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Purpose: To study the expected usefulness of the introduction of the DRG-PPS (Diagnosis-Related Group/Prospective Payment System, in which an insurer pays a fixed medical fee per hospitalization) into the current medical care of tuberculosis (TB) in Japan., Method: The medical fees were reviewed for all TB inpatients at 19 hospitals under the National Hospital Organization who were discharged in either June 2007 or February 2008. The sum of the fixed fee by the DRG was assumed based on the bivariate regression analysis of each patient's hospital days and his or her total actual fees during the hospital stay under the current (fee for care) system, since it was difficult to directly calculate the daily fees for every patient that would be the basis of DRG-PPS., Results: Linear regression analysis estimated that the medical fees (including fees for the medical examinations and the treatments) for a hospital stay of 60 days, which is the standard for TB treatment, was 1,192,470 yen (19,870 yen per person per day) in June 2007, and 1,167,600 yen (19,460 yen per person per day) in February 2008., Discussion: If we assume an average medical fee of about Y1.1-1.2 million yen for the standard hospital care of TB, the economic balance of the hospitals is negative, with a deficit of 0.6-0.7 million yen, given the estimated expenses of 1.8 million yen (i.e., 30,000 yen per person per day x 60 days)., Conclusion: If the DRG-PPS is to be implemented based on the current medical fee rating system, the hospital administrators could not accept its introduction to the TB medical care service as it is, because it may undermine the economic management of hospitals.

A 33-year male was readmitted to our hospital for the treatment of multi-drug resistant pulmonary tuberculosis in February 1993. Six years after the treatment, the left pleuropneumonectomy was done because of the enlargement of cavitary lesions with formation of fluid. Four years after the operation, M. tuberculosis from the patient was resistant to all first- and second-line anti-tuberculosis drugs. Apical lesion and cavitary lesion on the upper lung were still seen on chest X ray and sputum smear and culture were continuously positive. Minocycline and gatifloxacin were prescribed after five years of the operation. Sixteen months after changing the regimen sputum smear and culture converted negative. Chemotherapy was terminated in August 2007, two years after the negative conversion. One year after the termination of treatment no relapse occurred. We considered minocycline was effective in this case, because gatifloxacin was resistant by the drug susceptibility test and was previously used.

Objective: It has been understood that cough-generated aerosols act as an important vector for the spread of pulmonary tuberculosis. Humans commonly exhale aerosols during the normal respiration process that contain small droplets of the airway lining fluid. We aimed to determine whether aerosols exhaled by active pulmonary tuberculosis (AP-TB) patients may contain droplets with Mycobacterium tuberculosis (M-TB) during normal breathing., Methods: Preliminarily, the collection efficiency of M-TB that was suspended in normal saline or distilled water was examined after subjecting the suspension to centrifugation at 3,000 g for 20 minutes. Better collection efficiency was observed in case of M-TB suspended in distilled water than that suspended in normal saline after centrifugation. Therefore, we selected distilled water instead of normal saline to prepare the fluid that was bubbled with exhaled breath. AP-TB patients with smear positive pulmonary tuberculosis who were being treated with anti-TB drugs for less than 7 days or those before the initiation of therapy expired into a 50-ml tube containing 10 ml distilled water for 30 minutes. We also prepared an exhaled breath condensate by cooling exhaled air through the tubing apparatus., Results: In case of 20 AP-TB patients, the distilled water bubbled with the exhaled breath were negative for M-TB on smear, culture, and PCR (polymerase chain reaction) detection methods. The exhaled breath condensates were also negative in 24 AP-TB patients., Conclusion: These results suggest that exhaled breath-generated aerosols from AP-TB patients during normal breathing do not act as a vector for the spread of pulmonary tuberculosis.

A backward flow signal in the left atrium masquerading as mitral regurgitation was studied by a pulsed Doppler method. The subjects consisted of 20 normal volunteers, 12 cases with mitral valve prolapse syndrome, five cases with rheumatic mitral regurgitation, five cases with lone atrial fibrillation, four cases with asymmetric septal hypertrophy and three cases with the Björk-Shiley tilting disc valve in the mitral position. In two-dimensional echocardiography combined with pulsed Doppler method, a Doppler signal was recorded by locating a sample volume in the left atrium. In all of the cases with mitral valve prolapse syndrome and the cases with the prosthetic valve as well as in all of the normal subjects, the backward flow signal was observed in the left atrium. In three cases with mitral valve prolapse syndrome, it was differentiated from a transvalvular regurgitant flow signal. In all cases with rheumatic mitral regurgitation, the backward flow signal was masked by a turbulent flow signal representing regurgitation. In cases with mitral stenosis, the backward flow signal was scarcely recognized. The duration of the backward flow signal had no relationship with heart rate. The histogram of incidence on the scale of R-R interval revealed normal distribution with a mean value of 0.24 sec (+/- 0.09 sec). Therefore, in cases with tachycardia, the backward flow signal was seen throughout systole. The peak backward flow velocity of Doppler signals was correlated (r = 0.71, p less than 0.01) with the peak forward flow velocity in diastole. The faint backward flow signal seen in cases with mitral stenosis and post-extrasystolic potentiation of the backward flow signal were suggestive of the foregoing relationship. The mechanism producing the backward flow was postulated as a water hammer phenomenon caused by closure of the mitral valve.

A 46-year-old male (performance status 1) with hepatocellular carcinoma (HCC), which diffusely involved the anterior segment of the right lobe, occluded the second portal branch and metastased to the left lobe (stage IV-A), was on combined therapy with TAE of lipiodol (LPD), mitomycin C (MMC) 10 mg and gelatin sponge at the time of angiography on March 16, 1987. Immunochemotherapy with tegafur suppository (Teg sp) 1,000 mg/day and OK432 i.m. was performed for one month after TAE. Instead of OK432, lentinan (LNT) 2 mg in 20% glucose sol. 20 ml i.v./wk was combined with Teg sp 1,000 mg/day from May 13, 1987. Teg sp was reduced to 1,000 mg/2 days from June of the same year, and since then the same therapy of Teg + LNT has been continuing even now. Serum AFP values showing 150 X 10(4) ng/ml at maximum were decreased down to less than 20 ng/ml 13 months after this therapy (total doses: Teg ca. 250 g, LNT 108 mg), remaining still normal. Marked reduction in the size of the lesion (PR) by the therapy has also been proved by the body CT. His PS is now in grade 0. Although in this case the initial steep decline in AFP values was possibly brought about by TAE, the successive antitumor effect indicated by persistent low AFP values may have been mainly due to Teg + LNT. Collection of data on the therapy is needed to clarify this point.

Despite a large gender gap, life satisfaction among women has been nearly equal to or even higher than that among men in Japan. We investigated the relationship between life satisfaction and system justification using two existing datasets and two preregistered surveys administered to Japanese adults (total N=2,833), employing two scales一system justification for gender disparity in annual personal income (Existing dataset 1 and Survey 1)and gender system justification (Existing dataset 2 and Survey 2). In line with previous research, we found that life satisfaction among women was nearly equal to (Existing datasets 1 and 2 and Survey 1)and significantly higher than (Survey 2) that among men. Contrary to our prediction, women were less likely to endorse system justification than men across four datasets. However, as expected, we found a palliative function of system justification among women across four datasets一women who strongly justified the existing system displayed higher life satisfaction than women who weakly justified it. [ABSTRACT FROM AUTHOR]