Search

The development of pneumococcal conjugate vaccines has substantially decreased the incidence of invasive pneumococcal diseases. However, the incidence of bacteremia due to nonvaccine serotypes has increased. Therefore, it is important to recognize the symptoms and complications of pneumococcal infection to expedite diagnosis. Herein, we report the case of a 22-month-old patient diagnosed with pneumococcal bacteremia who presented with cholestatic jaundice and fever without any other signs of systemic sepsis. The patient's condition improved soon after antibacterial therapy. Other causes of jaundice were possibly ruled out based on the screening test for viral hepatitis, and there were no abnormal findings on abdominal ultrasonography. Therefore, the present case suggests that cholestatic jaundice could be a manifestation of pneumococcal bacteremia.

The appropriate antimicrobial treatment period for febrile urinary tract infection (UTI) can be changed, depending on whether the patient has acute focal bacterial nephritis (AFBN). The aim of this study was to clarify the characteristics of AFBN compared with those of acute pyelonephritis (APN) and establish a strategy to detect AFBN.A total of 77 patients diagnosed with febrile UTI were enrolled. They were divided into APN (n = 64) and AFBN groups (n = 13). The clinical data and other laboratory biomarkers were retrospectively analyzed.The time required for fever resolution after antimicrobial treatment was significantly longer in the AFBN group than in the APN group (2.77 days vs 1.11 days, respectively, P0.001). Also, the time to disappearance of pyuria after antimicrobial treatment was longer in the AFBN group than in the APN group (6.22 days vs 2.32 days, respectively, P = 0.001). Fever lasting1.75 days after antimicrobial treatment had a sensitivity of 92% and specificity of 79% for the detection of AFBN, while pyuria disappearance after 4 days had a sensitivity of 88% and specificity of 85%. When patients fulfilled both cut-offs, the sensitivity and specificity were 89% and 97%.Acute focal bacterial nephritis was associated with fever of significantly longer duration after antimicrobial treatment, and it took a longer time for pyuria to disappear. Children with febrile UTI should be evaluated for AFBN if the fever persists ≥48 h after the initiation of antimicrobial treatment and if pyuria lasts for 4 days.

During the period from January to December 2015, 104 Streptococcus pneumoniae strains, 129 Haemophilus influenzae strains and 54 Moraxella catarrhalis strains isolated from clinical specimens of pediatric infections in the national 16 institutions, studied susceptibilities of total 28 antibiotics, the capsular serotype for S. pneumoniae, the capsular b type and β-lactamase production capability for H. influenzae, and the β-lactamase production capability for M. catarrhalis were measured. In S. pneumoniae, the results showed that 68 strains (65.4%) were PSSP, 32 (30.8%) were PISP, and 4 (3.8%) were PRSP. The susceptibilities of TBPM and GRNX among oral antibiotics, and PAPM among injectable antibiotics demonstrated the lowest value with MIC90 ≤ 0.06 μg/mL. The most frequent distribution of S. pneumoniae serotypes was seen in 15B, followed by 19A, and 35B. Serotype strains contained in 13-valent pneumococcal conjugate vaccine (PCV13) were 19 strains (18.3%). In H. influenzae, the results showed that BLNAS accounted for 40 strains (31.0%), BLNAI for 28 strains (21.7%), BLNAR for 47 strains (36.4%), β-lactamase producing for 14 strains (10.8%). The susceptibilities of quinolones demonstrated the lowest outcome among oral antibiotics with MIC90 ≤ 0.06 μg/mL, and CTRX and TAZ/PIPC (TAZ4 fixed) among injectable antibiotics with MIC of 0.25 μg/mL. There was no detection of capsular type b strains. In M. catarrhalis, all the isolates were β-lactamase producing strains. The susceptibilities of TBPM, CPFX, TFLX and GRNX among oral antibiotics, and TAZ/PIPC (TAZ4 fixed), PAPM, MEPM and DRPM among injectable antibiotics demonstrated the lowest outcome with MIC of ≤0.06 μg/mL.

Lower respiratory tract infections due to respiratory syncytial virus are associated with morbidity and mortality in infants and children. Thus precise elucidation of respiratory syncytial virus lower respiratory tract infection pathophysiology is important.Medical records of hospitalized patients were reviewed. Patients were divided into three groups. Group I: patients who improved without oxygen supply. Group II: patients who received oxygen supply, but not nasal high-flow cannula therapy. Group III: patients who received nasal high-flow cannula. Patients were also divided by age group into the6 months and ≥6 months groups. Parameters for differentiating the severity among groups were then evaluated. Further, serum concentration of high-mobility group box-1 and several cytokines (Inerleukin-6, soluble tumor necrosis factor receptor-1/2, Interleukin-18, Interferon-gamma responsive protein-100) were evaluated.One hundred eighty-nine were enrolled. An analysis of variance for those6 months showed overall differences including younger age, lower pH, and increased partial pressure of carbon dioxide (pCO2), bicarbonate (HCO3-), and base excess at the time of admission. On the other hand, analysis of variance for ≥6 months revealed that, in addition to a lower pH and increased pCO2, patients showed differences including decreased serum total protein and albumin, and increased aspartate aminotransferase (AST), alanin aminotransferase (ALT), lactate dehydrogenase (LDH), Ferritin and C-reactive protein (CRP) levels. Further, evaluation of serum cytokines showed that IL-6, s tumor necrotizing factor receptor-1/2, and high-mobility group box-1 were higher in Group II/III among the ≥6 months age group, but not for those in the6 months group.The pathophysiology of severe respiratory syncytial virus lower respiratory tract infection varies according to the age at onset. In late infancy and childhood, a certain proportion of patients show a hyperinflammatory status.

Universities in the EFL context aim to foster graduates who can use English in the workplace. Regardless, university students’ insufficient amount of out-of-class study time is a major issue. This problem may stem from learners’ lack of learning skills, low levels of learning motivation, and high levels of academic procrastination. Self-coaching skills have the potential to tackle this problem. In this study, we introduce how self-coaching skills training can be applied in the EFL classroom while drawing on relevant literature in ELT. Respecting the diverse characteristics of learners, we grouped participants into different trajectories based on levels of intrinsic motivation, self-regulated learning skills, and academic procrastination tendencies at four different data collection points throughout a required 15-week EFL course. Quantitative data revealed five trajectories in which we examined how self-coaching skills training through self-questioning influenced out-of-class study time in two repr...

We evaluated 24 children with invasive Haemophilus influenzae infections between 2006 and 2015 in Kamikawa subprefecture of Hokkaido, Japan. The most frequent disease was pneumonia in 12 cases (50.0%), followed by meningitis in 7 (29.2%) and bacteremia in 5 (20.8%). Patients ranged in age from 3 months to 12 years of age. Seventeen (70.8%) of the total were less than 2 years old. The incidence rate of H. influenzae infection varied from 15.1 to 36.3 per 100,000 population in the Kamikawa area during the period from 2006 through 2011. The corresponding rate decreased to 10.4 per 100,000 population in 2012, and there were no cases after 2013. Meningitis occurred in 1–2 patients annually from 2006 to 2011, showing an incidence rate of 4–10 per 100,000 population per year, while no cases were reported during or after 2012. No patients with invasive H. influenzae infection died, but sequelae were seen at discharge in 1 patient with meningitis, that had hydrocephalus and developmental delay. In Japan, introduction of the H. influenzae type b (Hib) vaccine was in November 2008. Initially, this vaccination was voluntary, resulting in a low vaccination rate. According to the national policy, and the self-pay burden for vaccination was decreased in December 2010, and the vaccination rate increased markedly to over 90%. This report provides a meaningful demonstration that introduction of the Hib vaccine markedly reduced invasive H. influenzae infections, exerting a beneficial effect in Japan, as it has in the world.

