Shoichi Ohta

Tokyo Medical University, Edo, Tōkyō, Japan

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Publications (33)68.4 Total impact

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    ABSTRACT: Introduction Though many governmental and nongovernmental efforts for disaster prevention have been sought throughout Japan since the Great East Japan Earthquake on March 11, 2011, most of the preparation efforts for disasters have been based more on structural and conventionalized regulations than on scientific and objective grounds. Problem There has been a lack of scientific knowledge for space utilization for triage posts in disaster drill sessions. This report addresses how participants occupy and make use of the space within a triage post in terms of areas of use and occupied time. The trajectories of human movement by using Ubiquitous Stereo Vision (USV) cameras during two emergency drill sessions held in 2012 in a large commercial building have been measured. The USV cameras collect each participant's travel distance and the wait time before, during, and after undergoing triage. The correlation between the wait time and the space utilization of patients at a triage post has been analyzed. In the first session, there were some spaces not entirely used. This was caused largely by a patient who arrived earlier than others and lingered in the middle area, which caused the later arrivals to crowd the entrance area. On the other hand, in the second session, the area was used in a more evenly-distributed manner. This is mainly because the earlier arrivals were guided to the back space of the triage post (ie, the opposite side of the entrance), and the late arrivals were also guided to the front half, which was not occupied by anyone. As a result, the entire space was effectively utilized without crowding the entrance. This study has shown that this system could measure people's arrival times and the speed of their movements at the triage post, as well as where they are placed until they receive triage. Space utilization can be improved by efficiently planning and controlling the positioning of arriving patients. Based on the results, it has been suggested that for triage operation, it is necessary to efficiently plan and control the placement of patients in order to use strategically limited spatial resources. Ohta S , Yoda I , Takeda M , Kuroshima S , Uchida K , Kawai K , Yukioka T . Evidence-based effective triage operation during disaster: application of human-trajectory data to triage drill sessions. Prehosp Disaster Med. 2015;30(1):1-8 .
    Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation 12/2014; 30(01):1-8. DOI:10.1017/S1049023X14001381
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    ABSTRACT: CaseA 20-year-old woman developed acute psychotic symptoms and altered level of consciousness. She presented with neck stiffness, tremulous arms, facial dyskinesia, and distension of the lower abdomen. Pelvic magnetic resonance imaging showed bilateral ovarian teratomas. Anti-N-methyl-D-aspartate receptor antibodies were detected in her cerebrospinal fluid.OutcomeResection of the tumors and immunotherapy were carried out. She gradually recovered and was discharged with few neurological deficits on the 105th day of hospitalization.Conclusion Our survey of 63 previous reports describing 92 cases revealed that 21.7% of the patients were sent to emergency departments and 59.8% of the patients were managed in intensive care units. Emergency physicians and intensivists should be aware of this disorder, as they may encounter undiagnosed disorders in patients with epileptic attacks, acute psychotic signs, dyskinesia, or hypoventilation in the course of the illness.
    09/2014; 2(1). DOI:10.1002/ams2.57
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    ABSTRACT: CaseA 30-year-old woman had her left thigh run over by a train. We tried to compress the left femoral area to control the arterial bleeding, but bleeding continued from the stump and injured soft tissue. The application of a tourniquet bandage also failed because of the limited remaining thigh. She developed impending cardiac arrest. As the left femoral arterial pulsation was still palpable, we inserted an intra-aortic balloon occlusion catheter percutaneously. The hemorrhage from the stump region decreased rapidly. She was transferred to an operating room to carry out surgical hemostasis, and it was confirmed with deflation of the balloon in the common iliac artery.OutcomeThere was no complication of the skin or soft tissue at the surgical site caused by impaired circulation, and her consciousness fully recovered.Conclusion We report the successful control of bleeding by the emergently modified application of intra-aortic balloon occlusion in the left common iliac artery.
    08/2014; 2(1). DOI:10.1002/ams2.62
