Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Only a few studies have reported the association between age and mortality in COVID-19 patients who require invasive mechanical ventilation (IMV). We aimed to evaluate the effect of age on COVID-19-related mortality among patients undergoing IMV therapy. METHODS: This cohort study was conducted using the COVID-19 Registry Japan database, a nationwide multi-centre study of hospitalized patients with laboratory-confirmed COVID-19. Of all 33,808 cases registered between 1 January 2020 to 28 February 2021, we analysed 1555 patients who had undergone IMV. We evaluated mortality rates between age groups using multivariable regression analysis after adjusting for known potential components, such as within-hospital clustering, comorbidities, steroid use, medication for COVID-19, and vital signs on admission, using generalized estimation equation. RESULTS: By age group, the mortality rates in the IMV group were 8.6%, 20.7%, 34.9%, 49.7% and 83.3% for patients in their 50s, 60s, 70s, 80s, and 90s, respectively. Multivariable analysis showed that compared with those for patients aged < 60 years, the odds ratios (95% confidence interval) of death were 2.6 (1.6-4.1), 6.9 (4.2-11.3), 13.2 (7.2-24.1), 92.6 (16.7-515.0) for patients in their 60s, 70s, 80s, and 90s, respectively. CONCLUSIONS: In this cohort study, age had a great effect on mortality in COVID-19 patients undergoing IMV, after adjusting for variables independently associated with mortality. This study suggested that age was associated with higher mortality and that preventing progression to severe COVID-19 in elderly patients may be a great public health issue.

File： 13613_2021_Article_959.pdf

DOI： 10.1186/s13613-021-00959-6

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Rebleeding of aneurysmal subarachnoid hemorrhage (aSAH) is one of the significant risk factors for poor clinical outcome. The rebleeding risk is the highest during the acute phase with an approximate rebleeding rate of 9-17% within the first 24 h. Theoretically, general anesthesia can stabilize a patient's vital signs; however, its effectiveness as initial management for preventing post-aSAH rebleeding remains unclear. The purpose of this study was to determine the feasibility and safety of ultra-early general anesthesia induction for reducing the rebleeding rates among patients with aSAH. MATERIALS AND METHODS: We retrospectively evaluated patients with aSAH who were admitted to our department between January 2013 and December 2019. All the patients underwent ultra-early general anesthesia induction as initial management regardless of their severity. We evaluated the rebleeding rate before definitive treatment, factors influencing rebleeding, and general anesthesia complications. RESULTS: We included 191 patients with two-third of them having a poor clinical grade (World Federation of Neurological Society [WFNS] grade IV or V). The median duration from admission to general anesthesia induction was 22 min. Rebleeding before definitive treatment occurred in nine patients (4.7%). There were significant differences in the Glasgow Coma Scale score (p = 0.047), WFNS grade (p = 0.02), and dissecting aneurysm (p <0.001) between the rebleeding and non-rebleeding patients. There were no cases of unsuccessful tracheal intubation or rebleeding during general anesthesia induction. CONCLUSION: Ultra-early general anesthesia induction could be performed safely in patients with aSAH, regardless of the WFNS grade; moreover, it resulted in lower rebleeding rate than that reported in previous epidemiological reports.

File： 金子先生共著.pdf

DOI： 10.1016/j.jstrokecerebrovasdis.2021.105926

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Surgical clipping of an internal carotid artery (ICA)-posterior communicating artery (ICPC) aneurysm is often difficult in cases involving limited space to insert a clip at the proximal aneurysm neck hidden by the tent. In such cases, we perform incision of the anterior petroclinoidal fold to secure the proximal space for clip insertion. Between April 2013 and March 2018, we treated 89 ICPC aneurysm cases by clipping. Incision of the anterior petroclinoidal fold was performed in 15 of the 89 cases (16.8%). Fast imaging employing steady-state acquisition (FIESTA) magnetic resonance imaging (MRI) can indicate the locations of the aneurysm and tent and can help assess the need for tent incision. We widely dissected the distal sylvian fissure and sufficiently exposed around the aneurysmal space. We coagulated and cut the anterior petroclinoidal fold supra between the ICA and proximal neck of the aneurysm using a low-power bipolar system and needles or micro-scissors with care to avoid injury around structures such as the ICA, aneurysm, and oculomotor nerve. When using this strategy, we often select the Yasargil FT717 clip that has a curve along the skull base because of easy insertion. All cases showed complete aneurysm exclusion on three-dimensional computed tomography angiography, and there was no cerebral infarction, neurological deficit (such as hemiparesis), or oculomotor nerve palsy. Therefore, our strategy of incision of the anterior petroclinoidal fold during clipping for securing the proximal space of an ICA aneurysm is effective and safe.

