Search

Background: To provide more effective pregraduate patient safety education, understanding medical students' perceptions of patient safety before pregraduate patient safety education is necessary. Therefore, we conducted this study to examine patient safety awareness among medical students at the time of admission and compare it with that among controls. Methods: In the 2019 academic year, 132 medical school freshmen enrolled at Teikyo University and 166 age-matched, non-medical students enrolled at an affiliated institution within the Teikyo University organization were surveyed using an anonymous and self-administered questionnaire. The questionnaire divided patient safety awareness into three categories: perception, knowledge, and attitude, which were evaluated on a 5-point Likert scale (Cronbach's alpha coefficient was 0.77). To assess overall patient safety awareness, the total scores were calculated for the item groups on "perception", "knowledge", and "attitude" and compared these scores between the two groups. Results: The total scores (mean ± SD) were 104.2 ± 10.2 for medical students and 88.8 ± 9.6 for controls (p < 0.001). In the "perception" and "attitude" item groups, a higher proportion of medical students provided a positive response than controls. In particular, medical students were more motivated to learn about patient safety than the controls. In the "knowledge" item group, neither medical students nor controls provided a high proportion of positive responses. Conclusions: Medical students demonstrated a higher awareness of patient safety than controls and showed a strong sensitivity to patient safety from the time of enrollment. [ABSTRACT FROM AUTHOR]

Intraplate earthquakes occur more frequently in the Japanese islands than in other regions. Large intraplate earthquakes in the island arc preferentially occur in strain concentration zones detected by geological and geodetic studies. Crustal heterogeneity plays a crucial role in generating large intraplate earthquakes and strain concentrations. Thus, we elucidated the crustal heterogeneities beneath a strain concentration area on the back‐arc side of the northeastern Japan Arc based on electrical resistivity, which is sensitive to weak zones in the crust. By deploying wideband magnetotelluric surveys, we revealed the three‐dimensional electrical resistivity structure in the crust, suggesting the coexistence of two different types of strain‐concentration mechanisms in the strain‐concentration area. The shallow conductive layers and lower‐crustal conductors appear to act as low‐elastic‐modulus and low‐viscosity areas, respectively, and are responsible for the strain concentration. We found shallow and lower‐crustal conductors in the strain concentration zone revealed by geological studies. Those conductive areas are considered to act as mechanically weak zones and cause stress loading on the brittle pars of pre‐existing faults, resulting in large intraplate earthquakes. The resultant earthquakes presumably contribute to strain accumulation on a geological timescale. In addition, a spatial correlation between the epicenters of large intraplate earthquakes and edges of lower‐crustal conductors implies the contribution of the fluids in the lower crust to the generation of large earthquakes. We also identified vertical conductors ranging from the lower crust to Quaternary volcanoes, which may indicate trans‐crustal magmatic systems under these volcanoes. Plain Language Summary: Intraplate earthquakes occur more frequently in the Japanese islands than in other regions worldwide. Large intraplate earthquakes in this region preferentially occur in high‐deformation zones, as detected by geological studies and global positioning system (GPS) measurements. Heterogeneous structure in the crust plays a crucial role in the generation of large intraplate earthquakes and high crustal deformations. Thus, we revealed the three‐dimensional crustal electrical resistivity structure beneath a strain‐concentration area in the northeastern Japan. The resistivity structure suggests the coexistence of two different mechanisms of high deformation. Shallow conductive layers and lower‐crustal conductors appear to act as low‐stiffness and low‐viscosity areas, respectively, leading to high crustal deformation. We found shallow and deep conductors in the high‐deformation zones revealed by geological studies. As both can act as weak zones, those conductors presumably play a key role in loading on faults, resulting in intraplate earthquakes. Because the epicenters of large intraplate earthquakes are positioned near the edges of lower‐crustal conductors, the fluids in those deep conductors possibly contribute to the generation of large earthquakes. We also revealed vertical conductors ranging from the deep crust to Quaternary volcanoes, which may indicate magma‐rich areas under these volcanoes. Key Points: The electrical resistivity structure suggests the coexistence of two strain‐concentration mechanisms in the strain‐concentration areaThe shallow conductive layers and lower‐crustal conductors act as low‐elastic‐modulus and low‐viscosity areas, respectivelyWeak zones in the crust, imaged as conductors, presumably cause stress loading on faults and contribute to large intraplate earthquakes [ABSTRACT FROM AUTHOR]

Background During the coronavirus disease-2019 (COVID-19) pandemic, segments of the public relied on social media platforms such as Twitter for medical information shared by medical personnel. Although physicians are likely to disseminate more accurate information on Twitter than non-medical individuals, it cannot be taken for granted. As such, tweets written by physicians in Japan should also be scrutinized for accuracy. Purpose The purpose of this study was to create a profile of the most popular physician influencers on Twitter in Japan, and to do a fact-check of their tweets regarding COVID-19-related drugs. Design This is a retrospective observational study. Methods We purchased Twitter data for Japan for the initial 9 months of the COVID-19 pandemic (from January 2020 to September 2020), and extracted tweets with keywords related to COVID-19 at a sampling rate of 3%. The most popular physicians were identified and selected consecutively by searching for the top 1000 accounts using Twitter's search function. These top accounts were considered influencers and their tweets and retweets concerning COVID-19-related drugs were fact-checked against scientific literature. Results We identified 21 physician influencers with real names: most were male in their 40s and 50s working at private medical facilities. The contents of their tweets were mainly sourced from scientific publications that were current at that time. The fact-check revealed that only one of 50 tweets was not correct while the others had no identifiable inaccuracies. Conclusions Except for one tweet, tweets written and retweeted by Japanese physician influencers concerning the COVID-19-related drugs contained predominantly accurate information.   What is already known on this topic?   During the COVID-19 pandemic, Japanese physicians were likely to disseminate more accurate information on Twitter than non-medical individuals, but it cannot be taken for granted. What this study adds?   We identified 21 Japanese physician influencers on Twitter. Except for one tweet in Japanese, their tweets contained predominantly accurate information. How this study might affect research, practice, or policy?   Use of Twitter by Japanese physicians with real names will continue to be an effective means of providing rapid information. [ABSTRACT FROM AUTHOR]

Aim: Validity of Algorithms in Large Databases: Infectious Diseases, Rheumatoid Arthritis, and Tumor Evaluation in Japan (VALIDATE‐J) study examined algorithms for identifying rheumatoid arthritis (RA) in Japanese claims data. Methods: VALIDATE‐J was a multicenter, cross‐sectional retrospective study. Disease‐identifying algorithms were used to detect RA diagnosed between January 2012 and December 2016 using claims data from two Japanese hospitals. An RA diagnosis was confirmed using one of four gold standard definitions. Positive predictive values (PPVs) were calculated for prevalent (regardless of baseline RA‐free period) and incident (preceded by a 12‐month RA‐free period) cases. Results: Of patients identified using claims‐based algorithms, a random sample of 389 prevalent and 134 incident cases of RA were included. Cases identified by an RA diagnosis, no diagnosis of psoriasis, and treatment with any disease‐modifying antirheumatic drugs (DMARDs) resulted in the highest PPVs versus other claims‐based treatment categories (29.0%–88.3% [prevalent] and 41.0%–78.2% [incident]); cases identified by an RA diagnosis, no diagnosis of psoriasis, and glucocorticoid‐only treatment had the lowest PPVs. Across claims‐based algorithms, PPVs were highest when a physician diagnosis or decision by adjudicators (confirmed and probable cases) was used as the gold standard and were lowest when American College of Rheumatology/European Alliance of Associations for Rheumatology 2010 criteria were applied. PPVs of claims‐based algorithms for RA in patients aged ≥66 years were slightly higher versus a USA Medicare population (maximum PPVs of 95.0% and 88.9%, respectively). Conclusion: VALIDATE‐J demonstrated high PPVs for most claims‐based algorithms for diagnosis of prevalent and incident RA using Japanese claims data. These findings will help inform appropriate RA definitions for future claims database research in Japan. [ABSTRACT FROM AUTHOR]

