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The article presents a study which examines the mercury (Hg) and selenium (Se) concentrations in tissue samples of harbor seals and the in vitro methylmercury (Me-Hg) demethylating activity. The study analyzed the livers and kidneys of harbor seals captured from the Sea of Okhotsk in Hokkaido, Japan. The results showed that there is no significant correlation between Hg and Se concentrations in the kidneys, but there is a positive correlation of I-Hg and metallothionein.

Injury recurrence in young children is a significant public health concern, as it may indicate an unfavorable home environment. This study evaluates whether infantile injuries increase recurrence during preschool years, contributing to more effective prevention strategies for vulnerable families. The study included 20,191 children from "The Longitudinal Survey of Babies in the 21st Century," a representative sample of infants born in Japan between May 10 and 24, 2010. We conducted a logistic regression analysis to compare injury recurrence risk between children aged 18 months to seven years with and without infantile injury histories. The study revealed that infants with a history of injuries had a higher risk of subsequent hospital visits for injuries during preschool years (crude Odds Ratio (cOR) 1.52, 95% CI, 1.41-1.64, adjusted OR (aOR) 1.48, 95% CI 1.37-1.60). Specific injuries, such as falls (aOR 1.34, 95% CI, 1.26-1.43), pinches (aOR 1.22, 95% CI, 1.15-1.29), drowning (aOR 1.29, 95% CI, 1.19-1.40), ingestion (aOR 1.35, 95% CI, 1.17-1.55), and burns (aOR 1.47, 95% CI, 1.31-1.65), independently increased the risk of future injuries. Our findings highlight the necessity of universal safety measures in the home environment and targeted interventions for families with a history of high-risk injuries., (© 2024. The Author(s).)

Background: Limited data are available on organ donation practices and recipient outcomes, particularly when comparing donors who experienced cardiac arrest and received extracorporeal cardiopulmonary resuscitation (ECPR) followed by veno-arterial extracorporeal membrane oxygenation (ECMO) decannulation, versus those who experienced cardiac arrest without receiving ECPR. This study aims to explore organ donation practices and outcomes post-ECPR to enhance our understanding of the donation potential after cardiac arrest., Methods: We conducted a nationwide retrospective cohort study using data from the Japan Organ Transplant Network database, covering all deceased organ donors between July 17, 2010, and August 31, 2022. We included donors who experienced at least one episode of cardiac arrest. During the study period, patients undergoing ECMO treatment were not eligible for a legal diagnosis of brain death. We compared the timeframes associated with each donor's management and the long-term graft outcomes of recipients between ECPR and non-ECPR groups., Results: Among 370 brain death donors with an episode of cardiac arrest, 26 (7.0%) received ECPR and 344 (93.0%) did not; the majority were due to out-of-hospital cardiac arrests. The median duration of veno-arterial ECMO support after ECPR was 3 days. Patients in the ECPR group had significantly longer intervals from admission to organ procurement compared to those not receiving ECPR (13 vs. 9 days, P = 0.005). Lung graft survival rates were significantly lower in the ECPR group (log-rank test P = 0.009), with no significant differences in other organ graft survival rates. Of 160 circulatory death donors with an episode of cardiac arrest, 27 (16.9%) received ECPR and 133 (83.1%) did not. Time intervals from admission to organ procurement following circulatory death and graft survival showed no significant differences between ECPR and non-ECPR groups. The number of organs donated was similar between the ECPR and non-ECPR groups, regardless of brain or circulatory death., Conclusions: This nationwide study reveals that lung graft survival was lower in recipients from ECPR-treated donors, highlighting the need for targeted research and protocol adjustments in post-ECPR organ donation., (© 2024. The Author(s).)

