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Objectives　Deficiency of zinc, an essential trace element in the body, adversely affects taste, wound healing, and immunity. This study aimed to identify the dietary patterns of male and female workers using factor analysis and clarify the relationship between dietary patterns and zinc intake.Methods　The participants were 395 municipal employees (193 men and 202 women) in Northern Kyushu aged 19-71 years. To obtain the dietary intake data, participants were asked to complete a lifestyle and health questionnaire and brief self-administered dietary history questionnaire. Zn intake was evaluated per 1,000 kcal (mg/1,000 kcal). The values were adjusted for energy using the density method, and multiple regression analysis was performed.Results　Three dietary patterns were identified for each participant. Among men, "main and side dish type pattern" characterized by higher intakes of potatoes, legumes, vegetables, seafood, meat, and low for cereals, "snack type pattern" characterized by higher intakes of sweets and coffee, and "Mediterranean diet pattern" characterized by higher intakes of bread, pasta, fruits, eggs, and milk, and low for miso soup and rice were identified. For women, a "vegetarian diet type pattern" characterized by higher intakes of beans, vegetables, mushrooms, and seaweed, "main and side dish type pattern" characterized by low intake of rice, and "dinner-time drinking pattern" characterized by higher intakes of alcoholic beverages were identified. Zinc intake was positively associated with the "main and side dish type pattern" and "Mediterranean diet pattern" in men and "vegetarian diet" and "main and side dish type pattern" in women. Additionally, zinc intake was negatively associated with the "dinner-time drinking pattern" among women.Conclusion　Despite adjusting for age, BMI, marriage, occupation, smoking habits, and exercise habits, the "main and side dish type pattern" and "Mediterranean diet pattern" were positively correlated with zinc intake in men and the "vegetarian diet" and "main and side dish type pattern" in women. The data suggest awareness of the dietary patterns that are conducive to ensuring zinc intake.

The Japan Clinical Oncology Group (JCOG) 0802/West Japan Oncology Group (WJOG) 4607L trial has recently reported that in small lung cancer, segmentectomy has a higher overall survival rate than lobectomy, increasing the significance of sublobar resection. However, local recurrence is a major concern after sublobar resection, and an insufficient surgical margin is a significant risk factor for locoregional recurrence. Therefore, since 2014, we have performed virtual-assisted lung mapping (VALMAP), a preoperative bronchoscopic multiple-spot dye-marking technique, using indigo carmine as a preoperative localization technique to identify hardly detectable pulmonary nodules and confirm the adequacy of the surgical margin. However, conventional VAL-MAP (VAL-MAP 1.0) faced some chal-lenges. One issue is that approximately 10% marks were invisible and unidentifiable due to patient factors or technical issues. Another problem was that, in some cases requiring large resection depth, VAL-MAP did not lead to successful resection with adequate surgical margin. Thus, we have invented several novel techniques to solve these issues. VAL-MAP dual staining is a technique using indocyanine green (ICG) as well as indigo carmine that has improved the success rate of marking detection during surgery without causing additional complications. VAL-MAP 2.0 is a proximal mapping technique that involves the use of a coil, enabling three-dimensional mapping and making sublobar resection more accurate, particularly for a deeply located tumor.

Aim: The late-stage medical care system for older people provides medical examinations, including questionnaires for frailty. We examined whether or not this approach is useful in clinical practice., Methods: We used this questionnaire for the screening of frailty as follows: according to the manual prepared by the Japan Geriatrics Society, each question was classified as concerning oral (Q4, 5), physical (Q6-9), cognitive (Q10, 11), or social (Q13-15) frailty. Each frailty was defined if there was at least one negative answer in each question. The grip power and skeletal muscle index (SMI) according to a bioelectrical impedance analysis were also evaluated. Subjects who showed a reduced grip strength and SMI were defined as having sarcopenia, and those who showed only a reduced grip strength were defined as having possible sarcopenia., Results: One hundred and seventy-one subjects aged 81.0±4.2 years old (63.1% female) were enrolled. A total of 12.3% of subjects showed sarcopenia, and 17.5% showed possible sarcopenia. The prevalence of physical, cognitive, and social frailties was associated with sarcopenia. Oral frailty, defined as having decreased swallowing and mastication functions (Q4 and 5), was significantly related to sarcopenia. Physical frailty was associated with age. In patients with hypertension, a low incidence of cognitive frailty was found. Social frailty was related to a decreased body weight., Conclusions: A questionnaire during medical examinations for older subjects may be useful for screening various frailties and may lead to promotion of the preventive care activities in the community. Further studies are needed to elucidate the relationship between each type of frailty and background characteristics.

