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BackgroundFew studies have assessed older adult patients who received extracorporeal cardiopulmonary resuscitation (ECPR) after cardiac arrest, and outcomes and prognostic factors of ECPR in this population remain unclear. This study aimed to assess the long-term outcomes and prognostic factors among patients older than 75 years who received ECPR after experiencing cardiac arrest.MethodsThis is a single-centre, retrospective case–control study conducted between August 2010 and July 2019. Consecutive patients older than 75 years who had in-hospital (IHCA) or out-of-hospital cardiac arrest (OHCA) and received ECPR at the Emergency Department in the Hyogo Emergency Medical Center, Hyogo, Japan, were included. The primary outcome was a favourable neurological outcome, defined as a Cerebral Performance Category score of 1–2 at 1 year after the event. Univariate logistic regression was used to determine the association between variables and patient outcomes.ResultsOf the 187 patients with cardiac arrest who received ECPR, 30 were older than 75 years and 28 (15% of the cohort receiving ECPR) were examined in this study. The median age of the patients was 79 years (IQR 77–82), and there were 13 (46%) male patients. Neurological outcomes were favourable for seven (25%) patients, five of whom had IHCA and two with out-of-hospital OHCA. On univariate analysis, patients with a favourable outcome had a shorter median total collapse time (TCT) than those with an unfavourable outcome (favourable: 18.0 min (IQR 13.0–33.5) vs unfavourable: 44.0 min (IQR 25.0–53.0); p=0.049).ConclusionIn selected patients older than 75 years, ECPR could be beneficial by providing a shorter TCT, which may contribute to favourable neurological outcomes. Nevertheless, further studies are needed to validate these findings.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has caused great disruptions in education and healthcare systems. However, before the COVID-19 pandemic, Hyogo Prefecture did not have a centralized system for sharing information among hospitals, public healthcare centers, the government, fire departments, and medical associations. In March 2021, we used Slack® an enterprise social network, to invite people from hospitals, healthcare centers, the government, fire departments, and medical associations to join our workspace. This study was undertaken to verify whether the use of Slack can improve information sharing during a disaster.Methods: A questionnaire on whether information-sharing tools such as Slack are useful for disaster response in Hyogo Prefecture, including for COVID-19, was administered using a Google Form.Results: Of the 19 people who responded to the questionnaire, 15 (78.9 percent) were first-time users of Slack and 18 (94.7 percent) found it easy to use. All 19 participants stated that Slack proved useful in providing pertinent information regarding preventive measures for the control of COVID-19, and they believed that it would be a helpful tool if such disasters were to occur in the future. Regarding the launch time of Slack, 11 respondents (57.9 percent) answered that it was launched at the appropriate time, while five respondents (26.3 percent) answered that it was launched too late. Conclusions: The participants thought that Slack was effective for accelerating their communication. The use of Slack could also improve future disaster response communications.

A 46-year-old man experienced facial burns due to a fire in his house. In the prehospital setting, suspecting inhalation injury and carbon monoxide poisoning, an emergency physician decided to bring him to the hospital for carbon dioxide (CO2) monitoring without endotracheal intubation for approximately 20 min because of less severe respiratory distress. On the way to the hospital, the patient’s end-tidal CO2 monitoring ranged from 19 to 30 mm Hg, and transcutaneous carbon dioxide (TcPCO2) remained between 50 and 55 mm Hg. On arrival at the hospital, PaCO2 showed 51.6 mm Hg. Endotracheal intubation using a bronchoscope was performed in the emergency room, and inhalation injury was observed. He was extubated on day 5 and discharged on day 10. In the prehospital setting, TcPCO2 monitoring is useful for initial management of non-intubated inhalation injury patients even with high concentration oxygen.

