CD151 (PETA-3 ⁄ SFA-1) is a member of the tetraspanin family of proteins, possessing four membranespanning domains [1]. CD151 was initially identified in platelets [2] and T-cell leukemic cells [3] and has been found to be expressed in a wide variety of cells, including epithelial, endothelial, muscle, Schwann and dendritic cells. Studies using antibodies and small interfering RNA (siRNA) against CD151 have revealed that treatments with these antibodies and siRNA attenuate cell adhesion to and migration on substrates, and disturb epithelial cell-cell adhesion and polarization in cultured cells [4][5][6][7][8][9][10], indicating that CD151 is involved in the regulation of cell-cell and cell-substratum adhesions. Several studies performed in vivo highlight the physiological importance of CD151: in humans, a nonsense mutation in CD151 causes diseases, including end-stage hereditary nephropathy, pretibial epidermolysis bullosa and sensorineural deafness [11]. CD151-null mice show defects in platelet aggregation, keratinocyte migration, T-cell proliferation and pathological angiogenesis, although these mice are viable and fertile [12][13][14][15]. Recently, Sachs et al. [16] reported that CD151 knockout mice show strain-dependent severe renal defects caused by abnormalities of the glomerular basement membrane, loss of podocyte foot processes, glomerulosclerosis and cystic tubular dilation.CD151 interacts with various membrane proteins, including the laminin-binding integrins a3b1, a6b1, a6b4 and a7b1, and other tetraspanin family members, The tetraspanin CD151 forms a stable complex with integrin a3b1, a widely expressed laminin receptor, and is implicated in the regulation of integrin a3b1-mediated cellular responses, including cell attachment, spreading and migration. However, the molecular mechanism by which CD151 regulates integrin a3b1 functions remains unclear. To address this issue, we knocked down CD151 expression in A549 human lung adenocarcinoma cells by RNA interference. When plated on laminin-511 (laminin-10), the CD151-knocked-down cells showed aberrant membrane protrusions and exhibited reductions in the tyrosine phosphorylation of focal adhesion kinase, Src, p130Cas and paxillin. The formation of membrane protrusions was attenuated when the cells were either plated on surfaces coated with higher concentrations of laminin-511 or treated with the integrin b1-activating mAb TS2 ⁄ 16; however, neither treatment could rescue the reduced tyrosine phosphorylation. These results indicate that CD151 knockdown weakens the integrin a3b1-mediated adhesion to laminin-511 and thereby provokes an aberrant morphology, but this reduced adhesive activity is not involved in the decline of signaling events in CD151-knocked-down cells. Thus, our results suggest that CD151 regulates integrin a3b1 functions in two independent aspects: potentiation of integrin a3b1-mediated cell adhesion and promotion of integrin a3b1-stimulated signaling events involving tyrosine phosphorylation.Abbreviations EGFP, enhanced green fluorescent...

The coronavirus disease (COVID-19) pandemic massively impacted emergency department (ED) visits. The unavailability of specific therapies or vaccines has made non-pharmaceutical interventions (NPIs) an alternative strategy for COVID-19. We assessed the impact of NPIs (nationwide school closures and state of emergency) on ED visits during the COVID-19 pandemic in Japan. Methods: This retrospective study compared the trends in ED visits from 1 January to 25 May, 2020 (during the pandemic) with the average during 2015-2019 (before the pandemic). The primary end-point was the change in the number of ED visits during the COVID-19 pandemic with those from before the pandemic, with the NPI application stratified across four periods in 2020:

