Yamamoto, Ryo

写真a

Affiliation

School of Medicine, Department of Emergency and Critical Care Medicine (Shinanomachi)

Position

Instructor

Career 【 Display / hide

  • 2006.04
    -
    2008.03

    東京都済生会中央病院, 初期研修医

  • 2008.04
    -
    2012.03

    Keio University School of Medicine, Department of Emerfency and Critical Care Medicine, Resident

  • 2012.04
    -
    2015.04

    済生会横浜市東部病院, 救急科, 医員

  • 2014.05
    -
    2014.12

    栃木県済生会宇都宮病院, 救急科, 医員

  • 2015.01
    -
    2017.01

    University of Texas Health Science Center at San Antonio, Department of Surgery/Division of Trauma and Emergency Surgery, Trauma Surgery Fellow

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Academic Background 【 Display / hide

  • 2000.04
    -
    2006.03

    Keio University, School of Medicine

    University, Graduated

Academic Degrees 【 Display / hide

  • 学士(医学), Keio University, Coursework, 2006.03

  • 博士(医学), Keio University, Dissertation, 2019.05

    Hydrogen gas distribution in organs after inhalation: Real-time monitoring of tissue hydrogen concentration in rat.

Licenses and Qualifications 【 Display / hide

  • ECFMG certification, 2011.07

 

Books 【 Display / hide

Papers 【 Display / hide

  • Nasal intubation for trauma patients and increased in-hospital mortality.

    Yamamoto R, Fujishima S, Sasaki J

    European journal of trauma and emergency surgery : official publication of the European Trauma Society  2022.01

    ISSN  1863-9933

  • Development of On-Site Medical System for Mass-Gathering Events During TOKYO 2020: Vulnerability Analysis Using Healthcare Failure Mode and Effect Analysis.

    Yamamoto R, Maeshima K, Asakawa S, Haiden A, Nishida Y, Yamazaki N, Homma K, Sasaki J

    Disaster medicine and public health preparedness    1 - 7 2021.12

    Joint Work,  ISSN  1935-7893

  • Serum D-dimer level as a biomarker for identifying patients with isolated injury to prevent unnecessary whole-body computed tomography in blunt trauma care

    Nakama R, Yamamoto R, Izawa Y, Tanimura K, Mato T

    Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine)  29 ( 1 ) 12 - 12 2021.12

    Research paper (scientific journal), Joint Work

     View Summary

    Background: Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT. Methods: This single-center retrospective cohort study included patients with blunt trauma (2014–2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. “Isolated” injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels. Results: Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815–0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 μg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0%) and positive predictive value (100.0%). Approximately 30% of patients had serum D-dimer levels below this cutoff value. Conclusion: D-dimer level ≤ 2.5 μg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.

  • Hyperoxemia during resuscitation of trauma patients and increased intensive care unit length of stay: inverse probability of treatment weighting analysis

    Yamamoto R, Fujishima S, Sasaki J, Gando S, Saitoh D, Shiraishi A, Kushimoto S, Ogura H, Abe T, Mayumi T, Kotani J, Nakada T.a, Shiino Y, Tarui T, Okamoto K, Sakamoto Y, Shiraishi S.I, Takuma K, Tsuruta R, Masuno T, Takeyama N, Yamashita N, Ikeda H, Ueyama M, Hifumi T, Yamakawa K, Hagiwara A, Otomo Y

    World Journal of Emergency Surgery (World Journal of Emergency Surgery)  16 ( 1 ) 19 - 19 2021.12

    Research paper (scientific journal), Joint Work

     View Summary

    Background: Information on hyperoxemia among patients with trauma has been limited, other than traumatic brain injuries. This study aimed to elucidate whether hyperoxemia during resuscitation of patients with trauma was associated with unfavorable outcomes. Methods: A post hoc analysis of a prospective observational study was carried out at 39 tertiary hospitals in 2016–2018 in adult patients with trauma and injury severity score (ISS) of > 15. Hyperoxemia during resuscitation was defined as PaO2 of ≥ 300 mmHg on hospital arrival and/or 3 h after arrival. Intensive care unit (ICU)-free days were compared between patients with and without hyperoxemia. An inverse probability of treatment weighting (IPW) analysis was conducted to adjust patient characteristics including age, injury mechanism, comorbidities, vital signs on presentation, chest injury severity, and ISS. Analyses were stratified with intubation status at the emergency department (ED). The association between biomarkers and ICU length of stay were then analyzed with multivariate models. Results: Among 295 severely injured trauma patients registered, 240 were eligible for analysis. Patients in the hyperoxemia group (n = 58) had shorter ICU-free days than those in the non-hyperoxemia group [17 (10–21) vs 23 (16–26), p < 0.001]. IPW analysis revealed the association between hyperoxemia and prolonged ICU stay among patients not intubated at the ED [ICU-free days = 16 (12–22) vs 23 (19–26), p = 0.004], but not among those intubated at the ED [18 (9–20) vs 15 (8–23), p = 0.777]. In the hyperoxemia group, high inflammatory markers such as soluble RAGE and HMGB-1, as well as low lung-protective proteins such as surfactant protein D and Clara cell secretory protein, were associated with prolonged ICU stay. Conclusions: Hyperoxemia until 3 h after hospital arrival was associated with prolonged ICU stay among severely injured trauma patients not intubated at the ED. Trial registration: UMIN-CTR, UMIN000019588. Registered on November 15, 2015.