Appropriate decisions by medical technicians at a trauma scene may influence a patient's prognosis. Emergency life-saving technicians (ELSTs) are certified specialists trained with the knowledge to provide advanced techniques for prehospital emergency care in Japan. However, the benefit of treatment by ELSTs compared to basic emergency medical technicians (BEMTs) remains unclear. The aim of this study is to determine whether treatment by ELSTs improves outcomes for trauma patients.We retrospectively reviewed the Japan Trauma Data Bank for the years 2004 to 2017. Patients transferred to the hospital directly from the trauma scene and at least 16 years old were included in this study. The following criteria were used to exclude patients; presence of burns, untreatable severe traumas, unknown ELST attendance, and missing prognosis. We compared two groups (ELST group: patients transported by emergency medical services (EMS) with the presence of at least one ELST; BEMT group: patients transported only by BEMTs). Primary outcome was survival to discharge. Secondary outcomes were the need of definitive treatments defined by surgical intervention, intravascular radiology and blood transfusion at the receiving hospital within 24 h. A multivariable logistic regression model was used to calculate odds ratio (OR) and confidence intervals (CI) adjusted by age, sex, revised trauma score, and Injury severity score (ISS).Overall survival to discharge did not improve significantly (adjusted OR 1.13, 95% CI 0.99-1.30) with ELST intervention. In-hospital blood transfusion was more frequently required in the ELST group (adjusted OR 1.10, 95% CI 1.01-1.20). Emergency interventions (adjusted OR 1.03, 95% CI 0.97-1.09) were not different between the groups. In stratified analysis, the benefit of ELST attendance for survival was observed among patients with ISS16 (adjusted OR 1.53, 95% CI 1.10-2.15), aged 65 years or older (adjusted OR 1.27, 95% CI 1.07-1.52), during the earlier study period (2004-2008, adjusted OR 1.50, 95% CI 1.14-1.97), and shorter transportation time (adjusted OR 1.21, 95% CI 1.03-1.41).Dispatch systems with ELST should be considered for trauma transports, which may benefit elderly or moderate severity trauma groups, with shorter transportation time conditions.

Background Management of acute type A aortic dissection (AADA) presenting with cardiopulmonary arrest (CPA) may require aggressive cardiopulmonary resuscitation (CPR), including extracorporeal CPR followed by aortic repair. This study evaluated the early and long-term outcomes of patients with preoperative CPA related to AADA. Methods Between September 2003 and August 2019, 474 patients with AADA were brought to our hospital, 157 (33.1%) presenting with CPA. Their mean age was 74.3 ± 11.3 years and prevalence of out-of-hospital CPA 90%, and causes of CPA were cardiac tamponade in 75%, hemothorax in 10%, and coronary malperfusion in 10% of cases. In the same time periods 2974 patients with CPA were transported, and AADA was 4.8% of all cause of CPA. Results Return of spontaneous circulation was achieved in 26 patients (17%) and extracorporeal CPR was required in 31 (20%); 131 CPA patients (83%) died before surgery, 24 (15%) underwent aortic repair, and 2 (1%) received nonsurgical care. Hospital mortality was 90%, and none survived without aortic repair. Of patients achieving return of spontaneous circulation 17 underwent aortic repair, 13 survived, and 5 fully recovered. All patients with extracorporeal CPR died: 24 before surgery and 7 postoperatively. There were significant differences in hospital mortality between patients who did and did not undergo aortic repair (P Conclusions AADA with CPA is associated with significantly high mortality; however aortic repair can be performed with a 30% likelihood of functional recovery, if return of spontaneous circulation is achieved. Preoperative extracorporeal membrane oxygenation is not recommended in this patient cohort.

Background Necrotizing fasciitis is a well-known disease that causes extensive tissue infection and requires radical debridement of the infected tissue. It can occur in all parts of the body, but there are few reports of necrotizing fasciitis in the axilla. We treated three patients with axillary necrotizing fasciitis. Methods In all cases, patients were referred to us after radical debridement of the infected soft tissue in the emergency department. At the first visit to our department, there were fist-sized soft tissue defects in the axilla. Moreover, the ipsilateral pectoralis major and latissimus dorsi muscles were partially resected because of the debridement of necrotizing fasciitis. In all cases, the ipsilateral thoracodorsal vessels were severely damaged and free-flap transfer was performed to close the axillary wound. Results All free flaps survived without complications. The patient's range of motion for shoulder abduction on the affected side was maintained postoperatively. Conclusion If necrotizing fasciitis occurs in the axilla, tissue infection can spread beyond it. In such a case, free-flap transfer can be an optimal treatment. Radical resection of the infected tissue results in the absence of recipient vessels in the axilla. Surgeons should bear in mind that, because of radical resection of the infected tissue, they may need to seek recipient vessels for free-flap transfer far from the axilla.