Urban areas are responsible for more than 40 % of global energy-related carbon dioxide (CO 2) emissions. The Tokyo metropolitan area (TMA), Japan, one of the most populated regions in the world, includes various emission sources, such as thermal power plants, automobile traffic, and residential facilities. In order to infer a top–down emission estimate, we conducted an intensive field campaign in the TMA from February to April 2016 to measure column-averaged dry-air mole fractions of CO 2 (XCO 2) with three ground-based Fourier transform spectrometers (one IFS 125HR and two EM27/SUN spectrometers). At two urban sites (Saitama and Sodegaura), measured XCO 2 values were generally larger than those at a rural site (Tsukuba) by up to 9.5 ppm, and average diurnal variations increased toward evening. To simulate the XCO 2 enhancement (Δ XCO 2) resulting from emissions at each observation site, we used the Stochastic Time-Inverted Lagrangian Transport (STILT) model driven by meteorological fields at a horizontal resolution of ∼1 km from the Weather Research and Forecasting (WRF) model, which was coupled with anthropogenic (large point source and area source) CO 2 emissions and biogenic fluxes. Although some of the diurnal variation of Δ XCO 2 was not reproduced and plumes from nearby large point sources were not captured, primarily because of a transport modeling error, the WRF–STILT simulations using prior fluxes were generally in good agreement with the observations (mean bias, 0.30 ppm; standard deviation, 1.31 ppm). By combining observations with high-resolution modeling, we developed an urban-scale inversion system in which spatially resolved CO 2 emission fluxes at >3 km resolution and a scaling factor of large point source emissions were estimated on a monthly basis by using Bayesian inference. The XCO 2 simulation results from the posterior CO 2 fluxes were improved (mean bias, -0.03 ppm; standard deviation, 1.21 ppm). The prior and posterior total CO 2 emissions in the TMA are 1.026 ± 0.116 and 1.037 ± 0.054 Mt-CO 2 d -1 at the 95 % confidence level, respectively. The posterior total CO 2 emissions agreed with emission inventories within the posterior uncertainty, demonstrating that the EM27/SUN spectrometer data can constrain urban-scale monthly CO 2 emissions. [ABSTRACT FROM AUTHOR]

Background: Gasping during resuscitation has been reported as a favorable factor for out-of-hospital cardiac arrest. We examined whether gasping during resuscitation is independently associated with favorable neurological outcomes in patients with refractory ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) undergoing extracorporeal cardiopulmonary resuscitation ECPR. Methods: Data from a 2014 study on advanced cardiac life support for ventricular fibrillation with extracorporeal circulation in Japan (SAVE-J), which examined the efficacy of ECPR for refractory VF/pVT, were analyzed. The primary endpoint was survival with a 6-month favorable neurological outcome in patients who underwent ECPR with or without gasping during resuscitation. Multivariate logistic regression analysis was performed to evaluate the association between gasping and outcomes. Results: Of the 454 patients included in the SAVE-J study, data from 212 patients were analyzed in this study after excluding those with missing information and those who did not undergo ECPR. Gasping has been observed in 47 patients during resuscitation; 11 (23.4%) had a favorable neurological outcome at 6 months. Multivariate logistic regression analysis showed that gasping during resuscitation was independently associated with a favorable neurological outcome (odds ratio [OR], 10.58 [95% confidence interval (CI) 3.22–34.74]). The adjusted OR for gasping during emergency medical service transport and on arrival at the hospital was 27.44 (95% CI 5.65–133.41). Conclusions: Gasping during resuscitation is a favorable factor in patients with refractory VF/pVT. Patients with refractory VF/pVT with continuously preserved gasping during EMS transportation to the hospital are expected to have more favorable outcomes. [ABSTRACT FROM AUTHOR]

Background: The Cockcroft–Gault formula is commonly used as a substitute for glomerular filtration rate (GFR) in Calvert's formula for carboplatin dosing, where adjusting serum creatinine measured using the enzymatic method with 0.2 mg/dL has been suggested in Japan. However, the effects of these adjustments on efficacy in patients with non‐small‐cell lung cancer remain unknown. Methods: We conducted a post hoc analysis of the PREDICT1 study (CJLSG1201), a multicenter prospective observational trial of carboplatin–pemetrexed. Glomerular filtration rate values in Calvert's formula were back‐calculated from the administered dosages of carboplatin and the reported value of the target area under the curve. We estimated the serum creatinine adjustments and divided the patients into crude and adjusted groups. Results: Patients in the crude group (N = 169) demonstrated similar efficacy to those in the adjusted group (N = 104) in progression‐free survival (PFS) and overall survival (OS) (hazard ratio [HR], 1.02; 95% confidence interval [CI], 0.76–1.35; p = 0.916 vs. HR, 0.87; 95% CI, 0.65–1.17; p = 0.363), with higher grade 3–4 hematologic toxicity. Among patients aged ≥75 years, the crude group (N = 47) showed superior efficacy compared with the adjusted group (N = 17) in PFS and OS (HR, 0.37; 95% CI, 0.20–0.69; p = 0.002 vs. HR, 0.43; 95% CI, 0.23–0.82; p = 0.010). Conclusions: Serum creatinine adjustment may be associated with similar efficacy compared to the crude serum creatinine value. In older patients, the adjustment should be cautiously applied owing to the potential for reduced efficacy. [ABSTRACT FROM AUTHOR]

Summary: Immune-related sclerosing cholangitis (irSC) is relatively rare and its clinical characteristics are not well known. In this study, we aimed to summarize the clinical features of irSC. Clinical data were collected retrospectively from 1,393 patients with advanced malignancy treated with immune-checkpoint inhibitors (ICIs) between August 2014 and October 2021. We analyzed patients with immune-related adverse events of liver injury (liver-irAEs) and compared irSC and non-irSC groups. Sixty-seven patients (4.8%) had a liver-irAE (≥ grade 3) during the follow-up period (median, 262 days). Among these, irSC was observed in eight patients (11.9%). All patients in the irSC group were treated with anti-PD-1/PD-L1 antibodies. Compared with the non-irSC group, the irSC group showed mainly non-hepatocellular liver injury (87.5 % vs 50.8 %, P = 0.065), and had elevated serum inflammatory markers (e.g., CRP and NLR) and biliary enzymes (e.g., GGTP and ALP) at the onset of liver-irAEs. Furthermore, most patients with irSC had abdominal pain. In the non-irSC group, the liver injury of 23 patients improved only with the discontinuation of ICIs, and 22 patients improved with medication including prednisolone (PSL). Conversely, almost all patients (n=7) in the irSC group were treated with PSL, but only two patients experienced an improvement in liver injury. We found that irSC is characterized by a non-hepatocellular type of liver injury with abdominal pain and a high inflammatory response and is refractory to treatment. Further examination by imaging is recommended to detect intractable irSC in cases with these characteristics. [ABSTRACT FROM AUTHOR]

Iodine-containing formulations have been widely used to treat iodine deficiency and as antiseptics. Lecithin-bound iodine (LBI) has been approved to treat allergic diseases in Japan; however, its underlying mechanism remains unknown. In this study, we show that LBI ameliorated disease symptoms in an ovalbumin (OVA)-induced allergic rhinitis mouse model. LBI suppressed OVA-specific IgE production by attenuating germinal center (GC) reaction in the draining lymph nodes. The antiallergic effect of LBI is most likely attributed to increased serum iodine levels but not thyroid hormone levels. In vitro treatment of activated B cells with potassium iodide induced ferroptosis by increasing intracellular reactive oxygen species (ROS) and ferrous iron in a concentration-dependent manner. Accordingly, LBI diets increased ROS levels in GC B cells of the draining lymph nodes. This study suggests that iodine directly promotes ferroptosis in activated B cells and attenuates GC reactions, leading to the alleviation of allergic symptoms. [ABSTRACT FROM AUTHOR]

Urban areas are responsible for more than 40 % of global energy-related carbon dioxide (CO2) emissions. The Tokyo Metropolitan Area (TMA), Japan, one of the most populated regions in the world, includes various emission sources, such as thermal power plants, automobile traffic, and residential facilities. We conducted an intensive field campaign in the TMA from February to April 2016 to measure column-averaged dry-air mole fractions of CO2 (XCO2) with three ground-based Fourier transform spectrometers (one IFS 125HR and two EM27/SUN spectrometers). At two urban sites (Saitama and Sodegaura), measured XCO2 values were generally larger than those at a rural site (Tsukuba) by up to 9.5 ppm, and average diurnal variations increased toward evening. To simulate the XCO2 enhancement (ΔXCO2) resulting from emissions at each observation site, we used the Stochastic Time‐Inverted Lagrangian Transport (STILT) model driven by meteorological fields at a horizontal resolution of ~1 km from the Weather Research Forecast (WRF) model, which was coupled with anthropogenic (large point source and nonpoint source) CO2 emissions and biogenic fluxes. Although some of the diurnal variation of ΔXCO2 was not reproduced and plumes from nearby large point sources were not captured, primarily because of a transport modeling error, the WRF–STILT simulations using prior fluxes were generally in good agreement with the observations (mean bias, 0.30 ppm; standard deviation, 1.31 ppm). By combining observations with high-resolution modeling, we developed an urban-scale inversion system in which spatially resolved CO2 emission fluxes at >3 km resolution and a scaling factor of large point source emissions were estimated on a monthly basis by using Bayesian inference. The ΔXCO2 simulation results from the posterior CO2 fluxes were improved (mean bias, –0.03 ppm; standard deviation, 1.21 ppm). In addition, the inverse analysis reduced the uncertainty in total CO2 emissions in the TMA by a factor of ∼2. The posterior total CO2 emissions agreed with emission inventories within the posterior uncertainty at the 95 % confidence level, demonstrating that the EM27/SUN spectrometer data can constrain urban-scale monthly CO2 emissions. [ABSTRACT FROM AUTHOR]

