Department of Acute Critical Medicine

Traumatology and Acute Critical Medicine

A new era of emergency medicine
  • Study of mechanisms regulating inflammation and immunity in response to infection
  • Role of the intestinal microbial flora and immune system in severe illnesses
  • Role of cerebral oxygen levels in cardiopulmonary resuscitation
  • Better outcomes for head injuries
  • Construction of a Japanese-style ER education system
Professor SHIMAZU Takeshi
Traumatology and Acute Critical Medicine
The laboratory was founded in 1967 and was the first emergency care unit in Japan. It’s contribution to emergency care in Japan is highlighted by the NHK program Project X. Currently, it is a leader in training emergency room doctors from across the country.

Using clincial research to advance basic research and basic research to advance clincal research

The lab has been studying injuries and infections that commonly lead to emergencies such as severe trauma, burns, severe infections, SIRS (systemic inflammatory response syndrome), sepsis, DIC (disseminated intravascular coagulation), ARDS (acute respiratory distress syndrome) and MODS (multiple organ dysfunction syndrome).

There are many aspects about the mechanisms with which the body overcomes these injuries and infections that are unknown. Inflammation is an important response that aids in repairing damaged tissue. However, in severe cases, inflammation can exasperate the damage. What causes the inflammation to dysfunction? On the flip side, some patients are more vulnerable to infection. We are studying the connection between inflammation and immunity to elucidate the pathology of develop new treatments.

Figure 1

In addition to investigating this relationship in infections, we are studying other factors in emergency care including the role of the intestinal microbial flora in infections, cerebral oxygen levels in cardiopulmonary resuscitation, severe head trauma, NETs (neutrophil extracellular traps), heat stroke and trauma. We are also conducting basic and clinical research on various fields such as evaluation of emergency care systems. Altogether, we aim to improve the prognosis of severe emergency cases.

The intestinal microbial flora is gaining increasing attention in its role in the body’s reaction to infections. The intestinal tract is particularly susceptible to systemic invasion. Our laboratory has published clinical data on the use of fecal matter as a marker for the prognosis of patients with severe SORS [1]. In addition, we reported that the presence of the synbiotics Bifidobacterium breve and Lactobacillus casei in the flora decreases the incidence of septic complications in these patients [2].

We have developed a model to explain how the intestinal microbial flora affects the immune response upon infection. This model has helped us identify the importance of maintaining the intestinal epithelium, as otherwise the immune system and metabolism can be compromised. Additionally, trauma, burn injury, heat stroke, etc. can result in DAMPs (damage-associated molecular patterns), which risk systemic inflammation, abnormal coagulation and shock. Along with studying the molecular mechanisms responsible for these reactions, we are developing new drugs and cell therapies to combat them.

Finally, the lab regularly participates in international conferences such as JSS (Japan Shock Society), AAST (American Association for the Surgery of Trauma), and SCCM (Society of Critical Care Medicine). It also provides its members opportunities to study abroad.

Those who are interested in emergency medicine, trauma, and infection are always welcome!

Figure 2

Reference

1. Shimizu et al. Dig Dis Sci. 56 (6): 1782-8, 2011.
2. Shimizu et al. Dig Dis Sci. 54 (5): 1071-8, 2009.