We present the first documented case of emergent pericardial drainage and return (PD-R) under extracorporeal membrane oxygenation (ECMO) for the management of aortic rupture into the pericardial sac caused by acute type A aortic dissection (AADA). An 83-year-old woman collapsed during an elective coronary intervention. ECMO was eventually required. Acute accumulation of pericardial effusion with aortic dissection was revealed by echocardiography. Percutaneous pericardial drainage was performed using a drainage line connected to the venous line of the ECMO system to maintain blood flow and blood pressure. After stabilization of the patient’s hemodynamics, immediate aortic repair was successfully performed and the patient was discharged with no neurological deficit. In cases of massive amounts of pericardial drainage and persistent hemorrhagic shock due to aortic rupture with AADA, PD-R connected to ECMO is useful while waiting for aortic repair.

We analyzed patients with acute type A aortic dissection complicated by malperfusion syndrome to establish whether the timing of operative treatment and the location of malperfusion are factors in determining outcomes.A total of 331 patients with acute type A aortic dissection were treated surgically between August 2003 and May 2019. Eighty-four patients (25%) presented with preoperative malperfusion syndrome. Fifty-eight patients with malperfusion syndrome (69%) were transferred to the operating room within 5 hours of the onset of symptoms (immediate repair); 26 patients (31%) were transferred after 5 hours (later repair). We analyzed the effects of immediate aortic repair on surgical outcomes.There was no significant difference in the early mortality rates between patients with immediate and later aortic repair, which were 20.0% (n = 11/58) and 26.9% (n = 7/19), respectively (P = .12). Preoperative coronary malperfusion was the only predictor of early mortality. The cumulative 5-year survivals of patients with malperfusion syndrome in the immediate and later repair groups were 76.7% and 45.4%, respectively. A significant difference was noted in the long-term outcomes between the 2 groups (P = .02). On multivariable Cox survival analysis, coronary malperfusion and shock on arrival were associated with increased long-term mortality (P .01 and P = .04). Conducting surgery within 5 hours of the onset of symptoms was a significant predictor of favorable long-term outcome (P = .03).Although preoperative coronary malperfusion and shock on arrival worsened the long-term outcomes in patients undergoing aortic repair for acute type A aortic dissection with preoperative malperfusion syndrome, conducting an operation within 5 hours of the onset of symptoms significantly improved their long-term outcomes.

The slow loris monkey is one of the few venomous mammals. Its venom repels predators and can cause anaphylactic shock and even death in humans. The venom protein has been evaluated and has high sequence similarity to cat allergen; however, no studies involving subjects with cat allergy and who have been exposed to slow loris venom have been reported. We herein report the first case of severe anaphylactic shock following a slow loris bite in a patient with cat allergy.

We report a case of vascular injury caused by a multi‐lumen catheter for CRRT inserted through left jugular vein. Diagnosis was delayed because CRRT could be continued. Clinicians should be aware of potential vascular complications associated with the wrong placement of multi‐lumen catheters even if blood flow continues without difficulty., In case of wrong placement of the triple‐lumen catheter as a vascular access for CRRT, the blood flow may be maintained, even if a catheter causes vascular injury. The clinician should ensure to place the tip of catheter in the right atrium.

Background: Whether extracorporeal cardiopulmonary resuscitation (ECPR) is indicated for pulseless electrical activity (PEA) remains unclear. Pulmonary embolism with PEA was a good candidate for ECPR; however, PEA sometimes include an aortic disease and intracranial haemorrhage, with extremely poor neurological outcomes, and could not be a candidate. We have induced an ECPR strategy using the hybrid emergency room (ER) to perform computed tomography (CT) before extracorporeal membrane oxygenation (ECMO) induction from January 2020. Therefore, this study aimed to evaluate the effectiveness of our ECPR strategy.Methods: Medical records of patients who transferred to our hybrid emergency room (ER) and required ECPR for PEA between January 2020 and November 2021 were reviewed.Results: Twelve consecutive patients (median age, 67 [range, 57-73] years) with PEA requiring ECPR were identified in our hybrid ER. Among them, nine were diagnosed through initial CT scan (intracranial haemorrhage, 3; cardiac tamponade due to aortic dissection, 3; aortic rupture, 2; and cardiac rupture, 1), and unnecessary ECMO was avoided. The remaining three patients underwent ECPR, and two of them survived with favourable neurological outcomes. All patients not indicated for ECPR were excluded before ECMO induction.Conclusion: Our ECPR strategy using the hybrid ER may be useful for the exclusion of patients with PEA non-indication for ECPR and decision making.

