| JaLCDOI | 10.18926/AMO/52897 |
|---|---|
| フルテキストURL | 68_5_285.pdf |
| 著者 | Morisada, Sunao| Ugawa, Toyomu| Nosaka, Nobuyuki| Ujike, Yoshihito| |
| 抄録 | Current systems for the evaluation of trauma severity are tedious and difficult to apply in an actual emergency setting. We aimed to develop and assess the accuracy of a more efficient severity evaluation system, termed the Ugawa classification, using brain-type natriuretic peptide (BNP) measurement and the estimated glomerular filtration rate (eGFR). Two-hundred trauma patients were divided into 2 groups using an eGFR cut-off value of 90ml/min/1.73m2 as an indicator of normal renal function and 2 additional groups according to whether the BNP values were greater or less than the age in years. This resulted in 4 subject groups with different combinations of eGFR and BNP. The mean SOFA score, injury severity scores (ISS), trauma and injury severity scores (TRISS), and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of the groups were compared by Kruskal-Wallis test, and the mortality rate after 90 days was calculated. Significant intergroup differences were found in SOFA scores, ISS scores, and APACHE II-predicted mortality rates. Although no significant differences were found in the mortality rate after 90 days or TRISS-predicted mortality rate among the 4 groups, there was a trend toward increasing trauma severity from group 1 to 4. Thus, the Ugawa classification is as accurate as existing systems, has greater efficiency, and is user-friendly. |
| キーワード | acute injury Acute Physiology and Chronic Health Evaluation II injury severity score sequential organ failure assessment trauma and injury severity score |
| Amo Type | Original Article |
| 出版物タイトル | Acta Medica Okayama |
| 発行日 | 2014-10 |
| 巻 | 68巻 |
| 号 | 5号 |
| 出版者 | Okayama University Medical School |
| 開始ページ | 285 |
| 終了ページ | 290 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| 資料タイプ | 学術雑誌論文 |
| 言語 | 英語 |
| 著作権者 | CopyrightⒸ 2014 by Okayama University Medical School |
| 論文のバージョン | publisher |
| 査読 | 有り |
| PubMed ID | 25338485 |
| Web of Science KeyUT | 000343269300005 |
| 関連URL | http://ousar.lib.okayama-u.ac.jp/metadata/52958 |
| JaLCDOI | 10.18926/AMO/53021 |
|---|---|
| フルテキストURL | 68_6_323.pdf |
| 著者 | Hirayama, Takahiro| Nagano, Osamu| Shiba, Naoki| Yumoto, Tetsuya| Sato, Keiji| Terado, Michihisa| Ugawa, Toyomu| Ichiba, Shingo| Ujike, Yoshihito| |
| 抄録 | In adult high-frequency oscillatory ventilation (HFOV), stroke volume (SV) and mean lung pressure (PLung) are important for lung protection. We measured the airway pressure at the Y-piece and the lung pressure during HFOV using a lung model and HFOV ventilators for adults (R100 and 3100B). The lung model was made of a 20-liter, airtight rigid plastic container (adiabatic compliance: 19.3ml/cmH2O) with or without a resistor (20cmH2O/l/sec). The ventilator settings were as follows: mean airway pressure (MAP), 30cmH2O;frequency, 5-15Hz (every 1Hz);airway pressure amplitude (AMP), maximum;and % of inspiratory time (IT), 50% for R100, 33% or 50% for 3100B. The measurements were also performed with an AMP of 2/3 or 1/3 maximum at 5, 10 and 15Hz. The PLung and the measured MAP were not consistently identical to the setting MAP in either ventilator, and decreasing IT decreased the PLung in 3100B. In conclusion, we must pay attention to the possible discrepancy between the PLung and the setting MAP during adult HFOV. |
| キーワード | HFOV mean lung pressure mean airway pressure |
| Amo Type | Original Article |
| 出版物タイトル | Acta Medica Okayama |
| 発行日 | 2014-12 |
| 巻 | 68巻 |
| 号 | 6号 |
| 出版者 | Okayama University Medical School |
| 開始ページ | 323 |
| 終了ページ | 329 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| 資料タイプ | 学術雑誌論文 |
| 言語 | 英語 |
| 著作権者 | CopyrightⒸ 2014 by Okayama University Medical School |
| 論文のバージョン | publisher |
| 査読 | 有り |
| PubMed ID | 25519026 |
| Web of Science KeyUT | 000346882200002 |
| 関連URL | http://ousar.lib.okayama-u.ac.jp/metadata/53132 |
| JaLCDOI | 10.18926/AMO/53557 |
|---|---|
| フルテキストURL | 69_4_213.pdf |
| 著者 | Yumoto, Tetsuya| Sato, Keiji| Ugawa, Toyomu| Ichiba, Shingo| Ujike, Yoshihito| |