Aims: Using the reliable change index (RCI), we aimed to examine the effect of a multicomponent exercise program on the individual level. Methods: Overall, 270 adults (mean age, 78 years) completed a multicomponent physical exercise program (strength, aerobic, gait, and balance) for 40 min, 1–2 times per week, continued up to 1 year at a daycare center. Effectiveness was assessed using grip, ankle, knee, and hip strength; Timed Up & Go (TUG); Berg Balance Scale (BBS); gait speed; and 6-min walking distance. These were measured at baseline and every 3 months thereafter. We calculated the RCI using the data between two-time points (baseline and at 3, 6, 9, or 12 months) in each participant and then calculated the mean RCI value across the participants. A paired t-test was also employed to evaluate the effect of the intervention as an average-based statistics. Results: The highest mean RCI values were on ankle plantar-flexion strength, followed by gait speed, hip abduction strength, BBS, knee extensor strength, 6-min walk distance, grip strength, and finally TUG. Paired t-test also revealed significant improvement with moderate effect sizes for ankle plantar-flexion strength (0.504), gait speed (0.413), hip abduction strength (0.374), BBS (0.334), knee extensor strength (0.264), and 6-min walk distance (0.248). Significant but small effect size was seen on TUG (0.183). Conclusion: The RCI is a convenient method of comparing the effect between different assessments, especially at an individual level. This index can be applied to the use of personal feedback. [ABSTRACT FROM AUTHOR]

Pulmonary oxalosis can be fatal, and Aspergillus tubingensis is commonly resistant to azoles in Japan. We report a case of bronchopulmonary oxalosis caused by A. tubingensis in a non-neutropenic patient who was successfully treated with voriconazole monotherapy. The susceptibility of the isolates to voriconazole and the effective elimination of contagious necrotic tissue by expectoration seemed to be two major factors contributing to the patient's survival. According to the literature review, pulmonary oxalosis is associated with a high mortality rate over a short term. An exploration of detailed information about the genomic characteristics and drug susceptibility of Aspergillus isolates is important for the development of treatment strategies for this life-threatening disease. [ABSTRACT FROM AUTHOR]

The degradation of chlorophyll in mature soybean seeds is closely related to the development of their yellow color. In this study, we examined G , its homologue G-like (GL), and their mutant alleles and investigated the relationship between these genes and chlorophyll accumulation in the seed coats of mature seeds. Transient expression of G and GL proteins fused with green fluorescent protein revealed that both were localized in plastids. Overexpression of G resulted in the accumulation of chlorophyll in the seed coats and cotyledons of mature seeds, indicating that high expression levels of G result in chlorophyll accumulation that exceeds its metabolism in the seeds of yellow soybean. Analysis of near isogenic lines at the G locus demonstrated a significant difference in the chlorophyll content of the seed coats and cotyledons of mature seeds when G and mutant g alleles were expressed in the d1d2 stay-green genetic background, indicating that the G protein might repress the SGR-independent degradation of chlorophyll. We examined the distribution of mutant alleles at the G and GL loci among cultivated and wild soybean germplasm. The g allele was widely distributed in cultivated soybean germplasm, except for green seed coat soybean lines, all of which contained the G allele. The gl alleles were much fewer in number than the g alleles and were mainly distributed in the genetic resources of cultivated soybean from Japan. None of the landraces and breeding lines investigated in this study were observed to contain both the g and gl alleles. Therefore, in conclusion, the mutation of the G locus alone is essential for establishing yellow soybeans, which are major current soybean breeding lines. [ABSTRACT FROM AUTHOR]

Background: The proportion of tuberculosis (TB) patients who are older adults is increasing worldwide. Nearly 60% of TB patients in Japan are 70 years or older, and the TB incidence rate in Japan is one of the highest among high-income countries. The previous TB treatment guidelines prior to 2018 in Japan recommended excluding pyrazinamide (PZA) from the initial regimen for patients aged over 80 years. Objectives: We aimed to examine differences in TB treatment outcomes among different age groups, and between those who received PZA and those who did not. Methods: We performed a retrospective cohort study of patients with pulmonary TB who were managed at a single medical center in Japan. We compared treatment outcomes and adverse events that resulted in treatment interruption across the age groups. Results: Of 246 patients, 117 (48%) were aged 75 years or older. Compared with patients aged < 74 years, those ≥ 75 years were less likely to have PZA in the initial regimen (53.0% vs 89.9%; p < 0.0001), more likely to die during treatment (38.5% vs 6.2%; p < 0.0001), and more likely to experience adverse events (30.8% vs 19.4%; p < 0.05). The mortality rate related to TB at 2 months after TB treatment initiation was 28% in those aged ≥ 84 years. Furthermore, among patients aged ≥ 84 years, those who did not receive PZA were significantly more likely to die than those who did (65.8% vs 36.8%; p < 0.05). Conclusions: Patients aged ≥ 75 years with pulmonary TB experienced increased mortality related to TB during treatment and more frequent adverse events than younger patients, even though PZA was often avoided among older patients. [ABSTRACT FROM AUTHOR]

Background: Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) is associated with cardiovascular events and poor renal outcome in patients with chronic kidney disease (CKD). This study aimed to investigate the initial responsiveness to darbepoetin alfa (DA) and its contributing factors using the data from the BRIGHTEN. Methods: Of 1980 patients enrolled at 168 facilities, 1695 were included in this analysis [285 patients were excluded mainly due to lack of hemoglobin (Hb) values]. The initial ESA response index (iEResI) was defined as a ratio of Hb changes over 12 weeks after DA administration per weight-adjusted total DA dose and contributing factors to iEResI were analyzed. Results: The mean age was 70 ± 12 years (male 58.8%; diabetic nephropathy 27.6%). The median creatinine and mean Hb levels at DA initiation were 2.62 mg/dL and 9.8 g/dL, respectively. The most frequent number of DA administration during 12 weeks was 3 times (41.1%), followed by 4 (15.6%) times with a wide distribution of the total DA dose (15–900 μg). Remarkably, 225 patients (13.3%) did not respond to DA. Multivariate analysis showed that male gender, hypoglycemic agent use, iron supplementation, high eGFR, low Hb, low CRP, low NT-proBNP, and low urinary protein–creatinine ratio were independently associated with better initial response to DA (P = < 0.0001, 0.0108, < 0.0001, 0.0476, < 0.0001, 0.0004, 0.0435, and 0.0009, respectively). Conclusions: Non-responder to DA accounted for 13.3% of patients with non-dialysis CKD. Iron supplementation, low CRP, low NT-proBNP, and less proteinuria were predictive and modifiable factors associated with better initial response to DA. [ABSTRACT FROM AUTHOR]

Bone modifying agents (BMAs) have become a standard treatment to prevent skeletal‐related events (SREs) in bone metastases (BMs). The aim of our study is to determine the clinical value of serum bone resorption markers for predicting clinical outcomes after using BMAs in patients with BM. Patients were enrolled between May 2013 and October 2017 at the Nagoya University Hospital, Japan. We prospectively observed changes in pyridinoline cross‐linked carboxyterminal telopeptide of type I collagen (ICTP) and tartrate‐resistant acid phosphatase 5b (TRACP‐5b) during treatment with BMAs. The relationship between serum markers before and after treatment and clinical outcomes such as progression of bone disease (BD), SREs and overall survival (OS) were evaluated. Pearson chi‐square test and Kaplan–Meier product limit methods were used for analysis. Sixty‐seven patients were analyzed. The primary tumor sites were 21 lung, 16 breast and 30 others. Forty and 27 patients were treated with Denosumab and Zoledronic acid, respectively. Progression of BDs, SREs and death were observed in 10, 16 and 31 cases, respectively. The median follow‐up period after using BMAs was 12.3 (range 0.3–66.3) months. ICTP at 3–4 weeks was significantly correlated with increasing BD progression, SREs and death after treatment in both the whole and lung cancer cohorts. Base line ICTP and TRACP‐5b were also associated with increasing BD progression in the whole cohort. Our study showed that early posttreatment ICTP is useful for predicting BD progression, SREs and OS after use of BMAs in patients with BM and even in patients with lung cancer BM. What's new? Bone modifying agents (BMAs) have become a standard treatment to prevent skeletal‐related events (SREs) in bone metastases. This study assessed the clinical value of serum bone metabolism biomarkers ICTP and TRACP‐5b to predict disease progression, SREs, and overall survival after BMA treatment in 67 lung, breast, and other cancer patients with metastatic bone disease (BD). High ICTP at 3–4 weeks after the start of BMA use was significantly associated with progression of BD, increasing SREs, and death in both the whole and lung cancer cohorts. Baseline ICTP and TRACP‐5b were also associated with increasing BD progression in the whole cohort. [ABSTRACT FROM AUTHOR]

