研究者詳細 - 上村　修二

論文 - 上村　修二

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Prediction of the future number of fall-related emergency medical services calls in older individuals.

Shuji Uemura, Ryuichi Nakayama, Masayuki Koyama, Yukiko Taguchi, Naofumi Bunya, Keigo Sawamoto, Hirofumi Ohnishi, Eichi Narimatsu

International journal of emergency medicine 17 ( 1 ) 72 - 72 2024年06月 [国際誌]

BACKGROUND: Falls among older individuals contribute significantly to the rise in ambulance transport use. To recognize the importance of future countermeasures, we estimated the projected number and percentage of fall-related emergency medical service (EMS) calls. METHODS: We examined the sex, age group, and location of falls among patients aged ≥ 65 years who contacted emergency services in Sapporo City from 2013 to 2021. Annual fall-related calls per population subgroup were calculated, and trends were analyzed. Four models were used to estimate the future number of fall-related calls from the 2025-2060 projected population: (1) based on the 2022 data, estimates from the 2013-2022 data using (2) Poisson progression, (3) neural network, (4) estimates from the 2013-2019 data using neural network. The number of all EMS calls was also determined using the same method to obtain the ratio of all EMS calls. RESULTS: During 2013-2022, 70,262 fall-related calls were made for those aged ≥ 65 years. The rate was higher indoors among females and outdoor among males in most age groups and generally increased with age. After adjusting for age, the rate increased by year. Future estimates of the number of fall calls are approximately double the number in 2022 in 2040 and three times in 2060, with falls accounting for approximately 11% and 13% of all EMS calls in 2040 and 2060, respectively. CONCLUSION: The number of fall-related EMS calls among older people is expected to increase in the future, and the percentage of EMS calls will also increase; therefore, countermeasures are urgently needed.

Prehospital advanced airway management and ventilation for out-of-hospital cardiac arrest with prehospital return of spontaneous circulation: a prospective observational cohort study in Japan.

Ryuichi Nakayama, Naofumi Bunya, Shuji Uemura, Keigo Sawamoto, Eichi Narimatsu

Prehospital emergency care 1 - 12 2023年09月 [国際誌]

BackgroundThe relationship among advanced airway management (AAM), ventilation, and oxygenation in patients with out-of-hospital cardiac arrest (OHCA) who achieve prehospital return of spontaneous circulation (ROSC) has not been validated. This study was designed to evaluate ventilation and oxygenation for each AAM technique (supraglottic devices [SGA] or endotracheal intubation [ETI]) using arterial blood gas (ABG) results immediately after hospital arrival.MethodsThis observational cohort study, using data from the Japanese Association for Acute Medicine OHCA Registry, included patients with OHCA with prehospital and hospital arrival ROSC between July 1, 2014, and December 31, 2019. The primary outcomes were the partial pressure of carbon dioxide in the arterial blood (PaCO2) and partial pressure of oxygen in the arterial blood (PaO2) in the initial ABG at the hospital for each AAM technique (SGA or ETI) performed by paramedics. The secondary outcome was favorable neurological outcome (cerebral performance category [CPC] 1 or 2) for specific PaCO2 levels, which were defined as good ventilation (PaCO2 ≤45 mmHg) and insufficient ventilation (PaCO2 >45 mmHg).ResultsThis study included 1,527 patients. Regarding AAM, 1,114 and 413 patients were ventilated using SGA and ETI, respectively. The median PaCO2 and PaO2 levels were 74.50 mmHg and 151.35 mmHg in the SGA group, while 66.30 mmHg and 173.50 mmHg in the ETI group. PaCO2 was significantly lower in the ETI group than in the SGA group (12.55 mmHg; 95% CI 15.27 to 8.20, P-value < 0.001), while no significant difference was found in PaO2 by multivariate linear regression analysis. After stabilizing inverse probability of weighting (IPW), the adjusted odds ratio for favorable neurological outcome at 1 month was significant in the good ventilation group compared to the insufficient ventilation cohort (adjusted odds ratio = 2.12, 95%CI: 1.40 to 3.19, P value < 0.001).ConclusionThe study showed that in OHCA patients with prehospital ROSC, the PaCO2 levels in the initial ABG were lower in the group with AAM by ETI than in the SGA group. Furthermore, patients with prehospital ROSC and PaCO2 ≤45 mmHg on arrival had an increased odds of favorable neurological outcome after stabilized IPW adjustment.

一般住宅と高齢者施設から救急要請された高齢者転倒患者の比較

上村修二, 中山龍一, 小山雅之, 原正浩, 田口裕紀子, 大西浩文, 成松英智

日本転倒予防学会誌 ( 日本転倒予防学会 ) ( 第10回学術集会 ) 150 - 150 2023年09月

Extension of Selection Time for the Emergency Destination of Patients with a Fever Due to the Coronavirus Disease 2019 Pandemic: A Difference-in-differences Analysis.

Ryuichi Nakayama, Shuji Uemura, Masayuki Koyama, Masahiro Hara, Naofumi Bunya, Keigo Sawamoto, Hirofumi Ohnishi, Eichi Narimatsu

Internal medicine (Tokyo, Japan) 2023年06月 [国内誌]

Background During the coronavirus disease 2019 (COVID-19) pandemic period, an extended total activity time (TAT) in emergency cases has been reported, especially in febrile patients. A brief selection time (ST) regarding the transport of patients to designated hospitals is vital to achieving a good outcome. However, to our knowledge, no studies have reported the impact of the COVID-19 pandemic on the ST. We therefore examined the impact of a fever on the ST for the transportation of emergency patients during the COVID-19 pandemic. Method We analyzed emergency medical services (EMS) data in Sapporo between January 2015 and December 2020. The primary outcome was the ST for the emergency destination of patients. The secondary outcomes were the number of inquiries, time from emergency call to arrival at the scene [call-to-scene time (CST)], time from arrival at the hospital to return base [arrival-to-return time (ART)], and TAT. We used a multivariable linear regression model to estimate the difference-in-differences effect. Results A total of 383,917 patients who were transported to the hospital were enrolled within the study period. The mean ST was 5.8 min in 2019 and 7.1 min in 2020. The difference-in-differences analyses showed that the mean ST increased by 2.52 min (p<0.001), the mean ART by 3.10 min (p<0.001), and the mean TAT by 7.27 min (p<0.001) for patients with a fever during the COVID-19 period. Conclusions This study showed that febrile patients had a longer ST, ART, and TAT during the 2020 COVID-19 period. Considering the COVID-19 pandemic and the threat of future pandemics, regional infection control and information-sharing should be conducted to reduce the EMS activity time.

Influence of work and family environments on burnout among emergency medical technicians.

Junpei Haruna, Shuji Uemura, Yukiko Taguchi, Saori Muranaka, Sachi Niiyama, Hirotoshi Inamura, Keigo Sawamoto, Hirotoshi Mizuno, Eichi Narimatsu

Clinical and experimental emergency medicine 2023年02月 [国際誌]

OBJECTIVE: : Burnout among emergency medical technicians is a serious problem affecting delivery of quality emergency medical services. Although the repetitive nature of the job and lower education level requirements for technicians have been reported as risk factors, little is known about the influence of burden of responsibility, degree of supervisor support, and home environment on burnout among emergency medical technicians. This study aimed to test the hypothesis that burden of responsibility, degree of supervisor support, and home environment increase burnout probability. METHODS: : A web-based survey was conducted among emergency medical technicians in Hokkaido, Japan from July 26, 2021 to September 13, 2021. A total of 21 facilities were randomly selected from 42 fire stations. Prevalence of burnout was measured using the Maslach Burnout-Human Services Survey Inventory. Burden of responsibility was measured using a visual analog scale. Occupational background was also measured. Supervisor support was measured using the Brief Job Stress Questionnaire. Family-work negative spillover was measured using the Survey Work-Home Interaction-NijmeGen-Japanese. The cutoff value for burnout syndrome was defined as emotional exhaustion ≥ 27 and/or depersonalization ≥ 10. RESULTS: : A total of 700 survey respondents were included, and 27 surveys with missing data were excluded. The suspected burnout frequency was 25.6%. Covariates were adjusted using multilevel logistic regression model analysis, and low supervisor support (OR,1.421; 95% CI:1.136-1.406, p < .001) and high family-work negative spillover (OR:1.264, 95% CI:1.285-1.571, p < .001) were independent factors that predicted higher probability of burnout. CONCLUSION: : This study indicated that focusing on improvement of supervisor support for emergency medical technicians and creating supportive home environments may assist in reducing burnout frequency.