Introduction: Sepsis is not only the leading cause of death in the intensive care unit (ICU) but also a major risk factor for physical and cognitive impairment and mental disorders, known as postintensive care syndrome (PICS), reduced health-related quality of life (HRQoL) and even mental health disorders in patient families (PICS-family; PICS-F). The ABCDEF bundle is strongly recommended to overcome them, while the association between implementing the bundle and the long-term outcomes is also unknown., Methods and Analysis: This is a multicentre prospective observational study at 26 ICUs. All consecutive patients between 1 November 2020 and 30 April 2022, who are 18 years old or older and expected to stay in an ICU for more than 48 hours due to sepsis or septic shock, are enrolled. Follow-up to evaluate survival and PICS/ PICS-F will be performed at 3, 6 and 12 months and additionally every 6 months up to 5 years after hospital discharge. Primary outcomes include survival at 12 months, which is the primary outcome, and the incidence of PICS defined as the presence of any physical impairment, cognitive impairment or mental disorders. PICS assessment scores, HRQoL and employment status are evaluated. The association between the implementation rate for the ABCDEF bundle and for each of the individual elements and long-term outcomes will be evaluated. The PICS-F, defined as the presence of mental disorders, and HRQoL of the family is also assessed. Additional analyses with data up to 5 years follow-up are planned., Ethics and Dissemination: This study received ethics approvals from Saiseikai Utsunomiya Hospital (2020-42) and all other participating institutions and was registered in the University Hospital Medical Information Network Clinical Trials Registry. Informed consent will be obtained from all patients. The findings will be published in peer-reviewed journals and presented at scientific conferences., Trial Registration Number: UMIN000041433., Competing Interests: Competing interests: The authors declare that they have no competing interests for the submitted work. Some authors report potential conflicts of interest outside of this submitted study. KL reports personal fees from MERA and is the core research member of TXP Medical completely outside the submitted work. KN reports personal fees from Abbott Laboratory, Nestle, TERUMO, GETINGE, Asahi Kasei Pharma, Ono Pharmaceutical, Japan Blood Products Organisation, Nihon Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Toray and Baxter, and grants from Asahi Kasei Pharma outside the submitted work. HK receives a salary from the Japanese Society for Early Mobilisation (non-profit society) as a chair (full time) outside the submitted work., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Recombinant human thrombomodulin (rhTM) is an anti-coagulant used to treat disseminated intravascular coagulation (DIC). The efficacy of rhTM in patients with sepsis-induced DIC has been proved in some clinical trials, but the determining factors are not known. The aim of this study was to identify patients for whom rhTM will be effective and the factors that determine rhTM efficacy in alleviating DIC. A single-center, retrospective, observational study was conducted in patients with sepsis-induced DIC who were treated with rhTM in Okayama Saiseikai General Hospital (Okayama, Japan) between January 2010 and December 2019. Among 67 patients who were treated with rhTM, DIC was resolved in 24 patients. The multivariate logistic regression analysis revealed that age (odds ratio (OR) 1.05; 95% confidence interval (CI) 1.00-1.10; p < 0.05) and acute physiology and chronic health evaluation II scores (OR 0.88; 95% CI 0.78-0.98; p < 0.05) were factors that determined rhTM efficacy in alleviating DIC. Overall, our study provides valuable information on factors that should be considered before rhTM administration to patients with sepsis-induced DIC for a better management of healthcare costs.

Blast furnace slag (BFS) is generated as a by-product in the ironmaking process, and hence, the development of a recycling system for BFS waste is important. In this study, the calcium component of BFS obtained from a steel company in Japan was successfully used as raw material of the synthesis of metaettringite. Metaettringite has been recently considered for as an adsorbent for boron, which is toxic to humans and animals. The BFS used was amorphous, and mainly consisted of CaO, SiO 2 , Al 2 O 3 , and MgO; in particular, it contained 42.82 mass % CaO. The X-ray diffraction pattern and Fourier transform infrared spectrum of the synthesized sample indicated the formation of metaettringite. Field-emission scanning electron microscopy observations revealed its needle-like morphology. The synthesized metaettringite adsorbed 1.189 mg-B/g-adsorbent in 240 min, which was approximately 25 times greater than that achieved using the parent BFS. The metaettringite can reduce the boron concentration to below the uniform effluent standard in industrial wastewater in Japan (16 mg/L).

From fiscal year 2012 to 2014, we surveyed the concentration of radioactive cesium in 39 wild animal meats obtained from 20 wild boars and 19 deer caught in Chiba prefecture, using a germanium semiconductor detector. Four wild boar meats in the fiscal years 2012 and 2013 exceeded the radioactive cesium limit in general foods (100 Bq/kg), whereas none of the deer meats exceeded the limit. The left side of the wild boar that showed a radioactive cesium concentration above 100 Bq/kg was divided into 14 parts. We compared the radioactive cesium concentration in the ham used for the screening test with those in other parts. The concentration was highest in ham, among the edible parts.

