Alocasia odora poisoning due to calcium oxalate needle crystals in Japan.

Objective: To elucidate the actual circumstances of damage caused by Japanese Alocasia (A) odora. Materials and Methods: We investigated cases in Japan from our own hospital in the eastern part of Shizuoka Prefecture as well as published reports. Results: A. dorais found in western Japan, and plants of the Alocasia genus are cultivated often. A. odora is frequently associated with food poisoning because its aboveground parts resemble those of Satoimo (Colocasia esculenta). Moreover, A. odora contains insoluble calcium oxalate crystals, which cause poisoning symptoms, such as oral pain, nausea, vomiting, and laryngeal edema, resulting in near asphyxia, diarrhea following shock, and skin dermatitis. Calcium oxalate crystals are abundant in Araceae family plants, and cases of health damage owing to the accidental ingestion of Araceae plants have been reported worldwide. Conclusion: Due to the strong irritation felt in the mouth upon contact with the plant, it is advisable to immediately spit out the plant and rinse the mouth. In addition to drug administration, ensuring a secure airway may be necessary if there is a risk of asphyxiation.

Fatal Head Injury in a 1-Year-Old Child Secured in a Rear-Facing Child Seat by Offset Car-to-Car Collision.

This case study describes a fatal head injury in a 1-year-old child involved in a motor vehicle accident in Japan. The child, secured in a rear-facing child seat, was a passenger in a car driven by their mother when the offset car-to-car collision occurred. The car rotated counterclockwise before coming to a stop. Despite remaining secured in the child seat, the child suffered severe head trauma, leading to cardiac arrest. Autopsy computed tomography revealed a right open depressed fracture, left head contusion, traumatic subarachnoid hemorrhage, intraventricular hemorrhage, and pneumocephalus. The injury mechanism involved the child's head striking the right headrest, followed by a swing to the left, induced by the initial impact and subsequent rotational movement. This case highlights the importance of age-specific data in understanding pediatric injuries in motor vehicle accidents and improving child seat safety measures.

Carbazochrome sodium sulfonate and tranexamic acid combination therapy to reduce blood transfusions after 24 h of injury: A retrospective study.

Aim: Reducing the blood transfusion volume is important in severe trauma. We hypothesized that carbazochrome sodium sulfonate (CSS) combined with tranexamic acid (TXA) would reduce blood transfusions in severe trauma. Methods: From April 2017 to March 2023, data were collected from patients (aged ≥16 years) admitted to our hospital for trauma and administered packed red blood cells (pRBC) and plasma transfusions within 12 h postinjury. Patients infused with CSS and TXA (CSS + TXA group) were compared with those infused with TXA alone (TXA group). The outcomes were blood product transfusion volumes within and after 24 h, the number of patients receiving >6 units of pRBC transfusion after 24 h, duration of intensive care unit and in-hospital stays, and 28-day in-hospital mortality. Results: In total, 138 patients were included in the study. In the univariate analyses, the CSS + TXA group (n = 62) showed a significant reduction in the total pRBC transfusion volume, in-hospital days, and number of patients receiving >6 units of pRBCs in the delayed phase. Based on the multivariate logistics regression analysis, only the CSS + TXA group had a significantly lower adjusted odds ratio for receiving >6 units of pRBC transfusion after 24 h. During the in-hospital days, the CSS + TXA group did not experience an increased incidence of major complications when compared with the TXA group. Conclusion: In patients with trauma, treatment with CSS with TXA may reduce the requirement for blood transfusion after 24 h. Moreover, this treatment can improve admission outcomes without increasing complications.

The Factors Associated With Decreasing Hemoglobin Levels and Platelet Counts After Trauma.

Objective In this study, we investigated the factors related to anemia and platelet reduction in patients with moderate to severe trauma to gain a deeper understanding of these phenomena. Methods Our study spanned the period from April 2021 to September 2023, and it involved a retrospective review of the hospital medical charts of all emergency outpatients of all ages who were transported by a physician-staffed helicopter and treated at our hospital and were diagnosed with an Injury Severity Score (ISS) of >8 by CT on arrival. The following data were analyzed: sex; age; mechanism of injury; vital signs upon arrival at the hospital; ISS; hemoglobin level and platelet count on arrival and day two; fibrin degradation product (FDP) level, lactate dehydrogenase (LDH) level, and diameter of the inferior vena cava (IVC) on arrival; and infusion volume on day one. We then statistically calculated the independent risk factors for differences between hemoglobin levels and platelet counts on arrival and those on day two. Results The study included a total of 209 subjects, with an average age of 58 years and a male predominance. Multivariate analysis showed that the FDP level, IVC diameter, and age were significantly associated with changes in hemoglobin levels on arrival and day two, whereas the IVC diameter, LDH, age, systolic blood pressure, and sex were significantly associated with changes in the platelet count on arrival and day two. Conclusions A noteworthy correlation was found between certain factors and changes in hemoglobin levels and platelet counts between the initial assessment and the second day in our cohort. We recommend further prospective research to determine whether our findings hold true for a larger population of trauma patients.