DOI： 10.1007/s10143-019-01121-4

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本集中治療医学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Little is known regarding functional outcome following poor-grade (World Federation of Neurosurgical Societies grades IV and V) aneurysmal subarachnoid hemorrhage (aSAH), especially in individuals treated aggressively in the early phase after ictus. METHODS: We provided patients with aSAH with ultra-early definitive treatment, coiling or clipping, within 6 hours from arrival as per protocol. We classified the patients into 3 groups according to their computed tomography findings: Group 1, intraventricular hemorrhage with obstructive hydrocephalus; Group 2, massive intracerebral hemorrhage with brain herniation; and Group 3, neither Group 1 nor Group 2. We retrospectively evaluated patients with poor-grade aSAH who were admitted to our department between January 2013 and December 2016. We evaluated functional outcome at 6 months, defining modified Rankin Scale (mRS) scores of 0-2 as good and those of 3-6 as poor outcomes. RESULTS: A good functional outcome was observed in 39.4% (28/71) of all cases. All-cause mortality at 6 months was 15.5% (11/71). A good outcome in Group 3 was significantly higher than that in the other two groups (Group 1 and 2 vs. Group 3, 20.8% vs. 48.9%, p = 0.02), even after adjustment with a multiple logistic regression analysis (odds ratio 6.1, 95% confidence interval 1.1 to 34.8). CONCLUSIONS: Approximately 40% of patients with poor-grade aSAH became functionally independent, and approximately half of the patients with poor-grade aSAH who had neither intraventricular hemorrhage with obstructive hydrocephalus nor with brain herniation had good functional outcomes. Although further trials are required to confirm our results, ultra-early surgery may be considered for patients with poor-grade aSAH.

File： 金子先生論文　共著 .pdf

DOI： 10.1272/jnms.JNMS.2019_86-203

PubMed

researchmap

Language：Japanese   Publisher：メディカル・サイエンス・インターナショナル  

CiNii Books

J-GLOBAL

researchmap

Language：Japanese   Publisher：(株)メディカル・サイエンス・インターナショナル  

＜Main points＞急性期脳梗塞に対する治療法が劇的に発展してきているなかで,急性期脳出血の治療法自体には大きな変化がない。テント上脳出血の手術適応については定まった見解がなく,目的(救命もしくは機能予後改善)に基づいた適応決定は各施設に委ねられている。小脳出血に対する血腫除去,脳室内出血,閉塞性水頭症に対する脳室ドレナージ術は確立した方法である。新たな脳出血の治療法として,低侵襲手術の有用性が示唆されている。(著者抄録)

CiNii Books

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER HEIDELBERG  

Background: Previous studies have suggested that antithrombin may be beneficial for treating coagulopathy in patients with severe burns. However, robust evidence for this idea is lacking. We examined the hypothesis that antithrombin may be effective in treating patients with severe burns.
Methods: We performed propensity score-matched analyses of the nationwide administrative Japanese Diagnosis Procedure Combination inpatient database. We identified patients with severe burns (burn index &gt;= 10) who were recorded in the database from 1 July 2010 to 31 March 2013. We compared patients who were administered antithrombin within 2 days of admission (antithrombin group) and those who were not administered antithrombin (control group). The main outcomes were 28-day mortality and ventilator-free days (VFDs).
Results: Eligible patients (n = 3223) from 618 hospitals were categorized into either an antithrombin group (n = 152) or control group (n = 3071). Propensity score matching created a matched cohort of 103 pairs with and without antithrombin. Twenty-eight-day mortality was lower in the antithrombin group compared with the control group in propensity-matched analysis (control vs. antithrombin, 47.6 vs. 33.0%; difference, 14.6%; 95% confidence interval [CI] 1.2-28.0). Cox regression analysis showed a significant difference in 28-day in-hospital mortality between the control and antithrombin propensity-matched groups (hazard ratio 0.58; 95% CI 0.37-0.90). There were significantly more VFDs in the antithrombin compared with the control group in propensity score-matched analysis (control vs. antithrombin, 12.6 vs. 16.4 days; difference -3.7; 95% CI -7.2 to -0.12).
Conclusions: This nationwide database study demonstrated that antithrombin use may improve 28-day survival and increase VFDs in patients with severe burns. Further prospective studies are required to confirm these results.