The Japanese Association for Infectious Diseases (JAID) and Japanese Society of Chemotherapy (JSC) announced the “Guide for the Use of Antimicrobial Drugs” in 2001 and the “Guidelines for the Use of Antimicrobial Drugs” in 2005. Subsequently, the “The JAID/JSC guide to clinical management of infectious diseases 2011” was published. With its revision, guidelines were newly prepared. Concerning respiratory infectious diseases, in Japan, the Japanese Respiratory Society published guidelines for the management of community-acquired pneumonia, hospital-acquired pneumonia, respiratory tract infection, and -/nursing and healthcare-associated pneumonia. Furthermore, the Japanese Society of Pediatric Pulmonology and Japanese Society for Pediatric Infectious Diseases announced the “Guidelines for the Management of Respiratory Infectious Diseases in Children in Japan”. Internationally, many guidelines, including those established by the American Thoracic Society and Infectious Diseases Society of America, have been published from various countries. Thereafter, clinical research on respiratory infectious diseases has advanced, leading to the accumulation of many outcomes regarding epidemiology, clinical diagnosis, and treatment. However, the types of microorganisms that cause respiratory infectious diseases have increased with the number of resistant bacteria. In addition, conditions have also varied with causative microorganisms through the recent compromised host's severe status. The place of treatment varies: from the outpatient clinic to the ICU. Physicians responsible for treatment also vary: practitioners, hospital doctors, pulmonologists, emergency physicians, board certified member of JAID, Japanese antimicrobial chemotherapy physician. There are a large number of options of antimicrobial drugs that are available, including new drugs; therapeutic strategies are confused. On the other hand, recently, the entity of PK-PD has been commonly recognized, and the importance of scientifically using antimicrobial drugs has been emphasized. In addition, the Japanese Society of Chemotherapy established a system for antimicrobial chemotherapy-certified physicians, and promoted the widespread, adequate use of antimicrobial drugs. Based on these, the two societies prepared the JAID/JSC Guidelines for the Treatment of Respiratory Infectious Diseases. If specific treatment guidelines can be presented, this may contribute to an improvement in the treatment responses of respiratory infectious diseases, a reduction in health expenditure, and the prevention of resistant bacteria. The guidelines were prepared based on the EBM so that they reflected the management of respiratory infectious diseases in Japan and covered all such diseases in adults and children. To prepare the guidelines, a committee was established in 2012, and a draft was published on homepage based on an approval from the boards of directors at the two societies through a review-based consensus. Opinions were collected from the two societies' members. In Japan, there have been no such guidelines covering respiratory infectious diseases. In the future, with further advances in research, the contents of the guidelines must be revised. However, we successfully provided treatment guidelines that are the most advanced at present. The guidelines were prepared for all clinicians to understand the Treatment of Respiratory Infectious Diseases and manage them with antimicrobial drugs adequately. They do not limit treatment by individual physicians or affect their rights to select it. The guidelines may be commonly applied for respiratory infectious disease management/research/education in Japan, improving the quality of respiratory infectious disease management, preventing an increase in the number of resistant bacteria, and contributing to national health. We hope that the guidelines will be utilized by a large number of clinicians in respiratory infectious disease management. Lastly, we thank the committee members and secretariat staff for their cooperation. 1. Descriptions on the recommendation grade and evidence level Recommendation grade Evidence level A Strongly recommended, I Randomized comparative study B General recommendation II Non-randomized comparative study C Comprehensive evaluation by the attending physician III Case report IV Specialist's opinion Open in a separate window 2. Definition of first- and second-choice drugs First-choice drugs Drugs to be recommended for initial treatment Second-choice drugs Alternative drugs when first-choice drugs cannot be used due to allergy, organ disorder, or local factors Open in a separate window 3. Precautions - In this article, with respect to the administration method (especially doses) of antimicrobial drugs, they are recommended based on sufficient doses. Considering the products adopted at each medical institution, antibiograms, severity, underlying disease, age, and presence or absence of organ disorder, the dose should be increased or decreased if necessary. - The spectra of third-generation cephems for intravenous injection, CTX and CTRX, are similar, but CTX, which is excreted in the kidney, should be primarily used when liver dysfunction is present, and CTRX, which is excreted in bile, should be primarily used when renal dysfunction is present. - As quinolones exhibit antitubercular actions, patients with pulmonary tuberculosis should be excluded for use. 4. A list of antimicrobial drug abbreviations and doses for neonates are presented at the end of this volume.

In Japan, the 7-valent pneumococcal conjugate vaccine (PCV-7) became commercially available as a voluntary vaccine in March 2010. It was included in the routine immunization schedule in April 2013 and was replaced by PCV-13 in November 2013. We evaluated 146 cases of invasive pneumococcal disease (IPD) in 142 children (2 developed the disease twice, and 1 developed it three times) treated in the northern district of Hokkaido, Japan from April 2000 to March 2015, before and after the introduction of PCV-7. The incidence rate per 100,000 people aged

To assess the incidence of colonization with group B streptococci (GBS) among neonates as influenced by maternal GBS carriage and intrapartum antibiotic prophylaxis (IAP).Between October 2014 and May 2015, nasopharyngeal and rectal swab samples were collected from 730 neonates at 1 week and 1 month after birth. GBS and capsular serotype were identified by real-time polymerase chain reaction and by culture. IAP at delivery was determined retrospectively from hospital records.Sixty-four neonates (8.8%) were GBS-positive by real-time polymerase chain reaction and culture. Among neonates born to mothers who were GBS carriers (n = 107), 94.4% (101/107) had maternal IAP; 19.6% nonetheless were GBS-positive, compared with 6.5% of neonates born to noncarrier mothers (P .01). Among neonates born to mothers receiving IAP, more were positive only at 1 month of age than at both 1 week and 1 month. The frequency of GBS in neonates born to mothers receiving IAP was significantly lower than that in neonates born to mothers not receiving IAP (P .05). Capsular serotypes V (25%) and III (23.4%) were common, followed by Ib (15.6%), Ia (14.1%), II (7.8%), IV (6.3%), nontypeable (4.7%), and VI and VIII (each 1.6%).Delayed colonization with GBS occurs in infants born to GBS carrier mothers receiving IAP. GBS should be considered in all infants at 1 month after birth with signs of infection.