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Background With the aging society, the number of emergency transportations has been growing. Although it is important that a patient be immediately transported to an appropriate hospital for proper management, accurate diagnosis in the prehospital setting is challenging. However, at present, patient information is mainly communicated by telephone, which has a potential risk of communication errors such as mishearing. Sharing correct and detailed prehospital information with emergency departments (EDs) should facilitate optimal patient care and resource use. Therefore, the implementation of an app that provides on-site, real-time information to emergency physicians could be useful for early preparation, intervention, and effective use of medical and human resources. Objective In this paper, we aimed to examine whether the implementation of a mobile app for emergency medical service (EMS) would improve patient outcomes and reduce transportation time as well as communication time by phone (ie, phone-communication time). Methods We performed an interrupted time-series analysis (ITSA) on the data from a tertiary care hospital in Japan from July 2021 to October 2021 (8 weeks before and 8 weeks after the implementation period). We included all patients transported by EMS. Using the mobile app, EMS can send information on patient demographics, vital signs, medications, and photos of the scene to the ED. The outcome measure was inpatient mortality and transportation time, as well as phone-communication time, which was the time for EMS to negotiate with ED staffs for transport requests. Results During the study period, 1966 emergency transportations were made (n=1033, 53% patients during the preimplementation period and n=933, 47% patients after the implementation period). The ITSA did not reveal a significant decrease in patient mortality and transportation time before and after the implementation. However, the ITSA revealed a significant decrease in mean phone-communication time between pre- and postimplementation periods (from 216 to 171 seconds; −45 seconds; 95% CI −71 to −18 seconds). From the pre- to postimplementation period, the mean transportation time from EMS request to ED arrival decreased by 0.29 minutes (from 36.1 minutes to 35.9 minutes; 95% CI −2.20 to 1.60 minutes), without change in time trends. We also introduced cases where the app allowed EMS to share accurate and detailed prehospital information with the emergency department, resulting in timely intervention and reducing the burden on the ED. Conclusions The implementation of a mobile app for EMS was associated with reduced phone-communication time by 45 seconds (22%) without increasing mortality or overall transportation time despite the implementation of new methods in the real clinical setting. In addition, real-time patient information sharing, such as the transfer of monitor images and photos of the accident site, could facilitate optimal patient care and resource use.

Serum potassium levels are considered as a marker of cerebrovascular emergencies but there is less clarity on the association between initial serum potassium levels recorded on patient's arrival at the emergency department with the type of stroke. This is a case-control study using data of a tertiary care hospital in Japan from April 2018 to September 2019. We identified adult patients with hemorrhagic stroke including subarachnoid hemorrhage (cases) and those with ischemic stroke (controls). Data on age, sex, chief complaints, vital signs, and initial blood tests were collected. We analyzed the association between serum potassium levels and the type of stroke by drawing a LOWESS curve. Additionally, we fitted a logistic regression model to examine the association of interest. There were 416 stroke patients (158 hemorrhagic and 258 ischemic). The median age was 77 years (IQR: 68, 84), and 54% were male. The mean potassium level was 3.69 § 0.55 mEq/L for hemorrhagic stroke and 4.08 § 0.65 mEq/L for ischemic stroke. The LOWESS curve showed that the lower initial potassium level was linearly associated with a greater likelihood of hemorrhagic stroke. In the logistic regression model, the odds ratio for the risk of hemorrhagic stroke per 1 mEq/L lower potassium level was 3.31 (95% confidence interval [CI]: 2.24À5.04). This association remained significant in a multivariable model adjusting for other covariates (OR: 2.62 [95% CI: 1.70À4.16]). Initial potassium level was lower in patients with hemorrhagic stroke compared to those with ischemic stroke.

Aim In patients with thunderclap headaches, reversible cerebral vasoconstriction syndrome (RCVS) should be considered as a differential diagnosis. However, RCVS diagnosis in the emergency department (ED) remains challenging. This report describes the clinical features and factors related to RCVS diagnosis and suggests diagnostic strategies for its management. Methods We retrospectively reviewed the medical records of eight patients diagnosed with RCVS from January 2010 to March 2019 (aged 18–69 years, 5 women). Results The median duration from the ED visit to RCVS diagnosis was 6 days (range, 1–11 days). Of the eight patients, seven were middle‐aged, six had apparent triggers, six had subarachnoid hemorrhage (SAH), five had high systolic blood pressure, and none had any specific abnormality observed upon physical examination. At the initial visit, RCVS was diagnosed in only one patient who had a history of RCVS. Of the other patients, SAH was diagnosed in two, and primary headache was diagnosed in four patients with negative computed tomography (CT) findings. Based on follow‐up angiography (e.g., magnetic resonance angiography), seven of eight patients with convexal SAH were diagnosed with RCVS (as the cause of SAH). Conclusion Reversible cerebral vasoconstriction syndrome with negative CT findings at the ED visit was likely to be misdiagnosed as a primary headache. In patients with thunderclap headache and negative CT findings, physicians should consider RCVS as a differential diagnosis, inform patients of the risk of RCVS, and undertake follow‐up imaging within 2 weeks.