Prehospital emergency care patient satisfaction scale [PECPSS] for care provided by emergency medical teams: Scale development and validation.

Junpei Haruna, Nobuyasu Hayasaka, Yukiko Taguchi, Saori Muranaka, Sachi Niiyama, Hirotoshi Inamura, Shuji Uemura, Keigo Sawamoto, Hirotoshi Mizuno, Nobuaki Himuro, Eichi Narimatsu

AIMS public health 10 ( 1 ) 129 - 144 2023年 [国際誌]

The purpose of this study was to develop and validate an emergency medical technician (EMT) care patient satisfaction scale to measure patient satisfaction with prehospital emergency care. To date, patient satisfaction surveys of EMTs have been performed subjectively, e using each facility's questionnaire, without the use of a validated patient satisfaction scale. However, no specific scale has been devised to assess patient satisfaction with EMTs. The study population comprised patients who used an ambulance between November 2020 and May 2021 (N = 202). A survey instrument was administered to participants who provided informed consent. In the process of validating the patient satisfaction scale, an exploratory factor analysis (EFA) of construct validity was performed. The results of the EFA showed a factor structure consisting of five factors: "teamwork", "explanation and communication", "physical treatment and psychological support", "quickness of transport", and "environment in the ambulance". In addition, domain and summary scores showed good internal reliability (Cronbach's range = 0.82-0.94). The patient satisfaction scale developed in this study was designed and validated considering the role of EMTs and patients' needs for prehospital care. This scale may be useful in the development of assessments and interventions to improve patient satisfaction with EMTs.

人工鼻除去による死腔の減少が換気を改善したCOVID-19によるARDSの1例

岩元悠輔, 中山龍一, 文屋尚史, 後藤祐也, 渡辺梨花, 和田健志郎, 宮下龍, 沢本圭悟, 上村修二, 成松英智

日本集中治療医学会雑誌 ( (一社)日本集中治療医学会 ) 29 ( Suppl.1 ) 631 - 631 2022年11月

新型コロナウイルス感染症の自宅療養者に対する健康観察アプリケーションのユーザビリティ

中山龍一, 小山雅之, 高塚伸太朗, 向原強, 谷川琢海, 藤本直樹, 福田潤, 小澤秀弘, 大西浩文, 上村修二

医療情報学連合大会論文集 ( (一社)日本医療情報学会 ) 42回 539 - 541 2022年11月

新型コロナウイルス感染症の自宅療養者に対する健康観察アプリケーションのユーザビリティ

中山龍一, 小山雅之, 高塚伸太朗, 向原強, 谷川琢海, 藤本直樹, 福田潤, 小澤秀弘, 大西浩文, 上村修二

医療情報学連合大会論文集 ( (一社)日本医療情報学会 ) 42回 539 - 541 2022年11月

COVID-19肺炎によるARDSに続発した二次性器質化肺炎に対してステロイドが有効であった3例

萩原詢哉, 中山龍一, 柿崎隆一郎, 和田健志郎, 文屋尚史, 沢本圭悟, 上村修二, 原田敬介, 成松英智

日本集中治療医学会雑誌 ( (一社)日本集中治療医学会 ) 29 ( Suppl.1 ) 611 - 611 2022年11月

保健所での入院調整

石川幸司, 上村修二, 水野浩利, 田口裕紀子

日本集中治療医学会雑誌 ( (一社)日本集中治療医学会 ) 29 ( Suppl.1 ) 410 - 410 2022年11月

HFNCによる呼吸管理の有用性人工呼吸管理前HFNC期間は重症COVID-19の予後予測因子である

宮下龍, 文屋尚史, 中山龍一, 柿崎隆一郎, 沢本圭悟, 原田敬介, 上村修二, 成松英智

日本集中治療医学会雑誌 ( (一社)日本集中治療医学会 ) 29 ( Suppl.1 ) 288 - 288 2022年11月

札幌市における救急搬送となった運動競技中のアキレス腱損傷の実際調査

萩原詢哉, 上村修二, 青柳有沙, 中山龍一, 成松英智

日本救急医学会雑誌 ( (一社)日本救急医学会 ) 33 ( 10 ) 854 - 854 2022年10月

札幌市における雪下ろし作業関連外傷についての検討

青柳有沙, 上村修二, 中山龍一, 萩原詢哉, 成松英智

日本救急医学会雑誌 ( (一社)日本救急医学会 ) 33 ( 10 ) 784 - 784 2022年10月

Dexmedetomidine improves excessive extracellular glutamate-induced synaptic depression (BRAINRES-D-21-00941)

Eichi Narimatsu, Ryuichiro Kakizaki, Kazuhito Nomura, Keigo Sawamoto, Kazunobu Takahashi, Shuji Uemura, Masanori Ishiguro

BRAIN RESEARCH ( ELSEVIER ) 1789 2022年08月

We investigated the effects of dexmedetomidine, a selective alpha 2-adrenergic agonist and a sedative, on excessive glutamate-induced depressions of central excitatory synaptic transmissions in vitro. From the CA1 in rat hippocampal slices, orthodromically elicited population spikes (PSs) and field excitatory postsynaptic potentials (fEPSPs) at 0.1 Hz were simultaneously recorded. ANOVA was used for statistics, and p < 0.05 was accepted as significant. Glutamate (10 mM for 10 min) completely depressed PSs and fEPSPs, which were partially recovered by the following washout for 40 min (57.4 & PLUSMN; 10.2% and 59.9 & PLUSMN; 9.8% of the control, respectively, p < 0.01, n = 6). The recoveries in PSs and fEPSPs were improved by pre-treatment and simultaneous treatment with dexmedetomidine (p < 0.01, n = 6) but were not altered by post-treatment. Dexmedetomidine alone did not alter PSs and fEPSPs. Simultaneous treatment with isoproterenol or dobutamine exacerbated the recoveries in PSs and fEPSPs (p < 0.01, n = 6), but simultaneous treatment with salbutamol, propranolol, phenylephrine or phentramine did not influence the recoveries. Simultaneous treatment with AP5 improved the recoveries in PSs and fEPSPs that were depressed by glutamate alone and by glutamate with dexmedetomidine, isoproterenol or dobutamine (p < 0.01, n = 6). Excessive glutamate depresses glutamatergic excitatory synaptic transmissions by mainly mediating NMDA receptors, and the depressed transmissions are improved by alpha 2-adrenoceptor stimulation but are exacerbated by beta 1-adrenoceptor stimulation. Dexmedetomidine has a protective effect on neuronal dysfunctions induced by excessive glutamate, which is one of the main mechanisms of the secondary damage in the central nervous system.

Disseminated mucormycosis in a patient with severe COVID-19 on venovenous extracorporeal membrane oxygenation: a case report.

Hazuki Ito, Ryuichiro Kakizaki, Keisuke Harada, Daisuke Kyuno, Terufumi Kubo, Naofumi Bunya, Takehiko Kasai, Shuji Uemura, Eichi Narimatsu

IDCases e01578 2022年07月 [国際誌]

Background: Since the global outbreak of coronavirus disease 2019 (COVID-19), there have been several reports of mucormycosis as a secondary complication. However, the disseminated type of mucormycosis is extremely rare. Case: A 58-year-old male patient with COVID-19 started receiving venovenous extracorporeal membrane oxygenation because of severe respiratory failure. During hospitalization, intra-abdominal hemorrhage occurred and an emergency laparotomy was performed. Subsequently, the patient suffered septic shock, and part of the small intestines and the abdominal wall became necrotic. Finally, the patient died. At autopsy, he was diagnosed with disseminated mucormycosis. Conclusion: Disseminated mucormycosis should be considered in patients with COVID-19 with refractory sepsis unresponsive to broad-spectrum antimicrobial therapy.