Mild Encephalopathy/Encephalitis with Reversible Splenial Lesions after Amphetamine and Opioid Use.

A 47-year-old woman with a history of substance abuse, depression, and insomnia experienced a collapse. Upon arrival at the hospital, the patient displayed low systolic blood pressure, confusion, dehydration, and renal failure. Urine tests confirmed an amphetamine and opioid overdose. Her condition fluctuated with reduced consciousness, myoclonic movements, fever, and suspected psychogenic seizures. Brain magnetic resonance imaging revealed abnormalities in the splenium of the corpus callosum, which later resolved. The patient's condition gradually improved without any specific treatment. This unique case represents the first report of mild encephalopathy/encephalitis with reversible splenial lesions associated with amphetamine and opioid use.

Physicochemical Treatments of Graphene Oxide to Improve Water Vapor/Gas Separation Performance of Supported Laminar Membranes: Sonication and H2O2 Oxidation.

We investigated the previously unexplored domain of water vapor/gas separation using graphene oxide (GO) membranes, expecting future applications, including gas dehumidifiers and superior humidity controllers. While the importance of manipulation of GO nanosheet size and surface chemistry in traditional water purification and gas separation has been acknowledged, their potential impact on water vapor/gas separation remained unexplored until now. We applied sonication and hydrogen peroxide treatments to GO water dispersions and systematically evaluated the size and surface chemistry of each GO nanosheet. Both treatments reduced the GO nanosheet size to shorten the diffusion length, which improved water permeance. In addition, hydrogen peroxide treatment improved the hydrophilicity of the nanosheet. Our novel findings demonstrate that optimization of GO nanosheet size and the increase in their hydrophilicity via hydrogen peroxide treatments for 5 h significantly enhance water permeance, leading to a remarkable water vapor permeance of 4.6 × 10-6 mol/(m2 s Pa) at 80 °C, a 3.1-fold improvement over original GO membranes, while maintaining a water vapor/nitrogen permeance ratio exceeding 10,000. These results not only provide important insights into the nature of water vapor/gas separation but also suggest innovative methods for optimizing the GO membrane structure.

Steam recovery from flue gas by organosilica membranes for simultaneous harvesting of water and energy.

Steam recovery from the spent gases from flues could be a key step in addressing the water shortage issue while additionally benefiting energy saving. Herein, we propose a system that uses organosilica membranes consisting of a developed layered structure to recover steam and latent heat from waste. Proof-of-concept testing is conducted in a running incinerator plant. The proposed system eliminates the need for a water supply while simultaneously recovering latent heat from the waste stream. First, the long-term stability of an organosilica membrane is confirmed over the course of six months on a laboratory-scale under a simulated waste stream. Second, steam recovery is demonstrated in a running waste incinerator plant (bench-scale), which confirms the steady operation of this steam recovery system with a steam recovery rate comparable to that recorded in the laboratory-scale test. Third, process simulation reveals that this system enables water-self-reliance with energy recovery that approximates 70% of waste combustion energy.

Outcome in intoxicated patients transported by a physician-staffed helicopter in Japan from 2015 to 2020.

Aim: We retrospectively investigated the current status of poisoned patients who had been transported by a physician-staffed helicopter emergency medical service and their final outcomes using data from the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM. Methods: The following details of dispatch activity were collected from the database of the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM: patient age and sex, timing of dispatch request, presence of cardiac arrest, vital signs, medical intervention, main etiology of intoxication, and final outcome. The patients were divided into two groups: those with a good outcome and those with a poor outcome. The variables were compared between the two groups. Results: A total of 336 patients were intoxicated. Psychotropic drug overdose was the dominant cause, followed by carbon monoxide and ethanol. The median Glasgow Coma Scale score was significantly higher in the good outcome group than in the poor outcome group. The rates of cardiac arrest, interventions to secure an airway and/or assist with ventilation, and drug administration were significantly lower in the good outcome group than in the poor outcome group. There were no records concerning the decontamination of the intoxicating substance at the scene or during air evacuation. Conclusion: The study suggests that various factors may influence the outcomes of patients with different types of intoxication. These findings offer valuable insights that could help to establish effective treatment strategies and the operation of doctor helicopters for intoxicated patients.