Background This study examined the trends for the serotypes of S. pneumoniae that have caused infections before (2010) and after (2012) the introduction of PCV-7 in Japan. Methods We examined 458 strains of Streptococcus pneumoniae obtained from 22 pediatric institutions throughout Japan from January to June 2010 (immediately after the introduction of the seven-valent pneumococcal conjugate vaccine [PCV-7]), and 370 strains obtained from 19 institutions from January to June 2012 (after PCV-7 became widely used). The samples were collected from children aged 0–14 years with conditions such as respiratory tract infections (upper airway inflammation, bronchitis, and pneumonia), meningitis, and sepsis. Results The most frequent serotype in the 2010 strains was 19F (17.3%), followed by 6B (16.8%), and 23F (15.1%). The most frequent serotype in the 2012 strains was 6C (10.0%), followed by 19F (9.7%), 15A (8.9%) and 15B (8.9%), indicating a significant change in the distribution. The serotypes contained in PCV-7 were detected in 280 strains (61.1%) in 2010 and in 81 strains (21.9%) in 2012 (P < 0.01). The serotypes contained in PCV-13 were detected in 356 strains (77.7%) in 2010 and in 146 strains (39.5%) in 2012 (P < 0.01). A total of 129 subjects who had not been vaccinated with PCV-7 and 127 subjects who had been vaccinated with PCV-7 at least once, were compared with regard to the 2012 strains. The serotypes contained in PCV-7 were found in 21 strains (16.5%) in those who had been vaccinated and in 37 strains (28.7%) in those who had not been vaccinated (P < 0.05). Conclusions The increased use of PCV-7 led to decreases in the serotypes contained in PCV-13 and increases in the serotypes not contained in PCV-13, suggesting serotype replacement.

Background The frequency of occurrence of pediatric invasive streptococcal infection in Japan has not been studied, therefore the aim of this study was to survey the northern and eastern regions of Hokkaido from 2010 to 2012. Method Survey sheets were sent to the pediatric departments at 17 facilities where children in the subject region can be hospitalized. Responses were obtained from all of the 17 facilities. Results Seven patients developed group A streptococcal infection over the 3 years, and their ages ranged from 1 day after the birth to 15 years old. Sepsis was diagnosed in five children, and empyema and arthritis in the knee were found in one child each, respectively. The number of cases in children under 15 years old was six excluding the child who was 15 years old, and the incidence rate per 100 000 population was 1.00. Eight children developed group B streptococcal infection, and their ages ranged from 0 days to 2 months after birth. Two cases were the early onset type (age within 7 days) and six cases were the late onset type. Five children developed sepsis and three children developed meningitis. The frequency of occurrence was 0.24 per 1000 births; which was 0.06 per 1000 births for the early onset type and was 0.18 per 1000 births for the late onset type. No reports for group C or group G hemolytic streptococcal infection were obtained. Conclusions The incidence rates identified in the present survey are similar to those in other advanced countries, and appear to be valid.

Background Congenital cytomegalovirus (CMV) infection and neonatal herpes are major mother-to-child infections, and analyses of the important clinical issues, including risk factors for prognosis, are essential. Methods A secondary survey of congenital CMV infection and neonatal herpes was performed using questionnaires for cases reported in the primary survey between 2006 and 2008. Results Univariate analysis of 71 cases of congenital CMV infection showed that intrauterine growth restriction (IUGR) or other specific findings on fetal ultrasonography (US), microcephaly, intracranial calcification, disseminated intravascular coagulation, abnormal findings on computed tomography, and the use of i.v. gammaglobulin were all significantly correlated with poor outcome (death or severe sequelae). Multivariate analysis showed that only IUGR was significantly associated with poor outcome. Hearing impairment is one of the major abnormalities associated with congenital CMV infection. Automatic auditory brainstem response (automatic ABR) appeared to be useful for detection of hearing impairment in comparison with conventional ABR. Moreover, univariate analysis showed that specific fetal US or abnormal magnetic resonance imaging findings were correlated with sensorineural hearing loss. In 24 cases of neonatal herpes, fever and seizure were correlated with poor outcome on univariate analysis. All patients received acyclovir treatment, although substantial numbers of patients in severe clinical categories (disseminated or central nervous system diseases) received a low dose of acyclovir (

Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae are the main pathogens causing community-acquired pneumonia (CAP). We identified S. pneumoniae (n = 241), H. influenzae (n = 123), and M. pneumoniae (n = 54) as causative pathogens from clinical findings and blood tests from pediatric CAP patients (n = 903) between April 2008 and April 2009. Identification of genes mediating antimicrobial resistance by real-time PCR was performed for all isolates of these three pathogens, as was antibiotic susceptibility testing using an agar dilution method or broth microdilution method. The genotypic (g) resistance rate was 47.7 % for penicillin-resistant S. pneumoniae (gPRSP) possessing abnormal pbp1a, pbp2x, and pbp2b genes, 62.6 % for β-lactamase-nonproducing, ampicillin-resistant (gBLNAR) H. influenzae possessing the amino acid substitutions Ser385Thr and Asn526Lys, and 44.4 % for macrolide-resistant M. pneumoniae (gMRMP) possessing a mutation of A2063G, A2064G, or C2617A. Serotype 6B (20.3 %) predominated in S. pneumoniae, followed by 19F (15.4 %), 14 (14.5 %), 23F (12.0 %), 19A (6.2 %), and 6C (5.4 %). Coverage for the isolates by heptavalent pneumococcal conjugate vaccine (PCV7) and PCV13, respectively, was calculated as 68.5 and 80.9 %. A small number of H. influenzae were identified as type b (6.5 %), type e (0.8 %), or type f (0.8 %); all others were nontypeable. Proper use of antibiotics based on information about resistance in CAP pathogens is required to control rapid increases in resistance. Epidemiological surveillance of pediatric patients also is needed to assess the effectiveness of PCV7 and Hib vaccines after their introduction in Japan.

Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of commonly used clinical antimicrobial drugs were examined for 76 strains of Streptococcus pneumoniae isolated between 2006 and 2011 from pediatric patients with invasive pneumococcal infection. Patients from whom bacterial strains were isolated ranged from 4 months to 6 years old and included 50 infants (65.8%) 1 year old and 10 (13.2%) less than 1 year old, i.e., 79.1% of all patients studied. In diagnosis, 38 (50.0%) had occult bacteremia, 34 (44.7%) pneumonia, 3 (3.9%) meningitis, and 1 (1.3%) sepsis. Infections in all but one case who died of sepsis were treated without sequelae. The most frequent capsular serotype among isolates was 6B (20 strains, 26.3%), followed by 19 F (13 strains, 17.1%) and 14 (9 strains, 11.8%). Serotypes for 55 strains (72.4%) corresponded to those contained in heptavalent pneumococcal conjugate vaccine. In classification by resistance based on mutations in penicillin-binding protein genes, 32 were penicillin-resistant S. pneumoniae (42.1%), 35 penicillin intermediate-resistant S. pneumoniae (46.1%), and 11 penicillin-susceptible S. pneumoniae (11.8%). MIC90/MBC90 of drugs were as follows: ampicillin 4/4 microg/mL, cefotaxime 0.5/0.5 microg/mL, ceftriaxone 1/2 microg/ mL, panipenem 0.125/0.125 microg/mL, meropenem 0.5/0.5 microg/mL, and doripenem 0.25/0.25 microg/mL.

