Search

Background: Surgical antimicrobial prophylaxis (SAP) is one of the major purposes of antimicrobial use.Aim: To determine the adherence to the Japanese SAP guidelines in Japanese university hospitals.Methods: This was a retrospective cohort study including 15 general hospitals and one dental university hospital. Up to three cases of 18 designated surgeries were evaluated regarding adherence to Japanese SAP guidelines: selection of antibiotics, timing of administration, re-dosing intervals, and duration of SAP. When all items were appropriate, surgery was defined as 'appropriate'.Findings: In total, 688 cases (22-45 cases per surgery) were included. The overall appropriateness was 46.8% (322/688), and the appropriateness of each surgery ranged from 8.0% (2/25, cardiac implantable electronic device implantation) to 92.1% (35/38, distal gastrectomy). The appropriateness of each item was as follows: pre/intraoperative selections, 78.5% (540/688); timing of administrations, 96.0% (630/656); re-dosing intervals, 91.6% (601/656); postoperative selection, 78.9% (543/688); and duration of SAP, 61.4% (423/688). The overall appropriateness of hospitals ranged from 17.6% (9/51) to 73.3% (33/45). The common reasons for inappropriateness were the longer duration (38.5%, 265/688) and choice of antibiotics with a non-optimal antimicrobial spectrum before/during, and after surgery (19.0%, 131/688 and 16.9%, 116/688, respectively), compared to the guideline.Conclusions: Adherence to the guidelines differed greatly between the surgeries and hospitals. Large-scale multi-centre surveillance of SAP in Japanese hospitals is necessary to identify inappropriate surgeries, factors related to the appropriateness, and incidences of surgical site infections. [ABSTRACT FROM AUTHOR]

Background: Hospital outbreaks of antimicrobial-resistant (AMR) bacteria should be detected and controlled as early as possible.Aim: To develop a framework for automatic detection of AMR outbreaks in hospitals.Methods: Japan Nosocomial Infections Surveillance (JANIS) is one of the largest national AMR surveillance systems in the world. For this study, all bacterial data in the JANIS database were extracted between 2011 and 2016. WHONET, a free software for the management of microbiology data, and SaTScan, a free cluster detection tool embedded in WHONET, were used to analyse 2015-2016 data of eligible hospitals. Manual evaluation and validation of 10 representative hospitals around Japan were then performed using 2011-2016 data.Findings: Data from 1031 hospitals were studied; mid-sized (200-499 beds) hospitals accounted for 60%, followed by large hospitals (≥500 beds; 24%) and small hospitals (<200 beds; 16%). More clusters were detected in large hospitals. Most of the clusters included five or fewer patients. From the in-depth analysis of 10 hospitals, ∼80% of the detected clusters were unrecognized by infection control staff because the bacterial species involved were not included in the priority pathogen list for routine surveillance. In two hospitals, clusters of more susceptible isolates were detected before outbreaks of more resistant pathogens.Conclusion: WHONET-SaTScan can automatically detect clusters of epidemiologically related patients based on isolate resistance profiles beyond lists of high-priority AMR pathogens. If clusters of more susceptible isolates can be detected, it may allow early intervention in infection control practices before outbreaks of more resistant pathogens occur. [ABSTRACT FROM AUTHOR]

Background: The Japanese government adopted a national action plan on antimicrobial resistance, which aims to reduce drug-resistant pathogens and antimicrobial use. A point-prevalence survey (PPS) is a useful surveillance method to gain information about hospital epidemiology; however, no multi-centre PPS has previously been performed in Japan.Aim: To investigate general information about hospital epidemiology, healthcare-associated infections (HCAIs), and antimicrobial use in multiple Japanese university hospitals.Methods: In July 2016, a multi-centre PPS was conducted using a standardized protocol at four university hospitals in Japan.Findings: A total of 3199 patients were included. Median age and duration of hospital stay were 64 years and 10 days, respectively. A total of 246 (7.7%; 95% confidence interval (CI): 6.8-8.7) patients had 256 active HCAIs, and 933 (29.2%; 95% CI: 27.6-30.8) patients received 1318 antimicrobials. Pneumonia and gastrointestinal system infection were the most common HCAIs (N = 42, 16.4%), and Enterobacteriaceae (N = 49, 30.8%) were the predominant causative organisms. Carbapenems (N = 52, 17.8%), anti-MRSA medications, and cephems with antipseudomonal activity were the most frequently prescribed antimicrobials for HCAIs. As surgical prophylaxis, 46 of 278 antimicrobials (16.5%) were administered orally. Proportions of HCAI and antimicrobial use in each hospital ranged from 4.8% to 9.5% and 19.3%-35.0%, respectively.Conclusion: This multi-centre PPS recorded detailed HCAI data and distinct antimicrobial use in Japanese university hospitals. Further surveillance is necessary to reduce HCAIs and formulate feasible plans to achieve the national action plan on antimicrobial resistance. [ABSTRACT FROM AUTHOR]

