Medical validity and layperson interpretation of emergency visit recommendations by the GPT model: A cross-sectional study.

Aim: In Japan, emergency ambulance dispatches involve minor cases requiring outpatient services, emphasizing the need for improved public guidance regarding emergency care. This study evaluated both the medical plausibility of the GPT model in aiding laypersons to determine the need for emergency medical care and the laypersons' interpretations of its outputs.

Methods: This cross-sectional study was conducted from December 10, 2023, to March 7, 2024.

Changes in gene expression in healthcare workers during night shifts: implications for immune response and health risks.

Background: Shift work is common in healthcare, especially in emergency and intensive care, to maintain the quality of patient care. Night shifts are linked to health risks such as cardiovascular disease, metabolic disorders, and poor mental health. It has been suggested that inflammatory responses due to the disruption of circadian rhythm may contribute to health risks, but the detailed mechanisms remain unclear.

A hidden danger: lung abscess following inhalation of kerosene-based pyrethroid insecticide spray.

Background: Pyrethroid insecticides are widely used because of their low toxicity in humans. Spray-type pyrethroids are often formulated with kerosene as a carrier solvent, and inhalation of kerosene-containing products can lead to pneumonitis and the formation of lung abscesses. We report a case of chemical pneumonitis resulting in the development of a lung abscess due to the intentional inhalation of pyrethroids.

Relationship between growth differentiation factor 15 and functional prognosis and severity in traumatic brain injury.

Circulating growth differentiation factor 15 (GDF-15) increases in response to inflammation and tissue damage. Its association with functional prognosis in cerebral infarction and subarachnoid hemorrhage is established; however, its role in traumatic brain injury (TBI) and its relationship with Sequential Organ Failure Assessment (SOFA) score, an indicator of systemic organ damage in TBI, remains unclear. This study aimed to explore the correlation between GDF-15 and functional outcomes at discharge in patients with TBI and stroke, including its association with SOFA scores in TBI.

A case of penetrating neck injury in zone II treated with combined endovascular and surgical management.

Background: We report a case of zone II penetrating neck trauma with active bleeding in which endovascular treatment was performed prior to neck exploration to identify and control the bleeding point.

Case Presentation: A man in his 50s presented to our emergency department in hemorrhagic shock stemming from a penetrating knife wound injury to the right side of his neck. He was bleeding massively from the right neck wound and oral cavity.

A review on targeted temperature management for cardiac arrest and traumatic brain injury.

Therapeutic hypothermia inhibits organ damage by suppressing metabolism, which makes it a therapy of choice for treating various diseases. Specifically, it is often used to treat conditions involving central nervous system disorders where it is expected to positively impact functional prognosis. Although keeping the body temperature at a hypothermic level has been conventionally used, how to manage the body temperature correctly remains a topic of debate.

Validity of Diagnosis of Disseminated Intravascular Coagulation Based on International Classification of Diseases Coding in a Claims Database.

Background:  Accuracy in diagnoses recorded using the International Classification of Diseases (ICD) coding is the most important element ensuring the foundation of research using real-world data analyses.

Objective:  To evaluate the validity of ICD coding for diagnoses of disseminated intravascular coagulation (DIC) using the International Society on Thrombosis and Haemostasis (ISTH) overt DIC criteria and the Japanese Association for Acute Medicine (JAAM) DIC criteria as reference standards.

Methods:  This retrospective observational study included adult hospitalized patients diagnosed as having diseases potentially causing DIC extracted from a part of a large-scale database in Japan.

How can heatstroke damage the brain? A mini review.

Record-breaking heat waves over the past 20 years have led to a global increase in heat-related deaths, including heatstroke. Heat-related illnesses occur when the body cannot adapt to the elevated temperatures in the environment, leading to various symptoms. In severe situations, such as heatstroke, the body temperature can rise above 40°C, leading to significant injury to body systems, with particular susceptibility of the central nervous system (CNS).

A machine learning model for early and accurate prediction of overt disseminated intravascular coagulation before its progression to an overt stage.

Background: Recent studies suggested an expected survival benefit associated with anticoagulant therapies for sepsis in patients with disseminated intravascular coagulation (DIC). However, anticoagulant therapies for overt DIC are no longer assumed to regulate pathologic progression as overt DIC is a late-phase coagulation disorder. Therefore, methods for early prediction of sepsis-induced DIC before its progression to an overt stage are strongly required.

Mass Gathering Events at an Event Hall in Osaka Are a Non-direct Risk of Admission to a Neighboring Emergency Hospital.

Background: The influence of planned mass gathering events on surrounding residents is not understood sufficiently.

Objectives: The purpose of this study was to investigate how events at an event hall affect a neighboring emergency hospital throughout the year.

Methods: This was a single-center, retrospective, observational study conducted on all patients who presented to the emergency department from January 1 to December 31, 2019.

