Report From the 32nd Annual Congress of the Japanese Society for Aeromedical Services

BackgroundTraumatic cardiac arrest (TCA) is associated with poor outcomes. Helicopter emergency medical services (HEMSs) are often used to transport critically ill patients to hospitals. However, the role of HEMS in the treatment of TCA remains unclear. Therefore, in this study, we aimed to determine the current status of patients with prehospital TCA managed by HEMS personnel in Japan and compare the outcomes of patients who experienced TCA before and after the arrival of HEMS.MethodsThe Japanese Society for Aeromedical Services registry data of patients managed by HEMS personnel from April 2015 to March 2020 were analyzed in this retrospective cohort study. HEMS arrival and physicians’ interventions at the scene were the variables of interest. The survival rate and neurological outcomes at 28 days after injury were analyzed.ResultsOf the 55 299 registered patients, 722 who experienced prehospital TCA were included in the analysis. The distribution of first-witnessed TCA was as follows: pre-emergency medical service (EMS) arrival (n = 426/722, 60.3%), after EMS arrival (n = 113/722, 16.0%), and after HEMS arrival (n = 168/722, 23.8%). The 28-day survival rate was 6.2% (n = 44/706), with a cerebral performance category of 1 or 2 in 18 patients. However, patients who experienced TCA after receiving interventions provided by physicians before HEMS arrival had the worst outcomes, with only 0.6% of them surviving with favorable neurological outcomes. Multivariable analysis revealed that securing the intravenous route by the EMS team (adjusted odds ratio: 2.43, 95% confidence interval [CI]: 1.11–5.30) and tranexamic acid infusion by the HEMS team (adjusted odds ratio: 2.78, 95% CI: 1.16–6.64) may have increased the return of spontaneous circulation (ROSC) rate.ConclusionsThe results of our study were similar to those reported in previous studies with regards to the use of HEMS in Japan for transporting patients with TCA. Our findings suggest that in patients with severe trauma, cardiac arrest after initiation of HEMS, the highest level of prehospital medical intervention, may be associated with an inferior prognosis. Tracheal intubation and administration of tranexamic acid by the EMS team may increase the rate of ROSC in TCA.

Background: Twitter has become increasingly popular at annual medical congresses as a platform to communicate to attendees. The aim of this study is to reveal the twitter usage in the annual congress of the Japanese Cirsulation Society.Methods and Results: We compared the total number of tweets during the Japanese Circulation Society’s annual meetings in 2019 and 2020. The total number of tweets increased from 7,587 in 2019 to 23,867 in 2020. Most tweets were retweets (>70%), and approximately half of Twitter users tweeted only once.Conclusions: Twitter usage during the Japanese Circulation Society’s annual meeting increased from 2019 to 2020, and a large number of tweets were from Twitter ambassadors of the Japanese Circulation Society. However, further evaluation is needed, with future studies investigating the usefulness of this platform.

BackgroundCritically ill patients can deteriorate rapidly; therefore, prompt prehospital interventions and seamless transition to in-hospital care upon arrival are crucial for improving survival. In Japan, helicopter emergency medical services (HEMS) complement general emergency medical services (GEMS) by providing on-site care, reducing transport times, and aiding facility selection. Vital signs at hospital arrival determine initial management, but existing models are poor at predicting them, especially in patients receiving continuous interventions from both GEMS and HEMS. Therefore, we developed a machine-learning model to accurately predict the actual values of vital signs at hospital arrival using limited patient characteristic data and prehospital vital signs.MethodsUsing data from the Japanese Society for Aeromedical Services registry, we retrospectively analyzed data from patients aged ≥18 years transported by HEMS between April 2020 and March 2022. Patients with cardiac arrest during transport, missing vital signs, and data inconsistencies were excluded. The predictive model used prehospital vital signs from GEMS and HEMS contact times, demographic characteristics, and intervention information. The primary outcome was the actual values of vital signs measured at hospital arrival. After data preprocessing, we constructed a deep neural network multi-output regression model using Bayesian optimization. Model performance was assessed by comparing the predicted values with the actual hospital arrival measurements using mean absolute error, R² score, residual standard deviation, and Spearman’s correlation coefficient. Additionally, the NN model’s performance was compared with alternative methods, namely HEMS contact values and change-based predictions derived solely from prehospital data.ResultsThe study included 10,478 patients (median age 70 years; 69% male). The model achieved mean absolute errors of 7.1 bpm for heart rate, 15.7 mmHg for systolic blood pressure, 10.8 mmHg for diastolic blood pressure, 2.9 breaths/min for respiratory rate, and 0.62 points for Glasgow Coma Scale score. The Spearman’s correlation coefficients ranged from 0.54 to 0.86. The model outperformed other methods, especially for R² scores and residual standard deviations, demonstrating its superior ability to predict actual vital signs values.ConclusionThe multi-output regression model accurately predicted the actual values of vital signs measured at hospital arrival using limited prehospital information, demonstrating the effectiveness of advanced modeling techniques.