  • Emergency angiography for trauma patients and potential association with acute kidney injury

    Yamamoto R, Cestero R.F, Yoshizawa J, Maeshima K, Sasaki J

    World Journal of Emergency Surgery (World Journal of Emergency Surgery)  16 ( 1 ) 56 2021.12

    Joint Work

     View Summary

    Background: Angiography has been conducted as a hemostatic procedure for trauma patients. While several complications, such as tissue necrosis after embolization, have been reported, little is known regarding subsequent acute kidney injury (AKI) due to contrast media. To elucidate whether emergency angiography would introduce kidney dysfunction in trauma victims, we compared the incidence of AKI between patients who underwent emergency angiography and those who did not. Methods: A retrospective cohort study was conducted using a nationwide trauma database (2004–2019), and adult trauma patients were included. The indication of emergency angiography was determined by both trauma surgeons and radiologists, and AKI was diagnosed by treating physicians based on a rise in serum creatinine and/or fall in urine output according to any published standard criteria. Incidence of AKI was compared between patients who underwent emergency angiography and those who did not. Propensity score matching was conducted to adjust baseline characteristics including age, comorbidities, mechanism of injury, vital signs on admission, Injury Severity Scale (ISS), degree of traumatic kidney injury, surgical procedures, and surgery on the kidney, such as nephrectomy and nephrorrhaphy. Results: Among 230,776 patients eligible for the study, 14,180 underwent emergency angiography. The abdomen/pelvis was major site for angiography (10,624 [83.5%]). Embolization was performed in 5,541 (43.5%). Propensity score matching selected 12,724 pairs of severely injured patients (median age, 59; median ISS, 25). While the incidence of AKI was rare, it was higher among patients who underwent emergency angiography than in those who did not (140 [1.1%] vs. 67 [0.5%]; odds ratio = 2.10 [1.57–2.82]; p < 0.01). The association between emergency angiography and subsequent AKI was observed regardless of vasopressor usage or injury severity in subgroup analyses. Conclusions: Emergency angiography in trauma patients was probably associated with increased incidence of AKI. The results should be validated in future studies.

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Papers, etc., Registered in KOARA 【 Display / hide

Reviews, Commentaries, etc. 【 Display / hide

Presentations 【 Display / hide

  • 骨盤骨折の治療戦略 up to date 骨盤骨折救急治療 up to date

    宇田川 和彦, 山元 良, 大野 聡一郎, 西田 有正, 佐々木 淳一

    東日本整形災害外科学会雑誌, 

    2021.08

    Oral presentation (general), 東日本整形災害外科学会

  • 【日本版敗血症診療ガイドライン2020(J-SSCG2020)特別編-COVID-19薬物療法に関するRapid/Living recommendations-】本邦初のMAGICappガイドライン なぜMAGICappなのか

    山元 良

    ICUとCCU, 

    2021.07

    Oral presentation (general), 医学図書出版(株)

     View Summary

    日本版敗血症診療ガイドライン2020特別委員会COVID-19対策タスクフォースは、非営利団体であるMAGIC Evidence Ecosystem Foundationが運営するガイドライン公開プラットフォームMAGICappを用いて、COVID-19薬物療法に関するRapid/Living recommendationsのデジタル版ガイドラインを公表している。MAGICappを利用してガイドラインを公開することは、ガイドライン作成者、使用者、患者のそれぞれにとって有益であり、ガイドラインに高い利便性を持たせることができる。例えば、living systematic reviewによって数ヵ月ごとにアップデートするガイドラインでは、ガイドライン使用者にとって最新版へ追随していく能動的作業は容易ではないが、MAGICappによるデジタル版ガイドラインではアップデートした内容へ容易にアクセスすることができる。ここではMAGICappについて解説する。(著者抄録)