Background: Diamond-Blackfan anemia is a rare, clinically heterogeneous, congenital red cell aplasia: 40% of patients have congenital abnormalities. Recent studies have shown that in western countries, the disease is associated with heterozygous mutations in the ribosomal protein (RP) genes in about 50% of patients. There have been no studies to determine the incidence of these mutations in Asian patients with Diamond-Blackfan anemia., Design and Methods: We screened 49 Japanese patients with Diamond-Blackfan anemia (45 probands) for mutations in the six known genes associated with Diamond-Blackfan anemia: RPS19, RPS24, RPS17, RPL5, RPL11, and RPL35A. RPS14 was also examined due to its implied involvement in 5q- syndrome., Results: Mutations in RPS19, RPL5, RPL11 and RPS17 were identified in five, four, two and one of the probands, respectively. In total, 12 (27%) of the Japanese Diamond-Blackfan anemia patients had mutations in ribosomal protein genes. No mutations were detected in RPS14, RPS24 or RPL35A. All patients with RPS19 and RPL5 mutations had physical abnormalities. Remarkably, cleft palate was seen in two patients with RPL5 mutations, and thumb anomalies were seen in six patients with an RPS19 or RPL5 mutation. In contrast, a small-for-date phenotype was seen in five patients without an RPL5 mutation., Conclusions: We observed a slightly lower frequency of mutations in the ribosomal protein genes in patients with Diamond-Blackfan anemia compared to the frequency reported in western countries. Genotype-phenotype data suggest an association between anomalies and RPS19 mutations, and a negative association between small-for-date phenotype and RPL5 mutations.

A total of 18,639 clinical isolates in 19 species collected from 77 centers during 2004 in Japan were tested for their susceptibility to fluoroquinolones (FQs) and other selected antibiotics. The common respiratory pathogens, Streptococcus pyogenes, Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae showed a high susceptible rate against FQs. The isolation rate of beta lactamase non-producing ampicillin-resistant H. influenzae was approximately three times as large as those of western countries. Most strains of Enterobacteriaceae were also susceptible to FQs. The resistance rate of Escherichia coli against FQs has however been rapidly increasing so far as we surveyed since 1994. The FQs-resistant rate in methicillin-resistant Staphylococcus aureus (MRSA) showed approximately 90% except for 36%. of sitafloxacin while FQs-resistant rate in methicillin-susceptible S. aureus (MSSA) was around 5%. The FQs-resistant rate of methicillin-resistant coagulase negative Staphylococci (MRCNS) was also higher than that of methicillin-susceptible coagulase negative Staphylococci (MSCNS), however, it was lower than that of MRSA. In Pseudomonas aeruginosa clinical isolates, 32-34% from UTI and 15-19% of from RTI was resistant to FQs. Acinetobacter spp. showed a high susceptibility to FQs. Although FQs-resistant Neisseria gonorrhoeae have not been increased in western countries, it is remarkably high in Japan. In this survey, isolates of approximately 85% was resistant to FQs.

A survey was conducted to determine the antimicrobial activity of fluoroquinolones and other antimicrobial agents against 8,474 clinical isolates obtained from 37 Japanese medical institutions in 2000. A total of 25 antimicrobial agents were used, comprising 4 fluoroquinolones, 13 beta-lactams, minocycline, chloramphenicol, clarithromycin, azithromycin, gentamicin, amikacin, sulfamethoxazole-trimethoprim, and vancomycin. A high resistance rate of over 85% against fluoroquinolones was exhibited by methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecium. Isolates showing resistance to fluoroquinolones among methicillin-resistant coagulase-negative Staphylococci, Enterococcus faecalis, and Pseudomonas aeruginosa from UTI accounted for 30-60%. However, many of the common pathogens were still susceptible to fluoroquinolones, such as Streptococcus pneumoniae (including penicillin-resistant isolates), Streptococcus pyogenes, methicillin-susceptible S. aureus (MSSA), methicillin-susceptible coagulase-negative Staphylococci, Moraxella catarrhalis, the Enterobacteriaceae family, and Haemophilus influenzae (including ampicillin-resistant isolates). About 85% of P. aeruginosa isolated from RTI were susceptible to fluoroquinolones. In conclusion, this survey of sensitivity to antimicrobial agents clearly indicated trend for increasing resistance to fluoroquinolones among MRSA, Enterococci, and P. aeruginosa isolated from UTI, although fluoroquinolones are still effective against other organisms and P. aeruginosa from RTI as has been demonstrated in previous studies.