勇の探求:2020東京オリンピック・パラリンピック開催時の救急医療の実際オリンピック・マラソン競技医療救護の経験から得たレガシー

上村修二, 沢本圭悟, 田口裕紀子, 大西昌亮

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 ) 25 ( 2 ) 264 - 264 2022年05月

Pneumomediastinum as patient self-inflicted lung injury in patients with acute respiratory distress syndrome due to COVID-19: a case series.

Rika Watanabe, Ryuichi Nakayama, Naofumi Bunya, Naoya Yama, Yusuke Iwamoto, Yoichi Katayama, Takehiko Kasai, Keigo Sawamoto, Shuji Uemura, Eichi Narimatsu

Acute medicine & surgery 9 ( 1 ) e796 2022年 [国際誌]

BACKGROUND: In patients with coronavirus disease (COVID-19) due to severe acute respiratory syndrome coronavirus 2 infection, pneumomediastinum has been increasingly reported in cases of noninvasive oxygen therapy, including high-flow nasal cannula, and invasive mechanical ventilation. However, its pathogenesis is still not understood. CASE PRESENTATION: We report two cases of pneumomediastinum in acute respiratory distress syndrome (ARDS) caused by COVID-19. In both cases, control of spontaneous breathing with neuromuscular blocking agents resulted in resolution of pneumoperitoneum. CONCLUSION: The improvement of pneumomediastinum with control of spontaneous breathing suggested patient self-inflicted lung injury as a possible mechanism in this case series. In ARDS cases with pneumomediastinum, in addition to controlling plateau pressure with conventional lung protective ventilation, spontaneous breathing should be controlled if the patient's inspiratory effort is suspected to be strong.

【禍難を乗り越えて】COVID-19の病態を医学する COVID-19死亡原因の疫学とその特徴について J-RECOVER中間解析結果より

文屋尚史, 中山龍一, 上村修二, 成松英智, 早川峰司, 田上隆

日本救急医学会雑誌 ( (一社)日本救急医学会 ) 32 ( 12 ) 1065 - 1065 2021年11月

コロナ禍における救急対応と今後の課題-臨床現場と保健所の協働による挑戦- 臨床と保健所が手をつないだ札幌の医療提供体制の確保

水野浩利, 石川幸司, 田口裕紀子, 上村修二, 成松英智

日本救急看護学会雑誌 ( (一社)日本救急看護学会 ) 23 ( Suppl. ) [SY2 - 04] 2021年10月

内因性脳梗塞が先行した外傷症例に対し急性期再灌流療法を施行した1例

青柳有沙, 宮田圭, 山岡歩, 葛西毅彦, 上村修二, 成松英智

日本救急医学会雑誌 ( (一社)日本救急医学会 ) 32 ( 6 ) 314 - 319 2021年06月

標準的な外傷診療では生理学的機能の管理および安定化を重視しており,神経学的所見は見逃されやすい。内因性脳梗塞が先行した外傷症例の診療について検討した。症例は78歳の男性,階段2階の踊り場から転落した。右共同偏視,右片麻痺,Glasgow coma scale(GCS) 12の意識障害を認めた。外傷全身computed tomography(CT)で頭蓋内に占拠性病変は認めず,動脈優位相で左中大脳動脈の造影欠損を認めた。急性期脳梗塞と診断し,機械的血栓回収療法を行った。外傷機転を介在する内因性脳梗塞では,見逃しや治療介入に時間を要する可能性がある。病院前脳卒中スケールが症状検出に役立つ可能性があり,頭頂部の動脈優位相を含む造影CT検査で主幹動脈閉塞の検索が可能である。画像評価には熟練を要するため,3次元画像処理を行うとともに,適切に専門医へコンサルトし早期診断治療へつなげることが重要である。(著者抄録)

Successful diagnosis and treatment of pulmonary aspergillosis-related malignant catatonia using propofol and quetiapine: A case report.

Kazuhito Nomura, Sonoko Sakawaki, Eiji Sakawaki, Ayumu Yamaoka, Wakiko Aisaka, Hiroyuki Okamoto, Yoshihiro Takeyama, Shuji Uemura, Eichi Narimatsu

Medicine 100 ( 19 ) e25967 2021年05月 [国際誌]

INTRODUCTION: Malignant catatonia (MC) is a movement disorder syndrome characterized by immobility, rigidity, and consciousness disorders that develops in association with mental and physical diseases. It is often fatal due to hyperthermia, rhabdomyolysis, and acute kidney injury. Its clinical symptoms are similar to those of another disorder, neuroleptic malignant syndrome (NMS), and it is often difficult to distinguish between the 2 disorders. PATIENT CONCERNS: An Asian woman in her 60s with history of schizophrenia. She was admitted to our hospital because of symptoms such as fever, unconsciousness, and muscle rigidity. Blood tests showed kidney injury and high creatinine kinase levels. DIAGNOSES: At the time of admission, she had been diagnosed with NMS complicated by pulmonary aspergillosis and was undergoing treatment although there was no improvement. INTERVENTIONS: Subsequently, the administration of propofol, a gamma-aminobutyric acid A agonist, markedly improved the symptoms, and the diagnosis was corrected to MC. At the beginning of her hospitalization, she received dantrolene, bromocriptine, amantadine, and L-3,4-dihydroxyphenylalanine as treatment for NMS, but her symptoms did not improve. With propofol, which is used for sedation, her catatonic symptoms improved markedly. Quetiapine administration further improved the symptoms, and it eventually resolved completely. OUTCOMES: The patient's MC was in remission. Prolonged intensive care management resulted in a decline in activities of daily living, and she required rehabilitation at another hospital. CONCLUSION: This is the first report of MC with suspected involvement of pulmonary aspergillosis. MC differs from NMS, in that it is treated more effectively with gamma-aminobutyric acid A agonists. Although benzodiazepines are the first choice for the diagnosis and treatment of MC, they are ineffective for majority of patients with schizophrenia. However, even in such cases, propofol and quetiapine are effective, and they facilitate diagnosis and treatment.

Pathophysiologic Mechanisms of Hypothermia-Induced Pancreatic Injury in a Rat Model of Body Surface Cooling

Hiroyuki Inoue, Keisuke Harada, Eichi Narimatsu, Shuji Uemura, Wakiko Aisaka, Naofumi Bunya, Kazuhito Nomura, Yoichi Katayama

Pancreas ( NLM (Medline) ) 50 ( 2 ) 235 - 242 2021年02月

OBJECTIVE: The mechanisms underlying hypothermia-induced pancreatic injury are unclear. Thus, we investigated the pathophysiology of hypothermia-induced pancreatic injury. METHODS: We created a normal circulatory model with body surface cooling in rats. We divided the rats into control (36°C-38°C), mild hypothermia (33°C-35°C), moderate hypothermia (30°C-32°C), and severe hypothermia (27°C-29°C) (n = 5 per group) groups. Then, we induced circulatory failure with a cooling model using high-dose inhalation anesthesia and divided the rats into control (36°C-38°C) and severe hypothermia (27°C-29°C) (n = 5 per group) groups. Serum samples were collected before the introduction of hypothermia. Serum and pancreatic tissue were collected after maintaining the target body temperature for 1 hour. RESULTS: Hematoxylin and eosin staining of the pancreas revealed vacuoles and edema in the hypothermia group. Serum amylase (P = 0.056), lactic acid (P < 0.05), interleukin 1β (P < 0.05), interleukin 6 (P < 0.05), and tumor necrosis factor α (P = 0.13) levels were suppressed by hypothermia. The circulatory failure model exhibited pancreatic injury. CONCLUSIONS: Hypothermia induced bilateral effects on the pancreas. Morphologically, hypothermia induced pancreatic injury based on characteristic pathology typified by vacuoles. Serologically, hypothermia induced protective effects on the pancreas by suppressing amylase and inflammatory cytokine levels.