A 35-year-old woman presented with fever and mild diarrhoea without any respiratory symptoms 9 days after travelling to Japan from Wuhan, China. Her computed tomography scan revealed pneumonia. The first polymerase chain reaction (PCR) test on throat swab for the novel corona virus upon admission was negative. Therefore, she was treated for community-acquired pneumonia, but fever persisted. On hospital day 5, PCR test on induced sputum was positive, but a second polymerase chain reaction test on throat swab remained negative. She was discharged, fully recovered, on hospital day 12. A lower respiratory tract specimen should be obtained for better diagnosis of corona virus disease 2019, even in the absence of respiratory symptoms for patients with significant travel or exposure history. [ABSTRACT FROM AUTHOR]

• Outpatient parenteral antimicrobial therapy (OPAT) is not widely recognized in Japan. • The infectious diseases team at a general hospital in Japan implemented a new OPAT program in 2012 and treated 66 patients for 5.5 years. • This study is the first English description of a comprehensive OPAT program in Japan. • OPAT is a safe and feasible practice not only for efficient bed utilization and medical cost savings but also for better antimicrobial stewardship. • Many barriers, such as financial disincentives or drug administration-related issues in the healthcare insurance system, negatively impact the expansion of OPAT practice in Japan. The infectious diseases team at Kameda Medical Center, Japan, implemented a new outpatient parenteral antimicrobial therapy (OPAT) program in July 2012 and expanded the program with the support of home care services. This study reviews the OPAT program after 5.5 years of operation. We prospectively collected data about the age, sex, diagnoses, causative organisms, types of OPAT, modes of administration, selected antibiotics, treatment durations, bed days saved, outcomes, readmissions, and estimated cost reductions of all patients who were treated in the OPAT program from July 2012 to December 2017. Of the 66 patients treated under the OPAT program, 45 (68.2%) were treated using clinic OPAT, and 21 (31.8%) were treated using homecare OPAT. The most commonly targeted organism was methicillin-susceptible Staphylococcus aureus. Continuous infusion with elastomeric pumps was employed in 55 patients (83.3%). Cefazolin was the most frequently used antibiotic (39.4%), followed by penicillin G (24.2%). The median OPAT duration was 13 days (range, 3–51), and the total bed days saved was 923. The estimated medical cost reduction was approximately 87,000 US dollars. Our experience shows that OPAT is a safe and feasible practice not only for efficient bed utilization and medical cost savings but also for better antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are classified as carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE; the majority of CPE in Japan produce IMP carbapenemase.Objectives: We evaluated the clinico-epidemiological and microbiological information and effects of IMP-type carbapenemase production in CRE.Methods: Patients with isolations of CRE (MICs of meropenem ≥2 mg/L, imipenem ≥2 mg/L or cefmetazole ≥64 mg/L) from August 2016 to March 2018 were included. Microbiological analyses and WGS were conducted and clinical parameters were compared between groups. Independent predictors for the isolation of CPE from patients were identified by logistic regression. For comparing clinical outcomes, a stabilized inverse probability weighting method was used to conduct propensity score-adjusted analysis.Results: Ninety isolates (27 CPE and 63 non-CPE) were collected from 88 patients (25 CPE and 63 non-CPE). All CPE tested positive for IMP carbapenemase. Antibiotic resistance (and the presence of resistance genes) was more frequent in the CPE group than in the non-CPE group. Independent predictors for CPE isolation were residence in a nursing home or long-term care facility, longer prior length of hospital stay (LOS), use of a urinary catheter and/or nasogastric tube, dependent functional status and exposure to carbapenem. Although in-hospital and 30 day mortality rates were similar between the two groups, LOS after CRE isolation was longer in the CPE group.Conclusions: IMP-CPE were associated with prolonged hospital stays and had different clinical and microbiological characteristics compared with non-CPE. Tailored approaches are necessary for the investigational and public health reporting, and clinical and infection prevention perspectives for IMP-CPE and non-CPE. [ABSTRACT FROM AUTHOR]

Background: Before the androgen target therapy era, flutamide was widely used for castration-resistant prostate cancer in Japan. Enzalutamide is currently the recommended treatment; however, the efficacy and safety of enzalutamide and flutamide after combined androgen blockade therapy with bicalutamide, has not been compared. Methods: Patients with castration-resistant prostate cancer who received combined androgen blockade therapy with bicalutamide were randomly assigned to receive either enzalutamide or flutamide. The primary endpoint for efficacy was the 3-month prostate-specific antigen response rate. This trial is registered with ClinicalTrials.gov (NCT02346578) and the University hospital Medical Information Network (UMIN000016301). Results: Overall, 103 patients were enrolled. The 3- (80.8% vs. 35.3%; p < 0.001) and 6-month (73.1% vs. 31.4%; p < 0.001) prostate-specific antigen response rates were higher in the enzalutamide than in the flutamide group. The 3-month disease progression rates (radiographic or prostate-specific antigen progression) were 6.4% and 38.8% in the enzalutamide and flutamide groups, respectively [hazard ratio (HR): 0.16; 95% confidence interval (CI): 0.05–0.47; p < 0.001]; the 6-month rates were 11.4% and 51.1%, respectively (HR 0.22; 95% CI 0.09–0.50; p < 0.001). Enzalutamide provided superior prostate-specific antigen progression-free survival compared with flutamide (HR 0.29; 95% CI 0.15–0.54; p < 0.001). Median time to prostate-specific antigen progression-free survival was not reached and was 6.6 months in the enzalutamide and flutamide groups, respectively. Conclusions: As an alternative anti-androgen therapy in patients with castration-resistant prostate cancer who fail bicalutamide-combined androgen blockade therapy, enzalutamide provides superior clinical outcomes compared with flutamide. Enzalutamide should be preferred over flutamide in these patients. [ABSTRACT FROM AUTHOR]

Background: In Japan, R0 resection has been recommended for colorectal cancer patients with peritoneal metastases confined to the adjacent peritoneum and those with a few metastases to the distant peritoneum. R0 resection for M1c disease has drawn attention in Western countries and is currently considered an acceptable therapeutic option in the US National Comprehensive Cancer Network guidelines. However, clinical factors that affect the choice of R0 resection are unknown. Methods: This multicenter, prospective, observational study was conducted by the Japanese Society for Cancer of the Colon and Rectum. Colorectal cancer patients with synchronous peritoneal metastases were enrolled at 28 institutions in Japan from October 2012 to December 2016. To determine factors affecting R0 resection and R1 resection with intended R0 resection, stepwise logistic regression analyses were performed on clinical factors including age, sex, performance status (PS), body mass index, peritoneal cancer index (PCI) score, presence of ascites, presence of distant metastases, and primary tumor site. Results: R0/R1 resection was performed in 36 (31/5; 25%) of 146 patients. No distant metastases [odds ratio (OR) 52.9; 95% confidence interval (CI) 13.3–210.1; p < 0.0001], low PCI score (1–6) (OR 20.0; 95% CI 4.8–83.4; p < 0.0001), and high PS (0) (OR 2.40; 95% CI 0.66–8.68; p = 0.18) were independent factors affecting R0/R1 resection. PCI score and PS were also independent factors affecting R0/R1 resection in M1c patients without non-peritoneal distant metastases (n = 59). Conclusion: Distant metastases, PCI score, and PS are three factors which affect R0 resection for M1c disease. [ABSTRACT FROM AUTHOR]

