinical validation, this computer-assisted system could serve as an auxiliary tool in identifying patients requiring emergency surgery.
{"title":"Automated CT image prescription of the gallbladder using deep learning: Development, evaluation, and health promotion","authors":"Chien-Yi Yang, Hao-Lun Kao, Yu Cheng Chen, Chung-Feng Kuo, Chieh Hsing Liu, Shao-Cheng Liu","doi":"10.1002/ams2.70049","DOIUrl":"https://doi.org/10.1002/ams2.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Most previous research on AI-based image diagnosis of acute cholecystitis (AC) has utilized ultrasound images. While these studies have shown promising outcomes, the results were based on still images captured by physicians, introducing inevitable selection bias. This study aims to develop a fully automated system for precise gallbladder detection among various abdominal structures, aiding clinicians in the rapid assessment of AC requiring cholecystectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The dataset comprised images from 250 AC patients and 270 control participants. The VGG-16 architecture was employed for gallbladder recognition. Post-processing techniques such as the flood fill algorithm and centroid calculation were integrated into the model. U-Net was utilized for segmentation and features extraction. All models were combined to develop a fully automated AC detection system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The gallbladder identification accuracy among various abdominal organs was 95.3%, with the model effectively filtering out CT images lacking a gallbladder. In diagnosing AC, the model was tested on 120 cases, achieving an accuracy of 92.5%, sensitivity of 90.4%, and specificity of 94.1%. After integrating all components, the ensemble model achieved an overall accuracy of 86.7%. The automated process required 0.029 seconds of computation time per CT slice and 3.59 seconds per complete CT set.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The proposed system achieves promising performance in the automatic detection and diagnosis of gallbladder conditions in patients requiring cholecystectomy, with robust accuracy and computational efficiency. With further clinical validation, this computer-assisted system could serve as an auxiliary tool in identifying patients requiring emergency surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497094","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}
The publication of invaluable papers in the Acute Medicine & 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, 2024 to December 31, 2024.
The 2024 revised edition of the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock (J-SSCG 2024) is published by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine. This is the fourth revision since the first edition was published in 2012. The purpose of the guidelines is to assist healthcare providers in making appropriate decisions in the treatment of sepsis and septic shock, leading to improved patient outcomes. We aimed to create guidelines that are easy to understand and use for physicians who recognize sepsis and provide initial management, specialized physicians who take over the treatment, and multidisciplinary healthcare providers, including nurses, physical therapists, clinical engineers, and pharmacists. The J-SSCG 2024 covers the following nine areas: diagnosis of sepsis and source control, antimicrobial therapy, initial resuscitation, blood purification, disseminated intravascular coagulation, adjunctive therapy, post-intensive care syndrome, patient and family care, and pediatrics. In these areas, we extracted 78 important clinical issues. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 42 GRADE-based recommendations, 7 good practice statements, and 22 information-to-background questions were created as responses to clinical questions. We also described 12 future research questions.