BACKGROUND Initial electrocardiogram (ECG) rhythm is a predictor of outcomes in out-of-hospital cardiac arrest (OHCA) in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). However, ECG rhythm often changes before ECPR, and the consequence of this change remains unclear. This study aimed to assess the relationship between the conversion of ECG rhythm from initial shockable rhythm before ECPR and mortality. PATIENTS AND METHODS This was a retrospective cohort study of OHCA patients with initial shockable rhythm who underwent ECPR between January 2010 and September 2020. Patients were classified into two groups: asystole (patients whose ECG rhythm converted to asystole at any time before initiating ECPR) and non-asystole (patients whose ECG rhythm did not convert to asystole at any time before initiating ECPR) groups. The primary outcome was in-hospital mortality. RESULTS A total of 102 patients were included in the study; in-hospital mortality rate was 46.1% (n = 47) and 76 (74.5%) patients had unfavorable neurological outcomes (Cerebral Performance Category: 3-5). There were 33 and 69 patients in the asystole and non-asystole groups, respectively. The mortality rates in the asystole and non-asystole groups were 69.7% and 34.8%, respectively (P = 0.001). On multivariable analysis, the asystole group showed a significant association with mortality (odds ratio, 5.42; 95% confidence interval, 2.11-15.36; P

Coronavirus disease 2019 (COVID-19) has become a serious public health problem worldwide. In general, healthcare workers are considered to be at higher risk of COVID-19 infection. However, the prevalence of COVID-19 among healthcare workers in Japan is not well characterized. In this study, we aimed to examine the seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibodies among 2160 healthcare workers in hospitals and clinics that are not designated to treat COVID-19 patients in Japan. The prevalence of SARS-CoV-2 immunoglobulin G was 1.2% in August and October 2020 (during and after the second wave of the pandemic in Japan), which is relatively higher than that in the general population in Japan (0.03–0.91%). Because of the higher risk of COVID-19 infection, healthcare workers should be the top priority for further social support and vaccination against SARS-CoV-2.

Background Studies describing the effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for peripartum cardiopulmonary arrest are lacking. Case Presentation A 39‐year‐old woman underwent elective cesarean section. Right after surgery, she fell into a cardiac arrest and was promptly transferred to our institute by ambulance. On arrival, we immediately initiated ECPR, within 63 min of the cardiac arrest. Return of spontaneous circulation was achieved 80 min after induction of extracorporeal membrane oxygenation. As the hemodynamics of the patient stabilized, extracorporeal membrane oxygenation was discontinued on day 3 of hospitalization. The patient’s cerebral performance category score was 3 at discharge, which improved to 2 after 3 months. Conclusion This case suggests that prompt interhospital transfer and ECPR might be effective for peripartum cardiac arrest due to nonhemorrhagic events., We report a rescue case that required interhospital transfer for extracorporeal cardiopulmonary resuscitation in a patient who had a cardiopulmonary arrest after undergoing cesarean section.

Background We report the first case of retro‐odontoid pseudotumor with an isolated symptom of C2–C3 dysesthesia triggered by a traumatic event. Case Presentation An 86‐year‐old man, who was a wood craftsman for more than 50 years, presented to the emergency room with sudden‐onset severe posterior head and neck dysesthesia after accidentally falling backward. No neurological impairment of the extremities was noted. Computed tomography revealed a C2–C7 osteophyte formation, mainly in front of the vertebral bodies. Moreover, magnetic resonance imaging showed cervical spinal cord compression by a soft tissue mass posterior to the odontoid process of the axis. Therefore, we diagnosed a cervical spine injury with an isolated symptom of C2–C3 dysesthesia due to a retro‐odontoid pseudotumor. He did not undergo surgical intervention and was transferred to a rehabilitation hospital on day 11 for pain control. Conclusion Our report could be useful to emergency physicians dealing with similar cases of cervical symptoms following trauma., We report an uncommon presentation of central cord syndrome due to a relatively rare condition, retro‐odontoid pseudotumor. To the best of our knowledge, no previous reports have described a relationship between the two entities. Our report could help emergency physicians dealing with similar cases of cervical symptoms following trauma.