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    ABSTRACT: Automated external defibrillators (AEDs) have been rented in various places in Japan. When rental AEDs are placed in locations where the probability of sudden cardiac arrest is high and permanent placement of AEDs is difficult, the possibility of improving survival rates might increase. In this preliminary study, we investigated how, when, and where rental AEDs have been used in Japan to clarify their characteristics when used in actual situations and to facilitate better usage in the future. We investigated the total number of AEDs rented, the duration of rental of each AED, the total number of AEDs rented monthly, the rental sites, the frequency and location of use, the number of defibrillations, and the time to defibrillation success for devices rented between January 2008 and December 2010 by a single company in Japan. The number of AEDs rented annually was 590 at 391 sites in 2008, 767 at 465 sites in 2009, and 847 at 477 sites in 2010. More AEDs were rented during the summer. The devices were actually used on 17 individuals, of whom 2 individuals (at a beach and a marathon) underwent defibrillation, and 1 individual (at a marathon) survived. Rental AEDs can play an important role in emergency cases occurring during seasonal and temporary outdoor events. The provision of rental AEDs in locations where permanent AEDs would be unfeasible may offer a useful strategy for efficiently improving survival rates in the future.
    Journal of Cardiology 12/2013; 64(2). DOI:10.1016/j.jjcc.2013.11.012 · 2.78 Impact Factor
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    ABSTRACT: It would be helpful if we could predict positive or negative blood culture results. This study considered the usefulness of measuring procalcitonin (PCT) level and standard clinical biomarkers such as white blood cell (WBC) count, C-reactive protein (CRP) level, and platelet (PLT) count to predict blood culture results. We retrospectively analyzed the data from 422 specimens collected at our emergency center within the preceding 36 consecutive months. Primary component analysis (PCA) was used for detecting the degree of the relational contribution of each of the 4 biomarkers to the blood culture results. Procalcitonin alone (cut-off value, 0.5 ng/mL) yielded a positive blood culture rate of 34.0%. Procalcitonin plus 3 biomarkers (WBC, CRP, and PLT) analyzed by PCA yielded 45.9% or 35.3% when a case was in the first or fourth quadrant, which was significantly higher than cases in the second or third quadrant. Primary component analysis also revealed that positive blood culture results were mainly affected by primary component 1, to which PCT and PLT (not WBC or CRP) predominantly contribute. Although it is difficult to predict blood culture results, even using 4 biomarkers analyzed by PCA, our new finding that blood culture results are affected not by WBC and CRP, but mainly by PCT and PLT, might help explain the mechanism of sepsis.
    The American journal of emergency medicine 12/2013; 32(4). DOI:10.1016/j.ajem.2013.12.035 · 1.27 Impact Factor
  • Junya Tsurukiri · Shiro Mishima · Shoichi Ohta ·
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    ABSTRACT: Introduction: We speculated that initial middle latency auditory evoked potentials index (MLAEPi) can indicate cerebral function and predict the restoration of spontaneous circulation (ROSC), postresuscitation survival or of neurologic outcomes among patients with cardiac arrest. Methods: This prospective study included 61 patients with cardiac arrest who received basic life support and did not achieve ROSC until arrival at the emergency center between September 2010 and September 2011. All patients were then administered advanced cardiac life support at the emergency department. Initial MLAEPi was immediately measured using an MLAEP monitor (aepEX plus; Audiomex, Glasgow, Scotland, UK) during the first cycle of advanced cardiac life support. Prediction of the ROSC, survival, and good outcome were investigated. Results: Sixteen patients achieved ROSC (ROSC group), and 45 did not achieve ROSC at the scene (non-ROSC group). The initial MLAEPi was significantly higher in the ROSC than in the non-ROSC group (33 vs 28, P < .01). Four survivors in the ROSC group were classified as good outcomes (Cerebral Performance Category 1 and 2). Initial MLAEPi in survivors were significantly higher than that in nonsurvivors (43 vs 29, P < .01). The receiver operating characteristic curves for the initial MLAEPi with area under the curves was 0.75 (95% confidence interval [CI], 0.62-0.88; P < .01) for ROSC, 0.94 (95% CI, 0.88-1.00; P < 0.01) for survival, and 0.96 (95% CI, 0.89-1.03; P < .01) for a good outcome, respectively. Conclusions: Initial MLAEPi represented by simple numerical values upon presentation at emergency facilities could predict ROSC, survival, and neurologic outcomes among patients with cardiac arrest.
    The American journal of emergency medicine 05/2013; 31(6). DOI:10.1016/j.ajem.2013.02.014 · 1.27 Impact Factor
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    ABSTRACT: We investigated active screening for colonization with methicillin-resistant Staphylococcus aureus (MRSA) on admission and weekly follow-up surveillance after admission to a tertiary care center (TCC) between June 2007 and 31 December 2007. Eleven percent (30/267) of patients were found to be positive for MRSA by polymerase chain reaction (PCR) and/or culture on admission; 5% (12/267) became positive during the TCC stay. The major primary diagnoses in MRSA-positive patients were pneumonia and cerebrovascular diseases. Twenty-two (52%) of 42 patients were found to be MRSA positive by both PCR and culture, compared with 19 (45%) of 42 who were PCR positive and culture negative. These findings suggest that active surveillance with PCR is highly sensitive and useful for the detection of MRSA colonization. To our knowledge, this is the first report of active surveillance of MRSA by PCR and bacterial culture in critically ill inpatients in Japan.
    Journal of Infection and Chemotherapy 02/2012; 18(5). DOI:10.1007/s10156-012-0385-8 · 1.49 Impact Factor
  • Junya Tsurukiri · Yukio Ikeda · Shiro Mishima · Shoichi Ohta · Jo Haraoka ·