We evaluated the efficacy and safety of a 3-day treatment regimen of tebipenem pivoxil for pediatric community-acquired pneumonia. Tebipenem pivoxil was administered to 49 patients, and its effectiveness was evaluated in 36 patients 2–4 days after initiation of treatment. Thirty-two patients were cured 7–15 days after initiation of treatment. Body temperature was significantly lower on the day following initial administration (median 38.8 to 37.0 °C, n = 33). Leukocyte counts and C-reactive protein levels were significantly reduced by Day 2–4 of treatment (median 16,100 to 7800 white blood cells/μL, and 5.6 to 1.5 mg/dL, respectively; n = 28). Six of the 49 patients had mild diarrhea. Thus, we concluded that 3-day treatment with tebipenem pivoxil was safe and efficacious for treating pediatric community-acquired pneumonia.

Safety information regarding drug use during pregnancy is insufficient. The present study aimed to establish an optimal signal detection method to identify adverse drug reactions in pregnant women and to evaluate information in the Japanese Adverse Drug Event Report (JADER) database between April 2004 and November 2014. We identified reports on pregnant women using the Standardised MedDRA Queries. We calculated the proportional reporting ratio (PRR) and reporting odds ratio (ROR) of the risk factors for the two known risks of antithyroid drugs and methimazole (MMI) embryopathy, and ritodrine and fetal/infant cardiovascular events. The PRR and ROR values differed between all reports in the JADER database and those on pregnant women, affecting whether signal detection criteria were met. Therefore we considered that reports on pregnant women should be used when risks associated with pregnancy were determined using signal detection. Analyses of MMI embryopathy revealed MMI signals [PRR, 159.7; ROR, 669.9; 95% confidence interval (CI), 282.4-1588.7] but no propylthiouracil signals (PRR, 1.98; ROR, 2.0; 95%CI, 0.3-15.4). These findings were consistent with those of reported risks. Analyses of fetal/infant cardiovascular events revealed ritodrine signals (PRR, 2.1; ROR, 2.1; 95%CI, 1.4-3.3). These findings were also consistent with reported risks. Mining the JADER database was helpful for analyzing adverse drug reactions in pregnant women.

Background Spirometry is the most widely used pulmonary function test and the measured values of spirometric parameters need to be evaluated using reference values predicted for the corresponding race, sex, age, and height. However, none of the existing reference equations for Japanese children covers the entire age range of 6–18 years. The Japanese Society of Pediatric Pulmonology had organized a working group in 2006, in order to develop a new set of national standard reference equations for commonly used spirometric parameters that are applicable through the age range of 6–18 years. Methods Quality assured spirometric data were collected through 2006–2008, from 14 institutions in Japan. We applied multiple regression analysis, using age in years (A), square of age (A2), height in meters (H), square of height (H2), and the product of age and height (AH) as explanatory variables to predict forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), peak expiratory flow (PEF), forced expiratory flow between 25% and 75% of the FVC (FEF25–75%), instantaneous forced expiratory flow when 50% (FEF50%) or 75% (FEF75%) of the FVC have been expired. Results Finally, 1,296 tests (674 boys, 622 girls) formed the reference data set. Distributions of the percent predicted values did not differ by ages, confirming excellent fit of the prediction equations throughout the entire age range from 6 to 18 years. Cut-off values (around 5 percentile points) for the parameters were also determined. Conclusions We recommend the use of this new set of prediction equations together with suggested cut-off values, for assessment of spirometry in Japanese children and adolescents. Pediatr Pulmonol. 2013; 48:35–44. © 2012 Wiley Periodicals, Inc.

We evaluated 103 cases of invasive pneumococcal disease (IPD) encountered in 99 children (two developed the disease twice and one, three times) treated in the northern district of Hokkaido (Kamikawa and Soya subprefecture) from April 2000 until March 2010, before the introduction of the 7-valent pneumococcal conjugate vaccine. The main diseases were as follows: pneumonia, 54 cases (52.9%); occult bacteremia, 34 cases (33.3%); meningitis, five cases (4.9%). There were 42 cases during the first half of the study period (from April 2000 to March 2005) and 61 during the second half (from April 2005 to March 2010). The IPD morbidity rate for the 10-year period was 41.3 per 100,000 population in children

An evaluation committee studied the relationship between initial treatment drug and prognosis in 339 of 466 subjects with bacterial meningitis treated at 108 institutions between April 2004 and January 2007, after excluding those with uncertain diagnosis or non-assessable records. Prognosis was considered unfavorable if meningitis sequelae such as quadriplegia, deafness, or epilepsy were present in 3- month follow-up; Based on this definition, 43 (12.7%) had a poor prognosis. No significant relationship was seen between unfavorable prognosis and age or causative pathogen. More had an unfavorable prognosis if treatment was initiated 4 days or later after onset. The percentage with an unfavorable prognosis was 6.4% (4/64) in the group administered combined panipenem/betamipron (PAPM/BP) plus ceftriaxone (CTRX), 10.5% (6/57) administered MEPM plus cefotaxime (CTX), 14.0% (7/50) administered meropenem (MEPM) plus CTRX, and none of the 23 administered CTRX alone. The percentage with an unfavorable prognosis was 26.2% (11/42) in those administered MEPM, significantly higher than that in those administered PAPM/BP plus CTRX, MEPM plus CTX, or CTRX alone (p < 0.05). We concluded that in initial treatment, it would be more desirable to use MEPM combined with another drug than alone.

Background. The ratio of CA-MRSA in children with impetigo has been increasing in Japan.Methods. Antimicrobial susceptibilities of 136S. aureusisolates from children with impetigo were studied. Furthermore, molecular epidemiological analysis and virulence gene analysis were performed.Results. Of the 136S. aureusisolates, 122 (89.7%) were MSSA and 14 (10.3%) were MRSA. Of the 14 MRSA strains, 11 belonged to CC89 (ST89, ST91, and ST2117) and carried diverse types of SCCmec: type II (IIb: 3 strains; unknown subtype: 4 strains), type IVa (2 strains), and unknown type (2 strains). The remaining three strains exhibited CC8 (ST-8)-SCCmectype VIa, CC121 (ST121)-SCCmectype V, and CC5 (ST5)-nontypeable SCCmecelement, respectively. None werelukS-PV-lukF-PV gene positive. Gentamicin- and clarithromycin-resistant strains were frequently found in both MRSA and MSSA.Conclusions. PVL-negative CC89-SCCmectype II strains are the most predominant strains among the CA-MRSA strains circulating in the community in Japan.

To describe clinical aspects of pandemic (H1N1) 2009 virus–associated pneumonia in children, we studied 80 such children, including 17 (21%) with complications, who were admitted to 5 hospitals in Japan during August–November 2009 after a mean of 2.9 symptomatic days. All enrolled patients recovered (median hospitalization 6 days). Timely access to hospitals may have contributed to favorable outcomes.

