Noto General Hospital

Bystander automated external defibrillator (AED) placement is expected to benefit all out-of-hospital cardiac arrest (OHCA) cases, even in the absence of prehospital defibrillation. This study investigated the factors influencing bystander-AED placement and evaluated its impact on neurologically favourable outcomes in bystander-witnessed, out-of-home OHCA cases receiving bystander cardiopulmonary resuscitation (CPR). This retrospective cohort study analysed nationwide EMS-transported emergency and OHCA databases (2021-2022), including 22,443 bystander-witnessed, out-of-home OHCAs with bystander CPR, of which 10,324 involved bystander-AED placement. AEDs were placed by bystanders in 25,333 (10.6%) of 238,871 non-EMS-witnessed OHCA cases. Logistic regression showed the associations of prehospital defibrillation, no bystander CPR, male sex, outdoor location, at-home setting, and family- or friend/colleague-witnessed OHCA with lower bystander-AED placement rates. In contrast, rural municipality EMS, daytime, DA-CPR attempt, presumed cardiac aetiology, shockable initial rhythm, conventional bystander CPR, and care/medical facilities were associated with higher rates. Neurologically favourable survival was 2.2% for bystander-AED and 2.3% for EMS-AED placement cases within care/medical facilities, compared to 19.5% and 11.6%, respectively, outside these facilities. In both logistic regression analyses after propensity score matching, bystander-AED placement improved outcomes of OHCA outside care/medical facilities only in the presence of prehospital defibrillation (adjusted odds ratio 1.24 [1.04-1.48]) but worsened outcomes of OHCA within the facilities in the absence of prehospital defibrillation (0.73 [0.54-0.99]). Bystander-AED placement was common in care/medical facilities but had limited benefits. The effectiveness of bystander-AED placement depends on location, early prehospital defibrillation, and responder training.

Abstract Bystander automated external defibrillator (AED) placement is expected to benefit all out-of-hospital cardiac arrest (OHCA) cases, even in the absence of prehospital defibrillation. This study investigated the factors influencing bystander-AED placement and evaluated its impact on neurologically favourable outcomes in bystander-witnessed, out-of-home OHCA cases receiving bystander cardiopulmonary resuscitation (CPR). This retrospective cohort study analysed nationwide EMS-transported emergency and OHCA databases (2021–2022), including 22,443 bystander-witnessed, out-of-home OHCAs with bystander CPR, of which 10,324 involved bystander-AED placement. AEDs were placed by bystanders in 25,333 (10.6%) of 238,871 non-EMS-witnessed OHCA cases. Logistic regression showed the associations of prehospital defibrillation, no bystander CPR, male sex, outdoor location, at-home setting, and family- or friend/colleague-witnessed OHCA with lower bystander-AED placement rates. In contrast, rural municipality EMS, daytime, DA-CPR attempt, presumed cardiac aetiology, shockable initial rhythm, conventional bystander CPR, and care/medical facilities were associated with higher rates. Neurologically favourable survival was 2.2% for bystander-AED and 2.3% for EMS-AED placement cases within care/medical facilities, compared to 19.5% and 11.6%, respectively, outside these facilities. In both logistic regression analyses before and after propensity-score matching, bystander-AED placement improved outcomes of OHCA outside care/medical facilities only in the presence of prehospital defibrillation (adjusted odds ratio1.44 [95%CI 1.23–1.69] and 1.24 [1.04–1.48], respectively) but worsened outcomes of OHCA within the facilities in the absence of prehospital defibrillation (0.74 [0.56–0.99] and 0.73 [0.54–0.99]). Bystander-AED placement was common in care/medical facilities but had limited benefits. The effectiveness of bystander-AED placement depends on location, early prehospital defibrillation, and responder training.

Disasters disproportionately affect vulnerable populations, necessitating specialized support through welfare shelters, which offer tailored care for those with special needs. Despite their importance, comprehensive reporting on welfare shelter operations during disasters remains limited. This study aimed to analyze the establishment and operation of a welfare shelter in Wajima City, Japan, following the 2024 Noto Peninsula Earthquake, providing insights into operational processes. The research presents a first-hand narrative account of a welfare shelter's operation over a 3-month period. The authors, directly involved in key roles, structured the narrative around 3 phases: Initial (January 1-7, 2024), Operational (January 8-March 31, 2024), and Withdrawal (March-April 2024). Key findings include challenges in personnel management and resource procurement during the initial phase, implementation of continuous care systems and health management in the operational phase, and difficulties in securing relocation sites for evacuees during the withdrawal phase. Challenges in maintaining nutritional balance and managing infectious diseases were observed throughout the shelter's operation. Implementing flexible staffing strategies may serve as a practical means to support sustained welfare shelter management. This case study highlights the importance of pre-disaster planning, broad regional collaboration, and adaptability and continuity in welfare shelter management. The study offers valuable lessons for improving welfare shelter operations and emphasizes the need for comprehensive disaster preparedness strategies including long-term care and relocation planning for vulnerable populations.