The treatment contents and the outcome of three-port thoracoscopic surgery for multiple lung cancer are studied and discussed in this report. 239 cases of synchronous or metachronous multiple lung cancer (11.5%) out of 2,076 cases of primary lung cancer resected in our department from the year of 2010 to 2018 are subjected to this study. There are 158 cases of synchronous multiple lung cancer and 81 cases of the metachronous. The pathological findings for both synchronous and metachronous multiple lung cancer are adenocarcinoma for 194 cases. The pathological stages for the both are stageⅠfor 208 cases. For the synchronous group, there are 156 cases, in which the patients underwent one-stage surgery was performed. For metachronous group, lobectomy was performed for the first surgery in 69 cases. For the second surgery, bilateral lobectomy was performed in the 13 cases, and there was one case of right completion pneumonectomy. There was no intraoperative death or critical postoperative complication. The five-year survival rates are 84.9% for the synchronous group, and 75.2% for the metachronous group. Above all, three-port thoracoscopic surgery for multiple lung cancer was carried out safely. Bilateral lobectomy and completion pneumonectomy are also possible for metachronous multiple lung cancer if a patient has a decent lung function and good performance status. Especially for stageⅠcases, we could expect a good prognosis, and therefore surgical treatment should actively be performed.

Aim: We investigated seasonal variations in blood pressure (BP) and factors related to these variations among older patients receiving home medical care., Method: A total 57 patients ≥ 65 years old receiving home medical care who participated in the Osaka Home Care REgistry study (OHCARE), a prospective cohort study, were included. We investigated the seasonal patient characteristics and variations in the BP. In addition, to determine the influence of seasonal variations in the systolic blood pressure (SBP) on the occurrence of clinical events (hospitalization, falls and death), we classified patients into larger- and smaller- change groups based on the median seasonal variations in SBP., Result: About 60% of subjects were very frail or bedridden. The mean BP was higher in winter than in summer (124.7±11/69.5±7 vs.120.5±12/66.9±8 mmHg) (P< 0.01). On comparing the characteristics of the two groups with larger and smaller changes in the SBP, the group with large BP changes had a significantly lower BP in summer than the group with small BP changes. In addition, the incidence of "hospitalization" was significantly higher in the group with large BP changes than in the group with small BP changes (P = 0.03)., Conclusion: The present study revealed that there were seasonal changes in the BP in older patients receiving home medical care. It was also suggested that seasonal changes in the BP might be associated with the risk of hospitalization events. Given these BP variations, doctors and visiting nurses should be alert for systemic abnormalities, especially in frail patients receinving home medical care.

A 73-year-old Japanese man visited the urology clinic with the chief complaint of gross hematuria in June 2015. His prostate specific antigen (PSA) level was 146.7 ng/ml and he was diagnosed with prostate adenocarcinoma with a Gleason Score of 5+4. With bone metastasis in the right femur (cT3aN0M1), he was treated by orchiectomy and bicalutamide. He had gross hematuria in October 2017 and a prostate tumor was detected by computed tomography (CT) and magnetic resonance imaging without increasing PSA levels. Prostate re-biopsy showed prostate neuroendocrine carcinoma and local radiation therapy (74 Gy) was performed. Follow-up CT revealed a left adrenal tumor with a positive positron emission tomographic scan in October 2018. Under the diagnosis of metastatic neuroendocrine carcinoma, chemotherapy using cisplatinum and etoposide was performed. The tumor shrunk after five courses of treatment, followed by regrowth in April 2019. Radiation therapy (50 Gy) was added to the left adrenal tumor and it shrunk again. However, a left retroperitoneal tumor was detected in July 2019 and it was resected under laparoscopic surgery and diagnosed as metastatic neuroendocrine carcinoma. Since then, no recurrence has been observed.

Herein, we investigated the pharmacokinetic (PK) profile of nedaplatin (cis-diamine-glycolateplatinum; CDGP) in a hemodialysis (HD) patient with advanced esophageal squamous cell carcinoma (ESCC) by administering the CDGP immediately prior to HD. Our patient was treated with CDGP (45 mg/m 2 for a total dose of 60.2 mg) and 5-fluorouracil (560 mg/m 2 for a total dose of 750 mg) before initiating HD. The total platinum (Pt) concentration (Pt &#95;total ) and free Pt concentration (Pt &#95;free ) 2 h after completion of HD were 0.4 μg/mL and 0.3 μg/mL, respectively. The removal rates of Pt &#95;total and Pt &#95;free by the dialyzer were 76.5% and 84.6%, respectively. Twenty-four hours after CDGP administration, the Pt &#95;free was below the detection limit of the method of analysis. Pt &#95;free within the range of the recommended CDGP target AUC 0-24 was 8-10 μg/mL•h, the AUC 0-24 of Pt &#95;total and Pt &#95;free were 16.5 μg/mL•h and 8.8 μg/mL•h, respectively. We conclude that HD should be performed after the end of CDGP infusion as part of the CDGP chemotherapy regimen for HD patients with ESCC, and suggest that HD is effective for obtaining a PK profile of CDGP similar to patients with normal renal function.