Patients With Atrioventricular Block Transported by a Physician-Staffed Helicopter in Japan From 2015 to 2020.

OBJECTIVE: We retrospectively investigated the current status of patients with atrioventricular block (AVB) who had been transported by the physician-staffed helicopter emergency medical service and their final outcome using data from the Japan Doctor Helicopter Registry (JDHR) system. METHODS: The following details of the dispatch activity were collected from the database of the JDHR: age and sex, vital signs when emergency medical technicians encountered the patient at the scene and on arrival at the receiving hospitals, contents of the medical intervention, new cardiac arrest during transportation, the main etiology of AVB, and the number of deaths in 1 month. The changes in vital signs between the scene and upon arrival at the hospital were compared. RESULTS: A total of 99 patients had complete AVB. The average age of the patients was 75 years, and there was a male predominance. All subjects were evacuated from the scene. Among the 62 subjects who received the drugs, 18 received atropine. Six patients underwent percutaneous pacing. None of the patients developed a new cardiac arrest during transportation. The average Glasgow Coma Scale score and heart rate upon arrival at the hospital were significantly greater than those at the scene. CONCLUSION: The present study showed the current status of patients with AVB who were transported by a doctor helicopter using registry data from the JDHR. The present findings suggest that a doctor helicopter could provide safe transportation for patients with AVB.

Outcomes of prehospital traumatic cardiac arrest managed by helicopter emergency medical service personnel in Japan: a registry data analysis.

BACKGROUND: Traumatic cardiac arrest (TCA) is associated with poor outcomes. Helicopter emergency medical services (HEMSs) are often used to transport critically ill patients to hospitals. However, the role of HEMS in the treatment of TCA remains unclear. Therefore, in this study, we aimed to determine the current status of patients with prehospital TCA managed by HEMS personnel in Japan and compare the outcomes of patients who experienced TCA before and after the arrival of HEMS. METHODS: The Japanese Society for Aeromedical Services registry data of patients managed by HEMS personnel from April 2015 to March 2020 were analyzed in this retrospective cohort study. HEMS arrival and physicians' interventions at the scene were the variables of interest. The survival rate and neurological outcomes at 28 days after injury were analyzed. RESULTS: Of the 55 299 registered patients, 722 who experienced prehospital TCA were included in the analysis. The distribution of first-witnessed TCA was as follows: pre-emergency medical service (EMS) arrival (n = 426/722, 60.3%), after EMS arrival (n = 113/722, 16.0%), and after HEMS arrival (n = 168/722, 23.8%). The 28-day survival rate was 6.2% (n = 44/706), with a cerebral performance category of 1 or 2 in 18 patients. However, patients who experienced TCA after receiving interventions provided by physicians before HEMS arrival had the worst outcomes, with only 0.6% of them surviving with favorable neurological outcomes. Multivariable analysis revealed that securing the intravenous route by the EMS team (adjusted odds ratio: 2.43, 95% confidence interval [CI]: 1.11-5.30) and tranexamic acid infusion by the HEMS team (adjusted odds ratio: 2.78, 95% CI: 1.16-6.64) may have increased the return of spontaneous circulation (ROSC) rate. CONCLUSIONS: The results of our study were similar to those reported in previous studies with regards to the use of HEMS in Japan for transporting patients with TCA. Our findings suggest that in patients with severe trauma, cardiac arrest after initiation of HEMS, the highest level of prehospital medical intervention, may be associated with an inferior prognosis. Tracheal intubation and administration of tranexamic acid by the EMS team may increase the rate of ROSC in TCA.

Outcomes of patients with decompression illness transported by physician-staffed helicopter according to Japanese Registry data (2015-2020).

