Tokyo Metropolitan Bokutoh Hospital

従来の遠心法によるクリオ作製には大型冷却遠心機が必要であり，施設の制約がある．そこで，血漿から乏クリオ血漿を重力で除去するサイホン法の改良版として，「簡易サイホン法（簡易法）」と「2回凍結サイホン法（2回凍結法）」を検討した．簡易法は，購入した新鮮凍結血漿（FFP）を血液専用保冷庫内でサイホン（オーバーナイト）する方法で，Fbg回収率約49.2%，Fbg精製率約56.4%と，遠心法とほぼ同等のクリオが作製できた．2回凍結法は，FFPを低温融解し再凍結後にサイホンする方法で，Fbg回収率約72.9%，Fbg精製率約74.9%，FFP480からFbg 1g以上回収できた．大型遠心機がなくても，サイホン法で十分なクリオを作製可能であり，大量出血による後天性低フィブリノゲン血症に対しても有効な止血戦略が立てられ，血液製剤の有効活用，適正使用推進に役立つことが期待される．

ST-segment elevation on a post-cardiac arrest electrocardiogram (ECG) is traditionally viewed as a hallmark of acute coronary occlusion. However, this finding can also arise from non-coronary etiologies like massive pulmonary embolism (PE), creating a high-stakes diagnostic dilemma. An 83-year-old woman hospitalized for trauma developed cardiac arrest with pulseless electrical activity (PEA). Immediate post-resuscitation ECG showed marked ST-segment elevation in leads V1-V4, II, III, and aVF, suggesting extensive myocardial infarction. A point-of-care echocardiogram showed severe right ventricular dilation, raising the suspicion of PE, which was confirmed by computed tomography. Fortuitously, a Holter monitor was attached, capturing the sequence of ECG changes before and after the onset of PE. It revealed that ST-segment elevation appeared after the onset of cardiac arrest and gradually decreased thereafter. The patient was successfully treated with anticoagulation. This case suggests that post-arrest ST-segment elevation in PE may reflect dynamic right ventricular strain and supply-demand mismatch, rather than fixed coronary occlusion.Recognizing the "dynamic" nature of these ECG changes, alongside rapid echocardiographic assessment, is essential to avoid unnecessary emergent coronary angiography and ensure timely treatment for PE.

BackgroundAdvancing antimicrobial stewardship programs (ASP) has led to various metrics for assessing antimicrobial consumption. Since introducing the antimicrobial spectrum index (ASI) in 2017, similar metrics, such as days of antibiotic spectrum coverage (DASC), have emerged to better evaluate antimicrobial use, particularly considering de-escalation process. This study assessed antimicrobial consumption with a de-escalation process using DASC in 12 hospitals across three regions in Japan.Table 1.Characteristics of participating hospitalsFigure 1.Trend of monthly DASC/DOT and DOT per 1,000 patient-days stratified by hospital types.MethodsIntravenous antimicrobial consumption data from 12 Japanese hospitals (April 2016–March 2024) were collected. The participating hospitals were located in three regions: West (Okinawa, n=6), East (Tokyo, n=5), and Midwest (Aichi, n=1). Monthly antimicrobial consumption was expressed as days of therapy (DOT) and then converted to DASC per 1,000 patient-days (PD). Hospital-wide de-escalation was evaluated using DASC/DOT. The correlation between DASC/DOT (a new metric) and DOT per 1,000 PD (a conventional metric) was assessed using Spearman’s rank-order correlation test. Hospital characteristics, including ASP availability, and infectious disease consultation, were also collected.Figure 2.Trends of DOT per 1,000 PD, DASC per 1,000 PD and DASC/DOT stratified by hospital regionsResultsA total of 96 months of data were analyzed. Monthly median DOT, DASC, and DASC/DOT were 303.4, 2107.0, and 7.2, respectively. There was little correlation between DASC/DOT and DOT per 1,000 PD (rho=0.11; P< 0.73). University hospitals (median 7.7) and a cancer center (median 8.0) had higher DASC/DOT than the remaining 9 community hospitals (median 6.9), likely owing to the availability of transplant services and a larger number of ICU beds (Figure 1 and Table 1). A substantial decrease in DASC/DOT at one university hospital since August 2022 was observed, likely due to implementing a hospital-wide restriction of carbapenem use. Median DASC/DOTs in East and West were 6.9 and 7.2, respectively, suggesting that the de-escalation process has progressed more at hospitals in Tokyo than at hospitals in Okinawa (Figure 2).ConclusionDASC/DOT, showing little correlation with traditional DOT per 1,000 PD, is a useful metric to assess antimicrobial use and de-escalation process. A regional-level and hospital type-level comparisons can help identify facilities needing further ASP promotion.DisclosuresAll Authors: No reported disclosures