Non-surgical treatment of tetanus infection associated with breast cancer skin ulcer: a case report and literature review.

Kazuhito Nomura, Eiji Sakawaki, Sonoko Sakawaki, Ayumu Yamaoka, Wakiko Aisaka, Hiroyuki Okamoto, Yoshihiro Takeyama, Shuji Uemura, Eichi Narimatsu

BMC infectious diseases 21 ( 1 ) 37 - 37 2021年01月 [国際誌]

BACKGROUND: Previous studies have reported poor prognosis in cases of tetanus that develops after bacteria enters via breast cancer-related skin ulcers that are not treated with surgical debridement. Herein, we review the literature concerning this presentation and report the first case of complete remission from tetanus without surgical debridement of the skin ulcer. CASE PRESENTATION: An Asian woman aged over 60 years had a history of skin ulcer caused by breast cancer. She was diagnosed with tetanus due to trismus and opisthotonus. Based on the suspicion that the skin ulcer was the portal of entry for tetanus bacteria, we considered several debridement and thoracic surgical options for tetanus treatment. However, debridement was not performed as the surgery was considered high risk and the patient did not consent to it. The patient received treatment with anti-tetanus globulin and metronidazole; sound insulation and shielding were also performed in a dark room. Subsequently, the patient's symptoms improved, and sound insulation and deep sedation management were completed on 19th day of hospitalization. With no symptom recurrence, the patient was discharged on Day 54. To date, over 3 years after treatment, no evidence of tetanus recurrence has been observed. The case was characterized by a lack of autonomic hyperactivity. The tetanus severity was likely representative of the low amount of toxin that the patient was exposed to. CONCLUSION: This case involved moderate severity tetanus originating from a chronic skin ulcer related to breast cancer. The patient survived without undergoing extensive debridement. No evidence of tetanus relapse was observed during the follow-up period, likely due to vaccination that might have restored the patient's active immunity. Debridement is not always necessary for tetanus complicated by breast cancer skin ulcers. Furthermore, appropriate toxoid vaccination is critical for preventing the onset and recurrence of tetanus in these patients.

Gasping during refractory out-of-hospital cardiac arrest is a prognostic marker for favourable neurological outcome following extracorporeal cardiopulmonary resuscitation: a retrospective study

Naofumi Bunya, Hirofumi Ohnishi, Kenshiro Wada, Ryuichiro Kakizaki, Takehiko Kasai, Nobutaka Nagano, Nobuaki Kokubu, Kei Miyata, Shuji Uemura, Keisuke Harada, Eichi Narimatsu

Annals of Intensive Care ( Springer ) 10 ( 1 ) 2020年12月

Background: Gasping during cardiac arrest is associated with favourable neurological outcomes for out-of-hospital cardiac arrest. Moreover, while extracorporeal cardiopulmonary resuscitation (ECPR) performed for refractory cardiac arrest can improve outcomes, factors for favourable neurological outcomes remain unknown. This study aimed to examine whether gasping during cardiac arrest resuscitation during transport by emergency medical services (EMS) was independently associated with a favourable neurological outcome for patients who underwent ECPR. This retrospective study was based on medical records of all adult patients who underwent ECPR due to refractory cardiac arrest. The primary endpoint was neurologically intact survival at discharge. The study was undertaken at Sapporo Medical University Hospital, a tertiary care centre approved by the Ministry of Health, Labour and Welfare, located in the city of Sapporo, Japan, between January 2012 and December 2018. Results: Overall, 166 patients who underwent ECPR were included. During transportation by EMS, 38 patients exhibited gasping, and 128 patients did not. Twenty patients who exhibited gasping during EMS transportation achieved a favourable neurological outcome (20/38 52.6%) 14 patients who did not exhibit gasping achieved a favourable neurological outcome (14/128 10.9%). Gasping during transportation by EMS was independently associated with favourable neurological outcome irrespective of the type of analysis performed (multiple logistic regression analysis, odds ratio [OR] 9.52 inverse probability of treatment weighting using propensity score, OR 9.14). Conclusions: The presence of gasping during transportation by EMS was independently associated with a favourable neurological outcome in patients who underwent ECPR. The association of gasping with a favourable neurological outcome in patients with refractory cardiac arrest suggests that ECPR may be considered in such patients.

Mechanism of central hypopnoea induced by organic phosphorus poisoning

Kazuhito Nomura, Eichi Narimatsu, Hiroyuki Inoue, Ryoko Kyan, Keigo Sawamoto, Shuji Uemura, Ryuichiro Kakizaki, Keisuke Harada

Scientific Reports ( Springer Science and Business Media LLC ) 10 ( 1 ) 2020年12月

Abstract Whether central apnoea or hypopnoea can be induced by organophosphorus poisoning remains unknown to date. By using the acute brainstem slice method and multi-electrode array system, we established a paraoxon (a typical acetylcholinesterase inhibitor) poisoning model to investigate the time-dependent changes in respiratory burst amplitudes of the pre-Bötzinger complex (respiratory rhythm generator). We then determined whether pralidoxime or atropine, which are antidotes of paraoxon, could counteract the effects of paraoxon. Herein, we showed that paraoxon significantly decreased the respiratory burst amplitude of the pre-Bötzinger complex (p < 0.05). Moreover, pralidoxime and atropine could suppress the decrease in amplitude by paraoxon (p < 0.05). Paraoxon directly impaired the pre-Bötzinger complex, and the findings implied that this impairment caused central apnoea or hypopnoea. Pralidoxime and atropine could therapeutically attenuate the impairment. This study is the first to prove the usefulness of the multi-electrode array method for electrophysiological and toxicological studies in the mammalian brainstem.

細胞外液補充液製剤の長期加温保管による成分変化の検討

村中沙織, 田口裕紀子, 稲村広敏, 上村修二, 水野浩利, 沢本圭悟, 成松英智

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 ) 23 ( 3 ) 486 - 486 2020年08月

Veno-venous extracorporeal membrane oxygenation and prone ventilation for therapeutic management of COVID-19.

Takehiko Kasai, Naofumi Bunya, Kenshiro Wada, Ryuichiro Kakizaki, Hirotoshi Mizuno, Hiroyuki Inoue, Shuji Uemura, Satoshi Takahashi, Eichi Narimatsu, Shinhiro Takeda

Acute medicine & surgery 7 ( 1 ) e546 2020年 [国際誌]

BACKGROUND: The efficacy and safety of the combined use of veno-venous extracorporeal membrane oxygenation (ECMO) and prone ventilation are currently not known for coronavirus disease 2019 (COVID-19). CASE PRESENTATION: We report two cases in which the combination of veno-venous ECMO and prone ventilation for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia were successfully carried out. Both patients had developed severe respiratory failure due to SARS-CoV-2 pneumonia, thus requiring veno-venous ECMO. Prone ventilation was also administered safely. CONCLUSION: Oxygenation and lung compliance gradually improved during prone ventilation, and both patients were successfully extubated. For patients with severe SARS-CoV-2 pneumonia who require veno-venous ECMO, the use of prone ventilation could be beneficial, and should be considered.