| 抄録 | Hyponatremia, a common electrolyte disorder associated with traumatic brain injuries (TBIs), has high mortality and morbidity rates. The aim of this study was to identify the risk factors for hyponatremia associated with TBI. We retrospectively analyzed the cases of TBI patients who were admitted to the emergency intensive care unit at Okayama University Hospital between October 2011 and September 2014. A total of 82 TBI patients were enrolled. The incidences of hyponatremia (serum sodium level of＜135mEq/L) and severe hyponatremia (serum sodium level of＜130mEq/L) within the first 14 days after admission were 51ｵ (n＝42) and 20ｵ (n＝16), respectively. After admission, hyponatremia took a median period of 7 days to develop and lasted for a median of 3 days. Multivariate analysis demonstrated that higher fluid intake from days 1 to 3 and the presence of cranial fractures were risk factors for hyponatremia. The 58 patients with hyponatremia experienced fewer ventilator-free days, longer intensive care unit stays, and less favorable outcomes compared to the 24 patients without hyponatremia;however, these differences were not significant. Further studies are needed to determine the optimal management strategy for TBI-associated hyponatremia in the intensive care unit setting. |
| キーワード | traumatic brain injury hyponatremia cranial fracture fluid intake |
| Amo Type | Original Article |
| 出版物タイトル | Acta Medica Okayama |
| 発行日 | 2015-08 |
| 巻 | 69巻 |
| 号 | 4号 |
| 出版者 | Okayama University Medical School |
| 開始ページ | 213 |
| 終了ページ | 218 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| 資料タイプ | 学術雑誌論文 |
| 言語 | 英語 |
| 著作権者 | CopyrightⒸ 2015 by Okayama University Medical School |
| 論文のバージョン | publisher |
| 査読 | 有り |
| PubMed ID | 26289912 |
| Web of Science KeyUT | 000365519100004 |
| JaLCDOI | 10.18926/AMO/53673 |
|---|---|
| フルテキストURL | 69_5_275.pdf |
| 著者 | Nosaka, Nobuyuki| Goda, Yu| Knaup, Emily| Tsukahara, Kohei| Yumoto, Tetsuya| Ugawa, Toyomu| Ujike, Yoshihito| |
| 抄録 | We sought to identify the incidence, injury patterns, and financial burden of ladder fall injuries to provide a reference for reinforcing guidelines on the prevention of such injuries. We enrolled the patients who were injured in a ladder-related fall and required intensive care between April 2012 and March 2014 at Okayama University Hospital, a tertiary care hospital in Okayama City:9 patients injured in 7 stepladder falls and 2 straight ladder falls. The median patient age was 69 years, and 8 were males. Six falls occurred in non-occupational settings. Head injuries predominated, and the injury severity score ranged from 2 to 35 (mean＝21±12). At the time of discharge from the intensive care unit, one patient had died and 5 patients had some neurological disabilities. The case fatality rate was 11%. The total cost of care during the review period was ￥16,705,794, with a mean cost of ￥1,856,199 per patient. Ladder fall injuries are associated with a high rate of neurological sequelae and pose a financial burden on the health insurance system. A prevention education campaign targeting at older-aged males in non-occupational settings may be a worthwhile health service investment in this community. |
| キーワード | accidental falls accident prevention hospital costs injuries ladder |
| Amo Type | Original Article |
| 出版物タイトル | Acta Medica Okayama |
| 発行日 | 2015-10 |
| 巻 | 69巻 |
| 号 | 5号 |
| 出版者 | Okayama University Medical School |
| 開始ページ | 275 |
| 終了ページ | 278 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| 資料タイプ | 学術雑誌論文 |
| 言語 | 英語 |
| 著作権者 | CopyrightⒸ 2015 by Okayama University Medical School |
| 論文のバージョン | publisher |
| 査読 | 有り |
| PubMed ID | 26490024 |
| Web of Science KeyUT | 000365519600003 |
| JaLCDOI | 10.18926/AMO/54590 |
|---|---|
| フルテキストURL | 70_5_331.pdf |
| 著者 | Iida, Atsuyoshi| Nosaka, Nobuyuki| Yumoto, Tetsuya| Knaup, Emily| Naito, Hiromichi| Nishiyama, Chihiro| Yamakawa, Yasuaki| Tsukahara, Kohei| Terado, Michihisa| Sato, Keiji| Ugawa, Toyomu| Nakao, Atsunori| |
| 抄録 | In recent years, it has become evident that molecular hydrogen is a particularyl effective treatment for various disease models such as ischemia-reperfusion injury; as a result, research on hydrogen has progressed rapidly. Hydrogen has been shown to be effective not only through intake as a gas, but also as a liquid medication taken orally, intravenously, or locally. Hydrogenʼs effectiveness is thus multifaceted. Herein we review the recent research on hydrogen-rich water, and we examine the possibilities for its clinical application. Now that hydrogen is in the limelight as a gaseous signaling molecule due to its potential ability to inhibit oxidative stress signaling, new research developments are highly anticipated. |