Liver resection (LR) and liver transplantation (LT) are the two principal curative options for early-stage hepatocellular carcinoma (HCC), but the optimal choice for individual patients remains uncertain. Recent meta-analyses suggest that LT confers superior long-term survival compared with LR, particularly when tumor burden meets transplant criteria and donor availability is sufficient. Although LT requires lifelong immunosuppressive therapy, patient-reported quality of life appears comparable between LT and LR. Overall, current evidence indicates that LT may offer improved survival without compromising quality of life in appropriately selected patients.

Anticoagulant effects of direct oral anticoagulants (DOACs) are influenced by their plasma levels and anti-factor Xa (FXa) activity. Delayed bleeding is a major adverse event associated with endoscopic mucosal resection (EMR) of colorectal neoplasms. However, the association between post-EMR bleeding and pharmacodynamics in patients taking DOAC remains unknown. This study investigated the association between pharmacological risk factors and delayed bleeding in patients receiving DOAC. This multicenter prospective trial in Japan evaluated the incidence of post-EMR delayed bleeding in DOAC users between April 2018 and May 2022 and determined the association of post-EMR delayed bleeding with plasma levels and FXa activity. The incidence of post-EMR delayed bleeding was 10.5% (95% confidence interval [CI]: 5.3%-18.0%). There were large individual differences in plasma levels and FXa activity for each DOAC. At the trough and Tmax, plasma DOAC levels and plasma level/dose ratios were significantly correlated with FXa activity. Multivariate analysis showed that high anticoagulant ability was a risk factor for post-EMR delayed bleeding (adjusted OR, 12.211; 95% CI: 1.081-137.922, p = 0.043). DOAC users with high anticoagulant activity may be at higher risk of post-EMR delayed bleeding from colorectal neoplasms.

Food-Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE-mediated food allergy that causes gastrointestinal symptoms, though its anatomical origin and pathogenesis remain unclear. Abdominal distention is common in adult FPIES, but symptoms vary among patients. This study aimed to establish objective criteria for assessing abdominal distention and to clarify the pathophysiology and anatomical origin of FPIES. This study targeted 26 adult FPIES patients. Abdominal distention was broken down into eight factors, and an evaluation algorithm was developed based on items with high positivity rates. Clinical characteristics, blood, and imaging analyses were performed before and after OFC (oral food challenge) to investigate the pathophysiology. Among 14 adult FPIES patients who underwent OFC, seven showed positive results. The latency period was 1.5 h, with the most frequent symptoms being abdominal distention (100%), abdominal pain, and nausea (71.4%). All patients received treatment with intravenous extracellular fluid infusion and ondansetron, which resulted in reduced symptom duration. In an evaluation of blood test data, there were no specific serological markers of FPIES, except in the severe case. Image analysis with computed tomography revealed significant dilation and edema of the small intestine during the FPIES event, suggesting that dilation of the small intestine is associated with adult FPIES. These results are expected to aid in the early and appropriate diagnosis of FPIES based on medical interviews, blood test data, and imaging findings when adult patients present to medical institutions with severe acute gastroenteritis symptoms.

