Objective: To analyze the background information of individuals who died by suicide, handled by the Osaka Prefectural Medical Examiner’s Office, and identify factors associated with a history of suicide attempts.

Methods: From 569 recorded suicide death cases in 2017, anonymized data from 343 cases, excluding those with missing values, were aggregated and subjected to statistical analysis using multivariate logistic regression.

Results: Statistical analysis revealed significant associations between a history of attempted suicide and female (AOR: 2.30, 95%CI: 1.32-3.99), having cohabitants (AOR: 2.15, 95%CI: 1.19-3.86), having psychiatric consultation history (AOR: 3.60, 95%CI: 1.88-6.90).

Conclusion: The study found that female, having cohabitants, and having psychiatric consultation history were associated factors with a history of suicide attempts. Further examination is needed to explore the clinical applications of these findings.

Introduction: This study aimed to clarify the support provided by certified nurse specialists in critical care nursing to family members who are responsible for surrogate decision-making.

Methods: Semi-structured interviews were conducted with 15 certified nurse specialists in critical care nursing, and text mining methods using KH Coder were used to extract frequently appearing words from the verbatim data obtained, and hierarchical cluster analysis and co-occurrence network analysis were conducted.

Results: The results of the analysis using words that appeared more than 25 times were classified into 10 hierarchies and 9 sub-graphs. These were further grouped to generate three categories: [bridging communication], [information sharing and collaboration] and [information gathering and decision-making facilitation].

Conclusion: Certified nurse specialists in critical care nursing provided multifaceted support to families making proxy decisions, mainly as intermediaries between physicians and families, confirming their understanding and encouraging families to make decisions based on appropriate information and perceptions.

A female patient aged > 80 years, undergoing chemotherapy for rectal cancer, presented with melena and was admitted to our hospital owing to hemorrhagic shock. Following an emergency blood transfusion and rescue endovascular balloon occlusion of the aorta (REBOA), her hemodynamics remained unstable. After consulting with her family, we decided to monitor her condition under REBOA inflation. After 90 min, her hemodynamics improved, and she regained consciousness. Subsequently, following further discussions with the patient and her family, transcatheter arterial embolization (TAE) was performed. During TAE, the REBOA inflation level was adjusted by palpating the dorsal foot artery. The total inflation time, from insertion to the end of TAE, was 260 min. The patient was discharged on the fourth day of hospitalization without further complications.

In this case, circulatory stabilization using partial REBOA allowed us to reaffirm the patient’s willingness to undergo treatment in an oncological emergency setting, leading to a favorable outcome.

Metformin-associated lactic acidosis (MALA) is a rare but highly fatal adverse event associated with metformin.We present a case of MALA in a patient with an unknown background, which precluded early diagnosis. A 59-year-old man was transported with complaints of epigastric pain and vomiting since the previous day. Upon arrival, the patient exhibited circulatory failure and altered consciousness, along with significant lactic acidosis. Although the cause was unclear, the patient was successfully treated with prompt intensive care including mechanical ventilation, administration of vasopressors and sodium bicarbonate, and continuous hemodiafiltration. Extubation was performed on the second day; the patient was able to walk and was discharged on the seventh day. Post-extubation interview revealed that the patient had taken metformin on the day before transport. Accordingly, we diagnosed the patient with MALA. Early diagnosis of MALA in severely ill patients with unknown medication history is challenging. However, in patients with severe unexplained lactic acidosis, a detailed medical history should be obtained, and MALA should be considered as a differential diagnosis with early intervention considering its fatal nature.

Cervical spinal cord injury patients are prone to developing hypotension and bradycardia, which can lead to cardiac arrest. However, there is no clear consensus regarding the indications for permanent pacemaker (PPM) implantation. Here, we present a case of cervical spinal cord injury that required PPM implantation after experiencing two episodes of cardiac arrest. The patient was a woman in her 40s with traumatic spinal cord injury below C6, that was classified as A on the Frankel scale, due to a traffic accident that resulted in the death of a passenger. She frequently experienced bradycardia with a heart rate of 40-50 beats per minute and suddenly went into cardiac arrest during oral care on the 3rd and 8th days of hospitalization. Since this was determined as being due to autonomic dysfunction associated with high-level spinal cord injury, a PPM was implanted on the 16th day of hospitalization following temporary pacemaker implantation. Subsequently, there were no further episodes of bradycardia or cardiac arrest, and her condition stabilized. She was transferred to another facility for rehabilitation on the 119th day of hospitalization. High cervical spinal cord injuries can easily lead to cardiac arrest due to airway stimulation, such as suctioning. Therefore, early consideration of PPM placement is necessary for safe airway management and rehabilitation.