Exploring the Potential of CarbonCool® in Rapid Prehospital Cooling for Severe Heat Stroke.

OBJECTIVE: Heat stroke is a life-threatening condition that is characterized by body temperatures above 40 °C and central nervous system dysfunction. Immediate cooling is imperative to prevent irreversible cellular damage and improve patient outcomes. Here, we report two cases of heat stroke that highlight the use of a novel cooling suit (CarbonCool®) as a rapid cooling intervention administered in the prehospital setting, primarily focusing on patients with classic heat stroke. METHODS: This study was a retrospective review of two cases involving older patients with severe classic heat stroke, wherein CarbonCool® was used. The device was deployed at the scene of the incidents, throughout transport, and into the emergency department setting, allowing for continuous cooling and medical intervention as needed. The effectiveness of the cooling device was assessed based on the rate of temperature reduction and overall clinical outcomes of the patients. RESULTS: In both cases, CarbonCool® facilitated a rapid reduction in body temperature, aligning with the crucial requirement of immediate cooling for the management of heat stroke. The first case involved a comatose 90-year-old woman whose body temperature decreased from 42.0 to 35.8 °C within 60 min. The second case involved a comatose 70-year-old man who experienced a decrease in body temperature from 41.2 to 36.6 °C over 196 min. CarbonCool® allowed for the execution of concurrent resuscitative procedures and was compatible with various imaging modalities (including computed tomographic scan), allowing for continuous application from the scene to the intensive care unit. Moreover, both patients showed marked improvements in consciousness and were stabilized without the need for more invasive cooling procedures that are typically employed in hospital settings for such cases. Both patients were discharged without any disabilities. CONCLUSION: We present an innovative approach to prehospital care for patients with heat stroke through the use of CarbonCool®, highlighting its efficacy for rapid cooling and its potential impact on patient outcomes. However, further studies are warranted to fully confirm the efficacy of the system.

Sepsis-Associated Delirium: A Narrative Review.

Delirium is characterized by an acutely altered mental status accompanied by reductions in cognitive function and attention. Delirium in septic patients, termed sepsis-associated delirium (SAD), differs in several specific aspects from the other types of delirium that are typically encountered in intensive care units. Since sepsis and delirium are both closely associated with increased morbidity and mortality, it is important to not only prevent but also promptly diagnose and treat SAD. We herein reviewed the etiology, pathogenesis, risk factors, prevention, diagnosis, treatment, and prognosis of SAD, including coronavirus disease 2019 (COVID-19)-related delirium. Delirium by itself not only worsens long-term prognosis, but it is also regarded as an important factor affecting the outcome of post-intensive care syndrome. In COVID-19 patients, the difficulties associated with adequately implementing the ABCDEF bundle (Assess, prevent, and manage pain; Both spontaneous awakening and breathing trials: Choice of analgesia and sedation; Delirium assess, prevent, and manage; Early mobility and exercise; Family engagement/empowerment) and the need for social isolation are issues that require the development of conventional care for SAD.

Effect of angioembolization for isolated complex pelvic injury: A post-hoc analysis of a nationwide multicenter trauma database in Japan.

BACKGROUND AND IMPORTANCE: Complex pelvic injuries are among the types of trauma with the highest mortality. Treatment strategies should be based on the hemodynamic status, the anatomical type of fracture, and the associated injuries. Combination therapies, including preperitoneal pelvic packing, temporary mechanical stabilization, resuscitative endovascular balloon occlusion of the aorta, and angioembolization, are recommended for pelvic injuries. OBJECTIVE: To investigate the effect of urgent angioembolization alone on severe pelvic injury-associated mortality. DESIGN, SETTINGS, AND PARTICIPANTS: We used the Japan Trauma Data Bank database, a multicenter observational study, to retrospectively identify adult patients with isolated blunt pelvic injuries (Abbreviated Injury Scale [AIS] score: 3-5) from 2004 to 2018. OUTCOME MEASURES AND ANALYSIS: The primary outcome measure was in-hospital mortality. We subdivided patients into two groups, those who underwent urgent angioembolization and non-urgent angioembolization, and compared their mortality rates. We performed multiple imputation and multivariable analyzes to compare the mortality rates between groups after adjusting for known potential confounding factors (age, sex, Glasgow Coma Scale score, systolic blood pressure on hospital arrival, Injury Severity Score, pelvic AIS score, laparotomy, resuscitative endovascular balloon occlusion of the aorta, and external fixation) and for within-hospital clustering using the generalized estimating equation. MAIN RESULTS: We analyzed 4207 of 345,932 trauma patients, of whom 799 underwent urgent angioembolization. The in-hospital mortality rate was significantly higher in the urgent embolization group than in the non-urgent embolization group (7.4 vs. 4.0%; p < 0.01). However, logistic regression analysis revealed that the mortality rates of patients with urgent angioembolization significantly decreased after adjusting for factors independently associated with mortality (odds ratio: 0.60; 95% confidence interval: 0.37-0.96; p = 0.03). CONCLUSION: Urgent angioembolization may be an effective treatment for severe pelvic injury regardless of the pelvic AIS score and the systolic blood pressure on hospital arrival.