Background: The Barthel Index (BI) is a measure of independence in activities of daily living (ADL). In the modified Barthel Index (MBI), a five-point system replaced the original two or three or four point rating system. Based on this modified measure, the performance evaluation tool MBI (PET-MBI) was developed in Japan. Although the reliability and validity of PET-MBI have been verified for older people, the use of this tool in stroke patients has not been evaluated. This study investigated the validity and reliability of PET-MBI for stroke patients.Methods: Ten raters independently determined the BI and PET-MBI scores of stroke patients by direct observation. These patients' ADL were videotaped, and 10 other raters then evaluated the videos privately and assigned PET-MBI scores twice, one month apart. The criterion-related validity of the PET-MBI against the BI was evaluated using the correlation coefficients for their total scores. Furthermore, to assess inter- and intra-rater reliabilities from the results of the first and second sessions, Fleiss' intraclass correlation coefficients (ICCs) were calculated for the total scores, with the lower limits of the 95% confidence interval (95%CI), along with weighted kappa (κw) coefficients for agreement in individual tasks of this evaluation tool. ICC and κw coefficients of 0.81-1.00 were considered to be "almost perfect" agreement.Results: The mean age of the 30 patients (23 men, 7 women) was 71.9 (standard deviation 10.5) years. One patient had diplegia, 14 had right hemiplegia, and 15 had left hemiplegia. For the total scores obtained by direct evaluation, Pearson's and Spearman's correlation coefficients of the BI versus the PET-MBI were both 0.95 (lower limit of the 95%CI, 0.90). The ICC representing inter-rater reliability for the first session was 0.99 (lower limit of the 95%CI, 0.98]. For intra-rater reliability, the mean value of the ICCs was 0.99 (range, 0.99-1.00). For individual tasks of the PET-MBI, inter-rater κw coefficients for the first session ranged from 0.77 to 0.94, with intra-rater κw coefficients from 0.85 to 0.96.Conclusions: PET-MBI showed strong criterion-related validity against the BI, with high reliabilities. This scoring system may become a convenient tool allowing anyone to assess ADL. [ABSTRACT FROM AUTHOR]

Continuous self-potential (SP) monitoring has been conducted at Izu-Oshima volcano to detect signals resulting from volcanic activity since the installation of an SP monitoring network in March 2006. Since the installation, annual variations of up to 100 mV have been recorded. If we exclude these annual variations, temporal variations in SP do not show notable changes. This is consistent with the volcano being in a state of quiescence during the measurement period. The annual variations have the different amplitudes and mean levels between stations. To investigate the causes of these annual variations, we carried out numerical simulations of SP generation associated with downward meteoric water flow through electrokinetic coupling in a ~ 550 m thick unsaturated layer. The results show that the vertical electric potential gradient varies with changes in liquid-phase saturation in the unsaturated layer. These changes are caused by variations in the rate of meteoric water percolation. This, in turn, correlates with fluctuations in daily precipitation, thus explaining the annual SP variation recorded at the ground surface. Differences in the amplitude and mean level of SP variation are shown to be associated with different rock properties, especially permeability, porosity, and electrical conductivity. Our results indicate that observable SP changes will appear at stations near the summit if the distributions of liquid-phase saturation and/or pertinent parameters controlling the electrokinetic coupling in the thick unsaturated layer are modified the upward flow of volcanic gas. [ABSTRACT FROM AUTHOR]

Introduction: Natalizumab, a humanized anti-α4 integrin monoclonal antibody, received marketing approval in Japan in 2014 for the treatment of multiple sclerosis (MS). Because the previous large-scale clinical trials of natalizumab were mainly conducted in Europe and North American countries, and data in patients with MS from Japan were limited, we conducted an all-case post-marketing surveillance of natalizumab-treated MS patients from Japan to investigate the safety and effectiveness of natalizumab in a real-world clinical setting in Japan. Here, we report the results of an interim analysis. Methods: During the observation period of 2 years, all patients who were treated with natalizumab subsequent to its approval in Japan were followed. The effectiveness of natalizumab was assessed by examining the changes in expanded disability status scale (EDSS) score and annualized relapse rate (ARR) from baseline. Safety was assessed by analyzing the incidence of adverse drug reactions (ADRs). Results: The safety analysis included 106 patients (mean age 39.3 years; women 62.3%) whose data were collected until the data lock point (February 7, 2016). The effectiveness analysis included 75 patients. The majority of patients had relapsing-remitting MS (93/106 patients; 87.7%). The mean length of treatment exposure in the present study was 6.6 months. During the 2-year observation period, no significant change in the EDSS was observed, while the ARR decreased significantly from baseline (72.9% reduction, p = 0.001). ADRs and serious ADRs were observed in 11.3% and 3.8% of patients, respectively; however, no new safety concerns were detected. No patient had progressive multifocal leukoencephalopathy (PML) during the present study period. Conclusion: The safety and effectiveness of natalizumab were confirmed in Japanese patients with MS in clinical practice. Nevertheless, potential risks including PML require continuous, careful observation. Funding: Biogen Japan Ltd (Tokyo, Japan). [ABSTRACT FROM AUTHOR]

Purpose: The nutritional changes that have accompanied the modernization of Japanese dietary patterns have led to significant increases in the number of people who are overweight or obese. This study aimed to clarify the effects of these nutritional changes on postprandial energy expenditure and the release of metabolism-regulating hormones. Methods: The total daily energy content (20 % breakfast, 40 % lunch, and 40 % dinner) and macronutrient composition (carbohydrate/fat/protein) was 8807.3 kJ and 364.3:30.1:66.4 (g) for the traditional test diet and 9217.6 kJ and 331.7:66.1:76.9 (g) for the modern test diet. In experiment 1, nine healthy Japanese men participated in a crossover study during which they ingested a test diet comprising three meals; postprandial blood parameters were measured after each meal. In experiment 2, another ten men participated in a crossover study during which they ingested 2 meals, after which metabolic responses and blood variables were evaluated. Results: The modern diet induced greater blood levels of glucose-dependent insulinotropic polypeptide (GIP) and ghrelin than did the traditional diet. The expected increase in postprandial energy expenditure (∆REE) tended to be dampened after the modern compared with the traditional diet. GIP was inversely correlated with ∆REE after lunch, and ghrelin was positively associated with ∆REE. Conclusion: Both GIP and ghrelin are robust indicators of postprandial energy expenditure. The nutritional changes accompanying the modernization of Japanese dietary patterns may increase the levels of the anabolic intestinal hormone GIP, which is associated with ∆REE, in the Japanese population. The contribution of an increased ghrelin concentration to the decreased ∆REE after the modern diet warrants further investigation. [ABSTRACT FROM AUTHOR]

Topical or systemic antifungal therapy was administered to patients diagnosed with Malassezia folliculitis during the 5-year period between March 2007 and October 2013. The diagnosis of Malassezia folliculitis was established on the basis of characteristic clinical features and direct microscopic findings (10 or more yeast-like fungi per follicle). Treatment consisted of topical application of 2% ketoconazole cream or 100 mg oral itraconazole based on symptom severity and patients' preferences. Treatment was given until papules flattened, and flat papules were examined to determine whether the patient's clinical condition had "improved" and the treatment had been "effective". The subjects were 44 patients (35 men, 9 women), with a mean disease period of 25±15 days. In regard to the lesion site, the frontal portion of the chest was the most common, accounting for 60% of all patients. The mean period required for improvement was 27±16 days in 37 patients receiving the topical antifungal agent and 14±4 days in the 7 patients receiving the systemic antifungal agent. The results were "improved" and the treatment was "effective" in all patients. Neither treatment resulted in any adverse reactions. Although administration of oral agents has been recommended for the treatment of Malassezia folliculitis, this study revealed that beneficial results are safely obtained with topical antifungal therapy alone, similar to those of systemic antifungal agents. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine the association between accessibility to cardiovascular emergency centers and cardiovascular mortality in Japan.Design: A semi-ecological study.Setting: Three databases were generated: accessibility to emergency cardiovascular centers, population records and death records.Main Outcome Measures: The standardized mortality ratio (SMR) for cardiovascular disease was adjusted by age and sex. Accessibility was represented by transfer time, number of cardiovascular emergency hospitals, and the proportion of habitable areas. Combinations of the three were divided into Categories 1-8 from the worst to the best, and the association with SMR was analyzed.Results: There were 1998 cardiovascular emergency hospitals. The median of crude mortality was 0.16%. The median SMR of the reference Category 8 (transfer time <30 min and habitable area ≥50% with cardiovascular emergency hospitals) was 0.96, but that of the low accessibility Category 1 (transfer time ≥30 min and habitable area <50% without cardiovascular emergency hospitals) was 1.10. The SMR of accessibility Category 1 : Category 8 was 1.18 (95% confidence interval: 1.14-1.21).Conclusions: Decreased accessibility to cardiovascular emergency hospitals was associated with increased SMR. Areas with less accessibility and higher cardiovascular mortality were characterized by geographical variability in Japan. [ABSTRACT FROM AUTHOR]

