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Decreased neutrophil apoptosis is implicated in persistent inflammation resulting in systemic inflammatory response syndrome and multiple organ dysfunctions syndromes. Short-chain fatty acids (SCFAs) may be a candidate to control neutrophil apoptosis because SCFAs are normally produced in the gut and related products have been approved for human use. We investigated the effects of SCFAs on apoptosis of activated and non-activated neutrophils and their mechanisms. Purified neutrophils obtained from healthy volunteers were preincubated for 1 h with or without the G-protein receptor (GPR) inhibitor pertussis toxin (100 ng/mL) or U-73122 (50 ng/mL), extracellular signal-related protein kinase inhibitor PD98059 (10 μM), mitogen-activated protein kinase (MAPK) p38 inhibitor SB203580 (25 μM), Jun kinase inhibitor-I (2 μM), caspase-3 and -7 inhibitor Z-VAD-FMK (100 μM), caspase-8 inhibitor Z-IETD-FMK (50 μM), or caspase-9 inhibitor Z-LEHD-FMK (50 μM). The cells were then cultured with or without SCFAs or trichostatin A, a typical histone deacetylase inhibitor, in the presence or absence of lipopolysaccharide (1 μg/mL) or tumor necrosis factor-α (100 ng/mL). Neutrophil apoptosis was assessed by annexin V staining using flow cytometry. The GPR-41 and -43 and apoptosis-related proteins (bax, mcl-1, a1) mRNA were measured by quantitative real-time polymerase chain reaction and the expression of acetylated histone H3 was determined by western blot. The caspase inhibitors inhibited butyrate- and propionate-induced neutrophil apoptosis treated or untreated with lipopolysaccharide or tumor necrosis factor-α, whereas GPR and MAPK inhibitors had no effect. The mRNA expressions of GPR-43 and a1 protein were reduced by butyrate and propionate. The expressions of acetylated histone H3 were induced by butyrate and propionate. These results suggest that butyrate and propionate increase apoptosis of neutrophils irrespective of their activation state, by factors other than GPRs and MAPKs, and their mechanisms likely relate to their histone deacetylase inhibition activity, which may control a1 mRNA expression.

Trauma patients die from massive bleeding due to disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype in the early phase, which transforms to DIC with a thrombotic phenotype in the late phase of trauma, contributing to the development of multiple organ dysfunction syndrome (MODS) and a consequently poor outcome. This is a sub-analysis of a multicenter prospective descriptive cross-sectional study on DIC to evaluate the effect of a DIC diagnosis on the survival probability and predictive performance of DIC scores for massive transfusion, MODS, and hospital death in severely injured trauma patients. A DIC diagnosis on admission was associated with a lower survival probability (Log Rank P  < 0.001), higher frequency of massive transfusion and MODS and a higher mortality rate than no such diagnosis. The DIC scores at 0 and 3 h significantly predicted massive transfusion, MODS, and hospital death. Markers of thrombin and plasmin generation and fibrinolysis inhibition also showed a good predictive ability for these three items. In conclusion, a DIC diagnosis on admission was associated with a low survival probability. DIC scores obtained immediately after trauma predicted a poor prognosis of severely injured trauma patients.

We usually associate triage with the Simple Triage and Rapid Treatment method, but much of its origin is still unknown. Therefore, French studies and the origin of triage shown in domestic and foreign published works have been investigated and its significance reaffirmed. The etymology of the word “triage” means “to break into three pieces.” It was suggested by a literature review that the rise of Napoleon led to military tactical changes, and that the prototype of triage arose from the experience gained in the difficult campaign in Egypt and Syria. Subsequently, triage was refined by Napoleon's military surgeon, D. J. Larrey, who created the ambulance transport system. Although there is a clash between the ruthless and philanthropic aspects of triage, triage is in accordance with the primary purpose of evacuation or treatment. We should choose the triage method that is consistent with the purpose of each disaster situation. French studies and the origin of triage shown in domestic and foreign published works have been investigated and its significance reaffirmed. It was suggested by a literature review that the rise of Napoleon led to military tactical changes, and that the prototype of triage arose from the experience gained in the difficult campaign in Egypt and Syria. We should choose the triage method that is consistent with the purpose of each disaster situation.

Background Diagnosing sepsis remains difficult because it is not a single disease but a syndrome with various pathogen- and host factor-associated symptoms. Sepsis-3 was established to improve risk stratification among patients with infection based on organ failures, but it has been still controversial compared with previous definitions. Therefore, we aimed to describe characteristics of patients who met sepsis-2 (severe sepsis) and sepsis-3 definitions. Methods This was a multicenter, prospective cohort study conducted by 22 intensive care units (ICUs) in Japan. Adult patients (≥ 16 years) with newly suspected infection from December 2017 to May 2018 were included. Those without infection at final diagnosis were excluded. Patient’s characteristics and outcomes were described according to whether they met each definition or not. Results In total, 618 patients with suspected infection were admitted to 22 ICUs during the study, of whom 530 (85.8%) met the sepsis-2 definition and 569 (92.1%) met the sepsis-3 definition. The two groups comprised different individuals, and 501 (81.1%) patients met both definitions. In-hospital mortality of study population was 19.1%. In-hospital mortality among patients with sepsis-2 and sepsis-3 patients was comparable (21.7% and 19.8%, respectively). Patients exclusively identified with sepsis-2 or sepsis-3 had a lower mortality (17.2% vs. 4.4%, respectively). No patients died if they did not meet any definitions. Patients who met sepsis-3 shock definition had higher in-hospital mortality than those who met sepsis-2 shock definition. Conclusions Most patients with infection admitted to ICU meet sepsis-2 and sepsis-3 criteria. However, in-hospital mortality did not occur if patients did not meet any criteria. Better criteria might be developed by better selection and combination of elements in both definitions. Trial registration UMIN000027452