Aim: The present study investigated the behavioral and psychological symptoms of dementia (BPSD) and pharmacological therapy among elderly people with dementia who received home medical treatment., Methods: This study was part of the Osaka Home Care Registry study (OHCARE-study). Participants were >65 years old with dementia. Demographic and medical data, BPSD, and the LTCI [long-term care insurance] care-need level were collected. A multiple logistic regression analysis was performed in order to clarify the factors associated with BPSD., Results: Among 110 subjects (82.0±11.3 years old), 64.6% had a diagnosis of dementia, most commonly Alzheimer's dementia. Aside from home medical treatment, 58.1% had a nurse visit, 48.1% received home care, and 40.0% used a day service. The prevalence of BPSD was 53.0%. Those with BPSD most frequently had an LTCI care-need level of 3, and the prevalence of BPSD declined as the level increased after 3. Psychotropic drugs were prescribed in 61.5% of those with BPSD. Antipsychotic drugs were used significantly more frequently in those with nursing care resistance, assault and delusions than in others (all, p <0.005). A multivariate analysis showed that the positive predictor of BPSD was antipsychotic drug use, while negative predictors were an LTCI care-need level and the use of visiting rehabilitation., Conclusion: The BPSD in elderly dementia patients receiving home medical treatment were clarified. The LTCI care-need level is an independent predictor of BPSD after adjusting for the activities of daily life. Further longitudinal investigations including the BPSD severity and frequency are needed.

Hepatitis A virus (HAV) is a common infectious agent that causes acute hepatitis worldwide. Since the incubation period of HAV infection is about one month, it is difficult to identify the source of infection based only on medical interviews. Molecular epidemiological analysis of HAV isolated from patients can help to reveal the infection route and to identify diffuse outbreaks caused by common food vehicles. In the present study, samples were collected from 108 cases notified to the active epidemiological investigation system in Tokyo between 2016 and 2017. Samples found to be HAV-positive by semi-nested RT-PCR were subjected to sequencing and phylogenetic analysis; the results were analyzed together with the epidemiological data. HAV was detected in 99 out of 108 cases. Phylogenetic analysis showed that the 99 HAV strains were divided into 91 of genotype IA, two of IB, and six of IIIA. The 91 HAV strains typed as IA were further divided into four main line-ages, IA-1, IA-2, IA-3, and IA-4, each with a unique epidemiological background. Our nucleotide sequence database of HAV and epidemiological background data will be helpful to investigate sources of infection and the epidemiology of hepatitis A cases in the future.

Previous reports suggested that sharing outpatient information during chemotherapy is very important for managing pharmaceutical usage between community pharmacies and hospitals. We herein examined using a questionnaire survey whether pharmaceutical management for outpatient chemotherapy is desired by community and hospital pharmacists. The response rates were 44.3% (133/300) for pharmacists in community pharmacies and 53.7% (161/300) for pharmacists in hospitals. Prescriptions for outpatients during chemotherapy were issued at 88.2% of the hospitals. Currently, 28.9% of hospital pharmacists rarely provide pharmaceutical care, such as patient guidance and adverse effect monitoring, for outpatients receiving oral chemotherapy. Furthermore, whereas 93.7% of hospital pharmacists conducted prescription audits based on the chemotherapy regimen, audits were only performed by 14.8% of community pharmacists. Thus, outpatients, particularly those on oral regimens, were unable to receive safe pharmaceutical care during chemotherapy. Community pharmacists suggested that hospital pharmacists should use "medication notebooks" and disclose prescription information when providing clinical information to community pharmacists. They also suggested sending clinical information to hospital pharmacists by fax. On the other hand, hospital pharmacists suggested the use of "medication notebooks" and electronic medical records when providing clinical information to community pharmacists. In addition, they suggested for community pharmacists to use electronic medical records when providing clinical information to hospital pharmacists. As there may be differences in opinion between community and hospital pharmacists, mutual preliminary communication is important for successful outpatient chemotherapy.

During 2015-2016, we examined norovirus (NoV) RNA in swab specimens collected for investigation of suspected food poisoning outbreaks in Tokyo by real-time RT-PCR. Of 1,726 swab samples, 65 (3.8%) were NoV-positive and all positive swab samples were derived from NoV-positive outbreaks. Swab specimens were positive in 41 of 181 (22.7%) NoV outbreaks, while no positive swabs were detected in NoV-negative outbreaks. PCR fragments amplified from 32 swabs were sequenced, and all of them displayed complete homology with sequences from clinical and food samples. Though the results of swabs may be useful for determining the causative agent and infection route in some outbreaks, there was no case in which the results of swabs alone could elucidate the cause of food poisoning. Swabs may be useful in food poisoning investigations, if the results are interpreted in conjunction with epidemiological findings and clinical data. Swab samples are often collected several days after an outbreak, and the influence of disinfection should be taken into consideration. In NoV outbreaks, 55 out of 640 (8.6%) restroom swab specimens were NoV-positive whereas six of 618 (1.0%) were positive among kitchen swab specimens. In the restroom, the toilet bowl (43.6%) showed the highest positive rate and next was the toilet seat (14.5%). Additionally, NoV was detected at various sites in the restroom, including doorknob and floor. Since NoV-positive swab specimens may suggest that sanitation management is not performed properly in the facility, swab results may be utilized as a basis for hygiene guidance.