File： 田上先生論文　共著.pdf

DOI： 10.1186/s13613-017-0244-y

Web of Science

PubMed

researchmap

Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

researchmap

Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

researchmap

Language：Japanese   Publisher：(一社)日本集中治療医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：Japanese   Publisher：(一社)日本外傷学会  

researchmap

Language：Japanese   Publisher：日本救急医学会-関東地方会  

74歳男性。駅前で心肺停止となり、バイスタンダーによる心肺蘇生とAEDによる除細動後に心拍が再開し搬送となった。精査の結果、心肺停止の原疾患は虚血性心疾患と判明したが、冠動脈の石灰化が高度であったため経皮的冠動脈形成術を行なえず、急性期管理として大動脈バルーンパンピング(IABP)を挿入した。蘇生後脳症に対しては低体温療法を施行し、意識は回復した。血行動態も安定したためIABPは第5病日に抜去したが、心不全の合併や不穏のため容易には人工呼吸器から離脱できず、冠動脈バイパス手術を勧めたが家族は希望しなかった。その後も内科的治療を継続したところ、心不全の改善および人工呼吸器離脱と抜管に至り、ADLも回復し、第66病日に自宅退院となった。

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本救急医学会  

researchmap

Language：English   Publisher：(一社)日本救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：東京  

researchmap

Language：Japanese   Presentation type：Poster presentation  

researchmap

Language：Japanese  

researchmap

Language：Japanese   Presentation type：Oral presentation (general)  

researchmap

Language：Japanese   Presentation type：Oral presentation (general)  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese   Presentation type：Poster presentation  

researchmap

Language：Japanese   Presentation type：Oral presentation (general)  

File： スクリーンショット 2024-03-25 12.25.48.png

researchmap

Presentation type：Poster presentation  

researchmap

Presentation type：Oral presentation (invited, special)  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Presentation type：Poster presentation  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese   Presentation type：Oral presentation (general)  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：English  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese   Presentation type：Oral presentation (general)  

researchmap

Language：Japanese  

researchmap

Language：Japanese  

researchmap

Language：Japanese   Presentation type：Poster presentation  

researchmap

Language：Japanese   Presentation type：Oral presentation (general)  

researchmap

Language：Japanese   Presentation type：Oral presentation (general)  

researchmap

Language：Japanese  

74歳男性。駅前で心肺停止となり、バイスタンダーによる心肺蘇生とAEDによる除細動後に心拍が再開し搬送となった。精査の結果、心肺停止の原疾患は虚血性心疾患と判明したが、冠動脈の石灰化が高度であったため経皮的冠動脈形成術を行なえず、急性期管理として大動脈バルーンパンピング(IABP)を挿入した。蘇生後脳症に対しては低体温療法を施行し、意識は回復した。血行動態も安定したためIABPは第5病日に抜去したが、心不全の合併や不穏のため容易には人工呼吸器から離脱できず、冠動脈バイパス手術を勧めたが家族は希望しなかった。その後も内科的治療を継続したところ、心不全の改善および人工呼吸器離脱と抜管に至り、ADLも回復し、第66病日に自宅退院となった。

researchmap

Language：Japanese  

researchmap

Language：Japanese  

File： スクリーンショット 2022-08-06 0.40.43.png

researchmap

Language：Japanese  

researchmap

Language：Japanese   Presentation type：Oral presentation (general)  

researchmap

Language：Japanese  

researchmap

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：東京  

researchmap

Language：English   Presentation type：Poster presentation  

researchmap

Language：English   Presentation type：Poster presentation  

researchmap

Language：Japanese  

researchmap

Language：Japanese   Presentation type：Oral presentation (general)  

researchmap

Language：Japanese  

researchmap

File： スクリーンショット 2024-04-18 9.03.44.png

researchmap

Language：Japanese   Presentation type：Oral presentation (general)  

File： 石井先生抄録.pdf

researchmap