Background: With the aim of improving the quality of life of children with cancer, this study presents an analysis of one hospital's experience with terminal care., Methods: Between 1994 and 2000, 28 children died after treatment for cancer at Hamamatsu University Hospital. The circumstances of their deaths were analyzed through medical records and interviews with 8 sets of bereaved parents. We compared results of this analysis with our previous data collected from 1978 to 1993., Results: Of the 28 children, 11 had leukemia/lymphoma (LL group) and 17 had solid tumors (ST group). Six children (21.4%), all of whom were in the LL group, died of treatment-related complications. Twenty children (71.4%) died during terminal care: three (27.3%) were in the LL group and 17 (100%) in the ST group. Eleven children (39.3%) received terminal care at home and eight (28.6%) of these died at home. The number of children who received terminal care and died at home had increased in comparison with the previous period. Among problems with terminal care identified by parents were the lack of opportunity for the child to continue with education and an inadequate support system after the child's death., Conclusions: Some advances in the quality of life of the children were recognized. However, these advances were extended to a greater percentage of children in the ST group than in the LL group. The psychosocial problems faced by children and their families are now changing for the better.

We describe the prevalence of community-acquired M. pneumoniae pneumonia diagnosed by culture methods in a single institute in Japan from January 1979 to December 1999. Cultures were performed in 2971 pneumonia cases and yielded M. Pneumoniae in 508 cases. The epidemic peaks recurred regularly at 4-year intervals (1980, 84, 88 and 91-2). Although a large epidemic has not occurred since 1992, traces of epidemic periodicity have still persisted from 1992 to 1999 at 3-year intervals.

In Japan terminal medicine for children dying from cancer has not yet been developed nor has a support system for home terminal care and bereaved families been established. We have analyzed our own experiences in these areas and researched the possibilities of establishing support systems. In the 16 years from 1978 to 1993, 56 children with cancer have been treated and have died at Hamamatsu University Hospital. We analyzed the circumstances of their deaths. We interviewed 25 sets of parents about their acceptance of their child's death. Three children (5%) died unexpectedly during treatment, 27 children (48%) died from the side-effects of intensive treatment, and 26 children (47%) died during terminal care. More children with leukemia and lymphoma died from side-effects than children with solid tumors (P < 0.05). Six out of the 25 families had not yet accepted the loss of their child due to regrets associated with the missed opportunity for terminal care. From our experiences with the five children who received terminal care at home, we recognize the need for a support system run by the hospital and conclude the time is ripe for initiating home-based terminal care in Japan.

The hair-organ relationship of mercury concentration was investigated in 46 autopsy samples in Tokyo, Japan. Hair mercury levels were highly significantly correlated with organ Hg levels in the cerebrum, cerebellum, heart, spleen, liver, kidney cortex, and kidney medulla, when the total mercury or methyl mercury value in the organ was compared with the hair total mercury or organic mercury, respectively. When the inorganic mercury value was tested, significant correlations remained, with weaker coefficients in all the organs but the spleen. Stepwise multiple regression analysis evidenced that the hair organic mercury value was the major explanatory variable for the organ total mercury or organ methyl mercury value in all the organs. To explain the organ inorganic mercury value, the hair organic mercury value was the major variable for the cerebrum and kidney (both cortex and medulla), the hair inorganic mercury value was the major variable for the cerebellum and heart, and the hair phosphorous and hair organic mercury were the major variables for the liver; no explanatory variable existed for the spleen. Auxiliary explanatory variables accounted for the organ total mercury and inorganic mercury levels, among which the hair selenium value was conspicuous with negative regression coefficients.

When the nutritional status of minerals and essential trace elements is assessed by their levels in plasma, intra-individual variation in the measured values, particularly diurnal variation, must be considered. In this paper, concentrations of nine elements (Na, Mg, P, K, Ca, Fe, Cu, Zn, and Se) in plasma collected 7 times in a 24-h period from 10 healthy Japanese adults were measured with hemoglobin and plasma concentrations of proteins (total protein, albumin, retinol binding protein (RBP), ceruloplasmin, and transferrin), total cholesterol, and cortisol. Then the pattern of diurnal variation in, and the interrelationships among, these parameters were clarified in subjects who consumed an ordinary meal. Significant diurnal variation examined by two-way analysis of variance (variations due to subject and sampling time) was found for Zn, RBP, and cortisol. Plasma Zn level was higher in the forenoon samples than in those taken in the afternoon. The pattern of diurnal variation found for cortisol was similar to, but slightly different from, that for Zn. The correlation coefficient between Zn and cortisol was significant (r = 0.555) using the standardized values for individuals, and in the result of multiple regression analysis, cortisol level was selected as the significant explanatory factor for Zn variation; however, the sampling time was the most significant factor. For other elements besides Zn, no significant diurnal variation was found. Moreover, no meaningful factors were selected for variations of those elements in the result of multiple regression analysis. These results indicate that, in assessing Zn nutriture with its plasma levels, it is necessary to unify the sampling time.