Objective: No nationwide reports have focused on patients with decompression illness (DCI) transported by doctor helicopter (DH) in Japan. We performed this retrospective study to examine this population using data from the Japan DH registry system (JDRS). Patients and Methods: Patients were initially selected from the JDRS database. They were divided into two groups: those transported by the Eastern Shizuoka DH (ES-DH) and those transported by other DHs. Variables were compared between the two groups. Results: There were 44 patients who had DCI out of 41,592 patients in the JDRS. The majority of cases (70%) were transported by the ES-DH. In the ES-DH group, age, rate of request type using key words, and rate of instrumental intervention to secure an airway were significantly greater, and the median Glasgow Coma Scale score was significantly lower than that of the other DH group. However, there was no statistically significant difference in the rate of cases with fatal outcomes between the two groups. Conclusions: This is the first report regarding the current status of patients with DCI transported by DH in Japan. Most patients were transported by ES-DH to the Izu Peninsula. In addition, the patients transported by ES-DH due to decompression illness tended to be severely ill; however, the outcomes of the ES-DH and other DH groups did not differ to a statistically significant extent and therefore effective recompression therapy could be successfully performed at suitable hospitals owing to timely transportation.

Usefulness of Key Word Methods to Execute Early Requests for a Physician-Staffed Helicopter Emergency Medical Service Dispatch to Facilitate Early Medical Intervention by Physicians.

OBJECTIVE: A physician-staffed helicopter emergency medical service is called a doctor helicopter (DH) in Japan. We retrospectively investigated this service using a data bank provided by the Japan DH registry system. METHODS: The following details of the dispatch activity were collected: patient age and sex, vital signs (Japan Coma Scale [JCS], systolic blood pressure, heart rate, and respiratory rate) at the scene measured by emergency medical technicians (EMTs), dispatch of the DH before the EMTs made contact with patients (key words group) or after (control group), and the survival outcome at 1 month. RESULTS: During the investigation period, 28,357 patient records were analyzed (key words group, n = 13,861; control group, n = 14,496). The age, JCS, and respiratory rate were significantly smaller in the key words group than in the control group. The rates of male sex and survival in the key words group were significantly greater than those in the control group. In the multivariate analysis, dispatch of the DH after EMTs made contact with the patients (odds ratio [OR] = 0.72; 95% confidence interval [CI], 0.55-0.92), female sex (OR = 0.86; 95% CI, 0.75-0.98), older age (OR = 0.97; 95% CI, 0.96-0.97), elevated respiratory rate (OR = 0.97; 95% CI, 0.97-0.98), and high JCS (OR = 0.99; 95% CI, 0.99-0.99) were associated with a decreased 1-month survival (P > .0001). CONCLUSION: This is the first report to describe the key words method as a potential factor influencing optimal outcomes/potential survival rates in patients evacuated by the DH using the JDRS. Our study results suggest that the firefighting central command room should consider adopting the key words method when the helicopter emergency medical service is used.

Narrative minireview of the current status of hyperbaric oxygen therapy for pregnant women.

We performed a narrative minireview for a PubMed search on March 31, 2023, using the keywords "pregnant" and "hyperbaric oxygen" to identify any related articles. Most reports have described pregnant women with carbon monoxide (CO) poisoning being treated by hyperbaric oxygen therapy (HBOT). HBOT helped improve the maternal condition and ensure normal fetal development. Some pregnant women with CO poisoning treated by HBOT suffered abortions or gave premature birth to low-weight babies or with congenital malformations. However, these results were considered sequelae of CO poisoning, not HBOT. We hypothesized that for pregnant women facing a life-threatening situation, for which the effectiveness of HBOT has previously been suggested, prioritizing the stabilization of the mother may also be beneficial for normal fetal development.

Permeation Properties of Water Vapor through Graphene Oxide/Polymer Substrate Composite Membranes.

Graphene oxide (GO) has attracted attention as an excellent membrane material for water treatment and desalination owing to its high mechanical strength, hydrophilicity, and permeability. In this study, composite membranes were prepared by coating GO on various polymeric porous substrates (polyethersulfone, cellulose ester, and polytetrafluoroethylene) using suction filtration and casting methods. The composite membranes were used for dehumidification, that is, water vapor separation in the gas phase. GO layers were successfully prepared via filtration rather than casting, irrespective of the type of polymeric substrate used. The dehumidification composite membranes with a GO layer thickness of less than 100 nm showed a water permeance greater than 1.0 × 10-6 mol/(m2 s Pa) and a H2O/N2 separation factor higher than 104 at 25 °C and 90-100% humidity. The GO composite membranes were fabricated in a reproducible manner and showed stable performance as a function of time. Furthermore, the membranes maintained high permeance and selectivity at 80°C, indicating that it is useful as a water vapor separation membrane.