Hepatic artery and portal vein thrombosis are devastating complications of partial liver transplantation. Early detection of inflow complications is important, as re-reconstruction can salvage the graft. Near-infrared spectroscopy or laser Doppler flowmetry can be used to detect tissue oxygenation or microcirculation on the liver surface. The aim of this study was to examine which of these two methods better detects changes in hepatic inflow. Sangen-strain pigs (n = 5) were used. The tips of the near-infrared spectroscopy and laser Doppler flowmetry probes were placed separately on the surface of the right liver. Inflow to the liver was controlled during the following seven conditions: control (not clamped), half- and totally clamped portal vein, half- and totally clamped hepatic artery, and half- and totally clamped portal vein and artery. Tissue blood flow was calculated using laser Doppler flowmetry. Oxyhemoglobin, deoxyhemoglobin, and the tissue oxygenation index were measured and calculated using a near-infrared spectroscopy system. The tissue blood flow and oxygenation index could not be used to differentiate between the half-clamped portal vein, half-clamped hepatic artery, and totally clamped portal vein conditions. The oxyhemoglobin minus deoxyhemoglobin value was significantly decreased after half or total clamping of the portal vein or hepatic artery (p

We evaluated the beta-lactamase-producing ability and resistance to 20 antibacterial agents of 448 clinically isolated strains of Haemophilus influenzae accumulated from October 2000 to July 2001 (phase 1) and of 376 different strains accumulated from January to June 2004 (phase 2), from institutions that participated in a nationwide Drug-Resistant Pathogen Surveillance Group in Pediatric Infectious Disease. Between phase 1 and phase 2 the proportion of beta-lactamase-negative ampicillin (ABPC)-susceptible (BLNAS) strains declined from 62.9% to 34.3%; the proportions of beta-lactamase-positive ABPC-resistant (BLPAR) strains were 8.3% and 6.4% in phases 1 and 2, but the proportion of beta-lactamase-negative ABPC-resistant (BLNAR) strains increased from 28.8% in phase 1 to 59.3% in phase 2. Comparison of the MIC(90) values of the antibacterial agents for H. influenzae in phase 1 and phase 2 showed that cefcapene, cefpodoxime, ceftriaxone, panipenem, and clarithromycin kept the same level, while cefdinir, faropenem, and rokitamycin showed 2-fold to 8-fold decreases. With the exception of the above antibiotics, all of the other antibacterial agents tested showed 2-fold to 4-fold increases. The MIC(90) values of the beta-lactam drugs for BLNAR were 2-fold to 32-fold higher than the values for BLNAS. The proportion of BLNAR H. influenzae strains rose dramatically over the 3 years between phases 1 and 2. In relation to age, prior administration of antibacterial agents, and attendance at a day nursery as background factors, no significant differences between BLNAS and BLNAR were detected in phase 1. In the phase 2 survey, the proportion of BLNAR strains showed significant differences between children under 3 years and those aged 3 years or more, and there were also significant differences according to whether antibacterial agents, especially beta-lactams, had been administered previously. No significant difference was found in resistant bacteria according to whether or not a child had attended a day nursery.

Recurrent Group A Streptococcus (GAS) infection was defined as a case in which GAS infection was suspected during June 2006-December 2008 and GAS was detected more than 2 times by throat culture. T serotype and emn genotype were investigated for GAS bacteria isolated from children with recurrent GAS infection. Bacteria gene homology was studied using pulsed-field gel electrophoresis (PFGE). Of the 43 cases of GAS infection in 21 children used as subjects, 20 had GAS infection 2 times and one 3 times. A comparison of the first and second infection in subjects (and the second and third for the child with 3), bacteria isolated from 11 cases had coincident properties and those from the remaining 11 not-coincident. The mean period of first and second infections (second and third for the child with 3) was 29.1 +/- 17.1 days for the coincident group and 215.2 +/- 187.8 days for the not-coincident group. A significant group difference in period was seen (p = 0.0013). Ten of 12 children with recurrent GAS infection within 8 weeks of the first infection and one of 10 who had it more than 8 weeks after that were included in the coincident group, indicating a significant difference (p = 0.0028).

We evaluated 12 children infected with group B Streptococcus (GBS) at Asahikawa Kosei Hospital, in Japan between 1998 and 2007. The diagnosis was bacteremia in 8 and meningitis in 4. Infection occurred before day 7 in 3 patients, between days 7 and 28 in 4, and between days 29 and 131 in 5. The incidence of early onset GBS infection was 0.4 cases/1,000 live births. Four of 11 mothers were found to have GBS in antenatal culture screening. Although 2 underwent intrapartum antibiotic prophylaxis, infants suffered GBS infection. No patients with GBS infection died, but sequelae seen in 3 patients involved epilepsy and developmental delay of varying severity. The most frequent serotypes were III in 7 patients, followed by Ia in 2, Ib in 2, and II in 1. The MIC90 was 0.015 microg/mL in panipenem and imipenem, 0.03 microg/mL in meropenem, 0.06 microg /mL in cefotaxime and ceftriaxone, and 0.12 microg/mL in ampicillin. Serotypes and MICs were measured in 28 strains from pregnant women, 11 from newborns, 19 from children, and 30 from adults between May 2007 and December 2008. The frequency of serotype III in patients with GBS infection was significantly more than that in pregnant women or adults (p < 0.05). The MIC90 in these strains was the same as those of patients with GBS infection.

As the number of medicines that patients bring with them on hospitalization is expected to increase with the introduction DPC system and patient co-payment rates rise,it will be necessary to make rules for the safety control and identification of medicines.However,one dose packages and cutting tablets into halves reduces the ability to identify the medicines that patients bring with them and their medicines may include those requiring greater caution,such as oral hypoglycemic agents.In view of this,we investigated the use of symbols on tablets and capsules by pharmacists for identification purposes as well as those on oral hypoglycemic agents.We found that a lot of pharmacists identify medicines only by identification numbers,though only a few medicines can be uniquely identified using such numbers,and that it became more difficult to identify tablets uniquely when cut in a half using the secant.It is therefore necessary to make rules that all related staff can use to identify oral hypoglycemic agents and other medicines requiring caution,not only for the identification of medicines that patients bring with them but also for identifying medicines in outpatient and emergency departments which is a frequent daily task.

Background: Retinopathy of prematurity (ROP) is a major cause of blindness in children. Because the use of oxygen is a known risk factor for development of ROP, supplemental oxygen is used carefully. However, it does not necessarily reduce the morbidity of ROP-induced blindness. The aim of the present study was to identify the possible risk factors for progression to retinal detachment, a most relevant cause of visual impairment, in extremely low-birthweight infants (ELBWI). Methods: The medical records of the 42 ELBWI who were admitted to the neonatal intensive care unit in Asahikawa Kosei Hospital from April 1999 to March 2004 were retrospectively reviewed. Seven infants (16.7% of the ELBWI) developed retinal detachment and two of them became blind. Perinatal and postnatal variables in these infants with retinal detachment were compared with those in infants without retinal detachment. Results: A striking difference in the daily intake of human milk was found between the infants with or without retinal detachment when their gestational ages at birth were matched. The infants without retinal detachment were fed more human milk (67–83% volume of total nutritional intake) as compared to those with retinal detachment (24–38% volume of total nutritional intake) at a specific postnatal period, 5–7 weeks postnatal age. Conclusions: Human milk may contain some beneficial factors to reduce the severity of ROP. Identifying these factors in human milk may contribute to development of a strategy to rescue premature infants from blindness.