This study sought to confirm if thoracic endovascular aortic repair (TEVAR) was an appropriate therapeutic strategy for blunt thoracic aortic injury (BTAI). Between 3/2005 and 12/2020, 104 patients with BTAI were brought to our hospital. The severity of each trauma case was evaluated using the Injury Severity Score (ISS); aortic injuries were classified as type I to IV according to Society for Vascular Surgery guidelines. Initial treatment was categorized into four groups: nonoperative management (NOM), open aortic repair (OAR), TEVAR, or emergency room thoracotomy/cardiopulmonary resuscitation (ERT/CPR). The patients’ mean age and ISS were 56.7 ± 20.9 years and 48.3 ± 20.4, respectively. Type III or IV aortic injury were diagnosed in 82 patients. The breakdown of initial treatments was as follows: NOM for 28 patients, OAR for four, TEVAR for 47, and ERT/CPR for 25. The overall early mortality rate was 32.7%. Logistic regression analysis confirmed ISS > 50 and shock on admission as risk factors for early mortality. The cumulative survival rate of all patients was 61.2% at 5 years after treatment. After initial treatment, eight patients receiving TEVAR required OAR. The cumulative rate of freedom from reintervention using TEVAR at 5 years was higher in approved devices than in custom-made devices (96.0 vs. 56.3%, p = 0.011). Using TEVAR as an initial treatment for patients with BTAI is a reasonable approach. Patients with severe multiple traumas and shock on admission had poor early outcomes, and those treated with custom-made devices required significant rates of reintervention.

PurposeWith Japan’s population rapidly skewing toward aging, the number of geriatric trauma patients is expected to increase. Since we need to continue to improve the quality of geriatric trauma patient care, this study aimed to evaluate in-hospital mortality trends among geriatric trauma patients in Japan over a recent 10-year period.MethodsThis was a retrospective cohort study of data from a Japanese nationwide trauma registry (the Japan National Trauma Data Bank) on patients admitted between January 1, 2008 and December 31, 2017. Geriatric patients were defined as those 65 years old and older. The primary outcome was to clarify in-hospital mortality trends and changes over these 10 years.ResultsWe identified 265 268 eligible trauma patients. Excluding those under 65 years old and those with inadequate or unknown age data, missing prognosis, out-of-hospital cardiac arrest, and burns, 107 766 patients were enrolled in this study. The total trauma patient in-hospital mortality trend was evaluated using the Cochran-Armitage test and showed a significant decrease (pConclusionsWhile recognizing the limitations of the current analysis, our data demonstrated that prognoses for severe trauma patients over 65 years old improved dramatically over these 10 years, especially in those with severe trauma.Level of evidenceⅢ—retrospective cohort study.

There are some cases of traumatic asphyxia whose therapeutic efficacy is very good even with cardiac arrest, so it is important not to spare efforts for life support in such cases., Aim To investigate the clinical features of traumatic asphyxia, specifically the presence of cardiac arrest and therapeutic efficacy. This review will be useful for future emergencies. Methods Sixteen traumatic asphyxia cases from our hospital between April 2007 and March 2019 were reviewed and divided into three groups: those experiencing cardiac arrest at the time of rescue (group A, six cases), those experiencing cardiac arrest after rescue (group B, five cases), and those who did not experience cardiac arrest (group C, five cases). Results All cases had abnormal findings in the skin or conjunctiva. The total mortality rate reached 56%. Among the 11 cases in groups A and B that resulted in cardiac arrest, 10 had an Injury Severity Score of 16 or higher and an Abbreviated Injury Scale score in the chest of 3 or higher. The patients’ injuries included pneumothorax, flail chest, and pericardial hematoma. The heartbeat was restarted in seven cases, and two cases completely recovered. Conclusion In some traumatic asphyxia cases, the treatment course was relatively effective even with cardiac arrest; thus, life support efforts should not be spared in such cases.

We report a case of perforation of the superior vena cava caused by a multi-lumen central venous catheter. Diagnosis was delayed because extra-corporeal blood flow was not interrupted. Clinicians should be aware of potential vascular complications associated with multi-lumen catheters even in cases in which hemodialysis continues with no complications.

