集中治療医学

救急医学

ショック

外傷

敗血症

ライフサイエンス, 外科学一般、小児外科学

ライフサイエンス, 救急医学

Development and temporal evaluation of an emergency severity index-informed Bayesian sequential model for hospital admission prediction using time-to-urination.
Atsushi Senda; Yuki Takatsu; Ryokan Ikebe; Hiroshi Suginaka; Koji Morishita; Akira Endo
Scientific reports, 2026年06月17日, ［国際誌］
英語, 研究論文（学術雑誌）, Triage tools in routine emergency care are largely static and may miss simple dynamic bedside cues available after presentation. We developed and temporally evaluated an emergency severity index (ESI)-informed Bayesian sequential prediction model for hospital admission using time-to-urination (TTU) in a prospective single-center cohort of ambulance-transported emergency department patients in Japan (February-August 2025; [Formula: see text]). The outcome was hospital admission at emergency department disposition. ESI was used as the initial pretest risk layer, TTU as a dynamic updating cue, and age and sex as refinement variables. Population-level fit to the cumulative admission curve was strong. In nested model comparison, ESI alone yielded an AUROC of 0.661 (95% CI 0.640-0.680), adding TTU improved discrimination to 0.677 (95% CI 0.658-0.698), and further adjustment for age and sex yielded the best performance (AUROC 0.741, 95% CI 0.722-0.760). Recalibration improved probability alignment without materially changing discrimination. Calibration deteriorated later in the post-arrival period, suggesting that the model is most informative in the early post-arrival window. This framework is designed to augment, rather than replace, existing triage systems.

Association between intraoperative irrigation volume and postoperative abdominal abscess in perforated peptic ulcer.
Atsushi Tabeta; Yusuke Tsutsumi; Hiromasa Hoshi; Akira Endo; Koji Ito; Tomohiro Akutsu; Hikaru Odera; Hideto Shiraki; Kei Ito; Takeshi Yokoyama; Yasukazu Narita; Taro Masuda; Akira Suekane; Koji Morishita
BMC surgery, 26, 1, 2026年05月06日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Perforated peptic ulcer is a critical emergency disease requiring surgery, and postoperative intra-abdominal abscess (IAA), an organ/space surgical site infection (SSI), is a common complication. Intraoperative irrigation is a common IAA prevention approach; however, scientific evidence supporting its effectiveness is lacking. We aimed to investigate the association between intraoperative irrigation volume and IAA using multicentre data. METHODS: This multicentre retrospective cohort study was conducted between January 2011 and December 2023. The study included patients aged ≥ 18 years who underwent laparotomy or laparoscopy for perforated peptic ulcer, defined as perforation of a gastric or duodenal ulcer. The primary and secondary outcomes were IAA incidence and superficial incisional SSI, respectively, and their association with the intraoperative irrigation volume was determined through multivariable logistic regression analyses. RESULTS: The study included 478 patients with a median age of 66 years (interquartile range [IQR]: 54-75 years), 344 (72.0%) of whom were males. The median irrigation volume was 7.0 (IQR: 5-10) L. Among the 478 patients, IAA and superficial incisional SSI occurred in 52 (10.9%) and 71 (14.9%), respectively. The irrigation volume and the outcomes exhibited no significant association (for IAA: adjusted odds ratio [AOR] = 1.04, 95% confidence interval [CI] = 0.97-1.11, p = 0.25; for superficial incisional SSI: AOR = 1.07, 95% CI = 1.00-1.14, p = 0.053). CONCLUSIONS: There was no statistically significant association between increased intraoperative irrigation volume and a decreased incidence of postoperative IAA formation. These findings suggest that alternative strategies, rather than uncontrolled high-volume irrigation, are required for IAA prevention.

Association Between Time to Target Mean Arterial Pressure and 90-Day Mortality in Septic Shock: A Post Hoc Analysis of the OPTPRESS Trial
Ryuto Yokoyama; Tatsuya Hayasaka; Kenya Yarimizu; Kazuma Yamakawa; Takashi Tagami; Yutaka Umemura; Akira Endo
Annals of Intensive Care, 16, 100088, 100088, Elsevier BV, 2026年05月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: In septic shock resuscitation, maintaining a mean arterial pressure (MAP) of at least 65 mmHg is recommended; however, the clinical relevance of the time required to achieve target MAP remains unclear. We evaluated the association between time to target MAP (TTT-MAP) and clinical outcomes in septic shock. METHODS: This post hoc secondary analysis used data from the OPTPRESS randomized controlled trial. TTT-MAP was defined as the time from randomization to first attainment of the randomized-arm lower-bound MAP target (80 mmHg in the high-target arm; 65 mmHg in the low-target arm) and categorized as <1 h, 1-3 h, 3-6 h, 6-12 h, ≥12 h, and unreached. The primary outcome was 90-day all-cause mortality. The primary analysis used doubly robust estimation. Secondary analyses included continuous TTT-MAP modeling, Cox proportional hazards models, and assessments of hypotension burden and vasopressor exposure. RESULTS: Among 516 patients enrolled in OPTPRESS, 476 were included in the complete-case cohort. In the primary six-category analysis, compared with TTT-MAP <1 h, the delayed-attainment category (≥12 h) was associated with higher 90-day mortality (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.11-1.98; p = 0.008), whereas 1-3 h, 3-6 h, and 6-12 h were not. In the continuous analysis restricted to patients who achieved target MAP within 24 h, TTT-MAP was not significantly associated with 90-day mortality per 1-h increase (aOR 1.025, 95% CI 0.972-1.082; p = 0.362). In Cox models, prolonged TTT-MAP (≥12 h or unreached) was associated with increased 90-day mortality versus early attainment (<12 h and reached) (adjusted hazard ratio [aHR] 3.24, 95% CI 2.19-4.80; p < 0.001). CONCLUSION: In this secondary analysis of the OPTPRESS trial, delayed attainment of the randomized lower-bound MAP target was associated with higher 90-day mortality. However, because TTT-MAP reflects time to first target attainment rather than the hypotension burden itself, these findings should not be interpreted as defining a clinically acceptable duration of hypotension or a threshold effect.

Effect modification by chronic kidney disease on renal outcomes in septic shock patients undergoing high-MAP targeting: a secondary analysis of the OPTPRESS trial.
Hiraaki Okuzawa; Akira Endo; Tomohiro Akutsu; Keisuke Suzuki; Hiromasa Hoshi; Kazuma Yamakawa; Takashi Tagami; Yutaka Umemura
Journal of intensive care, 14, 1, 2026年04月18日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: The optimal mean arterial pressure (MAP) target for renal protection in septic shock remains unclear. Although higher MAP targets have been suggested to improve renal outcomes in selected patient subgroups, it is unknown whether baseline chronic kidney disease (CKD) modifies the renal response to MAP targeting strategies. METHODS: We conducted a post hoc secondary analysis of the OPTPRESS trial, a multicenter randomized controlled trial enrolling patients aged ≥ 65 years with septic shock, comparing high-MAP (80-85 mmHg) versus standard-MAP (65-70 mmHg) targets. The primary outcome was renal replacement therapy-free days (RRT-FD) at 28 days, and the secondary outcome was major adverse kidney events (MAKE) at hospital discharge. Multivariable regression models were used to assess the interaction between MAP targeting strategy and documented history of CKD status. Stratified analysis was subsequently performed within CKD and non-CKD subgroups. Sensitivity analysis using inverse probability of treatment weighting (IPTW) and multiple imputation was conducted. RESULTS: Among 431 patients included in the complete case analysis, 70 had CKD and 361 did not. A statistically significant interaction between MAP targeting strategy and CKD status was observed for RRT-FD (p for interaction = 0.040). In adjusted analyses stratified by CKD status, high-MAP targeting was associated with fewer RRT-FD in patients without CKD (adjusted β, - 3.5 days; 95% CI - 5.94 to - 1.11), whereas no significant association was observed in patients with CKD (adjusted β, + 2.0 days; 95% CI - 4.34 to + 8.35). For MAKE, the direction of effect was consistent with that observed for RRT-FD although statistical significance was not reached in patients without CKD. Sensitivity analysis yielded directionally consistent findings. CONCLUSIONS: Documented history of CKD may modify the renal response to high-MAP targeting in elderly patients with septic shock. High-MAP targets were associated with fewer RRT-FD in patients without CKD. Given the exploratory and post hoc nature of this analysis, these findings should be interpreted cautiously and warrant confirmation in prospective studies evaluating individualized MAP targets according to baseline renal function in septic shock.

Development and internal-external validation of a machine learning model to predict the risk for postoperative adverse events in patients with peptic ulcer perforation: a secondary cohort study of the perforated peptic ulcer analyzing project study.
Kei Ito; Akira Endo; Hiromasa Hoshi; Koji Ito; Tomohiro Akutsu; Hikaru Odera; Hideto Shiraki; Takeshi Yokoyama; Yasukazu Narita; Taro Masuda; Akira Suekane; Shigeru Yamagishi; Koji Morishita
International journal of surgery (London, England), 2026年02月18日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Morbidity and mortality rates after surgery in patients with perforated peptic ulcer (PPU) remain high. Although several scoring systems have been proposed, only a few machine learning models have been designed to predict postoperative adverse events. This study aimed to develop and deploy a predictive model for the risk of postoperative adverse events in patients with PPU. METHODS: We analyzed data from the Perforated Peptic Ulcer Analyzing Project, which is a retrospective survey of adult patients with PPU in seven participating institutions in Japan between January 2011 and December 2022. The postoperative adverse events were defined as complications with a Clavien-Dindo classification of Grade III or higher. The variables were selected based on permutation feature importance derived from a random forest algorithm using bootstrap sampling. Internal-external cross-validation was conducted to develop and evaluate the model's performance. The final model was deployed as an interactive web application. RESULTS: Of the 702 potentially eligible patients, 425 were treated surgically. Of these, 78 patients (18.3%) experienced postoperative adverse events. Ten variables were selected and used to develop a random forest model that displayed favorable discriminatory ability, with a pooled area under the receiver operating characteristic curve (AUROC) of 0.83. Compared to the other systems, the random forest model outperformed the PULP (AUROC, 0.79) and Boey scores (AUROC, 0.67). CONCLUSION: In this study, a machine learning model was developed and deployed to predict postoperative adverse events in patients with PPU. Further external validation is required for clinical use.

Development of a Scoring System to Predict the Treatment Success for Nonoperative Management of Peptic Ulcer Perforation: A Secondary Data Analysis of PPAP Study.
Kei Ito; Akira Endo; Hiromasa Hoshi; Koji Ito; Tomohiro Akutsu; Hikaru Odera; Hideto Shiraki; Takeshi Yokoyama; Yasukazu Narita; Taro Masuda; Akira Suekane; Shigeru Yamagishi; Koji Morishita
Annals of gastroenterological surgery, 10, 1, 95, 102, 2026年01月, ［国内誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Although surgical treatment is the primary measure for patients with perforated peptic ulcer (PPU), nonoperative management (NOM) has become a common alternative. However, risk score models predicting the success of NOM based on the analysis of a large number of patients remain scarce. We developed a clinically applicable scoring system to predict the success of NOM in patients with PPU using data from a large cohort. METHOD: We analyzed data of the Perforated Peptic ulcer Analyzing Project (PPAP), which was a retrospective survey of adult patients with PPU between January 2011 to December 2022. The successful NOM case was defined as patients who survived until hospital discharge without requiring surgery. Factors associated with NOM were identified using a multivariable logistic regression analysis, and a scoring system to predict NOM was developed by weighting these factors based on the regression coefficients. RESULT: Of 702 potentially eligible patients, 584 were treated with NOM, of which 130 patients (22.2%) were treated successfully. Age, sex, body temperature, heart rate, the extent of peritoneal irritation signs, C reactive protein, spread of ascites, and sepsis were included in the final model. Using these variables, we developed the scoring system named PPAP score, which had favorable discriminating ability with the area under receiving operating characteristic curve of 0.799. When the cut-off was set to 56, the sensitivity and the specificity were 0.738 and 0.722, respectively. CONCLUSION: A predictive scoring model was developed. However, external validation of the model is required to confirm its clinical applicability.

Outcomes and Risk Factors for In‐Hospital Mortality in Mild‐to‐Moderate Trauma Patients: A Nationwide Observational Study
Shogo Takashima; Kazuma Yamakawa; Ryo Yamamoto; Akira Endo; Noritaka Ushio; Ryo Hisamune; Tomonobu Nishii; Akira Takasu
Acute Medicine & Surgery, 13, 1, e70145, 2026年01月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Although minor (mild-to-moderate) trauma generally leads to favorable outcomes, some patients experience in-hospital mortality. Traditional trauma severity scores alone may not sufficiently reflect the prognostic variability in aging populations with comorbidities. This study examined the associations between patient characteristics and in-hospital mortality among patients with minor trauma. METHODS: This retrospective cohort study used data from adult patients with minor trauma, defined by an Injury Severity Score (ISS) < 16 from the Japan Trauma Data Bank. A logistic regression analysis was performed to evaluate associations between mortality and patient characteristics, including age, sex, ISS, and the Charlson Comorbidity Index (CCI) score. Subgroup analyses were conducted among patients with moderate trauma (ISS 9-15) to examine the associations between the Abbreviated Injury Scale (AIS) scores of injuries at three specific anatomical regions and in-hospital mortality. RESULTS: After applying the exclusion criteria, of the 56,821 patients with ISS < 16 identified in the Japan Trauma Data Bank, 50,087 were included in the final analysis. The logistic regression analysis identified older age, male sex, ISS ≥ 9, and higher CCI scores as independent predictors of in-hospital mortality. In patients with moderate trauma, the AIS scores of injuries involving the three regions (head/neck, abdomen, and external/other trauma injury regions) were significantly associated with increased mortality. CONCLUSION: Among patients with minor trauma, advanced age, male sex, comorbidities, and specific injury regions were associated with increased in-hospital mortality. These findings highlight the importance of early risk recognition and tailored clinical management in this population.

External validation of the revised lethal triad criteria for appropriate strategic decision making
Keisuke Suzuki; Akira Endo; Tomohiro Akutsu; Hiromasa Hoshi; Takayuki Ogura; Atsushi Shiraishi; Shigeki Kushimoto; Tasuku Miyake; Nao Hiroe; Kazushige Inoue; Toru Hifumi; Takahito Miyake; Ayaka Matsuoka; Wataru Takayama; Hiromichi Naito; Taeko Sasaki; Motoo Fujita; Keita Miyazaki; Noritaka Ushio; Yuki Saoyama; Kazutaka Kirizume; Atsuyoshi Iida; Yuya Yoshimura; Takeshi Wada; Kohei Kato; Koichiro Sueyoshi; Mitsuhide Hamaguchi; Tadashi Kaneko; Koji Morishita
Journal of Trauma and Acute Care Surgery, 100, 1, 113, 118, 2026年01月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: The conventional lethal triad criteria for trauma are too specific for death and, thus, inappropriate as a standard for strategic decisions. Revised lethal triad criteria were previously proposed based on a multicenter study. Positive is defined as meeting one major criterion (fibrin/fibrinogen degradation product >90 μg/mL) or two minor criteria (base excess <-3 mEq/L or temperature <36°C). The aim of this study was to externally validate the revised lethal triad criteria by evaluating their predictive performance for 28-day mortality in severely injured patients. METHODS: Patients with trauma with an Injury Severity Score of ≥16, admitted to 25 Japanese institutions between April 2018 and March 2019, were included. The proportion of patients for whom the revised criteria could be calculated was assessed. The predictive accuracy of the conventional and revised lethal triad criteria was evaluated using the area under the receiver operating characteristic curve. Calibration plots were created to visually evaluate the agreement between predicted and observed 28-day mortality. RESULTS: Among 1,177 patients with severe blunt trauma, 125 (10.6%) died during hospitalization. The revised criteria could be calculated for 770 patients (65.4%). The conventional criteria predicted 28-day mortality with 2.8% sensitivity and 99.8% specificity, whereas the revised criteria showed 80.6% sensitivity and 64.4% specificity. The area under the receiver operating characteristic curves for the conventional and revised criteria were 0.68 and 0.77, respectively. Calibration plots showed high agreement between predicted and observed values for the revised criteria, indicating a well-calibrated model. CONCLUSION: The revised lethal triad criteria demonstrated clinically sufficient sensitivity and appropriate specificity for predicting 28-day mortality in patients with severe trauma, suggesting their utility as indicators for adopting critical therapeutic strategies. LEVEL OF EVIDENCE: Diagnostic Test or Criteria; Level IV.

Seasonal and cultural effects on calendar day variations in trauma incidence in Japan
Keisuke Suzuki; Akira Endo; Tomohiro Akutsu; Hiromasa Hoshi; Akira Suekane; Ryo Yamamoto; Kazuma Yamakawa; Shin Watanabe; Akihiro Hirakawa; Yasuhiro Otomo; Koji Morishita
Scientific Reports, 15, 1, 44106, 44106, 2025年12月18日, ［国際誌］
英語, 研究論文（学術雑誌）, Trauma incidence patterns are influenced by societal and cultural factors. However, research has mainly focused on short-term periods. This study examined daily trauma trends throughout the year to identify fluctuations aligned with lifestyle patterns under a relatively homogeneous ethnocultural context, using long-term nationwide trauma data. Data from patients with trauma recorded in the Japan Trauma Data Bank (2004-2021; n = 383,473) were retrospectively analyzed. Participants were grouped by transport date into 365 daily cohorts. Daily patient volumes, injury severity, suicide attempts, and mortality were assessed. Outliers were identified using negative binomial regression with periodic functions, logistic regression adjusted for trauma severity, and the Generalized Extreme Studentized Deviate test. Human behavioral patterns appeared to significantly influence the trauma incidence. Cases increased during Golden Week (late April-early May), Sports Day (October 10), Culture Day (November 3), and the end of the year while declining during the Obon holiday (mid-August) and in early January. Suicide attempts peaked in May-June and September, diverging from overall trauma trends. Mortality rates remained consistent, with no significant seasonal variation or outliers. Long-term data suggest that trauma volumes vary in relation to seasonal and cultural events, offering valuable insights for optimizing trauma resource allocation and preventive strategies.

Hospital volume-outcome relationship in emergency trunk interventional radiology for trauma patients: a nationwide observational study in Japan.
Shogo Takashima; Kazuma Yamakawa; Ryo Hisamune; Noritaka Ushio; Akira Endo; Ryo Yamamoto; Kazuhiro Yamamoto; Keigo Osuga; Akira Takasu
European radiology, 35, 12, 7571, 7580, 2025年12月, ［国際誌］
英語, 研究論文（学術雑誌）, OBJECTIVES: As with surgery, transcatheter arterial embolization is effective in managing arterial bleeding from trauma-related pelvic fractures and organ injuries. High-volume hospitals generally achieve better outcomes due to provider experience, but whether this applies to interventional radiology (IR) in trauma care remains unclear. This study examined whether hospitals with higher IR volumes improve outcomes for trauma patients. MATERIALS AND METHODS: This retrospective cohort study used data on trauma patients undergoing emergency IR within the torso from the Japan Trauma Data Bank. Hospitals were categorized by annual emergency IR case volume: 1-6 (Category 1), 7-12 (Category 2), 13-18 (Category 3), 19-24 (Category 4), and > 24 cases (Category 5). The association between hospital volume and in-hospital mortality was analyzed with a mixed-effects logistic regression model adjusted for injury severity. Subgroup analyses conducted by dividing the 18-year study period into three intervals, 2004-2009, 2010-2015, and 2016-2021, assessed the time-related impact of volume on outcomes. RESULTS: We analyzed 16,090 trunk-IR patients from 303 hospitals. In-hospital mortality rates were 16.2%, 13.9%, 14.3%, 13.1%, and 11.8% for Categories 1 to 5, respectively. Higher volumes of IR cases were associated with reduced mortality. When the annual case number was analyzed as a continuous variable, an increase of one was associated with decreased mortality (odds ratio = 0.988, 95% confidence interval = 0.982-0.994, p  < 0.001). Subgroup analyses showed a significant association between higher volume and reduced mortality during 2004-2009 and 2010-2015, but not during 2016-2021. CONCLUSION: High-volume hospitals were associated with lower in-hospital mortality among patients undergoing emergency trunk IR. KEY POINTS: Question The relationship between patient volume and clinical outcome is unknown for trauma patients undergoing emergency radiological interventions of the torso. Findings Higher hospital volumes of interventional radiology procedures performed in the trunk were associated with reduced in-hospital mortality. Clinical relevance Centralizing emergency interventional radiology cases, advancing trauma care education, and increasing awareness of interventional radiology can lead to better patient outcomes.

Bayesian Sequential Modeling of Time-to-Urination for Dynamic ED Triage
Atsushi Senda; Yuki Takatsu; Ryokan Ikebe; Hiroshi Suginaka; Koji Morishita; Akira Endo
2025年10月19日

Impact of Corrected Minute Ventilation on Mortality in Mechanically Ventilated Patients With COVID-19-Related Acute Respiratory Distress Syndrome: A Multicenter, Observational Study Using the J-RECOVER Registry Data.
Jun Kataoka; Masahiro Konaka; Hiroyuki Ohbe; Koichi Hayashi; Akira Endo; Takashi Tagami; Shigeki Fujitani
Cureus, 17, 9, e92347, 2025年09月, ［国際誌］
英語, 研究論文（学術雑誌）, Background Corrected minute ventilation (VEcorr) has been proposed as a surrogate marker for dead space ventilation and may be associated with increased mortality in COVID-19-related acute respiratory distress syndrome (ARDS). However, prior studies have shown inconsistent results, and the mechanisms contributing to elevated VEcorr remain unclear. Methodology A multicenter, observational study was conducted using data from the J-RECOVER registry, including 335 adult patients with COVID-19-related ARDS who received invasive mechanical ventilation. VEcorr was calculated using the initial ventilator settings and arterial blood gas values. Multivariable logistic regression analysis was performed to assess the association between VEcorr and in-hospital mortality, adjusting for potential confounders. Results Higher VEcorr was independently associated with increased in-hospital mortality (odds ratio = 1.11; 95% confidence interval = 1.01-1.23; p = 0.039). Patients with a higher VEcorr also had higher levels of fibrin degradation products and Fibrosis-4 scores. In addition, a higher VEcorr was significantly associated with elevated PaCO2 (≥45 mmHg), respiratory acidosis (pH <7.25), and increased mean airway pressure (≥15 cmH2O). Patients with both a high VEcorr and hypercapnia had significantly higher mortality. Conclusions VEcorr was independently associated with mortality in mechanically ventilated COVID-19 ARDS patients and might reflect underlying microvascular pathology. Monitoring VEcorr may help identify high-risk patients and inform ventilatory and therapeutic strategies.

Consensus-based indications for resuscitative endovascular balloon occlusion of the aorta: a combined survey and descriptive database study in Japan
Toshinao Suzuki; Atsushi Shiraishi; Akira Endo; Hayaki Uchino; Yasuhiro Otomo
Injury, 56, 9, 112589, 112589, 2025年09月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used in recent years as an adjunctive strategy to haemostatic procedures to counteract exsanguination in patients with trauma. However, no consensus has been reached regarding the haemostatic procedures deemed appropriate indications for REBOA. This study aimed to define appropriate indications for REBOA through consensus among trauma specialists and to investigate the characteristics and outcomes of patients undergoing REBOA with or without appropriate indications defined in this study. METHODS: Using the 42 haemostatic procedures defined in the Japan Trauma Databank (JTDB), we conducted a repeated Delphi survey to obtain consensus from trauma specialists on the haemostatic procedures deemed appropriate indications for REBOA. Subsequently, patients registered in the JTDB who underwent REBOA were divided into two groups based on whether they had appropriate or inappropriate indications, as defined through the Delphi survey. Patient baseline characteristics, door-to-haemostasis time, door-to-blood transfusion time, emergency-department and in-hospital mortality, and complications were compared between the groups. The observed mortality and predicted mortality were compared. RESULTS: After five rounds of questionnaire assessments including 11 trauma specialists, intraabdominal, retroperitoneal, pelvic, and extremity haemorrhage were defined as consensus-based appropriate indications for REBOA. Among the 361,706 patients with trauma registered in the JTDB, 1833 underwent REBOA: 1077 with appropriate and 756 with inappropriate indications. Crude in-hospital mortality (57.6 vs. 72.9 %, p < 0.001) and crude emergency-department mortality (15.4 vs. 38.6 %, p < 0.001) were significantly higher in patients with inappropriate indications than in those with appropriate indications. The observed mortality was higher than the predicted mortality, but it more closely aligned with the predicted mortality in 2013-2019 than in 2004-2012. CONCLUSION: In over 40 % of cases in which REBOA was employed, it was used outside the appropriate indications defined in this study. Mortality was higher among patients with inappropriate indications than in those with appropriate indications. Further studies are required to elucidate the association between corresponding haemostatic procedures and outcomes for REBOA.

Effectiveness of remdesivir for hospitalized COVID-19 patients depending on the severity of respiratory status: a multicenter retrospective study in Japan.
Hidero Yoshimoto; Kazuma Yamakawa; Yoshihiro Tanaka; Itsuki Osawa; Takashi Tagami; Akira Endo; Ryo Yamamoto; Mineji Hayakawa; Takayuki Ogura; Atsushi Hirayama; Hideo Yasunaga; Akira Takasu; Sang-Woong Lee
BMC infectious diseases, 25, 1, 1016, 1016, 2025年08月13日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Remdesivir, an antiviral nucleotide analog prodrug, is approved for clinical use against COVID-19 worldwide. However, its effectiveness varies depending on the respiratory failure status of patients. This study aimed to evaluate the effectiveness of remdesivir treatment based on the severity of respiratory failure, as indicated by the oxygen demand upon hospital admission. Subgroups analyses were conducted to identify patient groups that might benefit from remdesivir treatment. METHODS: This retrospective observational study (the J-RECOVER) enrolled patients with COVID-19 from 64 institutions in Japan between January 1 and September 30, 2020. Patients aged ≥ 18 years who were administered remdesivir within 3 days of hospital admission were included. A total of 3,591 patients were included, and propensity score overlap weighting analysis was used to compare in-hospital mortality based on respiratory failure status at admission between remdesivir and control groups. Subgroup analyses identified specific patient populations that may benefit most from remdesivir treatment, considering factors such as respiratory status and renal function. RESULTS: The overlap weighting (OW)-adjusted odds ratio (OR) for mortality in overall cohort, mild cases without supplemental oxygen, moderate cases requiring supplemental oxygen, and severe cases requiring ventilation was (OR, 0.65 (95% confidence interval (CI), 0.36-1.19; P = 0.16), 0.11 (95% CI, 0.01-1.03; P = 0.05). 0.82 (95% CI, 0.31-2.16; P = 0.69), and 0.78 (95% CI, 0.28-2.17; P = 0.63), respectively. A trend toward improvement in mortality was observed in respiratory indicators, such as SpO2 ≥ 94% (OR, 0.43; 95% CI, 0.19-0.99; P = 0.04), oxygen support with FiO2 < 0.5 (OR, 0.40; 95% CI, 0.16-0.97; P = 0.04), and PFR ≥ 300 (OR, 0.17; 95% CI, 0.03-0.94; P = 0.04). Subgroup analyses indicated improved mortality in patients with an estimated glomerular filtration rate (eGFR) of > 60 mL/min per 1.73 m2 (OR, 0.29; 95% CI, 0.09-0.94; P = 0.03), with a p-value for interaction of P = 0.18. CONCLUSION: Remdesivir treatment may reduce the risk of in-hospital mortality in patients with mild respiratory distress. Subgroup analysis suggested that remdesivir treatment may improve mortality in patients with eGFR ≥ 60 mL/min per 1.73 m2.

Socioeconomic burden of patients hospitalized for fecal impaction: a nationwide retrospective observational study.
Hiromasa Hoshi; Akira Endo; Kiyohide Fushimi; Koji Morishita
BMC gastroenterology, 25, 1, 563, 563, 2025年08月07日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Fecal impaction (FI) causes serious complications and has a high mortality rate, particularly among older individuals. However, there have been few large-scale studies on FI, and understanding of FI is incomplete. In this study, we aimed to elucidate the characteristics, mortality rates, and healthcare costs of patients hospitalized for FI. METHODS: This retrospective observational study used data from the Japanese national administrative database and included patients hospitalized for FI between April 2016 and March 2023. The characteristics, treatment, outcomes, and healthcare costs of patients were evaluated. The risks for in-hospital mortality were examined using a Fine and Gray model as an exploratory analysis. RESULTS: In total, 30,439 patients were eligible for the study. The median (interquartile range) age was 79 (69-86) years. In total, 4,093 (13.4%) patients were admitted from nursing homes. On admission, 10,734 patients (35.3%) had a history of constipation. The in-hospital mortality rate was 8.4%, increasing with age and reaching 13.5% in patients aged 85 years or older. Total healthcare costs also increased with age, with more than 18 billion JPY spent cumulatively on patients aged 65 years or older across the study period, accounting for 85.9% of the total costs. Total annual healthcare costs exceeded 2700 million JPY and gradually increased over time. In an exploratory analysis, sepsis was the most significant risk factor for mortality, followed by emergency ambulance transportation and admission from a nursing home. CONCLUSIONS: The mortality rate of fecal impaction was 8.4% in our study of a large Japanese national dataset, with the rate approaching 13.5% in those aged 85 years or older. Inpatient healthcare costs increased with age and over time.

OPTPRESS or OPTPRESSIN? Authors' reply
Akira Endo; Kazuma Yamakawa; Takashi Tagami; Yutaka Umemura
Intensive Care Medicine, 51, 8, 1563, 1564, 2025年08月, ［国際誌］
英語, 研究論文（学術雑誌）

High mean arterial pressure (MAP) targets in septic shock: one size does not fit all. Authors’ reply
Akira Endo; Kazuma Yamakawa; Takashi Tagami; Yutaka Umemura
Intensive Care Medicine, 51, 8, 1559, 1560, 2025年08月, ［国際誌］
英語, 研究論文（学術雑誌）

Reconsidering high-MAP targets in septic shock: the need for cardiac function-oriented resuscitation. Authors' reply
Akira Endo; Kazuma Yamakawa; Takashi Tagami; Yutaka Umemura
Intensive Care Medicine, 51, 7, 1393, 1394, 2025年07月, ［国際誌］
英語, 研究論文（学術雑誌）

Time series differences in coagulopathy in mechanically ventilated COVID-19 and bacterial pneumonia patients: a nationwide observational study in Japan.
Ryo Hisamune; Kazuma Yamakawa; Noritaka Ushio; Katsunori Mochizuki; Tadashi Matsuoka; Yutaka Umemura; Mineji Hayakawa; Hirotaka Mori; Akira Endo; Takayuki Ogura; Atsushi Hirayama; Hideo Yasunaga; Takashi Tagami; Kohji Okamoto; Akira Takasu
Thrombosis journal, 23, 1, 61, 61, 2025年06月10日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Severe acute respiratory syndrome coronavirus 2 infection causes systemic immune overresponse (cytokine storm), which can lead to microthrombi and dysfunction of coagulation such as disseminated intravascular coagulation (DIC) of sepsis. Coronavirus disease 2019 (COVID-19) coagulopathy is known to occur mainly in the pulmonary microcirculation. We aimed to investigate hematological differences in coagulopathy between COVID-19 pneumonia and bacterial pneumonia. METHODS: We performed an observational cohort study using the Japanese REsearch of COVID-19 by assEmbling Real-world data (J-RECOVER) study database for COVID-19 patients and the Japan Medical Data Center (JMDC) database for bacterial pneumonia patients. The J-RECOVER database includes data from patients discharged between January 1 and September 31, 2020. The JMDC database covers patients emergently hospitalized from 2014 to 2022. We analyzed the association between hematological coagulopathy, systematic inflammation, and organ dysfunction in both groups after one-to-one propensity score matching. RESULTS: We enrolled 572 COVID-19 patients and 2,413 bacterial pneumonia patients who required mechanical ventilation. The COVID-19 group was younger, had higher intensive care unit admission rates, and lower mortality in comparison to the bacterial group (p < 0.05). On day 1, the two groups showed no significant differences in JAAM-2 and sepsis-induced coagulopathy criteria. After matching, platelet counts, antithrombin activity, and prothrombin time-international normalized ratio were consistently maintained within normal ranges in the COVID-19 group. However, trends in D-dimer and fibrin degradation products in the COVID-19 group were similar to those in the bacterial pneumonia group. CONCLUSIONS: COVID-19 coagulopathy differs from bacterial septic DIC by exhibiting lower platelet consumption and minimal vascular hyperpermeability. Consequently, management strategies for COVID-19 coagulopathy should be distinct from those for septic DIC.

Efficacy of targeting high mean arterial pressure for older patients with septic shock (OPTPRESS): a multicentre, pragmatic, open-label, randomised controlled trial
Akira Endo; Kazuma Yamakawa; Takashi Tagami; Yutaka Umemura; Takeshi Wada; Ryo Yamamoto; Hiroki Nagasawa; Wataru Takayama; Masayuki Yagi; Kyosuke Takahashi; Mitsuaki Kojima; Chihiro Narita; Satoshi Kazuma; Jiro Takahashi; Atsushi Shiraishi; Masaki Todani; Masaki Nakane; Toshihiko Nagata; Shohei Tanaka; Yuta Yokokawa; Kunihiko Takahashi; Haruka Ishikita; Ryo Hisamune; Junichi Sasaki; Ken-ichi Muramatsu; Hiroyuki Sonobe; Kazunobu Minami; Hiromasa Hoshi; Yasuhiro Otomo; Tomohiko Akutsu; Daiki Kaito; Hiromichi Ohsaka; Yohei Iwasaki; Fumino Taketazu; Tomoko Iguchi; Ryu Azumaguchi; Noritaka Ushio; Takahiro Okane; Toshiyuki Karumai; Ayaka Matsuoka; Chikashi Takeda; Toshiki Sera; Hiroko Okura; Yoichi Katayama; Keiichiro Shimoyama; Tadanaga Shimada; Ryuzo Abe; Tsuyoshi Nakashima; Tatsuhiko Anzai; Keisuke Suzuki; Takahiro Yamanaka; Youichi Yanagawa; Yuichi Araki
Intensive Care Medicine, 51, 5, 883, 892, 2025年05月13日, ［国際誌］
英語, 研究論文（学術雑誌）, PURPOSE: We examined the effect of a high-target mean arterial pressure (MAP) on septic shock in a previously underrepresented region. METHODS: A multicentre, pragmatic, open-label, randomised controlled trial was conducted in 29 hospitals in Japan, where the prevalence of chronic hypertension among older individuals is 66.9%. Patients who were diagnosed with septic shock, aged ≥ 65 years, and admitted to an intensive care unit were randomised 1:1 to the high (target MAP = 80-85 mmHg) or control (target MAP = 65-70 mmHg) groups from 1 July 2021 to 12 December 2023. The target MAP was maintained for 72 h or until vasopressors were no longer required. The primary outcome was the 90-day all-cause mortality. Secondary outcomes included organ support-free days and adverse events. RESULTS: The trial was terminated early on the basis of the interim analysis results, suggesting the harm of the high-target strategy. Of the 518 patients, 258 were in the high-target group, and 260 were in the control group. By 90 days after randomisation, 101 patients (39.3%) in the high-target group and 74 (28.6%) in the control group had died from any cause (risk difference = 10.7; 95% confidence interval, 2.6-18.9). Renal replacement therapy-free days at 28 days were shorter in the high-target group. No clinical benefits for any outcome were observed in any subpopulation, including those with known chronic hypertension. CONCLUSION: Among older patients with septic shock, high-target MAP significantly increased mortality compared with standard care. TRIAL REGISTRATION: UMIN Clinical Trials Registry; UMIN000041775; 13 September 2020.