Background: Influenza-associated encephalopathy is reported to be frequent in Japan and East Asia. No evaluating markers except interleukin (IL)-6 and tumor necrosis factor (TNF)-α and no likely pathological mechanism for the disease have yet been elucidated. Methods: In this study, influenza-associated encephalopathy was defined by clinical symptoms, and the use of an anti-influenza antibody test and/or influenza antigen detection kits, as well as computed tomography and/or magnetic resonance imaging. The levels of proinflammatory cytokines, acute phase proteins, endothelial markers and cytochrome c were compared in sera from 11 patients with and 42 without encephalopathy. Results: Cytochrome c concentration in sera from patients with encephalopathy was markedly increased compared with that from patients without encephalopathy and normal controls. Although levels of several other proinflammatory cytokines and acute phase proteins such as TNF-α and IL-8 were also elevated in patients with influenza virus infection, the difference between those with and without encephalopathy, though significant, was less dramatic. The mean serum concentration of cytochrome c in 11 patients with encephalopathy, consisting of four deceased, four with and three without residual central nervous system sequelae, was 26.7 ± 19.5 ng/mL on admission. In contrast, cytochrome c levels in 42 patients without encephalopathy were 0.3 ± 0.7 ng/mL. Conclusion: The present results indicate that cytochrome c is a useful marker to follow patients with influenza-associated encephalopathy and suggest that an apoptosis of cells in several organs including the cerebrum and liver under the influence of hypercytokinemia is a possible mechanism of the disease.

From July 1999 to June 2004, we evaluated Streptococcus pneumoniae bacteremia in 40 children in Kamikawa and Soya Subprefectures in Hokkaido by obtaining the patient's information from 7 out of 9 hospitals in the area. The incidences of S. pneumoniae bacteremia in children aged2 years and5 years were 79.1 and 63.4. Median age was 19.6 months with a range from 4 months to 4 years. Thirty-one (77.5%) of the total were less than 2 years old. All of the children were admitted. The diagnoses were occult bacteremia in 12 patients, pneumonia or bronchitis in 11, pharyngitis in 7, pneumonia and acute otitis media in 5, acute otitis media in 3, orbital cellulitis in 1, and arthritis in 1. All of the patients had fever and temperatures and 35 (87.5%) of them were more than 39 degrees C. Ten patients had a febrile convulsion. Twenty-nine had a high total white blood cell counts (15,000/microg/ml) and 31 had positive CRP values (0.6 mg/dl) on admission. Meningitis and poor prognosis did not occur after occult bacteremia in our patients. We studied the susceptibility to penicillin G in 22 strains of S. pneumoniae isolated from the children. One and 18 strains were penicillin-resistant (MICor = 2.0 microg/ml) and intermediate (MIC 0.1-1.0 microg/ml).

Feasibility of self-healing insulation system was studied. A silicone rubber without filler was mounted on a glass substrate with a needle electrode. An ac voltage with 4 kV in rms was applied. The voltage was cut off when the tree had propagated into 150 micrometers in length. After the cut-off, the partial discharge inception voltage was periodically observed. The partial discharge inception voltage had once reduced into as low as 2 kV. However, it gradually increased with time, and finally exceeded the tree inception voltage (4 kV) when 30 - 60 hours had passed. It was also observed by optical microscope that the tree gradually disappeared in parallel with the recovery of the partial discharge inception voltage. The same phenomenon was observed even if 1 kV ac voltage had been continuously applied during the process of the recovery. A simulation using a needle-shaped void was performed in order to clarify the mechanism of the self-healing effect. It was observed that the tip of the needle-shaped void gradually got wet with a liquid material. It would be the result of "bleed-out" of the low molecular component included in the rubber. The tip of the void was finally filled with the liquid, however, the rest of the needle-shaped void stayed without being filled. In this type of tree, it was suggested that the self-healing effect is expected if the diameter of the tree did not exceed ca. 5 micrometers.

We evaluated 83 children with bacterial meningitis in 67 of 81 insitutions in Hokkaido, Japan between 1999 and 2003 by questionnaire. The incidence of bacterial meningitis in children aged < 5 years and 5 < or =, < 10 years was 6.3 and 0.7 cases per 100, 000 children/year. The incidences of meningitis due to Haemophilus influenzae, Streptococcus pneumoniae, and Streptococcus agalactiae in children aged < 5 years were 3.7, 1.4 and 0.8. Median age was 13 months ranging from 0 day to 9 years. Seventy-four (89.1%) of the total were less than 5 years old with 39 (47.0%) less than 1 year old. Major causative organisms were H. influenzae in 51 patients, S. pneumoniae in 18, S. agalactiae in 9 and E. coli in 3. Four deaths occurred, giving an overall case mortality rate of 4.8%. Sequelae were seen at discharge in 25.3%, predominantly epilepsy, hearing loss, and developmental delay of varying severity. The frequency of poor prognosis was 55.6% for patients with meningitis due to S. pneumoniae compared with 21.6% for H. influenzae and 22.2% for S. agalactiae.

Oral branched chain amino acid preparations consisting of three branched chain amino acids are used for the treatment of decompensated liver cirrhosis associated with hypoalbuminemia which occurs in spite of a sufficient intake in food. In order to evaluate the efficacy of oral branched chain amino acids, we investigated their effect in patients with liver cirrhosis, focusing on blood platelet levels. We analyzed the relationship between blood platelet counts and severity score, serum albumin concentration, total bilirubin concentration and prothrombin time.Our subjects were 13 patients with decompensated liver cirrhosis (1 female and 12 males, mean age 60.8 years). In patients with blood platelet counts of more than 10×104/μL, serum albumin concentration and severity score were significantly improved by the oral administration of branched chain amino acids. On the other hand, total bilirubin concentration and prothrombin time were not significantly changed by orally administered branched chain amino acids in patients with blood platelet counts of more than 10×104/μL and also when they were under 10×104/μL.These results suggest that classifying patients based on blood platelet levels might be useful in evaluation of the efficacy of oral branched chain amino acids, and doing this in addition to working out severity scores would be valuable in ensuring the proper use of oral branched chain amino acids.

Since the mid-1980s, there have been increasing reports of severe invasive group A streptococcal (GAS) disease in children and adults. There are few reports, however, of neonatal invasive disease, particularly neonatal pleural empyema caused by GAS. Although many mechanisms have been reported for the pathophysiology of invasive GAS infections, similar reports for neonates were unable to be located. Reported herein is the case of a 3-day-old girl with pleural empyema caused by GAS that demonstrated a high invasive capacity for human epithelial cells.