Aim Transporting critically ill patients outside of disaster-affected areas for treatment is an important activity of Japan Disaster Medical Assistance Teams (DMATs). We investigated whether this activity is possible after possible catastrophic damage from a Nankai Trough earthquake. Methods Japan was divided into three areas based on the level of predicted damage (definitely, possibly, and non-affected areas). A survey of DMATs and the locations of emergency base hospitals and intensive care units (ICUs) in each area was carried out, and the ability to support disaster areas was investigated. Next, a survey of wide-area medical transport by Self-Defense Force aircraft and the medical transport abilities of helicopter ambulances was carried out. The numbers of ICU beds in each area were compared, and the capacity to accept patients was investigated. Finally, subjects for further study were examined. Results The number of DMATs that could be sent from non-affected areas was insufficient. The number of patients that can be transported by Self-Defense Force aircraft and helicopter ambulance during the first 3 days was determined to be 1,443. The number of patients that can be accepted by ICUs in non-affected areas was insufficient. A system needs to be developed to provide medical treatment for critically ill patients within disaster areas during the acute phase. This will require DMAT operational reforms and the creation of logistics systems such as the supply of resources for earthquake-reinforced hospitals. Conclusion In addition to patient transport, systems to provide medical care inside disaster-affected areas are needed.

OBJECTIVES The purpose of this study was to identify the cut-off value of sarcopenia based on the psoas muscle area index and evaluate early and late outcomes following elective total arch replacement in the elderly. METHODS Sarcopenia was assessed by the psoas muscle area index [defined as the psoas muscle area at the L3 level on computed tomography (cm 2 )/body surface area (m 2 )]. The cut-off value for sarcopenia was defined as > 2 standard deviations below the mean psoas muscle area index value obtained from 464 normal control patients. Between October 1999 and July 2015, 266 patients who were ≥ 65 years and had undergone psoas muscle area index measurement underwent elective total arch replacement. These patients were classified into the sarcopenia (Group S, n = 81) and non-sarcopenia (Group N, n = 185) groups. RESULTS The mean age was 76.2 ± 5.6 years in Group S and 75.7 ± 5.7 years in Group N ( P = 0.553). Hospital mortality was 3.7% (3/81) in Group S and 2.2% (4/185) in Group N ( P = 0.483). Mean follow-up was 48.3 ± 38.7 months. Five-year survival was significantly worse in Group S (S: 63.2 ± 6.6% vs N: 88.7 ± 2.6%, P

Introduction: It have reported previously that extracorporeal cardiopulmonary resuscitation (ECPR) for out of hospital cardiac arrest should induct within 45 minutes from collapse. However, We often encounter patients with favorable neurological outcome who had longer time interval from collapse to induction of V-A ECMO (Downtime: DT). We analyzed that relation about neurological outcome and DT for patients undergone ECPR. Methods: In this single center retrospective study, from January 2010 to April 2019, we identified 147 patients who underwent ECPR. Of these, 87 patients (59%) had shorter DT (≦45min:Group S), and 60 patients (41%) had longer DT (≧46min:Group L). We compared neurological outcome between two groups. Glasgow-Pittsburgh Cerebral Performance Category (CPC) 1-2 was defined as favorable neurological outcome, CPC3-5 was defined as unfavorable outcome at 3 months. Results were expressed as Median (IQR). Results: Patient characteristics were not different between the two groups. DT were 37 min (32-42: Group S) and 57 min (50-64: Group L). 51 % of the patients in Group S (46 patients) were alive at 3 month, as compared with 35% in Group L (21 patients) (p: 0.05). At the 3 month follow up, Group S had a higher rate of favorable neurological outcome than Group L (39% (34 patients) vs 28% (17 patients) (p:0.18 ). In younger patients (≦65y.o), the rate of favorable neurological outcome were roughly equal in each groups (Group S: 41% (20/48 patients) vs 37% (11/30 patients) ) (p:0.51). Conclusions: Because it is possible younger patients with cardiac arrest had a favorable neurological outcome, even if they had longer DT, it should consider the expanded adaptation of ECPR.

We report a high-repetition-rate, picosecond fiber master-oscillator and power-amplifier system operating at 120 and 240 MHz in the pulse range of 28-87 ps and its fifth-harmonic generation for semiconductor inspection at 213 nm.