Analysis of the characteristics and management of perforated peptic ulcer from 2011 to 2022: A multicenter and retrospective descriptive study.
Hiromasa Hoshi; Akira Endo; Koji Ito; Tomohiro Akutsu; Hikaru Odera; Hideto Shiraki; Kei Ito; Takeshi Yokoyama; Yasukazu Narita; Taro Masuda; Akira Suekane; Koji Morishita
Annals of gastroenterological surgery, 9, 3, 464, 475, 2025年05月, ［国内誌］
英語, 研究論文（学術雑誌）, AIM: Although perforated peptic ulcer is common in Japan, few large-scale studies have assessed its management, including surgical procedures and outcomes. This study aimed to survey the characteristics, management, and outcomes of perforated peptic ulcer. METHODS: A multicenter retrospective descriptive analysis was conducted across seven centers in Japan between 2011 and 2022. Perforated peptic ulcer was defined as gastric or duodenal ulcer perforation, excluding malignant or iatrogenic perforation. RESULTS: We enrolled 703 patients with perforated peptic ulcer. The overall in-hospital mortality rate was 35/703 (5.0%). Conservative treatment was performed as an initial treatment in 217/703 (30.9%) patients, among whom 52 (24.0%) eventually underwent surgery. The median age (interquartile range) of patients who successfully completed the conservative treatment was 60 (46-71) years. A total of 538/703 (76.5%) patients underwent surgery. The gastrectomy percentage increased with the perforation diameter. The anastomotic leakage rate for gastrectomy was high in 10/66 (15.2%) patients. Laparoscopy was performed in 115/538 (21.4%) patients, among whom 23 (20.0%) were converted to open surgery. Patients who underwent laparoscopy had a perforation diameter ≤ 20 mm. The use of laparoscopy varied among facilities, ranging from 1.8% to 61.2%. CONCLUSION: The in-hospital mortality rate for perforated peptic ulcer in this study was 5.0%, and conservative treatment was safely performed even in elderly patients. As the perforation diameter increased, the rate of gastrectomy tended to rise, and the rate of anastomotic leakage in those patients was high. UMIN Clinical Trials Registry; UMIN000054391.

Mortality rates in physician staffed ground vs. air ambulance for severe trauma patients: retrospective analysis of the Japanese nationwide trauma registry.
Tomohiro Akutsu; Akira Endo; Ryo Yamamoto; Kazuma Yamakawa; Hiraaki Okuzawa; Keisuke Suzuki; Hiromasa Hoshi; Yasuhiro Otomo; Koji Morishita
Scientific reports, 15, 1, 6255, 6255, 2025年02月20日, ［国際誌］
英語, 研究論文（学術雑誌）, While both physician-staffed ground ambulances (GA) and air ambulances (AA) can function as viable transportation options in severe trauma cases, no study has directly compared their efficacies. We aimed to compare the effects of physician-staffed GA and AA on the outcomes of patients with trauma. This retrospective cohort study used records from the Japan Trauma Data Bank collected between April 2004 and December 2021. Data from patients aged ≥ 15 years with an Injury Severity Score > 15, who were directly transferred from the injury scenes, were analyzed. Patients were categorized into two groups based on the transportation method: physician-staffed GA and AA. The primary outcome measure (in-hospital mortality) and secondary outcomes (time to emergency department arrival, time to physician contact and prehospital treatment) were compared between the propensity score-matched groups. Of the 3,508 propensity score-matched pairs, the AA group exhibited significantly lower in-hospital mortality (810 [23.0%]) than the GA group (894 [25.4%]), odds ratio: 0.88 (95% confidence interval [CI] 0.79-0.98). Time to emergency department was significantly longer in the AA group than in the GA group. While patients in the GA group were likely to receive more treatments during transportation, patients in the AA group were likely to receive more surgical interventions after hospital arrival.

Fulminant myocarditis in immune-mediated thrombotic thrombocytopenic purpura: A case report.
Haruka Ishikita; Akira Endo; Keisuke Suzuki; Tomohiro Akutsu; Yuichi Araki; Koji Morishita
Acute medicine & surgery, 12, 1, e70075, 2025年, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Thrombotic thrombocytopenic purpura is a life-threatening thrombotic microangiopathy characterized by systemic microvascular thrombosis. Cardiovascular complications, including myocardial ischemia and necrosis, are a leading cause of acute mortality. CASE PRESENTATION: A 54-year-old man was diagnosed with immune-mediated thrombotic thrombocytopenic purpura. On Day 2, he developed sudden cardiac arrest, requiring venoarterial extracorporeal membrane oxygenation for circulatory support. Echocardiography revealed diffuse severe hypokinesis, ventricular hypertrophy, and pericardial effusion. Myocardial biopsy performed on Day 3 showed no findings of microthrombi or necrosis. These findings suggested fulminant myocarditis rather than myocardial ischemia. The patient was successfully treated with multidisciplinary treatment including plasma exchange, achieving full recovery by Day 44. CONCLUSION: This case highlights fulminant myocarditis as a complication of immune-mediated thrombotic thrombocytopenic purpura. As myocarditis is potentially reversible, providing appropriate supportive therapy may contribute to an improved prognosis.

Association between neurological outcomes and prehospital time in patients with out-of-hospital cardiopulmonary arrest.
Kazuhide Yoshikawa; Akira Endo; Wataru Takayama; Tomohisa Shoko; Yasuhiro Otomo; Koji Morishita
Acute medicine & surgery, 12, 1, e70025, 2025年, ［国際誌］
英語, 研究論文（学術雑誌）, INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) remains an important health care issue. Considering the importance of such a time course after cardiac arrest, detailed evaluation of the prehospital time (i.e., time from EMS contact to a patient to hospital arrival) is essential to improve the mortality and neurologic outcome of OHCA. In this study, we aimed to evaluate the impact of prehospital time on neurological outcomes in patients with OHCA. METHODS: This retrospective observational study included adult non-traumatic OHCA patients who were transported to 2 emergency centers in Tokyo from January 2015 to December 2020. The following data were obtained retrospectively from medical records. RESULTS: Of the 3120 OHCA patients who were transported during the study period, 2215 patients were evaluated via the inclusion and exclusion criteria. Sixty-nine patients were alive at hospital discharge with a good neurological outcome (i.e., CPC 1 or 2). The multivariate logistic regression model showed that prehospital time (time from EMS contact to hospital arrival) was an independent predictor for hospital discharge with good neurological outcome, in addition to age, bystander CPR, initial rhythm, and cause of cardiac arrest. The GAM plot showed that the adjusted odds ratio of prehospital time for the good neurological outcome was decreased linearly according to time, and the threshold was approximately 30 min. CONCLUSION: The threshold of allowable prehospital time, including field activity and transport, for OHCA patients might be 30 min at least in a Japanese urban setting.

External Validation of the Traumatic Bleeding Severity Score for the Predictive Accuracy of the Need for Massive Transfusion
Kei Kimoto; Akira Endo; Atsushi Shiraishi; Kensuke Fujita; Takuya Kimura; Yoshihiro Hagiwara; Takayuki Ogura
Acute Medicine & Surgery, 12, 1, e70095, 2025年01月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: The Traumatic Bleeding Severity Score (TBSS), developed in Japan, has shown high predictive accuracy in internal validation; however, external validation has still not been performed. We conducted the first external validation of the TBSS in Japan and compared it with other massive transfusion (MT) prediction scores. METHODS: This multicenter retrospective study included severe trauma patients (aged ≥ 18 years, Injury Severity Score [ISS] ≥ 16) from 25 tertiary critical care centers (April 2018-March 2019), excluding those with isolated head injury or cardiac arrest on arrival. TBSS's accuracy for predicting MT was analyzed using the area under the curve (AUC). A complete case was the primary approach, with sensitivity analysis using multiple imputed datasets. The Trauma-Associated Severe Hemorrhage (TASH) score and Assessment of Blood Consumption (ABC) score were also evaluated for comparison. RESULTS: Of 1193 patients, 873 were eligible, and 365 patients were included in the complete case analysis. The median age was 63 (interquartile range [IQR]: 45-75) years, the median ISS was 25 (IQR: 20-34), 69.3% were male individuals, 98.1% experienced blunt trauma, and 24.7% received MT. TBSS' AUC was 0.86 (sensitivity: 70.1%; specificity: 88.4%). The TASH score showed a comparable AUC of 0.88 (p = 0.850), whereas the ABC score had a significantly lower AUC of 0.80 (p = 0.024). Sensitivity analysis confirmed these findings. CONCLUSION: TBSS' accuracy for predicting MT was comparable to that of the TASH score and superior to that of the ABC score. Further research is needed to determine its clinical utility and broader applicability in trauma care.

Early lymphopenia as a predictor of COVID-19 outcomes: A multicenter cohort study.
Kazuhiro Okada; Takashi Tagami; Takanobu Otaguro; Mineji Hayakawa; Kazuma Yamakawa; Akira Endo; Takayuki Ogura; Atsushi Hirayama; Hideo Yasunaga; Yoshiaki Hara
Acute medicine & surgery, 12, 1, e70044, 2025年, ［国際誌］
英語, 研究論文（学術雑誌）, INTRODUCTION: Lymphopenia is recognized as a biomarker for predicting outcomes in coronavirus disease (COVID-19). However, the optimal timing for its observation remains uncertain. We investigated the association between early lymphopenia and COVID-19 prognosis, as well as the relationship between lymphocyte count trends and disease outcomes. METHODS: We analyzed data from the J-RECOVER study, a multicenter retrospective cohort study in Japan, encompassing patients with COVID-19 between January and September 2020. The patients were categorized into lymphopenia (LP) (<800 cells/μL) and non-lymphopenia (NL) (≥800 cells/μL) groups based on the lymphocyte counts between days 1 and 4 post-onset. They were further divided into "persistent," "recovered," "exacerbated," and "stable" groups based on lymphocyte counts between days 7 and 10. The primary outcome was the in-hospital mortality. The Cox proportional hazard regression was used for the analysis. RESULTS: Of 995 enrolled patients, 212 patients (21.3%) were classified into the LP group. LP was significantly associated with in-hospital mortality (hazard ratio [HR] 2.32, [95% CI 1.39 to 3.87], p-value 0.001). In both the LP and NL groups, lower lymphocyte counts between 7 and 10 days-categorized as the "persistent" and "exacerbated" groups-was associated with in-hospital mortality (HR 4.65, [95% CI 2.07 to 10.47], p-value <0.001, and HR 5.59, [95% CI 2.24 to 13.97], p-value <0.001, respectively). CONCLUSIONS: Early lymphopenia is predictive of poor prognosis in patients with COVID-19. A declining lymphocyte count trend post-onset further indicates disease deterioration.

Functional outcomes following injury in pediatric patients without traumatic brain injury
Ryo Yamamoto; Lillian Liao; Keitaro Yajima; Akira Endo; Kazuma Yamakawa; Junichi Sasaki
Journal of Pediatric Surgery Open, 2025年01月
研究論文（学術雑誌）

Author Correction: Optogenetic stimulation of vagal nerves for enhanced glucose-stimulated insulin secretion and β cell proliferation.
Yohei Kawana; Junta Imai; Yosuke M Morizawa; Yoko Ikoma; Masato Kohata; Hiroshi Komamura; Toshihiro Sato; Tomohito Izumi; Junpei Yamamoto; Akira Endo; Hiroto Sugawara; Haremaru Kubo; Shinichiro Hosaka; Yuichiro Munakata; Yoichiro Asai; Shinjiro Kodama; Kei Takahashi; Keizo Kaneko; Shojiro Sawada; Tetsuya Yamada; Akira Ito; Kuniyasu Niizuma; Teiji Tominaga; Akihiro Yamanaka; Ko Matsui; Hideki Katagiri
Nature biomedical engineering, 8, 11, 1501, 1501, 2024年11月, ［国際誌］
英語

Veno-arterial extracorporeal membrane oxygenation uses in trauma: a retrospective analysis of the Japanese nationwide trauma registry.
Tomohiro Akutsu; Akira Endo; Ryo Yamamoto; Kazuma Yamakawa; Keisuke Suzuki; Hiromasa Hoshi; Yasuhiro Otomo; Koji Morishita
BMC emergency medicine, 24, 1, 179, 179, 2024年10月08日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Extracorporeal membrane oxygenation (ECMO) can provide temporary circulatory support and vital organ oxygenation and is potentially useful as a bridge therapy in some trauma cases. We aimed to demonstrate the characteristics and outcomes of patients with trauma treated with veno-arterial ECMO (V-A ECMO) using data from a Japanese nationwide trauma registry. METHODS: This retrospective descriptive study analyzed data from the Japan Trauma Data Bank between January 2019 and December 2021. Patients with severe trauma (injury severity score [ISS] ≥ 9) and treated using V-A ECMO were assessed. RESULTS: Among the 72,439 patients with severe trauma, 51 received V-A ECMO. Sixteen patients (31.3%) survived until hospital discharge. On hospital arrival, six (37.5%) survivors and 15 (42.9%) non-survivors experienced cardiac arrest. The median ISS for the survivor and non-survivor group was 25 (range, 25-39) and 25 (range, 17-33), respectively. Thoracic trauma was the most common type of trauma in both groups. In the non-survivor group, open-chest cardiopulmonary resuscitation, aortic cross-clamping, and resuscitative endovascular balloon occlusion of the aorta were performed in 10 (28.6%), 5 (14.3%), and 4 (11.4%) patients, respectively. However, these procedures were not performed in the survivor group. Peripheral oxygen saturation tended to be lower in the survivor group both before and upon arrival at the hospital. CONCLUSIONS: The results of this study suggest the potential benefit of V-A ECMO in some challenging trauma cases. Further studies are warranted to assess the indications for V-A ECMO in patients with trauma.

Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for trauma and its performance in Japan over the past 18 years: a nationwide descriptive study.
Hiromasa Hoshi; Akira Endo; Ryo Yamamoto; Kazuma Yamakawa; Keisuke Suzuki; Tomohiro Akutsu; Koji Morishita
World journal of emergency surgery : WJES, 19, 1, 19, 19, 2024年05月31日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to control massive hemorrhages. Although there is no consensus on the efficacy of REBOA, it remains an option as a bridging therapy in non-trauma centers where trauma surgeons are not available. To better understand the current landscape of REBOA application, we examined changes in its usage, target population, and treatment outcomes in Japan, where immediate hemostasis procedures sometimes cannot be performed. METHODS: This retrospective observational study used the Japan Trauma Data Bank data. All cases in which REBOA was performed between January 2004 and December 2021 were included. The primary outcome was the in-hospital mortality rate. We analyzed mortality trends over time according to the number of cases, number of centers, severity of injury, and overall and subgroup mortality associated with REBOA usage. We performed a logistic analysis of mortality trends over time, adjusting for probability of survival based on the trauma and injury severity score. RESULTS: Overall, 2557 patients were treated with REBOA and were deemed eligible for inclusion. The median age of the participants was 55 years, and male patients constituted 65.3% of the study population. Blunt trauma accounted for approximately 93.0% of the cases. The number of cases and facilities that used REBOA increased until 2019. While the injury severity score and revised trauma score did not change throughout the observation period, the hospital mortality rate decreased from 91.3 to 50.9%. The REBOA group without severe head or spine injuries showed greater improvement in mortality than the all-patient group using REBOA and all-trauma patient group. The greatest improvement in mortality was observed in patients with systolic blood pressure ≥ 80 mmHg. The adjusted odds ratios for hospital mortality steadily declined, even after adjusting for the probability of survival. CONCLUSIONS: While there was no significant change in patient severity, mortality of patients treated with REBOA decreased over time. Further research is required to determine the reasons for these improvements in trauma care.

A well-managed case of discontinuous anorectal injury caused by a personal watercraft treated by combining surgery and colonoscopy.
Hiraaki Okuzawa; Akira Endo; Tomohiro Akutsu; Keisuke Suzuki; Hiromasa Hoshi; Shunichiro Kato; Koji Ito; Yasuhiro Otomo; Koji Morishita
Acute medicine & surgery, 11, 1, e972, 2024年, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Anorectal injury caused by personal watercraft (PWC)-related trauma is rare. However, PWC accidents have increased recently, and since patients tend to be younger, treatment strategies should consider anal function preservation in addition to saving lives. CASE PRESENTATION: A 30-year-old female patient who fell into the water when a PWC suddenly accelerated and injured her perineum with a forceful water jet was transported to our hospital. On examination, she was diagnosed with a traumatic rectal perforation with intraperitoneal findings and an anorectal injury. Emergency surgery, which involved direct suturing, temporary colostomy with intraoperative endoscopy for the rectal perforation, and anorectal reconstruction, was performed. The patient was discharged on postoperative day 19 without complications, and the colostomy was closed 5 months postoperatively. CONCLUSION: We encountered a case of multiple noncontinuous anorectal injuries due to a PWC accident that was successfully treated using a combination of surgery and intraoperative endoscopy.

Effect of Inhaled Ciclesonide in Non-Critically Ill Hospitalized Patients With Coronavirus Disease 2019: A Multicenter Observational Study in Japan.
Jun Suzuki; Shiro Endo; Takayuki Suzuki; Teppei Sasahara; Shuji Hatakeyama; Yuji Morisawa; Mineji Hayakawa; Kazuma Yamakawa; Akira Endo; Takayuki Ogura; Atsushi Hirayama; Hideo Yasunaga; Takashi Tagami
Open forum infectious diseases, 10, 12, ofad571, 2023年12月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic. Although systemic steroids play an important role in treating patients with severe COVID-19, the role of inhaled corticosteroids in non-critically ill, hospitalized patients with COVID-19 remains unclear. METHODS: We analyzed findings in non-critically ill, hospitalized patients with COVID-19 who were >18 years old and were admitted to 64 Japanese hospitals between January and September 2020. We performed propensity score matching analysis to evaluate 28-day and in-hospital mortality rates with or without inhaled ciclesonide within 2 days of admission. Sensitivity analyses using inverse probability weighting analysis, and generalized estimating equation method were also performed. RESULTS: Eligible patients (n = 3638) were divided into ciclesonide (n = 290) and control (n = 3, 393) groups. The 1-to-4 propensity score matching analysis included 271 ciclesonide users and 1084 nonusers. There were no significant differences between the 2 groups for 28-day (3.3% vs 2.3%; risk difference, 1.0% [95% confidence interval, -1.2 to 3.3]) or in-hospital (4.8% vs 2.6%; risk difference, 2.2 [-.5 to 4.9]) mortality rates. The sensitivity analysis showed similar outcomes. CONCLUSIONS: From this multicenter observational study in Japan, inhaled ciclesonide did not decrease 28-day or in-hospital mortality rates in non-critically ill, hospitalized patients with COVID-19. Future large, multinational, randomized trials are required to confirm our results.

Associated organs and system with COVID-19 death with information of organ support: a multicenter observational study
Ryuichi Nakayama; Naofumi Bunya; Takashi Tagami; Mineji Hayakawa; Kazuma Yamakawa; Akira Endo; Takayuki Ogura; Atsushi Hirayama; Hideo Yasunaga; Shuji Uemura; Eichi Narimatsu
BMC Infectious Diseases, 23, 1, 814, 814, Springer Science and Business Media LLC, 2023年11月20日, ［国際誌］
英語, 研究論文（学術雑誌）, Abstract

Background

The organ dysfunction that is associated with death in COVID-19 patients has not been determined in multicenter epidemiologic studies. In this study, we evaluated the major association with death, concomitant organ dysfunction, and proportion of multiple organ failure in deaths in patients with COVID-19, along with information on organ support.

Methods

We performed an observational cohort study using the Japanese multicenter research of COVID-19 by assembling a real-world data (J-RECOVER) study database. This database consists of data on patients discharged between January 1 and September 31, 2020, with positive SARS-CoV-2 test results, regardless of intensive care unit admission status. These data were collected from the Diagnosis Procedure Combination and electronic medical records of 66 hospitals in Japan. The clinician identified and recorded the organ responsible for the death of COVID-19.

Results

During the research period, 4,700 patients with COVID-19 were discharged from 66 hospitals participating in the J-RECOVER study; of which, 272 patients (5.8%) from 47 institutions who died were included in this study. Respiratory system dysfunction (87.1%) was the leading association with death, followed by cardiovascular (4.8%), central nervous (2.9%), gastrointestinal (2.6%), and renal (1.1%) dysfunction. Most patients (96.7%) who died of COVID-19 had respiratory system damage, and about half (48.9%) had multi-organ damage. Of the patients whose main association with death was respiratory dysfunction, 120 (50.6%) received mechanical ventilation.

Conclusion

This study showed that although respiratory dysfunction was the most common association with death in many cases, multi-organ dysfunction was associated with death due to COVID-19.

Trends in massive transfusion practice for trauma in Japan from 2011 to 2020: a nationwide inpatient database study.
Hiroyuki Ohbe; Takashi Tagami; Akira Endo; Shigeki Miyata; Hiroki Matsui; Kiyohide Fushimi; Shigeki Kushimoto; Hideo Yasunaga
Journal of intensive care, 11, 1, 46, 46, 2023年10月18日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Previous studies have reported conflicting results regarding fresh frozen plasma (FFP)-to-red blood cell (RBC) ratio and platelet-to-RBC ratio on outcomes for massive transfusion for trauma. Moreover, nationwide data on massive transfusion practices for trauma in the real-world clinical setting are scarce. This study aimed to examine the nationwide practice patterns and trends in massive transfusion for trauma in Japan using a national administrative, inpatient database. METHOD: We identified patients who underwent emergency hospitalization for trauma and received massive transfusion, defined as administration of at least 20 units of RBC within the first 2 days of admission, using the nationwide inpatient database, which covers approximately 90% of all tertiary emergency hospitals in Japan, between 2011 and 2020. Trends in the incidence and practice patterns of massive transfusion were described by calendar year. The association of practice patterns with mortality or adverse events was tested. RESULTS: A total of 3,530,846 trauma hospitalizations were identified, of which 5247 (0.15%) received massive transfusion. A significant declining trend was observed in the incidence of massive transfusion in trauma hospitalizations from 0.24% in 2011 to 0.10% in 2020 (P for trend < 0.001). The FFP-to-RBC ratio rose significantly from 0.77 in 2011 to 1.08 in 2020 (P for trend < 0.001), while the platelet-to-RBC ratio remained virtually unchanged from 0.71 in 2011 to 0.78 in 2020 (P for trend 0.060). Massive transfusion with lower FFP-to-RBC (< 0.75) and platelets-to-RBC ratio (< 1.00) were associated with increased in-hospital mortality compared with those ≥ 1.00, while there were linear increases in adverse events with increasing FFP and platelets ratios. CONCLUSIONS: This study demonstrated a declining trend in the incidence and a rise in higher FFP-to-RBC ratios in massive transfusion in association with patient outcomes for trauma from 2011 to 2020 in Japan.

Effectiveness of intravenous immunoglobulin therapy for invasive group A Streptococcus infection: A Japanese nationwide observational study.
Atsushi Senda; Akira Endo; Kiyohide Fushimi; Yasuhiro Otomo
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 135, 84, 90, 2023年10月, ［国際誌］
英語, 研究論文（学術雑誌）, OBJECTIVES: Invasive group A Streptococcus infection (iGAS) is a rare but fatal condition. We aimed to evaluate the effectiveness of intravenous immunoglobulin (IVIG) in the treatment of iGAS. METHODS: Patients' data were extracted from a Japanese nationwide database between April 2018 and March 2021. The primary outcome was in-hospital mortality rate, whereas the secondary outcomes were 30-day and 7-day mortality rates. RESULTS: Overall, 481 patients (median age, 65 years; female, 49.7%) were included in the analysis. The overall mortality rate was 31.0%. After adjusting for background factors, we found that IVIG treatment had no effect on in-hospital mortality (adjusted odds ratio [OR]: 0.99, 95% confidence interval [CI]: 0.93-1.04, P = 0.92). Similar results were obtained after propensity score matching (OR: 1.00, 95% CI: 0.62-1.61, P >0.99). The 7-day and 30-day mortality rates were not associated with IVIG treatment. CONCLUSION: IVIG administration had no survival benefit in iGAS patients. However, these overall findings should not be extrapolated to streptococcal toxic shock syndrome as the effect of IVIG therapy in this condition remains uncertain. Considering the rarity of iGAS, conducting a randomized controlled trial may be impractical. Therefore, an equivalent or more extensive observational study is warranted to validate these findings.

Time-saving effect of real-time ultrasound-guided cannulation for extracorporeal cardiopulmonary resuscitation: A multicenter retrospective cohort study.
Keita Nakatsutsumi; Akira Endo; Todd W Costantini; Wataru Takayama; Koji Morishita; Yasuhiro Otomo; Akihiko Inoue; Toru Hifumi; Tetsuya Sakamoto; Yasuhiro Kuroda
Resuscitation, 191, 109927, 109927, 2023年10月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR), a bridge to treatments for cardiac arrest patients, can be technically challenging and requires expertise. While ultrasound guidance is frequently used for vascular access, its effects on cannulation time in patients treated with ECPR are poorly defined. We hypothesized that real-time ultrasound guidance would contribute to faster and safer cannulation for ECPR. METHODS: This nationwide, multicenter, retrospective study analyzed data from 36 Japanese institutions. Patients who were over age 18 years and underwent ECPR between January 1, 2013, and December 31, 2018, were included. Patients who underwent open surgical vascular access were excluded. Cannulation time and outcomes of patients who underwent real-time ultrasound-guided cannulation (i.e., ultrasound-guided group) were compared to those cannulated without the use of real-time ultrasound guidance (control group) using propensity score matching analysis. RESULTS: The ultrasound-guided group comprised 510 cases, whereas the control group comprised 941 cases. Of those, 443 propensity score-matched pairs were evaluated. Cannulation time in the ultrasound-guided group was 2.5 minutes shorter than in the control group [difference, -2.5 minutes; 95% Confidence interval (CI), -3.7 to -1.3, p < 0.001]. The incidence of catheter-related complications and the incidence of the poor neurological outcomes (Cerebral Performance Category ≥3) did not differ between groups [Odds ratio (OR), 1.51; 95% CI, 0.64-3.74; OR, 1.08; 95% CI, 0.83-1.59]. CONCLUSION: Real-time ultrasound-guided cannulation was associated with shorter cannulation time of ECPR.

Early restricted oxygen therapy after resuscitation from cardiac arrest (ER-OXYTRAC): protocol for a stepped-wedge cluster randomised controlled trial.
Ryo Yamamoto; Kazuma Yamakawa; Akira Endo; Koichiro Homma; Yasunori Sato; Ryo Takemura; Takeshi Yamagiwa; Keiki Shimizu; Daiki Kaito; Masayuki Yagi; Taku Yonemura; Takayuki Shibusawa; Ginga Suzuki; Takahiro Shoji; Naoya Miura; Jiro Takahashi; Chihiro Narita; Saori Kurata; Kazunobu Minami; Takeshi Wada; Yoshihisa Fujinami; Yohei Tsubouchi; Mai Natsukawa; Jun Nagayama; Wataru Takayama; Ken Ishikura; Kyoko Yokokawa; Yasuo Fujita; Hirofumi Nakayama; Hideki Tokuyama; Kota Shinada; Takayuki Taira; Shoki Fukui; Noritaka Ushio; Masaki Nakane; Eisei Hoshiyama; Akihito Tampo; Hisako Sageshima; Hiroki Takami; Shinichi Iizuka; Hitoshi Kikuchi; Jun Hagiwara; Takashi Tagami; Yumi Funato; Junichi Sasaki; Study Group Er-Oxytrac
BMJ open, 13, 9, e074475, 2023年09月15日, ［国際誌］
英語, 研究論文（学術雑誌）, INTRODUCTION: Cardiac arrest is a critical condition, and patients often experience postcardiac arrest syndrome (PCAS) even after the return of spontaneous circulation (ROSC). Administering a restricted amount of oxygen in the early phase after ROSC has been suggested as a potential therapy for PCAS; however, the optimal target for arterial partial pressure of oxygen or peripheral oxygen saturation (SpO2) to safely and effectively reduce oxygen remains unclear. Therefore, we aimed to validate the efficacy of restricted oxygen treatment with 94%-95% of the target SpO2 during the initial 12 hours after ROSC for patients with PCAS. METHODS AND ANALYSIS: ER-OXYTRAC (early restricted oxygen therapy after resuscitation from cardiac arrest) is a nationwide, multicentre, pragmatic, single-blind, stepped-wedge cluster randomised controlled trial targeting cases of non-traumatic cardiac arrest. This study includes adult patients with out-of-hospital or in-hospital cardiac arrest who achieved ROSC in 39 tertiary centres across Japan, with a target sample size of 1000. Patients whose circulation has returned before hospital arrival and those with cardiac arrest due to intracranial disease or intoxication are excluded. Study participants are assigned to either the restricted oxygen (titration of a fraction of inspired oxygen with 94%-95% of the target SpO2) or the control (98%-100% of the target SpO2) group based on cluster randomisation per institution. The trial intervention continues until 12 hours after ROSC. Other treatments for PCAS, including oxygen administration later than 12 hours, can be determined by the treating physicians. The primary outcome is favourable neurological function, defined as cerebral performance category 1-2 at 90 days after ROSC, to be compared using an intention-to-treat analysis. ETHICS AND DISSEMINATION: This study has been approved by the Institutional Review Board at Keio University School of Medicine (approval number: 20211106). Written informed consent will be obtained from all participants or their legal representatives. Results will be disseminated via publications and presentations. TRIAL REGISTRATION NUMBER: UMIN Clinical Trials Registry (UMIN000046914).

A case of fulminant myocarditis with full recovery after a 38-h sustained asystole.
Tomohiro Akutsu; Akira Endo; Hiroyuki Sonobe; Keisuke Suzuki; Kiyoshi Murata; Yasuhiro Otomo
Clinical case reports, 11, 8, e7722, 2023年08月, ［国際誌］
英語, 研究論文（学術雑誌）, KEY CLINICAL MESSAGE: Even if cardiac rhythm deteriorated to asystole in the clinical course of fulminant myocarditis, cardiac function may recover, and the patient may be discharged without brain damage, if circulation could be maintained by appropriate mechanical cardiac supports. ABSTRACT: A 69-year-old man was diagnosed with fulminant myocarditis with circulatory collapse. His cardiac rhythm deteriorated to asystole on the second day; however, circulatory status was maintained through extracorporeal membrane oxygenation and intra-aortic balloon pumping. After 38 h-lasting asystole, his heart resumed beating. He was discharged without neurological deficits on Day 25.

Manual Chest Compression versus Automated Chest Compression Device during Day-Time and Night-Time Resuscitation Following Out-of-Hospital Cardiac Arrest: A Retrospective Historical Control Study
Wataru Takayama; Akira Endo; Koji Morishita; Yasuhiro Otomo
Journal of Personalized Medicine, 13, 8, 2023年07月28日, ［国際誌］
英語, 研究論文（学術雑誌）, OBJECTIVE: We assessed the effectiveness of automated chest compression devices depending on the time of admission based on the frequency of iatrogenic chest injuries, the duration of in-hospital resuscitation efforts, and clinical outcomes among out-of-hospital cardiac arrest (OHCA) patients. METHODS: We conducted a retrospective historical control study of OHCA patients in Japan between 2015-2022. The patients were divided according to time of admission, where day-time was considered 07:00-22:59 and night-time 23:00-06:59. These patients were then divided into two categories based on the in-hospital cardiopulmonary resuscitation (IHCPR) device: manual chest compression (mCC) group and automatic chest compression devices (ACCD) group. We used univariate and multivariate ordered logistic regression models adjusted for pre-hospital confounders to evaluate the impact of ACCD use during IHCPR on outcomes (IHCPR duration, CPR-related chest injuries, and clinical outcomes) in the day-time and night-time groups. RESULTS: Among 1101 patients with OHCA (day-time, 809; night-time, 292), including 215 patients who underwent ACCD during IHCPR in day-time (26.6%) and 104 patients in night-time group (35.6%), the multivariate model showed a significant association of ACCD use with the outcomes of in-hospital resuscitation and higher rates of return in spontaneous circulation, lower incidence of CPR-related chest injuries, longer in-hospital resuscitation durations, greater survival to Emergency Department and hospital discharge, and greater survival with good neurological outcome to hospital discharge, though only in the night-time group. CONCLUSIONS: Patients who underwent ACCD during in-hospital resuscitation at night had a significantly longer duration of in-hospital resuscitation, a lower incidence of CPR-related chest injuries, and better outcomes.

