Exploring the subtle and novel renal pathological changes in diabetic nephropathy using clustering analysis with deep learning.

To decrease the number of chronic kidney disease (CKD), early diagnosis of diabetic kidney disease is required. We performed invariant information clustering (IIC)-based clustering on glomerular images obtained from nephrectomized kidneys of patients with and without diabetes. We also used visualizing techniques (gradient-weighted class activation mapping (Grad-CAM) and generative adversarial networks (GAN)) to identify the novel and early pathological changes on light microscopy in diabetic nephropathy.

Inflammation-Triggering Engineered Macrophages (MacTriggers) Enhance Reactivity of Immune Checkpoint Inhibitor Only in Tumor Tissues.

We have previously reported engineered macrophages (MacTriggers) that can accelerate the release of tumor necrosis factor-α in response to M2 polarization. MacTriggers are characterized by two original characteristics of macrophages: (1) migration to tumors; and (2) polarization to the M2 phenotype in tumors. Intravenously administered MacTriggers efficiently accumulated in the tumors and induced tumor-specific inflammation.

ACA-28, an ERK MAPK Signaling Modulator, Exerts Anticancer Activity through ROS Induction in Melanoma and Pancreatic Cancer Cells.

The extracellular signal-regulated kinase (ERK) MAPK pathway is dysregulated in various human cancers and is considered an attractive therapeutic target for cancer. Therefore, several inhibitors of this pathway are being developed, and some are already used in the clinic. We have previously identified an anticancer compound, ACA-28, with a unique property to preferentially induce ERK-dependent apoptosis in melanoma cells.

Characteristics and comparative study of thoracolumbar spine injury and dislocation fracture due to tertiary trauma.

Purpose: Thoracolumbar spine injury is frequently seen with high-energy trauma but dislocation fractures are relatively rare in spinal trauma, which is often neurologically severe and requires urgent treatment. Therefore, it is essential to understand other concomitant injuries when treating dislocation fractures. The purpose of this study is to determine the differences in clinical features between thoracolumbar spine injury without dislocation and thoracolumbar dislocation fracture.

Association of the COVID-19 pandemic with bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a population-based analysis in Tokyo, Japan.

Background: The impact of the COVID-19 pandemic on bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) is unclear. This study aimed to investigate whether rates of bystander CPR and patient outcomes changed during the initial state of emergency declared in Tokyo for the COVID-19 pandemic.

Methods: This retrospective study used data from a population-based database of OHCA maintained by the Tokyo Fire Department.

Hyperoxia Is Not Associated With 30-day Survival in Out-of-Hospital Cardiac Arrest Patients Who Undergo Extracorporeal Cardiopulmonary Resuscitation.

Introduction: The appropriate arterial partial pressure of oxygen (PaO) in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) remains unclear. The present study aimed to investigate the relationship between hyperoxia and 30-day survival in patients who underwent ECPR.

Materials And Methods: This single-center retrospective cohort study was conducted between January 2010 and December 2018.

Systemic capillary leak syndrome requiring fasciotomy for limb compartment syndrome: A case report and literature review.

Background: Limb compartment syndrome (LCS), a rare but serious complication of systemic capillary leak syndrome (SCLS)-related systemic edema, warrants prompt decompressive fasciotomy. We report a case of SCLS complicated by LCS of four extremities requiring emergent fasciotomies; furthermore, we reviewed existing published reports on SCLS with LCS.

Case Presentation: A 36-year-old man was diagnosed with SCLS based on profound vascular permeability with no other underlying conditions.

A new screening model for quantitative risk assessment of blunt thoracic aortic injury.

Purpose: Early identification of blunt thoracic aortic injury is vital for preventing subsequent aortic rupture. However, risk factors for blunt thoracic aortic injury remain unclear, and a prediction rule remains to be established. We developed and internally validated a new nomogram-based screening model that allows clinicians to quantify blunt thoracic aortic injury risk.

Evaluation of initial shockable rhythm as an indicator of short no-flow time in cardiac arrest: a national registry study.

Background: The duration from collapse to initiation of cardiopulmonary resuscitation (no-flow time) is one of the most important determinants of outcomes after out-of-hospital cardiac arrest (OHCA). Initial shockable cardiac rhythm (ventricular fibrillation or ventricular tachycardia) is reported to be a marker of short no-flow time; however, there is conflicting evidence regarding the impact of initial shockable cardiac rhythm on treatment decisions. We investigated the association between initial shockable cardiac rhythm and the no-flow time and evaluated whether initial shockable cardiac rhythm can be a marker of short no-flow time in patients with OHCA.