Magnaporthe oryzae chrysovirus 1 (MoCV1) is a mycovirus with a dsRNA genome that infects the rice blast fungus Magnaporthe oryzae and impairs its growth. To date, MoCV1 has only been found in Vietnamese isolates of M. oryzae, and the distribution of this virus in M. oryzae isolates from other parts of the world remains unknown. In this study, using a one-step reverse transcription PCR (RT-PCR) assay, we detected a MoCV1-related virus in M. oryzae in Japan (named MoCV1-AK) whose sequence shares considerable similarity with that of the MoCV1 Vietnamese isolate. To establish a system for a comprehensive survey of MoCV1 infection in the field, we developed a reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay for direct detection of the virus. The sensitivity of the RT-LAMP assay was at least as high as that of the one-step RT-PCR assay. In addition, we detected MoCV1-AK in M. oryzae-infected oatmeal agar plates and lesions on rice leaves using the RT-LAMP assay without dsRNA extraction, by simple sampling with a toothpick. Preliminary screening of MoCV1 in Japanese M. oryzae isolates indicated that MoCV1 is currently distributed in rice fields in Japan. Our results provide a first example of the application of RT-LAMP for the detection of mycoviruses, which will accelerate surveys for mycovirus infection. [ABSTRACT FROM AUTHOR]

The quantitative antigen test based on the chemiluminescent enzyme immunoassay for SARS-CoV-2 has been used in international airports for quarantine in Japan. While cases of false-positive rapid antigen tests for SARS-CoV-2 were reported, false-positive cases of the quantitative antigen test with clinical information are rare. Here, we report a case of acute respiratory infection whose quantitative antigen test for SARS-CoV-2 was suspected to be false positive. A 9-month-old boy who presented with fever and rhinorrhea was admitted to our hospital under the Quarantine Act. He was diagnosed with COVID-19 based on the quantitative antigen test for SARS-CoV-2 performed at the quarantine station. None of the accompanying family members were positive for COVID-19. Nucleic acid amplification tests (NAAT) for SARS-CoV-2 were all negative, and multiplex polymerase chain reaction detected human rhinovirus or enterovirus infection. This case suggests that the results of the quantitative antigen test should be interpreted together with clinical information, and NAAT should be performed when false-positive results are suspected to avoid unnecessary isolation. [ABSTRACT FROM AUTHOR]

The World Health Organization Fracture Risk Assessment Tool (FRAX(®)) was recently developed to estimate the 10-year absolute risk of osteoporotic fracture among the general population. However, the evidence for its use in chronic kidney disease patients has been lacking, and the association between the FRAX(®) and mortality is unknown. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of the FRAX(®) for mortality in hemodialysis patients. A total of 252 patients who had been started on maintenance hemodialysis, 171 men and 81 women, with a mean age of 67 ± 14 years, was studied. The endpoint was defined as all-cause death. The Cox proportional hazards model was used to calculate hazard ratios and 95 % confidence intervals. During the mean follow-up period of 3.4 ± 2.7 years, 61 deaths occurred. The median (interquartile range) of the FRAX(®) for major osteoporotic fracture was 6.9 (4.6-12.0) % in men and 19.0 (7.6-33.0) % in women. Cumulative survival rates at 5 years after starting dialysis, with the FRAX(®) levels above and below the median, were 51.9 and 87.9 %, respectively, in men and 67.4 and 83.7 %, respectively, in women. Overall, in men, the multivariate Cox regression analyses revealed that the log-transformed FRAX(®) remained an independent predictor of death after adjusting by confounding variables. However, in women, the significant association between the FRAX(®) value and the outcome was eliminated if age was put into these models. Among Japanese hemodialysis patients, the FRAX(®) seems to be useful for predicting death, especially in men. [ABSTRACT FROM AUTHOR]

The article focuses on a study conducted in a Japanese general hospital for restricting overuse of ceftriaxone and increased need of systematic outpatient parenteral antimicrobial therapy (OPAT). Topics discussed include avoiding inappropriate use of ceftriaxone by implementing systematic OPAT program, considering strategies for better parenteral antimicrobial use by collecting national data regarding OPAT usage and efforts involving physicians in improving antimicrobial stewardship.

Mycobacterium tuberculosis transmission routes can be estimated from genotypic analysis of clinical isolates from patients. In Japan, still a middle-incidence country of TB, a unique genotype strain designated as ‘M-strain’ has been isolated nationwide recently. To ascertain the history of the wide spread of the strain, 10 clinical isolates from different areas were subjected to genome-wide analysis based on deep sequencers. Results show that all isolates possessed common mutations to those of referential strains. The greatest number of accumulated single nucleotide variants (SNVs) from the oldest coalescence was 13 nucleotides, indicating high clonality of these isolates. When an SNV common to the isolates was used as a surrogate marker of the clone, authentic clonal isolates with variation in a reliable subset of variable number of tandem repeat (VNTR) genotyping method can be selected successfully from clinical isolates populations of M. tuberculosis. When the authentic clones can also be assigned to sub-clonal groups by SNVs derived from the genomic comparison, they are classifiable into three sub-clonal groups with a bias of geographical origins. Feedback from genomic analysis of clinical isolates of M. tuberculosis to genotypic markers will be an efficient strategy for the big data in various settings for public health actions against TB. [ABSTRACT FROM AUTHOR]

Purpose: A prospective, multicenter, observational study was performed to investigate the risk factors of surgical site infection (SSI) in patients with ulcerative colitis (UC). Methods: From 2009 to 2010, perioperative clinicopathological data were collected from patients who had undergone surgery for UC within the research period, for up to 6 consecutive months in 13 hospitals in Japan. The primary outcome was the development of SSI. Results: A total of 195 patients with UC who underwent colorectal surgery were enrolled. SSI was diagnosed in 38 (19.5 %) patients, in the form of incisional infection in 23 (11.8 %), organ/space infection in 16 (8.2 %), and both in 1 (0.5 %). There were no significant risk factors associated with an increased risk of development of incisional SSI. An American Society of Anesthesiologists physical status of ≥ 3 was indicated as the only significant risk factor for organ/space SSI ( P = 0.02) compared with other factors, such as a neutrophil count of >100 × 10/mm, albumin level of <3.5 g/dl, perioperative packed red blood cell transfusion, fair or poor colonic cleanliness, and therapeutic use of antibiotics. Conclusion: Poor general physical status was the significant independent risk factor for organ/space SSI in patients with UC in Japan. [ABSTRACT FROM AUTHOR]

Sociology can be both a science and literature. While sociology as science investigates general tendencies of social phenomena through statistical analysis and advances social policies based on the understanding of their objective causes, sociology as literature focuses on the non-generalizable aspects of an individual event and considers the reasons for the resulting actions of human beings. In this article I examine prominent works in the sociology of literature by three representative Japanese sociologists, Sosuke Mita, Keiichi Sakuta and Shun Inoue, from the 1970s to the early 1980s. After this period, contemporary French philosophy, such as that of Foucault, introduced to Japan during the 1980s, made it clear that literature is nothing more than a social institution that produces interiority in individuals. As a result, sociology as discourse has dominated the intellectual scene in Japan ever since, eclipsing the possibility of sociology as literature, which focuses more on the romantic individual. However, I argue that an alternative possibility for sociology as literature can be found in a sociology of singularity, which grasps the concrete facticity of human activities in ordinary everyday life through reading their descriptions in works of literature. [ABSTRACT FROM AUTHOR]

The practice of video production as a means of learning through art is closely related to the concept of media literacy, although misuse of the term in Japan has created some obstacles. First, an imbalance exists between video literacy's two educational aspects: using video to express ideas and interpreting the expressions used within them. Second, unqualified instructors are frequently tasked to teach video production in an educational context. Third, rapid changes in social environments lead to disparities between social reality and educational objectives. These problems are rooted in an outdated understanding of media literacy as a concept in Japan, which in turn can be attributed to an inadequate translation of the term into Japanese that strips away its creative connotations. [ABSTRACT FROM AUTHOR]

Aim The usefulness and safety of endobronchial ultrasound transbronchial needle aspiration ( EBUS-TBNA) have been established recently, but no study has evaluated whether or not aging increases the risk of the procedure. In the present study, we aimed to assess the usefulness and safety of EBUS-TBNA in older patients. Methods The medical records and database of 109 patients who received EBUS-TBNA between 2008 and 2011 at Nagoya University Hospital, Nagoya, Japan were reviewed retrospectively. All patients underwent bronchoscopy under light sedation with midazolam. A total of 34 patients were aged 70 years or older (the older group) and 75 were aged 69 years or younger (the younger group). We analyzed patients' characteristics, changes of clinical parameters, usage doses of midazolam and lidocaine, procedure duration, geographic data of biopsied lymph nodes, diagnostic yield, and complications in both groups. Results There were more comorbidities in the older group. Four patients (11.8%) in the older group had poor performance status (2-3). Systolic blood pressure at baseline was significantly higher in the older group. There were no statistical differences between the two groups in some clinical parameters (minimum oxygen saturation [ SpO2], reduction in SpO2, maximum oxygen supplementation, elevation of systolic blood pressure, increase of heart rate) during the procedure. Diagnostic performance in older patients was similar to that found in younger patients. There was no difference in the frequency of complications between both groups. Conclusion Safety and usefulness of EBUS-TBNA in older people were comparable with those in younger people. Geriatr Gerontol Int 2013; 13: 986-992. [ABSTRACT FROM AUTHOR]

