Clinical relevance of impaired consciousness in accidental hypothermia: a Japanese multicenter retrospective study

[Aim] This study aimed to investigate the association between level of impaired consciousness and severe hypothermia (<28°C) and to evaluate the association between level of impaired consciousness and inhospital mortality among accidental hypothermia patients. [Methods] This was a multicenter retrospective study using the J-Point registry database, which includes data regarding patients whose core body temperature was 35.0°C or less and who were treated as accidental hypothermia in emergency departments between April 1, 2011 and March 31, 2016. We estimated adjusted odds ratios of the level of impaired consciousness for severe hypothermia less than 28°C and inhospital mortality using a logistic regression model. [Results] The study included 505 of 572 patients in the J-Point registry. Relative to mildly impaired consciousness (Glasgow Coma Scale [GCS] 13–15), the adjusted odds ratios for severe hypothermia less than 28°C were: moderate (GCS 9–12), 3.26 (95% confidence interval [CI], 1.69–6.25); and severe (GCS < 9), 4.68 (95% CI, 2.40–9.14). Relative to mildly impaired consciousness (GCS 13–15), the adjusted odds ratios for inhospital mortality were: moderate (GCS9–12), 1.65 (95% CI, 0.95–2.88); and severe (GCS < 9), 2.10 (95% CI, 1.17–3.78). [Conclusion] The level of impaired consciousness in patients with accidental hypothermia was associated with severe hypothermia and inhospital mortality

Osborn Wave Is Related to Ventricular Fibrillation and Tachycardia in Hypothermic Patients

Nobunaga Okada, Tasuku Matsuyama, Sachiko Morita, Naoki Ehara, Nobuhiro Miyamae, Yohei Okada, Takaaki Jo, Yasuyuki Sumida, Makoto Watanabe, Masahiro Nozawa, Ayumu Tsuruoka, Yoshihiro Fujimoto, Yoshiki Okumura, Kunio Hamanaka, Tetsuhisa Kitamura, Kei Nishiyama, Bon Ohta, Osborn Wave Is Related to Ventricular Fibrillation and Tachycardia in Hypothermic Patients, Circulation Journal, 2020, Volume 84, Issue 3, Pages 445-455, Released February 25, 2020, [Advance publication] Released January 30, 2020, Online ISSN 1347-4820, Print ISSN 1346-9843, https://doi.org/10.1253/circj.CJ-19-0856, https://www.jstage.jst.go.jp/article/circj/84/3/84_CJ-19-0856/_article/-char/e

Clinical Utility of Three-dimensional Computed Tomography for Esophageal Reconstruction using Colon Interposition after Gastrectomy

Reconstruction after esophagectomy may represent a serious problem when a previous gastric resection has been performed. The colon is frequently used, but the marginal artery is of insufficient caliber to maintain the viability of a transposed colon. Three-dimensional computed tomography(3D -CT) provides abundant information about a patient’s anatomy without requiring an arterial puncture. We present a case in which 3D-CT was used. A 68-year-old man who had previously undergone a gastrectomy was diagnosed with esophageal cancer.3D-CT showed that the left colic artery was straight and long and had a solitary branch from the inferior mesenteric artery. The vascular pedicle of the left colon was found during the operation to be in accord with the 3D-CT evaluation. The patient underwent a transthoracic esophagectomy,followed by reconstruction using left colon interposition. No anastomotic leakage or necrosis of the reconstructive colon occurred

Rapid detection of SNP (c.309T>G) in the MDM2 gene by the Duplex SmartAmp method.

BACKGROUND: Genetic polymorphisms in the human MDM2 gene are suggested to be a tumor susceptibility marker and a prognostic factor for cancer. It has been reported that a single nucleotide polymorphism (SNP) c.309T>G in the MDM2 gene attenuates the tumor suppressor activity of p53 and accelerates tumor formation in humans. METHODOLOGY: In this study, to detect the SNP c.309T>G in the MDM2 gene, we have developed a new SNP detection method, named "Duplex SmartAmp," which enabled us to simultaneously detect both 309T and 309G alleles in one tube. To develop this new method, we introduced new primers i.e., nBP and oBPs, as well as two different fluorescent dyes that separately detect those genetic polymorphisms. RESULTS AND CONCLUSIONS: By the Duplex SmartAmp method, the genetic polymorphisms of the MDM2 gene were detected directly from a small amount of genomic DNA or blood samples. We used 96 genomic DNA and 24 blood samples to validate the Duplex SmartAmp by comparison with results of the conventional PCR-RFLP method; consequently, the Duplex SmartAmp results agreed totally with those of the PCR-RFLP method. Thus, the new SNP detection method is considered useful for detecting the SNP c.309T>G in the MDM2 gene so as to judge cancer susceptibility against some cellular stress in the clinical setting, and also to handle a large number of samples and enable rapid clinical diagnosis