Hospital Volume-Outcome Relationship in Severe Traumatic Brain Injury: A Nationwide Observational Study in Japan.

Objective: The hospital volume-outcome relationship in patients with severe traumatic brain injury (TBI) remains unclear. This study investigated the association between the volume of patients with severe TBI and in-hospital mortality.

Methods: This observational study identified patients with severe TBI (Glasgow Coma Scale score <9 and Abbreviated Injury Scale head score ≥3) from the Japan Trauma Databank (2010-2018).

Nursing Home Versus Community Resuscitation After Cardiac Arrest: Comparative Outcomes and Risk Factors.

Objective: To investigate the characteristics and outcomes of patients who experienced cardiac arrest in nursing homes compared with those in private residences and determine prognostic factors for survival.

Design: This was a retrospective study that analyzed data from an Utstein-style registry of the Tokyo Fire Department.

Setting And Participants: We identified patients aged ≥65 years who experienced cardiac arrest in a nursing home or private residence from the population-based registry of out-of-hospital cardiac arrests in Tokyo, Japan, from 2014 to 2018.

External validation of simplified out-of-hospital cardiac arrest and cardiac arrest hospital prognosis scores in a Japanese population: a multicentre retrospective cohort study.

Background: The novel simplified out-of-hospital cardiac arrest (sOHCA) and simplified cardiac arrest hospital prognosis (sCAHP) scores used for prognostication of hospitalised patients have not been externally validated. Therefore, this study aimed to externally validate the sOHCA and sCAHP scores in a Japanese population.

Methods: We retrospectively analysed data from a prospectively maintained Japanese database (January 2012 to March 2013).

Development of a risk stratification scoring system for deep vein thrombosis upon psychiatric admission.

Aim: Psychiatric patients have increased risk of deep vein thrombosis (DVT). However, there is no systematic data on risk assessment of DVT among psychiatric inpatients. The aim of this study was to develop a risk stratification scoring system for DVT among psychiatic patients on admission.

Effectiveness of public-access automated external defibrillators at Tokyo railroad stations.

Aim: To investigate the effectiveness of public-access automated external defibrillators (AEDs) at Tokyo railroad stations.

Methods: We analysed data from a population-based registry of out-of-hospital cardiac arrests in Tokyo, Japan (2014-2018). We identified patients aged ≥18 years who experienced bystander-witnessed cardiac arrest due to ventricular fibrillation of presumed cardiac origin at railroad stations.

Older Adults with Traumatic Brain Injury in the Most Aged and Most Rapidly Aging Country: An Analysis of the Nationwide Trauma Registry of Japan.

Background: Despite the increasing numbers of older adults with traumatic brain injury (TBI), minimal data are available to support the development of treatment strategies. We aimed to comprehensively describe the incidence, characteristics, outcomes, and predictive accuracy of the severity indicators among older adults with TBI.

Methods: Using the Japan Trauma Data Bank, we identified patients aged ≥18 years with TBI from 2004 to 2019.

Derivation and validation of a quantitative screening model for blunt cerebrovascular injury.

Objective: The objective of this study was to derive and validate a new screening model using a nomogram that allows clinicians to quantify the risk of blunt cerebrovascular injury (BCVI).

Methods: In this study, the authors examined 258,935 patients from a prospectively collected nationwide Japanese database (January 2009-December 2018) who experienced blunt injury. Patients were randomly divided into training (n = 129,468) and validation (n = 129,467) cohorts.

Acceptable Blood Pressure Levels in the Prehospital Setting for Patients with Traumatic Brain Injury: A Multicenter Observational Study.

Background: Safe blood pressure levels in the prehospital setting for patients with traumatic brain injury (TBI) remain unclear. We aimed to investigate the association between prehospital blood pressure and the outcomes of patients with TBI to determine optimal threshold for hypotension that could be considered in the prehospital setting.

Methods: Using data from the Japan Trauma Data Bank, we identified adult patients (aged ≥18 years) who experienced severe TBI (maximum head Abbreviated Injury Severity score ≥3) and were transported directly from the scene of the blunt trauma occurrence to the hospital, between 2004 and 2019.

Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study.

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown.