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Objectives: This study aimed to evaluate occupational health-related activities and factors related to the violation of labor-related regulations in hospitals in Hokkaido and Tohoku districts., Methods: The study questionnaires were distributed to 1,108 Hokkaido and Tohoku hospitals in April 2024, among whom 307 (answered by June 2) participated. The questionnaires included queries on hospital characteristics, occupational health-related activities, and labor-related laws. Relationships between the hospital location, number of hospital beds, number of employees, and provision of emergency services and the number of labor-related regulation violations (assignments of occupational physicians and health officers, agreement on overtime [per Article 36 of the Labour Standards Act], physician interviews for workers with prolonged overtime, and implementation of the Stress Check program) were analyzed using multivariable ordinal logistic regression., Results: Among the hospitals, 4.2%, 11.9%, 11.1%, 8.5%, and 2.6% did not assign occupational physicians, assigned directors as occupational physicians, did not assign health officers, did not have an agreement on overtime, and did not implement the Stress Check program, respectively. The multivariable ordinal logistic regression analysis revealed that hospitals with few beds and employees and those that did not offer emergency services had significantly higher odds of violating labor-related regulations., Conclusions: Smaller hospitals and hospitals that did not offer emergency services in Hokkaido and Tohoku districts had some difficulties complying with labor-related regulations. These hospitals may need external support for occupational health-related activities.

A 56-year-old man was referred to our hospital for multidisciplinary treatment of advanced sigmoid colon carcinoma with a suspected bladder invasion. The patient received 8 courses of modified Leucovorin, fluorouracil, and oxaliplatin (mFOLFOX6)plus panitumumab as neoadjuvant chemotherapy for reliable and safe radical resection after ileostomy construction. There was a significant reduction in the tumor size following chemotherapy; hence, low anterior resection was performed. In addition, since preoperative and intraoperative findings suggested bladder invasion, a total cystectomy with ileal conduit urinary diversion was performed. The pathological diagnosis was ypT4b, N0, M0, and ypStage Ⅱc, with all surgical margins being negative. Subsequently, the patient received adjuvant chemotherapy with 4 courses of mFOLFOX6, and his condition improved with no incidence of cancer recurrence following 8 months after the operation. Neoadjuvant chemotherapy for locally advanced colon cancer is one of the effective treatments for reliable and safe radical resection.

Background: We report a case with bilateral endogenous fungal subretinal abscesses. To our knowledge, this is the first report from Japan in which Scedosporium prolificans (S. prolificans) was cultured from intraocular tissue., Case: A 74-year-old man, receiving chemotherapy for acute myeloid leukemia, complained of visual loss in both eyes. Best-corrected visual acuity was hand motion in the right and 2/200 in the left eye. His right eye showed exophthalmos, inflammation in the anterior chamber and iris neovascularization. Funduscopy revealed no details as there was vitreous opacity in the right eye, and irregular round yellowish-white subretinal lesions involving the macula in the left eye. Blood culture was negative, and C-reactive protein (CRP) and β-D glucan titers were high. An antifungal drug and broad-spectrum antibiotics were initiated. Two days after the initial visit, right visual acuity had deteriorated to light perception. Enucleation of the right eye was performed for diagnosis and treatment. Fungi were cultured from the subretinal lesion, confirming a diagnosis of S. prolificans infection. After systemic administration and intravitreal injections of antifungal agents, the subretinal abscess in the left eye gradually diminished. At present, six months after the first visit, left visual acuity is 20/200., Conclusion: Although S. prolificans endophthalmitis can be intractable, this case suggests that repeated intravitreal antifungal agent injections can be effective.

Purpose: To evaluate the relationship between nocturnal dipping in heart rates and iris and/or angle neovascularization (NV) in patients with proliferative diabetic retinopathy(PDR)., Subjects and Method: One hundred fifty-one patients with PDR who underwent surgery were divided into groups based on either the presence or absence of iris and/or angle NV (NV group, 37; non-NV group, 114 patients). Pulse oximetry was conducted overnight and the heart rates were measured both before and during sleep; the resting and nocturnal heart rates and the resting-nocturnal heart rate dip ratio were calculated., Results: The resting and nocturnal heart rates did not differ significantly between the two groups. The resting-nocturnal heart rate dip ratio was significantly lower in the NV group than in the non-NV group (p = 0.006). In the NV group, the frequency of insulin therapy (p = 0.003) and a history of coronary artery disease were significantly (p = 0.033) higher than in the non-NV group. Pearson's correlation analysis showed that only the NV group was significantly negatively correlated with the resting-nocturnal heart rate dip ratio (r = -0.18, t value = -2.2, p = 0.028)., Conclusion: In patients with PDR, the non-occurrent of nocturnal dip in heart rate may be a related factor for iris and/or angle neovascularization.

Background: Although patients with Prader-Willi syndrome have a high rate of diabetes, to date, there have been only 4 reported cases (6 eyes) undergoing vitrectomy for proliferative diabetic retinopathy. Herein, we report a case of Prader-Willi syndrome with proliferative diabetic retinopathy that was treated by early vitrectomy OU under local anesthesia., Case: A 30-year-old man was diagnosed as having Prader-Willi syndrome at the age of 2 years and diabetes at age 17. He was referred to our hospital as diabetic retinopathy had been detected in his first ophthalmological examination at age 29. Visual acuity was 0.6 bilaterally. Proliferative retinopathy, with cataract and macular edema, was identified in both eyes. Panretinal photocoagulation was performed on both eyes. However, proliferative membranes developed bilaterally, and vitreous hemorrhage occurred OS. Visual acuity decreased to 0.3 OU. The patient was hospitalized at our internal medicine department for blood glucose control. Subsequently, with an anesthesiologist on standby, a hypnotic sedative was injected intramuscularly, achieving retro-bulbar anesthesia. Combined cataract and vitreous surgery was performed on the left eye. One week later, a similar operation was performed on the right eye. The patient was discharged four days later. In the two years since these operation, visual acuity has been maintained at 0.8 OU., Conclusion: Patients with Prader-Willi syndrome should be examined for early detection and treatment of diabetic retinopathy.