Helicopter Emergency Medical Services (HEMS) provide rapid prehospital care for patients with severe trauma and acute medical conditions. Airway management (including tracheal intubation, placement of supraglottic airway [SGA] device, cricothyrotomy, and bag-valve-mask [BVM] ventilation) and respiratory management (including mechanical ventilation and thoracostomy) are critical strategies used in prehospital settings. Although data on airway or respiratory management in patients who were treated by HEMS teams that are staffed by physicians in Japan are limited, this study aimed to describe the proportion and clinical characteristics of such patients using a nationwide registry. We conducted a nationwide cohort study with a retrospective design, analyzing data from the Japanese Society for Aeromedical Services Registry between April 2020 and March 2023. Patients who underwent prehospital airway or respiratory management were included in this study. Data regarding age, sex, diagnosis, cardiac arrest, type of telecommunication, and airway or respiratory management were also collected. Descriptive statistics were used for analyses. Among 54,140 patients treated by HEMS, 7477 (13.8%) underwent airway or respiratory management. The median age of the patients was 69years, and 67.8% were male. The most frequent age group was 60-79years (42.7%), and trauma was the most common diagnosis (35.4%). The most common management was orotracheal intubation (8.7%), followed by BVM ventilation (2.3%), mechanical ventilation (1.9%), thoracostomy (performed either via needle or chest tube) (1.0%), and SGA device placement (0.2%). This nationwide study revealed that airway or respiratory management was required in 13.8% of HEMS patients in Japan, particularly among older adults and those with trauma.

Background: The relationship between Twitter ambassadors and retweets has not been fully evaluated for “tweet the meeting” activity.Methods and Results: We collected data on the number of tweets and retweets during the Japanese Circulation Society’s (JCS) annual meetings in 2019, 2020, and 2021. After adjustment, JCS Twitter Ambassadors, selected by the JCS to increase the meeting’s visibility, increased the total number of retweets by 9%.Conclusions: This is the first report on the numerical relationship between JCS Twitter Ambassadors and the total number of retweets during an annual congress. Original tweets by JCS Twitter Ambassadors increased the number of retweets, but retweets by influencers were more effective at stimulating social media engagement.

Critical hemorrhage is a life-threatening condition in which blood transfusion is an essential lifesaving intervention. Although the importance of prehospital blood transfusion is increasingly recognized, its effectiveness remains unclear, particularly in Asian health care settings. This study aimed to characterize patients receiving prehospital blood transfusion through helicopter emergency medical services (HEMS) and evaluate their association with survival outcomes in a Japanese population-based cohort. We conducted a retrospective evaluation of data from the Japanese Society for Aeromedical Services Registry from April 2020 to March 2023. This study included adult patients transported by physician-staffed HEMS. Propensity score matching (1:4) was used to adjust for confounding factors. The primary outcome measure was patient survival until hospital discharge. Among the 24,776 patients, 71 (0.3%) received prehospital blood transfusions using type O packed red blood cells. Transfusion recipients had lower systolic blood pressures (83 mm Hg vs. 138 mm Hg; P < .001) and higher rates of external causes of injury (80.3% vs. 51.1%; P < .001) than did those who did not receive a transfusion. After propensity score matching (N = 230), prehospital transfusion was associated with improved survival (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.05-4.18). The results of the trauma subgroup analysis showed no statistically significant association (OR, 1.88; 95% CI, 0.80-4.40). In Japan's physician-staffed HEMS, prehospital blood transfusion was appropriately provided to patients with hemorrhagic shock and, after adjustment for confounding factors, was associated with improved survival. These findings provide evidence supporting the potential benefits of prehospital blood transfusion in appropriately selected patients within physician-staffed air medical systems.