To better understand the response of forest vegetation to climate and fire regimes with reference to human activities over the last deglacial period in the Aso Caldera, central Kyushu, southwestern Japan, a 33.9 m long sediment core was examined in order to reconstruct the vegetational and fire history using pollen and charcoal analyses. The results show that a cool temperate broad-leaved deciduous forest, dominated by Quercus (deciduous oaks) with Carpinus and Fagus, prevailed in the Aso Valley from ca. 14.6 ka cal. b. p., indicating warming since the last glacial period. The landscape was presumably covered by a mosaic of deciduous Quercus forests and terrestrial Artemisia communities. Around 12.8-11.7 ka cal. b. p., Quercus dominated the forest and fires occurred frequently. Co-expansion of distinctive Ulmus- Zelkova and Celtis- Aphananthe forests coupled with a progressive retreat of Quercus in the early Holocene could reflect a strengthening of the East Asian summer monsoon under mild and humid climate conditions. Around 8 ka cal. b. p., significant increases in Cyclobalanopsis (evergreen oaks), Castanopsis/ Castanea and Podocarpus indicate a further warming, in particular an increased winter temperature. Warm temperate lucidophyllous forests, dominated by Cyclobalanopsis, flourished after 7.3 ka cal. b. p., probably corresponding to the 'Holocene Climatic Optimum' interval. Progressive expansion of Quercus at the expense of Cyclobalanopsis began around 6.4 ka cal. b. p. and paralleled an increase in charcoal until ca. 4.8 ka cal. b. p.; this could be evidence of fire disturbance induced by the early-middle Jomon people. The disturbed evergreen forest experienced a temporary recovery but then opened again from 3.6 ka cal. b. p. due to extensive fire deforestation, as suggested by the high charcoal levels during this time. Human exploitation and buckwheat ( Fagopyrum) agriculture may have contributed to the opening of the forest, which allowed secondary forests (primarily Pinus and Quercus) and herbaceous communities (mainly Poaceae) to spread. These results are discussed in comparison with other high-resolution pollen data from western Japan to better elucidate the vegetation and fire history over the last deglacial in the Aso Caldera. [ABSTRACT FROM AUTHOR]

Aim: The new TNM classification is currently being implemented. We evaluated the TNM-7 staging system based on the two nationwide colon cancer registries in the United States and Japan to clarify whether this system better stratifies patients' prognoses than the TNM-6 did and to determine whether stratification can be effectively simplified. Methods: The Surveillance, Epidemiology, and End Results population-based data from 1988 to 2001 for 50 139 colon cancer patients and the multi-institutional registry data from the Japanese Society for Cancer of the Colon and Rectum from 1984 to 1994 for 10 754 patients were analysed. We devised a modified version of the TNM-7 staging system to allow simpler classification of the TN categories and compared the TNM-6, TNM-7, modified TNM-7, and the Dukes staging system based on survival curves and objective statistical tests such as likelihood ratio χ2 tests, Akaike's information criterion, and Harrell's c-index. Results: The TNM-7 was superior to the TNM-6 in all objective statistical tests in the United States ( c-index; 0.700 vs 0.696, P < 0.001) as well as in the Japan data sets (0.732 vs 0.729, P = 0.035). The modified TNM-7 is much simpler, but it nevertheless showed similar values to those of the original TNM-7 ( c-index; the United States 0.702, Japan 0.733). Conclusions: The new TNM-7 is complicated but better at stratifying patients than the TNM-6 in the United States and Japan, and could be effectively simplified. [ABSTRACT FROM AUTHOR]

A flight of Holocene marine terraces on the southwestern coast of Cape Omaezaki of central Japan provides evidence of recurrent millennium-scale uplift events. We reconstructed the uplift history of these terraces by using facies analysis of drill core and geoslicer samples, environmental analysis of trace fossils, and 14C age determinations. Coastal uplift can be identified by the displacement of beach deposits such as foreshore deposits, which represent the intertidal swash zone of a wave-dominated sandy coast. Three levels of former beach deposits facing the Nankai Trough were identified near the coast in the Omaezaki area. The highest of these, dated at about 3020–2880 BC, records a maximum of 2.2–2.7 m of emergence. The middle beach surface, of minimum age 370–190 BC, shows 1.6–2.8 m of emergence. The lowest beach surface, which is older than 1300–1370 AD, records 0.4–1.6 m of emergence. Our analysis of vertical crustal deformation data during the Holocene in this region suggests that rapid and strong uplift was restricted to the southwestern coast of the Omaezaki area and was probably caused by high-angle thrusting on subsidiary faults branching from the underlying plate boundary megathrust. [ABSTRACT FROM AUTHOR]

A self-potential (SP) survey is conducted in Izu-Oshima volcano to reveal subsurface fluid flows during a dormant period. At the southwestern slope outside the caldera, terrain-related SP is observed. Higher potentials are observed in the southern caldera, where fumarolic and thermal activities are found. Contrarily, lower potentials are observed in the northern caldera. This region coincides with an area where lavas pile thicker than that on the outside. 3-D simulations of the groundwater flow due to meteoric water infiltration and induced SP are performed with a heterogeneous electrical resistivity model, to understand the fundamental groundwater flow regime and causes of the observed SP. The observed SP variation is strongly affected by the subsurface resistivity structure and streaming potential within the unsaturated zone, and an overall pattern of the observed SP is reproduced without including an effect of thermally driven upward flows. The terrain-related SP at the southwestern slope is caused by the downward flow of the meteoric water in the unsaturated zone as proposed by previous researchers. The primary cause of the high SP observed in the southern caldera is shallow conductors connecting with a lower conductive layer. Contribution from the upward fluid flows due to the thermal activities, which was believed to be the main cause of the high SP at active areas, is thought to be smaller. The lower potential at the northern caldera is interpreted by the greater streaming potential as compared to that of the surroundings. This can be caused by the difference in the electrical and/or hydraulic parameters of lavas compared with those of pyroclastic rocks. One of the probable reasons of the greater streaming potential is the greater magnitude of zeta potentials of lavas. Probably, lower vertical permeabilities of lavas also lead to the greater streaming potential. [ABSTRACT FROM AUTHOR]

Summary: A population-based study of Mycobacterium tuberculosis isolated from homeless tuberculosis patients was performed during 2002–2004 in Osaka City, Japan. The data show that the ancient Beijing subfamily was predominant, whereas clustered isolates based on refined variable number of tandem repeats genotyping (19 loci) mainly belonged to the modern Beijing subfamily, suggesting its increased transmissibility. [Copyright &y& Elsevier]

Background: The aim of this multicenter study was to clarify the influence of timing of relapse after curative resection for colorectal cancer on prognosis. Methods: We enrolled 5,230 consecutive patients who underwent curative resection for colorectal cancer at 14 hospitals from 1991 to 1996. All patients were intensively followed up. Time to relapse (TR) was classified into three groups as follows: group A, TR ≤1 year; group B, TR >1 year and ≤3 years, and group C, TR >3 years. The prognoses after relapse were compared among the three groups. Results: Of the 5,230 patients, 906 experienced relapse (17.3%). The curative resection rates for recurrent tumors were 35.2% in group A, 46.6% in group B, and 45.1% in group C (p = 0.0045). There were significant differences in the prognoses after relapse among the three TR groups in patients with relapse to the liver (p = 0.0175) and in those with local relapses (p = 0.0021), but not in those with pulmonary or anastomotic recurrence. There were no differences in prognoses after relapse in any recurrence site among the three groups in patients who underwent curative resection for relapse. Conclusion: If patients can undergo curative resection for relapse, they receive a survival benefit regardless of the timing of relapse. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

To investigate the seedling growth of a biologically invasive larch Larix kaempferi (Lamb.) Carr. on Mount Koma, Japan, seedlings were excavated from three microhabitats (bareground = BA, Salix reinii patch = SP, and Larix understory = LU) in three elevational zones. Seedlings showed the highest ectomycorrhizal (ECM) colonization percentage in the most shaded microhabitat, LU. ECM colonization percentages in BA and SP were found to decrease with decreasing elevation. These results inferred that the ECM colonization percentages were related to seedling growth, particularly in BA and SP. However, the annual seedling growth was not synchronized with the increases in either elevational gradients. Although ECM colonization was most evident in LU, the seedling growth was the lowest. We concluded that the effects of ECM colonization on seedling growth were reduced mostly by microhabitat characteristics. [ABSTRACT FROM AUTHOR]