日本重症医学会和日本急性医学协会发布了2024年修订版《日本败血症和感染性休克管理临床实践指南》（J-SSCG 2024）。这是自2012年第一版出版以来的第四次修订。该指南的目的是帮助医疗保健提供者在脓毒症和脓毒性休克的治疗中做出适当的决定，从而改善患者的预后。我们的目标是为识别败血症并提供初始管理的医生、接管治疗的专业医生以及包括护士、物理治疗师、临床工程师和药剂师在内的多学科医疗保健提供者创建易于理解和使用的指南。J-SSCG 2024涵盖以下九个领域：败血症诊断和源头控制、抗菌治疗、初始复苏、血液净化、弥散性血管内凝血、辅助治疗、重症监护后综合征、患者和家庭护理以及儿科。在这些领域，我们提取了78个重要的临床问题。采用GRADE （Grading of Recommendations Assessment, Development and Evaluation）法提出建议，采用改进的德尔菲法由委员会全体成员投票确定建议。结果，42个基于grade的建议，7个良好实践声明和22个信息背景问题被创建作为对临床问题的回应。我们还描述了12个未来的研究问题。
{"title":"The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024","authors":"Nobuaki Shime, Taka-aki Nakada, Tomoaki Yatabe, Kazuma Yamakawa, Yoshitaka Aoki, Shigeaki Inoue, Toshiaki Iba, Hiroshi Ogura, Yusuke Kawai, Atsushi Kawaguchi, Tatsuya Kawasaki, Yutaka Kondo, Masaaki Sakuraya, Shunsuke Taito, Kent Doi, Hideki Hashimoto, Yoshitaka Hara, Tatsuma Fukuda, Asako Matsushima, Moritoki Egi, Shigeki Kushimoto, Takehiko Oami, Kazuya Kikutani, Yuki Kotani, Gen Aikawa, Makoto Aoki, Masayuki Akatsuka, Hideki Asai, Toshikazu Abe, Yu Amemiya, Ryo Ishizawa, Tadashi Ishihara, Tadayoshi Ishimaru, Yusuke Itosu, Hiroyasu Inoue, Hisashi Imahase, Haruki Imura, Naoya Iwasaki, Noritaka Ushio, Masatoshi Uchida, Michiko Uchi, Takeshi Umegaki, Yutaka Umemura, Akira Endo, Marina Oi, Akira Ouchi, Itsuki Osawa, Yoshiyasu Oshima, Kohei Ota, Takanori Ohno, Yohei Okada, Hiromu Okano, Yoshihito Ogawa, Masahiro Kashiura, Daisuke Kasugai, Ken-ichi Kano, Ryo Kamidani, Akira Kawauchi, Sadatoshi Kawakami, Daisuke Kawakami, Yusuke Kawamura, Kenji Kandori, Yuki Kishihara, Sho Kimura, Kenji Kubo, Tomoki Kuribara, Hiroyuki Koami, Shigeru Koba, Takehito Sato, Ren Sato, Yusuke Sawada, Haruka Shida, Tadanaga Shimada, Motohiro Shimizu, Kazushige Shimizu, Takuto Shiraishi, Toru Shinkai, Akihito Tampo, Gaku Sugiura, Kensuke Sugimoto, Hiroshi Sugimoto, Tomohiro Suhara, Motohiro Sekino, Kenji Sonota, Mahoko Taito, Nozomi Takahashi, Jun Takeshita, Chikashi Takeda, Junko Tatsuno, Aiko Tanaka, Masanori Tani, Atsushi Tanikawa, Hao Chen, Takumi Tsuchida, Yusuke Tsutsumi, Takefumi Tsunemitsu, Ryo Deguchi, Kenichi Tetsuhara, Takero Terayama, Yuki Togami, Takaaki Totoki, Yoshinori Tomoda, Shunichiro Nakao, Hiroki Nagasawa, Yasuhisa Nakatani, Nobuto Nakanishi, Norihiro Nishioka, Mitsuaki Nishikimi, Satoko Noguchi, Suguru Nonami, Osamu Nomura, Katsuhiko Hashimoto, Junji Hatakeyama, Yasutaka Hamai, Mayu Hikone, Ryo Hisamune, Tomoya Hirose, Ryota Fuke, Ryo Fujii, Naoki Fujie, Jun Fujinaga, Yoshihisa Fujinami, Sho Fujiwara, Hiraku Funakoshi, Koichiro Homma, Yuto Makino, Hiroshi Matsuura, Ayaka Matsuoka, Tadashi Matsuoka, Yosuke Matsumura, Akito Mizuno, Sohma Miyamoto, Yukari Miyoshi, Satoshi Murata, Teppei Murata, Hiromasa Yakushiji, Shunsuke Yasuo, Kohei Yamada, Hiroyuki Yamada, Ryo Yamamoto, Ryohei Yamamoto, Tetsuya Yumoto, Yuji Yoshida, Shodai Yoshihiro, Satoshi Yoshimura, Jumpei Yoshimura, Hiroshi Yonekura, Yuki Wakabayashi, Takeshi Wada, Shinichi Watanabe, Atsuhiro Ijiri, Kei Ugata, Shuji Uda, Ryuta Onodera, Masaki Takahashi, Satoshi Nakajima, Junta Honda, Tsuguhiro Matsumoto","doi":"10.1002/ams2.70037","DOIUrl":"https://doi.org/10.1002/ams2.70037","url":null,"abstract":"<p>The 2024 revised edition of the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock (J-SSCG 2024) is published by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine. This is the fourth revision since the first edition was published in 2012. The purpose of the guidelines is to assist healthcare providers in making appropriate decisions in the treatment of sepsis and septic shock, leading to improved patient outcomes. We aimed to create guidelines that are easy to understand and