Association between obesity and mortality in critically ill COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective observational study.
Keiichiro Shimoyama; Akira Endo; Takashi Shimazui; Takashi Tagami; Kazuma Yamakawa; Mineji Hayakawa; Takayuki Ogura; Atsushi Hirayama; Hideo Yasunaga; Jun Oda
Scientific reports, 13, 1, 11961, 11961, 2023年07月24日, ［国際誌］
英語, 研究論文（学術雑誌）, This study aimed to determine whether obesity and disease outcomes are associated in patients with critically-ill coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation (IMV). This retrospective observational study using Japanese multicenter registry data included COVID-19 patients who required IMV and were discharged between January and September 2020. The patients were divided into the obese (body mass index [BMI] ≥ 25 kg/m2) and nonobese (BMI < 25 kg/m2) groups. Logistic regression models were used to analyze the association between obesity and disease outcomes. The primary outcome was in-hospital mortality; the secondary outcome was venovenous extracorporeal membrane oxygenation (VV-ECMO) implementation. Altogether, 477 patients were enrolled (obese, n = 235, median BMI, 28.2 kg/m2; nonobese, n = 242, median BMI, 22.4 kg/m2). Obesity was significantly associated with lower in-hospital mortality in the unadjusted logistic regression model (odds ratio 0.63; 95% confidence interval, 0.42-0.97; p = 0.033), but not with mortality in the adjusted logistic regression model using age, sex, and Charlson Comorbidity Index as covariates (p = 0.564). Obesity was not associated with VV-ECMO implementation in both unadjusted and adjusted models (unadjusted, p = 0.074; adjusted, p = 0.695). Obesity was not associated with outcomes in COVID-19 patients requiring IMV. Obesity may not be a risk factor for poor outcomes in these patients.

The Restrictive Red Blood Cell Transfusion Strategy for Critically Injured Patients (RESTRIC) trial: a cluster-randomized, crossover, non-inferiority multicenter trial of restrictive transfusion in trauma.
Mineji Hayakawa; Takashi Tagami; Daisuke Kudo; Kota Ono; Makoto Aoki; Akira Endo; Tetsuya Yumoto; Yosuke Matsumura; Shiho Irino; Kazuhiko Sekine; Noritaka Ushio; Takayuki Ogura; Sho Nachi; Yuhei Irie; Katsura Hayakawa; Yusuke Ito; Yuko Okishio; Tomohiro Muronoi; Yoshinori Kosaki; Kaori Ito; Keita Nakatsutsumi; Yutaka Kondo; Taichiro Ueda; Hiroshi Fukuma; Yuichi Saisaka; Naoki Tominaga; Takeo Kurita; Fumihiko Nakayama; Tomotaka Shibata; Shigeki Kushimoto
Journal of intensive care, 11, 1, 34, 34, 2023年07月24日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: The efficacies of fresh frozen plasma and coagulation factor transfusion have been widely evaluated in trauma-induced coagulopathy management during the acute post-injury phase. However, the efficacy of red blood cell transfusion has not been adequately investigated in patients with severe trauma, and the optimal hemoglobin target level during the acute post-injury and resuscitation phases remains unclear. Therefore, this study aimed to examine whether a restrictive transfusion strategy was clinically non-inferior to a liberal transfusion strategy during the acute post-injury phase. METHODS: This cluster-randomized, crossover, non-inferiority multicenter trial was conducted at 22 tertiary emergency medical institutions in Japan and included adult patients with severe trauma at risk of major bleeding. The institutions were allocated a restrictive or liberal transfusion strategy (target hemoglobin levels: 7-9 or 10-12 g/dL, respectively). The strategies were applied to patients immediately after arrival at the emergency department. The primary outcome was 28-day survival after arrival at the emergency department. Secondary outcomes included transfusion volume, complication rates, and event-free days. The non-inferiority margin was set at 3%. RESULTS: The 28-day survival rates of patients in the restrictive (n = 216) and liberal (n = 195) strategy groups were 92.1% and 91.3%, respectively. The adjusted odds ratio for 28-day survival in the restrictive versus liberal strategy group was 1.02 (95% confidence interval: 0.49-2.13). Significant non-inferiority was not observed. Transfusion volumes and hemoglobin levels were lower in the restrictive strategy group than in the liberal strategy group. No between-group differences were noted in complication rates or event-free days. CONCLUSIONS: Although non-inferiority of the restrictive versus liberal transfusion strategy for 28-day survival was not statistically significant, the mortality and complication rates were similar between the groups. The restrictive transfusion strategy results in a lower transfusion volume. TRIAL REGISTRATION NUMBER: umin.ac.jp/ctr: UMIN000034405, registration date: 8 October 2018.

Prophylactic effect of negative-pressure wound therapy and delayed sutures against incisional-surgical site infection after emergency laparotomy for colorectal perforation: A multicenter retrospective cohort study.
Keita Nakatsutsumi; Akira Endo; Hiroshi Asano; Shoichi Shinohara; Ryo Kurosaki; Shuji Kawashima; Wataru Ishii; Masashi Nozawa; Nobumi Tagaya; Yasuhiro Otomo
Annals of gastroenterological surgery, 7, 3, 441, 449, 2023年05月, ［国内誌］
英語, 研究論文（学術雑誌）, AIM: The prophylactic effect of negative-pressure wound therapy against incisional surgical site infection after highly contaminated laparotomies has not been sufficiently explored. This study aimed to evaluate the prophylactic effect of negative-pressure wound therapy against incisional surgical site infection after emergency surgery for colorectal perforation. METHODS: This nationwide, multicenter, retrospective cohort study analyzed data from the 48 emergency hospitals certificated by the Japanese Society for Abdominal Emergency Medicine. Patients who underwent an emergency laparotomy for colorectal perforation between April 2015 and March 2020 were included in this study. Outcomes, including the incidence of incisional surgical site infection, were compared between patients who were treated with prophylactic negative-pressure wound therapy and delayed sutures (i.e., negative-pressure wound therapy group) and patients who were treated with regular wound management (i.e., control group) using 1:4 propensity score matching analysis. RESULTS: The negative-pressure wound therapy group comprised 88 patients, whereas the control group consisted of 1535 patients. Of them, 82 propensity score-matched pairs (negative-pressure wound therapy group: 82; control group: 328) were evaluated. The negative-pressure wound therapy group showed a lower incidence of incisional surgical site infection [18 (22.0%) in the negative-pressure wound therapy group and 115 (35.0%) in the control group, odds ratio, 0.52; 95% confidence interval, 0.30 to 0.92; p = 0.026]. CONCLUSIONS: The prophylactic use of negative-pressure wound therapy with delayed sutures was associated with a lower incidence of incisional surgical site infection after emergency surgery for colorectal perforation.

Decreased community-acquired pneumonia coincided with rising awareness of precautions before governmental containment policy in Japan.
Masato Tashiro; Shuntaro Sato; Akira Endo; Ryosuke Hamashima; Yuya Ito; Nobuyuki Ashizawa; Kazuaki Takeda; Naoki Iwanaga; Shotaro Ide; Ayumi Fujita; Takahiro Takazono; Kazuko Yamamoto; Takeshi Tanaka; Akitsugu Furumoto; Katsunori Yanagihara; Hiroshi Mukae; Kiyohide Fushimi; Koichi Izumikawa
PNAS nexus, 2, 5, pgad153, 2023年05月, ［国際誌］
英語, 研究論文（学術雑誌）, The effectiveness of population-wide compliance to personal precautions (mask-wearing and hand hygiene) in preventing community-acquired pneumonia has been unknown. In Japan, different types of nonpharmaceutical interventions from personal precautions to containment and closure policies (CACPs, e.g. stay-at-home requests) were sequentially introduced from late January to April 2020, allowing for separate analysis of the effects of personal precautions from other more stringent interventions. We quantified the reduction in community-acquired pneumonia hospitalizations and deaths and assessed if it coincided with the timing of increased public awareness of personal precautions before CACPs were implemented. A quasi-experimental interrupted time-series design was applied to non-COVID-19 pneumonia hospitalization and 30-day death data from April 2015 to August 2020 across Japan to identify any trend changes between February and April 2020. We also performed a comparative analysis of pyelonephritis and biliary tract infections to account for possible changes in the baseline medical attendance. These trend changes were then compared with multiple indicators of public awareness and behaviors related to personal precautions, including keyword usage in mass media coverage and sales of masks and hand hygiene products. Hospitalizations and 30-day deaths from non-COVID-19 pneumonia dropped by 24.3% (95% CI 14.8-32.8) and 16.1% (5.5-25.5), respectively, in February 2020, before the implementation of CACPs, whereas pyelonephritis and biliary tract infections did not suggest a detectable change. These changes coincided with increases in indicators related to personal precautions rather than those related to contact behavior changes. Community-acquired pneumonia could be reduced by population-wide compliance to moderate precautionary measures.

Risk Factors Associated with Mortality among Mechanically Ventilated Patients with Coronavirus Disease 2019 Pneumonia: A Multicenter Cohort Study in Japan (J-RECOVER Study).
Mayu Hikone; Keita Shibahashi; Masahiro Fukuda; Yuichiro Shimoyama; Kazuma Yamakawa; Akira Endo; Mineji Hayakawa; Takayuki Ogura; Atsushi Hirayama; Hideo Yasunaga; Takashi Tagami
Internal medicine (Tokyo, Japan), 62, 15, 2187, 2194, 2023年04月28日, ［国内誌］
英語, 研究論文（学術雑誌）, Objective Mortality analyses of patients with coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation in Japan are limited. The present study therefore determined the risk factors for mortality in patients with COVID-19 requiring invasive mechanical ventilation. Methods This retrospective cohort study used the dataset from the Japanese multicenter research of COVID-19 by assembling real-word data (J-RECOVER) study that was conducted between January 1 and September 31, 2020. Independent risk factors associated with in-hospital mortality were evaluated using a multivariate logistic regression analysis. Kaplan-Meier estimates of the survival were calculated for different age groups. A subgroup analysis was performed to assess differences in survival rates according to additional risk factors, including an older age and chronic pulmonary disease. Patients A total of 561 patients were eligible. The median age was 67 (interquartile range: 56-75) years old, 442 (78.8%) were men, and 151 (26.9%) died in the hospital. Results Age, chronic pulmonary disease, and renal disease were significantly associated with in-hospital mortality. Compared with patients 18-54 years old, the adjusted odds ratios of patients 55-64, 65-74, and 75-94 years old were 3.34 (95% CI, 1.34-8.31), 7.07 (95% CI, 3.05-16.40), and 18.43 (95% CI, 7.94-42.78), respectively. Conclusion Age, chronic pulmonary disease, and renal disease were independently associated with mortality in patients with COVID-19 requiring invasive mechanical ventilation, and age was the most decisive indicator of a poor prognosis. Our results may aid in formulating treatment strategies and allocating healthcare resources.

Surgical strategy for airway management and bleeding control in penetrating neck injury in zone II: A case report.
Tomohiro Akutsu; Akira Endo; Hiroyuki Sonobe; Fumitaka Saida; Kyuhei Miyakawa; Fumino Takedatsu; Keisuke Suzuki; Kiyoshi Murata; Yasuhiro Otomo
Clinical case reports, 11, 1, e6862, 2023年01月, ［国際誌］
英語, 研究論文（学術雑誌）, We report the case of a 33-year-old man with a self-inflicted neck wound with severe hypopharynx injury, and hemorrhagic shock, which was well managed by a trauma surgeon trained in esophageal surgery. Training in cervical lymph node dissection for esophageal cancer could be useful in the management of penetrating neck injuries.

Usefulness of resuscitative endovascular balloon occlusion of the aorta compared to aortic cross-clamping in severely injured trauma patients: Analysis from the Japan Trauma Data Bank.
Koichi Haruta; Akira Endo; Atsushi Shiraishi; Yasuhiro Otomo
Acute medicine & surgery, 10, 1, e830, 2023年, ［国際誌］
英語, 研究論文（学術雑誌）, AIM: To compare in-hospital mortality of severely injured trauma patients who underwent resuscitative endovascular balloon occlusion of the aorta (REBOA) or aortic cross-clamping (ACC). METHODS: In this multicenter, retrospective cohort study using data from a nationwide trauma registry of tertiary emergency medical centers in Japan (n = 280), trauma patients who underwent aortic occlusion at the emergency department from 2004 to 2019 were divided into two groups according to the treatment they received: patients treated with ACC and patients who underwent placement of a REBOA catheter. Multiple imputations were used to handle the missing data. In-hospital mortality of the patients who underwent REBOA or ACC was compared using a mixed-effect logistic regression analysis and a propensity score-matching analysis, in which the confounders, including baseline patient demographics and severity, were adjusted. RESULTS: Of 1,670 patients (1,137 with REBOA and 533 with ACC), 66% were male. The median age was 56 years, and the mortality rate was 55.2% in the REBOA group and 81.6% in the ACC group. The mixed-effect model regression analysis showed a significantly lower odds ratio for in-hospital mortality rate in the REBOA group (odds ratio 0.17; 95% confidence interval, 0.12-0.26). A similar odds ratio was observed in the propensity score matching analysis (odds ratio 0.27; 95% confidence interval, 0.18-0.40). CONCLUSION: Compared with ACC, REBOA use was associated with decreased mortality in severely injured trauma patients.

Gastric tube perforation penetrating the pericardium after esophagectomy that needed surgical repair.
Tomohiro Akutsu; Akira Endo; Hiraaki Okuzawa; Keisuke Suzuki; Chisato Yonekawa; Hiromasa Hoshi; Yasuhiro Otomo
Acute medicine & surgery, 10, 1, e861, 2023年, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: As the prognosis of esophageal cancer surgery has improved, reports on postoperative complications of gastric tubes have increased. Among them, gastric tube ulcer perforation is infrequent but often severe and difficult to treat. CASE PRESENTATION: A 73-year-old man had undergone thoracoscopic subtotal esophagectomy and laparoscopic-assisted gastric tube reconstruction via the retrosternal route for thoracic esophageal cancer 8 years previously. He was transferred to our hospital with a diagnosis of gastric tube ulcer perforation, penetrating the pericardium. Emergency surgery was performed to remove the gastric tube, followed by immediate reconstruction by right colon interposition. The patient was discharged on postoperative day 142. CONCLUSION: We report a rare complication of gastric tube ulcer perforation, penetrating the pericardium, after esophagectomy for esophageal cancer. It was successfully treated with appropriate surgical management.

Relationship between institutional ventilated COVID-19 case volume and in-hospital death: A multicenter cohort study.
Shunsuke Amagasa; Satoko Uematsu; Mitsuru Kubota; Masahiro Kashiura; Hideto Yasuda; Mineji Hayakawa; Kazuma Yamakawa; Akira Endo; Takayuki Ogura; Atsushi Hirayama; Hideo Yasunaga; Takashi Tagami
PloS one, 18, 6, e0287310, 2023年, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: The volume-outcome relationship in patients with severe Coronavirus disease 2019 (COVID-19) is unclear and is important for establishing a system for the medical care of severe COVID-19. This study aimed to evaluate the association between institutional case volume and outcomes in patients with ventilated COVID-19. METHODS: We analyzed patients with severe COVID-19 on ventilatory control aged > 17 years who were enrolled in the J-RECOVER study, which is a retrospective multicenter observational study conducted between January 2020 and September 2020 in Japan. Based on the ventilated COVID-19 case volume, the higher one-third of institutions were defined as high-volume centers, the middle one-third as middle-volume centers, and the lower one-third as low-volume centers. The primary outcome measure was in-hospital mortality during hospitalization due to COVID-19. Multivariate logistic regression analysis for in-hospital mortality and ventilated COVID-19 case volume was performed after adjusting for multiple propensity scores and in-hospital variables. To estimate the multiple propensity score, we fitted a multinomial logistic regression model, which fell into one of the three groups based on patient demographics and prehospital factors. RESULTS: We analyzed 561 patients who required ventilator management. In total, 159, 210, and 192 patients were admitted to low-volume (36 institutions, < 11 severe COVID-19 cases per institution during the study period), middle-volume (14 institutions, 11-25 severe cases per institution), and high-volume (5 institutions, > 25 severe cases per institution) centers, respectively. After adjustment for multiple propensity scores and in-hospital variables, admission to middle- and high-volume centers was not significantly associated with in-hospital death compared with admission to low-volume centers (adjusted odds ratio, 0.77 [95% confidence interval (CI): 0.46-1.29] and adjusted odds ratio, 0.76 [95% CI: 0.44-1.33], respectively). CONCLUSIONS: There may be no significant relationship between institutional case volume and in-hospital mortality in patients with ventilated COVID-19.

Relationship between institutional intensive care volume prior to the COVID-19 pandemic and in-hospital death in ventilated patients with severe COVID-19.
Shunsuke Amagasa; Masahiro Kashiura; Hideto Yasuda; Mineji Hayakawa; Kazuma Yamakawa; Akira Endo; Takayuki Ogura; Atsushi Hirayama; Hideo Yasunaga; Takashi Tagami
Scientific reports, 12, 1, 22318, 22318, 2022年12月24日, ［国際誌］
英語, 研究論文（学術雑誌）, We aimed to evaluate the association between ICU patient volume before the COVID-19 pandemic and the outcomes of ventilated COVID-19 patients. We analyzed ventilated patients with COVID-19 aged > 17 years and enrolled in the J-RECOVER study, a retrospective multicenter observational study conducted in Japan between January and September 2020. Based on the number of patients admitted to the ICU between January and December 2019, the top third institutions were defined as high-volume centers, the middle third ones as middle-volume centers, and the bottom third ones as low-volume centers. The primary outcome measure was in-hospital mortality. Multivariate logistic regression analysis for in-hospital mortality and ICU patient volume was performed after adjusting for multiple propensity scores. Among 461 patients, 158, 158, and 145 patients were admitted to low-volume (20 institutions), middle-volume (14 institutions), and high-volume (13 institutions) centers, respectively. Admission to middle- and high-volume centers was not significantly associated with in-hospital death compared with admission to low-volume centers (adjusted odds ratio, 1.11 [95% confidence interval (CI): 0.55-2.25] and adjusted odds ratio, 0.81 [95% CI: 0.31-1.94], respectively). In conclusion, institutional intensive care patient volume prior to the COVID-19 pandemic was not significantly associated with in-hospital death in ventilated COVID-19 patients.

Development of practical triage methods for critical trauma patients: machine-learning algorithm for evaluating hybrid operation theatre entry of trauma patients (THETA).
Atsushi Senda; Akira Endo; Takahiro Kinoshita; Yasuhiro Otomo
European journal of trauma and emergency surgery : official publication of the European Trauma Society, 48, 6, 4755, 4760, 2022年12月, ［国際誌］
英語, 研究論文（学術雑誌）, PURPOSE: Hybrid operating rooms benefit patients with severe trauma but have a prerequisite of significant resources. This paper proposes a practical triage method to determine patients that should enter the hybrid operating room considering a limited availability of medical resources. METHODS: This retrospective observational study was conducted using the database from the Japan Trauma Data Bank comprising information collected between January 2004 and December 2018. A machine-learning-based triage algorithm was developed using the baseline demographics, injury mechanisms, and vital signs obtained from the database. The analysis dataset comprised information regarding 117,771 trauma patients with an abbreviated injury scale (AIS) > 3. The performance of the proposed model was compared against those of other statistical models [logistic regression and classification and regression tree (CART) models] while considering the status quo entry condition (systolic blood pressure < 90 mmHg). RESULTS: The proposed trauma hybrid-suite entry algorithm (THETA) outperformed other pre-existing algorithms [precision-recall area under the curve: THETA (0.59), logistic regression model (0.22), and classification and regression tree (0.20)]. CONCLUSION: A machine-learning-based algorithm was developed to triage patient entry into hybrid operating rooms. Although the validation in a prospective multicentre arrangement is warranted, the proposed algorithm could be a potentially useful tool in clinical practice.

Hospital-onset sepsis and community-onset sepsis in critical care units in Japan: a retrospective cohort study based on a Japanese administrative claims database
Mayuko Tonai; Atsushi Shiraishi; Toshiyuki Karumai; Akira Endo; Hirotada Kobayashi; Kiyohide Fushimi; Yoshiro Hayashi
Critical Care, 26, 1, 136, 136, 2022年12月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Hospital- and community-onset sepsis are significant sepsis subgroups. Japanese data comparing these subgroups are limited. This study aimed to describe the epidemiology of hospital- and community-onset sepsis in critical care units in Japan. METHODS: We performed a retrospective cohort study using the Japanese Diagnosis and Procedure Combination database. Adult patients admitted to critical care units with sepsis from April 2010 to March 2020 were included. Sepsis cases were identified based on ICD-10 codes for infectious diseases, procedure codes for blood culture tests, and medication codes for antimicrobials. Patients' characteristics, in-hospital mortality, and resource utilization were assessed. The in-hospital mortality between groups was compared using the Poisson regression generalized linear mixed-effect model. RESULTS: Of 516,124 patients, 52,183 (10.1%) had hospital-onset sepsis and 463,940 (89.9%) had community-onset sepsis. Hospital-onset sepsis was characterized by younger age, infrequent emergency hospitalization, frequent surgery under general anesthesia, and frequent organ support upon critical care unit admission compared to community-onset sepsis. In-hospital mortality was higher for hospital-onset than for community-onset sepsis (35.5% versus 19.2%; unadjusted mean difference, 16.3% [95% confidence interval (CI) 15.9-16.7]; adjusted mean difference, 15.6% [95% CI 14.9-16.2]). Mean hospital length of stay was longer for hospital-onset than for community-onset sepsis (47 days versus 30 days; unadjusted mean difference, 17 days [95% CI 16-17]; adjusted mean difference, 13 days [95% CI 12-14]). CONCLUSION: Patients with hospital-onset sepsis admitted to critical care units in Japan had a poorer prognosis and more resource utilization including organ support rate, number of days with critical care unit surcharge codes, and hospital length of stay than those with community-onset sepsis.

Optimal target blood pressure in elderly with septic shock (OPTPRESS) trial: study protocol for a randomized controlled trial
Akira Endo; Kazuma Yamakawa; Takashi Tagami; Yutaka Umemura; Kyosuke Takahashi; Hiroki Nagasawa; Yuichi Araki; Mitsuaki Kojima; Toshiki Sera; Masayuki Yagi; Ryo Yamamoto; Jiro Takahashi; Masaki Nakane; Chikashi Takeda; Chihiro Narita; Satoshi Kazuma; Hiroko Okura; Hiroyuki Takahashi; Takeshi Wada; Shu Tahara; Ayaka Matsuoka; Todani Masaki; Atsushi Shiraishi; Keiichiro Shimoyama; Yuta Yokokawa; Rintaro Nakamura; Hisako Sageshima; Yuichiro Yanagida; Kunihiko Takahashi; Yasuhiro Otomo
Trials, 23, 1, 799, 799, Springer Science and Business Media LLC, 2022年09月24日, ［国際誌］
英語, 研究論文（学術雑誌）, Abstract

Background

Hemodynamic stabilization is a core component in the resuscitation of septic shock. However, the optimal target blood pressure remains debatable. Previous randomized controlled trials suggested that uniformly adopting a target mean arterial pressure (MAP) higher than 65 mmHg for all adult septic shock patients would not be beneficial; however, it has also been proposed that higher target MAP may be beneficial for elderly patients, especially those with arteriosclerosis.

Methods

A multicenter, pragmatic single-blind randomized controlled trial will be conducted to compare target MAP of 80–85 mmHg (high-target) and 65–70 mmHg (control) in the resuscitation of septic shock patients admitted to 28 hospitals in Japan. Patients with septic shock aged ≥65 years are randomly assigned to the high-target or control groups. The target MAP shall be maintained for 72 h after randomization or until vasopressors are no longer needed to improve patients’ condition. To minimize the adverse effects related to catecholamines, if norepinephrine dose of ≥ 0.1 μg/kg/min is needed to maintain the target MAP, vasopressin will be initiated. Other therapeutic approaches, including fluid administration, hydrocortisone use, and antibiotic choice, will be determined by the physician in charge based on the latest clinical guidelines. The primary outcome is all-cause mortality at 90 days after randomization.

Discussion

The result of this trial will provide great insight on the resuscitation strategy for septic shock in the era of global aged society. Also, it will provide the better understanding on the importance of individualized treatment strategy in hemodynamic management in critically ill patients.

Trial registration

UMIN Clinical Trials Registry; UMIN000041775. Registered 13 September 2020.

Therapeutic anticoagulation using heparin in early phase severe coronavirus disease 2019: A retrospective study.
Wataru Takayama; Akira Endo; Yasuhiro Otomo
The American journal of emergency medicine, 58, 84, 88, 2022年08月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Although several reports recommend the use of systemic anticoagulation therapy in patients with severe coronavirus disease 2019 (COVID-19) pneumonia, appropriate target population and timing of administration are unknown. We assessed association between therapeutic anticoagulation administration with unfractionated heparin and outcomes in patients with severe COVID-19 pneumonia, assuming that anticoagulant administration effects are influenced by therapy timing. METHODS: This retrospective observational study included severe COVID-19 patients requiring mechanical ventilation in a tertiary emergency critical care hospital intensive care unit (ICU) in Japan from May 1, 2020 to September 30, 2021. All included patients were divided into early and late-phase administration groups based on therapeutic anticoagulant administration timing (≤5 and >5 days, respectively, after commencing oxygen therapy). Primary outcomes (in-hospital mortality and adverse events related to anticoagulation therapy) and secondary outcomes [veno-venous extracorporeal membrane oxygenation (ECMO), ventilator-free days (VFD), and ICU-free days] were compared between groups using univariate and multivariate models. RESULTS: Of 198 included patients 104 (52.5%) and 94 (47.5%) were in early-phase and late-phase administration groups, respectively. Although background characteristics were similar between the groups, the early-phase administration group had a significantly lower in-hospital mortality rate (3.8% vs. 27.7%; p < 0.001), lower adverse event rates (1.9% vs. 12.8%; p < 0.001), significantly longer VFD and ICU-free days, and lower ECMO rates, than the late-phase administration group, in the multivariate model. CONCLUSIONS: Late administration of therapeutic-dose anticoagulation in patients with severe COVID-19 pneumonia was significantly associated with worse outcomes than early administration.

Early intubation and decreased in-hospital mortality in patients with coronavirus disease 2019.
Ryo Yamamoto; Daiki Kaito; Koichiro Homma; Akira Endo; Takashi Tagami; Morio Suzuki; Naoyuki Umetani; Masayuki Yagi; Eisaku Nashiki; Tomohiro Suhara; Hiromasa Nagata; Hiroki Kabata; Koichi Fukunaga; Kazuma Yamakawa; Mineji Hayakawa; Takayuki Ogura; Atsushi Hirayama; Hideo Yasunaga; Junichi Sasaki
Critical care (London, England), 26, 1, 124, 124, 2022年05月06日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Some academic organizations recommended that physicians intubate patients with COVID-19 with a relatively lower threshold of oxygen usage particularly in the early phase of pandemic. We aimed to elucidate whether early intubation is associated with decreased in-hospital mortality among patients with novel coronavirus disease 2019 (COVID-19) who required intubation. METHODS: A multicenter, retrospective, observational study was conducted at 66 hospitals in Japan where patients with moderate-to-severe COVID-19 were treated between January and September 2020. Patients who were diagnosed as COVID-19 with a positive reverse-transcription polymerase chain reaction test and intubated during admission were included. Early intubation was defined as intubation conducted in the setting of ≤ 6 L/min of oxygen usage. In-hospital mortality was compared between patients with early and non-early intubation. Inverse probability weighting analyses with propensity scores were performed to adjust patient demographics, comorbidities, hemodynamic status on admission and time at intubation, medications before intubation, severity of COVID-19, and institution characteristics. Subgroup analyses were conducted on the basis of age, severity of hypoxemia at intubation, and days from admission to intubation. RESULTS: Among 412 patients eligible for the study, 110 underwent early intubation. In-hospital mortality was lower in patients with early intubation than those with non-early intubation (18 [16.4%] vs. 88 [29.1%]; odds ratio, 0.48 [95% confidence interval 0.27-0.84]; p = 0.009, and adjusted odds ratio, 0.28 [95% confidence interval 0.19-0.42]; p < 0.001). The beneficial effects of early intubation were observed regardless of age and severity of hypoxemia at time of intubation; however, early intubation was associated with lower in-hospital mortality only among patients who were intubated later than 2 days after admission. CONCLUSIONS: Early intubation in the setting of ≤ 6 L/min of oxygen usage was associated with decreased in-hospital mortality among patients with COVID-19 who required intubation. Trial Registration None.

Association between the plasma-to-red blood cell ratio and survival in geriatric and non-geriatric trauma patients undergoing massive transfusion: a retrospective cohort study.
Mitsuaki Kojima; Akira Endo; Atsushi Shiraishi; Tomohisa Shoko; Yasuhiro Otomo; Raul Coimbra
Journal of intensive care, 10, 1, 2, 2, 2022年01月11日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: The benefits of a high plasma-to-red blood cell (RBC) ratio on the survival of injured patients who receive massive transfusions remain unclear, especially in older patients. We aimed to investigate the interaction of age with the plasma-to-RBC ratio and clinical outcomes of trauma patients. METHODS: In this retrospective study conducted from 2013 to 2016, trauma patients who received massive transfusions were included. Using a generalized additive model (GAM),we assessed how the plasma-to-RBC ratio and age affected the in-hospital mortality rates. The association of the plasma-to-RBC ratio [low (< 0.5), medium (0.5-1.0), and high (≥ 1.0)] with in-hospital mortality and the incidence of adverse events were assessed for the overall cohort and for patients stratified into non-geriatric (16-64 years) and geriatric (≥ 65 years) groups using logistic regression analyses. RESULTS: In total, 13,894 patients were included. The GAM plot of the plasma-to-RBC ratio for in-hospital mortality demonstrated a downward convex unimodal curve for the entire cohort. The low-transfusion ratio group was associated with increased odds of in-hospital mortality in the non-geriatric cohort [odds ratio 1.38, 95% confidence interval (CI) 1.22-1.56]; no association was observed in the geriatric group (odds ratio 0.84, 95% CI 0.62-1.12). An increase in the transfusion ratio was associated with a higher incidence of adverse events in the non-geriatric and geriatric groups. CONCLUSION: The association of the non-geriatric age category and plasma-to-RBC ratio for in-hospital mortality was clearly demonstrated. However, the relationship between the plasma-to-RBC ratio with mortality among geriatric patients remains inconclusive.

Severe pancreatic injury with total disruption of main pancreatic duct successfully managed by multi-stage endoscopic therapy: a case report.
Kei Ito; Akira Endo; Masanori Kobayashi; Yasuhiro Otomo
Acute medicine & surgery, 9, 1, e735, 2022年, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: The management of pancreatic injury is not well-established. Recently, endoscopic therapy has been reported as a treatment option for main pancreatic duct disruption. CASE PRESENTATION: A 68-year-old man presented to our hospital and was diagnosed with severe traumatic pancreatic injury that developed 2 days prior. Endoscopic retrograde cholangiopancreatography revealed main pancreatic duct disruption. Although initial stenting to the distal main pancreatic duct was not achieved because of the widespread intermediate fluid collection, an endoscopic naso-pancreatic drainage tube was successfully inserted into via the main duodenal papilla. After drainage, the endoscopic naso-pancreatic drainage tube was replaced with an endoscopic retrograde pancreatic drainage tube, and a stent was successfully placed into the distal main pancreatic duct via the minor papilla. CONCLUSION: We report a case of severe pancreatic injury managed using multi-stage endoscopic therapy that could be a possible treatment strategy for pancreatic injury with total main pancreatic duct disruption.

Optimal target blood pressure in critically ill adult patients with vasodilatory shock: A systematic review and meta-analysis.
Hidero Yoshimoto; Satoshi Fukui; Koki Higashio; Akira Endo; Akira Takasu; Kazuma Yamakawa
Frontiers in physiology, 13, 962670, 962670, 2022年, ［国際誌］
英語, 研究論文（学術雑誌）, While the Surviving Sepsis Campaign guidelines recommend an initial target value of 65 mmHg as the mean arterial pressure (MAP) in patients with septic shock, the optimal MAP target for improving outcomes remains controversial. We performed a meta-analysis to evaluate the optimal MAP for patients with vasodilatory shock, which included three randomized controlled trials that recruited 3,357 patients. Between the lower (60-70 mmHg) and higher (>70 mmHg) MAP target groups, there was no significant difference in all-cause mortality (risk ratio [RR], 1.06; 95% confidence intervals [CI], 0.98-1.16) which was similar in patients with chronic hypertension (RR, 1.10; 95% CI, 0.98-1.24) and patients aged ≥65 years (RR, 1.10; 95% CI, 0.99-1.21). No significant difference in adverse events was observed between the different MAP groups (RR, 1.04; 95% CI, 0.87-1.24); however, supraventricular arrhythmia was significantly higher in the higher MAP group (RR, 1.73; 95% CI, 1.15-2.60). Renal replacement therapy was reduced in the higher MAP group of patients with chronic hypertension (RR, 0.83; 95% CI, 0.71-0.98). Though the higher MAP control did not improve the mortality rate, it may be beneficial in reducing renal replacement therapy in patients with chronic hypertension. Systematic review registration: UMIN Clinical Trials Registry, identifier UMIN000042624.

Effective hemostasis by preperitoneal pelvic packing for common iliac vein injury without pelvic fracture in severe blunt trauma: a case report
Akihiro Fujita; Keita Nakatsutsumi; Tatsuaki Takahashi; Tensei Suzuki; Choko Nakashima; Kei Ito; Akira Endo; Yasuhiro Otomo
ACUTE MEDICINE & SURGERY, 9, 1, 2022年01月
英語, 研究論文（学術雑誌）

Effective hemostasis by preperitoneal pelvic packing for common iliac vein injury without pelvic fracture in severe blunt trauma: a case report.
Akihiro Fujita; Keita Nakatsutsumi; Tatsuaki Takahashi; Tensei Suzuki; Choko Nakashima; Kei Ito; Akira Endo; Yasuhiro Otomo
Acute medicine & surgery, 9, 1, e771, 2022年, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: A common iliac vein injury in the absence of pelvic fractures due to blunt trauma is rare, with no treatment strategy established. CASE PRESENTATION: A 48-year-old man, who was injured in a dumbwaiter accident, presented to the hospital with hemorrhagic shock. Computed tomography (CT) revealed active bleeding from the intercostal and hepatic arteries as well as the left common iliac vein. No pelvic fracture was noted. Preperitoneal pelvic packing was performed for the left common iliac vein injury as a damage control surgery. After the operation, endovascular embolization was performed to address the arterial bleeding. The patient became hemodynamically stable, and follow-up CT showed no signs of bleeding. The packing gauze was removed 3 days after the admission. The patient was discharged without complications. CONCLUSION: Preperitoneal pelvic packing provided temporary hemostasis in a hemodynamically unstable patient with common iliac vein injury but with no pelvic fractures.

