Activity

In addition, a π-π inter-action between the benzene rings of adjacent acid mol-ecules and a C-H⋯O hydrogen bond are observed in the crystal of (I), and C-H⋯O hydrogen bonds and O⋯Cl contacts occur in the crystals of (III) and (IV). These inter-molecular inter-actions connect the acid and base mol-ecules, forming a layer structure parallel to the bc plane in (I), a column along the a-axis direction in (II), a layer parallel to the ab plane in (III) and a three-dimensional network in (IV). 6-Benzylaminopurine Hirshfeld surfaces for the title compounds mapped over dnorm and shape index were generated to visualize the weak inter-molecular inter-actions.

Anaphylaxis is a severe, life-threatening, generated or systemic reaction, and biphasic reaction could occur in some cases. We investigated the clinical course of anaphylaxis in our hospital and studied the relationship between biphasic reactions and the symptoms and treatments for predicting the onset of biphasic reactions.

We retrospectively reviewed the medical records of 120 patients with anaphylaxis who were admitted to our hospital from the emergency department during April 2008-October 2015.

The incidence of biphasic reactions of anaphylaxis in our hospital was 10.8% (13 patients) without significant difference when compared with that in previous reports. Regarding the development of biphasic reactions, symptoms, the number of systems of symptoms and severity of the initial reaction, and treatment with adrenaline and corticosteroid were not clearly related with biphasic reaction. Use of adrenaline in the initial treatment was approximately 60%. Of the 13 biphasic reactions, 11 (84.5%) were as equal/mild as the original symptoms.

This study could not show the factors predicting the onset of biphasic reactions. Further prospective and nationwide studies are required to research biphasic reactions.

This study could not show the factors predicting the onset of biphasic reactions. Further prospective and nationwide studies are required to research biphasic reactions.

Extubation failure-associated factors have not been investigated in elderly patients. We hypothesized that psoas cross-sectional area, an emerging indicator of frailty, can be a predictor of extubation outcomes.

This retrospective study analyzed data from patients admitted between January and April 2016 at the mixed medical intensive care unit (ICU) of the Tokyo Medical University Hospital. Patients were considered eligible if aged 65years or older, required intubation at the emergency room, and were admitted to ICU for over 24h. Overall, 39 ICU patients were eligible and categorized into two groups extubation success (

=24) and extubation failure (

=15) groups. The psoas cross-sectional area was measured at the third lumbar level on computer tomography images. Psoas Muscle Index (PMI) was defined as the psoas cross-sectional area/height

. Primary outcome was to evaluate differences between the psoas cross-sectional area and f(PMI) between the groups, if any.

Both groups were comparable in terms of demographic characteristics. Psoas cross-sectional area (extubation success group, 1,776.5±498.2mm

, extubation failure group, 1,391.2±589.4mm

;

=0.022) and PMI (extubation success group, 1,089±270.7 mm

/m

, extubation failure group, 889±338.5mm

/m

;

=0.032) were significantly greater in the extubation success group than in the extubation failure group.

The psoas cross-sectional area and PMI can predict extubation outcomes in elderly intensive care patients.

The psoas cross-sectional area and PMI can predict extubation outcomes in elderly intensive care patients.

Coronavirus disease (COVID-19) is an emerging infectious disease with human-to-human transmission. Early identification of patients with COVID-19 is important in preventing its spread.

A 36-year-old man with a fever for 3days fell from the 5th floor and was transported to our emergency department. Pan-scan computed tomography (CT) revealed multiple ground-glass opacities just below the pleura, pelvic fractures, thoracic vertebral fracture (Th11), and right femoral fracture. COVID-19 was ruled out based on negative real-time reverse transcription-polymerase chain reaction results on days 2 and 3, and a reduction in the multiple ground-glass opacities on CT carried out on day 5. Until the suspicion of COVID-19 was cleared, strict and standardized processing procedures were implemented in the same way as for a patient with COVID-19.

It is very difficult to rapidly differentiate between pulmonary contusions and COVID-19, as these conditions have many similarities on CT.

It is very difficult to rapidly differentiate between pulmonary contusions and COVID-19, as these conditions have many similarities on CT.

This study aimed to evaluate the effect of plasma transfusion before urgent hemostasis initiation on in-hospital mortality in hemodynamically unstable patients with severe trauma.

This retrospective observational study of patients admitted to hospital between January 2011 and January 2019 grouped patients according to whether plasma transfusion was initiated before (Before group) or after (After group) hemostasis initiation. Patients with severe trauma who were unable to wait for plasma transfusion and had started hemostasis before the plasma infusion were excluded. We used multivariable logistic regression analysis to determine the effect of plasma transfusion before the initiation of urgent hemostasis on in-hospital mortality.

We included 47 and 73 patients in the Before and After groups, respectively. Blunt trauma was more common, and the D-dimer levels and Injury Severity Score were significantly higher in the Before group than in the After group (median D-dimer, 57.5 versus 38.1μg/mL;

=0.040; median Injury Severity Score, 50 versus 34;

<0.001). Plasma given before hemostasis initiation was associated with significantly lower in-hospital mortality (adjusted odds ratio, 0.27; 95% confidence interval, 0.078-0.900;

=0.033) in contrast with the total plasma volume given in the first 6 or 24h.

Plasma transfusion before hemostasis initiation could be an important factor for improving outcomes in hemodynamically unstable patients with blunt trauma, high D-dimer levels, or a high Injury Severity Score.

Plasma transfusion before hemostasis initiation could be an important factor for improving outcomes in hemodynamically unstable patients with blunt trauma, high D-dimer levels, or a high Injury Severity Score.