Japanese women's hair, which had been cut in the past and preserved was examined for the presence of 12 elements (Na, K, Mg, Ca, Sr, Mn, Fe, Cu, Zn, Hg, Pb and P). Elevated levels of Fe, Mn, Cu, Pb and Hg (inorganic mercury) were conspicuous in the samples cut in the period 1880-1929 and used as hair pieces (kamoji). The effects of washing on element concentration depended on both the method of washing and the type of element. The least effective was washing with acetone and water, compared with two other methods involving anionic or non-ionic surface active agents. The most resistant elements to washing were Pb, Hg, Cu and Zn. From the intercorrelation of element content and factor analysis, by examining the diminution of contents by washing and by comparing the detected levels with the values measured on contemporary Japanese women's hair, the contribution of exogenous contamination to hair levels was found to be very strong for Fe, Mn, Cu, Hg (inorganic mercury), and Pb, moderate for Na and Zn, and negligible for Ca, Mg, Sr, K, Hg (organic mercury), and P.

Excavated bones (rib) obtained from 50 sites in Japan were measured by ICP atomic emission spectrometry and atomic absorption spectrometry for concentration of 19 elements, including Al, B, Ca, Cd, Cr, Co, Cu, Fe, K, Mg, Mn, Na, Ni, P, Pb, Sr, Ti, V and Zn. One hundred and forty-one specimens were classified into five groups according to Japanese prehistoric and historic eras (Jomon, Yayoi, Kofun, Kamakura and Muromachi, and Edo). The elements, with concentrations which showed no significant change with era were Al, B and Cr. Average concentrations of Ca were in the range 2-2.5 X 10(-1) g g-1 and those of P ranged from 1.1 to 1.3 X 10(-1) g g-1, indicating a well-preserved bone mineral matrix. The Ca/P ratio (mol/mol) was lowest in the Edo group--1.48 as compared with 1.54-1.66 in the other groups. Among the elements which showed changes with era were Pb, Fe, Co and Mn, all of which showed remarkably elevated concentrations in the Edo group. In addition to this unique elemental composition of Edo bones, samples from the Kofun era showed a completely different composition from those of other periods, i.e. they had the highest concentrations of Cd, Zn and Mg, and the lowest concentrations of Cu, K, Ni and Sr. The cause of the elevated Pb concentration in Edo bones is discussed in relation to human activities which may have led to environmental Pb pollution.

The hair samples of Japanese females during the period from 1881 to 1968 were obtained from various localities of the central area of Japan. Inorganic mercury levels were elevated in unwashed hair samples from prewar periods, especially during 1920s , while elevation of organic mercury levels was conspicuous during 1960s. The increase of inorganic mercury levels in samples from the 1920s is suspected to be due to mercury contamination of hair cosmetics, and increased organic mercury levels in the hair from the 1960s can be explained by active fish consumption.

The structure of bone changes with advancing age. In order to observe changes in the trabecular bone structure of the mandibular condyloid process and their relationship to age, the mandibular condyloid process and third lumbar vertebra were extracted from cadavers from several age groups, and changes in trabecular bone structure due to age were compared. Comparison of the trabecular bones of the lumbar vertebra and condyloid processes from single cadavers by age revealed a clear reduction in trabecular bone density and width in the lumbar vertebra accompanying advancing age. In the condyloid process in contrast no major changes were observed; it appears that the effects of aging are slight.

The incidence of Yersinia pseudotuberculosis isolation from humans, animals, water, and pork in Japan is presented on the basis of a review of the literature and serotyping of 633 strains referred to our laboratory. Most of the strains belonged to serogroup 4b, followed in frequency of isolation by serogroups 3, 1b, 5b, 5a, and the others, whereas serogroup 1a has not been detected. Although strains were isolated from 11 species of animals, none were isolated from birds.

Nineteen elements (Al, B, Ca, Cd, Co, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, P, Pb, Sr, Ti, V and Zn) were analyzed in excavated bone (rib) of the Edo era (a Japanese historical era, 300-120 BP (before present] from different burial conditions in Tokyo, and in contemporary Japanese bone (rib) obtained from autopsy cases. The elemental composition of the excavated bones varied according to their burial conditions. The concentration of soil-related elements such as Fe, Mn, Co and Ti in the bone was lowest in the samples in the "wooden coffin in a stone room", next lowest in the "funeral urn with mud", and highest in the "wooden coffin full of mud". The Pb concentration was higher in excavated bones than in contemporary bones and much higher, by as much as several tens micrograms/g, in the bones in the "wooden coffin in a stone room" and in the "funeral urn with mud". These results strongly support the notion that Japanese in the city of Edo were highly polluted by environmental lead.