Falls are common in elderly patients and are often serious. Several drugs have been associated with an increased risk of fall. Older adults often take multiple drugs for chronic diseases, and thus may be at increased risk from drugs associated with fall. We investigated the association between drug use and falling in hospitalized older people, with the goal of identifying medications that may increase the risk of a fall. A retrospective case control study was performed at the National Hospital Organization Kumamoto Saishunso Hospital in Japan. Medications taken by patients who fell (n=57) were compared with those taken by patients who did not fall (n=63). The median age (interquartile range; IQR) of the fall and non-fall groups were 75.0 (67.0-83.0) and 80.0 (70.3-84.5) years, respectively. The characteristics of the two groups were similar, with no significant differences in age, sex, or body weight. The probability of falling increased when the patients used zolpidem [odds ratio (OR)=2.47; 95%CI: 1.09-5.63; p<0.05] and calcium channel antagonists (OR=0.299; 95%CI: 0.13-0.68; p<0.01), and was also related to physical factors (OR=2.27; 95%CI: 1.01-5.09; p<0.05). Elderly patients taking zolpidem may fall due to sleepiness, and blood pressure control may be important to prevent orthostatic high blood pressure. In the treatment of elderly people, medical staff should try to choose drugs that prevent fall or are not associated with falling.

A 79-year-old female visited a hospital because of high fever and computed tomography(CT)showed a cystic lesion with fluid accumulation in her left lung. She had hemoptysis and left chest pain 3 days after antibiotic therapy was started. Chest CT demonstrated the cystic lesion rupturing and causing hemopneumothorax. Then she was referred to our department and thoracic drainage was performed. However, a week after the drainage, she had hemoptysis and chest pain again, and the left lower lobectomy was performed. Histopathological findings showed the cystic lesion was intrapulmonary bronchogenic cyst. We describe a rare case of the hemopneumothorax due to the hemorrhage in the bronchogenic cyst.

Intracellular membrane trafficking between membranous compartments is essential for organelle biogenesis, structure, and identity. Rab/Ypt GTPases are well-characterized regulators of intracellular membrane trafficking, functioning as molecular switches that alternate between GTP- and GDP-bound forms. In Saccharomyces cerevisiae, 11 Rab/Ypt GTPases have been identified and their functions are known to be conserved in their mammalian counterparts. In yeast, the secretory pathway is regulated by sequential activation and inactivation (the so-called Rab cascade) of three types of yeast Rab protein -Ypt1p, Ypt31p/32p and Sec4p -via specific guanine nucleotide exchange factors (GEFs) and GTPase-activating proteins (GAPs). In addition to these Rabs, we and others have recently demonstrated that Ypt6p is predominantly localized to the early Golgi compartment, and functions as another regulator of anterograde transport for intra-Golgi trafficking in the secretory pathway. On the other hand, the endocytic pathway is known to be regulated by three yeast Rab5s (Vps21p, Ypt52p and Ypt53p) and one Rab7 (Ypt7p). Rab5 and Rab7 are key determinants of endosome identity, and the Rab5-Rab7 cascade is important for the progression from early to late endosome. Our recent study demonstrates that the endocytic pathway branches into two vacuolar targeting pathways, the Rab5-dependent vacuole protein sorting (VPS) pathway and the Rab5-independent pathway. In this review, we focus on recent advances in our understanding of molecular mechanisms that regulate the localization and activity of yeast Rab GTPases in intracellular membrane trafficking.

Objectives: The purpose of this study was to examine how the nursing practice environment affects job retention and the turnover rate among hospital nurses. The Practice Environment Scale of the Nursing Work Index (PES-NWI) was applied to investigate the nurse working environment from the viewpoint of hospital nurses in Japan. Methods A postal mail survey was conducted using the PES-NWI questionnaire targeting 2,211 nurses who were working at 91 wards in 5 hospitals situated in the Tokyo metropolitan area from February to March in 2008. In the questionnaire, hospital nurses were asked about characteristics such as sex, age and work experience as a nurse, whether they would work at the same hospital in the next year, the 31 items of the PES-NWI and job satisfaction. Nurse managers were asked to provide staff numbers to calculate the turnover rate of each ward. Logistic regression analyses were carried out, with "intention to retain or leave the workplace next year" as the dependent variable, with composite and 5 sub-scale scores of the PES-NWI and nurse characteristics as independent variables. Correlation coefficients were calculated to investigate the relationship between nurse turnover rates and nursing practice environments., Results: A total of 1,067 full-time nurses (48.3%) from 5 hospitals responded. Almost all of them were men (95.9%), with an average age of 29.2 years old. They had an average of 7.0 years total work experience in hospitals and 5.8 years of experience at their current hospital. Cronbach's alpha coefficients were 0.75 for composite of the PES-NWI, and 0.77-0.85 for the sub-scales. All correlation coefficients between PES-NWI and job satisfaction were significant (P < 0.01). In the logistic regression analysis, a composite of PES-NWI, "Nurse Manager's Ability, Leadership, and Support of Nurses" and "Staffing and Resource Adequacy" among the 5 sub-scales correlated with the intention of nurses to stay on (P < 0.05). The means for turnover rate were 10.4% for nurses and 17.6% for newly hired nurses. These rates were significantly correlated to the composite and some sub-scales of the PES-NWI., Conclusion: The working environment for nurses is important in retaining nurses working at hospitals. We confirmed the reliability and the validity of the PES-NWI scale based on the magnitude of the Cronbach's alpha coefficient and correlation coefficient between the PES-NWI scale and job satisfaction in this study.