Japanese Multicenter Research of COVID-19 by Assembling Real-world Data: A Study Protocol
Takashi Tagami; Kazuma Yamakawa; Akira Endo; Mineji Hayakawa; Takayuki Ogura; Atsushi Hirayama; Hideo Yasunaga
Annals of Clinical Epidemiology, 4, 3, 92, 100, Society for Clinical Epidemiology, 2022年, ［国内誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Data on the evaluation of the clinical course of coronavirus disease 2019 (COVID-19) and the efficacy of treatments after hospitalization in Japan are limited. OBJECTIVE: This study aimed to construct a database of confirmed COVID-19 cases in Japan and promptly address unresolved research issues. METHODS: This multicenter observational study included patients who had a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and were discharged from each participating institution between January 1 and September 31, 2020. We called for participating facilities and research proposals until the end of September 2020. The research steering committee members provided advice to co-investigators on refining their research proposals and analyses. After developing the research proposal, we collected clinical information, facility information, and laboratory data from each participating institution. Clinical information was also obtained from the Diagnosis Procedure Combination (DPC) data using a dedicated software called DPC hash application. ANALYSIS: We planned to conduct an analysis based on the research proposal. Overall, 66 institutions from Japan announced their participation, and 102 research proposals were selected for the analyses. Research areas from the proposals included epidemiology, pathophysiology, therapeutic agents, ventilator settings, cost-benefit analyses, and prognosis prediction for COVID-19. CONTRIBUTION AND SIGNIFICANCE TO THE FIELD: We have established an efficient data collection system and clinical research team for COVID-19 infection studies. The results of this study may be utilized in future response strategies for COVID-19.

Dielectric Blood Coagulometry for the Early Detection of Sepsis-Induced Disseminated Intravascular Coagulation: A Prospective Observational Study.
Wataru Takayama; Akira Endo; Koji Morishita; Yasuhiro Otomo
Critical care medicine, 50, 1, e31-e39, 2021年08月09日, ［国際誌］
英語, 研究論文（学術雑誌）, OBJECTIVES: To evaluate the utility of dielectric blood coagulometry for early sepsis-induced disseminated intravascular coagulation diagnosis. DESIGN: Single-center, prospective observational study. SETTING: Patients with sepsis or septic shock at the Tokyo Medical and Dental University Hospital of Medicine between September 2019 and September 2020. PATIENTS: The patients were divided into three groups according to the timing of disseminated intravascular coagulation diagnosis based on the Disseminated Intravascular Coagulation score by the Japanese Association for Acute Medicine: 1) no disseminated intravascular coagulation group, 2) late-diagnosed disseminated intravascular coagulation group: not diagnosed with disseminated intravascular coagulation on day 1 but diagnosed within 48 hours after admission, and 3) disseminated intravascular coagulation group: diagnosed with disseminated intravascular coagulation on day 1. The study evaluated 80 patients (no disseminated intravascular coagulation, 31 [38.8%]; late-diagnosed disseminated intravascular coagulation, 34 (42.5%); disseminated intravascular coagulation, 15 [18.8%]). MEASUREMENTS AND MAIN RESULTS: We compared the clinical severity scores and mortality of the groups and assessed the correlation between the dielectric blood coagulometry-derived coagulation marker, thrombin levels, and Disseminated Intravascular Coagulation score using Spearman rank correlation. The mortality rate was 0% (0/31) in the no disseminated intravascular coagulation group, 35.3% (12/34) in the late-diagnosed disseminated intravascular coagulation group, and 33.3% (5/15) in the disseminated intravascular coagulation group. Although the Disseminated Intravascular Coagulation score on day 1 did not reflect disseminated intravascular coagulation in approximately 70% of patients who developed disseminated intravascular coagulation by day 2, dielectric clot strength measured by dielectric blood coagulometry on day 1 strongly correlated with disseminated intravascular coagulation development by day 2 (Spearman ρ = 0.824; p < 0.05) and with thrombin level on day 1 (Spearman ρ = 0.844; p < 0.05). CONCLUSIONS: Dielectric blood coagulometry can be used to detect early-phase disseminated intravascular coagulation in patients with sepsis and is strongly correlated with thrombin levels. Larger studies are needed to verify our results for developing clinical applications.

The impact of blood type on the mortality of patients with severe abdominal trauma: a multicenter observational study.
Wataru Takayama; Akira Endo; Kiyoshi Murata; Kota Hoshino; Shiei Kim; Hiroharu Shinozaki; Keisuke Harada; Hiroaki Nagano; Masahiro Hagiwara; Atsuhito Tsuchihashi; Nagato Shimada; Naomi Kitamura; Shunsuke Kuramoto; Yasuhiro Otomo
Scientific reports, 11, 1, 16147, 16147, 2021年08月09日, ［国際誌］
英語, 研究論文（学術雑誌）, Few studies have investigated the relationship between blood type and trauma outcomes according to the type of injury. We conducted a retrospective multicenter observational study in twelve emergency hospitals in Japan. Patients with isolated severe abdominal injury (abbreviated injury scale for the abdomen ≥ 3 and that for other organs < 3) that occurred between 2008 and 2018 were divided into four groups according to blood type. The association between blood type and mortality, ventilator-free days (VFD), and total transfusion volume were evaluated using univariate and multivariate regression models. A total of 920 patients were included, and were divided based on their blood type: O, 288 (31%); A, 345 (38%); B, 186 (20%); and AB, 101 (11%). Patients with type O had a higher in-hospital mortality rate than those of other blood types (22% vs. 13%, p < 0.001). This association was observed in multivariate analysis (adjusted odds ratio [95% confidence interval] = 1.48 [1.25-2.26], p = 0.012). Furthermore, type O was associated with significantly higher cause-specific mortalities, fewer VFD, and larger transfusion volumes. Blood type O was associated with significantly higher mortality and larger transfusion volumes in patients with isolated severe abdominal trauma.

Colon perforation as a complication of COVID-19: a case report.
Keita Nakatsutsumi; Akira Endo; Hiraaki Okuzawa; Iichiro Onishi; Anri Koyanagi; Eiki Nagaoka; Koji Morishita; Junichi Aiboshi; Yasuhiro Otomo
Surgical case reports, 7, 1, 175, 175, 2021年08月04日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Coagulopathy induced by COVID-19 has received much attention. Arterial and venous thrombosis of multiple organs due to COVID-19-related coagulopathy is associated with a poor outcome. CASE PRESENTATION: A 67-year-female was transferred to our hospital in need of intensive care for severe COVID-19 pneumonia. On day 7 after admission, despite the treatments, her respiratory and hemodynamic status deteriorated. Computed tomography revealed massive ascites and free air as well as wall defects of the transverse colon. An emergency laparotomy was undertaken in the intensive-care unit, and 17 cm of the transverse colon was resected. Histopathological findings revealed two perforation sites of 25 and 7 mm in diameter, necrosis of the intestinal mucosa around the perforation sites, and the microcirculatory thrombosis in the mesentery vessels which was suspected of having been induced by COVID-19-related coagulopathy. CONCLUSIONS: The case highlights the risk of intestinal ischemia and perforation induced by COVID-19 coagulopathy. Physicians treating COVID-19 should recognize the risk and evaluate patients carefully.

Planned Versus On-Demand Relaparotomy Strategy in Initial Surgery for Non-occlusive Mesenteric Ischemia
Akira Endo; Fumitaka Saida; Yuzuru Mochida; Shiei Kim; Yasuhiro Otomo; Daisuke Nemoto; Hisahiro Matsubara; Shigeru Yamagishi; Yoshinori Murao; Kazuki Mashiko; Satoshi Hirano; Kentaro Yoshikawa; Toshiki Sera; Mototaka Inaba; Hiroyuki Koami; Makoto Kobayashi; Kiyoshi Murata; Tomohisa Shoko; Noriaki Takiguchi
Journal of Gastrointestinal Surgery, 25, 7, 1837, 1846, Springer Science and Business Media {LLC}, 2021年07月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: There has been insufficient evidence regarding a treatment strategy for patients with non-occlusive mesenteric ischemia (NOMI) due to the lack of large-scale studies. We aimed to evaluate the clinical benefit of strategic planned relaparotomy in patients with NOMI using detailed perioperative information. METHODS: We conducted a multicenter retrospective cohort study that included NOMI patients who underwent laparotomy. In-hospital mortality, 28-day mortality, incidence of total adverse events, ventilator-free days, and intensive care unit (ICU)-free days were compared between groups experiencing the planned and on-demand relaparotomy strategies. Analyses were performed using a multivariate mixed effects model and a propensity score matching model after adjusting for pre-operative, intra-operative, and hospital-related confounders. RESULTS: A total of 181 patients from 17 hospitals were included, of whom 107 (59.1%) were treated using the planned relaparotomy strategy. The multivariate mixed effects regression model indicated no significant differences for in-hospital mortality (61 patients [57.0%] in the planned relaparotomy group vs. 28 patients [37.8%] in the on-demand relaparotomy group; adjusted odds ratio [95% confidence interval] = 1.94 [0.78-4.80]), as well as in 28-day mortality, adverse events, and ICU-free days. Significant reduction in ventilator-free days was observed in the planned relaparotomy group. Propensity score matching analysis of 61 matched pairs with comparable patient severity did not show superiority of the planned relaparotomy strategy. CONCLUSIONS: The planned relaparotomy strategy, compared with on-demand relaparotomy strategy, did not show clinical benefits after the initial surgery of patients with NOMI. Further studies estimating potential subpopulations who may benefit from this strategy are required.

Optimal target blood pressure in critically ill adult patients with vasodilatory shock: a protocol for a systematic review and meta-analysis.
Satoshi Fukui; Koki Higashio; Shuhei Murao; Akira Endo; Takasu Akira; Kazuma Yamakawa
BMJ open, 11, 3, e048512, 2021年03月19日, ［国際誌］
英語, 研究論文（学術雑誌）, INTRODUCTION: The optimal target of mean arterial pressure (MAP) for better outcomes in patients with vasodilatory shock remains a matter of debate. Although catecholamines are generally used to maintain target blood pressure in hypotensive patients with vasodilatory shock, the adverse effects of catecholamines must also be considered. We will perform a systematic review and meta-analysis of randomised controlled trials (RCTs) to assess the certainty of evidence determining the optimal target of MAP control for patients with vasodilatory shock in critically ill settings. METHODS AND ANALYSIS: This study protocol was registered in the University Hospital Medical Information Network Clinical Trials Registry. We will include only RCTs that evaluated the two different comparators for target MAP to be maintained for clinical outcomes of all-cause mortality: organ dysfunction and adverse events in critically ill adult patients with vasodilatory shock. We will search the electronic bibliographic databases of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials in November 2020. Two reviewers will independently screen titles and abstracts, perform full article reviews and extract study data. We will report study characteristics and assess methodological quality using the Cochrane Risk-of-Bias 2 tool. If pooling is appropriate, we will calculate relative risks with 95% CIs for all outcome measures. Clinical and methodological subgroup and sensitivity analyses will be performed to explore heterogeneity. Overall certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION: This study will not involve primary data collection, and formal ethics approval will therefore not be required. We aim to publish this systematic review in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: UMIN000042624.

Coronary spasm and optical coherence tomography defined plaque erosion causing ST-segment-elevation acute myocardial infarction in a patient with COVID-19 pneumonia
Masahiko Nakao; Junji Matsuda; Miho Iwai; Akira Endo; Taishi Yonetsu; Yasuhiro Otomo; Tetsuo Sasano
Journal of Cardiology Cases, 23, 2, 87, 89, Elsevier {BV}, 2021年02月, ［国内誌］
英語, 研究論文（学術雑誌）, An 84-year-old man with coronavirus disease 2019 pneumonia developed ST-segment-elevation myocardial infarction and was brought to the catheterization laboratory. His angiogram showed a haziness in distal right coronary artery, and optical coherence tomography (OCT) exhibited vascular spasm and OCT-defined plaque erosion, which were thought to be the causes of non-obstructive myocardial infarction. .

Physician-led prehospital management is associated with reduced mortality in severe blunt trauma patients: A retrospective analysis of the Japanese nationwide trauma registry
Akira Endo; Mitsuaki Kojima; Saya Uchiyama; Atsushi Shiraishi; Yasuhiro Otomo
Scandinavian journal of trauma, resuscitation and emergency medicine, 29, 1, 9, 9, Springer Science and Business Media {LLC}, 2021年01月04日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Although the results of previous studies suggested the effectiveness of physician-led prehospital trauma management, it has been uncertain because of the limited number of high-quality studies. Furthermore, the advantage of physician-led prehospital management might have been overestimated due to the shortened prehospital time by helicopter transportation in some studies. The present study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time. Also, subgroup analysis was performed to explore the subpopulation that especially benefit from physician-led prehospital management. METHODS: This retrospective cohort study analyzed the data of Japan's nationwide trauma registry. Severe blunt trauma patients, defined by Injury Severity Score (ISS) ≥16, who were transported directly to a hospital between April 2009 and March 2019 were evaluated. In-hospital mortality was compared between groups dichotomized by the occupation of primary prehospital healthcare provider (i.e., physician or paramedic), using 1:4 propensity score-matched analysis. The propensity score was calculated using potential confounders including patient demographics, mechanism of injury, vital signs at the scene of injury, ISS, and total time from injury to hospital arrival. Subpopulations that especially benefit from physician-led prehospital management were explored by assessing interaction effects between physician-led prehospital management and patient characteristics. RESULTS: A total of 30,551 patients (physician-led: 2976, paramedic-led: 27,575) were eligible for analysis, of whom 2690 propensity score-matched pairs (physician-led: 2690, paramedic-led: 10,760) were generated and compared. Physician-led group showed significantly decreased in-hospital mortality than paramedic-led group (in-hospital mortality: 387 [14.4%] and 1718 [16.0%]; odds ratio [95% confidence interval] = 0.88 [0.78-1.00], p = 0.044). Patients with age < 65 years, ISS ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and total prehospital time < 60 min were likely to benefit from physician-led prehospital management. CONCLUSIONS: Physician-led prehospital trauma management was significantly associated with reduced in-hospital mortality independent of prehospital time. The findings of exploratory subgroup analysis would be useful for the future research to establish efficient dispatch system of physician team.

Arterial and Venous Thrombosis Complicated in COVID-19: A Retrospective Single Center Analysis in Japan.
Seiya Oba; Tadashi Hosoya; Miki Amamiya; Takahiro Mitsumura; Daisuke Kawata; Hirokazu Sasaki; Mari Kamiya; Akio Yamamoto; Takahiro Ando; Sho Shimada; Tsuyoshi Shirai; Tsukasa Okamoto; Tomoya Tateishi; Akira Endo; Junichi Aiboshi; Nobuyuki Nosaka; Hideo Yamanouchi; Toyomu Ugawa; Eiki Nagaoka; Keiji Oi; Susumu Tao; Yasuhiro Maejima; Yukie Tanaka; Kousuke Tanimoto; Hiroaki Takeuchi; Shuji Tohda; Akihiro Hirakawa; Tetsuo Sasano; Hirokuni Arai; Yasuhiro Otomo; Yasunari Miyazaki; Shinsuke Yasuda
Frontiers in cardiovascular medicine, 8, 767074, 767074, 2021年, ［国際誌］
英語, 研究論文（学術雑誌）, Background: Thrombosis is a characteristic complication in coronavirus disease 2019 (COVID-19). Since coagulopathy has been observed over the entire clinical course, thrombosis might be a clue to understanding the specific pathology in COVID-19. Currently, there is limited epidemiological data of COVID-19-associated thrombosis in the Japanese population and none regarding variant strains of SARS-CoV-2. Here, we elucidate the risk factors and the pattern of thrombosis in COVID-19 patients. Methods: The patients consecutively admitted to Tokyo Medical and Dental University Hospital with COVID-19 were retrospectively analyzed. SARS-CoV-2 variants of concern/interest (VOC/VOI) carrying the spike protein mutants E484K, N501Y, or L452R were identified by PCR-based analysis. All thrombotic events were diagnosed by clinical symptoms, ultrasonography, and/or radiological tests. Results: Among the 516 patients, 32 patients experienced 42 thromboembolic events. Advanced age, severe respiratory conditions, and several abnormal laboratory markers were associated with the development of thrombosis. While thrombotic events occurred in 13% of the patients with a severe respiratory condition, those events still occurred in 2.5% of the patients who did not require oxygen therapy. Elevated D-dimer and ferritin levels on admission were independent risk factors of thrombosis (adjusted odds ratio 9.39 and 3.11, 95% confidence interval 2.08-42.3, and 1.06-9.17, respectively). Of the thrombotic events, 22 were venous, whereas 20 were arterial. While patients with thrombosis received anticoagulation and antiinflammatory therapies with a higher proportion, the mortality rate, organ dysfunctions, and bleeding complications in these patients were higher than those without thrombosis. The incidence of thrombosis in COVID-19 became less frequent over time, such as during the replacement of the earlier strains of SARS-CoV-2 by VOC/VOI and during increased use of anticoagulatory therapeutics. Conclusion: This study elucidated that elevated D-dimer and ferritin levels are useful biomarkers of thrombosis in COVID-19 patients. The comparable incidence of arterial thrombosis with venous thrombosis and the development of thrombosis in less severe patients required further considerations for the management of Japanese patients with COVID-19. Further studies would be required to identify high-risk populations and establish appropriate interventions for thrombotic complications in COVID-19.

Anticoagulation therapy using unfractionated heparin at a therapeutic dose for coronavirus disease 2019 patients with severe pneumonia: a retrospective historical control study
Wataru Takayama; Akira Endo; Yasuhiro Otomo
ACUTE MEDICINE & SURGERY, 8, 1, e679, 2021年01月, ［国際誌］
英語, 研究論文（学術雑誌）

Quick sequential organ failure assessment score combined with other sepsis-related risk factors to predict in-hospital mortality: Post-hoc analysis of prospective multicenter study data.
Ryo Ueno; Takateru Masubuchi; Atsushi Shiraishi; Satoshi Gando; Toshikazu Abe; Shigeki Kushimoto; Toshihiko Mayumi; Seitaro Fujishima; Akiyoshi Hagiwara; Toru Hifumi; Akira Endo; Takayuki Komatsu; Joji Kotani; Kohji Okamoto; Junichi Sasaki; Yasukazu Shiino; Yutaka Umemura
PloS one, 16, 7, e0254343, 2021年, ［国際誌］
英語, 研究論文（学術雑誌）, This study aimed to assess the value of quick sequential organ failure assessment (qSOFA) combined with other risk factors in predicting in-hospital mortality in patients presenting to the emergency department with suspected infection. This post-hoc analysis of a prospective multicenter study dataset included 34 emergency departments across Japan (December 2017 to February 2018). We included adult patients (age ≥16 years) who presented to the emergency department with suspected infection. qSOFA was calculated and recorded by senior emergency physicians when they suspected an infection. Different types of sepsis-related risk factors (demographic, functional, and laboratory values) were chosen from prior studies. A logistic regression model was used to assess the predictive value of qSOFA for in-hospital mortality in models based on the following combination of predictors: 1) qSOFA-Only; 2) qSOFA+Age; 3) qSOFA+Clinical Frailty Scale (CFS); 4) qSOFA+Charlson Comorbidity Index (CCI); 5) qSOFA+lactate levels; 6) qSOFA+Age+CCI+CFS+lactate levels. We calculated the area under the receiver operating characteristic curve (AUC) and other key clinical statistics at Youden's index, where the sum of sensitivity and specificity is maximized. Following prior literature, an AUC >0.9 was deemed to indicate high accuracy; 0.7-0.9, moderate accuracy; 0.5-0.7, low accuracy; and 0.5, a chance result. Of the 951 patients included in the analysis, 151 (15.9%) died during hospitalization. The AUC for predicting in-hospital mortality was 0.627 (95% confidence interval [CI]: 0.580-0.673) for the qSOFA-Only model. Addition of other variables only marginally improved the model's AUC; the model that included all potentially relevant variables yielded an AUC of only 0.730 (95% CI: 0.687-0.774). Other key statistic values were similar among all models, with sensitivity and specificity of 0.55-0.65 and 0.60-0.75, respectively. In this post-hoc data analysis from a prospective multicenter study based in Japan, combining qSOFA with other sepsis-related risk factors only marginally improved the model's predictive value.

Severe COVID-19 Pneumonia in a 30-Year-Old Woman in the 36th Week of Pregnancy Treated with Postpartum Extracorporeal Membrane Oxygenation.
Watatu Takayama; Akira Endo; Junichiro Yoshii; Hirokuni Arai; Keiji Oi; Eiki Nagaoka; Satoshi Toyama; Hiroto Yamamoto; Tokujiro Uchida; Yasuhiro Otomo
The American journal of case reports, 21, e927521, 2020年10月28日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND There are few reports of coronavirus disease 2019 (COVID-19) in pregnant women. Although coagulation dysfunction was reported to affect the severity of COVID-19, the association between pregnancy, which is usually accompanied by changes in coagulation function, and the worsening of COVID-19 is unknown. We present a case of a 30-year-old woman in the 36th week of pregnancy who was diagnosed with severe COVID-19 pneumonia and required postpartum extracorporeal membrane oxygenation (ECMO) therapy. CASE REPORT A 30-year-old, 36-weeks pregnant woman presented to our hospital and was diagnosed with severe COVID-19 pneumonia soon after she had undergone a cesarean section. Her respiratory failure could not be managed by conventional therapeutic approaches. Therefore, ECMO was administered on day 7. Controlling coagulation function to maintain ECMO therapy was challenging. Nafamostat mesylate and cryoprecipitate were administered to treat the hypercoagulative status and severe hypofibrinogenemia, respectively. Since coagulopathy and her respiratory state improved, the ECMO therapy was terminated on day 15. CONCLUSIONS We report a case of severe COVID-19 pneumonia in a pregnant woman urgently treated with ECMO in the postpartum period. Thus, this case highlights the importance of close monitoring and appropriate medical care for pregnant women with severe COVID-19 pneumonia.

Restrictive transfusion strategy for critically injured patients (RESTRIC) trial: a study protocol for a cluster-randomised, crossover non-inferiority trial.
Mineji Hayakawa; Takashi Tagami; Hiroaki IIjima; Daisuke Kudo; Kazuhiko Sekine; Takayuki Ogura; Tetsuya Yumoto; Yutaka Kondo; Akira Endo; Kaori Ito; Yosuke Matsumura; Shigeki Kushimoto
BMJ open, 10, 9, e037238, 2020年09月06日, ［国際誌］
英語, 研究論文（学術雑誌）, INTRODUCTION: Resuscitation using blood products is critical during the acute postinjury period. However, the optimal target haemoglobin (Hb) levels have not been adequately investigated. With the restrictive transfusion strategy for critically injured patients (RESTRIC) trial, we aim to compare the restrictive and liberal red blood cell (RBC) transfusion strategies. METHODS AND ANALYSIS: This is a cluster-randomised, crossover, non-inferiority trial of patients with severe trauma at 22 hospitals that have been randomised in a 1:1 ratio based on the use of a restrictive or liberal transfusion strategy with target Hb levels of 70-90 or 100-120 g/L, respectively, during the first year. Subsequently, after 1-month washout period, another transfusion strategy will be applied for an additional year. RBC transfusion requirements are usually unclear on arrival at the emergency department. Therefore, patients with severe bleeding, which could lead to haemorrhagic shock, will be included in the trial based on the attending physician's judgement. Each RBC transfusion strategy will be applied until 7 days postadmission to the hospital or discharge from the intensive care unit. The outcomes measured will include the 28-day survival rate after arrival at the emergency department (primary), the cumulative amount of blood transfused, event-free days and frequency of transfusion-associated lung injury and organ failure (secondary). Demonstration of the non-inferiority of restrictive transfusion will emphasise its clinical advantages. ETHICS AND DISSEMINATION: The trial will be performed according to the Japanese and International Ethical guidelines. It has been approved by the Ethics Committee of each participating hospital and The Japanese Association for the Surgery of Trauma (JAST). Written informed consent will be obtained from all patients or their representatives. The results of the trial will be disseminated to the participating hospitals and board-certified educational institutions of JAST, submitted to peer-reviewed journals for publication, and presented at congresses. TRIAL REGISTRATION NUMBER: UMIN Clinical Trials Registry; UMIN000034405. Registered 8 October 2018.

Age-related differences in the impact of coagulopathy in patients with isolated traumatic brain injury: An observational cohort study.
Wataru Takayama; Akira Endo; Hazuki Koguchi; Kiyoshi Murata; Yasuhiro Otomo
The journal of trauma and acute care surgery, 89, 3, 523, 528, 2020年09月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Although age and coagulopathy are well-known predictors of poor outcome after traumatic brain injury (TBI), the interaction effect of these two predictors remains unclear. OBJECTIVES: We assessed age-related differences in the impact of coagulopathy on the outcome following isolated TBI. METHODS: We conducted a retrospective observational study in two tertiary emergency critical care medical centers in Japan from 2013 to 2018. A total of 1036 patients with isolated TBI (head Abbreviated Injury Scale ≥ 3 and other Abbreviated Injury Scale < 3) were selected and divided into the nonelderly (n = 501, 16-64 years) and elderly group (n = 535, age ≥65 years). We further evaluated the impact of coagulopathy (international normalized ratio, >1.2) on the outcomes (Glasgow Outcome Scale-Extended [GOS-E] scores, in-hospital mortality, and ventilation-free days) in both groups using univariate and multivariate models. Further, we conducted an age-based assessment of the impact of TBI-associated coagulopathy on GOS-E using a generalized additive model. RESULTS: The multivariate model showed a significant association of age and TBI-associated coagulopathy with lower GOS-E scores, in-hospital mortality, and shorter ventilation-free days in the nonelderly group; however, significant impact of coagulopathy was not observed for all the outcomes in the elderly group. There was a decrease in the correlation degree between coagulopathy and GOS-E scores decreased with those older than 65 years. CONCLUSION: There was a low impact of coagulopathy on functional and survival outcomes in geriatric patients with isolated TBI. LEVEL OF EVIDENCE: Therapeutic study, Level IV.

Open-chest versus closed-chest cardiopulmonary resuscitation in trauma patients with signs of life upon hospital arrival: a retrospective multicenter study.
Akira Endo; Mitsuaki Kojima; Zhi-Jie Hong; Yasuhiro Otomo; Raul Coimbra
Critical care (London, England), 24, 1, 541, 541, 2020年09月01日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: The effectiveness and indications of open-chest cardiopulmonary resuscitation (OCCPR) have been still debatable. Although current guidelines state that the presence of signs of life (SOL) is an indication for OCCPR, scientific evidence corroborating this recommendation has been scarce. This study aimed to compare the effectiveness of OCCPR to closed-chest cardiopulmonary resuscitation (CCCPR) in severe trauma patients with SOL upon arrival at the emergency department (ED). METHODS: A retrospective cohort study analyzing data from the Trauma Quality Improvement Program (TQIP) database, a nationwide trauma registry in the USA, between 2010 and 2016 was conducted. Severe trauma patients who had SOL upon arrival at the hospital and received cardiopulmonary resuscitation within the first 6 h of ED admission were identified. Survival to hospital discharge was evaluated using logistic regression analysis, instrumental variable analysis, and propensity score matching analysis adjusting for potential confounders. RESULTS: A total of 2682 patients (OCCPR 1032; CCCPR 1650) were evaluated; of those 157 patients (15.2%) in the OCCPR group and 193 patients (11.7%) in the CCCPR group survived. OCCPR was significantly associated with higher survival to hospital discharge in both the logistic regression analysis (adjusted odds ratio [95% confidence interval] = 1.99 [1.42-2.79], p <  0.001) and the instrumental variable analysis (adjusted odds ratio [95% confidence interval] = 1.16 [1.02-1.31], p = 0.021). In the propensity score matching analysis, 531 matched pairs were generated, and the OCCPR group still showed significantly higher survival at hospital discharge (89 patients [16.8%] in the OCCPR group vs 58 patients [10.9%] in the CCCPR group; odds ratio [95% confidence interval] = 1.66 [1.13-2.42], p = 0.009). CONCLUSIONS: Compared to CCCPR, OCCPR was associated with significantly higher survival at hospital discharge in severe trauma patients with SOL upon ED arrival. Further studies to confirm these results and to assess long-term neurologic outcomes are needed.

Early administration of glucocorticoid for thyroid storm: analysis of a national administrative database.
Atsushi Senda; Akira Endo; Hisateru Tachimori; Kiyohide Fushimi; Yasuhiro Otomo
Critical care (London, England), 24, 1, 470, 470, Springer Science and Business Media {LLC}, 2020年07月29日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Thyroid storm is a life-threatening disease with a mortality rate of over 10%. Although glucocorticoids have been recommended as a treatment option for thyroid storm, supportive evidence based on a large-scale clinical research is lacking. The objective of the current study was to evaluate the beneficial effects of glucocorticoids in the treatment of patients with severe thyroid storm. METHODS: A retrospective nationwide cohort study was conducted using a Japanese national administrative claims database. Patients admitted to intensive care units due to severe thyroid storm between the financial years 2013 and 2017 were included in the study. The primary outcome was in-hospital mortality; secondary outcomes were mortality within 30 days and insulin administration during hospitalization. Generalized linear mixed model (GLMM) with maximum likelihood estimation (MLE) and Bayesian estimation using Markov chain Monte Carlo methods (MCMC), in addition to propensity score matching (PSM), were used for statistical analysis. RESULTS: A total of 811 patients were included in the study, of which 600 patients were treated with glucocorticoids, and 211 patients were treated without glucocorticoids. The early administration of glucocorticoids was not associated with a significant improvement in the in-hospital mortality of patients with thyroid storm [adjusted odds ratio (95% confidence interval) = 1.77 (0.95-3.34), 1.44 (1.14-1.93), and 1.46 (0.72-3.00) in the GLMM (MLE), GLMM (MCMC), and PSM, respectively]. The results of mortality within 30 days were almost identical to the results of in-hospital mortality. However, insulin use was significantly higher in the glucocorticoid group. CONCLUSIONS: This analysis of a nationwide administrative database indicates that the administration of glucocorticoids does not improve the survival of patients with thyroid storm.

Reply to the comment by Osuka et al.
Akira Endo; Atsushi Shiraishi; Kiyohide Fushimi; Yasuhiro Otomo
Journal of intensive care, 8, 1, 48, 48, Springer Science and Business Media {LLC}, 2020年, ［国際誌］
英語, 研究論文（学術雑誌）, Patient transfer between hospitals can be one of the biases when evaluating the hospital performance in severe burn care. Optimal handling of such a population is challenging in the analysis of an inpatient database not specialized for burn due to the lack of detailed information.

Differences in durations, adverse events, and outcomes of in-hospital cardiopulmonary resuscitation between day-time and night-time: An observational cohort study.
Wataru Takayama; Akira Endo; Hazuki Koguchi; Kiyoshi Murata; Yasuhiro Otomo
Resuscitation, 137, 14, 20, 2019年04月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Although patients with out-of-hospital cardiac arrest (OHCA) have a lower survival rate during night-time than during day-time, the cause of this difference remains unclear. We aimed to assess CPR parameters according to time period based on in-hospital cardiopulmonary resuscitation (IHCPR) duration and the frequency of iatrogenic chest injuries among OHCA patients. METHODS: This two-centre observational cohort study evaluated non-traumatic OHCA patients who were transferred between 2013-2016. These patients were categorised according to whether they received day-time treatment (07:00-22:59) or night-time treatment (23:00-06:59). Differences in IHCPR duration, CPR-related chest injuries, return of spontaneous circulation, and survivals to emergency department and hospital discharge were compared using a generalised estimating equation model adjusted for pre-hospital confounders. Sensitivity analysis was also performed using a propensity score matching method. RESULTS: Among 1254 patients (day-time: 948, night-time: 306), the night-time patients had a significantly shorter IHCPR duration (27.8 min vs. 23.6 min, adjusted difference: -5.1 min, 95% confidence interval [CI]: -6.7, -3.4), a higher incidence of chest injuries (40.4% vs. 67.0%, adjusted odds ratio [AOR]: 1.27, 95% CI: 1.20, 1.35), and a lower rate of return of spontaneous circulation (38.4% vs. 26.5%, AOR: 0.93, 95% CI: 0.88, 0.98). No significant differences were observed in the rates of survival to emergency department and hospital discharge. The propensity score-matched analysis revealed similar results. CONCLUSIONS: Patients who underwent night-time treatment for OHCA had an increased risk of CPR-related chest injuries despite their shorter resuscitation duration. Further studies are needed to clarify the underlying mechanism(s).

Age-Related Characteristics and Outcomes for Patients With Severe Trauma: Analysis of Japan's Nationwide Trauma Registry.
Mitsuaki Kojima; Akira Endo; Atsushi Shiraishi; Yasuhiro Otomo
Annals of emergency medicine, 73, 3, 281, 290, Elsevier {BV}, 2019年03月, ［国際誌］
英語, 研究論文（学術雑誌）, STUDY OBJECTIVE: Although geriatric trauma patients are becoming more common, few large-scale analyses have comprehensively evaluated geriatric-specific characteristics in trauma. This study aims to clarify the age-specific characteristics, outcomes, and predictive accuracy of current trauma scoring systems among geriatric trauma patients. METHODS: Patients with severe trauma, with an Abbreviated Injury Scale score greater than or equal to 3, and registered in the Japan Trauma Data Bank during 2004 to 2015 were retrospectively reviewed. Age-related differences were assessed for injury mechanism, injured region, anatomic and physiologic severity, and inhospital mortality. The mortality risk was evaluated with multivariate mixed-effect models adjusted for Injury Severity Score, Revised Trauma Score, year of injury, and treating facility. Age-related differences in the accuracy of the Injury Severity Score and Revised Trauma Score for predicting inhospital mortality were evaluated with an area under the receiver operating characteristic curve. RESULTS: We identified 127,303 patients, including 67,316 geriatric patients (52.9%) who were aged 60 years or older. The percentage of geriatric patients increased from 31.9% to 59.7% during the study period. The most frequent injury mechanism was ground-level falls (55.2%) and the most frequently injured region was the pelvis and lower extremities (43.7%). Severity-adjusted mixed-effects models revealed a marked age-dependent increase in mortality. Although the Injury Severity Score had similar predictive accuracy among all generations, the accuracy of the Revised Trauma Score decreased with increasing age. CONCLUSION: The characteristics of trauma patients varied widely according to age, and mortality risk increased steadily with increasing age, despite a decrease in anatomic injury severity. The Revised Trauma Score had decreasing predictive accuracy at older ages, suggesting that an alternative measure is needed.