use for physicians who recognize sepsis and provide initial management, specialized physicians who take over the treatment, and multidisciplinary healthcare providers, including nurses, physical therapists, clinical engineers, and pharmacists. The J-SSCG 2024 covers the following nine areas: diagnosis of sepsis and source control, antimicrobial therapy, initial resuscitation, blood purification, disseminated intravascular coagulation, adjunctive therapy, post-intensive care syndrome, patient and family care, and pediatrics. In these areas, we extracted 78 important clinical issues. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 42 GRADE-based recommendations, 7 good practice statements, and 22 information-to-background questions were created as responses to clinical questions. We also described 12 future research questions.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143475321","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}
A ruptured abdominal aortic aneurysm (rAAA) is fatal. While Resuscitative endovascular balloon occlusion of the aorta (REBOA) contributes to hemodynamic stability, organ ischemia should be carefully considered.
Case Presentation
A 69-year-old obese man with untreated hypertension presented with sudden back pain and hypotension. Computed tomography confirmed the presence of an rAAA. REBOA was initially planned in Zone 1 via the left brachial artery but was eventually switched to Zone 3 via the right femoral artery. Hemodynamic stability was achieved through blood transfusion and partial REBOA, followed by surgical intervention. The postoperative recovery was uneventful.
Conclusion
Zone 1 REBOA via the left brachial approach provided safe aortic occlusion. Transitioning to Zone 3 REBOA, combined with meticulous organ perfusion management and blood transfusion, prevented ischemia–reperfusion complications.
{"title":"Ruptured abdominal aortic aneurysm managed using resuscitative endovascular balloon occlusion of the aorta with a two-stage approach","authors":"Kenichiro Ishida, Yosuke Matsumura, Kai Kitabayashi, Haruka Ogawa, Masashi Tajiri, Koichi Ochi, Takashi Iehara, Masaya Nakagawa, Yukie Shirasaki, Hiroyuki Nishi, Mitsuo Ohnishi","doi":"10.1002/ams2.70048","DOIUrl":"https://doi.org/10.1002/ams2.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A ruptured abdominal aortic aneurysm (rAAA) is fatal. While Resuscitative endovascular balloon occlusion of the aorta (REBOA) contributes to hemodynamic stability, organ ischemia should be carefully considered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 69-year-old obese man with untreated hypertension presented with sudden back pain and hypotension. Computed tomography confirmed the presence of an rAAA. REBOA was initially planned in Zone 1 via the left brachial artery but was eventually switched to Zone 3 via the right femoral artery. Hemodynamic stability was achieved through blood transfusion and partial REBOA, followed by surgical intervention. The postoperative recovery was uneventful.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Zone 1 REBOA via the left brachial approach provided safe aortic occlusion. Transitioning to Zone 3 REBOA, combined with meticulous organ perfusion management and blood transfusion, prevented ischemia–reperfusion complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456102","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}
Aconitum poisoning can cause severe arrhythmias. We report, for the first time, the detailed blood and urine concentrations of four aconitine alkaloids in a male patient in his 20s who ingested aconite roots with suicidal intent.