Norovirus (NV) RNA has rarely been detected in foods despite the use of highly sensitive methods such as RT-PCR and real-time RT-PCR. In the modified method (A3T method) reported previously, a bacterial culture process was introduced into the standard protocol for NV detection to remove some inhibitor(s) present in food ingredients. To confirm the efficiency of the A3T method and to examine NV contamination in bivalve molluscs, we tried to detect NV RNA in bivalve molluscs on the market and in oyster samples associated with foodborne outbreaks by using the standard method and the A3T method. NV RNAs were detected in 20 samples (18.0%) of 111 bivalve molluscs, including oysters, on the market by use of the A3T method, while only one sample (0.9%) was positive according to the standard method. NV RNA was also detected in 10 of 35 oyster samples related to foodborne outbreaks by the A3T method. Those results show that the A3T method is suitable for the detection of NV in bivalve molluscs in general laboratories.

Itraconazole (ITCZ), a useful oral drug effective against Aspergillus, is reported to cause insufficient blood concentration through unstable enteral absorption. Hypoacidic gastic conditions have been reported to reduce absorption, whereas acidic drinks promote it. We present a case of pulmonary aspergillosis in a subject administered ITCZ with black vinegar, a popular health food in Japan. The 59-year-old man showed high blood concentrations of ITCZ, resulting in good Aspergillosis control. To confirm the efficacy in black vinegar on absorbing ITCZ, we administered ITCZ capsules with and without black vinegar to 10 healthy adults after preparation with a proton pump inhibitor to decrease gastric acidity, and measured blood concentrations of ITCZ and the metabolite OH-ITCZ. Administration of this combination increased ITCZ and OH-ITCZ Cmax significantly. For patients who produce too little gastric juice, black vinegar could thus serve to promote ITCZ capsule absorption.

We report the first case of acute kidney injury related to intravenous zoledronic acid (ZA)in a patient with multiple myeloma in Japan. A 37-year-old male was diagnosed as having multiple myeloma (MM) of the Bence Jones lambda type. He showed a good response to two courses of vincristine, adriamycin and dexamethasone (VAD) therapy, and remarkable reduction was seen in plasma cells in bone marrow from 38.4% to 6.8% and 24-hour urine protein from 18.5 g/dL to 2.8 g/dL. At that time, serum Cr(s-Cr) of 0.7 mg/dL and calcium of 9.3 mg/dL were in the normal range. ZA was administered intravenously at the dose of 4 mg for the first time. Subsequently, he developed a fever of up to 39.4 degrees C and used NSAIDs and cefepime. Four days later, s-Cr increasd rapidly to 7.3 mg/ dL and he received hemodialysis (HD) therapy. Four weeks later, renal biopsy was performed and demonstrated cast nephropathy (CN) and acute tubular necrosis. Seven months later, renal function had improved. ZA may be an identifiable precipitating factor of CN. We recommend that ZA should be used with caution, especially hypovolemia and NSAIDs, in patients with MM and renal insufficiency.

Purpose and Method: The Invader assay was developed to identify 23 mycobacterial species using probes derived from the species-specific region of the 16S rRNA gene and the 16S-23S rRNA internal transcribed spacer 1 (ITS-1) region, with minor modifications of our previous study. In the present study, we compared the identification capability between the Invader assay and DNA-DNA hybridization (DDH) method. DDH is commonly used to identify non-tuberculosis mycobacterium in Japan and 636 clinical mycobacterial strains cultured on Ogawa slants were tested., Results: The Invader assay could identify 615 (96.7%) of the 636 strains. The results contained 14 M.lentiflavum, 3 M. parascrofulaceum and 1 M. intermedium, which were undetectable with DDH method. On the other hand, DDH method could identify 580 (91.2%) strains with duplicate assay. Of 628 strains except 8 strains identified as a few species by Invader assay, 551 (87.7%) strains were identified as the same species by two methods. Discordant results were mainly recognized for the identification of M. gordonae, M. avium, M. lentiflavum and M. intracellurare. The results of other methods targeting 16S rRNA indicated correctness of the Invader assay., Conclusion: These results indicate that Invader assay could identify more correctly than DDH method and could identify about 97% of clinically important mycobacterium.

Factors such as low recovery rate and food contaminants may be responsible for the difficulty of detecting Norovirus (NV) by PCR in foodborne outbreaks. To detect NV more efficiently, we introduced a bacterial treatment, in which concentrated samples were incubated overnight with Klebsiella oxytoca at 35 degrees C before RNA extraction using the standard protocol. Recovery rates of NVs (G I/8 or G II/13) added to food suspensions in the modified method were compared with those in the standard method by quantification of NV RNAs using real-time PCR. Recovery rates in the modified method were 8.6% for G I/8 and 11.6% for G II/13 in 18 oyster samples and 13.9% for G I/8 and 19.6% for G II/13 in 15 other food samples, while those in the standard method were 0.3% for G I/8 and 0.5% for G II/13 in the oyster samples and 1.9% for G I/8 and 7.9% for G II/13 in the other food samples. These results indicate that the bacterial treatment increase the recovery of NV from foods such as oysters, suggesting that the modified method will be useful for NV detection in food samples.