Clinical Effects of Early Edaravone Use in Acute Ischemic Stroke Patients Treated by Endovascular Reperfusion Therapy.
Masaya Enomoto; Akira Endo; Hiroshi Yatsushige; Kiyohide Fushimi; Yasuhiro Otomo
Stroke, 50, 3, 652, 658, 2019年03月, ［国際誌］
英語, 研究論文（学術雑誌）, Background and Purpose- Although several clinical studies suggested the beneficial effects of edaravone in acute ischemic stroke, most were performed under settings that differ from those in the current treatment strategy, which has dramatically changed with progress in reperfusion therapies. This study aimed to evaluate the efficacy of edaravone in patients with acute ischemic stroke treated by emergent endovascular reperfusion therapy. Methods- We conducted a retrospective observational study using a national administrative database. Patients with acute ischemic stroke treated by emergent endovascular reperfusion therapy were identified and dichotomized by whether edaravone was used within 2 days of admission. We compared the functional independence at hospital discharge, in-hospital mortality, and intracranial hemorrhage after admission between groups, adjusted by a well-validated case-mix adjustment model, in multivariate mixed-effect regression and propensity score matching analyses. Results- Of 11 508 patients eligible for analysis, 10 281 (89.3%) received edaravone therapy. The established risk adjustment model had good predictability for functional independence at hospital discharge, with an area under the receiver operating characteristic curve of 0.74. In the mixed-effect regression analysis, edaravone use was significantly associated with greater functional independence at hospital discharge (32.3% in the edaravone group versus 25.9% in the control group; adjusted odds ratio, 1.21; 95% confidence interval, 1.03-1.41), lower in-hospital mortality (9.9% in the edaravone group versus 17.4% in the control group; adjusted odds ratio, 0.52; 95% confidence interval, 0.43-0.62), and reduced intracranial hemorrhage after admission (1.4% in the edaravone group versus 2.7% in the control group; adjusted odds ratio, 0.55; 95% confidence interval, 0.37-0.82). Results of the propensity score matching analysis corroborated these results. Conclusions- This retrospective analysis of a Japanese nationwide administrative database suggested that combination therapy with edaravone and endovascular reperfusion therapy could be a promising therapeutic strategy in acute ischemic stroke. Further randomized control trials are warranted.

Volume-outcome relationship on survival and cost benefits in severe burn injury: a retrospective analysis of a Japanese nationwide administrative database.
Akira Endo; Atsushi Shiraishi; Yasuhiro Otomo; Kiyohide Fushimi; Kiyoshi Murata
Journal of intensive care, 7, 1, 7, 7, Springer Science and Business Media {LLC}, 2019年, ［国際誌］
英語, 研究論文（学術雑誌）, Background: Although it has been reported that high hospital patient volume results in survival and cost benefits for several diseases, it is uncertain whether this association is applicable in burn care. Methods: We conducted a retrospective observational study on severe burn patients, defined by a burn index ≥ 10, using 2010-2015 data from a Japanese national administrative claim database. A generalized additive mixed-effect model (GAMM) was used to evaluate the nonlinear associations between patient volume and the outcomes (in-hospital mortality, healthcare costs per admission, and hospital-free days at 90 days). Generalized linear mixed-effect regression models (GLMMs) in which patient volume was incorporated as a continuous or categorical variable (≤ 5 or > 5) were also performed. Patient severity was adjusted using the prognostic burn index (PBI) or the risk adjustment model developed in this study, simultaneously controlling for hospital-level clustering. Sensitivity analyses evaluating patients who were directly transported, those with PBI ≤ 120 and those excluding patients who died within 2 days of admission, were also performed. Results: We analyzed 5250 eligible severe burn patients from 737 hospitals. The PBI and the developed risk adjustment model had good discriminative ability with areas under the receiver operating characteristic curves of 0.86 and 0.89, respectively. The GAMM plots showed that in-hospital mortality and healthcare costs increased according to the increase in patient volumes; then, they reached a plateau. Fewer hospital-free days were observed in the higher volume hospitals. The GLMM model showed that patient volume (incorporated as a continuous variable) was significantly associated with increased in-hospital mortality (adjusted odds ratio [95% confidence interval (CI)] = 1.14 [1.09-1.19]), high healthcare costs (adjusted difference [95% CI] = $4876 [4436-5316]), and few hospital-free days (adjusted difference [95% CI] = - 3.1 days [- 3.4 to - 2.8]). Similar trends were observed in the analyses in which patient volume was incorporated as a categorical variable. The results of sensitivity analyses showed comparable results. Conclusions: Analysis of Japanese nationwide administrative database demonstrated that high burn patient volume was significantly associated with increased in-hospital mortality, high healthcare costs, and few hospital-free days. Further studies are needed to validate our results.

Increased Severe Trauma Patient Volume is Associated With Survival Benefit and Reduced Total Health Care Costs: A Retrospective Observational Study Using a Japanese Nationwide Administrative Database.
Akira Endo; Atsushi Shiraishi; Kiyohide Fushimi; Kiyoshi Murata; Yasuhiro Otomo
Annals of surgery, 268, 6, 1091, 1096, 2018年12月, ［国際誌］
英語, 研究論文（学術雑誌）, OBJECTIVE: The aim of this study was to evaluate the associations of severe trauma patient volume with survival benefit and health care costs. BACKGROUND: The effect of trauma patient volume on survival benefit is inconclusive, and reports on its effects on health care costs are scarce. METHODS: We conducted a retrospective observational study, including trauma patients who were transferred to government-approved tertiary emergency hospitals, or hospitals with an intensive care unit that provided an equivalent quality of care, using a Japanese nationwide administrative database. We categorized hospitals according to their annual severe trauma patient volumes [1 to 50 (reference), 51 to 100, 101 to 150, 151 to 200, and ≥201]. We evaluated the associations of volume categories with in-hospital survival and total cost per admission using a mixed-effects model adjusting for patient severity and hospital characteristics. RESULTS: A total of 116,329 patients from 559 hospitals were analyzed. Significantly increased in-hospital survival rates were observed in the second, third, fourth, and highest volume categories compared with the reference category [94.2% in the highest volume category vs 88.8% in the reference category, adjusted odds ratio (95% confidence interval, 95% CI) = 1.75 (1.49-2.07)]. Furthermore, significantly lower costs (in US dollars) were observed in the second and fourth categories [mean (standard deviation) for fourth vs reference = $17,800 ($17,378) vs $20,540 ($32,412), adjusted difference (95% CI) = -$2559 (-$3896 to -$1221)]. CONCLUSIONS: Hospitals with high volumes of severe trauma patients were significantly associated with a survival benefit and lower total cost per admission.

Outcomes of patients receiving a massive transfusion for major trauma.
A Endo; A Shiraishi; K Fushimi; K Murata; Y Otomo
The British journal of surgery, 105, 11, 1426, 1434, 2018年10月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: The benefits of high transfusion ratios (plasma to red blood cells and platelets to red blood cells) on survival in injured patients who receive massive transfusions remain uncertain. This study aimed to assess the association between transfusion ratios and adverse events and survival in patients undergoing massive transfusion for major trauma. METHODS: A retrospective observational study was conducted on patients who had major trauma using a Japanese national administrative database. The associations between transfusion ratios and outcomes (in-hospital mortality and incidence of adverse events) were analysed using a non-linear logistic generalized additive model (GAM). In a logistic generalized estimating equation model, adjusted for patient and hospital-level confounders, transfusion ratios were included as continuous or categorical variables (low, transfusion ratio 0·75 or less; intermediate, over 0·75 to 1·25; high, over 1·25). RESULTS: Some 1777 patients were included in the analysis, of whom 602 died in hospital. GAM plots of the transfusion ratios for in-hospital mortality demonstrated a downward convex unimodal curve. In-hospital mortality was similar with increasing transfusion ratios for plasma (adjusted odds ratio (OR) 1·13, 95 per cent c.i. 0·82 to 1·55; P = 0·446) and platelets (adjusted OR 0·84, 0·66 to 1·08; P = 0·171). Both plasma to red blood cell ratio (adjusted OR 1·77, 1·32 to 2·37; P < 0·001) and platelet to red blood cell ratio (adjusted OR 1·71, 1·35 to 2·15; P < 0·001) were significantly associated with a higher incidence of adverse events. No significant differences in in-hospital mortality were observed between the three transfusion categories (low, medium and high). CONCLUSION: In this study, transfusion strategies with high plasma to red blood cell and platelet to red blood cell ratios did not have survival benefits, but were associated with an increase in adverse events.

Impact of continuous regional arterial infusion in the treatment of acute necrotizing pancreatitis: analysis of a national administrative database.
Akira Endo; Atsushi Shiraishi; Kiyohide Fushimi; Kiyoshi Murata; Yasuhiro Otomo
Journal of gastroenterology, 53, 9, 1098, 1106, 2018年09月, ［国内誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Although continuous regional arterial infusion (CRAI) of protease inhibitors and broad antibiotics has been suggested as one of the therapeutic option for patients with acute necrotic pancreatitis (ANP), the effectiveness has not been well-corroborated in clinical studies. METHODS: We conducted a retrospective cohort study using a Japanese national administrative database. Severe acute pancreatitis patients with a poorly enhanced pancreas region (i.e., definitive or clinically suspected ANP) were identified and dichotomized according to whether CRAI was performed. We compared the outcomes of in-hospital mortality, surgical interventions, hospital-free days, and healthcare costs between groups adjusted by the well-validated case-mix adjustment model using a multivariate mixed-effect regression analysis and a propensity score matching analysis. RESULTS: Of 243,312 acute pancreatitis patients, 702 eligible patients were identified, of these 339 patients underwent CRAI. The case-mix adjustment model established had good predictability for in-hospital mortality with an area under the receiver operating characteristics curve of 0.87. CRAI was significantly associated with reduced in-hospital mortality [14.5% in the CRAI group vs. 18.2% in the non-CRAI group, adjusted odds ratio (95% confidence interval; CI) = 0.60 (0.36-0.97)]. Significant associations were not observed for the frequency of surgical interventions and mean hospital-free days; however, significantly higher healthcare costs were observed in the CRAI group. Results of the propensity score matching analysis did not alter these results. CONCLUSIONS: Analysis of a nationwide large-scale database suggested that CRAI was significantly associated with reduced in-hospital mortality for patients with ANP. Further randomized controlled trials are warranted.

Comparative effectiveness of elemental formula in the early enteral nutrition management of acute pancreatitis: a retrospective cohort study.
Akira Endo; Atsushi Shiraishi; Kiyohide Fushimi; Kiyoshi Murata; Yasuhiro Otomo
Annals of intensive care, 8, 1, 69, 69, 2018年06月05日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Although enteral nutrition has become one of the standard therapies for patients with acute pancreatitis, the optimal formulae for enteral nutrition have been under debate. Elemental formula is assumed to be suitable in the treatment of patients with acute pancreatitis because it has less stimulating effects for exocrine secretions of the pancreas, simultaneously maintaining gut immunity; however, clinical studies corroborating this assumption have been scarce. METHODS: We conducted a retrospective cohort study using a Japanese national administrative database between 2010 and 2015. Patients with acute pancreatitis who received enteral feeding within 3 days of admission were identified and divided into two groups according to whether elemental formula was administered. We assessed the impact of elemental formula for the outcomes (primary, in-hospital mortality; secondary, development of sepsis, hospital-free days at 90 days, and total health-care costs) using a multivariate mixed-effect regression analysis and propensity score matching analysis adjusted by a well-validated case-mix adjustment model. Analysis for the subpopulation of patients with severe acute pancreatitis was also performed. RESULTS: Of 243,312 patients with acute pancreatitis, 948 patients were identified and classified into the elemental formula group (N = 382) and the control group (N = 566). No significant differences were observed for in-hospital mortality [10.2% in the elemental formula group vs. 11.0% in the control group; adjusted adds ratio (95% confidence interval; CI) = 0.94 (0.53-1.67)], sepsis development [5.0 vs. 7.1%; adjusted adds ratio (95% CI) = 0.66 (0.34-1.28)], mean hospital-free days [54 days vs. 51 days; adjusted difference (95% CI) = 2 days (- 2 to 5)], and mean total health-care costs [$29,360 vs. $34,214; adjusted difference (95% CI) = - $4250 (- 8643 to 141)]. Similar results were also observed in patients with severe acute pancreatitis. CONCLUSIONS: The results of our retrospective cohort study using a large-scale national database did not demonstrate the benefit of elemental formula compared to semi-elemental and polymeric formulae in patients with acute pancreatitis. Further assessment of alternative nutritional strategy is expected.

The impact of blood type O on mortality of severe trauma patients: a retrospective observational study.
Wataru Takayama; Akira Endo; Hazuki Koguchi; Momoko Sugimoto; Kiyoshi Murata; Yasuhiro Otomo
Critical care (London, England), 22, 1, 100, 100, 2018年05月02日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Recent studies have implicated the differences in the ABO blood system as a potential risk for various diseases, including hemostatic disorders and hemorrhage. In this study, we evaluated the impact of the difference in the ABO blood type on mortality in patients with severe trauma. METHODS: A retrospective observational study was conducted in two tertiary emergency critical care medical centers in Japan. Patients with trauma with an Injury Severity Score (ISS) > 15 were included. The association between the different blood types (type O versus other blood types) and the outcomes of all-cause mortality, cause-specific mortalities (exsanguination, traumatic brain injury, and others), ventilator-free days (VFD), and total transfusion volume were evaluated using univariate and multivariate competing-risk regression models. Moreover, the impact of blood type O on the outcomes was assessed using regression coefficients in the multivariate analysis adjusted for age, ISS, and the Revised Trauma Score (RTS). RESULTS: A total of 901 patients were included in this study. The study population was divided based on the ABO blood type: type O, 284 (32%); type A, 285 (32%); type B, 209 (23%); and type AB, 123 (13%). Blood type O was associated with high mortality (28% in patients with blood type O versus 11% in patients with other blood types; p <  0.001). Moreover, this association was observed in a multivariate model (adjusted odds ratio = 2.86, 95% confidence interval 1.84-4.46; p <  0.001). The impact of blood type O on all-cause in-hospital mortality was comparable to 12 increases in the ISS, 1.5 decreases in the RTS, and 26 increases in age. Furthermore, blood type O was significantly associated with higher cause-specific mortalities and shorter VFD compared with the other blood types; however, a significant difference was not observed in the transfusion volume between the two groups. CONCLUSIONS: Blood type O was significantly associated with high mortality in severe trauma patients and might have a great impact on outcomes. Further studies elucidating the mechanism underlying this association are warranted to develop the appropriate intervention.

The Association between Cardiopulmonary Resuscitation in Out-of-Hospital Settings and Chest Injuries: A Retrospective Observational Study.
Wataru Takayama; Hazuki Koguchi; Akira Endo; Yasuhiro Otomo
Prehospital and disaster medicine, 33, 2, 171, 175, 2018年04月, ［国際誌］
英語, 研究論文（学術雑誌）, OBJECTIVES: The aim of this study was to assess the risk of cardiopulmonary resuscitation (CPR) performed in out-of-hospital settings for chest injuries in patients with out-of-hospital cardiac arrest (OHCA). METHODS: This retrospective, observational study was conducted in an emergency critical care medical center in Japan. Non-traumatic OHCA patients transferred to the hospital from April 2013 through August 2016 were analyzed. The outcome was defined by chest injuries related to CPR, which is composite of rib fractures, sternal fractures, and pneumothoraces. A multivariate logistic regression analysis was performed to assess the independent risk factors for chest injuries related to CPR. The threshold of out-of-hospital CPR duration that increased risk of chest injuries was also assessed. RESULTS: A total of 472 patients were identified, of whom 233 patients sustained chest injuries. The multivariate logistic regression model showed that the independent risk factors for chest injuries were age and out-of-hospital CPR duration (age: AOR=1.06 [95% CI, 1.04 to 1.07]; out-of-hospital CPR duration: AOR=1.03 [95% CI, 1.01 to 1.05]). In-hospital CPR duration was not an independent risk factor for chest injuries. When the duration of out-of-hospital CPR extended over 15 minutes, the likelihood of chest injuries increased; however, this association was not statistically significant. CONCLUSIONS: Long duration of out-of-hospital CPR was an independent risk factor for chest injuries, possibly due to the difficulty of maintaining adequate quality of CPR. Further investigations to assess the efficacy of alternative CPR devices are expected in cases requiring long transportation times. Takayama W , Koguchi H , Endo A , Otomo Y . The association between cardiopulmonary resuscitation in out-of-hospital settings and chest injuries: a retrospective observational study. Prehosp Disaster Med. 2018;33(2):171-175.

A Case of Impalement Brain Injury That Could Achieve Good Neurological Outcome by Introducing Early Sedation and Immobilization Strategy.
Wataru Takayama; Kaho Yamasaki; Akira Endo; Yasuhiro Otomo
Case reports in emergency medicine, 2018, 3025717, 3025717, 2018年, ［国際誌］
英語, 研究論文（学術雑誌）, Impalement brain injury is rare, and the initial management of this condition is not well-established. We present a case of a well-managed brain injury caused by impalement with a metal bar. A 29-year-old man whose head had been impaled by a metal bar was transferred to our hospital. Upon arrival, he was agitated, with an unsteady gait and prominent odor of alcohol on his breath. He exhibited normal vital signs and neurological findings, except for his level of consciousness. To address the risk of secondary brain injury caused by movement of the foreign body, we immediately administered a sedative agent and muscle relaxant after the initial neurological evaluation. The imaging evaluation revealed the insertion of a metal bar into the right frontal lobe at a depth of >100 mm through the frontal bone; however, there was no apparent major vessel injury-related complication. Three hours after arrival at the hospital, a craniotomy was performed to remove the foreign body. The patient's postoperative course was uneventful, and he was discharged after rehabilitation without any neurological deficits. The strategy of immediate immobilization to prevent the secondary brain injury is important in the initial management of a patient who has survived an impalement brain injury and presented to an emergency department.

Multilateral Functional Alterations of Human Neutrophils in Sepsis: From the Point of Diagnosis to the Seventh Day.
Akira Endo; Miko Okamura; Shunsuke Yoshikawa; Yasuhiro Otomo; Tomohiro Morio
Shock (Augusta, Ga.), 48, 6, 629, 637, 2017年12月, ［国際誌］
英語, 研究論文（学術雑誌）, Neutrophil functional changes caused by sepsis itself and their time-course variation have not been fully elucidated because previous studies targeted patients who had received therapeutic interventions. We explored the multilateral functions of circulating neutrophils in patients with severe sepsis or septic shock who had not yet undergone interventions, and followed their changes. Patients were treated based on the Surviving Sepsis Campaign Guidelines 2012. Neutrophil functions were evaluated on days 0 (before therapeutic intervention), 3, and 7 in 59 septic patients. The clinical severity score (APACHE II and SOFA) and serum pro-/anti-inflammatory cytokine concentrations of the patients were significantly increased on day 0 and normalized on day 3. However, neutrophil priming state, estimated by measuring the fMLP-stimulated reactive oxygen species, was significantly elevated on day 0, further augmented on day 3, and then returned to day 0 levels on day 7 despite general resolution of the inflammatory response. The expression of CXC chemokine receptor 2 and paired immunoglobulin-like receptor α, assessed as surrogate markers of transmigration and adhesion potency, was suppressed most strongly on day 0 and gradually recovered. To conclude, contrary to the patient's clinical course, neutrophil priming state was augmented most strongly at 3 days after diagnosis of sepsis. Impaired transmigration and excessive adhesion potency were observed most prominently at diagnosis. These observations would partially explain the mechanism of development of multiple organ dysfunction of the host who is subjected to a secondary insult, and may provide an important perspective for the implementation of additional immune-modulating therapy in sepsis.

Open-chest versus closed-chest cardiopulmonary resuscitation in blunt trauma: analysis of a nationwide trauma registry.
Akira Endo; Atsushi Shiraishi; Yasuhiro Otomo; Makoto Tomita; Hiroki Matsui; Kiyoshi Murata
Critical care (London, England), 21, 1, 169, 169, 2017年07月03日, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Although open-chest cardiopulmonary resuscitation (OCCPR) is often considered as the last salvage maneuver in critically injured patients, evidence on the effectiveness of OCCPR has been based only on the descriptive studies of limited numbers of cases or expert opinions. This study aimed to compare the effectiveness of OCCPR with that of closed-chest cardiopulmonary resuscitation (CCCPR) in an emergency department (ED). METHODS: A nationwide registry-based, retrospective cohort study was conducted. Patients with blunt trauma, undergoing cardiopulmonary resuscitation (CPR) in an ED between 2004 and 2015 were identified and divided into OCCPR and CCCPR groups. Their outcomes (survival to hospital discharge and survival over 24 hours following ED arrival) were compared with propensity score matching analysis and instrumental variable analysis. RESULTS: A total of 6510 patients (OCCPR, 2192; CCCPR, 4318) were analyzed. The in-hospital and 24-hour survival rates in OCCPR patients were 1.8% (40/2192) and 5.6% (123/2192), and those in CCCPR patients were 3.6% (156/4318) and 9.6% (416/4318), respectively. In the propensity score-matched subjects, OCCPR patients (n = 1804) had significantly lower odds of survival to hospital discharge (odds ratio (95% CI)) = 0.41 (0.25-0.68)) and of survival over 24 hours following ED arrival (OR (95% CI) = 0.59 (0.45-0.79)) than CCCPR patients (n = 1804). Subgroup analysis revealed that OCCPR was associated with a poorer outcome compared to CCCPR in patients with severe pelvis and lower extremity injury. CONCLUSIONS: In this large cohort, OCCPR was associated with reduced in-hospital and 24-hour survival rates in patients with blunt trauma. Further comparisons between OCCPR and CCCPR using additional information, such as time course details in pre-hospital and ED settings, anatomical details regarding region of injury, and neurological outcomes, are necessary.

Assessment of Progress in Early Trauma Care in Japan over the Past Decade: Achievements and Areas for Future Improvement.
Akira Endo; Atsushi Shiraishi; Hiroki Matsui; Kenichi Hondo; Yasuhiro Otomo
Journal of the American College of Surgeons, 224, 2, 191, 198, 2017年02月, ［国際誌］
英語, 研究論文（学術雑誌）, BACKGROUND: Strategies to optimize early trauma care have been introduced in Japan; however, detailed evaluation of the progress achieved has not been reported. STUDY DESIGN: In this retrospective observational study, patients registered in the Japanese nationwide trauma registry were stratified according to probability of survival (Ps) > 0.5 or ≤ 0.5, respectively. Mortality rates during the first 2 days and in-hospital mortality rates were compared between early (2004 to 2009) and late cohorts (2010 to 2014) in each group, using mixed effects logistic regression analysis. Improvement in mortality rates during the first 2 days among subgroups were also assessed. RESULTS: We analyzed 80,949 patients with Ps > 0.5 (early, 25,917; late, 55,032) and 8,898 patients with Ps ≤ 0.5 (early, 3,511; late, 5,387). Mortality rates during the first 2 days in both groups were significantly reduced (adjusted odds ratio [AOR; 95% CI] 0.61 [0.53 to 0.69] in the Ps > 0.5 group and 0.67 [0.60 to 0.76] in the Ps ≤ 0.5 group). In-hospital mortality rates in both groups were also significantly reduced (AOR [95% CI] 0.70 [0.64 to 0.76] and 0.73 [0.64 to 0.82], respectively). Significant improvements were observed in patients with a Revised Trauma Score ≥ 7 on arrival or an Abbreviated Injury Scale (AIS) of the abdomen ≥ 3. Limited improvements were observed in patients with head AIS ≥ 3 and in patients who underwent thoracotomy. CONCLUSIONS: Although early trauma care has generally improved, specific progress was variable. Focused panel review of patients with severe head injury or undergoing thoracotomy may be an efficient strategy for further improvement.

Development of Novel Criteria of the "Lethal Triad" as an Indicator of Decision Making in Current Trauma Care: A Retrospective Multicenter Observational Study in Japan.
Akira Endo; Atsushi Shiraishi; Yasuhiro Otomo; Shigeki Kushimoto; Daizoh Saitoh; Mineji Hayakawa; Hiroshi Ogura; Kiyoshi Murata; Akiyoshi Hagiwara; Junichi Sasaki; Tetsuya Matsuoka; Toshifumi Uejima; Naoto Morimura; Hiroyasu Ishikura; Munekazu Takeda; Naoyuki Kaneko; Hiroshi Kato; Daisuke Kudo; Takashi Kanemura; Takayuki Shibusawa; Yasushi Hagiwara; Shintaro Furugori; Yoshihiko Nakamura; Kunihiko Maekawa; Gou Mayama; Arino Yaguchi; Shiei Kim; Osamu Takasu; Kazutaka Nishiyama
Critical care medicine, 44, 9, e797-803, 2016年09月, ［国際誌］
英語, 研究論文（学術雑誌）, OBJECTIVES: To evaluate the utility of the conventional lethal triad in current trauma care practice and to develop novel criteria as indicators of treatment strategy. DESIGN: Retrospective observational study. SETTINGS: Fifteen acute critical care medical centers in Japan. PATIENTS: In total, 796 consecutive trauma patients who were admitted to emergency departments with an injury severity score of greater than or equal to 16 from January 2012 to December 2012. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All data were retrospectively collected, including laboratory data on arrival. Sensitivities to predict trauma death within 28 days of prothrombin time international normalized ratio greater than 1.50, pH less than 7.2, and body temperature less than 35°C were 15.7%, 17.5%, and 15.9%, respectively, and corresponding specificities of these were 96.4%, 96.6%, and 93.6%, respectively. The best predictors associated with hemostatic disorder and acidosis were fibrin/fibrinogen degradation product and base excess (the cutoff values were 88.8 µg/mL and -3.05 mmol/L). The optimal cutoff value of hypothermia was 36.0°C. The impact of the fibrin/fibrinogen degradation product and base excess abnormality on the outcome were approximately three- and two-folds compared with those of hypothermia. Using these variables, if the patient had a hemostatic disorder alone or a combined disorder with acidosis and hypothermia, the sensitivity and specificity were 80.7% and 66.8%. CONCLUSIONS: Because of the low sensitivity and high specificity, conventional criteria were unsuitable as prognostic indicators. Our revised criteria are assumed to be useful for predicting trauma death and have the potential to be the objective indicators for activating the damage control strategy in early trauma care.

A case of purpura fulminans caused by Hemophilus influenzae complicated by reversible cardiomyopathy.
Akira Endo; Atsushi Shiraishi; Junichi Aiboshi; Yoshiro Hayashi; Yasuhiro Otomo
Journal of intensive care, 2, 1, 13, 13, 2014年, ［国際誌］
英語, 研究論文（学術雑誌）, Here, we report a case of a 41-year-old male diagnosed as septic shock with purpura fulminans (PF) infection. The causative organism was β-lactamase-negative ampicillin-resistant Hemophilus influenzae. He developed fulminant cardiac dysfunction approximately 1 h after admission, and the cause was considered to be septic cardiomyopathy. Blood pressure and oxygenation were maintained at adequate levels with the aid of extracorporeal membrane oxygenation (ECMO). The cardiac dysfunction was reversible, and he was successfully weaned from ECMO on day 12 of hospitalization. However, he needed amputation for all extremities because the infection spread to his limbs and eventually, succumbed to sepsis caused by empyema on day 34 of hospitalization. To the best of our knowledge, this is only the second case of PF caused by H. influenzae in an adult to be reported worldwide.

足関節から後腹膜に至る広範な劇症型溶連菌感染症に対し，患肢温存し救命し得た1例
Akira Endo; Masahito Kaji; Masaya Enomoto; Kiyoshi Murata; Naoki Tosaka; Junichi Aiboshi; Yasuhiro Otomo
日本救急医学会雑誌, 24, 9, 799, 804, Wiley, 2013年, ［筆頭著者］
研究論文（学術雑誌）

消化管穿孔疑いに対する手術において術中穿孔部位不明症例に対する治療戦略の検討
林 一真; 海藤 章郎; 星 博勝; 光法 雄介; 佐々木 恵; 石井 武; 田澤 美也子; 山下 大和; 坂野 正佳; 西岡 龍太郎; 松永 史穂; 柳澤 拓; 江澤 暸; 遠藤 彰; 伊東 浩次, 日本外科学会定期学術集会抄録集, 126回, DP, 7, 2026年04月
(一社)日本外科学会, 日本語

働き方改革による腹部救急診療現場の現状と課題 働き方改革時代にAcute Care Surgeryセンター化で救急医療の崩壊を防ぐ
阿久津 智洋; 成田 保和; 奥澤 平明; 星 博勝; 鈴木 啓介; 遠藤 彰, 日本腹部救急医学会雑誌, 46, 2, 228, 228, 2026年02月
(一社)日本腹部救急医学会, 日本語

腹部救急疾患に対する内視鏡外科手術の現状とロボット支援手術への展望 Acute Care Surgeryセンターにおける内視鏡外科手術の現状とロボット支援手術の展望
阿久津 智洋; 成田 保和; 奥澤 平明; 星 博勝; 鈴木 啓介; 遠藤 彰; 伊東 浩次, 日本腹部救急医学会雑誌, 46, 2, 231, 231, 2026年02月
(一社)日本腹部救急医学会, 日本語

上部消化管穿孔～保存的治療の限界は?～ 食道穿孔における保存治療の適応と治療成績
星 博勝; 奥澤 平明; 成田 保和; 鈴木 啓介; 阿久津 智洋; 遠藤 彰, 日本腹部救急医学会雑誌, 46, 2, 236, 236, 2026年02月
(一社)日本腹部救急医学会, 日本語

当院における急性胆嚢炎に対する治療方針とその妥当性について
奥澤 平明; 成田 保和; 星 博勝; 鈴木 啓介; 阿久津 智洋; 遠藤 彰, 日本腹部救急医学会雑誌, 46, 2, 252, 252, 2026年02月
(一社)日本腹部救急医学会, 日本語

大腸穿孔に対する鏡視下手術の現状と課題
奥澤 平明; 成田 保和; 星 博勝; 鈴木 啓介; 阿久津 智洋; 遠藤 彰, 日本腹部救急医学会雑誌, 46, 2, 258, 258, 2026年02月
(一社)日本腹部救急医学会, 日本語

当院におけるOpen Abdominal Management(OAM)の治療成績
成田 保和; 遠藤 彰; 奥澤 平明; 星 博勝; 阿久津 智洋; 鈴木 啓介, 日本腹部救急医学会雑誌, 46, 2, 267, 267, 2026年02月
(一社)日本腹部救急医学会, 日本語

穿孔性虫垂炎において腹腔鏡下虫垂切除術でドレーン留置の有効性に関する研究
阿久津 智洋; 遠藤 彰; 森下 幸治, 日本腹部救急医学会雑誌, 46, 2, 272, 272, 2026年02月
(一社)日本腹部救急医学会, 日本語

ERにおけるmorbidity and mortality conferencesの導入と課題
上澤 弘美; 米嶋 美晴; 阿久津 智洋; 鈴木 啓介; 遠藤 彰, 茨城県救急医学会雑誌, 49, 55, 56, 2026年01月
(一社)茨城県医師会, 日本語

多施設ランダム化試験における主任研究者の役割 日本救急医学会主導研究OPTPRESS trialの構想からpublishまで
遠藤 彰, 日本救急医学会雑誌, 36, 11, 740, 740, 2025年11月
(一社)日本救急医学会, 日本語

ノルアドレナリン抵抗性敗血症性ショックに対する2nd-line治療としてのvasopressinとhydrocortisoneの有効性の比較
遠藤 彰; 木下 喬弘, 日本救急医学会雑誌, 36, 11, 854, 854, 2025年11月
(一社)日本救急医学会, 日本語

茨城県における行政主導救急搬送患者からの選定療養費徴収によって起きたこと
遠藤 彰; 荒木 祐一; 阿久津 智洋; 鈴木 啓介; 鈴木 美麗; 星 博勝; 奥澤 平明; 成田 保和; 内山 絢登, 日本救急医学会雑誌, 36, 11, 855, 855, 2025年11月
(一社)日本救急医学会, 日本語

当院におけるOpen Abdominal Managementの治療成績
成田 保和; 遠藤 彰; 内山 絢登; 奥澤 平明; 星 博勝; 鈴木 美麗; 阿久津 智洋; 鈴木 啓介; 荒木 祐一, 日本救急医学会雑誌, 36, 11, 862, 862, 2025年11月
(一社)日本救急医学会, 日本語

救命救急センターに所属するAcute Care Surgeonとして習得しておきたい外傷性頸部損傷に対する手術
奥澤 平明; 阿久津 智洋; 内山 絢登; 成田 保和; 星 博勝; 鈴木 啓介; 遠藤 彰, 日本救急医学会雑誌, 36, 11, 866, 866, 2025年11月
(一社)日本救急医学会, 日本語

高齢敗血性ショック患者におけるvasopressin/noradrenaline投与比と予後・臓器障害との関連 OPTPRESS trial二次解析
鈴木 啓介; 前川 邦彦; 山川 一馬; 田上 隆; 梅村 穣; 阿久津 智洋; 星 博勝; 奥澤 平明; 遠藤 彰, 日本救急医学会雑誌, 36, 11, 906, 906, 2025年11月
(一社)日本救急医学会, 日本語

地域MCにおけるECPRプロトコール導入1年後の影響
鈴木 美麗; 遠藤 彰; 内山 絢登; 奥澤 平明; 成田 保和; 星 博勝; 鈴木 啓介; 阿久津 智洋; 荒木 祐一, 日本救急医学会雑誌, 36, 11, 940, 940, 2025年11月
(一社)日本救急医学会, 日本語