| キーワード | hydrogen antioxidant effect medical gas gaseous signaling molecule clinical tests |
| Amo Type | Review |
| 出版物タイトル | Acta Medica Okayama |
| 発行日 | 2016-10 |
| 巻 | 70巻 |
| 号 | 5号 |
| 出版者 | Okayama University Medical School |
| 開始ページ | 331 |
| 終了ページ | 337 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| 資料タイプ | 学術雑誌論文 |
| 言語 | 英語 |
| 著作権者 | CopyrightⒸ 2016 by Okayama University Medical School |
| 論文のバージョン | publisher |
| 査読 | 有り |
| PubMed ID | 27777424 |
| Web of Science KeyUT | 000388098700001 |
| JaLCDOI | 10.18926/AMO/54987 |
|---|---|
| フルテキストURL | 71_2_179.pdf |
| 著者 | Nosaka, Nobuyuki| Tsukahara, Kohei| Knaup, Emily| Yabuuchi, Toshihiko| Kikkawa, Tomonobu| Fujii, Yosuke| Yashiro, Masato| Yasuhara, Takao| Okada, Ayumi| Ugawa, Toyomu| Nakao, Atsunori| Tsukahara, Hirokazu| Date, Isao| |
| 抄録 | Newly published clinical practice guidelines recommend intracranial pressure (ICP) monitoring in critical care for the management of pediatric acute encephalopathy (pAE), but the utility of ICP monitoring for pAE has been poorly studied. We recently performed direct ICP monitoring for two patients. We observed that although the direct ICP monitoring had clinical benefits with less body weight gain and no vasopressor use in both cases, this monitoring technique is still invasive. Future studies should determine the utility of non-invasive ICP monitoring systems in pAE to further improve the quality of intensive-care management. |
| キーワード | cerebral perfusion encephalopathy child intracranial pressure neurological intensive care |
| Amo Type | Short Communication |
| 出版物タイトル | Acta Medica Okayama |
| 発行日 | 2017-04 |
| 巻 | 71巻 |
| 号 | 2号 |
| 出版者 | Okayama University Medical School |
| 開始ページ | 179 |
| 終了ページ | 180 |
| ISSN | 0386-300X |
| NCID | AA00508441 |
| 資料タイプ | 学術雑誌論文 |
| 言語 | 英語 |
| 著作権者 | CopyrightⒸ 2017 by Okayama University Medical School |
| 論文のバージョン | publisher |
| 査読 | 有り |
| PubMed ID | 28420900 |
| タイトル（別表記） | Non-high-output cardiac failure in patients undergoing hemodialysis through an arteriovenous shunt |
|---|---|
| フルテキストURL | 127_203.pdf |
| 著者 | 鵜川 豊世武| |
| 抄録 | Background: Hemodialysis-related heart failure has been considered to be associated with excessive blood flow through the arteriovenous (AV) shunt used for vascular access. However, some patients undergoing dialysis have heart failure in the absence of an increase in cardiac output (CO) related to shunt blood-flow loading because the loading cannot be compensated for by increasing CO. This condition may be challenging to manage ; thus, early diagnosis is important. Methods and Results: Twelve patients (mean age, 71 years ; 9 men) with end-stage renal disease, dialysis-related heart failure, a high brain natriuretic peptide (BNP) level, and a mean New York Heart Association (NYHA) class of II underwent AV shunt closure. Their cardiac index (CI), pre- and post-dialysis BNP levels, and several cardiac variables were assessed pre- and postoperatively. All patients achieved relief of heart failure symptoms and a reduction in NYHA class after AV closure, but six patients had a postoperative increase in CI (the "non-high-output" cardiac failure group), whereas the other six had a decrease in CI (the "high-output" cardiac failure group). The high-output patients had greater improvements in BNP levels and most cardiac variables compared to the non-high-output group ; therefore, the heart failure in the non-high-output patients was considered more serious than that in the high-output group. Conclusions: The selection of effective strategies for treating dialysis-related heart failure may depend partly on identifying which patients have non-high-output failure. Such identification requires serial measurements of BNP levels and evaluations of cardiac variables other than the ejection fraction. |
| キーワード | 心拍出量（cardiac output） 心不全（heart failure） 脳性ナトリウム利尿ペプチド（brain natriuretic peptide） 非過大シャント心不全（non-high-output cardiac failure） 腎臓（kidney） |
| 出版物タイトル | 岡山医学会雑誌 |
| 発行日 | 2015-12-01 |
| 巻 | 127巻 |
| 号 | 3号 |
| 開始ページ | 203 |
| 終了ページ | 207 |
| ISSN | 0030-1558 |
| 関連URL | isVersionOf https://doi.org/10.4044/joma.127.203 |
| 言語 | 日本語 |
| 著作権者 | Copyright (c) 2015 岡山医学会 |
| 論文のバージョン | publisher |
| DOI | 10.4044/joma.127.203 |
| NAID | 130005116810 |