From August 26th to 30th, the 2017 Annual Congress of the European Society of Cardiology (ESC 2017) was held in Barcelona, Spain. Despite the terrorism tradegy just before the ESC congress, the congress attracted many medical professionals from all over the world to discuss the recent topics in cardiovascular medicine in more than 500 sessions, including COMPASS (Cardiovascular OutcoMes for People using Anticoagulation StrategieS Trial), CANTOS (Canakinumab Anti-Inflammatory Thrombosis Outcomes Study), and ORION (which assessed the effect of a novel siRNA inhibitor to PCSK9 on reductions in low-density lipoprotein cholesterol). Japanese cardiologists and the Japanese Circulation Society greatly contributed to the congress. This report briefly introduces some late-breaking registry results, late-breaking clinical trials, and ESC Guidelines from the ESC 2017 Congress.

From August 27th to 31st, the 2016 Annual Congress of the European Society of Cardiology (ESC 2016) was held in Fiera di Roma, Italy. Despite the socially unstable situation, more than 32,000 attendees, including clinical physicians, basic researchers, medical students, and paramedical personnel, as well as 5,000 exhibitors from 106 countries gathered in this historical city to share the latest findings and to discuss the present issues in cardiovascular medicine. There were scientific sessions, including 28 Hot Lines, 26 clinical trial updates, 24 registry studies, and 5 clinical practice guideline sessions. Japan had 1,170 attendees, with 1,743 submitted and 670 accepted abstracts, including the NIPPON trial presented in the hotline session. From 2011 to 2016, Japan has been the first abstract submitter and has had the most abstracts accepted, which indicates the great contribution of Japanese cardiologists and the Japanese Circulation Society. This report briefly introduces the key presentations and highlights from the ESC 2016 Scientific Sessions. (Circ J 2016; 80: 2282-2286).

The establishment of intraosseous (IO) access in patients with out-of-hospital cardiac arrest (OHCA) enables reliable vasopressor administration. However, no studies have examined the association between IO access and vasopressor administration in a nationwide prehospital setting. We aimed to examine the association between IO access and vasopressor administration in patients with OHCA using a nationwide database. This retrospective cohort study used data from the Japanese Society for Aeromedical Services Registry (JSAS-R) between April 2020 and March 2023. The primary outcome was vasopressor administration before hospital arrival. Secondary outcomes included in-hospital mortality, length of hospital stay, doctor contact-to-hospital arrival time, and return of spontaneous circulation (ROSC) on hospital arrival. The association between IO access establishment and clinical outcomes was examined using multivariate logistic regression with multiple imputation. Among 3,264 patients with OHCA, 321 (9.8%) received IO access (IO group), while the remaining 2,943 (90.2%) who did not receive IO access formed the control group. Prehospital vasopressor administration was significantly more frequent in the IO group than in the control group (82.9% vs. 70.6%; p < 0.001; odds ratio [OR]: 1.77; 95% confidence interval [CI]: 1.28-2.46). However, the IO group showed a significant decrease in ROSC on hospital arrival (OR, 0.64; 95% CI: 0.45-0.91). No significant intergroup differences were observed in other secondary outcomes. IO access was associated with increased prehospital vasopressor administration, suggesting higher success rates of IO vascular access among patients with OHCA in the helicopter emergency medical service setting.