Abstract AX J145732-5901 is an unidentified X-ray source discovered in the ASCA Galactic Plane Survey. Its extended nature and heavily absorbed X-ray spectrum suggest that AX J145732-5901 is a cluster of galaxies behind the Galactic plane. However, due to limited photon statistics, the spectral shape was not well examined. Using the results of the Galactic ridge X-ray emission and cosmic X-ray background studies based on the Suzaku observations, we reanalyzed the ASCA data of AX J145732-5901. We confirmed that the source is more extended than the point spread function and the angular size is $14^{\prime }\times 10^{\prime }$. The spectrum was heavily absorbed by interstellar matter equivalent to an $N_{\rm H}$ of ${\sim}10^{23}$ cm$^{-2}$ and the emission line feature was confirmed. The spectrum was represented by a thin thermal plasma model with a temperature of 2.6 keV and a redshift of 0.12. Assuming the redshift value, the X-ray luminosity is calculated to be $2.6\times 10^{44}$ erg s$^{-1}$ in the 1–10 keV energy band. The observational results indicate that AX J145732-5901 is a cluster of galaxies behind the Galactic plane.

Abstract Objectives The discovery of complex patterns in contrast medium extravasation on computed tomography (CT) imaging is critical for improving trauma patient management. Identifying these patterns enables early detection of complications such as vascular injury, organ rupture, and active hemorrhage, facilitating timely and targeted interventions that enhance patient outcomes. This study introduces an advanced imaging analytics approach that integrates nonlinear dynamic analysis and geostatistical methods to characterize the temporal and spatial evolution of contrast medium extravasation in trauma cases. Methods We analyzed CT imaging sequences from trauma patients using fuzzy recurrence dynamics to uncover hidden structures within contrast dispersion patterns. This methodology quantifies subtle variations in blood flow, capturing previously unrecognized radiographic signatures associated with hemodynamics. Recurrence-based metrics were leveraged to identify dynamic changes indicative of impending complications, enhancing the predictive capabilities of trauma imaging. Results The proposed approach effectively detected subtle, high-risk extravasation patterns that are often overlooked by conventional imaging techniques. The integration of nonlinear dynamic analysis and geostatistical modeling provided a more precise characterization of contrast dispersion, revealing predictive markers of vascular compromise. These findings support the application of advanced computational techniques for improving trauma imaging and clinical decision-making. Conclusion The findings demonstrate the potential of integrating advanced nonlinear dynamics and network techniques into trauma imaging, offering a new framework for real-time detection, risk stratification, and predictive modeling of extravasation events. This approach represents a step toward precision medicine in emergency care, enabling automated, data-driven decision support for clinicians. By improving diagnostic accuracy and facilitating early therapeutic intervention, this study lays the foundation for a paradigm shift in trauma imaging, ultimately optimizing patient management and outcomes in critical care settings.

Niraparib is a small-molecule inhibitor of poly(adenosine diphosphate [ADP]-ribose) polymerase 1/2, which is used to treat ovarian cancer. Elevated maximum blood concentrations of niraparib and the area under the blood concentration-time curve (AUC) were correlated with body weight up to 77 kg. Lower body weight increases blood niraparib concentrations and the AUC of ovarian cancer in Asian patients. Therefore, therapeutic drug monitoring (TDM) of ovarian cancer drugs may increase niraparib efficacy and minimize adverse events. In this study, we quantified niraparib in human plasma (50 μL) using a simple and specific HPLC-UV method. The analyte was separated on a reversed-phase column with an isocratic mobile phase of 0.5% KH2PO4 (pH 4.5) and acetonitrile (75:25, v/v) at a flow rate of 1.0 mL/min. Calibration curves were linear over 0.25-5 μg/mL (r2 = 0.9998). Intraday and interday precision ranged from 2.25% to 6.29% and 1.73% to 3.20%, respectively, whereas accuracy and recovery ranged from -6.02% to -1.75% and > 93.2%, respectively. We cost-effectively quantified steady-state niraparib concentrations in the plasma of patients with ovarian cancer. Therefore, our method could be applied to the departments of pharmacy and clinical laboratories in general hospitals to facilitate the TDM of niraparib without the need for LC-MS/MS.