Refeeding syndrome and vitamin B1 deficiency in a young man with normal body mass index following starvation in the COVID-19 era.

COVID-19 has spread worldwide and significantly influenced economies. Refeeding syndrome (RFS) is a potentially fatal abnormalities of electrolytes and fluid that can occur in malnourished patients undergoing mechanical refeeding. Herein, we report the case of a man in his 20s with a normal body mass index who presented with RFS and vitamin B1 deficiency.

Association between the severity of hypothermia and in-hospital mortality in patients with infectious diseases: The J-Point registry.

Aim: Hypothermia is associated with poor prognosis in patients with sepsis. However, no studies have explored the correlation between the severity of hypothermia and prognosis.

Methods: Using data from the Japanese accidental hypothermia network registry (J-Point registry), we examined adult patients aged ≥18 years with infectious diseases whose initial body temperature was ≤35°C from April 1, 2011 to March 31, 2016, in 12 centers.

External Validation of Updated Prediction Models for Neurological Outcomes at 90 Days in Patients With Out-of-Hospital Cardiac Arrest.

Background: Few prediction models for individuals with early-stage out-of-hospital cardiac arrest (OHCA) have undergone external validation. This study aimed to externally validate updated prediction models for OHCA outcomes using a large nationwide dataset.

Methods And Results: We performed a secondary analysis of the JAAM-OHCA (Comprehensive Registry of In-Hospital Intensive Care for Out-of-Hospital Cardiac Arrest Survival and the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest) registry.

Acute alcohol intoxication presenting acquired lesion of the corpus callosum in a young healthy woman: A case of possible Marchiafava-Bignami disease.

Background: Marchiafava-Bignami disease is a rare neurological disease characterized by acquired lesions of the corpus callosum. Although the major causative etiology is chronic alcoholism, a case caused by acute alcohol intoxication has not yet been reported.

Case Presentation: A 19-year-old female with no known medical history or a history of chronic alcohol consumption was brought to the emergency department in a coma after binge alcohol consumption.

Association between eGFR and neurological outcomes among patients with out-of-hospital cardiac arrest: A nationwide prospective study in Japan.

Aim: We aimed to investigate the association between estimated glomerular filtration rate and prognosis in out-of-hospital cardiac arrest patients and explore the heterogeneity of the association.

Methods: Patients experiencing out-of-hospital cardiac arrest due to medical causes and registered in the JAAM-OHCA Registry between June 2014 and December 2019 were stratified into shockable rhythm, pulseless electrical activity, and asystole groups according to the cardiac rhythm at the scene. The primary outcome was a 1-month favorable neurological status.

Hospital-at-home care for immunodeficient patients with COVID-19: Approach to persistent COVID-19 infection.

Key Clinical Message: Patients with COVID-19 who have undergone B-cell depletion therapy could have prolonged SARS-CoV-2 infection; therefore, even in the hospital-at-home setting, primary care physicians should carefully consider the treatment regimen and the timing of ending isolations in such cases, and should not hesitate to consult with infectious disease specialists if necessary.

Abstract: We presented the first reported case of hospital-at-home care for a patient with persistent COVID-19 who had undergone B-cell depletion therapy. He received hospital-at-home care, including two courses of remdesivir; however, he ultimately failed to recover and was transferred to the hospital.

Impact of the COVID-19 pandemic on epidemiology, treatment, and outcome of major trauma in Japan in 2020: a retrospective observational nationwide registry-based study.

Aim: The nationwide impact of the coronavirus disease (COVID-19) pandemic on major trauma in Japan is unknown. The nationwide registry-based data of the Japanese Trauma Data Bank were analyzed to elucidate the impact of COVID-19 on the epidemiology, treatment, and outcomes of major trauma patients.

Methods: Among patients transported directly from the injury site by ambulance with an Injury Severity Score of ≥16, we compared patients managed from April to December in 2019 to those managed from April to December in 2020.

Clustering out-of-hospital cardiac arrest patients with non-shockable rhythm by machine learning latent class analysis.

Aim: We aimed to identify subphenotypes among patients with out-of-hospital cardiac arrest (OHCA) with initial non-shockable rhythm by applying machine learning latent class analysis and examining the associations between subphenotypes and neurological outcomes.

Methods: This study was a retrospective analysis within a multi-institutional prospective observational cohort study of OHCA patients in Osaka, Japan (the CRITICAL study). The data of adult OHCA patients with medical causes and initial non-shockable rhythm presenting with OHCA between 2012 and 2016 were included in machine learning latent class analysis models, which identified subphenotypes, and patients who presented in 2017 were included in a dataset validating the subphenotypes.

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

Aim: This study aimed to investigate the association between level of impaired consciousness and severe hypothermia (<28°C) and to evaluate the association between level of impaired consciousness and inhospital mortality among accidental hypothermia patients.

Methods: This was a multicenter retrospective study using the J-Point registry database, which includes data regarding patients whose core body temperature was 35.0°C or less and who were treated as accidental hypothermia in emergency departments between April 1, 2011 and March 31, 2016.