Interferon-ribavirin combination therapy is the mainstay treatment for chronic hepatitis C today. In view of its very common use, we investigated the adverse drug reactions through a retrospective review of medical records of chronic hepatitis C patients who underwent such therapy. We also determined their current condition by investigating hemoglobin levels, white blood cell counts and platelet counts.Subjects were 20 chronic hepatitis C patients (7 females and 13 males, mean age 53.6 years) who were hospitalized in the Department of Gastroenterology of Kasugai Municipal Hospital to undergo interferon-ribavirin combination therapy. Ten patients were classified as HCV serotype 1, and 10 as HCV serotype 2. Four patients discontinued the therapy. Bloodtests showed that the rate at which hemoglobin levels, white blood cell counts and platelet counts decreased tended to belower than before treatment.No notable adverse drug reactions were observed in this study, those that did occur were similar to those seen with interferon monotherapy and with the exception of muscle pain, there were no significant differences. However, many individualdifferences were seen in terms of severity, time of onset and duration of symptoms. This confirmed the need for guidanceto be geared towards individual patients. Based on the results of our investigation, we revised our brochure on interferonribavirin combination therapy to give a fuller explanation of the adverse reactions. We feel that it is very important for patients to have a good understanding of the possible adverse reactions beforehand and to make an adequate response whenthey occur during therapy.

The side effects were determined based on medical reports from 17 patients with chronic hepatitis type C who were admitted to a hospital in order to receive interferon (IFN) therapy. A pamphlet to explain the side effects was made by referring to the results of this investigation at the same time. All patients complained of fever. Two patients stopped the IFN therapy. In addition, the follow side effects have been reported in the literature; arthralgia, muscular pain, digestive system symptoms, eruptions, and sleeplessness.By investigating the period and length of time for such side effects caused by IFN therapy, we found a large number of side effects with the most frequent being fever due to IFN treatment. The occurrence of slight fever and general fatigue was immediately after IFN medication and tended to continue for a long period of time. The fever and the malaise reappeared after a fixed period during this investigation. Our findings helped us to accurately describe the side effects.In particular, patients undergoing long term IFN treatment tend to develop unique side effects. In conclusion, patients treated with IFN need to clearly understand what side effect, they can expect to experience during the course of therapy.

We evaluated rapid urinary antigen test kit for Streptococcus pneumoniae (Binax NOW S. pneumoniae) in 85 inpatients between February 2002 and November 2002. Diseases of patients were pneumonia in 82 and meningitis in 3. The age range of the patients was from 4 months to 14 years. We studied urinary antigen assay and culture of nasopharyngeal swab in all patients. Three infants with meningitis were measured liquor by the kit. Two infants with meningitis due to S. pneumoniae showed positive reactions in urine and liquor, but result of 1 infant with meningitis due to Haemophilus influenzae was negative. Of 82 patients with pneumonia, S. pneumoniae was isolated from 52 patients and the urinary antigen test was positive in 39. Thirty-eight patients were isolated S. pneumoniae in 39 positive patients and 14 children were isolated it in 44 negative patients. Sensitivity in this test kit was 73.1% and specificity was 96.8%. This test is useful for children as well as adults.

From 1992 to 2001, we studied the prevalence of infants colonized MRSA and antibiotic usage for very-low-birth-weight infants in a neonatal intensive care unit at Asahikawa Kosei Hospital. We investigated nasopharyngeal swabs and stool samples every week after admission, and occasionally skin swabs, eye discharges and urines. Seventeen infants contracted nosocomial blood stream infection caused by MRSA which occurred between 1993 and 1996. Rate of infants colonized MRSA to all inpatients was 14.9% in 1992, which increased to 40.0% in 1994, and decreased to 7.1% in 2001. In each birth-weight group, rates of > or = 1,500 g, 1,000-1,499 g, and < 1,000 g infants were 6.5%, 45.0% and 60.0% in 1992, 24.5%, 100%, and 100% in 1994, 6.2%, 10.5%, and 21.4% in 2001. The longest period of antibiotic usage was 148.4 per 1000 patient-day in 1995 and decreased to 32.6 per 1,000 patient-day in 2001. The total value of antibiotics in 1995 was about yen 3,050,000, but in 2001 was about yen 470,000.

We evaluated 82 children with bacterial meningitis in 78 institutions in Hokkaido, Japan between 1994 and 1998. The mean number of cases per year was 16.4 (range, 9 to 30). A male predominance occurred with 52 males and 30 females (1.7:1). Median age was 11 months with a range from 1 day to 11 years. Seventy-eight (95%) of the total were less than 5 years old with 55 (67%) less than 2 years old and 45 (55%) less than 1-year old. Four deaths occurred, giving an overall case fatality rate of 4.9%. Sequelae were seen at discharge in 29%, predominantly sensorineural hearing loss, epilepsy and development delay of varying severity. The main causative organisms were Haemophilus influenzae in 49 patients, Streptococcus pneumoniae in 14, Streptococcus agalactiae in 10 and Escherichia coli in 5. The frequency of poor prognosis was 50% for patients with meningitis due to S. pneumoniae or S. agalactiae compared with 27% for patients with meningitis due to H. influenzae.

Of pediatric patients with purulent meningitis seen at the institutions listed in the title page of this paper between 1986 and 1994, 93 patients treated with antibiotics and dexamethasone (DXM) were compared with 91 patients treated with antibiotics alone. The patients receiving antibiotics with dexamethasone achieved overall improvement in inflammatory symptoms and signs and cerebrospinal fluid findings and became afebrile significantly earlier than those receiving antibiotics alone. However, some of the patients became febrile again. The secondary fever rate for the DXM group was much higher than that for the antibiotic alone group (p < 0.0001). In most of the rebounded cases, the body temperature rose above 38 degrees C and remained elevated for 2-4 days. Cerebrospinal fluid (CSF) was cultured daily in 54 and 32 patients receiving antibiotics with and without DXM, respectively. Although this study was not a controlled study in a strict sense, these patients compared. In both groups, the CSF became mostly culture-negative within 48 hours. In a few patients receiving DXM, however, it became culture-negative after 72 hours or longer. DXM caused an adverse effect in a patient with meningitis caused by Streptococcus pneumoniae. The adverse effect was mild gastrointestinal bleeding, which recovered spontaneously. From the findings described above, the use of DXM combined with antibiotic therapy was considered to accelerate the relief from fever and improvement of inflammatory symptoms and signs and CSF findings. The body temperature rose again in more than half of the patients receiving DXM, but fell to normal spontaneously without treatment. The elevation doubtlessly could not be distinguished from recurrence of the meningitis itself or complications. It seems to be likely that no treatment but careful observation is required even if the fever recurs as far as the CSF findings showed favorable progress with excelluent general conditions. When DXM is given, it is essential that CSF tests and culture are repeated during the early stages and the progress is monitored carefully.