Study Objectives: Elevated serum cardiac troponin is a marker of myocardial injury associated with increased mortality in sepsis. Increasing use of high sensitivity troponin T (hsTrop) in the emergency department (ED) has allowed earlier and more sensitive detection of myocardial injury in acute coronary syndromes but has yet to be studied in relation to sepsis. The objective of this study was to determine the association between hsTrop changes and mortality in sepsis.Methods: This was a retrospective cohort study performed at a single, tertiary academic center. A concurrent multicenter sepsis trial was being conducted during the study period (June 1st, 2018 and March 20th, 2020) and the cohort for this study was derived from the screening log of this unrelated study. Adult patients with a suspected infection and hypotension after 1 liter of crystalloid fluids were included. All data were collected via direct database query to the electronic health record. hsTrop was measured in the ED and again approximately 2 hours later. The difference (delta) between the second and first measurements was the primary exposure and treated as a 4-level categorical variable (delta >6 ng/L, -6 > delta > 6, delta <-6 and no delta obtained). The primary outcome was 28-day mortality and secondary outcomes included mechanical ventilation, use of vasopressors, and crystalloid fluid received. Inverse probability weighting (IPW) was used to weight covariates for the probability of obtaining a hsTrop delta measurement in the ED. Using IPW derived weights, a multivariable logistic regression model was used to determine the association between hsTrop delta and 28-day mortality. Descriptive statistics and univariate analyses were also performed.Results: After exclusion of clinician suspected baseline hypotension or hypotension not due to sepsis cause, as well as non-sepsis causes of hsTrop delta, 763 patients met the inclusion and exclusion criteria. 48 had a delta > 6 ng/L, 54 had a delta < -6 ng/L, 175 had a delta between -6 and 6, and 486 had no hsTrop delta obtained in the ED. Patients who had a hsTrop testing skewed male, older and with history of renal, heart disease or with chief complaints of chest pain or shortness of breath. In the weighted multivariable analysis and after adjustment for sex, age, and Charlson comorbidity index, both an hsTrop delta > 6 (OR 3.4 [95% CI 1.7 -7.2]) and delta < -6 (OR 2.2 [95% CI 1.1 -4.4]) were associated with increased mortality at 28 days. The hsTrop delta >6 group was also associated with an increased risk for early mechanical ventilation (HR 3.0 [95% CI 1.8 -4.9]), use of vasopressors (OR 3.7 [95% CI 2.0 -7.0]), and increased crystalloid fluids administered during the first 24 hours (mean 4060 mL vs. w 3000 mL for all other groups, p ¼ 0.01).Conclusion: Dynamic changes in hsTrop obtained at ED presentation are associated with increased mortality in sepsis. Both an increasing and decreasing hsTrop delta are associated with a higher risk for 28-day mortality. This study was limited by its retrospe...

We describe the case of a 67‐year‐old man with shock and hypoxemia. Chest X‐ray showed bilateral lung mass shadows and left pleural effusion with a mediastinal shift, suggesting malignancy. Physical examination and point‐of‐care ultrasound findings did not suggest obstructive or cardiac shock, but the patient had prolonged shock refractory to fluid and blood transfusion therapy. We inserted a drain into the left thoracic cavity, which enabled the patient to recover from shock. We diagnosed the patient with obstructive and hypovolemic shock due to spontaneous haemothorax caused by primary lung cancer. Tension haemothorax due to malignancy is rare, and when obstructive shock is combined with haemorrhagic shock, it can be very difficult to determine the cause of shock.