Relationship between Incontinence and Disease Severity in Patients Transported by Ambulance.

Introduction: Retrospectively investigated this relationship using data from Shimoda Fire Department. Methods: We investigated patients who were transported by Shimoda Fire Department from January 2019 to December 2021. The participants were divided into groups based on the existence of incontinence at the scene or not (Incontinence [+] and Incontinence [-]). We compared the variables mentioned above between these groups. Results: There were 499 cases with incontinence and 8241 cases without incontinence. There were no significant differences between the two groups with respect to weather and wind speed. The average age, percentage of male patients, percentage of cases in the winter season, rate of collapse at home, scene time, rate of endogenous disease, disease severity, and mortality rate in the incontinence (+) group were significantly greater in comparison to the incontinence (-) group, whereas the average temperature in the incontinence (+) group was significantly lower than that in the incontinence (-) group. Regarding the rates of incontinence of each disease, neurologic, infectious, endocrinal disease, dehydration, suffocation, and cardiac arrest at the scene had more than twice the rate of incontinence in other conditions. Conclusions: This is the first study to report that patients with incontinence at the scene tended to be older, showed a male predominance, severe disease, high mortality, and required a long scene time in comparison to patients without incontinence. Prehospital care providers should therefore check for incontinence when evaluating patients.

Dataset dependency of low-density lipoprotein-cholesterol estimation by machine learning.

OBJECTIVES: We evaluated the applicability of a machine learning-based low-density lipoprotein-cholesterol (LDL-C) estimation method and the influence of the characteristics of the training datasets. METHODS: Three training datasets were chosen from training datasets: health check-up participants at the Resource Center for Health Science (N = 2664), clinical patients at Gifu University Hospital (N = 7409), and clinical patients at Fujita Health University Hospital (N = 14,842). Nine different machine learning models were constructed through hyperparameter tuning and 10-fold cross-validation. Another test dataset of another 3711 clinical patients at Fujita Health University Hospital was selected as the test set used for comparing and validating the model against the Friedewald formula and the Martin method. RESULTS: The coefficients of determination of the models trained on the health check-up dataset produced coefficients of determination that were equal to or inferior to those of the Martin method. In contrast, the coefficients of determination of several models trained on clinical patients exceeded those of the Martin method. The means of the differences and the convergences to the direct method were higher for the models trained on the clinical patients' dataset than for those trained on the health check-up participants' dataset. The models trained on the latter dataset tended to overestimate the 2019 ESC/EAS Guideline for LDL-cholesterol classification. CONCLUSION: Although machine learning models provide valuable method for LDL-C estimates, they should be trained on datasets with matched characteristics. The versatility of machine learning methods is another important consideration.

A study of factors associated with the prognosis of cardiac arrest patients in a depopulated area with a high elderly population transported by Shimoda Fire Department.

Objective: To investigate the etiology of cardiac arrest in patients living in depopulated rural areas with a high elderly population in the Kamo region. Patients and Methods: We investigated patients with cardiac arrest who were transported by the Shimoda Fire Department between January 2019 and December 2021. The following patients' details were collected: circumstance, age, sex, cause of cardiac arrest, witnessed collapse, chest compression performed by bystanders, oral instruction, use of an automated external defibrillator (AED), initial rhythm, advanced cardiac life support provided by emergency medical technicians, and neurological outcomes. The patients were divided into two groups based on the return of consciousness (RC). We compared the variables above between the two groups. Results: A total of 281 patients with cardiac arrest were included in this study. The participants were predominantly men (59.7%), and the average age was 76 years. AED was applied to eight patients at the scene; however, all eight did not have an initial shockable rhythm. RC was achieved in eight (2.8%) patients. The precise cause of cardiac arrest among the participants who achieved RC was cardiogenic, drowning, and suffocation in three, three, and two cases, respectively. The patients were significantly younger, and the ratio of securing a venous route and airway was significantly lower in the RC (+) group than in the RC (-) group. The ratio of helicopter emergency medical services (HEMS) in the RC (+) group was significantly greater than that in the RC (-) group. Conclusion: This study reported the etiology of cardiac arrest in patients living in a depopulated rural area of Japan with a high elderly population. The usefulness of an AED could not be proven; the cardiogenic cardiac arrest was not dominant among patients who achieved RC, and HEMS transport might be useful for obtaining RC.