Purposes: To investigate the prevalence of sleep-disordered breathing (SDB) in proliferative diabetic retinopathy (PDR) patients and clarify the relationship between SDB and PDR., Subject and Methods: Sixty-four PDR patients who had undergone vitrectomy in our hospital were included in this study. Forty-two patients were male, and 22 were female. Pulseoximetry was conducted during the nighttime; the sleeping 3% oxygen desaturation index (ODI/h) was calculated. If ODI was > or = 10/h, SDB was diagnosed. Blood glucose control and the presence of hypertension and albuminuria were evaluated and compared between the SDB and non-SDB groups., Results: Fifty percent of male patients, 27% of female patients and 42% of all PDR patients were diagnosed as having SDB. The presence of hypertension and albuminuria was 96% and 74%, respectively, in the SDB group, both significantly higher than in the non-SDB group. There were no significant differences between the two groups in preoperative HbAlc levels. However, compared with the non-SDB group, the prevalence of insulin therapy was significantly higher in the SDB group., Conclusion: PDR cases had a high frequency of SDB. It appears that SDB might hamper blood glucose control, raise the occurrence of hypertension and albuminuria, and is thus related to the progression of diabetic retinopathy.

Purpose: To clarify the relationship between systemic factors and the development of retinopathy in patients with type 2 childhood diabetes., Subjects and Methods: We evaluated the relationship between retinopathy incidence and systemic factors (i.e., sex, age at diagnosis, and mean HbA(1c)) in 36 patients (11 boys and 25 girls)., Results: Ten of the 36 cases (28%) developed retinopathy during a mean observation period of 7 years and 11 months. Retinopathy was found only in female patients. The mean HbA(1c) value correlated significantly with the onset of retinopathy. The incidence of retinopathy in the patients with mean HbA(1c) values less than 8.0% was 0% at 5 and 10 years, and 5% at 15 years. On the other hand, the incidence of retinopathy in the patients with mean HbA(1c) values of 8.0% or more was 44% at 5 years, and 56% at 10 and 15 years after the diagnosis of diabetes., Conclusion: As female patients with mean HbA(1c) values of 8.0% or more have a high risk of developing retinopathy, strict blood glucose control and frequent ophthalmologic examinations are necessary.

Purpose: To investigate the long-term results of grid pattern photocoagulation for diffuse diabetic macular edema., Subjects and Methods: In 45 cases, 56 eyes foveal thickness and visual outcome were observed 12 months or more after grid pattern photocoagulation., Results: Compared with preoperative values, average foveal thickness decreased significantly during the initial 3 postoperative months and this reduction was maintained through 30 postoperative months. Foveal thickness was reduced by more than 20% in 66% of eyes. The final logarithm of the minimum angle of resolution (logMAR) visual acuity improved 0.2 or more in 41% of eyes. There was a significant correlation between preoperative and postoperative visual acuity. A final visual acuity of 0.5 or better was obtained in 80% of eyes with a preoperative visual acuity of 0.4 or better. There were no eyes with visual loss due to atrophic creep in this study., Conclusion: Grid pattern photocoagulation for diffuse diabetic macular edema showed long-term effectiveness in reducing foveal thickness postoperatively. It will be possible to achieve a final visual acuity of 0.5 or better in a high percentage of cases, if grid pattern photocoagulation is performed for those with relatively good visual acuity. The foveal thickness measurement was useful for quantitative evaluation of photocoagulation for diabetic macular edema.

Purpose: To investigate the role of chemokines in the pathogenesis of proliferative diabetic retinopathy (PDR)., Subjects and Methods: In total, 41 eyes of 38 patients undergoing vitrectomy were divided into two groups; PDR and non-PDR. The PDR group was comprised of 30 eyes, and the non-PDR group of 11 eyes. Vitreous specimens obtained at vitrectomy were centrifuged and separated into supernatants and cellular components. Concentrations of vascular endothelial growth factor(VEGF), interleukin-8 (IL-8), monocyte chemotactic protein-1 (MCP-1), and regulated upon activation, normal T cell expressed and secreted(RANTES) in the supernatants were determined by enzyme-linked immunosorbent assay(ELISA) or chemiluminescence enzyme immunoassay(CLEIA). Expression of VEGF in the cellular components was determined by immunohistochemistry., Results: Vitreous levels of VEGF(p < 0.05), IL8 (p < 0.0001) and MCP-1 (p < 0.05) in the PDR group were significantly higher than in the non-PDR group. However, there was no significant difference in RANTES between the two groups. There was a significant correlation (p < 0.0001, r = 0.84) between vitreous IL-8 and MCP-1 levels in the PDR group. After immunohistochemical staining with antiVEGF monoclonal antibody, VEGF positivity was localized in polymorphonuclear leukocytes and monocytes of the cellular components of PDR vitreous specimens., Conclusions: These results indicate that chemokines are possibly involved in the recruitment of neutrophils and monocytes into the vitreous and that they play a role in the intraocular neovascularization characteristic of PDR.