Impact of rewarming rate on the mortality of patients with accidental hypothermia: Analysis of data from the J-Point registry

Watanabe, M., Matsuyama, T., Morita, S. et al. Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry. Scand J Trauma Resusc Emerg Med 27, 105 (2019). https://doi.org/10.1186/s13049-019-0684-

Prognostic ability of the sequential organ failure assessment score in accidental hypothermia: a multi-institutional retrospective cohort study

Kandori, K., Okada, Y., Matsuyama, T. et al. Prognostic ability of the sequential organ failure assessment score in accidental hypothermia: a multi-institutional retrospective cohort study. Scand J Trauma Resusc Emerg Med 27, 103 (2019). https://doi.org/10.1186/s13049-019-0681-

Machine learning-based prediction models for accidental hypothermia patients

Okada, Y., Matsuyama, T., Morita, S., et al. Machine learning-based prediction models for accidental hypothermia patients. j intensive care 9, 6 (2021). https://doi.org/10.1186/s40560-021-00525-

The development and validation of a “5A” severity scale for predicting in-hospital mortality after accidental hypothermia from J-point registry data

Abstract Background Accidental hypothermia is a serious condition that requires immediate and accurate assessment to determine severity and treatment. Currently, accidental hypothermia is evaluated using the Swiss grading system which uses core body temperature and clinical findings; however, research has shown that core body temperature is not associated with in-hospital mortality in urban settings. Therefore, we developed and validated a severity scale for predicting in-hospital mortality among urban Japanese patients with accidental hypothermia. Methods Data for this multi-center retrospective cohort study were obtained from the J-point registry. We included patients with accidental hypothermia who were admitted to an emergency department. The total cohort was divided into a development cohort and validation cohort, based on the location of each institution. We developed a logistic regression model for predicting in-hospital mortality using the development cohort and assessed its internal validity using bootstrapping. The model was then subjected to external validation using the validation cohorts. Results Among the 572 patients in the J-point registry, 532 were ultimately included and divided into the development cohort (N = 288, six hospitals, in-hospital mortality 22.0%) and the validation cohort (N = 244, six hospitals, in-hospital mortality 27.0%). The 5 “A” scoring system based on age, activities-of-daily-living status, near arrest, acidemia, and serum albumin level was developed based on the variables’ coefficients in the development cohort. In the validation cohort, the prediction performance was validated. Conclusion Our “5A” severity scoring system could accurately predict the risk of in-hospital mortality among patients with accidental hypothermia

腹腔鏡下生検で診断した悪性腹膜中皮腫の１例

症例は52歳,男性.腹部膨満感,体重減少,易疲労感,食思不振を主訴に石井病院内科を受診した.初診時腹 部は著明に膨満していた.CT検査で腹腔内に多量の腹水を認めたが,はっきりした腫瘤性病変などはなかっ た.PET-CTでは右腹腔内の壁側腹膜に沿った部位と下行結腸付近にFDGの集積がみられた.腹腔穿刺細 胞診では,出血炎症性の背景に中皮細胞が孤立性～集塊状に多数出現していて,中皮由来の細胞集塊と考え られたが,確定診断にはいたらなかった.生検を目的に,内科から外科に転科し,腹腔鏡手術を施行した.腹腔 鏡で観察すると,腹腔内には多量の腹水が貯留しており,PET-CTで集積を認めた右側腹部腹壁に白色調の うずら卵大の腫瘤があったが,下行結腸付近にははっきりした腫瘤はなかった.うずら卵大の腫瘤を切除し, 病理検査に供したところ腫瘤は悪性腹膜中皮腫と診断された.化学療法を目的として群馬大学第2外科に紹 介され,GemcitabineとCarboplatinによる化学療法を開殆した