When the Budd-Chiari syndrome (BCS) lesion extends to the inferior vena cava (IVC) or the orifices of the hepatic vein, the thickened IVC and/or hepatic vein wall must be removed and IVC reconstruction is required in living-donor liver transplantation (LDLT). In various reports about IVC resection in LDLT for BCS, there are none about left lobe liver transplantation with reconstruction of the retrohepatic IVC (rhIVC). To overcome removal and reconstruction of the rhIVC in LDLT for BCS, we introduced a composite IVC graft that is applicable to both right and left lobe partial liver grafts for LDLT for BCS. Pathogenic IVC was removed together with the native liver between the lower edge of the right atrium and 5 cm above the renal vein junction with the use of venovenous bypass. The e-polytetrafluoroethylene graft was anastomosed to the suprarenal intact IVC. Then the native part was detached at the level of just above the renal junction. The composite graft was inverted and a half rim of the native part of the graft was anastomosed to the posterior wall of the right atrium. Next, the common venous orifice of the left lobe graft was anastomosed to the wall defect which was composed of the anterior wall of the right atrium and the distal end of the native part of the composite graft. In conclusion, our inverted composite graft technique will overcome the weak points of LDLT for BCS, such as incomplete removal of the pathogenic caval wall and reconstruction of the rhIVC. [ABSTRACT FROM AUTHOR]

Abstract: Static and kinetic experiments on an accelerator-driven system have been conducted at the Kyoto University Critical Assembly. A small neutron detector using wavelength shifting fiber that can be inserted into a narrow space has been developed for measuring static and kinetic parameters. This study has found that the new detector type can be applied to kinetic experiments such as subcriticality measurements with the use of a D–T pulsed neutron source. [Copyright &y& Elsevier]

Abstract: The N2 and O2 pressure broadening coefficients of the pure rotational transitions at 625.66GHz (N KaKc=101▒9–100▒10, J=10.5–10.5) and 649.70GHz (N KaKc=102▒9–92▒8, J=9.5–8.5) in the vibronic ground state X 2 A′ of the perhydroxyl (HO2) radical have been determined by precise laboratory measurements. For the production of HO2, the mercury-photosensitized reaction of the H2 and O2 precursors was used to provide an optimum condition for measurement of the pressure broadening coefficient. The Superconducting Submillimeter-wave Limb Emission Sounder (SMILES) was designed to monitor the volume mixing ratio of trace gases including HO2 in the Earth''s upper atmosphere using these transitions. The precise measurement of pressure broadening coefficient γ in terms of the half width at half maximum is required in order to retrieve the atmospheric volume mixing ratio. In this work, γ coefficients of the 625.66GHz transition were determined for N2 and O2 at room temperature as γ(N2)=4.085±0.049MHz/Torr and γ(O2)=2.578±0.047MHz/Torr with 3σ uncertainty. Similarly, the coefficients of the 649.70GHz transition were determined as γ(N2)=3.489±0.094MHz/Torr and γ(O2)=2.615±0.099MHz/Torr. The air broadening coefficients for the 625.66GHz and 649.70GHz lines were estimated at γ(air)=3.769±0.067MHz and 3.298±0.099MHz respectively, where the uncertainty includes possible systematic errors. The newly determined coefficients are compared with previous results and we discuss the advantage of the mercury-photosensitized reaction for HO2 generation. In comparison with those of other singlet molecules, the pressure broadening coefficients of the HO2 radical are not much affected by the existence of an unpaired electron. [Copyright &y& Elsevier]

Abstract: To investigate the characteristics of a reactor and a neutron generator, a small scintillation detector with an optical fiber with ThO2 has been developed to measure fast neutrons. However, experimental facilities where 232Th can be used are limited by regulations, and S/N ratio is low because the background counts of this detector are increase by alpha decay of 232Th. The purpose of this study is to develop a new optical fiber detector for measuring fast neutrons that does not use nuclear material such as 232Th. From the measured and calculated results, the new optical fiber detector which uses ZnS(Ag) as a converter material together with a scintillator have the highest detection efficiency among several developed detectors. It is applied for the measurement of reaction rates generated from fast neutrons; furthermore, the absolute detection efficiency of this detector was obtained experimentally. [ABSTRACT FROM AUTHOR]

Abstract: A small neutron detector using an optical fiber was previously developed for reaction rate measurements at research reactors and accelerator facilities. This detector can be inserted into narrow spaces and its spatial resolution is less than 1mm; however, its neutron sensitivity is low because of the small size of its detector. The purpose of this study is to develop a new optical fiber detector with high neutron sensitivity by using a wavelength shifting fiber. Through the measurement of the reaction rate distribution in a reactor core, we found that it is possible to increase the effective length of the detector, resulting in increased neutron sensitivity compared with a conventional optical fiber detector. Additionally, using a longer wavelength shifting fiber, the sensitivity can be increased until it is as large as that of a typical small BF3 proportional counter, which means that this detector can be used for even low neutron flux fields. [Copyright &y& Elsevier]

Abstract: Objective: The pathological localization of vestibular neuritis is still controversial. Analyses of the spontaneous nystagmus support the temporal bone studies, which indicated the location of the pathology to be in the superior vestibular nerve. However, based on the data from the head impulse testing the pathology is in the vestibular nerve including the inferior branch. Methods: Twenty-three patients with vestibular neuritis participated in this study. The spontaneous nystagmus was recorded within 1 week after the onset of the disease. Three-dimensional analysis of the nystagmus was performed using video image analysis system. The rotation axis was calculated and compared to the anatomical axes of the semicircular canals. Results: The axes of the spontaneous nystagmus in all patients were scattered around the axes of horizontal and anterior canals, especially between the compound axis of anterior and horizontal canals and the axis of horizontal canal. The statistical analysis revealed that in the quite early stage of the disease (day 0–2 of the attack), the spontaneous nystagmus tended to have more torsional eye movements as compared to the less early stage (day 3–6). Conclusion: The present study strongly suggests that the pathology of vestibular neuritis is in the superior vestibular nerve branch. Also it can be speculated that at the early stage of this disease, the pathology is in the whole branch of the nerve. Subsequently, the anterior canal branch recovers faster than the horizontal canal branch. [Copyright &y& Elsevier]

Abstract The high-pressure behavior of the natural MTN-type clathrasil chibaite was investigated with in situ single-crystal X-ray diffraction and Raman spectroscopy under hydrostatic pressures up to 10.3 GPa. The experiments were conducted in diamond-anvil cells using 4:1 methanol-ethanol mixture (ME), helium (He) and neon (Ne) as pressure-transmitting media. The pressure dependent unit-cell volumes of the room-pressure polymorph yield an isothermal bulk modulus K T 0 = 25.75 (19) GPa for the compression in the non-penetrating ME fluid. Due to the penetration of the Ne and He atoms into the cages of the framework, the crystal structure is significantly stiffened resulting in K T 0 = 42.5 (1.2) GPa (Ne) and K T 0 = 58 (2) GPa (He). Under the influence of pressure both the evolution of the Raman spectra and the change in cell metrics indicate a distortion of the lattice without leading to a complete pressure-induced amorphization, as observed for many comparable porous structures. Compressed in the non-penetrating ME, the cubic F d 3 ¯ m framework of chibaite undergoes a first transformation step in the pressure range between 1.7 GPa and 2.2 GPa and a second one between 3.9 GPa and 4.3 GPa. The accompanied formation of crystal domains did not allow a reliable determination of the distorted crystal structures. The unit-cell parameters might suggest a monoclinic metric for pressures >1.7 GPa and a monoclinic or tetragonal metric for pressures >3.9 GPa. However, in some samples even the co-existence of crystal domains of a different degree of lattice distortions has been proved. Graphical abstract Image 1 Highlights • The compressibility of chibaite showing an isothermal bulk modulus K T 0 = 26.8(2) GPa is comparable to other clathrasils. • Up to 10.13 GPa chibaite undergoes two phase transitions, which are characterized by a distortion of the framework. • · In the investigated pressure range no pressure-induced amorphization was observed. • The penetration of the pressure-transmitting media helium and neon stiffens the chibaite structure under pressure. [ABSTRACT FROM AUTHOR]