A 53-year-old man underwent partial glossectomy for tongue cancer on the right side (well-differentiated squamous cell carcinoma T 1 N 0 M 0). One and 9 months later, cervical lymph node metastasis was observed bilaterally. After bilateral radical neck dissection, 2 courses of NDP/5-FU combined chemotherapy were administered. However, 2 metastatic lung cancers were observed 14 months after initial treatment. Stereotactic radiation therapy of 50 Gy in 5 fractions and 6 courses of docetaxel/cisplatin/5-FU chemotherapy were administered. As a result, no recurrence was observed, and a complete response was obtained for 41 months after lung metastasis.

Unlabelled: PROPOSED: Various techniques have so far been reported for the repair of hypospadias, however, a one-stage procedure for the repair of severe proximal hypospadias still remains difficult to perform. We recently have begun to use the Yoke hypospadias repair technique for the treatment of severe proximal hypospadias., Patients and Methods: As the chief surgeon, I performed a one-stage hypospadias repair on 40 proximal hypospadiac patients with severe fibrous chordee between July 1992 and December 2004. During the early period, eleven patients underwent urethroplasty by the Transverse Preputial Island Flap techinique (TPIF). Next, 10 patients underwent One-stage Urethroplasty with Parameatal Foreskin flap technique (OUPF IV). Finally, the most recent 19 had their hypospadias repaired by the Yoke technique., Results: With the TPIF technique in the early periods, only 6 out of 11 patients underwent a successful repair (54.5%). With the OUPF IV technique, the success rate was only 60.0% (6 out of 10 cases). In contrast, 17 out of 19 cases treated by the Yoke technique in the most recent period had a successful repair, although proximal urethrocutaneous fistula and urethral stenosis occurred in one patient, respectively. A relatively high success rate was therefore obtained using the Yoke technique for the repair of severe proximal hypospadias., Conclusion: The Yoke techniques for the repair of hypospadias is therefore considered to be a safe and effective technique for the repair of proximal hypospadias because of the continuous skin flap of the ventral urethral plate and the prepuce with a blood supply from the circumferential vascular pedicle. We consider this technique to be very useful for the treatment of severe proximal hypospadias.

The Kyushu Hematology Organization for Treatment (K-HOT) Study Group was organized in 1999 to study hematological disorders diagnosed in the participating institutions in the Kyushu district. We registered all new patients with hematological disorders and from February 2000 to the end of 2003, a total of 2908 patients had been registered. They include non-Hodgkin's lymphoma in 803 patients, leukemia in 556, multiple myeloma (MM) in 276, myelodysplastic syndrome in 273, and adult T-cell leukemia/lymphoma (ATL) in 269 followed in a decreasing order by idiopathic thrombocytopenic purpura, aplastic anemia, and other benign hematological disorders and myeloproliferative disorders. The annual incidence of MM is estimated to be much higher than that previously reported. It is also confirmed that ATL is still one of the frequently encountered lymphoid malignancies in the Kyushu district.

A novel urine tumor marker, diacetylspermine, was compared with two conventional serum tumor markers, carcinoembryonic antigen (CEA) (highly specific for pancreatic cancer) and carbohydrate antigen (CA) 19-9 (highly sensitive for pancreatic cancer), in 125 patients with bilio-pancreatic tumors. When the diagnoses of benign or malignant conditions were examined, the sensitivity of urine diacetylspermine (75%) was shown to be higher than that of CEA (44%; P = 0.044) and CA19-9 (75%). The specificity of urine diacetylspermine (81%) was lower than that of CEA (92%) and as high as that of CA19-9 (80%). These results suggest that urine discetylspermine is a highly sensitive and specific novel marker for bilio-pancreatic carcinoma.

A 20-year-old Japanese woman was diagnosed as having acute myeloid leukemia with inv(16)(p13 q22). She achieved complete remission (CR) after treatment with a standard dose of cytarabine(ara-C) and idarubicin. She received high dose ara-C and etoposide for the 2nd consolidation chemotherapy. On the 5th fraction of high dose ara-C, her heart rate dropped to 52/minute and returned to 72/minute after the cessation of ara-C. After achieving informed consent, we gave her another course of high dose ara-C, which once again resulted in a decreased heart rate. This suggests that the administration of high dose ara-C could cause bradycardia.