Approximately two months after the Fukushima nuclear accident, the Japan Atomic Energy Agency (JAEA) led off a series of demonstration tests to develop effective but easily applicable decontamination methods for various school facilities in Fukushima. This effort included (1) dose reduction measures in schoolyards, (2) purification of swimming pool water, and (3) removal of surface contamination from playground equipment. Through these demonstration tests, they established practical methods suitable for each situation: (1) In schoolyards, dose rates were drastically reduced by removing topsoil, which was then placed in 1-m-deep trenches at a corner of the schoolyard. (2) For the purification of pool water, the flocculation coagulation treatment was found to be effective for collecting radiocesium dissolved in the water. (3) Demonstration tests for playground equipment, such as horizontal bars and a sandbox wood frame indicated that the decontamination effectiveness considerably varied depending on the material, paint or coating condition of each equipment piece. These findings were summarized in reports, some of which were compiled in local/national guidelines or handbooks for decontaminating the living environment in Fukushima.

Following head trauma caused by traffic accidents, many patients are unable to completely recover their social functions due to higher brain dysfunction although they are able to return home. To predict the onset and severity of post-traumatic higher brain dysfunction, the visualization of responsible injury is considered urgent. In this study, we focused on five patients with higher brain dysfunction following head trauma caused by traffic accidents to establish a method for quantitatively evaluating higher brain dysfunction. The injury conditions were reproduced on the basis of multibody dynamic and collision analyses using finite element (FE) modeling of the human head to determine mechanical responses inside the cranium of these patients. The strain on the frontal lobe generated by an injury condition was suggested to contribute to the onset of attention disturbance during the chronic phase of medical treatment. Reproduction analysis of the injury conditions using FE modeling of the head could predict the onset and severity of traumatic higher brain dysfunction.

Introduction: We have reported previously a favorable neurological outcome by extracorporeal cardiopulmonary resuscitation (ECPR) for out of hospital cardiac arrest. However, effects of ECPR on patients with prolonged pulseless electrical activity (PEA) are unclear. We analyzed etiology of patients with favorable neurological outcomes after ECPR for PEA with witness. Methods: In this single center retrospective study, from January 2007 to May 2018, we identified 68 patients who underwent ECPR for PEA with witness. Of these, 13 patients (19%) had good neurological outcome at 1 month (Glasgow-Pittsburgh Cerebral Performance Category (CPC):1-2, Group G), and 55 patients (81%) had unfavorable neurological outcome (CPC:3-5, Group B). We compared courses of treatment and causes/places of arrests between two groups. Results are expressed as mean ± SD. Results: Patient characteristics were not different between the two groups. Time intervals from collapse to induction of V-A ECMO were also not significantly different (Group G; 46.1 ± 20.2 min vs Group B; 46.8 ± 21.7 min, p=0.92). Ten patients achieved favorable neurological outcome among 39 (26%) with non-cardiac etiology. In cardiac etiology, only 3 of 29 patients (9%) had a good outcome at 1 month (p=0.08). In particular, 5 patients of 10 pulmonary embolism, and 4 of 4 accidental hypothermia responded well to ECPR with a favorable neurological outcome. Additionally, 6 of 13 (46%), who had in hospital cardiac arrest, had good outcome, whereas 7 of 55 (15%) who had out of hospital cardiac arrest, had good outcome (p=0.02). Conclusions: In our small cohort of cardiac arrest patients with pulmonary embolism or accidental hypothermia and PEA with witness, EPCR contributed to favorable neurological outcomes at 1 month.

The present study analyzed the prevalence of variations of the aortic arch branching in Japanese population, comparing patients with aortic arch disease with healthy controls. Between from October 1999 and December 2015, 815 Japanese patients with aortic arch disease defined as aortic arch aneurysm (diameter ≥ 45 mm) and aortic dissection (group A) underwent aortic arch surgery in our institution. As a control group, 1506 traumatic screened patients were enrolled (group C). Aortic arch anomaly was diagnosed in 140 patients (17.2%) in the group A and in 222 patients (14.7%) in the group C (p = 0.125). Significant differences were found in the incidence of aberrant subclavian artery (A: 14 patients, 1.7%, vs. C: 8 patients, 0.5%, p = 0.006). Significantly more patients with aortic arch aneurysm in the group A had anomalies of the aortic arch compared with the group C (p = 0.009), including bovine aortic arch (p = 0.049) and aberrant subclavian artery (p