平成30年北海道胆振東部地震におけるDMATの船舶を用いた出動に関する検討

村中沙織, 田口裕紀子, 水野浩利, 上村修二, 稲村広敏, 沢本圭悟, 新山紗千, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 24 ( 3 ) 305 - 305 2019年12月

平成30年北海道胆振東部地震における当院の災害対応の課題

新山紗千, 田口裕紀子, 村中沙織, 上村修二, 水野浩利, 稲村広敏, 沢本圭悟

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 24 ( 3 ) 305 - 305 2019年12月

救命救急センターにおける医師事務作業補助者の活用と効果

井上弘行, 上村修二, 小出梨紗, 舘祐希, 喜屋武玲子, 文屋尚史, 片山洋一, 葛西毅彦, 成松英智

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 ) 22 ( 6 ) 761 - 767 2019年12月

目的:医師の業務負担軽減のため、当センターでは2016年に医師事務作業補助者(以下、DC)の業務内容を見直し、病棟庶務から本来業務に変更(以下、業務改革)した。2018年度からはDCを増員し2名体制としたため、それらの効果を検討した。方法:改革前、改革後、DC増員後それぞれの、DCによる各種文書の代行作成数、文書遅滞によるクレーム数、オーダー代行数、各種記録数、症例登録入力数、および医師の残業時間、患者受入応需率、医師満足度などを調査した。結果:業務改革によってDCによるすべての文書作成と記録の件数は増加した。多くの業務がDCに移行され、患者受入応需率は6.7%増加、医師の残業時間は14%減少し、医師の満足度は100%であった。結論:業務改革により医師の負担は軽減し、診療にエフォートをシフトし得た。また、業務が効率化され、生産性と医療の質を上げた。救急医の働き方改革の鍵はDCの活用にある。(著者抄録)

Elderly-onset acute necrotizing encephalopathy mimicking severe heat stroke: a case report and review of the literature.

Arisa Odagiri, Ayumu Yamaoka, Kei Miyata, Naofumi Bunya, Takehiko Kasai, Yoshihiro Takeyama, Shuji Uemura, Takeshi Mikami, Eichi Narimatsu

Acute medicine & surgery 6 ( 3 ) 316 - 320 2019年07月 [国際誌]

Background: Acute necrotizing encephalopathy (ANE), known as influenza-associated encephalitis, typically affects children. Case presentation: A 70-year-old woman was admitted to the hospital with altered consciousness, a high temperature, and severe hypotension. Computed tomography (CT) of the head showed no abnormalities; thus, a diagnosis of suspected severe heat stroke was made. On day 2, repeated head CT revealed bilateral symmetrical lesions to the thalamus, and a rapid influenza antigen test was positive. Based on the CT findings and the medical history of influenza, a differential diagnosis of ANE was made. Subsequently, brain edema spread across the whole brain, and the patient died on day 21. Conclusion: In elderly patients, differentiating ANE from severe heat stroke in a high-temperature environment is difficult because of the similarities in clinical symptoms due to multiple organ failure.

The prognostic value of agonal respiration in refractory cardiac arrest: a case series of non-shockable cardiac arrest successfully resuscitated through extracorporeal cardiopulmonary resuscitation.

Naofumi Bunya, Kenshiro Wada, Ayumu Yamaoka, Ryuichiro Kakizaki, Yoichi Katayama, Takehiko Kasai, Ryoko Kyan, Naoto Murakami, Nobuaki Kokubu, Shuji Uemura, Eichi Narimatsu

Acute medicine & surgery 6 ( 2 ) 197 - 200 2019年04月 [査読有り] [国際誌]

BACKGROUND: Agonal respiration following out-of-hospital cardiac arrest is associated with favorable neurological outcomes. Resuscitation using extracorporeal membrane oxygenation could contribute to achieving favorable neurological outcomes in patients with refractory cardiac arrest. CASE PRESENTATION: We report two cases of refractory cardiac arrest with non-shockable rhythms and agonal respiration; both patients were successfully resuscitated through extracorporeal cardiopulmonary resuscitation (ECPR). Both patients were breathing spontaneously upon arrival. One patient was asystolic and the other experienced pulseless electrical activity followed by ventricular fibrillation. Agonal respiration was observed in both and ECPR was implemented, leading to a favorable neurological outcome at discharge. CONCLUSION: The presence of agonal respiration has the potential to confer a favorable neurological outcome in patients with refractory cardiac arrest if maintained, even when the initial cardiac rhythm is not shockable. In these cases, resuscitation should not be abandoned, and ECPR should be considered.

大規模停電に対応した札幌医療圏DMAT活動拠点本部の活動報告(北海道胆振東部地震)

水野浩利, 窪田生美, 沢本圭悟, 田口裕紀子, 村中沙織, 上村修二, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 335 - 335 2019年02月

北海道マラソンにおける各救護地点のWBGTと熱中症発生数との関連

田口裕紀子, 沢本圭悟, 上村修二, 水野浩利, 稲村広敏, 村中沙織, 鈴木靖, 成松英智, 北海道救急医学会北海道マラソン準備委員会

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 449 - 449 2019年02月

医療系学生に対する災害医療実習の有効性について

瀬上朋宏, 上村修二, 水野浩利, 沢本圭悟, 田口裕紀子, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 460 - 460 2019年02月

北海道マラソンにおける運動誘発性熱中症の診断率・給水率と競技復帰後転帰の関係

沢本圭悟, 上村修二, 水野浩利, 田口裕紀子, 稲村広敏, 鈴木靖, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 409 - 409 2019年02月

DMAT1.5日隊員の技能維持に養成研修のタスク参加は有効か

村中沙織, 水野浩利, 瀬上朋宏, 稲村広敏, 上村修二, 沢本圭悟, 田口裕紀子, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 468 - 468 2019年02月

「災害医学・医療への先端技術の活用」本部活動クロノロジーのテキストマイニング解析結果は災害医療活動に利用可能か?

上村修二, 稲村広敏, 沢本圭悟, 窪田生美, 田口裕紀子, 村中沙織, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 292 - 292 2019年02月

「災害時の航空機運用」受け入れSCUでのドライブスルー方式による患者搬送方法の検討

上村修二, 沢本圭悟, 水野浩利, 瀬上朋宏, 稲村広敏, 田口裕紀子, 村中沙織, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 3 ) 317 - 317 2019年02月

Successful resuscitation for cardiac arrest due to severe accidental hypothermia accompanied by mandibular rigidity: A case of cold stiffening mimicking rigor mortis

Naofumi Bunya, Keigo Sawamoto, Ryuichiro Kakizaki, Kenshiro Wada, Yoichi Katayama, Hirotoshi Mizuno, Hiroyuki Inoue, Shuji Uemura, Keisuke Harada, Eichi Narimatsu

International Journal of Emergency Medicine ( BioMed Central Ltd. ) 11 ( 1 ) 2018年11月

Background: In cases of severe accidental hypothermia, it was recommended that resuscitation should be continued until the patient has rewarmed, as hypothermia itself can preserve cerebral function, and hypothermic cardiac arrest is reversible. During cardiopulmonary resuscitation for normothermic patients, muscle rigidity suggests the initiation of postmortem changes such as rigor mortis and can lead to the termination of resuscitation. Currently, the prognosis of cardiac arrest due to severe accidental hypothermia accompanied by rigidity is unknown. Case presentation: A 29-year-old woman was found unresponsive near a snowy mountain trail. Upon discovery, she was found to be in cardiac arrest with an initial asystole rhythm and exhibited mandibular rigidity. On admission, her core temperature was 22 °C. Although cardiac arrest continued, and she showed no response to normal resuscitation, blood gas analysis revealed that her initial serum potassium level was 5.4 mmol/L. Extracorporeal membrane oxygenation (ECMO) for systemic perfusion and rewarming was initiated. After ECMO was introduced, return of spontaneous circulation was achieved. She showed no neurological impairments at discharge. Conclusions: Muscle rigidity does not rule out the possibility of resuscitation in patients with severe accidental hypothermia under cardiac arrest. Serum potassium levels may assist in deciding whether ECMO should be introduced, even if a patient is in asystole. This knowledge may help emergency physicians to save the lives of such patients.