Case Presentation
The patient developed refractory torsade de pointes (TdP) and required veno-arterial extracorporeal membrane oxygenation. His TdP resolved 7 h after arrival, with sinus rhythm returning within 12 h. The patient was discharged 6 days later. Subsequent measurements of the four alkaloids over time showed that jesaconitine had the highest serum concentration, with the patient's sinus rhythm returning when the jesaconitine concentration was less than 1 ng/mL.
Conclusion
This report provides valuable insights into the disposition of aconitine alkaloids during severe intoxication. The changes in jesaconitine concentrations over time correlate with clinical symptoms, suggesting that these levels could guide treatment decisions in patients with severe Aconitum poisoning.
{"title":"Jesaconitine monitoring in a case of severe aconitum poisoning with torsade de pointes treated via extracorporeal membrane oxygenation","authors":"Yoshitaka Tomita, Keisuke Suzuki, Asuka Kaizaki-Mitsumoto, Natsumi Hattori-Usami, Satoshi Numazawa, Kazuki Kikuchi, Gen Inoue, Kazuyuki Miyamoto, Masaharu Yagi, Kenji Dohi","doi":"10.1002/ams2.70047","DOIUrl":"https://doi.org/10.1002/ams2.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p><i>Aconitum</i> poisoning can cause severe arrhythmias. We report, for the first time, the detailed blood and urine concentrations of four aconitine alkaloids in a male patient in his 20s who ingested aconite roots with suicidal intent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>The patient developed refractory torsade de pointes (TdP) and required veno-arterial extracorporeal membrane oxygenation. His TdP resolved 7 h after arrival, with sinus rhythm returning within 12 h. The patient was discharged 6 days later. Subsequent measurements of the four alkaloids over time showed that jesaconitine had the highest serum concentration, with the patient's sinus rhythm returning when the jesaconitine concentration was less than 1 ng/mL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This report provides valuable insights into the disposition of aconitine alkaloids during severe intoxication. The changes in jesaconitine concentrations over time correlate with clinical symptoms, suggesting that these levels could guide treatment decisions in patients with severe <i>Aconitum</i> poisoning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143446915","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}
Sepsis is prevalent globally, causing a significant disease burden in global health. Sepsis is a complex disease condition, and therefore, the effective strategies to overcome sepsis need to be set up in layers across different sectors and populations. Over the years, the global society has been making progress in addressing sepsis as a public health threat. This review aims to examine and describe the current sepsis strategies globally and to sustain the fight against sepsis in the context of global health.
{"title":"Sepsis in Global Health: Current global strategies to fight against sepsis","authors":"Hiroki Saito","doi":"10.1002/ams2.70045","DOIUrl":"https://doi.org/10.1002/ams2.70045","url":null,"abstract":"<p>Sepsis is prevalent globally, causing a significant disease burden in global health. Sepsis is a complex disease condition, and therefore, the effective strategies to overcome sepsis need to be set up in layers across different sectors and populations. Over the years, the global society has been making progress in addressing sepsis as a public health threat. This review aims to examine and describe the current sepsis strategies globally and to sustain the fight against sepsis in the context of global health.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439110","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}
Traumatic intracranial aneurysms (TICAs) can be fatal if ruptured. We report a case of a TICA, distant from facial bone fractures, successfully treated with flow diverter (FD) before rupture.
Case Presentation
A 20-year-old woman was admitted following a car accident. Initial contrast-enhanced computed tomography revealed traumatic subarachnoid hemorrhage, a 5-mm internal carotid artery aneurysm, LeFort type I + II, and mandibular fracture. On Day 8, she developed oculomotor palsy, and digital subtraction angiography revealed the aneurysm had increased to 12 mm. She started dual antiplatelet therapy (DAPT) following facial fracture repair. On Day 17, FD was placed, resulting in contrast agent stagnation within the aneurysm. Three months postinjury, her neurological symptoms improved.