Background: The role of chemoprophylaxis for household contacts of patients with acute streptococcal disease is uncertain. Methods: The subjects were 1440 sibling contacts of 1181 index patients with group A β-hemolytic streptococcal (GABHS) pharyngitis. Instances of subsequent GABHS pharyngitis in sibling contacts who received chemoprophylaxis and in a control group without prophylaxis were compared. Results: Of the 948 siblings in the prophylaxis group, 507 were treated with cephalosporins and 441 were treated with penicillins for 3 to 5 days. Subsequent GABHS pharyngitis occurred within 30 days in 28 (3.0%) of the 948 siblings in the prophylaxis group and in 26 (5.3%) of the 492 siblings in the control group. Among siblings in the prophylaxis group, subsequent GABHS pharyngitis occurred in 9 (1.8%) of the 507 siblings in the cephalosporin prophylaxis group and in 19 (4.3%) of the 441 siblings in the penicillin prophylaxis group. When these data were each compared with that in the control group (5.3%), a significant statistical difference was seen in the cephalosporin prophylaxis group (P = 0.003) but not in the penicillin prophylaxis group (P = 0.542). Only 5-day cephalosporin prophylaxis showed significant reduction in the rate of subsequent GABHS pharyngitis compared with that in the control group (P = 0.002). Conclusions: In view of the low incidence of subsequent GABHS pharyngitis in the nonprophylaxis group, the usual self-limited nature of GABHS pharyngitis, the cost of prophylaxis and the risk for selecting resistant flora, routine chemoprophylaxis against GABHS pharyngitis for sibling contacts is not recommended.

Between November 1996 and January 1997, 14 patients were diagnosed as having infection caused by adenovirus type 7 in a paediatric ward of Asahikawa Kosei Hospital. The age range of the patients was from two months to five years. Their diseases and abnormal laboratory findings were pneumonia in all 14, leucocytopenia in 10, myositis in nine, gastroenteritis in eight, encephalitis in five, liver dysfunction in three, pleuritis in two, inappropriate secretion of antidiuretic hormone syndrome in two, and thrombocytopenia in two. The infected patients, except for the first had been hospitalized in the paediatric ward for treatment of another disease and re-admitted because of high fever and coughing a few days after improvement or discharge. It is thought that the cause of the outbreak was hospital-acquired infection.

The patient was born by emergency cesarean section for fetal distress at 35 weeks gestation with a weight of 2740 g. The early neonatal course was complicated by transient tachypnea and renal failure. He was receiving oxygen and diureticus in incubator for 5 days and his condition was very improved on day 5. On day 7 he became lethargy and there was inability to tolerate feeding. Investigation of the cerebrospinal fluid revealed 8,000 leukocytes/microliter. S. marcescens was grown from cultures of both blood and cerebrospinal fluid. Treatment was started with cefotaxime and ampicillin every 6 hour. On day 14 the CT showed a brain abscess located parietooccipitally on the left side and diffuse infarction on the right side. On day 14 and 23 recurrence of increased leukocytes in the cerebrospinal fluid, high values of serum CRP and deterioration of clinical symptoms were observed. It is thought that the episodes show rupture of the abscess into the lateral ventricle. On day 55 surgical drainage was performed for the hydrocephalus. On day 110 the abscess was not found in the brain CT scan. His psychomotor development 3 years later was equivalent to two years old and he had secondary epilepsy.

Recent development of power semiconductor devices has produced remarkable advances in power electronics. Among them, the gate turn-off thyristor (GTO) is one of the most important devices. Carrier lifetime-controlled devices have been proposed recently to realize low turn-off switching loss. Thus, computer simulation for the device is now necessary to predict its characteristics. In this study, we simulated a carrier lifetime-controlled GTO with the FEM program. Lifetime control, such as heavy metal diffusion and electron beam irradiation, showed a trade-off relation between on-state and turn-off conditions. Partial lifetime control, which generates lattice defects locally by light ion irradiation, showed the possibility of reducing turn-off loss and improving the trade-off relations. Furthermore, the numerical analyses showed relations between the location of the irradiated point and variations of the internal carrier distributions. © 1997 Scripta Technica, Inc. Electr Eng Jpn 119(1): 82–89.

We observed 266 children with purulent meningitis in 27 institutions in Japan during the 14 years from 1981 on dividing these years into 3 periods, 1981-1985, 1986-1990 and 1991-1994, and studied the trend of causative organisms identified in 254 among the 266 patients. Their ages were less than 3 months after birth in 50 children and 3 months or older in 216: there were 141 boys and 125 girls. The causative organisms were H. influenzae in 134 patients and S. pneumoniae in 50, most of them being aged 3 months or older. Next to the above bacteria ranked S. agalactiae in 29 and E. coli in 12, many of the patients were aged less than 3 months. Staphylococcus spp. was found in 7 patients and about 70% of them were aged 3 months or older. L. monocytogenes was found in 4 patients and N. meningitidis in 3 and they were aged 3 months or older in both patient groups. S. pyogenes, Enterococcus spp., Peptostreptococcus spp., P. Mirabilis and Enterobacter spp. were detected each in 1 patient. The causative organism was unknown in 21 patients and there was no double infection. H. influenzae were detected in 18 patients in 1981-1985 period (36.7%), in 56 in 1986-1990 (54.9%) and in 60 in 1991-1994 (63.8%) showing an increasing tendency, but S. pneumoniae exhibited neither an increasing nor decreasing tendency. There was a decreasing tendency with S. agalactiae and E. coli, but the details were not clear because there were few patients aged less than 3 months. Although the period of coexistence of 4 main bacterial species was not made clear in this study. Listeria is considered to develop mainly in the early childhood, and we believe that the conventional way of using a cephem preparation and ampicillin combined for patients under 6 years need not be altered. However, panipenem (phonetic) is likely to be effective for insensible S. pneumoniae for the time being.

Arbekacin (ABK) is an aminoglycoside with excellent antibacterial activity against methicillin-resistantStaphylococcus aureus (MRSA). Although ABK is expected to be a useful drug for MRSA infection in newborns, there have been few reports concerning its pharmacokinetics, efficacy, and safety. Ten low-birth-weight infants were treated with ABK. Their mean gestational age was 29.4±5.3 weeks and their mean birth weight was 1204±532 grams. At the time of initial ABK administration, the mean postconceptional age was 33.9±4.2 weeks. ABK was infused over a period of 30 minutes every 12 hours at doses ranging between 2.2 and 3.1 mg/kg. Trough (predose) and peak (30 minute postdose) serum ABK concentrations were determined. TheN-acetyl-β-d-glucosaminidase (NAG) index (NAG:creatinine ratio) was measured before and after ABK therapy. The mean peak serum ABK concentration was 8.49±2.06 μg/mL and the mean trough concentration was 3.93±2.14 μg/mL, with a mean half-life of 11.4±6.1 hours. A significant negative correlation existed between postconceptional age and ABK half-life (r=0.64;P

BACKGROUND Although retinal breaks occur frequently during vitrectomy, the postoperative occurrence of new retinal holes close to the vascular arcade after vitrectomy for rhegmatogenous retinal detachment rarely has been reported. METHODS Three patients with rhegmatogenous, retinal detachment were treated by vitrectomy. More than 49 days after vitrectomy, posterior retinal holes with no retinal detachment occurred halfway between the vascular arcade and the chorioretinal scar around the extrusion hole or the primary retinal tear. RESULTS These new holes were effectively managed with photocoagulation. CONCLUSION New hole formation could be caused by the technique of the internal drainage, the contraction of the photocoagulation scar, or epiretinal membrane contraction. Another possibility is that new holes occur through two opposite tangential traction contractile forces: one induced by the contraction of the photocoagulation scar, the other caused by the contraction of the premacular cortical vitreous attached to the vascular arcade.