救急外科医が習得すべき血管手術について
星 博勝; 阿久津 智洋; 内山 絢登; 成田 保和; 奥澤 平明; 鈴木 美麗; 鈴木 啓介; 荒木 祐一; 遠藤 彰, 日本救急医学会雑誌, 36, 11, 943, 943, 2025年11月
(一社)日本救急医学会, 日本語

食道穿孔を伴う壊死性食道炎を手術により救命した1例
内山 絢登; 奥澤 平明; 遠藤 彰; 荒木 祐一; 阿久津 智洋; 鈴木 啓介; 鈴木 美麗; 星 博勝; 成田 保和, 日本救急医学会雑誌, 36, 11, 944, 944, 2025年11月
(一社)日本救急医学会, 日本語

サブスペシャリティを持つ救急医の育成が日本の救急医療を支えることができる
阿久津 智洋; 成田 保和; 奥澤 平明; 星 博勝; 鈴木 美麗; 鈴木 啓介; 遠藤 彰; 東京科学大学救急災害医学分野将来検討委員会, 日本救急医学会雑誌, 36, 11, 1051, 1051, 2025年11月
(一社)日本救急医学会, 日本語

Beyond Rapid Response System 外科的介入が可能な救急科がRRS要請後の患者の予後改善を目指す
阿久津 智洋; 井川 洋子; 奥澤 平明; 星 博勝; 鈴木 啓介; 荒木 祐一; 遠藤 彰, 日本救急医学会雑誌, 36, 11, 1052, 1052, 2025年11月
(一社)日本救急医学会, 日本語

当救命救急センターでマムシ咬傷と診断した65例の検討
島根 瑠唯; 遠藤 彰; 内山 絢登; 奥澤 平明; 成田 保和; 星 博勝; 鈴木 美麗; 阿久津 智洋; 鈴木 啓介; 荒木 祐一, 日本救急医学会雑誌, 36, 11, 1063, 1063, 2025年11月
(一社)日本救急医学会, 日本語

2度の胸腔鏡下縦隔ドレナージにより救命した深頸部膿瘍から進展した重症降下性壊死性縦隔炎の1例
清水 美音; 星 博勝; 鈴木 啓介; 阿久津 智洋; 荒木 祐一; 遠藤 彰, 日本救急医学会雑誌, 36, 11, 1081, 1081, 2025年11月
(一社)日本救急医学会, 日本語

ERでの手術準備における看護師教育
米嶋 美晴; 上澤 弘美; 阿久津 智洋; 鈴木 啓介; 遠藤 彰, Japanese Journal of Acute Care Surgery, 15, 1, 105, 110, 2025年10月
(一社)日本Acute Care Surgery学会, 日本語

敗血症研究の最前線 OPTPRESS trial結果報告と今後の敗血症性ショックの循環管理の展望
遠藤 彰; 山川 一馬; 田上 隆; 梅村 穣, 日本集中治療医学会雑誌, 32, Suppl.2, S405, S405, 2025年09月
(一社)日本集中治療医学会, 日本語

採用するべきシステムはどれか?まずはシステムの理解を深めよう～典型的MET,RRT,CCOTの利点、欠点の比較討論～ RRS要請後に外科的介入を行う救急集中治療科の協力で患者の予後を改善する
阿久津 智洋; 井川 洋子; 鈴木 啓介; 荒木 祐一; 遠藤 彰, 日本集中治療医学会雑誌, 32, Suppl.2, S425, S425, 2025年09月
(一社)日本集中治療医学会, 日本語

当院におけるNCSEの臨床像
中川 良太; 遠藤 彰; 奥澤 平明; 星 博勝; 西岡 龍太郎; 久下 晶子; 阿久津 智洋; 鈴木 啓介; 荒木 祐一, 日本集中治療医学会雑誌, 32, Suppl.2, S526, S526, 2025年09月
(一社)日本集中治療医学会, 日本語

糖尿病性ケトアシドーシスを合併した高トリグリセリド血症を伴う重症急性膵炎に対し血漿交換を行った一例
奥澤 平明; 阿久津 開; 河野 里咲; 中川 良太; 西岡 龍太郎; 星 博勝; 久下 晶子; 鈴木 啓介; 阿久津 智洋; 遠藤 彰, 日本集中治療医学会雑誌, 32, Suppl.2, S845, S845, 2025年09月
(一社)日本集中治療医学会, 日本語

外傷・Acute Care Surgeryセンターからみた腹腔内感染症治療における術前・術中管理
星 博勝; 中川 良太; 奥澤 平明; 西岡 龍太郎; 久下 晶子; 鈴木 啓介; 阿久津 智洋; 荒木 祐一; 遠藤 彰, 日本集中治療医学会雑誌, 32, Suppl.2, S958, S958, 2025年09月
(一社)日本集中治療医学会, 日本語

悪性症候群の経過中に正常血糖ケトアシドーシスを合併した一例
阿久津 開; 遠藤 彰; 河野 里咲; 奥澤 平明; 星 博勝; 西岡 龍太郎; 久下 晶子; 阿久津 智洋; 鈴木 啓介; 荒木 祐一, 日本集中治療医学会雑誌, 32, Suppl.2, S1034, S1034, 2025年09月
(一社)日本集中治療医学会, 日本語

【外傷性膵・十二指腸損傷に対する治療戦略】当院での20年間における外傷性膵損傷に対する治療戦略と成績
奥澤 平明; 阿久津 智洋; 星 博勝; 鈴木 啓介; 遠藤 彰, Japanese Journal of Acute Care Surgery, 15, 1, 9, 16, 2025年09月
(一社)日本Acute Care Surgery学会, 日本語

Acute Care Surgery体制整備に対する看護師長としての取り組み
上澤 弘美; 米嶋 美晴; 阿久津 智洋; 鈴木 啓介; 遠藤 彰, Japanese Journal of Acute Care Surgery, 15, 1, 101, 104, 2025年09月
(一社)日本Acute Care Surgery学会, 日本語

若手外科医の視点から見た救急外科の魅力と可能性
星 博勝; 奥澤 平明; 鈴木 啓介; 阿久津 智洋; 伊東 浩次; 遠藤 彰, 日本消化器外科学会総会, 80回, 328, 328, 2025年07月
(一社)日本消化器外科学会, 日本語

地方地域中核病院でAcute Care Surgeryチームを消化器外科から独立させたことによる働き方の変化(Result of separating the Acute Care Surgery team from the Gastroenterological Surgery department)
阿久津 智洋; 奥澤 平明; 星 博勝; 鈴木 啓介; 遠藤 彰; 伊東 浩次, 日本消化器外科学会総会, 80回, 635, 635, 2025年07月
(一社)日本消化器外科学会, 日本語

Acute Care Surgeryを極めるには(合併症対策と若手育成) 当施設でのAcute Care Surgeonの育成と合併症軽減への対策
阿久津 智洋; 阿久津 開; 西岡 龍太郎; 奥澤 平明; 星 博勝; 鈴木 啓介; 遠藤 彰, 日本外科学会定期学術集会抄録集, 125回, WS, 6, 2025年04月
(一社)日本外科学会, 日本語

Diagnosis Procedure Combination(DPC)データを用いた糞便性腸閉塞に関する後方視的観察研究
星 博勝; 奥澤 平明; 鈴木 啓介; 阿久津 智洋; 伊東 浩次; 伏見 清秀; 遠藤 彰, 日本外科学会定期学術集会抄録集, 125回, SF, 4, 2025年04月
(一社)日本外科学会, 日本語

当院での22年間における外傷性膵・十二指腸損傷に対する治療戦略
奥澤 平明; 阿久津 智洋; 星 博勝; 鈴木 啓介; 遠藤 彰, 日本外科学会定期学術集会抄録集, 125回, PS, 5, 2025年04月
(一社)日本外科学会, 日本語

働き方改革後の外傷診療のあり方 救命救急センターでのAcute Care Surgeonによる外傷診療と働き方改革への対応
阿久津 智洋; 奥澤 平明; 星 博勝; 鈴木 啓介; 遠藤 彰, 日本外傷学会雑誌, 39, 2, 171, 171, 2025年04月
(一社)日本外傷学会, 日本語

外傷外科医育成の鍵は市中病院と大学病院の協力体制の構築にある
阿久津 智洋; 奥澤 平明; 星 博勝; 鈴木 啓介; 井上 貴昭; 森下 幸治; 遠藤 彰, 日本外傷学会雑誌, 39, 2, 215, 215, 2025年04月
(一社)日本外傷学会, 日本語

高齢者の多発肋骨骨折に対するHFNCの有効性を検討する多施設共同研究 RIBREATH study
星 博勝; 奥澤 平明; 小寺 輝; 鈴木 啓介; 阿久津 智洋; 遠藤 彰; 森下 幸治, 日本外傷学会雑誌, 39, 2, 250, 250, 2025年04月
(一社)日本外傷学会, 日本語

挑戦者求む!「腹部救急症例」に挑む若手医師とベテラン医師の方々へ～診療科の壁を超えて繰り広げられる究極のDecision Makingバトル!～ Decision Makingスキルの向上を目指して
星 博勝; 奥澤 平明; 鈴木 啓介; 阿久津 智洋; 遠藤 彰, 日本腹部救急医学会雑誌, 45, 2, 220, 220, 2025年02月
(一社)日本腹部救急医学会, 日本語

SMA閉塞症に対する治療戦略 当院での上腸間膜動脈閉塞症の治療 15年の蓄積
阿久津 智洋; 奥澤 平明; 星 博勝; 鈴木 啓介; 内山 英俊; 伊東 浩次; 遠藤 彰, 日本腹部救急医学会雑誌, 45, 2, 226, 226, 2025年02月
(一社)日本腹部救急医学会, 日本語

急性胆嚢炎診療の進歩と見えてきた課題2 当院における急性胆嚢炎に対する治療の検討
奥澤 平明; 星 博勝; 鈴木 啓介; 阿久津 智洋; 遠藤 彰, 日本腹部救急医学会雑誌, 45, 2, 231, 231, 2025年02月
(一社)日本腹部救急医学会, 日本語

腹膜炎における低侵襲治療の適応と限界 汎発性腹膜炎に対する低侵襲手術
星 博勝; 榎本 馨; 奥澤 平明; 鈴木 啓介; 阿久津 智洋; 遠藤 彰, 日本腹部救急医学会雑誌, 45, 2, 241, 241, 2025年02月
(一社)日本腹部救急医学会, 日本語

始まった医師の働き方改革は、腹部救急医療にどのような影響を与えたか 救命救急センターでのAcute Care Surgeonの働き方とシステム構築
阿久津 智洋; 奥澤 平明; 星 博勝; 鈴木 啓介; 遠藤 彰, 日本腹部救急医学会雑誌, 45, 2, 248, 248, 2025年02月
(一社)日本腹部救急医学会, 日本語

機械的心肺蘇生装置の使用と転帰との関連および搬送時間の影響
天神 久実; 遠藤 彰; 阿久津 開; 河野 里咲; 西岡 隆太郎; 奥澤 平明; 星 博勝; 久下 晶子; 鈴木 啓介; 阿久津 智洋; 荒木 祐一, 茨城県救急医学会雑誌, 48, 31, 32, 2025年01月
(一社)茨城県医師会, 日本語

治療経過中に心停止となったが体外式膜型人工心肺での管理により救命しえたTTPの1例
島根 瑠唯; 阿久津 智洋; 鈴木 啓介; 荒木 祐一; 遠藤 彰, 茨城県救急医学会雑誌, 48, 61, 62, 2025年01月
(一社)茨城県医師会, 日本語

当院における外傷性十二指腸損傷の術式の検討
阿久津 智洋; 遠藤 彰; 奥澤 平明; 星 博勝; 鈴木 啓介; 伊東 浩次; 大友 康裕; 森下 幸治, Japanese Journal of Acute Care Surgery, 14, 1, 29, 36, 2024年12月
(一社)日本Acute Care Surgery学会, 日本語

働き方改革の時代への対応:一人ひとりが輝けるAcute Care Surgeonのライフワークバランスと診療の質の維持・向上を可能にする持続的システムの構築 救命救急センターでのAcute Care Surgeonの働き方とシステム構築 経験、予後、そしてプライベートも犠牲にしない働き方
阿久津 智洋; 阿久津 開; 下田 遥; 米川 知里; 西岡 龍太郎; 奥澤 平明; 星 博勝; 鈴木 啓介; 遠藤 彰, 日本救急医学会雑誌, 35, 11, 614, 614, 2024年11月
(一社)日本救急医学会, 日本語

Acute care surgeryを担う救急医のライフイベントとキャリアの両立
星 博勝; 阿久津 開; 河野 里咲; 天神 久美; 西岡 龍太郎; 奥澤 平明; 久下 晶子; 鈴木 啓介; 阿久津 智洋; 荒木 祐一; 遠藤 彰, 日本救急医学会雑誌, 35, 11, 673, 673, 2024年11月
(一社)日本救急医学会, 日本語

『新外傷死の三徴』のDamage Control Strategy施行基準としての妥当性の外部検証
鈴木 啓介; 遠藤 彰; 小倉 崇以; 白石 淳, 日本救急医学会雑誌, 35, 11, 685, 685, 2024年11月
(一社)日本救急医学会, 日本語

機械的心肺蘇生装置の使用による転帰改善と搬送時間との関連
天神 久実; 遠藤 彰; 阿久津 開; 河野 里咲; 西岡 隆太郎; 奥澤 平明; 星 博勝; 久下 晶子; 鈴木 啓介; 阿久津 智洋; 荒木 祐一, 日本救急医学会雑誌, 35, 11, 699, 699, 2024年11月
(一社)日本救急医学会, 日本語

侵襲性気管支肺アスペルギルス症に対して集学的治療を行った一例
梅本 恵理華; 遠藤 彰; 河野 里咲; 阿久津 智洋; 星 博勝, 日本救急医学会雑誌, 35, 11, 718, 718, 2024年11月
(一社)日本救急医学会, 日本語

S状結腸切除後の難治性急性偽性腸閉塞症(オジルビー症候群)に対してネオスチグミンが奏功した一例
奥澤 平明; 星 博勝; 鈴木 啓介; 阿久津 智洋; 荒木 祐一; 遠藤 彰, 日本救急医学会雑誌, 35, 11, 734, 734, 2024年11月
(一社)日本救急医学会, 日本語

急性バルプロ酸中毒に対してNH3測定で血中濃度を推測した一例
河野 里咲; 荒木 祐一; 遠藤 彰; 阿久津 智洋; 鈴木 啓介; 久下 晶子; 星 博勝; 石北 悠; 天神 久実; 下田 遥, 日本救急医学会雑誌, 35, 11, 766, 766, 2024年11月
(一社)日本救急医学会, 日本語

ホメピゾールの投与、血液透析を要したエチレングリコール中毒の一例
阿久津 開; 鈴木 啓介; 河野 里咲; 天神 久実; 西岡 龍太郎; 奥澤 平明; 星 博勝; 久下 晶子; 荒木 祐一; 阿久津 智洋; 遠藤 彰, 日本救急医学会雑誌, 35, 11, 766, 766, 2024年11月
(一社)日本救急医学会, 日本語

当院のRapid Response Systemの要請理由の検討
石北 悠; 阿久津 開; 河野 里咲; 天神 久実; 奥澤 平明; 星 博勝; 西岡 龍太郎; 久下 晶子; 阿久津 智洋; 鈴木 啓介; 荒木 祐一; 井川 洋子; 遠藤 彰, 日本救急医学会雑誌, 35, 11, 780, 780, 2024年11月
(一社)日本救急医学会, 日本語

第1種装置を用いてHart-Kindwall治療表で応急的に高気圧酸素治療を行った減圧症・空気塞栓症の4例
久下 晶子; 阿久津 開; 河野 里咲; 天神 久美; 西岡 龍太郎; 奥澤 平明; 星 博勝; 鈴木 啓介; 阿久津 智洋; 荒木 祐一; 遠藤 彰, 日本救急医学会雑誌, 35, 11, 813, 813, 2024年11月
(一社)日本救急医学会, 日本語

土浦協同病院での周産期ドクターカー運用
荒木 祐一; 米嶋 美晴; 遠藤 彰; 阿久津 智洋; 鈴木 啓介; 久下 晶子; 星 博勝; 奥澤 平明; 西岡 龍太郎; 天神 久美; 河野 里咲; 阿久津 開, 日本救急医学会雑誌, 35, 11, 823, 823, 2024年11月
(一社)日本救急医学会, 日本語

石灰硫黄合剤内服患者対応による医療者二次曝露の一例
西岡 龍太郎; 鈴木 啓介; 阿久津 開; 下田 遥; 河野 里咲; 天神 久実; 奥澤 平明; 星 博勝; 久下 晶子; 荒木 祐一; 阿久津 智洋; 遠藤 彰, 日本救急医学会雑誌, 35, 11, 867, 867, 2024年11月
(一社)日本救急医学会, 日本語

重症COVID-19における退院時自立歩行獲得症例の特徴
尾池 健児; 石橋 修; 野坂 宜之; 遠藤 彰, The Japanese Journal of Rehabilitation Medicine, 61, 10, 998, 1005, 2024年10月
(公社)日本リハビリテーション医学会, 日本語

Acute Care Surgeryの魅力と可能性 若手外科医の視点から
星 博勝; 奥澤 平明; 鈴木 啓介; 阿久津 智洋; 伊東 浩次; 遠藤 彰, 日本臨床外科学会雑誌, 85, 増刊, S47, S47, 2024年10月
日本臨床外科学会, 日本語

救命救急センターでのAcute Care Surgeonの働き方とシステム構築 ワークライフバランスとキャリア構築
阿久津 智洋; 阿久津 開; 西岡 龍太郎; 奥澤 平明; 星 博勝; 鈴木 啓介; 伊東 浩次; 遠藤 彰, 日本臨床外科学会雑誌, 85, 増刊, S57, S57, 2024年10月
日本臨床外科学会, 日本語

Acute Care Surgeryを担う外科医の仕事と育児の両立
星 博勝; 奥澤 平明; 鈴木 啓介; 阿久津 智洋; 伊東 浩次; 遠藤 彰, 日本臨床外科学会雑誌, 85, 増刊, S87, S87, 2024年10月
日本臨床外科学会, 日本語

救急医療におけるAcute Care Surgeonと当院の役割
阿久津 智洋; 阿久津 開; 西岡 龍太郎; 奥澤 平明; 星 博勝; 鈴木 啓介; 伊東 浩次; 遠藤 彰, 日本臨床外科学会雑誌, 85, 増刊, S95, S95, 2024年10月
日本臨床外科学会, 日本語

トリカブト中毒に対してintravenous lipid emulsionによる治療を行った症例
荒木 祐一; 藤田 友嗣; 久下 晶子; 鈴木 啓介; 阿久津 智洋; 遠藤 彰, 中毒研究, 37, 3, 345, 345, 2024年09月
(株)へるす出版, 日本語

災害派遣医療チーム(DMAT)における臨床工学技士の役割と参入意義
大内 智之; 遠藤 彰, 日本農村医学会雑誌, 73, 3, 226, 226, 2024年09月
(一社)日本農村医学会, 日本語

RRSのアウトカムに迫る 当院のRapid Response Systemの現状と改善への取り組み
下田 遥; 遠藤 彰; 井川 洋子; 山下 雄斗; 石北 悠; 星 博勝; 久下 晶子; 阿久津 智洋; 鈴木 啓介; 荒木 祐一, 日本集中治療医学会雑誌, 31, Suppl.1, S481, S481, 2024年09月
(一社)日本集中治療医学会, 日本語

ドクターカーとドクターヘリで搬送された重症外傷のICU在室日数の比較
阿久津 智洋; 下田 遙; 山下 雄斗; 石北 悠; 星 博勝; 久下 晶子; 荒木 祐一; 鈴木 啓介; 遠藤 彰, 日本集中治療医学会雑誌, 31, Suppl.1, S936, S936, 2024年09月
(一社)日本集中治療医学会, 日本語

当院における過去11年間の経鼻胃管誤挿入に関する後方視的観察研究
星 博勝; 遠藤 彰; 下田 遥; 山下 雄斗; 石北 悠; 久下 晶子; 鈴木 啓介; 阿久津 智洋; 荒木 祐一, 日本集中治療医学会雑誌, 31, Suppl.1, S937, S937, 2024年09月
(一社)日本集中治療医学会, 日本語

劇症型心筋炎を合併した後天性血栓性血小板減少性紫斑病の1例
石北 悠; 久下 晶子; 阿久津 智洋; 鈴木 啓介; 荒木 祐一; 遠藤 彰, 日本集中治療医学会雑誌, 31, Suppl.1, S988, S988, 2024年09月
(一社)日本集中治療医学会, 日本語

当院での食道領域のAcute Care Surgery 11年間の蓄積
阿久津 智洋; 奥澤 平明; 星 博勝; 鈴木 啓介; 伊東 浩次; 遠藤 彰, 日本消化器外科学会総会, 79回, 1895, 1895, 2024年07月
(一社)日本消化器外科学会, 日本語

新時代の熱傷手術・治療戦略
岩田 匡祐; 加藤 宏典; 船積 雅登; 盛山 吉弘; 石塚 俊介; 荒木 祐一; 久下 晶子; 阿久津 智洋; 鈴木 啓介; 遠藤 彰, 日本皮膚科学会雑誌, 134, 5, 1479, 1480, 2024年05月
(公社)日本皮膚科学会, 日本語

外傷患者における病院前活動の有効性と役割 ドクターカーとドクターヘリの搬送方法の違いによる外傷の生存率の検討
阿久津 智洋; 遠藤 彰; 山元 良; 山川 一馬; 星 博勝; 鈴木 啓介; 森下 幸治, 日本外傷学会雑誌, 38, 2, 173, 173, 2024年04月
(一社)日本外傷学会, 日本語

骨盤温存不可能なデグロービング損傷の1例
鈴木 啓介; 蘇我 孟群; 吉岡 隆文; 三浦 剛史; 鳥海 博司; 角地 祐幸; 阿久津 智洋; 遠藤 彰, 日本外傷学会雑誌, 38, 2, 227, 227, 2024年04月
(一社)日本外傷学会, 日本語

土浦協同病院にもたらしたAcute Care Surgeonの効能 過去4年との比較
阿久津 智洋; 奥澤 平明; 星 博勝; 鈴木 啓介; 遠藤 彰, 日本外科学会定期学術集会抄録集, 124回, SF, 2, 2024年04月
(一社)日本外科学会, 日本語

当院における過去12年間の胃潰瘍穿孔治療成績の検討
星 博勝; 遠藤 彰; 阿久津 智洋; 鈴木 啓介; 伊東 浩次, 日本外科学会定期学術集会抄録集, 124回, PS, 6, 2024年04月
(一社)日本外科学会, 日本語

腹部救急疾患とAcute care surgery Acute care surgeryチームを救急科内に配置したことの効果
阿久津 智洋; 下田 遙; 星 博勝; 鈴木 啓介; 遠藤 彰, 日本腹部救急医学会雑誌, 44, 2, 313, 313, 2024年02月
(一社)日本腹部救急医学会, 日本語

電撃傷により片麻痺を呈したまれな症例
久下 晶子; 米川 千里; 石北 悠; 阿久津 智洋; 鈴木 啓介; 荒木 祐一; 遠藤 彰, 救急医学, 48, 1, 115, 117, 2024年01月
(株)へるす出版, 日本語

Optimal Target Blood Pressure in Elderly with Septic Shock: OPTPRESS trial
遠藤 彰; 山川 一馬; 田上 隆; 梅村 穣, 日本救急医学会雑誌, 34, 12, 643, 643, 2023年12月
(一社)日本救急医学会, 日本語

土浦MC地区の院外心停止患者に対する自動心肺蘇生器の使用と転帰の検討
山下 雄斗; 遠藤 彰; 下田 遥; 石北 悠; 星 博勝; 久下 晶子; 阿久津 智洋; 鈴木 啓介; 荒木 祐一, 日本救急医学会雑誌, 34, 12, 712, 712, 2023年12月
(一社)日本救急医学会, 日本語

当院のRapid Response Systemの現状と院内急変との関連
下田 遥; 遠藤 彰; 井川 洋子; 山下 雄斗; 石北 悠; 星 博勝; 久下 晶子; 阿久津 智洋; 鈴木 啓介; 荒木 祐一, 日本救急医学会雑誌, 34, 12, 736, 736, 2023年12月
(一社)日本救急医学会, 日本語

外傷発生と暦との関連 過去18年間の365日の外傷患者発生状況
鈴木 啓介; 遠藤 彰; 山元 良; 山川 一馬; 阿久津 智洋; 星 博勝, 日本救急医学会雑誌, 34, 12, 738, 738, 2023年12月
(一社)日本救急医学会, 日本語

本邦における過去18年間のREBOA使用とその成績の経年変化
星 博勝; 遠藤 彰; 阿久津 智洋; 鈴木 啓介; 山元 良; 山川 一馬, 日本救急医学会雑誌, 34, 12, 751, 751, 2023年12月
(一社)日本救急医学会, 日本語

JTDB新データを用いての外傷におけるV-A ECMOの使用の検討
阿久津 智洋; 遠藤 彰; 山元 良; 山川 一馬; 鈴木 啓介; 星 博勝, 日本救急医学会雑誌, 34, 12, 877, 877, 2023年12月
(一社)日本救急医学会, 日本語

ロボット支援前立腺全摘後の右外腸骨静脈ヘルニアによる絞扼性腸閉塞の一例
杉村 長洋; 阿久津 智洋; 遠藤 彰, 日本救急医学会雑誌, 34, 12, 913, 913, 2023年12月
(一社)日本救急医学会, 日本語

穿孔性虫垂炎に対する腹腔鏡下虫垂切除術におけるドレーン留置の有効性の検討
阿久津 智洋; 星 博勝; 鈴木 啓介; 加藤 俊一郎; 遠藤 彰, 日本消化器外科学会雑誌, 56, Suppl.2, 295, 295, 2023年11月
(一社)日本消化器外科学会, 日本語

「ACSにおけるコメディカルの役割/Role of Medical Staff in Acute care surgery」 Acute Care Surgery導入における看護師教育
米嶋 美晴; 上澤 弘美; 阿久津 智洋; 鈴木 啓介; 遠藤 彰, Japanese Journal of Acute Care Surgery, 13, Suppl., 86, 86, 2023年10月
(一社)日本Acute Care Surgery学会, 日本語

当院での外傷性十二指腸損傷の術式の検討
阿久津 智洋; 遠藤 彰; 星 博勝; 奥澤 平明; 下田 遙; 鈴木 啓介; 伊東 浩次, Japanese Journal of Acute Care Surgery, 13, Suppl., 118, 118, 2023年10月
(一社)日本Acute Care Surgery学会, 日本語

Acute Care Surgeonの育成と拡充 大学病院派遣先 市中病院の視点
阿久津 智洋; 遠藤 彰; 星 博勝; 米川 知里; 奥澤 平明; 下田 遙; 鈴木 啓介; 高山 渉; 森下 幸治, Japanese Journal of Acute Care Surgery, 13, Suppl., 120, 120, 2023年10月
(一社)日本Acute Care Surgery学会, 日本語

広範囲熱傷に対してRegenerative Epidermal Suspension(RECELL)を使用した一例
下田 遥; 阿久津 智洋; 山下 雄斗; 星 博勝; 鈴木 啓介; 遠藤 彰; 岩田 匡祐; 盛山 吉弘, Japanese Journal of Acute Care Surgery, 13, Suppl., 134, 134, 2023年10月
(一社)日本Acute Care Surgery学会, 日本語

緊急開腹手術における手術一次縫合創に対するNPWTの治療成績
星 博勝; 遠藤 彰; 阿久津 智洋; 鈴木 啓介; 下田 遥, Japanese Journal of Acute Care Surgery, 13, Suppl., 154, 154, 2023年10月
(一社)日本Acute Care Surgery学会, 日本語

Acute care surgeonの育成と問題点 大学病院の連携施設の役割
阿久津 智洋; 遠藤 彰; 星 博勝; 米川 知里; 奥澤 平明; 下田 遙; 鈴木 啓介; 高山 渉; 森下 幸治, 日本臨床外科学会雑誌, 84, 増刊, S112, S112, 2023年10月
日本臨床外科学会, 日本語

敗血症:明日の定義と診断を科学する 高齢者の敗血症性ショックに対する初期蘇生を科学する
遠藤 彰; 山川 一馬; 田上 隆; 梅村 穣, Shock: 日本Shock学会雑誌, 37, 1, 53, 53, 2023年07月
(一社)日本Shock学会, 日本語

異なる経過を辿った日本紅斑熱の2例
鈴木 啓介; 荒木 祐一; 阿久津 智洋; 石北 悠; 米川 知里; 遠藤 彰, 日本集中治療医学会雑誌, 30, Suppl.1, S710, S710, 2023年06月
(一社)日本集中治療医学会, 日本語

重症COVID-19における退院時自立歩行獲得症例の特徴
尾池 健児; 石橋 修; 濱野 一平; 内御堂 亮; 野坂 宜之; 遠藤 彰, 日本集中治療医学会雑誌, 30, Suppl.1, S830, S830, 2023年06月
(一社)日本集中治療医学会, 日本語

心静止となった劇症型心筋炎で,V-A ECMOによって神経学的障害なく救命できた一例
阿久津 智洋; 園部 浩之; 吉行 綾子; 中本 礼良; 鈴木 啓介; 村田 希吉; 遠藤 彰, 日本集中治療医学会雑誌, 30, Suppl.1, S689, S689, 2023年06月
(一社)日本集中治療医学会, 日本語

当院におけるER手術室運用における人員確保のシステムの構築
阿久津 智洋; 山下 雄斗; 石北 悠; 米川 知里; 久下 晶子; 鈴木 啓介; 荒木 祐一; 遠藤 彰, 日本外傷学会雑誌, 37, 2, 204, 204, 2023年05月
(一社)日本外傷学会, 日本語

茨城県においてのAcute Care Surgeryの必要性と当院での守備範囲
阿久津 智洋; 米川 知里; 奥澤 平明; 星 博勝; 鈴木 啓介; 遠藤 彰, 日本外科学会定期学術集会抄録集, 123回, DP, 5, 2023年04月
(一社)日本外科学会, 日本語

当院での食道領域のAcute Care Surgery 11年間の蓄積
阿久津 智洋; 鈴木 啓介; 海藤 章郎; 伊東 浩次; 遠藤 彰, 日本腹部救急医学会雑誌, 43, 2, 385, 385, 2023年02月
(一社)日本腹部救急医学会, 日本語

鈍的肝損傷後にAPシャントを伴う仮性動脈瘤の形成を認めた一例
石北 悠; 西田 健二; 森 耕一; 奥澤 平明; 米川 知里; 阿久津 智洋; 鈴木 啓介; 荒木 祐一; 遠藤 彰, 日本腹部救急医学会雑誌, 43, 2, 434, 434, 2023年02月
(一社)日本腹部救急医学会, 日本語

高齢者の敗血症性ショックに対する初期蘇生を科学する
遠藤 彰; 山川 一馬; 田上 隆; 梅村 穣, Shock: 日本Shock学会雑誌, 37, 2, 15, 20, 2023年
(一社)日本Shock学会, 日本語

出血性ショックを呈した十二指腸潰瘍出血に対し緊急膵頭十二指腸切除術を施行し,胃癌十二指腸浸潤の併存を認めた1例
本多 正樹; 奥澤 平明; 星 博勝; 坂下 麻衣; 遠藤 彰; 伊東 浩次, 日本腹部救急医学会雑誌, 42, 7, 759, 762, 2022年11月
(一社)日本腹部救急医学会, 日本語

病院前診療の普及時代における活動の質向上を目指して 重症外傷における医師病院前診療はどのような症状で効果的か
遠藤 彰; 鈴木 啓介; 阿久津 智洋; 荒木 祐一; 大友 康裕, 日本病院前救急診療医学会誌, 17, 2, 34, 34, 2022年11月
(一社)日本病院前救急診療医学会, 日本語

穿通性心損傷に対して胸骨正中切開で右室修復を行い、救命できた一例
阿久津 智洋; 村田 希吉; 石北 悠; 米川 知里; 星 博勝; 鈴木 啓介; 荒木 祐一; 遠藤 彰, 日本臨床外科学会雑誌, 83, 増刊, S390, S390, 2022年10月
日本臨床外科学会, 日本語

重症COVID-19に対する早期挿管と死亡率の減少 多施設共同研究によるパンデミック初期の学説への挑戦
山元 良; 垣内 大樹; 松村 一希; 本間 康一郎; 遠藤 彰; 田上 隆; 鈴木 茂利雄; 八木 雅幸; 梨木 栄作; 佐々木 淳一, 日本救急医学会雑誌, 33, 10, 758, 758, 2022年10月
(一社)日本救急医学会, 日本語

穿通性頸部切創において食道癌頸部郭清の知識が有用であった一例
阿久津 智洋; 園部 浩之; 宮川 赳平; 石北 悠; 米川 知里; 星 博勝; 鈴木 啓介; 荒木 祐一; 村田 希吉; 遠藤 彰; 大友 康裕, Japanese Journal of Acute Care Surgery, 12, Suppl., 133, 133, 2022年09月
(一社)日本Acute Care Surgery学会, 日本語

適切な術式選択により良好な転帰を辿った巨大十二指腸穿孔の一例
星 博勝; 遠藤 彰; 鈴木 啓介; 阿久津 智洋, Japanese Journal of Acute Care Surgery, 12, Suppl., 147, 147, 2022年09月
(一社)日本Acute Care Surgery学会, 日本語

結腸および直腸穿孔に対する緊急手術における予防的創部陰圧閉鎖療法の有用性についての検討
中堤 啓太; 遠藤 彰; 大友 康裕; 淺野 博; 篠原 翔一; 黒崎 亮; 川嶋 秀治; 石井 亘; 野澤 雅之; 多賀谷 信美; 安松 比呂志; 栗山 桂一, 日本腹部救急医学会雑誌, 42, 2, 232, 232, 2022年02月
(一社)日本腹部救急医学会, 日本語

救命救急センターにおける栄養アセスメントシート導入の効果
本庄 智代; 鳥越 純子; 清水 行栄; 遠藤 彰; 溝江 亜紀子, 日本病態栄養学会誌, 24-25, Suppl., S, 39, 2022年01月
(一社)日本病態栄養学会, 日本語