長距離トライアスロンレースの救護体制についてアイアンマン・ジャパン北海道3年間の経験

上村修二, 沢本圭悟, 田口裕紀子, 水野浩利, 稲村広敏, 宮田圭, 成松英智

Japanese Journal of Disaster Medicine ( (一社)日本災害医学会 ) 23 ( 1 ) 38 - 44 2018年09月

IRONMANレースはスイム3.8km、バイク180.2km、ラン42.2kmのロングディスタンスのトライアスロン競技であり、2013年から2015年まで北海道で開催され、我々は3年間救護体制に関わった。救護範囲が広く、レース時間が長いため救護体制の構築に難渋した。救護率(救護対応数/参加者)は6.6〜8.9%と高く、ゴール後の脱水症や低体温症への対応が最も多かったが、スイムでは心停止や肺水腫、バイクでは転倒による外傷や低体温と各種目に応じた医療活動が必要であった。レース中の医療本部の役割は、救護班への指示や連絡、傷病者の治療方針の決定、地元医療機関への受け入れや地元消防への搬送の依頼、大会本部内での連絡と調整などがあり、その役割は大きかった。ロングディスタンスのトライアスロン競技の救護では全体を統括する医療本部と3種目の特性に応じた救護体制の構築が重要であった。(著者抄録)

寒冷地での病院前輸液保温管理の実態調査

上村修二, 吉田有法, 水野浩利, 沢本圭悟, 稲村広敏, 田口裕紀子, 村中沙織, 春名純平, 成松英智

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 ) 21 ( 2 ) 278 - 278 2018年04月

北海道マラソン2017におけるコース上のWBGTと熱中症発生の関連

田口裕紀子, 上村修二, 沢本圭悟, 水野浩利, 稲村広敏, 村中沙織, 春名純平, 鈴木靖, 成松英智, 北海道救急医学会北海道マラソン準備委員会

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 ) 21 ( 2 ) 356 - 356 2018年04月

Risk factors for acute pancreatitis in patients with accidental hypothermia

Hiroyuki Inoue, Shuji Uemura, Keisuke Harada, Hirotoshi Mizuno, Naofumi Bunya, Kazuhito Nomura, Ryuichiro Kakizaki, Eichi Narimatsu

American Journal of Emergency Medicine ( W.B. Saunders ) 2018年 [査読有り]

Background: Pancreatic damage is commonly observed as a consequence of accidental hypothermia (core body temperature below 35 °C). We aimed to investigate the risk factors for pancreatic damage and the causal relationship in patients with accidental hypothermia. Methods: This retrospective, single-center, observational case-control study was conducted in the emergency department of a tertiary care medical center. We investigated patients who were admitted for accidental hypothermia over a course of ten years (January 2008 to December 2017). Results: Of the 138 enrolled patients, 70 had elevated serum amylase levels (51%). We observed a correlation between initial core body temperature and serum amylase level (Spearman's rank correlation coefficient −0.302, p < 0.001). Patients who developed acute pancreatitis had a significantly lower initial core body temperature than those who did not develop it (odds ratio = 0.76 95% confidence interval [CI] = 0.61–0.94 p = 0.011). Receiver operating characteristic analysis showed that a body temperature lower than 28.5 °C at the time of visit was predictive of acute pancreatitis (area under the curve = 0.71, 95% CI = 0.54–0.88, sensitivity = 0.67, specificity = 0.69, p = 0.017). Conclusions: We concluded that an initial core body temperature lower than 28.5 °C was a risk factor for acute pancreatitis in accidental hypothermia cases. In such situations, careful follow-up is necessary.

重症急性心原性肺水腫に対する救急外来からの非侵襲的換気法(NIV)導入効果の検討

葛西毅彦, 武山佳洋, 平山傑, 坂脇園子, 坂脇英志, 小黒武雄, 北村裕之, 笹岡悠太, 野田昇宏, 山岡歩, 山口智佳, 上村修二, 成松英智

函館医学誌 ( 市立函館病院 ) 41 ( 1 ) 6 - 9 2017年10月

当センターに救急搬送された重症急性心原性肺水腫125例を対象に、救急外来における非侵襲的換気法(NIV)導入の効果について検討した。NIV非導入群54例とNIV導入群71例で比較したところ、患者背景に有意差は認めなかったが、救急外来での気管挿管率はNIV導入群で有意な減少を認めた。NIV使用の気管挿管回避率はNNT(number needed to treat):6.9であった。次に治療法により標準的酸素治療(ST群)92例、NIV群20例、気管挿管(TI)群13例に分け比較すると、入院時の二酸化炭素分圧濃度はNIV群で有意に高かった。HCU、ICU滞在期間はTI群が他の2群より有意に長かったが、7日後の死亡率、病院内死亡率については3群間で有意差は認められなかった。

Cardiac arrest caused by sibutramine obtained over the Internet: a case of a young woman without pre-existing cardiovascular disease successfully resuscitated using extracorporeal membrane oxygenation.

Naofumi Bunya, Keigo Sawamoto, Shuji Uemura, Ryoko Kyan, Hiroyuki Inoue, Junichi Nishida, Hidemichi Kouzu, Nobuaki Kokubu, Tetsuji Miura, Eichi Narimatsu

Acute medicine & surgery 4 ( 3 ) 334 - 337 2017年07月 [国際誌]

Case: Sibutramine is a weight loss agent that was withdrawn from the market in the USA and European Union because it increases adverse events in patients with cardiovascular diseases. However, non-prescription weight loss pills containing sibutramine can be still easily purchased over the Internet. A 21-year-old woman without history of cardiovascular diseases developed cardiac arrest. She was a user of a weight loss pills, containing sibutramine and hypokalemia-inducing agents, imported from Thailand over the Internet. Outcome: She was successfully resuscitated without any neurological deficits by using extracorporeal membrane oxygenation for refractory ventricular fibrillation. Conclusion: This case indicates that sibutramine can cause cardiac arrest even in subjects without pre-existing cardiovascular disease when combined with agents that promote QT prolongation.

多発肋骨骨折による陽圧呼吸管理開始のIndication

平山傑, 豊原隆, 山岡歩, 沢本圭悟, 上村修二, 葛西毅彦, 坂脇英志, 武山佳洋, 成松英智

日本外傷学会雑誌 ( (一社)日本外傷学会 ) 31 ( 2 ) 322 - 322 2017年05月

Cerebral air embolism associated with penetrating lung injury: a case report and review of the literature.

Ayumu Yamaoka, Kei Miyata, Eichi Narimatsu, Eiji Sakawaki, Sonoko Sakawaki, Suguru Hirayama, Shuji Uemura, Naoya Yama

Acute medicine & surgery 4 ( 2 ) 213 - 216 2017年04月 [国際誌]

CASE: A 44-year-old man intentionally stabbed himself in the anterior neck and left thorax with a fruit knife. Physical examination revealed two open wounds entering the thoracic cavity in the front chest, and a stab wound entering the trachea at the neck. Two chest tubes were initially inserted for the left lung injury with open hemopneumothorax. Nevertheless, the worsening oxygenation required positive pressure ventilation (PPV) with endotracheal intubation. OUTCOME: Right hemiparesis was found during weaning from PPV. Magnetic resonance imaging revealed multiple infarctions in the area of the bifrontal and right temporal lobes. Cerebral air embolism (CAE) was strongly suspected from the imaging findings and clinical course. CONCLUSION: We concluded that mechanical ventilation was strongly involved in the occurrence of CAE. If delayed abnormal neurological findings are observed in patients with penetrating lung injuries receiving PPV management, CAE should be considered.