Trends in Isolated Pelvic Fracture and 30-Day Survival during a Recent 15-Year Period: A Nationwide Study of the Japan Trauma Data Bank.

BACKGROUND: The epidemiology and treatment of isolated pelvic fracture in Japan are not well understood. This study evaluated epidemiological trends in isolated pelvic trauma and in-hospital survival rates during a recent 15-year period. METHODS: This retrospective cohort study analyzed data from the Japan Trauma Data Bank for 2004-2018. Patients of any age with isolated pelvic fracture were grouped according to time period, as follows: 2004-2008 (Phase 1), 2009-2013 (Phase 2), and 2014-2018 (Phase 3). The main outcome was 30-day in-hospital survival rate. The data were analyzed using the chi-square, Kruskal-Wallis, and Mantel-Haenszel trend tests. We analyzed change in the main outcome over time in multiple logistic regression analysis fitted with a generalized estimating equation, accounting for within-cluster association. RESULTS: In total, 5,348 isolated pelvic fractures were identified during the study period. There was no significant between-phase difference in proportions of patients who underwent resuscitative balloon occlusion of the aorta or external fixation. The proportion of patients who underwent transcatheter arterial embolization significantly increased with time (p=0.003), as did the survival rate (Phase 1, 77%; Phase 2, 86%; and Phase 3, 91%; p<0.001). The 30-day in-hospital mortality rate was significantly lower in Phase 3 than in Phase 1 and Phase 2, even after adjustment for hospital clustering and other confounders (p<0.01). CONCLUSIONS: The 30-day in-hospital survival rate after isolated pelvic fracture improved over a 15-year period in Japan.

Neuromyelitis optica with rapid respiratory failure: a case report.

BACKGROUND: Neuromyelitis optica is an inflammatory demyelinating disease of the central nervous system and is characterized by severe optic neuritis and transverse myelitis. CASE PRESENTATION: The patient was a 74-year-old man with pneumonia. On admission, he exhibited lower limb weakness and rapid respiratory deterioration in the form of tachypnea. Subsequently, he was transported to the Emergency Center of our hospital. High-signal lesions were observed from the cervical spinal cord to the thoracic spinal cord on T2-weighted spinal magnetic resonance images. Neuromyelitis optica was suspected, and the patient received steroid pulse therapy and immunoadsorption plasmapheresis. Serum samples obtained upon transfer were positive for anti-aquaporin-4 antibodies, which confirmed the diagnosis of neuromyelitis optica. Thereafter, the patient was transferred to a rehabilitation hospital. CONCLUSION: Rapid respiratory failure in neuromyelitis optica is rare, and care is needed while treating these cases.

Neuromuscular Electrical Stimulation Improves Energy Substrate Metabolism and Survival in Mice With Acute Endotoxic Shock.

This study investigated the therapeutic benefits of neuromuscular electrical stimulation (NMES).C57BL/6 mice were administered lipopolysaccharide (LPS; 20 mg/kg body weight) by intraperitoneal injection and divided into control (C) and NMES groups (n = 10-12 each). The latter received NMES to the bilateral gastrocnemius muscle for 1 h at low or high frequency (LF = 2 Hz and HF = 50 Hz, respectively) and low or high voltage (LV = 10 V and HV = 50 V, respectively). In LF-LV and LF-HV groups, NMES was performed twice and the results were compared with those for mice that received one round of NMES. Changes in energy metabolism were measured by indirect calorimetry up to 24 h; survival was evaluated up to 72 h after LPS administration; peroxisome proliferator-activated receptor gamma coactivator (PGC)-1α expression in the liver and gastrocnemius muscle was evaluated by quantitative PCR; and plasma concentration of interleukin (IL)-6 was determined by enzyme-linked immunosorbent assay.Survival was improved only in the LF-LV group with one round of NMES (P < 0.01) and the LF-HV group with two rounds of NMES (P < 0.05). Fatty acid oxidation (FAO) was slightly increased in these two groups, whereas carbohydrate oxidation (CHO) was decreased or not changed. Significant upregulation of PGC-1α in muscle as well as a decrease in plasma IL-6 level were also observed in these two groups (P < 0.05).Thus, NMES exerts therapeutic effects under conditions that induce a mild switch in energy metabolism from glucose to lipid predominant metabolism through PGC-1α upregulation and suppression of inflammation, and may be an effective early intervention even in hemodynamically unstable patients.

Alterations in energy substrate metabolism in mice with different degrees of sepsis.