Conclusion
Screening for cerebrovascular injury is crucial several days following severe head trauma, even without skull base fractures. Unruptured TICA can be safely treated with FD following DAPT administration.
背景：外伤性颅内动脉瘤（TICAs）一旦破裂可能是致命的。我们报告一例远离面骨骨折的TICA，在骨折前成功应用分流器（FD）治疗。病例介绍：一名20岁的女性在车祸后入院。最初的增强计算机断层扫描显示外伤性蛛网膜下腔出血，一个5mm的颈内动脉瘤，LeFort I + II型和下颌骨折。第8天，患者出现动眼性麻痹，数字减影血管造影显示动脉瘤增大至12mm。面部骨折修复后开始双重抗血小板治疗（DAPT）。在第17天，放置FD，导致造影剂在动脉瘤内停滞。受伤后三个月，她的神经症状有所改善。结论：在严重颅脑外伤后的几天内进行脑血管损伤筛查是至关重要的，即使没有颅底骨折。经DAPT治疗后，FD治疗未破裂的TICA是安全的。
{"title":"Traumatic internal carotid artery aneurysm distant from facial bone fractures treated with a flow diverter stent: A case report","authors":"Tatsuya Watanabe, Junzo Nakao, Keishun Boku, Koji Hirata, Yasukazu Totoki, Kuniharu Tasaki, Takeshi Miura, Tetsuya Hoshino, Yukei Matsumoto, Yuki Enomoto, Aiki Marushima, Yuji Matsumaru, Yoshiaki Inoue","doi":"10.1002/ams2.70034","DOIUrl":"10.1002/ams2.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Traumatic intracranial aneurysms (TICAs) can be fatal if ruptured. We report a case of a TICA, distant from facial bone fractures, successfully treated with flow diverter (FD) before rupture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 20-year-old woman was admitted following a car accident. Initial contrast-enhanced computed tomography revealed traumatic subarachnoid hemorrhage, a 5-mm internal carotid artery aneurysm, LeFort type I + II, and mandibular fracture. On Day 8, she developed oculomotor palsy, and digital subtraction angiography revealed the aneurysm had increased to 12 mm. She started dual antiplatelet therapy (DAPT) following facial fracture repair. On Day 17, FD was placed, resulting in contrast agent stagnation within the aneurysm. Three months postinjury, her neurological symptoms improved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Screening for cerebrovascular injury is crucial several days following severe head trauma, even without skull base fractures. Unruptured TICA can be safely treated with FD following DAPT administration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045440","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}
Kosuke Kiyohara, Mamoru Ayusawa, Masahiko Nitta, Takeichiro Sudo, Taku Iwami, Ken Nakata, Yuri Kitamura, Tetsuhisa Kitamura, For the SPIRITS Investigators
Aim
Timely use of automated external defibrillators by lay rescuers significantly improves the chances of survival in out-of-hospital cardiac arrest cases. We aimed to identify the factors influencing whether lay rescuers bring automated external defibrillators to the scene of nontraumatic out-of-hospital cardiac arrests in schoolchildren in Japan.
Methods
Data on out-of-hospital cardiac arrests among schoolchildren from April 2008 to December 2021 were obtained from the database of the Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools study. A multivariate Modified Poisson regression analysis was performed to evaluate the factors influencing whether a lay rescuer brought an automated external defibrillator to the scene of out-of-hospital cardiac arrest and the year-by-year changes in automated external defibrillator delivery for each factor were assessed.
Results
Of the 333 nontraumatic out-of-hospital cardiac arrests across the entire study period, lay rescuers brought automated external defibrillators in 85.3% of cases. Female patients and incidents occurring during non-sports activities had lower proportions of automated external defibrillator delivery. Significant year-by-year improvements in automated external defibrillator delivery were observed, with the overall proportion increasing from 73.7% in 2008–2010 to 93.3% in 2020–2021. However, the trend was less pronounced for female students, non-sports activities, and incidents occurring in classrooms/other locations than their counterparts.