BackgroundPediatric out-of-hospital cardiac arrests (OHCAs) are frequently associated with a respiratory etiology. Despite the high proportion of preschool children with OHCAs, very few studies on this special population exist. This study characterizes the epidemiologic features of preschool pediatric OHCAs and analyzes the advantage of conventional (ventilations with chest compressions) bystander cardiopulmonary resuscitation (CPR) over compression-only bystander CPR (BCPR) on the one-month post-event neurological status of the patient.MethodsJapanese nationwide databases for all ambulance transport events and OHCAs occurring during a 4-year period between 2016 and 2019 were combined, totalling 3,608 patient events. Children ≤6-years-old were included; physician- and EMS-witnessed events, no prehospital resuscitation effort events, and neonatal patient events were excluded. Neurologically favorable 1-month survival rates were compared among groups using univariate and multivariate analyses before and after propensity score matching.ResultsFrom the combined database, 2,882 pediatric OHCAs meeting selection criteria were categorized as no BCPR (984), compression-only BCPR (1,428), and conventional BCPR (470). The proportion of bystander-witnessed cases was low (22.3%). Most OHCA witnesses were family members (88.5%), and most OHCAs occurred at home (88.0%). The neurologically favorable 1-month survival rates were: no BCPR 2.4%, compression only, 3.2%, and conventional 6.6% (P < 0.01). Multivariate logistic regression analysis before and after matching showed that conventional BCPR was associated with higher neurologically favorable 1-month survival than compression-only BCPR. Subgroup analyses after matching demonstrated that conventional BCPR was associated with better outcomes in nonmedical (adjusted odds ratio; 95% confidence interval, 2.83; 1.09–7.32) and unwitnessed OHCA cases (3.42; 1.09–10.8).ConclusionsConventional CPR is rarely performed by bystanders in preschool pediatric OHCA. However, conventional BCPR results in neurologically favorable outcomes in nonmedical and unwitnessed cases.

Abstract Background: Aspiration pneumonia (AP), which is a major cause of death in the elderly, does present with typical symptoms in the early stages of onset, thus it is difficult to detect and treat at an early stage. In this study, we identified biomarkers that are useful for the detection of AP and focused on salivary proteins, which may be collected non-invasively. This is because expectorating saliva is often difficult for elderly people, so we collected salivary proteins from the buccal mucosa.Methods: We collected samples from the buccal mucosa of six patients with AP and six control patients (no AP) in an acute-care hospital. Following protein precipitation using trichloroacetic acid and washing with acetone, the samples were analyzed by liquid chromatography and tandem mass spectrometry (LC-MS/MS). We also determined the number of cytokines and chemokines in non-precipitated samples from buccal mucosa.Results: Comparative quantitative analysis of LC-MS/MS spectra revealed 179 and 181 proteins that were significantly higher and lower in abundance, respectively, in the AP group compared with the control group. We identified eight proteins (chloride intracellular channel protein 3, b-defensin 4A, protein S100-A7A, Purkinje cell protein 4-like protein 1, glutamine synthetase, protein S100-A7, cytosolic 5'-nucleotidase 3A, pyridoxal kinase) that were detected in all of the AP samples with high coverage, indicating that these proteins are promising AP biomarker candidates. In addition, the abundance of C-reactive protein (CRP) in oral samples was highly correlated with serum CRP levels, suggesting that oral CRP levels may be used as a surrogate to predict serum CRP in AP patients. A multiplex cytokine/chemokine assay revealed that MCP-1 tended to be low, indicating unresponsiveness of MCP-1 and its downstream immune pathways in AP.Conclusion: Our findings suggest that oral salivary proteins, which are obtained non-invasively, can be utilized for the detection of AP.

To investigate the blood markers for predicting pembrolizumab efficacy in advanced urothelial carcinoma (UC). This study included 91 advanced UC patients. The relationship between prognosis and markers from peripheral blood cell counts, including the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI=monocytes × neutrophils/lymphocytes), was evaluated. Multivariate analysis indicated that pretreatment NLR and the 1-month-change NLR were both significantly associated with overall survival (OS) after pembrolizumab initiation. When the patients were divided into four groups according to calculated cutoffs using Cox proportional hazard model, the pretreatment NLR <2.9 and 1-month change NLR <+43% groups had a significantly better OS than the pretreatment NLR ≥2.9 and 1-month-change NLR ≥+43% groups. NLR, MLR, PLR and SIRI before pembrolizumab and 1-month-change NLR in advanced UC correlated with OS after pembrolizumab treatment.

要旨：【背景】石川県能登地区（人口21.1 万人）での脳卒中パスの登録病型と再登録パターンについて検討した．【結果】2008–2014 年の6 年間に4,179 件（男2,216，女性1,963，平均75.4 歳）の登録があった．病型別では，脳梗塞2,945，脳出血854，くも膜下出血283，その他・不明97 件であった．人口10 万人あたりの年間パス登録率は，男性369.5 人，女性293.7 人と国内の脳卒中発症率に近似していた．197 人で複数回登録があり，再登録率は1.39％/人・年（95％ CI：1.20–1.58）であった．初回–2 回目の登録では，脳梗塞─脳梗塞は91％であったが，脳出血─脳出血は31％で，一致度は低かった．【結論】脳卒中発症を網羅するものではないが，パス登録結果の解析により地域での診療体制に有用な情報が得られる．また脳卒中の多くが，初回病型にかかわらず脳梗塞で再登録されることが示唆された．