A 21-year-old male, who had been operated on for bilateral vesicoureteral refluxes (VURs) with bilateral ureterocystoneostomy (Politano-Leadbetter's method) 19 years before, was admitted to our hospital due to recurrent VUR. Since the former operation, he had undergone voiding cystography (VCUG) twice for two years, and no refluxes were found. Moreover, no evidence of upper urinary tract deterioration was found by either intravenous pyelography (IVP) or renal ultrasound scanning taken the year before this admission. Nineteen years after the operation, the dilation of the left lower ureter was found on IVP and, consequently, he suffered from pyelonephritis. The VCUG revealed the recurrence of left VUR. Because of his allergic reaction to collagen, we again performed left ureterocystoneostomy (Politano-Leadbetter's method). At three months postoperatively, there was no VUR found on VCUG.

A 81-year-old man was admitted to our department with the chief complaints of pollakisuria and difficulty in voiding. He presented with increased serum PSA level (over 100 ng/ml). We performed biopsy of the prostate and found a moderately differentiated adenocarcinoma. Various urological examinations showed metastases to paraaortic lymph nodes and systemic bones. He was started-on hormonal therapy. Nine months from the start of hormonal therapy, this therapy was effective and the serum PSA level was decreased to 14 ng/ml. Thereafter, the serum PSA level and the tumor volume were increased and he died 29 months from the start of treatment. The autopsy revealed small cell carcinoma with adenocarcinoma of the prostate.

A 2-year-old boy was hospitalized with the chief complaint of oliguria and dyspnea. Bilateral hydronephrosis and obstruction of the pyeloureteral junction were detected by ultrasonography. Pulmonary edema was also found on chest radiographs. The clinical diagnosis was acute post renal failure due to bilateral pyeloureteral obstruction and pulmonary edema due to overtransfusion. After we performed bilateral percutaneous nephrostomy, the patient recovered from renal failure and pulmonary edema. Both nephrostomies were removed after we confirmed a non-obstructing pattern using the Whitaker test.

A 74-year-old woman had myelodysplastic syndrome (MDS) in 1986. In June 1994, she suffered exacerbation of pancytopenia with no chromosomal abnormalities, but AML1/EVI1 chimeric mRNA was detected by RT-PCR. Two months later, an increase in bone marrow blasts (5%) was noted, and chromosomal analysis detected t(3 ; 21) (q26 ; 22), del(7) (q22), del(11) (q23). In 1995, the marrow blasts increased to 30% and the patient died of disease progression. The AML1/EVI1 gene has been shown to cause blast crisis in chronic myelogenous leukemia. This case suggested that the AML1/EVI1 gene may be involved in the progression of MDS together with del(7) (q22) and del(11) (q23).

During the period from July 1995 to June 1996 we performed transurethral resection of the prostate (TURP) on 824 patients with benign prostatic hyperplasia (BPH). Among them, 13 were dementia patients between 74 and 96 years old; they presented with urinary hesitancy in 6, retention in 4, frequency in 2 and incontinence in 1 patient. Past history included stroke in 7, hypertension in 6, pulmonary tuberculosis in 4, diabetes in 3, asthma in 2, angina pectoris in 1, Parkinson's disease in 1, pneumonia in 1, and hepatitis in 1. Careful preoperative examination revealed that they were proper candidates for TURP. They underwent TURP under spinal anesthesia. The mean operative time was 34 min, ranging from 20 to 60 min. The adenoma resected weighed 24 g on the average, ranging from 7.5 to 48 g. During surgery, although hypotension was noted in 2 patients, there was no serious morbidity. Their mental condition was well controlled with ketamine and diazepam during and after surgery. Postoperative complications included acute myocardial infarction in 1, multiple gastric ulcer in 1, and decubitus in 1. None died within 3 months after TURP, 3 died there after, and 10 patients were alive at the mean follow-up period of 26 months. Six patients reported good urination, 3 reported some improvement in urination after surgery, although requiring intermittent catheterization and 1 developed mild incontinence. In conclusion, TURP appears to provide some benefit in selected patients with dementia and should not be considered to be a contraindication for such patients.

Herein, we report a case of quadruple cancer arising from the prostate, stomach, rectum and urinary bladder. A 92-year-old man was admitted to our hospital on March, 1996, with complaints of macroscopic hematuria and micturition pain. He had a history of prostate cancer (no details) at the age of 67, and subtotal gastrectomy for gastric cancer (tubular adenocarcinoma, conclusive stage Ia) at the age of 89. He underwent a polypectomy for rectal cancer (well-differentiated adenocarcinoma)2 at the age of 90. There was no evidence of local recurrence or metastasis of these three carcinomas. Cystoscopy revealed multiple papillary tumors which were resected transurethrally. At the same time transrectal needle biopsy of prostate was performed. Pathology revealed transitional cell carcinoma G2 of urinary bladder and well differentiated adenocarcinoma of prostate. The postoperative course was uneventful and the patient has been doing well without recurrence of bladder cancer during the follow-up period of six months.