Aim Post intensive care syndrome (PICS) is a critical issue in postsepsis care; however, no reliable biomarker exists to predict PICS. We hypothesized that plasma myostatin, a cytokine involved in muscle and brain function, could serve as a predictive biomarker for PICS. Methods This single‐center prospective observational study included adult patients with sepsis admitted to the intensive care unit (ICU). Plasma myostatin concentrations were measured using enzyme‐linked immunosorbent assay on days 1, 3–4, and 6–7 after sepsis diagnosis and ICU admission. PICS was assessed 6 months post‐ICU discharge via telephone interviews using the Barthel Index, Short‐Memory Questionnaire score, and Hospital Anxiety and Depression Scale. Multivariable logistic regression analysis was conducted to determine whether myostatin levels independently predicted PICS. Predictive performance was evaluated using the area under the curve (AUC). Results Seventy‐seven patients were enrolled (mean age: 71 ± 14 years; median SOFA score 7 [IQR: 6–11]). Plasma myostatin concentrations were 544 (311–1015) pg/mL on day 1, 495 (302–651) pg/mL on days 3–4, and 536 (385–817) pg/mL on days 6–7. Decreased plasma myostatin levels on day 1 and on days 6–7 contributed to identifying patients with cognitive and physical impairments, respectively (p = 0.04). A decreased plasma myostatin level on day 1 yielded an AUC of 0.70 for predicting cognitive impairment, whereas the day 6–7 level yielded an AUC of 0.76 for predicting physical impairment. Conclusion Lower plasma myostatin concentrations in the acute phase of sepsis may serve as a biomarker for predicting PICS‐related physical and cognitive impairments. We investigated the utility of plasma myostatin concentration as a predictive biomarker for PICS in patients with sepsis. Lower plasma myostatin concentrations in the acute phase of sepsis may serve as a potential biomarker for predicting PICS‐related physical and cognitive impairments.

Circulating lipopolysaccharide (LPS) concentrations are often elevated in patients with sepsis or various endogenous diseases related to bacterial translocation from the gut. Systemic inflammatory responses induced by endotoxemia induce severe involuntary loss of skeletal muscle, termed muscle wasting, which adversely affects the survival and functional outcomes of these patients. Currently, no drugs are available for the treatment of endotoxemia-induced skeletal muscle wasting. Here, we tested the effects of TAK-242, a Toll-like receptor 4 (TLR4)-specific signalling inhibitor, on myotube atrophy in vitro and muscle wasting in vivo induced by endotoxin. LPS treatment of murine C2C12 myotubes induced an inflammatory response (increased nuclear factor-κB activity and interleukin-6 and tumour necrosis factor-α expression) and activated the ubiquitin–proteasome and autophagy proteolytic pathways (increased atrogin-1/MAFbx, MuRF1, and LC-II expression), resulting in myotube atrophy. In mice, LPS injection increased the same inflammatory and proteolytic pathways in skeletal muscle and induced atrophy, resulting in reduced grip strength. Notably, pretreatment of cells or mice with TAK-242 reduced or reversed all the detrimental effects of LPS in vitro and in vivo . Collectively, our results indicate that pharmacological inhibition of TLR4 signalling may be a novel therapeutic intervention for endotoxemia-induced muscle wasting.

Migration of a pericardial drainage catheter into the right main pulmonary artery. If clinical symptoms of cardiac tamponade are unresolved and dense hemorrhagic fluid is evacuated after pericardial drain placement, this rare but lethal complication is a possibility.

Background The kidneys are one of the organs most commonly affected by blunt trauma; however, the anatomical variations that predispose kidney injury are poorly understood. Case Presentation An 80‐year‐old Japanese woman with lumber scoliosis was brought to our hospital because of severe flank pain after a minor fall at home. Contrast‐enhanced computed tomography showed a severe left kidney laceration at the level of an acute angle in the vertebral column caused by scoliosis. Extravasation of contrast medium from the left renal artery branches was also noted. Selective arterial embolization achieved hemostasis. The patient was transferred to a rehabilitation facility without sequelae. Conclusion Patients with scoliosis could be at higher risk of severe kidney laceration because of intrusion of the vertebral column into the retroperitoneal space. Therefore, even after low‐impact trauma, active exploration for kidney injury could be warranted in patients with spinal curvature disorders. This case illustrates that patients with lumbar scoliosis could be at higher risk of severe kidney laceration. Protrusion of the lateral edges of a scoliotic lumbar spine into the retroperitoneal space could crush the kidney, even after a minor fall. Clinicians should be cautious when examining patients with lumbar spine scoliosis because even minor trauma, such as a fall, can result in severe kidney injury.

Background Thyrocervical trunk rupture is an unusual, but critical, complication associated with central venous catheter (CVC) placement. The management of this complication has not been fully determined because it is rare. Case presentation A 53-year-old Japanese woman with anorexia nervosa developed refractory ventricular fibrillation. After returning spontaneous circulation, a CVC was successfully placed at the initial attempt in the right internal jugular vein using real-time ultrasound guidance. Immediately after CVC placement, she developed enlarging swelling around the neck. Contrast-enhanced computed tomography showed massive contrast media extravasation around the neck and mediastinum. Brachiocephalic artery angiography showed a “blush” appearance of the ruptured right thyrocervical trunk. After selective arterial embolization with 33% N-butyl-2-cyanoacrylate, the extravasation completely disappeared and hemostasis was achieved. Conclusion Our findings suggest that severe vascular complications arising from CVC placement can occur in patients with a fragile physiological state. Endovascular embolization is an effective treatment for such complications.