A small eruption occurred in the early spring of 1996 on the summit of Mount Koma, northern Japan, 67 years after the 1929 catastrophic eruption. To identify damage on the plant communities and recovery patterns, we established 400 50 × 50 cm permanent plots in four locations along the gradient of the thickness of tephra produced in 1996: non-disturbed (N), weakly disturbed (W), middle disturbed (M), and heavily disturbed (H). Annual monitoring was conducted from 1996 to 2001. Gullies and rills formed in M and H, indicating that the ground surface movements were more intense there. Mean vascular plant species richness increased from H to N, but did not increase from 1996 to 2001 in any location. In an area where tephra thickness was 10 cm, the recovery was mostly conducted by the species that could have survived during the eruption. A shrub, Salix reinii, was the leading species in most sites throughout most years. Large perennial herbs, Polygonum weyrichii, P. sachalinense and Miscanthus sinensis were common in the disturbed areas, in particular in M and H. Those three species develop large underground organs and enlarge clonally, suggesting that the tolerance to ground surface stability is the most important trait for the recovery of those species. Carex oxyandra established not only by vegetative regeneration but also by seedling regeneration. A short forb, Campanula lasiocarpa, could establish only in W by seedling regeneration. Mosses and lichens were predominant in plots in N and W, but less represented and not greatly increasing their cover in M and H up to 2001. We concluded that the community recovery was delayed in all the disturbed areas, mostly due to low seedling establishment. Only a few specific species established by vegetative reproduction. Disturbance gradients such as thickness of tephra and/or ground surface stability have determined plant community structure and development. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that the structure of fitness in patients with hemiparetic stroke can be categorized into impairment/disability, cardiopulmonary, muscular and metabolic domains, and to study longitudinal changes in their fitness during an inpatient rehabilitation programme. Design: Structure analysis of multiple fitness parameters with principlal component analysis (PCA), and a before and after trial. Setting: Tertiary rehabilitation centre in Japan. Patients: One hundred and seven consecutive inpatients with hemiparetic stroke. Intervention: A conventional stroke rehabilitation programme consisting of 80 minutes of physical therapy and occupational therapy sessions five days a week, and daily rehabilitation nursing for a median duration of 105.5 days. Main outcome measures: Principal component scores extracted from measurement of paresis/daily living (the Stroke Impairment Assessment Set (SIAS) and the Functional Independence Measure (FIM)); muscular (grip strength (GS), knee extensor torque, and cross-sectional areas of thigh muscles); metabolic (body mass index (BMI) and fat accumulation on CT); cardiopulmonary (heart rate oxygen coefficient (HR-O2-Coeff) obtained with a graded bridging activity and a 12-minute propulsion distance). Results: PCA categorized the original 15 variables into four factors corresponding to paresis/activities of daily living, muscular, metabolic and cardiopulmonary domains, and explained 78.1% of the total variance at admission and 69.6% at discharge. Except the metabolic domain, PCA scores for the other three domains improved significantly at discharge (paired t-test, p < 0.05). Conclusion: The hypothetical structure of fitness was confirmed, and the PCA scores were useful in following longitudinal changes of fitness during inpatient rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose : To study the status of contribution by non-English speaking countries to international rehabilitation literature taking Japan as an example, and to suggest recommendations to overcome the language barrier. Method : Descriptive study using a systematic MEDLINE search with outcome measures of annual numbers and proportions of articles by Japanese physiatrists published in peer-reviewed English rehabilitation journals, and of categories and types of studies. A database containing 292 relevant articles were used for analysis. Results : The publications have steadily increased annually both in absolute number and in proportion. The number was the largest for Arch Phys Med Rehabil (16.8%), followed by Am J Phys Med Rehabil (12.3%), Prosthet Orthot Int (8.6%), Disabil Rehabil (5.1 %) and so on. The percentage by category was the highest for stroke (26.0%), followed by spinal cord injury (11.6%), neurophysiology (11.6%) and amputation (6.2%), 67.8% of the articles were related to evaluation, 6.5% to outcome studies and 25.7% to therapy. The majority were descriptive studies (45.5%), followed by case control studies (13.0%), before-and-after trials (12.3%), case reports (7.2%) and others. Conclusion : The contribution from Japan to international rehabilitation literature is increasing. Measures were suggested to facilitate more scientific contribution by non-English speaking researchers. [ABSTRACT FROM AUTHOR]

Congenital hyperinsulinism and hyperammonaemia (CHH) is caused by dysregulation of glutamate dehydrogenase (GDH). We characterised the GDH gene in two Japanese patients with CHH. Patient I showed late-onset and mild hypoglycaemic episodes and mild hyperammonaemia, compared with patient 2. In GDH activity of lymphoblasts, patient I showed twofold higher basal GDH activity than control subjects and mild insensitivity for GTP inhibition. Patient 2 showed severe insensitivity for GTP inhibition, and similar allosteric stimulation by ADP in the controls. Genetic studies identified heterozygous and de novo L413V and G446D mutations in patients 1 and 2, respectively. COS cell expression study confirmed that both mutations were disease-causing gene. The insensitivity for GTP inhibition in L413V and G446D was emphasised in COS cell expression system as a result of the dosage effect of mutant GDH gene. L413V showed less impairment of GDH than G446D based on biochemical and genetic results, which was consistent with the clinical phenotype. Based on the structure of bovine GDH, G446D was located in GTP binding site of pivot helix and its surroundings, while L413V was located in α-helix of antenna-like structure. These different locations of mutations gave different effects on GDH enzyme. The antenna-like structure plays an important role in GDH activity. [ABSTRACT FROM AUTHOR]

Describes the superconducting NMR magnet developed at the Tsukuba Magnet Laboratory in Japan in 1999. Manufacture of the magnet with 15-percent tin-bronze-processed (Nb,Ti)[sub 3]Sn, Tantalum-reinforced (Nb,Ti)[sub 3]Sn and NbTi conductors; Cooling of coils used with pressurized superfluid helium.

Abstract Galactokinase (GALK) deficiency is an autosomal recessive disorder, which causes cataract formation in children not maintained on a lactose-free diet. We characterized the human GALK gene by screening a Japanese genomic DNA phage library, and found that several nucleotides in the 5'-untranslated region and introns 1, 2, and 5 in our GALK genomic analysis differed from published data. A 20-bp tandem repeat was found in three places in intron 5, which were considered insertion sequences. We identified five novel mutations in seven unrelated Japanese patients with GALK deficiency. There were three missense mutations and two deletions. All three missense mutations (R256W, T344M, and G349S) occurred at CpG dinucleotides, and the T344M and G349S mutations occurred in the conserved region. The three missense mutations led to a drastic reduction in GALK activity when individual mutant cDNAs were expressed in a mammalian cell system. These findings indicated that these missense mutations caused GALK deficiency. The two deletions, of 410delG and 509-510delGT, occurred at the nucleotide repeats GGGGGG and GTGTGT, respectively, and resulted in in-frame nonsense codons at amino acids 163 and 201. These mutations arose by slipped strand mispairing. All five mutations occurred at hot spots in the CpG dinucleotide for missense mutations and in short direct repeats for deletions. These five mutations in Japanese have not yet been identified in Caucasians. We speculate that the origin of GALK mutations in Japanese is different from that in Caucasians. [ABSTRACT FROM AUTHOR]

Abstract We identified three mutations in four Japanese patients with central type 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency. One missense mutation was a C-to-T transition, resulting in the substitution of Pro by Ser at codon 87 (P87S) in exon 5. Another missense mutation was a G-to-A transition, resulting in the substitution of Asp by Asn at codon 96 (D96N) in exon 5. A splicing mutation was found by skipping of exon 4 on PTPS mRNA analysis, and a G-to-A transition at the third base of codon 81 (E81E) and at the terminal base in exon 4 were detected on genomic PTPS DNA analysis. The E81E mutation affected the splice donor site of exon 4 and caused the splicing error. In COS cell expression analysis, the P87S and D96N mutant constructs revealed, respectively, 52% and 10% of wild-type activity. Patients with P87S/P87S (52%/52% in-vitro PTPS activity) exhibited 0.11 and 0 micro U/g hemoglobin [Hb] in erythrocyte PTPS activity (wild-type control: 11-29 micro U/ glib) erythrocyte PTPS activity, and the patient with P87S/ D96N mutations (52%/10%) had 0.97 micro U/glib in PTPS erythrocyte activity. The PTPS erythrocyte activity did not coincide with the in-vitro PTPS activity based on patient genotype. [ABSTRACT FROM AUTHOR]