A questionnaire study on the health administration of industrial workers was performed on 230 enterprises in city A in a rural region. Responding subjects numbered 140 and the response rate was 60.9%. Subjects by scale were: 16% with more than 50 workers, 48% with from 10 to 49 workers and 36% with less than 10 workers, and the proportions by industry were: 32% manufacturing, 22% wholesale-retail trade and 14% construction. The subject proportions classified according to the health insurance scheme were: 59% government-managed health insurance, 15% national health insurance and 11% society-managed health insurance. The rate of periodic health examination was 100% in enterprises with more than 50 workers, 67.2% in those with from 10 to 49 workers and 51.0% in those with less than 10 workers. The main reasons why then did not receive health examinations were: 40% had no time available to conduct examinations, 21% believed such examinations were not necessary, and 19% did not know of such an examination system. They encountered some difficulties in promoting health; for example, the advanced age of workers, and no time or money to spare for health administration. They desired provision of facilities close at hand for health examination, health consultation and health information. The results of this study show the difficulty of promoting health administration in small scale enterprises and also that it is difficult to obtain accurate information on actUal conditions including health administration in small enterprises.

The binding properties to human serum albumin (HSA) and the transport of drugs through human erythrocyte membranes were examined with benzoic acid or its twenty-five derivatives (o-, m-, or p-hydroxybenzoic acid, o-, m-, or p-aminobenzoic acid, o-, m-, or p-nitrobenzoic acid, o-, m-, or p-toluic acid, o-, m-, or p-fluorobenzoic acid, o-, m-, or p-chlorobenzoic acid, o-, m-, or p-bromobenzoic acid, aspirin, salicyluric acid, alpha-resorcylic acid and gamma-resorcylic acid) and with glycosides (arbutin, salicin, glycyrrhizin and four p-nitrophenylglycosides) or their aglycons (hydroquinone, saligenin, glycyrretinic acid and p-nitrophenol). The drugs having hydroxyl group and amino group to o-site and those having nitro group, methyl group and halogen group to m- or p-site showed higher affinity with HSA and the plasma hindered the permeability of these drugs. The glycosides bind to each site (1, 2, and 3) of HSA more weakly than do their aglycons and they were difficult for plasma to hinder membrane permeation. The binding constants of each drug to HSA (Kb-site 1, Kb-site 2, Kb-site 3 and Kb-total) and the inhibition ratio (IR) related to the partition coefficient (P): Kb-site 1 (M-1) = 2.1479 x 10(3).square root of P - 5.2824.P + 2.0985 x 10(3) (R = 0.9371), Kb-site 2 (M-1) = 4.3741 x 10(3).square root of P - 15.2068.P + 6.5660 x 10(3) (R = 0.6788), Kb-site 3 (M-1) = 2.2176 x 10(4).log P + 1.2022 x 10(4) (R = 0.5227), Kb-total (M-1) = 1.0214 x 10(4).square root of P - 33.3721.P + 1.6919 x 10(4) (R = 0.7413), IR (%) = 19.885.log P + 17.916 (R = 0.8605). IR obtained from predictive equations (IR = 17.837.log P - 13.286. log Kb-site 1 + 0.175.square root of Kb-site 2 + 0.074.square root of K b-site 3 + 37.355, R = 0.9642, F = 71.4937***, ***; p < 0.001) by multiple regression analysis was compatible with experimental IR.

Clinical efficacy of fluconazole was evaluated against fungal infections complicated with hematological diseases. Fluconazole 200 approximately 400 mg was administered intravenously to 20 suspected fungal infections occurring in patients with hematological diseases (acute leukemia 6, malignant lymphoma 11, adult T cell leukemia 2, chronic myelogenous leukemia blastic crisis 1). These mycoses included 8 cases of suspected pulmonary fungal infection, 10 cases suspected fungemia, and two cases of suspected hepatic fungal abscess. The clinical response rate was 60.0%. Side effects were observed in two cases, one with transient liver function test abnormality and the other with nausea. Fluconazole is considered to be a potent, safe antifungal agent for the treatment of suspected fungal infections associated with hematological diseases.

To examine the difference in abnormal conception by region and generation and its possible causes in the town of Tsunagi, which experienced intensive methylmercury-pollution during the 1950s and 1960s, reproductive histories of 109 women in 3 coastal villages and 64 controls in 5 inland villages were obtained by visit- and interview-study in 1991. There were about 290 married women in respective regions. The subjects were divided into 4 age groups to form 10-year-birth cohorts from 1915 to 1954. The rate of sterility and those who had never become pregnant after marriage, did not differ between coastal (7.3%) and inland women (6.3%). The younger the birth cohort, the smaller the total number of conceptions. The rate of abnormal conception, i.e., abnormal conception (abortion+stillbirth) per normal conceptions (total number of conceptions--number of artificial abortions), in the coastal women tended to increase after the 1960s with its peak (19%) in 1965-70. The rate in the inland women was already as high as 15% in 1945-50, and was constantly above 10% afterwards. However, it did not differ between the two groups during 1950-1970, when severe methylmercury-pollution occurred in the area. Breakdown of the abnormal conceptions in the inland women showed 4 stillbirths and 19 abortions, among the latter of which 16 were related to climbing up and down the hills to fetch water, hard agricultural work and agitation. The abnormal conceptions in the coastal women showed 3 stillbirths and 19 abortions. Sixteen of the latter were not related to any specific physical causes.