  • 新型コロナ禍の熱傷診療 国際社会における新型コロナ禍の熱傷診療

    松村 一希, 山元 良, 佐藤 幸男, 佐々木 淳一

    熱傷, 

    2021.06

    Oral presentation (general), (一社)日本熱傷学会

  • 高齢者大腿骨近位部骨折に対する早期手術の取り組み

    宇田川 和彦, 山元 良, 西田 有正, 大野 聡一郎, 佐々木 淳一

    日本外傷学会雑誌, 

    2021.05

    Oral presentation (general), (一社)日本外傷学会

  • REBOAに関する現状と展望 外傷性心肺停止に対するREBOAの施行率とその有効性について

    山元 良, 船曵 知弘, 佐々木 淳一

    日本外傷学会雑誌, 

    2021.05

    Oral presentation (general), (一社)日本外傷学会

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Research Projects of Competitive Funds, etc. 【 Display / hide

  • 腸管虚血に対する水素ガス吸入療法

    2022.04
    -
    2024.03

    MEXT,JSPS, Grant-in-Aid for Scientific Research, 若手研究, Principal investigator

  • 汎発性腹膜炎を伴う上部消化管穿孔に対する術式選択支援システムの開発:急性腹症ガイドラインのための新たなエビデンスの創出

    2021.07
    -
    Present

    日本腹部救急医学会, 2021年度消化器外科領域NCD新規研究, Research grant, Principal investigator

  • Optimal Tentative Abdominal Closure for Open Abdomen (OPTITAC) trial

    2020.11
    -
    Present

    日本腹部救急医学会, 日本腹部救急医学会プロジェクト研究, Research grant, Principal investigator

  • 重症COVID-19肺炎に対する水素ガス吸入療法

    2020.06
    -
    2021.03

    国立研究開発法人 日本医療研究開発機構, ウイルス等感染症対策技術開発事業, Research grant, Coinvestigator(s)

  • 水素ガスを利用した腸管虚血に対する新規治療法の開発

    2020.04
    -
    Present

    MEXT,JSPS, Grant-in-Aid for Scientific Research, Grant-in-Aid for Early-Career Scientists , Principal investigator

     View Summary

    本研究の目的は、重要課題であるにも関わらず特異的治療薬の存在しない腸管虚血(Mesenteric Ischemia)に対する新規治療を見出すことである。近年、水素ガス吸入療法に関する基礎的研究が進んでおり、心停止後症候群に対する臨床試験も進行しているが、研究代表者は、吸入水素ガスの体内動態が血流に依存していることを明らかにし、特にmesenteric ischemiaの様な虚血性障害に水素ガスが効果的である可能性を見出している。本研究は、ガス吸入という独創性の高い治療開発研究であり、すでに人体に無害であることが証明されているガスを利用することから、実現可能性も極めて高いと考えられる。

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Awards 【 Display / hide

  • The 35th Japan Shock Society General Meeting, President Award

    2021.05, Japan Shock Society

    Type of Award: Award from Japanese society, conference, symposium, etc.

 

Courses Taught 【 Display / hide

  • LECTURE SERIES, EMERGENCY MEDICINE

    2022

  • LECTURE SERIES, EMERGENCY MEDICINE

    2021

  • LECTURE SERIES, EMERGENCY MEDICINE

    2020

  • LECTURE SERIES, EMERGENCY MEDICINE

    2019

Courses Previously Taught 【 Display / hide

  • 救急科

    Keio University

    2017.04
    -
    2018.03

 

Memberships in Academic Societies 【 Display / hide

  • 日本熱傷学会, 

    2013
    -
    Present
  • 日本消化器外科学会, 

    2009.01
    -
    Present
  • Society of Critical Care Medicine, 

    2008
    -
    Present
  • 日本外傷学会, 

    2008
    -
    Present
  • 日本救急医学会, 

    2008
    -
    Present

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Committee Experiences 【 Display / hide

  • 2021.05
    -
    Present

    Japan CDC創設に関する委員会 新型コロナウイルス感染症の情報発信ワーキンググループ, 日本医学会連合

  • 2020.09
    -
    Present

    日本版敗血症診療ガイドライン2020特別委員会 COVID-19対策タスクフォース, 日本救急医学会・日本集中治療学会

  • 2020.09
    -
    Present

    国際委員会, 日本外傷学会

  • 2017.09
    -
    Present

    東京オリンピック・パラリンピック特別委員会委員, 日本外傷学会