Explore the vast range of titles available.

Pathological findings of coronavirus disease (COVID‐19) have rarely been reported owing to its contagious nature. Here, we treated an 82‐year‐old man whose condition was diagnosed as COVID‐19 pneumonia, which exacerbated approximately 25 days after the initial onset. The patient died despite receiving intensive care. Post‐mortem percutaneous needle biopsy of the lungs and liver tissue was performed, including genomic analysis, immunochemical tests, and pathological studies. Histopathology of the lungs showed both exudative and organizing diffuse alveolar damage. Supposedly, the organizing phase of acute respiratory distress syndrome (ARDS) induced COVID‐19. Polymerase chain reaction (PCR) test and immunostaining of biopsy specimens showed negative results for COVID‐19. Post‐mortem percutaneous needle biopsy was more effective in reducing the risk of contagiousness than autopsy. Here, we describe pathological findings detected through post‐mortem percutaneous needle biopsy of a patient with late‐onset severe pneumonia from coronavirus disease (COVID‐19).

Description Learning points Recurrent urolithiasis and urinary tract infections can cause iliopsoas abscess penetrating into the urinary tract. In patients with recurrent urinary tract infections, physicians need to evaluate anatomical abnormalities by imaging tests.

Recently, patients with out-of-hospital cardiac arrest (OHCA) refractory to conventional resuscitation have started undergoing extracorporeal cardiopulmonary resuscitation (ECPR). However, the mortality rate of these patients remains high. This study aimed to clarify whether a center ECPR volume was associated with the survival rates of adult patients with OHCA resuscitated using ECPR. This was a secondary analysis of a retrospective multicenter registry study, the SAVE-J II study, involving 36 participating institutions in Japan. Centers were divided into three groups according to the tertiles of the annual average number of patients undergoing ECPR: high-volume (≥ 21 sessions per year), medium-volume (11–20 sessions per year), or low-volume (< 11 sessions per year). The primary outcome was survival rate at the time of discharge. Patient characteristics and outcomes were compared among the three groups. Moreover, a multivariable-adjusted logistic regression model was applied to study the impact of center ECPR volume. A total of 1740 patients were included in this study. The center ECPR volume was strongly associated with survival rate at the time of discharge; furthermore, survival rate was best in high-volume compared with medium- and low-volume centers (33.4%, 24.1%, and 26.8%, respectively; P  = 0.001). After adjusting for patient characteristics, undergoing ECPR at high-volume centers was associated with an increased likelihood of survival compared to middle- (adjusted odds ratio 0.657; P  = 0.003) and low-volume centers (adjusted odds ratio 0.983; P  = 0.006). The annual number of ECPR sessions was associated with favorable survival rates and lower complication rates of the ECPR procedure. Clinical trial registration : https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041577 (unique identifier: UMIN000036490).

BackgroundData on extracorporeal cardiopulmonary resuscitation (ECPR) in older patients, particularly those aged ≥75 years, remain limited and inconsistent. In this study, we investigated the association between advanced age and outcomes in patients receiving ECPR and determined differences in outcomes by aetiology of out-of-hospital cardiac arrest (OHCA) to identify older patients who may benefit from ECPR.MethodsThis secondary analysis of a retrospective multicentre cohort study in Japan included adult patients with OHCA who received ECPR between 2013 and 2018. The study outcomes were unfavourable neurological outcomes at discharge, in-hospital mortality and ECPR-related complications. The study cohort was categorised by age groups, and the association between age group and outcomes was investigated. We also compared patient characteristics between favourable and unfavourable outcome groups and performed subgroup analysis to gain insights regarding the group of older patients who could benefit from ECPR.ResultsOf the 1904 included patients, 1106 were aged <65 years, 547 were 65–74 years, and 251 were ≥75 years. Patients aged 65–74 years and those aged <65 years had comparable rates of unfavourable neurological outcomes and in-hospital mortality. However, patients aged ≥75 years had significantly higher rates of unfavourable neurological outcomes and in-hospital mortality than those aged <65 years. Subgroup analysis of crude mortality rates revealed relatively high survival rates for patients with pulmonary embolism (54.5%) or hypothermia (25%) compared to those with other causes of arrest in the ≥75 years group.ConclusionsPatients with OHCA aged ≥75 years and receiving ECPR are at higher risk of unfavourable neurological outcomes and in-hospital mortality than those aged <65 years. However, neurological outcomes and in-hospital mortality in patients aged ≥75 years vary with the causes of OHCA. ECPR outcomes in super-geriatric patients with OHCA may be comparable to those in younger patients for specific aetiologies.