Relationship between in-hospital mortality and abdominal angiography among patients with blunt liver injuries: a propensity score-matching from a nationwide trauma registry of Japan.

Aim: To assess relationships between abdominal angiography and outcomes in adults with blunt liver injuries.

Methods: A retrospective observational study carried out from January 2004 to December 2018. Adult blunt-trauma patients with AAST grade Ⅲ-Ⅴ were analyzed with in-hospital mortality as the primary outcome using propensity-score-(PS) matching to seek associations with abdominal angiography findings.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020).

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock.

Timing of Prehospital Advanced Airway Management for Adult Patients With Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study in Japan.

Background The timing of advanced airway management (AAM) on patient outcomes after out-of-hospital cardiac arrest has not been fully investigated. We evaluated the association between the timing of prehospital AAM and 1-month survival. Methods and Results We conducted a secondary analysis of a prospective, nationwide, population-based out-of-hospital cardiac arrest registry in Japan.

Adequacy of hand positioning by medical personnel during chest compression in a simulation study.

Aim: During chest compressions (CCs), the hand position at the lower half of the sternum is not strictly maintained, unlike depth or rate. This study was conducted to determine whether medical staff could adequately push at a marked location on the lower half of the sternum, identify where the inappropriate hand position was shifted to, and correct the inappropriate hand position.

Methods: This simulation-based, prospective single-center study enrolled 44 medical personnel.

A case of urgent colonoscopic hemostasis of a cecal hemorrhagic ulceration in a patient receiving heparin for COVID-19 coagulopathy.

COVID-19 rarely causes lower gastrointestinal bleeding even though its RNA has been detected in patient's stool. Urgent colonoscopy in a COVID-19 patient with massive bloody stool requires various procedural and equipment considerations. Here, we present a case of colonoscopic hemostasis of a cecal hemorrhagic ulceration in a patient on heparin for COVID-19 coagulopathy.

Care at critical care medical centers is associated with improved outcomes in patients with accidental hypothermia: a historical cohort study from the J-Point registry.

Aim: The recommendation that patients with accidental hypothermia should be transported to specialized centers that can provide extracorporeal life support has not been validated, and the efficacy remains unclear.

Methods: This was a multicenter retrospective cohort study of patients with a body temperature of ≤35°C presenting at the emergency department of 12 hospitals in Japan between April 2011 and March 2016. We divided the patients into two groups based on the point of care delivery: critical care medical center (CCMC) or non-CCMC.

Epidemiological profile of emergency medical services in Japan: a population-based descriptive study in 2016.

Aim: The aim of our study is to describe the characteristics of patients who use emergency medical services (EMS), EMS performance, and regional variations in Japan.

Methods: We undertook a nationwide, population-based, descriptive review of anonymized ambulance transport records obtained from the Fire and Disaster Management Agency in Japan. All emergency patients transported to emergency medical institutions by EMS personnel from January to December 2016 were enrolled in this study, excluding patients who were not transported.

Prehospital characteristics, incidence trends, and outcome of emergency self-inflicted injury patients with gas substances: a population-based descriptive study in Osaka, Japan.

Aim: Little is known about the detailed characteristics of patients using gas substances for self-inflicted injury in prehospital settings. The aim of this study was to investigate the characteristics, incidence trends, and outcomes of patients who used gas substances for self-inflicted injury in Osaka City, Japan, using ambulance records.

Methods: This was a retrospective observational study that used data from 2009 to 2015.

Rear seating position is associated with a higher risk of mortality in motor vehicle crashes: analysis of Japanese Trauma Data Bank.

Aim: The study examined the association of vehicle seating positions with the risk of death in serious motor vehicle crashes (MVCs) in Japan.

Methods: Data from the Japan Trauma Data Bank between 2004 and 2015 were analyzed. All MVC drivers with the legal age for driving and all copassengers were enrolled ( = 23,040).

Sex Differences in Receiving Layperson Cardiopulmonary Resuscitation in Pediatric Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study in Japan.

Background Layperson cardiopulmonary resuscitation ( CPR ) is a crucial intervention for patients with out-of-hospital cardiac arrest ( OHCA ). Although a sex disparity in receiving layperson CPR (ie, female patients were less likely to receive layperson CPR ) has been reported in adults, there are few data in the pediatric population, and we therefore investigated sex differences in receiving layperson CPR in pediatric patients with OHCA . Methods and Results From the All-Japan Utstein Registry, a prospective, nationwide, population-based OHCA database, we included pediatric patients (≤17 years) with layperson-witnessed OHCA from 2005 through 2015.

Development and efficacy of a clinician-targeted refresher course for treating nonpneumonia respiratory tract infections.

Background: In 2017, the Japanese government published an evidence-based manual describing the appropriate use of antibiotics in outpatient settings to tackle the problem of antimicrobial resistance. To fill the evidence-practice gap, we developed a clinician-targeted course aimed at improving clinician skills in the daily clinical practice of treating acute respiratory tract infections (RTIs) based on the manual. The aim of this study was to evaluate the efficacy of the course.