    Nihon Kyukyu Igakukai Zasshi 01/2012; 23(6):278-281. DOI:10.3893/jjaam.23.278

  • The Journal of The Institute of Image Information and Television Engineers 01/2012; 66(5):J158-J166. DOI:10.3169/itej.66.J158
  • Junya Tsurukiri · Shiro Mishima · Shoichi Ohta ·

    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 03/2011; 9(8):e78-9. DOI:10.1016/j.cgh.2011.03.001 · 7.90 Impact Factor

  • Nihon Kyukyu Igakukai Zasshi 01/2011; 22(7):350-351. DOI:10.3893/jjaam.22.350

  • Nihon Kyukyu Igakukai Zasshi 01/2011; 22(4):165-173. DOI:10.3893/jjaam.22.165
  • J. Tsurukiri · S. Mishima · Y. Ikeda · S. Ohta ·

    Resuscitation 12/2010; 81(2). DOI:10.1016/j.resuscitation.2010.09.292 · 4.17 Impact Factor
  • Hirokazu Taguchi · Takao Arai · Shoichi Ohta ·

    Gastroenterology 02/2010; 138(4):e3-4. DOI:10.1053/j.gastro.2009.07.077 · 16.72 Impact Factor
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    ABSTRACT: Rapid trauma evaluation and intervention without time delay are considered integral to time-efficient management of trauma patients, particularly for those with hemodynamic instability. This study examined the impact of immediate availability of mobile angiography with digital subtraction angiography technology in the emergency department (ED) for hemodynamically unstable multiple trauma patients with pelvic injury. This retrospective review examined a cohort of all blunt trauma patients with pelvic injury who underwent transcatheter arterial embolization (TAE) using mobile angiography by trauma surgeons in the ED. This system was set up on a 24-hour basis with full-time trauma surgeons available in-hospital. Data collected included clinical characteristics, injury severity, resuscitation intervals from admission through to completion of hemostasis, metabolic factors (pH and core body temperature), mortality, and TAE-related complications. Subjects comprised 29 patients (hemodynamically stable group, n = 17; hemodynamically unstable group, n = 12) with a median age of 36 years (interquartile range [IQR], 29-53 years). Mean shock index, injury severity score, and trauma and injury severity score were 1.1 +/- 0.5, 32 +/- 12, and 0.79 +/- 0.27, respectively. Median intervals from ED arrival to diagnosis and from diagnosis to starting TAE were 66 minutes (IQR, 42-80 minutes) and 30 minutes (IQR, 25-37 minutes), respectively. Median interval from diagnosis to completion of TAE was 107 minutes (IQR, 93-130 minutes). Physical and anatomic injury statuses were more severe in the hemodynamically unstable group than in the hemodynamically stable group. However, intervals from diagnosis to starting TAE and from diagnosis to completion of hemostasis did not differ significantly between groups. No exacerbations of metabolic factors during resuscitation were identified. Pelvic injury related mortality was 17% and no TAE-related complications were encountered. Immediate availability of mobile angiography in the ED seems safe and effective for hemodynamically unstable trauma patients with pelvic injury and results in a rapid improvement in resuscitation intervals without leaving the ED. An adequately randomized controlled trial of mobile angiography in this subset of patients, who would seem to derive the most benefit from mobile angiography, would be ideal.
    The Journal of trauma 01/2010; 68(1):90-5. DOI:10.1097/TA.0b013e3181c40061 · 2.96 Impact Factor