悪性症候群治療中に投与したプロポフォールの効果から、カタトニア症候群の関与が疑われた一例

野村和史, 山岡歩, 相坂和貴子, 坂脇英志, 坂脇園子, 岡本博之, 武山佳洋, 上村修二, 成松英智

日本集中治療医学会雑誌 ( (一社)日本集中治療医学会 ) 24 ( Suppl. ) DP133 - 5 2017年02月

シートベルト着用は自動車同乗者の頭部および顔面外傷を予防する

山岡歩, 宮田圭, 葛西毅彦, 平山傑, 武山佳洋, 上村修二, 入船秀仁, 原田敬介, 成松英智

日本脳神経外傷学会プログラム・抄録集 ( (一社)日本脳神経外傷学会 ) 40回 140 - 140 2017年02月

Adaptive Cross-Resistance to Aminoglycoside Antibiotics in Pseudomonas aeruginosa Induced by Topical Dosage of Neomycin

Shuji Uemura, Shin-ichi Yokota, Tsukasa Shiraishi, Manabu Kitagawa, Suguru Hirayama, Ryoko Kyan, Hirotoshi Mizuno, Keigo Sawamoto, Hiroyuki Inoue, Atsushi Miyamoto, Eichi Narimatsu

CHEMOTHERAPY ( KARGER ) 62 ( 2 ) 121 - 127 2017年 [査読有り]

Background: Topical antimicrobial formulations containing neomycin are commonly used to prevent and treat burn infections. However, Pseudomonas aeruginosa shows rapid acquisition of adaptive resistance to neomycin. This study aimed to evaluate the survival of P. aeruginosa during exposure to neomycin at high concentrations comparable to those used in topical formulations, and to investigate the effect of adaptive resistance to neomycin on the susceptibility to other aminoglycosides. Methods: Strain IID1130 [neomycin minimal inhibitory concentration (MIC) = 4 mu g/ml] was incubated on an agar medium containing neomycin at high concentrations (8-4,096 mu g/ml), and growing colonies were macroscopically observed. Acquisition of adaptive resistance was examined for 5 P. aeruginosa strains. Cells were sequentially passaged on agar medium containing neomycin with step-wise increased concentrations (82,048 mu g/ml). To assess reversion of antibiotic susceptibility, the resulting colonies were repeatedly subcultured on antibiotic-free agar plates. Results: Growing IID1130 colonies were macroscopically detected on a neomycin-containing ( 2,048 mu g/ml) agar plate for 48 h. These cells showed increasing MIC for not only neomycin, but also gentamicin and amikacin; the MIC values were occasionally higher than the breakpoints. When the adapted cells were subcultured on antibiotic-free agar, several passages were required for reversion of susceptibility. Conclusions: Our findings suggest that P. aeruginosa can survive in the presence of neomycin with a concentration typically used in topical dosage forms, and that the acquired adaptive resistance is persistent and is accompanied by cross-resistance to other aminoglycosides. (C) 2016 S. Karger AG, Basel

マラソンにおけるMass Gathering Medicine アイアンマン・ジャパン北海道における医療救護体制救護本部の役割について

上村修二, 沢本圭悟, 田口裕紀子, 水野浩利, 宮田圭, 成松英智, 稲村広敏

日本臨床救急医学会雑誌 ( (一社)日本臨床救急医学会 ) 19 ( 2 ) 249 - 249 2016年04月

Therapeutic temperature modulation in severe or moderate traumatic brain injury: a propensity score analysis of data from the Nationwide Japan Neurotrauma Data Bank

Kei Miyata, Hirofumi Ohnishi, Kunihiko Maekawa, Takeshi Mikami, Yukinori Akiyama, Satoshi Iihoshi, Masahiko Wanibuchi, Nobuhiro Mikuni, Shuji Uemura, Katsutoshi Tanno, Eichi Narimatsu, Yasufumi Asai

JOURNAL OF NEUROSURGERY ( AMER ASSOC NEUROLOGICAL SURGEONS ) 124 ( 2 ) 527 - 537 2016年02月 [査読有り]

OBJECTIVE In patients with severe traumatic brain injury (TBI), a randomized controlled trial revealed that outcomes did not significantly improve after therapeutic hypothermia (TH) or normothermia (TN). However, avoiding pyrexia, which is often associated with intracranial disorders, might improve clinical outcomes. The objective of this study was to compare neurological outcomes among patients with moderate and severe TBI after therapeutic temperature modulation (TTM) in the absence of other interventions. METHODS Data from 1091 patients were obtained from the Japan Neurotrauma Data Bank Project 2009, a cohort observational study. Patients with cardiac arrest, those with a Glasgow Coma Scale score of 3 and dilated fixed pupils, and those whose cause of death was injury to another area of the body were excluded, leaving 687 patients aged 16 years or older in this study. The patients were divided into 2 groups: the TTM group underwent TN (213 patients) or TH (82 patients), and the control group (392 patients) did not receive TTM. The primary end point for this study was the rate of poor outcome at hospital discharge, and the secondary end point was in -hospital death. Out of the 208 total items in the database, 29 variables that could potentially affect outcome were matched using the propensity score (PS) method in order to reduce selection bias and balance the baseline characteristics. RESULTS From each group, 141 patients were extracted using the PS -matching process. Among the patients in the TTM group, 29 had undergone TH and 112 had undergone TN. In a log -rank test using Kaplan -Meier survival curves, no significant differences in patient outcome or death were observed between the 2 groups (poor outcome, p = 0.83; death, p = 0.18). A Cox proportional -hazards regression analysis established the HR for poor outcome and mortality at 1.03 (95% CI 0.78-1.36, p = 0.83) and 1.34 (95% CI 0.87-2.07, p = 0.18), respectively. CONCLUSIONS There was no clear improvement in neurological outcomes after TTM in patients with moderate or severe TBI. To elucidate the role of TTM in patients with these injuries, a prospective study is needed with long-term follow-up using specific target temperatures.

下行大動脈損傷予防のために肋骨骨折端を摘除した胸部外傷の１例

上村修二, 宮島正博, 窪田生美, 喜屋武玲子, 平山傑, 井上弘行, 渡辺敦, 成松英智

日本外傷学会雑誌 ( The Japanese Association for the Surgery of Trauma ) 30 ( 1 ) 23 - 26 2016年

症例は19歳女性，交通事故で頭部，顔面挫創，両肺挫傷，両側気胸，両側多発肋骨骨折，肝損傷と腸骨開放骨折を受傷．来院後，気道緊急のため気管挿管施行し人工呼吸管理とした．CTで左第９肋骨骨折端と下行大動脈の距離が12mmと近接しており経過観察としていたが，受傷後５日には４mmと近接したため，胸腔鏡下に肋骨骨折端摘除術を施行した．左下後部肋骨骨折による遅発性の下行大動脈損傷は稀ではあるが発生すると致命的である．本症例は予防的に肋骨骨折端を摘除することにより下行大動脈損傷を予防することができた．

Etiology of Sudden Cardiac Arrest in Patients with Epilepsy: Experience of Tertiary Referral Hospital in Sapporo City, Japan

Kei Miyata, Satoko Ochi, Rei Enatsu, Masahiko Wanibuchi, Nobuhiro Mikuni, Hiroyuki Inoue, Shuji Uemura, Katsuhiko Tanno, Eichi Narimatsu, Kunihiko Maekawa, Keiko Usui, Masahiro Mizobuchi

NEUROLOGIA MEDICO-CHIRURGICA ( JAPAN NEUROSURGICAL SOC ) 56 ( 5 ) 249 - 256 2016年 [査読有り]

It has been reported that epilepsy patients had higher risk of sudden death than that of the general population. However, in Japan, there is very little literature on the observational research conducted on sudden fatal events in epilepsy. We performed a single-center, retrospective study on all the out-of-hospital cardiac arrest (OHCA) patients treated in our emergency department between 2007 and 2013. Among the OHCA patients, we extracted those with a history of epilepsy and then analyzed the characteristics of the fatal events and the background of epilepsy. From 1,823 OHCA patients, a total of 10 cases were enrolled in our study. The median age was 34 years at the time of the incident [9-52 years; interquartile range (IQR), 24-45]. We determined that half of our cases resulted from external causes of death such as drowning and suffocation and the other half were classified as sudden unexpected death in epilepsy (SUDEP). In addition, asphyxia was implicated as the cause in eight cases. Only the two near-drowning patients were immediately resuscitated, but the remaining eight patients died. The median age of first onset of epilepsy was 12 years (0.5-30; IQR, 3-21), and the median disease duration was 25 years (4-38; IQR, 6-32). Patients with active epilepsy accounted for half of our series and they were undergoing poly anti-epileptic drug therapy. The fatal events related to epilepsy tended to occur in the younger adult by external causes. An appropriate therapeutic intervention and a thorough observation were needed for its prevention.