Atypical and non-classical CD45RB memory B cells are the majority of circulating SARS-CoV-2 specific B cells following mRNA vaccination or COVID-19.

Resting memory B cells can be divided into classical or atypical groups, but the heterogenous marker expression on activated memory B cells makes similar classification difficult. Here, by longitudinal analysis of mass cytometry and CITE-seq data from cohorts with COVID-19, bacterial sepsis, or BNT162b2 mRNA vaccine, we observe that resting B cell memory consist of classical CD45RB memory and CD45RB memory, of which the latter contains of two distinct groups of CD11c atypical and CD23 non-classical memory cells. CD45RB levels remain stable in these cells after activation, thereby enabling the tracking of activated B cells and plasmablasts derived from either CD45RB or CD45RB memory B cells.

The timing of death in burn patients.

Aim: When treating burn patients, some patients die in the chronic phase, even if they overcome the acute phase of the burn. To elucidate the timing of death and its underlying causes among burn patients.

Methods: Patients evaluated were admitted to our burn center between January 2015, and December 2019.

Assessing associated factors for failure of nonoperative management in pediatric blunt liver and spleen injuries: a secondary analysis of the SHIPPs study.

Purpose: The purpose of this study was to describe the characteristics of pediatric patients who underwent nonoperative management (NOM) for blunt splenic and hepatic injuries and to explore factors associated with NOM failure.

Methods: This was a secondary analysis of a multicenter cohort study of pediatric patients with blunt liver and spleen injuries in Japan. Participants included pediatric trauma patients aged 16 years or younger between 2008 and 2019 with NOM, which was defined as no surgery provided within 6 h of hospital arrival.

Effects of Concomitant Traumatic Spinal Cord and Brain Injury on In-Hospital Mortality: A Retrospective Analysis of a Nationwide Trauma Registry in Japan.

Isolated traumatic spinal cord injury (t-SCI) and traumatic brain injury (TBI) represent significant public health concerns, resulting in long-term disabilities and necessitating sophisticated care, particularly when occurring concurrently. The impact of these combined injuries, while crucial in trauma management, on clinical, socioeconomic, and health care outcomes is largely unknown. To address this gap, our secondary retrospective cohort study used data from the Japan Trauma Data Bank, covering patients enrolled over a 13-year period (2006-2018), to elucidate the effects of concurrent t-SCI and TBI on in-hospital mortality.

Analysis of comprehensive biomolecules in critically ill patients via bioinformatics technologies.

Each patient with a critical illness such as sepsis and severe trauma has a different genetic background, comorbidities, age, and sex. Moreover, pathophysiology changes dynamically over time even in the same patient. Therefore, individualized treatment is necessary to account for heterogeneity in patient backgrounds.

Plasma proteomics profile-based comparison of torso versus brain injury: A prospective cohort study.

Background: Trauma-related deaths and posttraumatic sequelae are a global health concern, necessitating a deeper understanding of the pathophysiology to advance trauma therapy. Proteomics offers insights into identifying and analyzing plasma proteins associated with trauma and inflammatory conditions; however, current proteomic methods have limitations in accurately measuring low-abundance plasma proteins. This study compared plasma proteomics profiles of patients from different acute trauma subgroups to identify new therapeutic targets and devise better strategies for personalized medicine.

T cell dysfunction in elderly ARDS patients based on miRNA and mRNA integration analysis.

Background: Acute respiratory distress syndrome (ARDS) is respiratory failure that commonly occurs in critically ill patients, and the molecular mechanisms underlying its pathogenesis and severity are poorly understood. We evaluated mRNA and miRNA in patients with ARDS and elucidated the pathogenesis of ARDS after performing mRNA and miRNA integration analysis.

Methods: In this single-center, prospective, observational clinical study of patients with ARDS, peripheral blood of each patient was collected within 24 hours of admission.

Association between lung contusion volume and acute changes in fibrinogen levels: A single-center observational study.

Aim: Organ tissue damage, including the lungs, may lead to acute coagulopathy. This study aimed to evaluate the association between lung contusion volume and serum fibrinogen level during the acute phase of trauma.

Methods: We conducted an observational study using electronic medical records at a tertiary-care center between January 2015 and December 2018.

Elective surgery for liver injury and misinserted tube into the inferior vena cava associated with chest tube replacement: A case report.

Background: Several reports on organ injury and death due to incorrect chest tube insertion exist; however, reports on the chest tube penetrating the liver and reaching the inferior vena cava are limited.

Case Presentation: A 79-year-old man presented with a clamped tube because of massive bleeding from the tube following right chest tube replacement in the hospital of origin. The tube entered the inferior vena cava from the hepatic parenchyma via the right hepatic vein and was removed 15 h later because his hemodynamics stabilized.