Background In out-of-hospital cardiac arrest (OHCA) patients with extracorporeal cardiopulmonary resuscitation (ECPR), the association between low-flow time and outcomes in accidental hypothermia (AH) patients compared to those of patients without AH has not been fully investigated. Methods This was a secondary analysis of the retrospective multicenter registry in Japan. We enrolled patients aged ≥ 18 years who had been admitted to the emergency department for OHCA and had undergone ECPR between January, 2013 and December, 2018. AH was defined as an arrival body temperature below 32 °C. The primary outcome was survival to discharge. Cubic spline analyses were performed to assess the non-linear associations between low-flow time and outcomes stratified by the presence of AH. We also analyzed the interaction between low-flow time and the presence of AH. Results Of 1252 eligible patients, 105 (8.4%) and 1147 (91.6%) were in the AH and non-AH groups, respectively. Median low-flow time was 60 (47–79) min in the AH group and 51 (42–62) min in the non-AH group. The survival discharge rates in the AH and non-AH groups were 44.8% and 25.4%, respectively. The cubic spline analyses showed that survival discharge rate remained constant regardless of low-flow time in the AH group. Conversely, a decreasing trend was identified in the survival discharge rate with longer low-flow time in the non-AH group. The interaction analysis revealed a significant interaction between low-flow time and AH in survival discharge rate ( p for interaction = 0.048). Conclusions OHCA patients with arrival body temperature < 32 °C who had received ECPR had relatively good survival outcomes regardless of low-flow time, in contrast to those of patients without AH.

Aim The optimal arterial partial pressure of carbon dioxide (PaCO2) for patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) remains unknown. We aimed to investigate the association between post‐resuscitation PaCO2 and neurological outcomes. Methods This retrospective cohort study analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan, a multicenter registry study across 36 hospitals in Japan, including patients with out‐of‐hospital cardiac arrest (OHCA) admitted to intensive care units (ICU) after ECPR between 2013 and 2018. Good PaCO2 management status was defined as a PaCO2 value of 35–45 mmHg. We classified patients into four groups (poor–poor, poor–good, good–poor, and good–good) according to their PaCO2 management status upon admission at the ICU and the following day. The primary outcome was a favorable neurological outcome, defined as cerebral performance category 1 or 2, 30 days after cardiac arrest. The secondary outcome was survival 30 days after cardiac arrest. Results We classified 885 eligible patients into poor–poor (n = 361), poor–good (n = 231), good–poor (n = 155), and good–good (n = 138) groups. No significant association was observed between PaCO2 management and favorable 30‐day neurological outcomes. Compared with the poor–poor group, the poor–good, good–poor, and good–good groups had adjusted odds ratios of 0.87 (95% confidence interval, 0.52–1.44), 1.17 (0.65–2.05), and 0.95 (0.51–1.73), respectively. The 30‐day survival rates among the four groups did not differ significantly. Conclusion PaCO2 values were not significantly associated with 30‐day neurological outcomes or survival of patients with OHCA after ECPR. Analysis of 885 patients from SAVE‐J II database in Japan revealed no significant associations between PaCO2 values and 30‐day neurological outcomes or survival of patients who underwent extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest.

Listeria monocytogenes is a well-known cause of meningitis in immunocompromised patients. This organism has a growing significance for community-acquired meningitis, which should have ampicillin added to the usual regimen. We describe a case of L. monocytogenes meningitis preceded by cholangitis. This case suggests gastrointestinal symptoms preceding meningitis may be a clue of listeriosis. It is important for physicians to consider L. monocytogenes as a cause of bacterial meningitis in patients with altered mental status preceded by gastrointestinal symptoms, especially in the immunocompromised population.