BackgroundSepsis is a leading cause of death and long-term disability in developed countries. A comprehensive report on the incidence, clinical characteristics, and evolving management of sepsis is important. Thus, this study aimed to evaluate the characteristics, management, and outcomes of patients with severe sepsis in Japan.MethodsThis is a cohort study of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) study, which was a multicenter, prospective cohort study conducted at 59 intensive care units (ICUs) from January 2016 to March 2017. We included adult patients with severe sepsis based on the sepsis-2 criteria.ResultsIn total, 1184 patients (median age 73 years, interquartile range (IQR) 64–81) with severe sepsis were admitted to the ICU during the study period. The most common comorbidity was diabetes mellitus (23%). Moreover, approximately 63% of patients had septic shock. The median Sepsis-related Organ Failure Assessment (SOFA) score was 9 (IQR 6–11). The most common site of infection was the lung (31%). Approximately 54% of the participants had positive blood cultures. The compliance rates for the entire 3-h bundle, measurement of central venous pressure, and assessment of central venous oxygen saturation were 64%, 26%, and 7%, respectively. A multilevel logistic regression model showed that closed ICUs and non-university hospitals were more compliant with the entire 3-h bundle. The in-hospital mortality rate of patients with severe sepsis was 23% (21–26%). Older age, multiple comorbidities, suspected site of infection, and increasing SOFA scores correlated with in-hospital mortality, based on the generalized estimating equation model. The length of hospital stay was 24 (12–46) days. Approximately 37% of the patients were discharged home after recovery.ConclusionOur prospective study showed that sepsis management in Japan was characterized by a high compliance rate for the 3-h bundle and low compliance rate for central venous catheter measurements. The in-hospital mortality rate in Japan was comparable to that of other developed countries. Only one third of the patients were discharged home, considering the aging population with multiple comorbidities in the ICUs in Japan.Trial registrationUMIN-CTR, UMIN000019742. Registered on 16 November 2015.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2186-7) contains supplementary material, which is available to authorized users.

Surgery can be avoided in most cases of blunt renal injury. Hemodynamic instability and injury to main renal veins remain indications for surgical exploration.

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The purpose of the present study was to develop an ankle -foot orthosis (AFO) that satisfies the requirements for an AFO for patients with hemiplegia as determined in a previous study. An oil damper has been introduced as an assistive device. The oil damper provides a resistive moment to plantar flexion of the ankle joint during initial stance on the paretic side. This function improves the insufficient eccentric contraction of the dorsiflexors. The magnitude of the resistive moment generated by this newly developed AFO can be changed easily to adjust its properties in accordance with the requirements of each patient. The mechanical properties of the AFO were measured, and the results showed that the AFO generated a sufficient resistive moment. Hemiplegic gaits with various types of AFOs were assessed, and it was found that the properties of the AFO affected the movements of the ankle, the knee, and the hip joints. The effects of the resistive moment on the alignment of the shank to the floor during initial stance are also discussed. Based on the results of this study, it is concluded that adjustability will be an essential feature for future AFOs.