cute aortic dissection (AAD) results in high mortality and morbidity if it is not recognized and treated promptly, 1 so rapid and accurate diagnosis is essential. 2,3 Needless to say, advanced image modalities, such as computed tomography (CT), magnetic resonance imaging and transesophageal echocardiography, are intrinsic to the accurate diagnosis and treatment of AAD, 2,4 but a simple laboratory test that can suggest the presence of AAD would also be useful, particularly in the emergency setting because it could support the use of advanced imaging. 5,6 Previous reports indicate that D-dimer testing (DT) for AAD has a sensitivity of 100% when the cut off value for D-dimer is set to the upper limit of the normal range, 5-8 indicating that we could exclude AAD if DT was negative. However, each of those study groups comprised small populations of less than 30 patients.The aim of this study was to confirm the positive rate of DT for AAD in a larger population in an emergency setting and to verify the factors related to the result of DT. We could review the D-dimer values on admission of a large population of AAD patients because it has been routinely measured from January 2001. Methods Study Setting and PatientsThis single-center, retrospective study comprised 113 consecutive patients with AAD who were admitted to the Osaka Mishima Emergency and Critical Care Center within 24 h of symptom onset between January 2001 and July 2005. Patients with cardiac arrest on arrival were excluded. The diagnosis of AAD was confirmed by thoracic and abdominal contrast-enhanced CT. Blood samples were taken in the emergency room immediately after admission. Study ProtocolThis study was approved by the Human Research Committee at the Osaka Mishima Emergency and Critical Care Center. We reviewed the age, time from the onset of the symptoms to admission (TIME) and serum D-dimer values (latex agglutination, Roche Diagnostic, Tokyo, Japan, normal limit ≤0.4 g/ml). The cut-off value for D-dimer was set to the upper limit of the normal range (ie, 0.4 g/ml) to calculate the positive rate of DT. The positive rate of DT and absolute D-dimer values were compared for each of the Background Previous reports indicate that D-dimer testing (DT) for acute aortic dissection (AAD) has a sensitivity of 100%, but each study comprised less than 30 patients. The aim of this study was to evaluate the positive rate and factors related to the results of DT for AAD in a larger population. Methods and Results DT (cutoff; upper normal limit) was performed for 113 consecutive AAD patients within 24 h of symptom onset. In total, 104 (92%) patients exhibited positive DT. The positive rate of DT showed a low tendency in patients aged less than 70 years and for a time interval from symptom onset to admission within 120 min, and there were significant differences between those with and without a thrombosed false lumen (TFL) (86.4% (n=59)

BackgroundWe established a multi-center, prospective cohort that could provide appropriate therapeutic strategies such as criteria for the introduction and the effectiveness of in-hospital advanced treatments, including percutaneous coronary intervention (PCI), target temperature management, and extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) patients.MethodsIn Osaka Prefecture, Japan, we registered all consecutive patients who were suffering from an OHCA for whom resuscitation was attempted and who were then transported to institutions participating in this registry since July 1, 2012. A total of 11 critical care medical centers and one hospital with an emergency care department participated in this registry. The primary outcome was neurological status after OHCA, defined as cerebral performance category (CPC) scale.ResultsA total of 688 OHCA patients were documented between July 2012 and December 2012. Of them, 657 were eligible for our analysis. Patients’ average age was 66.2 years old, and male patients accounted for 66.2 %. The proportion of OHCAs having a cardiac origin was 50.4 %. The proportion as first documented rhythm of ventricular fibrillation/pulseless ventricular tachycardia was 11.6 %, pulseless electrical activity 23.4 %, and asystole 54.5 %. After hospital arrival, 10.5 % received defibrillation, 90.8 % tracheal intubation, 3.0 % ECPR, 3.5 % PCI, and 83.1 % adrenaline administration. The proportions of 90-day survival and CPC 1/2 at 90 days after OHCAs were 5.9 and 3.0 %, respectively.ConclusionsThe Comprehensive Registry of In-hospital Intensive Care for OHCA Survival (CRITICAL) study will enroll over 2000 OHCA patients every year. It is still ongoing without a set termination date in order to provide valuable information regarding appropriate therapeutic strategies for OHCA patients (UMIN000007528).

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BackgroundThe level of intestinal fatty acid-binding protein (I-FABP) is considered to be useful diagnostic markers of small bowel ischemia. The purpose of this retrospective study was to investigate whether the serum I-FABP level is a predictive marker of strangulation in patients with small bowel obstruction (SBO).MethodsA total of 37 patients diagnosed with SBO were included in this study. The serum I-FABP levels were retrospectively compared between the patients with strangulation and those with simple obstruction, and cut-off values for the diagnosis of strangulation were calculated using a receiver operating characteristic curve. In addition, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.ResultsTwenty-one patients were diagnosed with strangulated SBO. The serum I-FABP levels were significantly higher in the patients with strangulation compared with those observed in the patients with simple obstruction (18.5 vs. 1.6 ng/ml p<0.001). Using a cut-off value of 6.5 ng/ml, the sensitivity, specificity, PPV and NPV were 71.4%, 93.8%, 93.8% and 71.4%, respectively. An I-FABP level greater than 6.5 ng/ml was found to be the only independent significant factor for a higher likelihood of strangulated SBO (P =  0.02; odds ratio: 19.826; 95% confidence interval: 2.1560 – 488.300).ConclusionsThe I-FABP level is a useful marker for discriminating between strangulated SBO and simple SBO in patients with SBO.

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