Conclusions
AED delivery to the scene of OHCA in schools has improved overall, with the proportion increasing from 73.7% in 2008–2010 to 93.3% in 2020–2021. However, there is still room for improvement, particularly in female patients, and incidents during non-sports activities.
{"title":"Factors influencing the delivery of automated external defibrillators by lay rescuers to the scene of out-of-hospital cardiac arrests in schools","authors":"Kosuke Kiyohara, Mamoru Ayusawa, Masahiko Nitta, Takeichiro Sudo, Taku Iwami, Ken Nakata, Yuri Kitamura, Tetsuhisa Kitamura, For the SPIRITS Investigators","doi":"10.1002/ams2.70040","DOIUrl":"10.1002/ams2.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Timely use of automated external defibrillators by lay rescuers significantly improves the chances of survival in out-of-hospital cardiac arrest cases. We aimed to identify the factors influencing whether lay rescuers bring automated external defibrillators to the scene of nontraumatic out-of-hospital cardiac arrests in schoolchildren in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data on out-of-hospital cardiac arrests among schoolchildren from April 2008 to December 2021 were obtained from the database of the Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools study. A multivariate Modified Poisson regression analysis was performed to evaluate the factors influencing whether a lay rescuer brought an automated external defibrillator to the scene of out-of-hospital cardiac arrest and the year-by-year changes in automated external defibrillator delivery for each factor were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 333 nontraumatic out-of-hospital cardiac arrests across the entire study period, lay rescuers brought automated external defibrillators in 85.3% of cases. Female patients and incidents occurring during non-sports activities had lower proportions of automated external defibrillator delivery. Significant year-by-year improvements in automated external defibrillator delivery were observed, with the overall proportion increasing from 73.7% in 2008–2010 to 93.3% in 2020–2021. However, the trend was less pronounced for female students, non-sports activities, and incidents occurring in classrooms/other locations than their counterparts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AED delivery to the scene of OHCA in schools has improved overall, with the proportion increasing from 73.7% in 2008–2010 to 93.3% in 2020–2021. However, there is still room for improvement, particularly in female patients, and incidents during non-sports activities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045435","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}
Takuya Sato, Hiroyuki Ohbe, Yusuke Sasabuchi, Ryota Inokuchi, Hideo Yasunaga, Kent Doi
Background
In this study, we aimed to determine the effects of the coronavirus disease 2019 (COVID-19) pandemic on in-hospital cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest (OHCA).
Methods and Results
Using the Japanese Diagnosis Procedure Combination inpatient database, we included patients with OHCA who were transported to hospitals between April 2018 and March 2021. Patients were categorized into groups, before and during the COVID-19 pandemic, according to the day of admission (before or after April 1, 2020, respectively). The primary outcome was in-hospital CPR duration after hospital arrival, and secondary outcomes included in-hospital death, intubation, and other resuscitation-related treatments. We examined the impact of the pandemic using interrupted time series (ITS) analyses. Among 144,867 patients with OHCA, 82,425 died in the outpatient department (53,286 before the pandemic and 29,139 during the pandemic) during the study period. The ITS analyses for patients who died in the outpatient department showed no significant level change in CPR duration after hospital arrival (0.41 min increase; 95% confidence interval [CI]: −0.54 to 1.4; p = 0.39), but the intubation rate was significantly lower (−5.9%; 95% CI: −8.4 to 3.4; p < 0.001). In-hospital death among all patients with OHCA showed a significant increase in trend (0.41% per month; 95% CI: 0.081–0.74; p = 0.016).
Conclusions
The COVID-19 pandemic had little impact on CPR duration after hospital arrival; however, there was a marked decrease in intubation for patients with OHCA after hospital arrival.