Severe accidental colchicine poisoning by the autumn crocus: A case of successful treatment

Ryoko Kyan, Shuji Uemura, Katsutoshi Tanno, Keigo Sawamoto, Keisuke Harada, Eiji Sakawaki, Yuji Fujita, Shigeatsu Endo, Eichi Narimatsu

Journal of Acute Medicine ( Elsevier ) 5 ( 4 ) 103 - 106 2015年12月 [査読有り]

Background: The common garden plant autumn crocus contains colchicine and its derivatives. Colchicine poisoning causes abdominal cramps and diarrhea within hours. Several days later, multiorgan failure, pancytopenia, and cardiovascular collapse occur.1,2 Severe colchicine poisoning is associated with high mortality. Case report: A 63-year-old woman who accidentally ingested an autumn crocus, which contained ~0.38 mg colchicine, had severe vomiting and was taken to an emergency center. She presented with symptoms of gastroenterocolitis within 1 hour of ingestion, and bone marrow hypoplasia with pancytopenia developed on the 3rd day after ingestion. We continued administration of granulocyte colony-stimulating factor (300 μg) for 5 days until we confirmed that the patient's white blood cell count was increasing. Also, there was focal and segmental intestinal ischemia and some cakes of charcoal remained in the intestinal tract. Therefore, we presumed that nonocclusive mesenteric ischemia was caused by hypotension with severe dehydration, although pseudo-obstruction due to the activated charcoal may have been a contributing factor. We were able to promptly intervene to treat paralytic ileus and gastrointestinal edema before anticipated worsening of abdominal compartment syndrome, by conducting open peritoneal drainage. Despite severe poisoning, our patient survived with intensive care. Conclusion: Colchicine intoxication may lead to a sudden and extreme critical course. Therefore, as there is no means to predict prognosis from initial severity of symptoms at onset, we suggest that all patients suspected of colchicine intoxication should be managed in hospital with continuous vital sign monitoring and frequent laboratory testing for at least a few days after ingestion.

超早期手術と計画的手術により救命した広範囲熱傷の1症例

平山傑, 上村修二, 山岡歩, 喜屋武玲子, 沢本圭悟, 井上弘行, 長谷守, 成松英智

熱傷 ( (一社)日本熱傷学会 ) 41 ( 2 ) 98 - 98 2015年06月

TAKOTSUBO CARDIOMYOPATHY INDUCED BY SUICIDAL NECK HANGING

Keigo Sawamoto, Mamoru Hase, Shuji Uemura, Takehiko Kasai, Eichi Narimatsu

JOURNAL OF EMERGENCY MEDICINE ( ELSEVIER SCIENCE INC ) 48 ( 2 ) E35 - E38 2015年02月 [査読有り]

Background: Takotsubo cardiomyopathy (TC) is an uncommon immune-endocrinologic cause of acute reversible heart failure, generally caused by some form of stress. Case Report: We report a case of TC after hanging for attempted suicide. Upon admission, the patient demonstrated an almost entirely normal electrocardiogram (ECG) and mild hypotension. However, on the third day after hanging, she developed chest and back pain with inverted T waves and QTc prolongation on ECG. Her coronary arteries were normal on angiogram, but the left ventricle showed apical ballooning, consistent with TC. She was treated with an intra-aortic balloon pump and fully recovered. We observed that the QTc interval seemed to be a good guide for clinical course in this case. Why Should an Emergency Physician Be Aware of This?: TC should be considered in any acute stressful presentation, and to assist in the diagnosis as TC, we suggest following the QTc on ECG. TC should be taken into consideration in patients after suicide attempt with low blood pressure or an abnormal ECG, including ST segment elevation, Twave inversion, and QTc prolongation. (C) 2015 Elsevier Inc.

アイアンマン・ジャパン北海道(トライアスロン)における医療救護体制について

上村修二, 丹野克俊, 沢本圭悟, 田口裕紀子, 稲村広敏, 宮田圭, 山岡歩, 成松英智

日本集団災害医学会誌 ( (一社)日本災害医学会 ) 19 ( 3 ) 551 - 551 2014年12月

北海道マラソンにおける救護体制と心停止事例への対応

山岡歩, 宮田圭, 丹野克俊, 窪田生美, 上村修二, 成松英智

日本救急医学会雑誌 ( (一社)日本救急医学会 ) 25 ( 8 ) 542 - 542 2014年08月

Outcome from severe accidental hypothermia with cardiac arrest resuscitated with extracorporeal cardiopulmonary resuscitation

Keigo Sawamoto, Steven B. Bird, Yoichi Katayama, Kunihiko Maekawa, Shuji Uemura, Katsutoshi Tanno, Eichi Narimatsu

AMERICAN JOURNAL OF EMERGENCY MEDICINE ( W B SAUNDERS CO-ELSEVIER INC ) 32 ( 4 ) 320 - 324 2014年04月 [査読有り]

Purpose: This study aimed to identify factors of neurologic prognosis in severe accidental hypothermic patients with cardiac arrest. Basic procedures: This retrospective observational study was performed in a tertiary care university hospital in Sapporo, Japan (January 1994 to December 2012). We investigated 26 patients with accidental hypothermic cardiac arrest resuscitated with extracorporeal cardiopulmonary resuscitation (ECPR). We evaluated the neurologic outcome in patients who were resuscitated with ECPR at discharge from hospital. Main findings: In those 26 patients, their median age was 50.5 years; and 69.2% were male. The cause of hypothermia was exposure to cold air in 46.1%, submersion in 46.1%, and avalanche in 7.8%. Ten (38.5%) of these patients survived to favorable neurological outcome at discharge. Factors associated with favorable neurological outcome were a cardiac rhythm other than asystole (P=.009), nonasphyxial hypothermia (P=.006), higher pH (P =.01), and lower serum lactate (P =.01). In subgroup analyses, the patients with hypothermic cardiac arrest due to submersion or avalanche (asphyxia group) showed no factors associated with good neurological outcome, whereas the nonasphyxia group showed a significantly lower core temperature (P =.02) and a trend towards a lower serum lactate (P =.09). Principal conclusions: Patients with hypothermic cardiac arrest due to nonasphyxial hypothermia have improved neurologic outcomes when treated with ECPR compared to patients with asphyxial hypothermic cardiac arrest. Further investigation is needed to develop a prediction rule for patients with nonasphyxial hypothermic cardiac arrest to determine which patients would benefit from treatment with ECPR. (c) 2014 Elsevier Inc. All rights reserved.

DMATと消防機関とのCSR・CSM合同訓練の経験

田口裕紀子, 春名純平, 平山傑, 坂脇英志, 稲村広敏, 酒井智史, 上村修二, 丹野克俊

日本集団災害医学会誌 ( (一社)日本災害医学会 ) 18 ( 3 ) 403 - 403 2013年12月

救急医療における飲酒の影響

武山佳洋, 岡本博之, 上村修二, 諸原基貴, 葛西毅彦, 俵敏弘, 井上弘行, 松本博志

日本救急医学会雑誌 ( (一社)日本救急医学会 ) 23 ( 10 ) 543 - 543 2012年10月

アルコールと外傷救急医療における飲酒の影響特に外傷との関連について

武山佳洋, 岡本博之, 上村修二, 井上弘行, 松本博志

日本アルコール・薬物医学会雑誌 ( (一社)日本アルコール・アディクション医学会 ) 47 ( 4 ) 88 - 88 2012年08月

Acquisition of a Transposon Encoding Extended-Spectrum beta-Lactamase SHV-12 by Pseudomonas aeruginosa Isolates during the Clinical Course of a Burn Patient

Shuji Uemura, Shin-ichi Yokota, Hirotoshi Mizuno, Eiji Sakawaki, Keigo Sawamoto, Kunihiko Maekawa, Katsutoshi Tanno, Kazuhisa Mori, Yasufumi Asai, Nobuhiro Fujii

ANTIMICROBIAL AGENTS AND CHEMOTHERAPY ( AMER SOC MICROBIOLOGY ) 54 ( 9 ) 3956 - 3959 2010年09月 [査読有り]

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