ERCPで救命し得た主膵管損傷を伴う外傷性膵損傷の一例
中熊 将太; 栗原 正道; 小林 正典; 村川 美也子; 伊藤 慧; 遠藤 彰; 大友 康裕; 東 正新; 大塚 和朗; 朝比奈 靖浩; 岡本 隆一, Progress of Digestive Endoscopy, 100, Suppl., s110, s110, 2021年12月
(一社)日本消化器内視鏡学会-関東支部, 日本語

・・・流、ACS最強チームの作り方、教えます! 本邦のAcute care surgery診療の一翼を担ってきた当センターにおけるチームマネージメントの実情
中堤 啓太; 藤田 晃浩; 鈴木 啓介; 遠藤 彰; 大友 康裕, Japanese Journal of Acute Care Surgery, 11, 1, 57, 57, 2021年11月
(一社)日本Acute Care Surgery学会, 日本語

鈍的重症多発外傷による左総腸骨静脈出血に対して、後腹膜パッキングを行い効果的な止血を得た1例
高橋 建叡; 藤田 晃浩; 伊藤 慧; 中堤 啓太; 高橋 麻里絵; 遠藤 彰; 大友 康裕, Japanese Journal of Acute Care Surgery, 11, 1, 109, 109, 2021年11月
(一社)日本Acute Care Surgery学会, 日本語

大規模臨床研究の実践
遠藤 彰, 日本救急医学会雑誌, 32, 12, 849, 849, 2021年11月
(一社)日本救急医学会, 日本語

【Challenge to Change】救急医療に関連するAI研究最前線 空間統計を利用した心肺停止患者の地理的要因が搬送時間と予後に与える影響について
千田 篤; 青山 夏子; 高橋 貴美; 比嘉 武宏; 遠藤 一平; 高野 慎也; 杉中 宏司; 遠藤 彰; 肥留川 賢一; 大友 康裕, 日本救急医学会雑誌, 32, 12, 952, 952, 2021年11月
(一社)日本救急医学会, 日本語

【Challenge to Change】臨床研究力向上特別強化合宿 臨床研究の面白さ・奥深さ
遠藤 彰, 日本救急医学会雑誌, 32, 12, 1284, 1284, 2021年11月
(一社)日本救急医学会, 日本語

High-Flow Nasal Cannula使用患者の人工呼吸器要否予測に関するROX indexの有効性の検証
坂根 和; 遠藤 彰; 大友 康裕, 日本救急医学会雑誌, 32, 12, 1793, 1793, 2021年11月
(一社)日本救急医学会, 日本語

早期経腸栄養が実施できなかった患者の判断根拠の分析
本庄 智代; 溝江 亜紀子; 齋藤 美沙; 藤波 結音; 遠藤 彰, 学会誌JSPEN, 3, Suppl.1, 471, 471, 2021年10月
(一社)日本栄養治療学会, 日本語

下部消化管穿孔手術後の創部感染における予防的Negative pressure wound therapyの効果
中堤 啓太; 遠藤 彰; 関谷 宏祐; 大友 康裕, 日本集中治療医学会雑誌, 28, Suppl.2, 341, 341, 2021年09月
(一社)日本集中治療医学会, 日本語

ScienceとしてのAcute Care Surgery 下部消化管穿孔に対する緊急手術後の創部感染における予防的Negative pressure wound therapyの効果に関する多施設後ろ向きコホート研究
中堤 啓太; 遠藤 彰; 関谷 宏祐; 伊藤 慧; 村田 希吉; 大友 康裕, Japanese Journal of Acute Care Surgery, 10, 2, 42, 42, 2021年04月
(一社)日本Acute Care Surgery学会, 日本語

ScienceとしてのAcute Care Surgery 重症外傷患者に対する医師病院前派遣の有効性についての検討
遠藤 彰; 内山 紗也; 小島 光暁; 大友 康裕, Japanese Journal of Acute Care Surgery, 10, 2, 44, 44, 2021年04月
(一社)日本Acute Care Surgery学会, 日本語

【救急・ICUでの新型コロナウイルス感染症対応マニュアル ウィズコロナ社会のnew normal医療の在り方】(第2章)新型コロナウイルス陽性患者に対する診療の在り方 重症化する患者の特徴
遠藤 彰, Emer Log, 別冊, 救急・ICUでの新型コロナウイルス感染症対応マニュアル, 57, 60, 2021年01月
(株)メディカ出版, 日本語

外科系新専門医制度のあるべきグランドデザイン 外科系新専門医制度の現状分析と課題
赤星 径一; 中川 剛士; 山内 慎一; 岡本 健太郎; 岡田 英理子; 遠藤 彰; 八島 正文; 石橋 洋則; 絹笠 祐介; 植竹 宏之; 大久保 憲一; 大友 康裕; 荒井 裕国; 田邉 稔, 日本外科学会雑誌, 122, 1, 86, 89, 2021年01月
(一社)日本外科学会, 日本語

【救急・ICUでの新型コロナウイルス感染症対応マニュアル ウィズコロナ社会のnew normal医療の在り方】(第2章)新型コロナウイルス陽性患者に対する診療の在り方 重症化する患者の特徴
遠藤 彰, Emer Log, 別冊, 救急・ICUでの新型コロナウイルス感染症対応マニュアル, 57, 60, 2021年01月
(株)メディカ出版, 日本語

患者背景や病態に応じて異なった蘇生アプローチを用いた敗血症性ショックの2例
内山 紗也; 遠藤 彰; 大友 康裕, エンドトキシン血症救命治療研究会誌, 24, 1, 65, 65, 2020年12月
(株)自然科学社, 日本語

敗血症性ショック患者におけるトレミキシンカラム前後の好中球機能とサイトカインの変化についての検討
遠藤 彰; 岡村 美湖; 吉川 俊輔; 森尾 友宏; 大友 康裕, エンドトキシン血症救命治療研究会誌, 24, 1, 122, 122, 2020年12月
(株)自然科学社, 日本語

東京医科歯科大学医学部付属病院集中治療室におけるCOVID-19患者受け入れに際してのゾーニング
山内 英雄; 三島 有華; 長島 道生; 山下 直美; 関谷 宏祐; 遠藤 彰; 相星 淳一; 溝江 亜紀子; 大友 康裕; 重光 秀信, 日本救急医学会雑誌, 31, 11, 2025, 2025, 2020年11月
(一社)日本救急医学会, 日本語

甲状腺クリーゼに対する糖質コルチコイド投与の有効性についての検討 DP Cデータを使用した大規模データベース研究
千田 篤; 遠藤 彰; 大友 康裕, 日本救急医学会雑誌, 31, 11, 2075, 2075, 2020年11月
(一社)日本救急医学会, 日本語

重症外傷患者における医師病院前派遣の有用性の検討
内山 紗也; 大友 康裕; 遠藤 彰, 日本救急医学会雑誌, 31, 11, 2191, 2191, 2020年11月
(一社)日本救急医学会, 日本語

来院時生命兆候を有する重症外傷患者における開胸心臓マッサージの有効性の検討
遠藤 彰; 小島 光暁; 大友 康裕, 日本救急医学会雑誌, 31, 11, 2281, 2281, 2020年11月
(一社)日本救急医学会, 日本語

日本外傷データバンク解析術 図表作成
遠藤 彰, 日本外傷学会雑誌, 34, 5, 220, 220, 2020年11月
(一社)日本外傷学会, 日本語

救急科初期研修医の時間外労働時間は敗血症患者の予後に影響を与えるか
中嶋 裕理; 遠藤 彰; 高山 渉; 大友 康裕, 日本救急医学会雑誌, 31, 11, 1796, 1796, 2020年11月
(一社)日本救急医学会, 日本語

東京医科歯科大学医学部付属病院集中治療室におけるCOVID-19患者受け入れに際してのゾーニング
山内 英雄; 三島 有華; 長島 道生; 山下 直美; 関谷 宏祐; 遠藤 彰; 相星 淳一; 溝江 亜紀子; 大友 康裕; 重光 秀信, 日本救急医学会雑誌, 31, 11, 2025, 2025, 2020年11月
(一社)日本救急医学会, 日本語

甲状腺クリーゼに対する糖質コルチコイド投与の有効性についての検討 DP Cデータを使用した大規模データベース研究
千田 篤; 遠藤 彰; 大友 康裕, 日本救急医学会雑誌, 31, 11, 2075, 2075, 2020年11月
(一社)日本救急医学会, 日本語

重症外傷患者における医師病院前派遣の有用性の検討
内山 紗也; 大友 康裕; 遠藤 彰, 日本救急医学会雑誌, 31, 11, 2191, 2191, 2020年11月
(一社)日本救急医学会, 日本語

来院時生命兆候を有する重症外傷患者における開胸心臓マッサージの有効性の検討
遠藤 彰; 小島 光暁; 大友 康裕, 日本救急医学会雑誌, 31, 11, 2281, 2281, 2020年11月
(一社)日本救急医学会, 日本語

Vasopressin vs Epinephrine:Norepinephrine抵抗性敗血症性ショックを伴う重症肺炎に対する昇圧剤選択
遠藤 彰; 千田 篤; 伏見 清秀; 大友 康裕, 日本集中治療医学会雑誌, 27, Suppl., 457, 457, 2020年09月
(一社)日本集中治療医学会, 日本語

Vasopressin vs Epinephrine:Norepinephrine抵抗性敗血症性ショックを伴う重症肺炎に対する昇圧剤選択
遠藤 彰; 千田 篤; 伏見 清秀; 大友 康裕, 日本集中治療医学会雑誌, 27, Suppl., 457, 457, 2020年09月
(一社)日本集中治療医学会, 日本語

救急科研修医の時間外労働時間は敗血症患者予後に影響を与えるか
中嶋 裕理; 遠藤 彰; 高山 渉; 大友 康裕, 日本集中治療医学会雑誌, 27, Suppl., 469, 469, 2020年09月
(一社)日本集中治療医学会, 日本語

外科系新専門医制度の現状分析と課題
赤星 径一; 伴 大輔; 中川 剛士; 山内 慎一; 岡本 健太郎; 岡田 英理子; 遠藤 彰; 八島 正文; 石橋 洋則; 絹笠 祐介; 植竹 宏之; 大久保 憲一; 大友 康裕; 荒井 裕国; 田邉 稔, 日本外科学会定期学術集会抄録集, 120回, SP, 5, 2020年08月
(一社)日本外科学会, 日本語

鼠径ヘルニアに続発した大網捻転に伴う大網動脈損傷により出血性ショックに至った1例
田村 友里; 中堤 啓太; 手塚 匠海; 星 博勝; 末金 彰; 松井 宏樹; 遠藤 彰; 大友 康裕, 日本腹部救急医学会雑誌, 40, 2, 423, 423, 2020年02月
(一社)日本腹部救急医学会, 日本語

十二指腸に遺残した結石により術後早期に再発に至った胆石イレウスの一症例
高橋 佑典; 中堤 啓太; 遠藤 彰; 大友 康裕, Japanese Journal of Acute Care Surgery, 9, 1, 193, 193, 2019年10月
(一社)日本Acute Care Surgery学会, 日本語

NOMIの初回手術における手術戦略についての検討
遠藤 彰; 斎田 文貴; 持田 弦; 金 史英; 大友 康裕; 根本 大資; 松原 久裕; 山岸 茂; 村尾 佳則; 益子 一樹; 平野 聡; 吉川 健太郎; 世良 俊樹; 稲葉 基高; 小網 博之; 小林 誠人; 村田 希吉; 庄古 智久; 滝口 典聡, Japanese Journal of Acute Care Surgery, 9, 1, 148, 148, 2019年10月
日本Acute Care Surgery学会, 日本語

開腹手術を施行し救命した、腹部コンパートメント症候群合併重症急性膵炎の一例
星 博勝; 中堤 啓太; 遠藤 彰; 大友 康裕, Japanese Journal of Acute Care Surgery, 9, 1, 180, 180, 2019年10月
日本Acute Care Surgery学会, 日本語

緊急手術における周術期感染対策 左側大腸穿孔に対する緊急手術における予防的局所陰圧閉鎖療法の効果に関する検討
遠藤 彰; 中堤 啓太; 関谷 宏裕; 大友 康裕, 日本外科感染症学会雑誌, 16, 5, 460, 460, 2019年10月
(一社)日本外科感染症学会, 日本語

Acute Care Surgeryを科学する NOMIの初回手術における手術戦略についての検討
遠藤 彰; 斎田 文貴; 持田 弦; 金 史英; 大友 康裕; 根本 大資; 松原 久裕; 山岸 茂; 村尾 佳則; 益子 一樹; 多施設共同研究グループNOMI, 日本救急医学会雑誌, 30, 9, 555, 555, 2019年09月
(一社)日本救急医学会, 日本語

ERから臨床研究を発信する 臨床研究のススメ
高山 渉; 遠藤 彰; 白石 淳; 大友 康裕, 日本救急医学会雑誌, 30, 9, 575, 575, 2019年09月
(一社)日本救急医学会, 日本語

センターコンソールアームレストが関連した腎損傷・脾損傷の一例
高山 渉; 遠藤 彰; 森下 幸治; 辻 武弘; 大友 康裕, 日本交通科学学会誌, 19, Suppl., 77, 77, 2019年06月
(一社)日本交通科学学会, 日本語

中等から重症外傷疾患に対する病院生存退院後の自然史、QOL、社会復帰に関する多施設共同研究
土谷 飛鳥; 久志本 成樹; 伊藤 香; 遠藤 彰; 大邉 寛幸; 小倉 崇以; 桂 守弘; 工藤 大介; 近藤 豊; 白石 淳; 関根 和彦; 田上 隆; 中尾 俊一郎; 萩原 章嘉; 松村 洋輔; 松本 松圭; 早川 峰司; 一二三 亨; 安田 英人; 山川 一馬; 湯本 哲也; 吉村 有矢; 日本外傷学会多施設臨床研究委員会, 日本外傷学会雑誌, 33, 2, 172, 172, 2019年05月
(一社)日本外傷学会, 日本語

大量輸血を要する重症外傷患者における超急性期の輸液 輸血蘇生戦略に関する多施設共同後ろ向き観察研究
遠藤 彰; 久志本 成樹; 伊藤 香; 大邉 寛幸; 小倉 崇以; 桂 守弘; 工藤 大介; 近藤 豊; 白石 淳; 関根 和彦; 田上 隆; 土谷 飛鳥; 中尾 俊一郎; 萩原 章嘉; 松村 洋輔; 松本 松圭; 早川 峰司; 一二三 亨; 安田 英人; 山川 一馬; 湯本 哲也; 吉村 有矢; 日本外傷学会多施設臨床研究委員会, 日本外傷学会雑誌, 33, 2, 173, 173, 2019年05月
(一社)日本外傷学会, 日本語

日本におけるPreventable Trauma Death peer reviewによる原因究明と評価
吉村 有矢; 久志本 成樹; 伊藤 香; 遠藤 彰; 大邉 寛幸; 小倉 崇以; 桂 守弘; 工藤 大介; 近藤 豊; 白石 淳; 関根 和彦; 田上 隆; 土谷 飛鳥; 中尾 俊一郎; 萩原 章嘉; 松村 洋輔; 松本 松圭; 早川 峰司; 一二三 亨; 安田 英人; 山川 一馬; 湯本 哲也; 日本外傷学会多施設臨床研究委員会, 日本外傷学会雑誌, 33, 2, 174, 174, 2019年05月
(一社)日本外傷学会, 日本語

重症外傷患者におけるヘパリン起因性血小板減少症発症およびHIT抗体陽性化のメカニズム探索のための多施設共同前向き観察研究
藤田 基生; 久志本 成樹; 伊藤 香; 遠藤 彰; 大邉 寛幸; 小倉 崇以; 桂 守弘; 工藤 大介; 近藤 豊; 白石 淳; 関根 和彦; 田上 隆; 土谷 飛鳥; 中尾 俊一郎; 萩原 章嘉; 松村 洋輔; 松本 松圭; 早川 峰司; 一二三 亨; 安田 英人; 山川 一馬; 湯本 哲也; 吉村 有矢; 日本外傷学会多施設臨床研究委員会, 日本外傷学会雑誌, 33, 2, 175, 175, 2019年05月
(一社)日本外傷学会, 日本語

年齢別、凝固障害が重症頭部外傷患者の予後に与える影響
高山 渉; 遠藤 彰; 大友 康裕, 日本外傷学会雑誌, 33, 2, 221, 221, 2019年05月
(一社)日本外傷学会, 日本語

DPCデータから見た出血性外傷患者に対するトラネキサム酸投与の有効性および効果の異質性の検討
遠藤 彰; 鈴木 啓介; 伏見 清秀; 大友 康裕, 日本集中治療医学会雑誌, 26, Suppl., [O24, 1], 2019年02月
(一社)日本集中治療医学会, 日本語

外傷症例の既往疾患別acute respiratory distress syndrome(ARDS)合併リスク評価
吉川 俊輔; 白石 淳; 遠藤 彰; 大友 康裕, 日本集中治療医学会雑誌, 26, Suppl., [O79, 4], 2019年02月
(一社)日本集中治療医学会, 日本語

重症外傷診療のエビデンス構築を目指して 本邦の外傷症例acute respiratory distress syndrome(ARDS)合併頻度と損傷部位別リスクの検証
吉川 俊輔; 白石 淳; 遠藤 彰; 大友 康裕, 日本救急医学会雑誌, 29, 10, 321, 321, 2018年10月
(一社)日本救急医学会, 日本語

qSOFAの敗血症特異的な予後予測精度の検討と新たな指標の提案
遠藤 彰; 白石 淳; 大友 康裕, 日本救急医学会雑誌, 29, 10, 485, 485, 2018年10月
(一社)日本救急医学会, 日本語

重症胸部外傷に対してV-V ECMOを併用したダメージコントロール戦略を行い救命し得た一例
浅倉 友理; 遠藤 彰; 小島 光暁; 落合 香苗; 大友 康裕, Japanese Journal of Acute Care Surgery, 8, 1, 86, 86, 2018年09月
日本Acute Care Surgery学会, 日本語

外傷症例のacute respiratory distress syndrome(ARDS)合併に関する損傷部位別リスクの検討
吉川 俊輔; 白石 淳; 遠藤 彰; 大友 康裕, Japanese Journal of Acute Care Surgery, 8, 1, 89, 89, 2018年09月
日本Acute Care Surgery学会, 日本語

高齢外傷患者の転帰予測における問題点とモデル改善の方向性についての検討
遠藤 彰; 小島 光暁; 大友 康裕, Japanese Journal of Acute Care Surgery, 8, 1, 91, 91, 2018年09月
日本Acute Care Surgery学会, 日本語

高齢者外傷治療の問題点 高齢者外傷の特徴と課題 超高齢社会の外傷レジストリ解析
遠藤 彰; 小島 光暁; 白石 淳; 大友 康裕, 日本外傷学会雑誌, 32, 2, 236, 236, 2018年06月
(一社)日本外傷学会, 日本語

外傷症例のacute respiratory distress syndrome(ARDS)合併と損傷部位の関係性
吉川 俊輔; 白石 淳; 遠藤 彰; 大友 康裕, 日本外傷学会雑誌, 32, 2, 335, 335, 2018年06月
(一社)日本外傷学会, 日本語

CBRNE災害発生時対応に関する医療従事者の意識・知識調査
伊東 翼; 岡 智; 落合 香苗; 遠藤 彰; 大友 康裕, 日本臨床救急医学会雑誌, 21, 2, 350, 350, 2018年04月
(一社)日本臨床救急医学会, 日本語

敗血症治療における輸液と転帰の関連
小林 茉耶; 遠藤 彰; 落合 香苗; 岡 智; 大友 康裕, 日本臨床救急医学会雑誌, 21, 2, 350, 350, 2018年04月
(一社)日本臨床救急医学会, 日本語

DPCデータベースを用いた救急領域の臨床疫学研究の利点と課題
遠藤 彰; 伏見 清秀; 白石 淳; 村田 希吉; 大友 康裕, 日本腹部救急医学会雑誌, 38, 2, 342, 342, 2018年02月
(一社)日本腹部救急医学会, 日本語

一歩進んだ外傷患者に対する集中治療 ABO型血液型と重症外傷患者予後との関係
高山 渉; 遠藤 彰; 大友 康裕, 日本集中治療医学会雑誌, 25, Suppl., [PD11, 3], 2018年02月
(一社)日本集中治療医学会, 日本語

本邦における外傷センターの整備 DPCデータからみた本邦における施設あたりの重症外傷患者数と生存率・入院総医療費との関連の検討
遠藤 彰; 白石 淳; 伏見 清秀; 村田 希吉; 大友 康裕, 日本外傷学会雑誌, 32, 1, 40, 43, 2018年01月
DPCデータの中から、2010〜2015年度に外傷の病名で入院した患者で、現場から直接救急搬送され、初日に救命救急管理料または特定集中治療室管理料が算定された16歳以上の患者116329例を抽出し、年間の施設あたり患者数別に5群に分け、「生存退院率」「入院総医療費」について群間比較を行った。結果、施設あたり患者数が50例以下の群は他群に比べて「生存退院率」が有意に低く、「入院総医療費」が有意に高かった。, (一社)日本外傷学会, 日本語

【外傷性凝固障害の病態と対応】Damage control resuscitationの指標としての「外傷死の三徴」
遠藤 彰, Thrombosis Medicine, 7, 4, 286, 290, 2017年12月
(株)先端医学社, 日本語

周産期医科歯科連携と北上市の3歳児う蝕有病者率の変化
赤坂 幾子; 藤原 凪; 高橋 綾; 畠山 良彦; 高橋 良明; 松田 尚美; 西本 光男; 星野 彰; 遠藤 秀彦, 岩手県立病院総合学会講演集, 6回, 250, 250, 2017年09月
岩手県立病院総合学会事務局, 日本語

DPCデータを用いた大量輸血を要した外傷患者の最適な新鮮凍結血漿/赤血球比の検討
遠藤 彰; 白石 淳; 大友 康裕, Japanese Journal of Acute Care Surgery, 7, 1, 87, 87, 2017年09月
日本Acute Care Surgery学会, 日本語

侵襲反応を制御する〜臨床研究(breakthrough) 外傷症例における好中球の活性酸素産生量の経時的評価と健常者との比較
吉川 俊輔; 岡村 美湖; 遠藤 彰; 大友 康裕; 森尾 友宏, 日本救急医学会雑誌, 28, 9, 424, 424, 2017年09月
(一社)日本救急医学会, 日本語

食道破裂19例の検討
持田 弦; 岡 智; 関谷 宏祐; 江頭 隆一郎; 八木 雅幸; 遠藤 彰; 小島 光暁; 本藤 憲一; 相星 淳一; 加地 正人; 大友 康裕, 日本救急医学会雑誌, 28, 9, 551, 551, 2017年09月
(一社)日本救急医学会, 日本語

DPCデータを用いた大量輸血患者の最適な新鮮凍結血漿/赤血球比と血小板/赤血球比の検討
遠藤 彰; 白石 淳; 大友 康裕, 日本救急医学会雑誌, 28, 9, 593, 593, 2017年09月
(一社)日本救急医学会, 日本語

本邦における外傷センターの整備 DPCデータからみた本邦における施設外傷症例数と転帰との関連
遠藤 彰; 白石 淳; 村田 希吉; 大友 康裕, 日本外傷学会雑誌, 31, 2, 183, 183, 2017年05月
(一社)日本外傷学会, 日本語

新たな「外傷死の三徴」基準の外的妥当性を検証する前向き縦断研究
遠藤 彰; 白石 淳; 久志本 成樹; 齋藤 大蔵; 中原 慎二; 萩原 章嘉; 早川 峰司; 関根 和彦; 小倉 崇以; 田上 隆; 一二三 亨; 工藤 大介; 吉矢 和久, 日本外傷学会雑誌, 31, 2, 224, 224, 2017年05月
(一社)日本外傷学会, 日本語

頭部外傷における転帰予測因子と手術適応の新基準
茂木 佑太; 遠藤 彰; 岡 智; 落合 香苗; 世良 俊樹; 大友 康裕, 日本救急医学会関東地方会雑誌, 38, 1, 83, 83, 2017年02月
日本救急医学会-関東地方会, 日本語

重症敗血症患者における水分バランスと予後の関係の解析
清水 厚哉; 岡 智; 遠藤 彰; 落合 香苗; 世良 俊樹; 大友 康裕, 日本救急医学会関東地方会雑誌, 38, 1, 108, 108, 2017年02月
日本救急医学会-関東地方会, 日本語

DPCデータを用いた肺炎による重症敗血症に対するvasopressin併用療法の有効性の検討
遠藤 彰; 伏見 清秀; 白石 淳; 松居 宏樹; 村田 希吉; 大友 康裕, 日本集中治療医学会雑誌, 24, Suppl., DP85, 3, 2017年02月
(一社)日本集中治療医学会, 日本語

Surgical Critical Careを要する感染症への対応 劇症型溶血性連鎖球菌感染症の治療戦略 患肢温存救命し得た一例と患肢温存手術中に死亡した一例の検討
遠藤 彰; 加地 正人; 大友 康裕, Japanese Journal of Acute Care Surgery, 6, 2, 160, 160, 2016年09月
日本Acute Care Surgery学会, 日本語

外傷外科手術off-the-job trainingコースの比較
吉川 俊輔; 森下 幸治; 本藤 憲一; 岡 智; 遠藤 彰; 加地 正人; 大友 康裕, Japanese Journal of Acute Care Surgery, 6, 2, 225, 225, 2016年09月
日本Acute Care Surgery学会, 日本語

重症体幹部外傷治療のための基礎的、臨床的挑戦 新しい外傷死の三徴
村田 希吉; 遠藤 彰; 大友 康裕, 日本救急医学会雑誌, 27, 9, 325, 325, 2016年09月
(一社)日本救急医学会, 日本語

当院における外傷性膵損傷の手術実績
平野 貴規; 関谷 宏祐; 遠藤 彰; 森下 幸治; 岡 智; 村田 希吉; 相星 淳一; 加地 正人; 大友 康裕, 日本救急医学会雑誌, 27, 9, 389, 389, 2016年09月
(一社)日本救急医学会, 日本語

Open Abdominal Management適応判断と予後に関する99症例の検討
三田 基樹; 関谷 宏裕; 八木 雅幸; 江頭 隆一郎; 遠藤 彰; 森下 幸治; 岡 智; 村田 希吉; 相星 淳一; 加地 正人; 大友 康裕, 日本救急医学会雑誌, 27, 9, 455, 455, 2016年09月
(一社)日本救急医学会, 日本語

重症敗血症における来院時のヒト好中球の機能変化とその後の経時的変動
遠藤 彰; 岡村 美湖; 吉川 俊輔; 大友 康裕; 森尾 友宏, 日本救急医学会雑誌, 27, 9, 470, 470, 2016年09月
(一社)日本救急医学会, 日本語

突然の腹腔内出血をきたした非外傷性の動脈破裂の6例
朝田 慎平; 八木 雅幸; 三田 基樹; 竹田津 史野; 松井 宏樹; 安達 朋宏; 関谷 宏祐; 遠藤 彰; 岡 智; 加地 正人; 大友 康裕, 日本救急医学会雑誌, 27, 9, 501, 501, 2016年09月
(一社)日本救急医学会, 日本語

電解質異常および乳酸値上昇をきたしたカフェイン多量内服患者を救命した一例
安達 朋宏; 加地 正人; 関谷 宏祐; 遠藤 彰; 落合 香苗; 植木 穣; 岡 智; 大友 康裕, 日本救急医学会雑誌, 27, 9, 506, 506, 2016年09月
(一社)日本救急医学会, 日本語

「外傷外科手術指南塾」の課題と展望および受講生アンケート結果報告
吉川 俊輔; 遠藤 彰; 本藤 憲一; 村田 希吉; 加地 正人; 大友 康裕, Japanese Journal of Acute Care Surgery, 6, 1, 85, 88, 2016年08月
2014〜2015年に行われた日本Acute Care Surgery学会「外傷外科手術指南塾」の総受講生214名を対象にアンケート調査を行い、前回のアンケート(2012〜2013年の受講生に対するアンケート)と比較した。その結果、前回に比べ救急医の受講者の割合が減少し、経験年数が多い(11〜15年)外科医の比率が増加していた。「Acute Care Surgeryを外科学の一分野として確立する必要があるか」という質問に対しては、前回アンケート同様に87%と大半の受講生が必要であると回答した。「外傷外科手術指南塾が今後の外傷診療に役立つかどうか」という質問に対しても、99%が大変役立つまたは役立つと回答し、前回アンケート同様に受講生から高い満足度が得られていた。, 日本Acute Care Surgery学会, 日本語

病院前輸液は外傷性血液凝固障害のリスク因子である
村田 希吉; 大友 康裕; 久志本 成樹; 齋藤 大蔵; 金子 直之; 武田 宗和; 白石 淳; 遠藤 彰; 早川 峰司; 萩原 章嘉; 佐々木 淳一; 小倉 裕司; 松岡 哲也; 植嶋 利文; 森村 尚登; 石倉 宏恭; 加藤 宏; 横田 裕行; 坂本 照夫; 田中 裕; 工藤 大介; 金村 剛宗; 渋沢 崇行; 萩原 靖; 古郡 慎太郎; 仲村 佳彦; 前川 邦彦; 真山 剛; 矢口 有乃; 金 史英; 高須 修; 西山 和孝, 日本外傷学会雑誌, 30, 3, 341, 347, 2016年07月
(一社)日本外傷学会, 日本語

治療指針としての『外傷死の三徴』の有用性の検証と新基準の提案
遠藤 彰; 白石 淳; 久志本 成樹; 大友 康裕; 齋藤 大蔵; 早川 峰司; 小倉 裕司; 村田 希吉; 萩原 章嘉; 佐々木 淳一; 松岡 哲也; 植嶋 利文; 森村 尚登; 石倉 宏恭; 武田 宗和; 金子 直之; 加藤 宏; 工藤 大介; 金村 剛宗; 渋沢 崇行; 萩原 靖; 古郡 慎太郎; 仲村 佳彦; 前川 邦彦; 真山 剛; 矢口 有乃; 金 史英; 高須 修; 西山 和孝, 日本外傷学会雑誌, 30, 3, 419, 423, 2016年07月
(一社)日本外傷学会, 日本語

わが国のPreventable Trauma Deathは減少できたのか? これまでの取り組みと今後の望むべき姿 我が国の11年間の外傷診療成績の検討 JTBDにおけるPTD症例数の推移から
遠藤 彰; 白石 淳; 本藤 憲一; 大友 康裕, 日本外傷学会雑誌, 30, 2, 127, 127, 2016年05月
(一社)日本外傷学会, 日本語

外傷性凝固障害 最新の知見 線溶異常は外傷性凝固障害を早期に反映し、治療戦略の指針となり得るか
遠藤 彰; 白石 淳; 大友 康裕; 村田 希吉, 日本外傷学会雑誌, 30, 2, 136, 136, 2016年05月
(一社)日本外傷学会, 日本語

外傷症例の手術に関するoff-the-job trainingコースの対比
吉川 俊輔; 森下 幸治; 本藤 憲一; 岡 智; 遠藤 彰; 村田 希吉; 加地 正人; 大友 康裕, 日本外傷学会雑誌, 30, 2, 208, 208, 2016年05月
(一社)日本外傷学会, 日本語

有鈎義歯誤飲による食道穿孔の1例
八木 雅幸; 相星 淳一; 竹田津 史野; 松井 宏樹; 冨重 智徳; 遠藤 彰; 世良 俊樹; 村田 希吉; 大友 康裕, 日本腹部救急医学会雑誌, 36, 2, 442, 442, 2016年02月
(一社)日本腹部救急医学会, 日本語

下膵十二指腸動脈瘤破裂による出血性ショックに対して緊急開腹を行い救命した一例
朝田 慎平; 八木 雅幸; 竹田津 史野; 松井 宏樹; 冨重 智徳; 世良 俊樹; 遠藤 彰; 森下 幸治; 村田 希吉; 相星 淳一; 大友 康裕, 日本救急医学会関東地方会雑誌, 37, 1, 119, 119, 2016年02月
日本救急医学会-関東地方会, 日本語

軽症急性膵炎患者の尿量と予後に関する検討
鈴木 健一郎; 関谷 宏祐; 落合 香苗; 江頭 隆一郎; 吉川 和秀; 遠藤 彰; 世良 俊樹; 岡 智; 森下 幸治; 白石 淳; 村田 希吉; 加地 正人; 相星 淳一; 大友 康裕, 日本救急医学会関東地方会雑誌, 37, 1, 119, 119, 2016年02月
日本救急医学会-関東地方会, 日本語

頭部外傷後のParoxysmal sympathetic hyperactivityの一例
松井 宏樹; 八木 雅幸; 竹田津 史野; 冨重 智徳; 遠藤 彰; 世良 俊樹; 森下 幸治; 村田 希吉; 相星 淳一; 大友 康裕, 日本救急医学会関東地方会雑誌, 37, 1, 123, 123, 2016年02月
日本救急医学会-関東地方会, 日本語

身体所見が鑑別に貢献した粘液水腫性昏睡
藤江 聡; 阿久津 智洋; 吉川 俊輔; 遠藤 彰; 落合 香苗; 世良 俊樹; 岡 智; 相星 淳一; 大友 康裕, 日本救急医学会関東地方会雑誌, 37, 1, 128, 128, 2016年02月
日本救急医学会-関東地方会, 日本語

フレイルチェストと外傷性気胸で呼吸管理に難渋した多発外傷の1例
竹田津 史野; 八木 雅幸; 松井 宏樹; 冨重 智徳; 遠藤 彰; 世良 俊樹; 森下 幸治; 村田 希吉; 相星 淳一; 大友 康裕, 日本救急医学会関東地方会雑誌, 37, 1, 140, 140, 2016年02月
日本救急医学会-関東地方会, 日本語