{"title":"Impact of COVID-19 on resuscitation after hospital arrival for patients with out-of-hospital cardiac arrest: An interrupted time series analysis","authors":"Takuya Sato, Hiroyuki Ohbe, Yusuke Sasabuchi, Ryota Inokuchi, Hideo Yasunaga, Kent Doi","doi":"10.1002/ams2.70039","DOIUrl":"10.1002/ams2.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In this study, we aimed to determine the effects of the coronavirus disease 2019 (COVID-19) pandemic on in-hospital cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest (OHCA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Using the Japanese Diagnosis Procedure Combination inpatient database, we included patients with OHCA who were transported to hospitals between April 2018 and March 2021. Patients were categorized into groups, before and during the COVID-19 pandemic, according to the day of admission (before or after April 1, 2020, respectively). The primary outcome was in-hospital CPR duration after hospital arrival, and secondary outcomes included in-hospital death, intubation, and other resuscitation-related treatments. We examined the impact of the pandemic using interrupted time series (ITS) analyses. Among 144,867 patients with OHCA, 82,425 died in the outpatient department (53,286 before the pandemic and 29,139 during the pandemic) during the study period. The ITS analyses for patients who died in the outpatient department showed no significant level change in CPR duration after hospital arrival (0.41 min increase; 95% confidence interval [CI]: −0.54 to 1.4; <i>p</i> = 0.39), but the intubation rate was significantly lower (−5.9%; 95% CI: −8.4 to 3.4; <i>p</i> < 0.001). In-hospital death among all patients with OHCA showed a significant increase in trend (0.41% per month; 95% CI: 0.081–0.74; <i>p</i> = 0.016).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The COVID-19 pandemic had little impact on CPR duration after hospital arrival; however, there was a marked decrease in intubation for patients with OHCA after hospital arrival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045422","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}
When inserting central venous catheters, inadvertent injury of major vessels is a rare yet critical complication. Direct surgery is sometimes overly invasive. This report describes a subclavian artery injury caused by inadvertent cannulation of a dialysis catheter, successfully treated with a covered stent.
Case Presentation
An 82-year-old woman with acute renal failure due to sepsis required emergency dialysis. During the insertion of a 12-Fr dialysis catheter into the right jugular vein, pulsatile reflux was noted. Computed tomography revealed catheter misplacement in the subclavian artery. Considering the patient's fragility, endovascular repair was performed. After embolization of side branches, a GORE VIABAHN stentgraft was delivered using a pull-through technique and deployed to seal the injury site. The patient was discharged without neurological or vascular complications.
Conclusion
Covered stents offer an effective solution for major vessel injuries requiring immediate hemostasis, particularly when direct surgery is complicated by underlying medical or anatomical conditions.
{"title":"Inadvertent insertion of dialysis catheter into subclavian artery treated with a covered stent: A case report","authors":"Yohei Takenobu, Akihiro Furuta, Sumire Haga, Hiroshi Yukawa, Noriko Nomura, Mizuha Toyama, Akihiro Okada, Takeshi Kawauchi, Yukinori Terada, Manabu Inoue, Kenji Hashimoto","doi":"10.1002/ams2.70038","DOIUrl":"10.1002/ams2.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>When inserting central venous catheters, inadvertent injury of major vessels is a rare yet critical complication. Direct surgery is sometimes overly invasive. This report describes a subclavian artery injury caused by inadvertent cannulation of a dialysis catheter, successfully treated with a covered stent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>An 82-year-old woman with acute renal failure due to sepsis required emergency dialysis. During the insertion of a 12-Fr dialysis catheter into the right jugular vein, pulsatile reflux was noted. Computed tomography revealed catheter misplacement in the subclavian artery. Considering the patient's fragility, endovascular repair was performed. After embolization of side branches, a GORE VIABAHN stentgraft was delivered using a pull-through technique and deployed to seal the injury site. The patient was discharged without neurological or vascular complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Covered stents offer an effective solution for major vessel injuries requiring immediate hemostasis, particularly when direct surgery is complicated by underlying medical or anatomical conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11738960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998258","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}
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