Vietnam is one of the most populated Southeast Asian countries, with a population of around 97 million people in 2018 (1). Three kinds of RRT, including hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation, are currently available in Vietnam; they service a total of about 36,000 patients, but this only accounts for about one third of the estimated ESKD population in need of dialysis across the country. The purpose of this article is to give a broad overview of some key aspects of RRT and nephrology in Vietnam. HD has been available in Vietnam since 1968. Initially, it was only used to treat acute kidney failure. During that period, only the Travenol Drake-Willock machine was used. Starting from 1996, with the initiation of the national insurance reimbursement system, a remarkable development in dialysis was seen throughout the country, with the number of patients on maintenance hemodialysis (MHD) steeply increasing. MHD has become the most common type of dialysis and has been available in many Vietnamese cities and provinces since then (2). Although little is known about the actual number of patients with ESKD in need of dialysis in the general population, it is estimated to be >100,000 persons. However, only about one third of them (approximately 30,000 patients) are actually on MHD all over the country. Although this proportion is still very low compared with the estimated demand, all dialysis facilities are frequently overwhelmed and have to operate up to four 4-hour shifts per day; home dialysis is not available yet in Vietnam. All dialyzers are capillary type, mainly low flux, and they are reused six times in total to compensate for the low reimbursement of only $25 per session. We import all dialysis machines and dialyzers from various foreign brands, such as Nipro (Japan), B. Braun, and Fresenius (Germany), …

Since 2015, the Committee of International Communication for Academic Research of the Japanese Society for Dialysis Therapy has held a symposium every year at the society’s Annual Congress to discuss the current status of and demand for dialysis therapy in developing countries in Asia with the aim of identifying ways to contribute to the field of dialysis therapy in these countries. The 2018 symposium opened the door further, beyond Asian countries to include all non-Western countries. Two speakers from Cambodia and Japan contributed their manuscripts to the 2018 symposium issue. In Cambodia in 2017, a study of hemodialysis data from 5 centers in Phnom Penh was conducted for the first time. This study involving 407 patients (233 men [57.2%]; mean age 52 [SD, ± 15] years) revealed that hypertension was the main cause of end-stage renal disease (46.8%), followed by concomitant hypertension and diabetes mellitus (31%), with diabetes mellitus alone accounting for only 8.1% of cases. Mean frequency of hemodialysis was 7.5 (SD, ± 2.3) sessions per month. The duration of each session was 4 h. Patients in Cambodia are required to bear the full cost for hemodialysis because the country lacks a national health insurance system. From 2007 to 2018, several Japanese societies and organizations for dialysis therapy and technology carried out activities aimed at resolving problems in dialysis medical care in developing countries in East and Southeast Asia. The role of the academic societies and their activities in this region are discussed.

The Annual Congress of the European Society of Cardiology (ESC) was held in London from 29 August to 2 September 2015. It is the leading conference in cardiology in the world, with presentations on the latest scientific discoveries, innovations, technology, education, and clinical practices. More than 32,000 delegates and 5,000 exhibitors from 140 countries participated, sharing a number of scientific presentations, including 28 clinical hot lines, 18 clinical trial updates, 20 registry studies, 12 basic and translational science hot line studies, and 4,533 abstract studies. Japan had the highest number of accepted abstracts at the Congress, indicating the great contribution of Japanese scientists and the Japanese Circulation Society.

Japanese physicians had maintained a close association with German surgery since the Meiji Restoration of 1868, which hoped to reintroduce advances in Western science to replace the previous closed-door attitude of the shogunates. A number of Japanese surgeons had studied under the Teutonic masters Billroth, Vincenz Czerny, Bernhard von Langenbeck, and Ernst von Bergmann and returned to their homeland where a robust Western-style university medical system was developing. The Japanese Surgical Society was founded in 1898 and began annual congresses to showcase Japanese surgical efforts that were far in advance of their mainland Asian colleagues. It was the Japanese delegation to the International Society of Surgery that petitioned for Germany and Austria to be readmitted after the conflagration of World War I [1]. In the interwar period the evolving Nipponese hospital and medical education system was generating admirable clinical results. By the 1930s Japanese surgeon Komei Nakayama reported a remarkably low mortality rate of 16.7% following esophagectomy for cancer [2]. At the same time Hiroshige Shiota had perfected radical methods to eradicate gastric cancer, again with a drastic reduction in operative mortality. While World War II was devastating for Japan’s medical system, energetic physician-scholars, with the support of the occupying Allied powers, quickly latched onto American medicine and, from a ruinous health system, began rebuilding the high standards of care they had formerly known.

Emotional Characteristics of Patients with Psychosomatic Disorders : Habitual high tension ando anxiety(Anxiety and Psychosomatic Disease : Introduction, Symposium at the 22 nd Annual Congress of the Japanese Psychosomatic Society)

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