BACKGROUND: Nutritional management is crucial during the acute phase of severe illnesses. However, the appropriate nutritional requirements for patients with sepsis are poorly understood. We investigated alterations in carbohydrate, fat, and protein metabolism in mice with different degrees of sepsis. MATERIALS AND METHODS: C57BL/6 mice were divided into three groups: control mice group, administered with saline, and low- and high-dose lipopolysaccharide (LPS) groups, intraperitoneally administered with 1 and 5 mg of LPS/kg, respectively. Rectal temperature, food intake, body weight, and spontaneous motor activity were measured. Indirect calorimetry was performed using a respiratory gas analysis for 120 h, after which carbohydrate oxidation and fatty acid oxidation were calculated. Urinary nitrogen excretion was measured to evaluate protein metabolism. The substrate utilization ratio was recalculated. Plasma and liver carbohydrate and lipid levels were evaluated at 24, 72, and 120 h after LPS administration. RESULTS: Biological reactions decreased significantly in the low- and high-LPS groups. Fatty acid oxidation and protein oxidation increased significantly 24 h after LPS administration, whereas carbohydrate oxidation decreased significantly. Energy substrate metabolism changed from glucose to predominantly lipid metabolism depending on the degree of sepsis, and protein metabolism was low. Plasma lipid levels decreased, whereas liver lipid levels increased at 24 h, suggesting that lipids were transported to the liver as the energy source. CONCLUSIONS: Our findings revealed that energy substrate metabolism changed depending on the degree of sepsis. Therefore, in nutritional management, such metabolic alterations must be considered, and further studies on the optimum nutritional intervention during severe sepsis are necessary.

The Effect of Lactoferrin and Pepsin-Treated Lactoferrin on IEC-6 Cell Damage Induced by Clostridium Difficile Toxin B.

Clostridium difficile infections (CDI) have recently increased worldwide. Some CDI progress to fulminant and recurrent CDI and are associated with high mortality and morbidity. CD produces toxins A and B, which cause intestinal mucosal damage, although toxin B exhibits greater cytotoxicity. Pepsin-treated lactoferrin (PLF) is the decomposed product of lactoferrin (LF), a multifunctional glycoprotein with anti-inflammatory properties. Here, we investigate the effects of LF and PLF in toxin B-stimulated rat intestinal epithelial (IEC-6) cells. Different toxin B concentrations were added to IEC-6 cells with or without LF or PLF. Mitochondrial function and cell cytotoxicity were assessed by measuring WST-1 and LDH levels, respectively. WST-1 levels were higher in IEC-6 cells treated with toxin B and LF or PLF than in the toxin B-only control (P < 0.05). Compared with the toxin B-only control, LDH levels significantly decreased after toxin B and LF or PLF addition (P < 0.05). Wound restitution measurement using microscopy demonstrated significantly greater levels of wound restitution in cells treated with toxin B and LF or PLF than in those treated with toxin B alone after 12 h (P < 0.001). Furthermore, changes in IEC-6 cell tight junctions (TJs) were evaluated by immunofluorescence microscopy and zonula occludens-1 (ZO-1) protein expression. When LF or PLF were added to IEC-6 cells, TJ structures were maintained, and ZO-1 and occludin expression was upregulated. Taken together, these results demonstrate that LF and PLF prevent the cytotoxicity of toxin B and might have the potential to control CDI.

Low-intensity exercise in the acute phase of lipopolysaccharide-induced sepsis improves lipid metabolism and survival in mice by stimulating PGC-1α expression.

BACKGROUND: The effect of exercise during the acute phase following sepsis onset is poorly understood. We investigated how low-intensity exercise during acute sepsis alters energy-substrate metabolism and survival in mice with lipopolysaccharide (LPS)-induced sepsis. METHODS: Mice were divided into control (C, saline), low-dose LPS (L, 1 mg/kg), medium-dose LPS (M, 5 mg/kg), and high-dose LPS (H, 10 mg/kg) groups. Each group was subdivided into sedentary (SED) and exercise (EX) groups; the EX group mice were exercised at low intensity on a treadmill after LPS administration. Survival proportions and vital functions were measured, and indirect calorimetry through respiratory gas analysis was performed until 72 hours after treatment. Organ weight and lipid levels in the plasma and liver were measured, and the messenger RNA and protein levels of peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α) were evaluated using quantitative polymerase chain reaction and Western blotting. RESULTS: Survival proportions of H-EX mice were higher than those of H-SED mice. At 16 hours after LPS administration, fatty acid oxidation was decreased in M-SED and H-SED groups but increased in all EX groups and was higher in surviving mice in H-SED and H-EX groups than in nonsurviving mice, suggesting that fatty acid oxidation is related to survival. Epididymal fat weight was lower in the EX groups than in the SED groups, whereas plasma and liver lipid levels were elevated in all EX groups; this suggests that exercise induces the transport of lipids from endogenous fat into the blood and the liver for use as the energy source. Lastly, PGC-1α messenger RNA and protein levels were lower in L-, M-, and H-SED groups than in the C-SED group but were high in all EX groups. CONCLUSION: Our study provides the revolutionary finding that exercise during the acute phase following sepsis onset might exert a therapeutic effect.