治療指針としての『外傷死の三徴』の有用性の検証と新基準の提案
遠藤彰; 白石淳; 久志本成樹; 大友康裕; 齋藤大蔵; 早川峰司; 小倉裕司; 村田希吉; 萩原章嘉; 佐々木淳一; 松岡哲也; 植嶋利文; 森村尚登; 石倉宏恭; 武田宗和; 金子直之; 加藤宏; 工藤大介; 金村剛宗; 渋沢崇行; 萩原靖; 古郡慎太郎; 仲村佳彦; 前川邦彦; 真山剛; 矢口有乃; KIM Shiei; 高須修; 西山和孝, 日本外傷学会雑誌(Web), 30, 3, 419‐423(J‐STAGE), 2016年
日本語

病院前輸液は外傷性血液凝固障害のリスク因子である
村田希吉; 大友康裕; 久志本成樹; 齋藤大蔵; 金子直之; 武田宗和; 白石淳; 遠藤彰; 早川峰司; 萩原章嘉; 佐々木淳一; 小倉裕司; 松岡哲也; 植嶋利文; 森村尚登; 石倉宏恭; 加藤宏; 横田裕行; 坂本照夫; 田中裕; 工藤大介; 金村剛宗; 渋沢崇行; 萩原靖; 古郡慎太郎; 仲村佳彦; 前川邦彦; 真山剛; 矢口有乃; KIM Shiei; 高須修; 西山和孝, 日本外傷学会雑誌(Web), 30, 3, 341‐347(J‐STAGE), 2016年
日本語

日本外傷データバンクを用いた外傷患者における開胸心マッサージの有効性の検討
遠藤 彰; 白石 淳; 大友 康裕, 日本集中治療医学会雑誌, 23, Suppl., 495, 495, 2016年01月
(一社)日本集中治療医学会, 日本語

敗血症性DICにおけるリコンビナントトロンボモジュリンの有用性
世良 俊樹; 牛澤 洋人; 高橋 宏之; 遠藤 彰; 落合 香苗; 森下 幸治; 相星 淳一; 加地 正人; 磯谷 栄二; 大友 康裕, 日本集中治療医学会雑誌, 23, Suppl., 541, 541, 2016年01月
(一社)日本集中治療医学会, 日本語

重症敗血症・敗血症性ショックにおける好中球機能の変化の検討
遠藤 彰; 岡村 美湖; 吉川 俊輔; 大友 康裕; 森尾 友宏, バイオメディカル, 25, 2, 8, 2015年12月
(株)メディカルレビュー社, 日本語

日本Acute Care Surgery学会主催「外傷外科手術指南塾」受講生アンケートの検討
吉川 俊輔; 遠藤 彰; 本藤 憲一; 小島 光暁; 村田 希吉; 加地 正人; 大友 康裕, Japanese Journal of Acute Care Surgery, 5, 2, 159, 159, 2015年10月
日本Acute Care Surgery学会, 日本語

開胸心マッサージはどのような患者に有効か
遠藤 彰; 白石 淳; 大友 康裕, Japanese Journal of Acute Care Surgery, 5, 2, 210, 210, 2015年10月
日本Acute Care Surgery学会, 日本語

心タンポナーデに対し、初療室で緊急心嚢ドレナージを行い救命した5例
松井 宏樹; 森下 幸治; 八木 雅幸; 遠藤 彰; 相星 淳一; 村田 希吉; 世良 俊樹; 冨重 智徳; 加地 正人; 大友 康裕, 日本救急医学会雑誌, 26, 8, 401, 401, 2015年08月
(一社)日本救急医学会, 日本語

緊急TAEを必要とした腎血管筋脂肪腫の1例
竹田津 史野; 八木 雅幸; 松井 宏樹; 冨重 智徳; 遠藤 彰; 世良 俊樹; 森下 幸治; 村田 希吉; 相星 淳一; 大友 康裕, 日本救急医学会雑誌, 26, 8, 414, 414, 2015年08月
(一社)日本救急医学会, 日本語

J-OCTET報告 今日の外傷診療における"Deadly triad"を改めて検討する
遠藤 彰; 白石 淳; 村田 希吉; 大友 康裕, 日本外傷学会雑誌, 29, 2, 166, 166, 2015年05月
(一社)日本外傷学会, 日本語

外傷性心嚢破裂の1例
吉川 俊輔; 阿久津 智洋; 加地 正人; 岡 智; 世良 俊樹; 落合 香苗; 遠藤 彰; 村田 希吉; 相星 淳一; 大友 康裕, 日本外傷学会雑誌, 29, 2, 287, 287, 2015年05月
(一社)日本外傷学会, 日本語

Top knifeに聞く 外傷手術の肝(キモ)と鍛練法 救急・外傷 Acute Care Surgeryに求められる外科手技
加地 正人; 八木 雅幸; 吉川 俊輔; 遠藤 彰; 小島 光暁; 本藤 憲一; 安池 純士; 森下 幸治; 岡 智; 中島 康; 村田 希吉; 相星 淳一; 大友 康裕, 日本外科学会定期学術集会抄録集, 115回, SY, 2, 2015年04月
(一社)日本外科学会, 日本語

大腿から下腿一部におよぶ筋間膿瘍を伴う閉鎖孔ヘルニア嵌頓の1手術例
鈴木 啓介; 岡 智; 遠藤 彰; 大友 康裕, 日本腹部救急医学会雑誌, 35, 2, 454, 454, 2015年02月
(一社)日本腹部救急医学会, 日本語

非外傷性膀胱破裂8例の検討
遠藤 彰; 漆畑 直; 大友 康裕, 日本腹部救急医学会雑誌, 35, 2, 473, 473, 2015年02月
(一社)日本腹部救急医学会, 日本語

十二指腸憩室穿孔の1例
吉川 俊輔; 遠藤 彰; 村田 希吉; 大友 康裕, 日本腹部救急医学会雑誌, 35, 2, 488, 488, 2015年02月
(一社)日本腹部救急医学会, 日本語

出血源が不明であった外傷性心タンポナーデの一例
鈴木 啓介; 遠藤 彰; 大友 康裕, 日本救急医学会関東地方会雑誌, 36, 1, 132, 132, 2015年02月
日本救急医学会-関東地方会, 日本語

鈍的外傷に伴う短胃動脈損傷の1例
吉川 俊輔; 阿久津 智弘; 藤江 聡; 鈴木 啓介; 遠藤 彰; 落合 香苗; 世良 俊樹; 岡 智; 相星 淳一; 大友 康裕, 日本救急医学会関東地方会雑誌, 36, 1, 133, 133, 2015年02月
日本救急医学会-関東地方会, 日本語

急性膵炎の発症を契機に診断され集中治療を要した全身性エリテマトーデスの一例
阿久津 智洋; 櫻井 啓暢; 遠藤 彰; 吉川 俊輔; 落合 香苗; 世良 俊樹; 岡 智; 相星 淳一; 大友 康裕, 日本集中治療医学会雑誌, 22, Suppl., [DP17, 2], 2015年01月
(一社)日本集中治療医学会, 日本語

ダビガトラン・メトホルミン服薬中に凝固異常・乳酸アシドーシスを来し、集学的治療を要した一例
阿久津 智洋; 櫻井 啓暢; 鈴木 啓介; 遠藤 彰; 吉川 俊輔; 落合 香苗; 世良 俊樹; 岡 智; 相星 淳一; 大友 康裕, 日本集中治療医学会雑誌, 22, Suppl., [DP50, 5], 2015年01月
(一社)日本集中治療医学会, 日本語

敗血症初期のヒト好中球における免疫不全状態に関する検討
遠藤 彰; 岡村 美湖; 吉川 俊輔; 白石 淳; 大友 康裕; 森尾 友宏, 日本集中治療医学会雑誌, 22, Suppl., [DP120, 2], 2015年01月
(一社)日本集中治療医学会, 日本語

白血球減少を伴った重症敗血症における好中球機能異常の解析
遠藤 彰; 岡村 美湖; 吉川 俊輔; 森尾 友宏; 大友 康裕, 日本救急医学会雑誌, 25, 8, 419, 419, 2014年08月
(一社)日本救急医学会, 日本語

病態別による腸管壊死予測因子の検討
鈴木 啓介; 遠藤 彰; 大友 康裕, 日本救急医学会雑誌, 25, 8, 520, 520, 2014年08月
(一社)日本救急医学会, 日本語

Massive transfusion protocolによる緊急O型輸血がRh不適合であった一例
櫻井 啓暢; 落合 香苗; 遠藤 彰; 村田 希吉; 大友 康裕, 日本救急医学会雑誌, 25, 8, 577, 577, 2014年08月
(一社)日本救急医学会, 日本語

可逆性心筋症を合併したHemophilus influenzaeによる電撃性紫斑病の一例
阿久津 智洋; 遠藤 彰; 白石 淳; 相星 淳一; 大友 康裕, 日本救急医学会雑誌, 25, 8, 599, 599, 2014年08月
(一社)日本救急医学会, 日本語

日本におけるAcute Care Surgeryの現状と課題 「外傷外科手術指南塾」で施行した受講生アンケートの結果から
遠藤 彰; 村田 希吉; 小島 光暁; 本藤 憲一; 加地 正人; 大友 康裕, Japanese Journal of Acute Care Surgery, 4, 1, 77, 81, 2014年07月
日本におけるAcute Care Surgeryの現状と課題について、「外傷外科手術指南塾」で施行した受講生アンケートの結果から検討した。アンケート回答者は528例で、普段は外科医として定時手術に従事し、それに加えて外傷手術にも携わっているのは355例であった。普段から救急診療に専従している受講生は132例であった。Acute Care Surgeonが扱うべき分野について、体幹部外傷においては394例、急性腹症は398例、出血や閉塞などのoncologic emergencyは312例、胸部大血管は260例、腹部大血管は343例、末梢血管は230例、頭部外傷は110例、四肢コンパートメント症候群や劇症型軟部組織感染症などは281例がそれぞれ扱うべきと回答した。「外傷外科手術指南塾」が今後の外傷診療に役立つかどうかにおいては、474例が大変役に立つ、もしくは役に立つと回答した。, 日本Acute Care Surgery学会, 日本語

PS-149-8 外科医からみたAcute Care Surgery : 外傷外科手術指南塾のアンケート結果(PS-149 救急 外傷,ポスターセッション,第114回日本外科学会定期学術集会)
遠藤 彰; 村田 希吉; 小島 光暁; 加地 正人; 白石 淳; 大友 康裕, 日本外科学会雑誌, 115, 2, 873, 873, 2014年03月05日
一般社団法人日本外科学会, 日本語

外科医からみたAcute Care Surgery(外傷外科手術指南塾のアンケート結果)
遠藤 彰; 村田 希吉; 小島 光暁; 加地 正人; 白石 淳; 大友 康裕, 日本外科学会雑誌, 115, 臨増2, 873, 873, 2014年03月
(一社)日本外科学会, 日本語

多発外傷を伴ったStanford A型外傷性大動脈解離の一例
吉行 綾子; 遠藤 彰; 落合 香苗; 本藤 憲一; 大友 康裕, 日本救急医学会関東地方会雑誌, 35, 1, 140, 140, 2014年02月
日本救急医学会-関東地方会, 日本語

右特発性食道破裂の1例
齋田 文貴; 遠藤 彰; 大友 康裕, 日本救急医学会関東地方会雑誌, 35, 1, 147, 147, 2014年02月
日本救急医学会-関東地方会, 日本語

酩酊状態で診断が遅延したクモ膜下出血の1例
高山 渉; 三島 有華; 遠藤 彰; 白石 淳一; 相星 淳一; 加地 正人; 大友 康裕, 日本救急医学会関東地方会雑誌, 34, 2, 309, 310, 2013年12月
症例は33歳男性で、飲酒後に駅のホームで嘔吐し倒れ、保護室にて2時間程度経過を見ていたが、嘔気が持続し、救急搬送された。不穏状態が継続しており、数人がかりで抑えながらライン確保し補液を開始するも、800ml程度入った時点で自己抜去した。本人は「やめろ」と繰り返し、これ以上の診察は困難と考え、警察保護のもと帰宅とした。帰宅後も不穏状態は継続し、10時間後に再度救急要請となった。再搬送時もレベルはほぼ変化なしであったが、意識障害遷延を理由に頭部CTを施行し、クモ膜下出血を認めたため、緊急手術となった。術後経過は良好で、第23病日に独歩退院となった。頭部CTを撮ることに関して、酩酊患者に施行した場合、検査後確率がどのくらい見積もられるかを検討してみた結果、酩酊患者に対する頭部CTの検査後の確率の予測は不確定との結果であった。, 日本救急医学会-関東地方会, 日本語

日本Acute Care Surgery学会主催「外傷外科手術指南塾」で施行した受講生アンケート結果
遠藤 彰; 村田 希吉; 小島 光暁; 加地 正人; 大友 康裕, 日本Acute Care Surgery学会学術集会プログラム・抄録, 5回, 39, 39, 2013年11月
日本Acute Care Surgery学会, 日本語

当センターにおける緊急内視鏡手術の現況と分析
安池 純士; 大友 康裕; 加地 正人; 相星 淳一; 村田 希吉; 本藤 憲一; 遠藤 彰; 小島 光暁; 千田 篤; 中堤 啓太; 斎田 文貴, 日本Acute Care Surgery学会学術集会プログラム・抄録, 5回, 86, 86, 2013年11月
日本Acute Care Surgery学会, 日本語

急性薬物中毒患者における入院日数、挿管率、胃洗浄率などの性差、年齢差および入院時のK値について
冨重 智徳; 大友 康裕; 加地 正人; 相星 淳一; 白石 淳; 村田 希吉; 遠藤 彰; 小島 光暁; 本藤 憲一; 高橋 麻里絵, 日本救急医学会雑誌, 24, 8, 526, 526, 2013年08月
(一社)日本救急医学会, 日本語

鉄道外傷の重症度と現場活動時間についての検討
遠藤 彰; 白石 淳; 大友 康裕, 日本救急医学会雑誌, 24, 8, 616, 616, 2013年08月
(一社)日本救急医学会, 日本語

Acute Care Surgery研究会主催「外傷外科手術指南塾」にて行われた受講生の意識調査について
遠藤 彰; 村田 希吉; 小島 光暁; 加地 正人; 大友 康裕, 日本消化器外科学会総会, 68回, RS, 1, 2013年07月
(一社)日本消化器外科学会, 日本語

本邦におけるacute care surgeryのあり方と将来像 本邦におけるAcute Care Surgeryのあり方
加地 正人; 大友 康裕; 相星 淳一; 登坂 直規; 村田 希吉; 遠藤 彰; 小島 光暁; 宮川 赳平; 白石 淳; 世良 俊樹, 日本臨床救急医学会雑誌, 16, 3, 325, 325, 2013年06月
(一社)日本臨床救急医学会, 日本語

外傷専門医だけでは重症外傷は救命できない
村田 希吉; 加地 正人; 相星 淳一; 遠藤 彰; 小島 光暁; 大友 康裕, 日本外傷学会雑誌, 27, 2, 178, 178, 2013年04月
(一社)日本外傷学会, 日本語

鏡視下手術で整復し得た開腹胃全摘後、Petersen's herniaの1例
遠藤 彰; 薄井 信介; 林 薫里; 藤原 尚志; 田代 雅紀; 春木 茂男; 有田 海舵; 伊東 浩二; 松本 日洋; 滝口 典聡; 平沼 進, 茨城県臨床医学雑誌, 48, 53, 53, 2013年02月
(一社)茨城県医師会, 日本語

出血性ショックを呈した腸チフスの一例
遠藤 彰; 牛澤 洋人; 板谷 早希子; 榎本 真也; 世良 俊樹; 村田 希吉; 大友 康裕, 日本腹部救急医学会雑誌, 33, 2, 443, 443, 2013年02月
(一社)日本腹部救急医学会, 日本語

診断困難であったくも膜下出血の一例
高山 渉; 三島 有華; 遠藤 彰; 白石 淳一; 相星 淳一; 加地 正人; 大友 康裕, 日本救急医学会関東地方会雑誌, 34, 1, 129, 129, 2013年02月
日本救急医学会-関東地方会, 日本語

最近7年間の腎損傷80例の検討
遠藤 彰; 漆畑 直; 村田 希吉; 大友 康裕, 日本救急医学会関東地方会雑誌, 34, 1, 137, 137, 2013年02月
日本救急医学会-関東地方会, 日本語

胸腹部外傷の手術成績向上が、外傷死亡患者を減らす Acute Care Surgeonのトレーニングコースについて
小島 光暁; 白石 淳; 高橋 麻里絵; 榎本 真也; 遠藤 彰; 吉川 和秀; 佐藤 浩之; 世良 俊樹; 村田 希吉; 登坂 直規; 相星 淳一; 加地 正人; 大友 康裕, 日本救急医学会関東地方会雑誌, 34, 1, 141, 141, 2013年02月
日本救急医学会-関東地方会, 日本語

外傷性膀胱破裂の1手術例
小島 光暁; 中本 礼良; 宮川 赳平; 遠藤 彰; 村田 希吉; 白石 淳; 登坂 直規; 相星 淳一; 加地 正人; 大友 康裕, 日本救急医学会関東地方会雑誌, 34, 1, 154, 154, 2013年02月
日本救急医学会-関東地方会, 日本語

外傷外科医養成コースの外科専門医取得時の経験症例の特徴と今後の展望
村田 希吉; 加地 正人; 相星 淳一; 登坂 直規; 遠藤 彰; 小島 光暁; 宮川 赳平; 高山 渉; 中本 礼良; 根波 朝陽; 大友 康裕, 日本救急医学会雑誌, 23, 10, 497, 497, 2012年10月
(一社)日本救急医学会, 日本語

外傷性脳損傷に関するTRIAGESスコア(TRIAGES score for traumatic brain injury)
榎本 真也; 白石 淳; 宮川 赳平; 遠藤 彰; 小島 光暁; 吉川 和秀; 村田 希吉; 登坂 直規; 相星 淳一; 加地 正人; 大友 康裕, 日本救急医学会雑誌, 23, 10, 544, 544, 2012年10月
(一社)日本救急医学会, 日本語

特発性食道破裂9例の検討
小島 光暁; 市野瀬 剛; 遠藤 彰; 世良 俊樹; 森 周介; 村田 希吉; 白石 淳; 登坂 直規; 相星 淳一; 加地 正人; 大友 康裕, 日本救急医学会雑誌, 23, 10, 595, 595, 2012年10月
(一社)日本救急医学会, 日本語

外傷急性期における血液凝固障害と急性期DIC診断基準 自験例からの考察
高橋 麻理絵; 村田 希吉; 加地 正人; 相星 淳一; 登坂 直規; 遠藤 彰; 小島 光暁; 宮川 赳平; 大友 康裕, 日本救急医学会雑誌, 23, 10, 619, 619, 2012年10月
(一社)日本救急医学会, 日本語

外傷性巨大胸膜外血腫に対するVATSの有用性
遠藤 彰; 稲垣 雅春; 小貫 琢也; 村田 希吉; 大友 康裕, 日本救急医学会雑誌, 23, 10, 710, 710, 2012年10月
(一社)日本救急医学会, 日本語

鏡視下手術で整復し得た開腹胃全摘後、Petersen's herniaの一例
遠藤 彰; 薄井 信介; 林 薫里; 藤原 尚志; 田代 雅紀; 春木 茂男; 有田 海舵; 伊東 浩二; 松本 日洋; 滝口 典聡; 平沼 進, 日本臨床外科学会雑誌, 73, 9, 2450, 2450, 2012年09月
日本臨床外科学会, 日本語

気管支鏡下及び局所麻酔下胸腔鏡によるPGAシート・フィブリン糊充填で治癒した右下葉切除後断端瘻の1例
中嶋 真之; 遠藤 彰; 小貫 琢哉; 稲垣 雅春; 足立 雄太; 齋藤 弘明; 山下 高明; 齊藤 和人; 若井 陽子; 高部 和彦; 篠原 陽子; 鈴木 恵子; 大原 潔, 気管支学, 34, 3, 294, 294, 2012年05月
(一社)日本呼吸器内視鏡学会, 日本語

腹腔鏡下超低位前方切除術の工夫と新展開 骨盤腔内切離の工夫と腹腔鏡下ISRの新展開
松本 日洋; 有田 海舵; 林 薫里; 藤原 尚志; 遠藤 彰; 田代 雅紀; 春木 茂男; 薄井 信介; 伊東 浩次; 滝口 典聡; 平沼 進, 日本外科学会雑誌, 113, 臨増2, 463, 463, 2012年03月
(一社)日本外科学会, 日本語

発症3年で横行結腸癌を合併し、胃-横行結腸瘻を来たした潰瘍性大腸炎の1例
有田 カイダ; 林 薫里; 葛井 総太郎; 遠藤 彰; 田代 雅紀; 春木 茂; 田中 優子; 薄井 信介; 伊東 浩次; 松本 日洋; 滝口 典聡; 堀 哲夫; 真田 勝弘; 平沼 進, 茨城県臨床医学雑誌, 47, 31, 31, 2012年02月
(一社)茨城県医師会, 日本語

腸石を伴った十二指腸憩室穿孔の1例
林 薫里; 平沼 進; 滝口 典聡; 葛井 総太郎; 遠藤 彰; 田代 雅紀; 春木 茂男; 有田 カイダ; 田中 優子; 薄井 信介; 伊藤 浩次; 松本 日洋; 真田 勝弘, 茨城県臨床医学雑誌, 47, 36, 37, 2012年02月
(一社)茨城県医師会, 日本語

同時性肝転移、異時性膵転移・局所再発、尿管転移・肺転移を切除し長期生存が得られている下行結腸癌の1例
滝口 典聡; 遠藤 彰; 春木 茂男; 有田 カイダ; 薄井 信介; 伊東 浩次; 松本 日洋; 平沼 進, 日本消化器外科学会雑誌, 45, 2, 232, 241, 2012年02月
(一社)日本消化器外科学会, 日本語

Reduced Port Surgeryの利点、欠点(食道・胃) TIL-DG(Triple Incision Laparoscopic Distal Gastrectomy)の利点・欠点
薄井 信介; 田代 雅紀; 遠藤 彰; 伊東 浩次; 松本 日洋; 滝口 典聡; 平沼 進; 真田 勝弘, 日本内視鏡外科学会雑誌, 16, 7, 289, 289, 2011年12月
(一社)日本内視鏡外科学会, 日本語

腹腔鏡下大腸癌手術の現況と展望
松本 日洋; 有田 海舵; 遠藤 彰; 田代 雅紀; 春木 茂男; 伊東 浩次; 滝口 典聡; 平沼 進; 真田 勝弘, 日本臨床外科学会雑誌, 72, 増刊, 482, 482, 2011年10月
日本臨床外科学会, 日本語

劇症型A型肝炎に後天性赤芽球癆を合併し脳膿瘍に至った1剖検例
村山 睦; 鈴木 貴久; 篠田 昌孝; 高士 ひとみ; 内山 功子; 宇佐美 彰久; 遠藤 伸也, 肝臓, 52, Suppl.2, A629, A629, 2011年09月
(一社)日本肝臓学会, 日本語

腸石を伴った十二指腸憩室穿孔の一例
林 薫里; 平沼 進; 滝口 典聡; 葛井 総太郎; 遠藤 彰; 田代 雅紀; 春木 茂男; 有田 カイダ; 田中 優子; 薄井 信介; 伊藤 浩次; 松本 日洋; 真田 勝弘, 日本臨床外科学会雑誌, 72, 7, 1904, 1904, 2011年07月
日本臨床外科学会, 日本語

胃癌に対する腹腔鏡下手術の新たな考え方と工夫 MiniMiniTrocarSleeveと天釣り把持鉗子を用いたTILDG(Triple Incision Laparoscopic Distal Gastrectomy)
薄井 信介; 田代 雅紀; 遠藤 彰; 春木 茂男; 伊東 浩次; 松本 日洋; 滝口 典聡; 平沼 進; 真田 勝弘, 日本消化器外科学会総会, 66回, 278, 278, 2011年07月
(一社)日本消化器外科学会, 日本語

腹腔鏡下直腸切除に対する新たな展開
松本 日洋; 有田 海舵; 葛井 総太郎; 遠藤 彰; 田代 雅紀; 春木 茂男; 薄井 信介; 伊東 浩次; 滝口 典聡; 平沼 進, 日本消化器外科学会総会, 66回, 534, 534, 2011年07月
(一社)日本消化器外科学会, 日本語

門脈右枝を結紮し二期的肝切除で切除し得た空腸GIST多発肝転移の1例
滝口 典聡; 林 薫里; 葛井 総太郎; 遠藤 彰; 田代 雅紀; 春木 茂男; 有田 カイダ; 田中 優子; 薄井 信介; 伊東 浩次; 松本 日洋; 平沼 進; 真田 勝弘, 日本外科学会雑誌, 112, 臨増1-2, 535, 535, 2011年05月
(一社)日本外科学会, 日本語

先進部に病変を認めなかった胃十二指腸重積の一例
市野瀬 剛; 庄古 知久; 遠藤 彰; 森下 幸治; 村田 希吉; 加地 正人; 相星 淳一; 大友 康裕, 日本腹部救急医学会雑誌, 30, 2, 344, 344, 2010年02月
(一社)日本腹部救急医学会, 日本語

収容決定までに複数の搬送連絡を要した三次救急患者の特徴(特別区の一大学病院における検討)
登坂 直規; 吉川 俊輔; 小島 光暁; 遠藤 彰; 小林 陽一; 森下 幸治; 関 裕; 村田 希吉; 大友 康裕, 日本救急医学会関東地方会雑誌, 30, 126, 127, 2009年12月
日本救急医学会-関東地方会, 日本語

壊死性筋膜炎(Fournier's gangrene)に対してデブリードマン後、皮下に睾丸を埋没した1例
吉川 俊輔; 小島 光暁; 遠藤 彰; 森下 幸治; 村田 希吉; 登坂 直規; 庄古 知久; 加地 正人; 磯谷 栄二; 大友 康裕, 日本臨床救急医学会雑誌, 12, 2, 221, 221, 2009年04月
(一社)日本臨床救急医学会, 日本語

頭蓋内圧モニタリングの有用性 蘇生後脳症の転帰と低体温療法中の頭蓋内圧は相関する
磯谷 栄二; 関 裕; 若林 正和; 吉川 俊輔; 遠藤 彰; 本藤 憲一; 小島 光暁; 加地 正人; 相星 淳一; 大友 康裕, 日本脳神経外科救急学会プログラム・抄録集, 14回, 91, 91, 2009年01月
(NPO)日本脳神経外科救急学会, 日本語

Severe sepsisに対するrecombinant thrombomodulinの使用経験
遠藤 彰; 磯谷 栄二; 吉川 俊輔; 村田 希吉; 白石 淳; 登坂 直規; 庄古 知久; 加地 正人; 相星 淳一; 大友 康裕, 日本集中治療医学会雑誌, 16, Suppl., 266, 266, 2009年01月
(一社)日本集中治療医学会, 日本語

重症頭部外傷における循環動態の解析
小島 光暁; 遠藤 彰; 吉川 俊輔; 関 裕; 磯谷 栄二; 大友 康裕, 日本集中治療医学会雑誌, 16, Suppl., 270, 270, 2009年01月
(一社)日本集中治療医学会, 日本語

重症頭部外傷における循環動態の解析
小島 光暁; 磯谷 栄二; 関 裕; 遠藤 彰; 吉川 俊輔; 森下 幸治; 登坂 直規; 庄古 知久; 相星 淳一; 加地 正人; 大友 康裕, 日本救急医学会雑誌, 19, 8, 672, 672, 2008年08月
(一社)日本救急医学会, 日本語

後腹膜出血をきたしたmicroscopic polyangiitisの一例
吉川 俊輔; 細谷 匡; 相星 淳一; 森下 幸治; 三上 さおり; 遠藤 彰; 小島 光暁; 関 裕; 登坂 直規; 加地 正人; 大友 康裕, 日本救急医学会雑誌, 19, 8, 811, 811, 2008年08月
(一社)日本救急医学会, 日本語

重症鉄道外傷患者はホームフェンスにより減少させられるか?
白石 淳; 遠藤 彰; 加地 正人; 大友 康裕, 日本救急医学会雑誌, 19, 8, 813, 813, 2008年08月
(一社)日本救急医学会, 日本語

劇症型様の発症経過を示した非自己免疫性1型糖尿病の1例
高橋 寛吉; 斎 秀二; 藤澤 泰子; 中西 俊樹; 遠藤 彰; 中川 祐一; 大関 武彦, 日本小児科学会雑誌, 108, 5, 813, 813, 2004年05月
(公社)日本小児科学会, 日本語

最近経験したインフルエンザ桿菌髄膜炎3症例の臨床的検討 劇症型症例と治療上の問題点を中心に
平野 浩一; 増井 礼子; 田口 智英; 稲葉 泰子; 遠藤 彰; 遠矢 和彦; 那須田 馨; 伊熊 正光; 本郷 輝明; 大関 武彦, 日本小児科学会雑誌, 104, 7, 782, 782, 2000年07月
(公社)日本小児科学会, 日本語

ER・ICUの適正輸液 : 不要な輸液を可視化する
土谷, 飛鳥, 多発外傷からの重症感染症
メジカルビュー社, 2025年03月, 9784758323048, x, 349p, 日本語, ［分担執筆］

Acute Care Surgery認定外科医テキスト
日本Acute Care Surgery学会テキスト作成小委員会; 日本Acute Care Surgery学会, 集中治療-循環管理
へるす出版, 2021年04月, 9784867190173, xiv, 519p, 日本語, ［分担執筆］

救急・ICUでの新型コロナウイルス感染症対応マニュアル : ウィズコロナ社会のnew normal医療の在り方
大友, 康裕, 重症化する患者の特徴
メディカ出版, 2021年01月, 9784840475099, vi,105p, 日本語, ［分担執筆］

臨床研修手技・処置ベッドサイド手帖
奈良, 信雄; 植竹, 宏之, 外科的気道確保
メジカルビュー社, 2012年09月, 9784758313056, 237p, 日本語, ［分担執筆］

敗血症に対する新たな臨床試験体制:アダプティブデザイン・プラットフォームの構築
科学研究費助成事業
2025年04月01日 - 2029年03月31日
久志本 成樹; 山元 良; 山川 一馬; 藤井 智子; 和田 剛志; 梅村 穣; 松田 航; 遠藤 彰; 松岡 義; 一原 直昭
日本学術振興会, 基盤研究(B), 東北大学, 25K02843

敗血症性ショックの蘇生における個別化戦略：多施設ランダム化試験とメタアナリシス
科学研究費助成事業
2021年04月01日 - 2026年03月31日
遠藤 彰; 梅村 穣; 田上 隆; 山川 一馬
本研究は日本救急医学会多施設共同試験特別委員会主導研究であり、正式名称は「高齢敗血症性ショック患者に対する初期血圧管理戦略多施設共同ランダム化比較試験（Optimal Target Blood Pressure in Elderly with Septic Shock (OPTPRESS) trial）」である。（https://www.jaam.jp/jaamoptpress/index.html）65歳以上の敗血症性ショック患者を対象とし、初期蘇生における平均血圧の目標を80mmHgとする介入群と65mmHgとするコントロール群とで転帰を比較する。類似のテーマとしていくつかRCTがあるが、いずれもHigh-targetの有用性を示せなかった。これについては昇圧に用いるNADの有害事象がHigh-targetそのもののbenefitを上回った可能性も指摘されている。本研究は経験的にHigh-targetが有効であろう65歳以上の患者を対象とし、早期からvasopressinを併用いてNADの有害事象を減少させるようなプロトコルで検討するのが特徴的である。普遍的なテーマで今後の世界的な高齢化社会に向けたメッセージ性も強く、結果がnegativeであっても大きなインパクトを有するランダム化比較試験であると考える。
日本学術振興会, 基盤研究(B), 東京医科歯科大学, 23K21518

敗血症性ショックの蘇生における個別化戦略：多施設ランダム化試験とメタアナリシス
科学研究費助成事業
2021年04月01日 - 2026年03月31日
遠藤 彰; 梅村 穣; 田上 隆; 山川 一馬
主施設及び各研究参加施設の倫理審査を終え、EDC (HOPE eACReSS)の設計と動作確認を行った。また本研究は特定臨床研究という位置付けではないものの、臨床研究保険にも加入した（賠償のみ）。研究参加施設研究にコメディカルに対する説明資料やプロトコルに則った昇圧薬のオーダーセットも作成した。また患者エントリーの方法や個々のプロトコル確認などを含む研究説明会ををWEBミーティング形式で行った。以上の環境整備が整ったのちに2021年7月1日から患者エントリーを開始した。
新型コロナウイルスパンデミックの影響で本邦の多くの救命救急センターがCOVID-19対応をせざるを得ない状況の中、新型開始当初は予定よりもエントリー数が伸び悩んでいる状況であった。しかし11月に行われた第49回日本救急医学会総会・学術集会や3月に行われた第49回日本集中治療医学会学術集会などで研究ミーティングを開催し、研究に関する問題点などを共有・対処法などを検討していく中で徐々に登録ペースの改善を認めている。また研究計画の文言の明確化や研究参加施設の追加などで適宜計画書の改訂も行い、UMIN-CTR登録情報もアップデートすることで研究の透明化への配慮も十分行った。同時に2021年度は2回のセントラルモニタリングを行い、研究が計画に則って実施されているかや登録データの正確性などについての検証も行っている。
2021年度終了時点で28施設が参加し、計111例の患者エントリーが得られている。現時点で明らかに研究に起因する重篤な有害事象は認めていない。
日本学術振興会, 基盤研究(B), 東京医科歯科大学, 21H03197

DPCデータを用いた日本の外傷診療の評価
科学研究費助成事業 若手研究(B)
2017年04月01日 - 2020年03月31日
遠藤 彰
本研究はDPCデータを解析することにより、外傷をはじめとして救急集中治療医学領域のいくつもの重篤疾患や希少疾患に関する疫学研究の結果を広く世界に発表することができた。
重症外傷については施設あたりの症例数増加が患者の生命転帰改善および入院医療費減少と有意に関連することを示し、患者の集約化が医学的・社会的観点から有用である可能性を示した。一方で重症熱傷患者についてはこのような傾向は認めず、課題が残ることを示した。
上記に加えて外傷急性期の最適な輸血戦略についての研究成果を発表した他、重症急性膵炎、急性期脳梗塞、甲状腺クリーゼなどの疾患についても複数の因果推論研究を行い、成果を国際誌に発表した。
日本学術振興会, 若手研究(B), 東京医科歯科大学, 17K17045