Among the triggering mechanisms of ischemic brain damage, mitochondrial dysfunction has recently attracted attention in neuropathy. Mitochondrial dysfunction, especially a phenomenon called mitochondrial permeability transition (MPT), is an important early event in mitochondrial-mediated cell death, and activation of the CypD (cyclophilin D) protein present in the mitochondrial matrix that play an important role to induce primary phenomenon. MPT with the involvement of F1F0ATPsynthase has been focused. In this article, I would like to reconsider the roles of cyclophilin D and MPT, which have the multiple functions for the cell homeostasis.

Objective：To examine factors associated with the location of adrenaline administration for out-of-hospital cardiac arrest.

Method：This retrospective cohort study used data from the Japan Utstein Registry and emergency transport data collected from patients who underwent pre-hospital adrenaline administration between 2016 and 2019. The location of adrenaline administration was determined as "on the scene" or "in the ambulance. Multiple logistic regression analysis was used to estimate the association between the location of adrenaline administration.

Result：Adrenaline administration on the scene was significantly positively associated with witnessed (AOR [95%CI], 1.05 [1.01-1.09]), with bystander CPR (AOR [95%CI], 1.17 [1.13-1.22]), with etiology cause of drowning (AOR [95%CI], 1.05 [1.01-1.09]).

Conclusion：To improve the prognosis of out-of-hospital cardiac arrest, the rate at which the procedure is performed on the scene needs to be improved. In the future, factors that cause procedure delays need to be scrutinized, and training provided to address them.

　The patient was a male in his 70s. For a burst fracture in L1, he was performed posterior fixation and vertebral body displacement with small lateral incision. The total intraoperative fluid balance was +2335mL with blood loss was 445 mL. After returning to the ward, anemia with Hb 6.4g/dL and low blood pressure were observed. CT scan showed retroperitoneal blood hematoma and hemorrhagic shock was suspected. We started to administer blood products and continuous noradrenaline. However, the extremely low blood pressure remained and emergency hematoma removal was planned. When entering the operating room, the patient presented pulseless electrical activity (PEA), and cardiopulmonary resuscitation was performed immediately. After the heartbeat resumed, the surgery started. Upon removal of the intrathoracic hematoma, there was a rapid increase in blood pressure (from 93 to 142mmHg), suggesting that the hematoma extending into the left thoracic cavity may have caused tension hemothorax, resulting in obstructive shock.

　Chest compressions during cardiopulmonary resuscitation are known to result in iatrogenic trauma. In recent years, the use of extracorporeal membranous oxygenation (ECMO) as an adjunct to cardiopulmonary resuscitation (ECPR) has increased in prevalence. ECPR requires the use of anticoagulants, increasing the likelihood for bleeding complications. This is a report of a case in which a 33-year-old female who underwent ECPR following a cardiopulmonary arrest. Her clinical course was followed shortly thereafter by a massive intraperitoneal hemorrhage from a minor liver laceration, likely exacerbated by her anticoagulated state, which necessitated an emergent exploratory laparotomy. She recovered following intensive multidisciplinary efforts, and was discharged ambulating to her residence 28 days after admission. Notably, the timing at which the hemorrhage became clinically evident was somewhat delayed compared to bleeding complications typically seen in ECMO patients. Hemorrhagic complications may present differently in ECMO patients who do or do not receive chest compressions.