  • Nihon Kyukyu Igakukai Zasshi 01/2010; 21(4):172-176. DOI:10.3893/jjaam.21.172
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    ABSTRACT: Morozumi J, Matsuno N, Sakurai E, Nakamura Y, Arai T, Ohta S. Application of an automated cardiopulmonary resuscitation device for kidney transplantation from uncontrolled donation after cardiac death donors in the emergency department. Clin Transplant 2009 DOI: 10.1111/j.1399-0012.2009.01140.x. © 2009 John Wiley & Sons A/S. Abstract: Vital-organ transplantation has become acceptable as the treatment of choice for end-stage organ failure. If the patient, facing the end of life, wishes to donate organs after cardiac arrest (CA), donation after cardiac death (DCD) is increasingly important for the realization of the patient’s desires after CA. In Japan, kidney transplantation from uncontrolled DCD donors, who are identified in modified Maastricht categories II or V, is one of the critical factors in expanding the donor pool. However, according to the forensic code for post-mortems and the requirement of legal consent for transplantation, the time required to meet all procedural requirements has sometimes prohibited organ procurement from uncontrolled DCD donors. We have therefore attempted to use an automated cardiopulmonary resuscitation (CPR) device and maintain arterial pressure for uncontrolled DCD donors during all interim procedures after sudden CA. Comparing kidneys procured from standard DCD donors (n = 10) and uncontrolled DCD donors (n = 4), significant differences were seen in warm ischemic time (WIT), defined as the time from CA to initiation of cooling in situ. However, our early experience showed good tolerance and viability of uncontrolled DCD kidneys. Immediate availability of an automated CPR device might provide a bridge to kidney procurement from uncontrolled DCD donors.
    Clinical Transplantation 11/2009; 24(5):620-5. DOI:10.1111/j.1399-0012.2009.01140.x · 1.52 Impact Factor
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    ABSTRACT: : To assess the immunologic alteration and long-term prognosis after splenic injury from preservation treatment (PT) (embolization, splenorrhaphy, partial splencetomy) and to compare with splenectomy (SN). : The long-term prognosis of patients with blunt splenic injury treated at seven tertiary emergency centers in Japan was retrospectively studied. Patients were followed up by telephone interview and written questionnaire. Blood samples and abdominal computer tomography scans were taken from patients who consented, and immunologic indices and the remaining volume of the spleen were measured. : There was no episode of severe infection requiring hospitalization among the 66 SN patients (760 patient-year) and the 34 PT (213 patient-year) patients. Blood tests from 58 patients (24 SN vs. 34 PT) revealed significant differences in platelet count, Howell-Jolly body positive rate (SN 87% vs. PT 3%), white blood cells, total lymphocyte count, T-cell count, B-cell count, and serum IgG level. There was no significant difference in serum levels of IgM or specific IgG antibodies against 14 types of Streptococcus pneumoniae capsular polysaccharide, C3, C4, high-sensitivity C-reactive protein, and B -cell subset (surface marker immunoglobulins: IgA, IgG, and IgM). Most patients had anti-S. pneumoniae antibody levels less than that of the reference level for multiple serotypes (average 3 in SN and 4 in PT). A computer tomography scan was taken from 33 PT patients; the volume of spleen remaining averaged 130 mL (range, 48-287 mL). : PT did not show discernible advantage over SN in immunologic indices including IgM and 14 serotypes of anti-S. pneumoniae antibodies, suggesting prophylactic measures and close follow-up are necessary after PT and SN.
    The Journal of trauma 10/2009; 67(3):557-63; discussion 563-4. DOI:10.1097/TA.0b013e3181af6ca9 · 2.96 Impact Factor
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    ABSTRACT: Digital subtraction angiography is frequently required in the initial evaluation of trauma patients. We hypothesized that mobile digital subtraction angiography technology directly into the trauma resuscitation area would save time in restoring metabolic derangements for patients with on-going hemorrhage. This is a retrospective review of a cohort of trauma patients treated before and after the direct availability of mobile angiography in the trauma resuscitation room performed by the trauma surgeons. Data collected for comparison-included demographics, hemodynamic variables, metabolic factors (pH and temperature), units of blood administered, and outcomes. Mean age, Shock Index, and Injury Severity Score were similar. The interval from the decision to perform transcatheter arterial embolization (TAE) to starting TAE were significantly different (59 minutes +/- 45 minutes vs. 31 minutes +/- 11 minutes, p = 0.001). The other resuscitation intervals were similar. The mean Deltabody temperature from emergency department arrival through completion of TAE between the two groups were significantly different (-1.18 +/- 1.69 vs. -0.08 +/- 1.42, p = 0.026). The mean DeltapH from emergency department arrival through completion of TAE were also significantly different (-0.118 +/- 0.083 vs. 0.028 +/- 0.127, p = 0.001). There were clinically significant correlations between Deltabody temperature and resuscitation interval, and between DeltapH and resuscitation interval. The introduction of mobile angiography into the trauma resuscitation room and the immediate availability of trained trauma surgeons to perform diagnostic and therapeutic angiographic procedures shortened the time required to restore normal physiology.
    The Journal of trauma 09/2009; 67(2):245-51. DOI:10.1097/TA.0b013e31819dcb2d · 2.96 Impact Factor
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    Injury Extra 07/2009; 40(7):122-124. DOI:10.1016/j.injury.2009.01.133