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The antibody titer is known to wane within months after receiving two doses of the Pfizer-BioNTech BNT162b2 mRNA SARS-CoV-2 vaccine. However, knowledge of the cellular immune response dynamics following vaccination is limited. This study to aimed to determine antibody and cellular immune responses following vaccination, and the incidence and determinants of breakthrough infection.This prospective cohort study a 6-month follow-up period was conducted among Japanese healthcare workers. All participants received two doses of BNT162b2 vaccine. Anti-SARS-CoV-2 antibody titers and T-cell immune responses were measured in serum samples collected at several timepoints before and after vaccination.A total of 608 participants were included in the analysis. Antibody titers were elevated 3 weeks after vaccination and waned over the remainder of the study period. T-cell immune responses showed similar dynamics. Six participants without predisposing medical conditions seroconverted from negative to positive on the IgG assay for nucleocapsid proteins, indicating breakthrough SARS-CoV-2 infection. Five of the six breakthrough infections were asymptomatic.Both humoral and cellular immunity waned within 6 months after BNT162b2 vaccination. The incidence of asymptomatic breakthrough infection within 6 months after vaccination was approximately one percent.UMIN000043340.

Ultrasound is a minimally invasive technique recommended for the evaluation of abdominal pain in young, premenopausal women and pregnant women. Ectopic pregnancy, ovarian cyst torsion, ovarian hemorrhage, myoma degeneration, and pyometra can be detected with point-of-care ultrasound (POCUS) in the case of acute abdominal pain. This article describes the utility of POCUS in females with abdominal pain in obstetrics and gynecological diseases.

Background SARS-CoV-2 vaccination has started worldwide, including Japan. Although high rates of vaccine response and adverse reactions of BNT162b2 vaccine have been reported, knowledge about the relationship between sex differences and antibody response is limited. Furthermore, it is uncertain whether adverse reactions are associated with the vaccine response. Methods This prospective observational study included 673 Japanese participants working in a medical school and its affiliated hospital in Tokyo, Japan (UMIN000043340). Serum samples were collected before the first dose and three weeks after the second dose of BNT162b2 vaccine, and antibody titers against the receptor-binding domain of the spike protein of SARS-CoV-2 were measured. Answers to questionnaires about background characteristics and adverse reactions were obtained at the time of sample collection, and the relationship between antibody titers was analyzed. Results After excluding participants who did not complete receiving two doses of vaccination or two series of serum sample collection, 646 participants were analyzed. Although all participants became sero-positive after vaccination, antibody titers were highly variable among individuals (260.9–57,399.7A U/mL), with a median titer of 13478.0AU/mL. Mean titer was higher in females than in males and higher in young (≤45 years old) participants than in aged (>45 years old) participants. Participants who experienced adverse reactions demonstrated a higher antibody titer after vaccination than those without adverse reactions. Multivariable analysis demonstrated that young age, female sex, and adverse reactions after the second dose were independently related to higher antibody titers after the second dose. Discussion A favorable antibody response was observed after two doses of BNT162b2 vaccination among mostly healthy Japanese participants, especially among female and young participants. Although further investigation is essential, our results imply that the systemic adverse reactions (i.e., fever and general fatigue) are associated with a higher antibody response that indicates the acquisition of humoral immunity.

Memory T cell responses have been analyzed only in small cohorts of COVID-19 vaccines. Herein, we aimed to assess anti-SARS-CoV-2 cellular immunity in a large cohort using QuantiFERON assays, which are IFN-γ release assays (IGRAs) based on short-term whole blood culture. The study included 571 individuals receiving the viral spike (S) protein-expressing BNT162b2 mRNA vaccine. QuantiFERON assays revealed antigen-specific IFN-γ production in most individuals 8 weeks after the second dose. Simultaneous flow cytometric assays to detect T cells expressing activation-induced markers (AIMs) performed for 28 randomly selected individuals provided data correlating with the QuantiFERON data. Simultaneous IFN-γ enzyme-linked immunospot and AIM assays for another subset of 31 individuals, based on short-term peripheral blood mononuclear cell culture, also indicated a correlation between IFN-γ production and AIM positivity. These observations indicated the acquisition of T cell memory responses and supported the usability of IGRAs to assess cellular immunity. The QuantiFERON results were weakly correlated with serum IgG titers against the receptor-binding domain of the S protein and were associated with pre-vaccination infection and adverse reactions after the second dose. The present study revealed cellular immunity after COVID-19 vaccination, providing insights into the effects and adverse reactions of vaccination.

The Surgical Patient Safety System (SURPASS) has been proven to improve patient outcomes. However, few studies have evaluated the details of litigation and its prevention in terms of systemic and diagnostic errors as potentially preventable problems. The present study explored factors associated with accepted claims (surgeon-loss). We retrospectively searched the national Japanese malpractice claims database between 1961 and 2017. Using multivariable logistic regression models, we assessed the association between medical malpractice variables (systemic and diagnostic errors, facility size, time, place, and clinical outcomes) and litigation outcomes (acceptance). We evaluated whether or not the factors associated with litigation could have been prevented with the SURPASS checklist. We identified 339 malpractice claims made against general surgeons. There were 159 (56.3%) accepted claims, and the median compensation paid was 164,381 USD. In multivariable analyses, system (odds ratio, 27.2 95% confidence interval 13.8-53.5) and diagnostic errors (odds ratio 5.3, 95% confidence interval 2.7-10.5) had a significant statistical association with accepted claims. The SURPASS checklist may have prevented 7% and 10% of the accepted claims and systemic errors, respectively. It is unclear what proportion of accepted claims indicated that general surgeon loses should be prevented from performing surgery if the SURPASS checklist were used. In conclusion, systemic and diagnostic errors were associated with accepted claims. Surgical teams should adhere to the SURPASS checklist to enhance patient safety and reduce surgeon risk.

Aim The Ministry of Health, Labour, and Welfare of Japan proposed a regulation of overtime work as a reform in work style. However, the regulation may deteriorate the quality of medical services due to the reduction in training time. Thus, the study aimed to reveal perceptions in terms of generation gaps in views on self-training and overtime work, among members of the Japan Society of Obstetrics and Gynecology (JSOG). Methods A web-based, self-administered questionnaire survey was conducted among members of the JSOG. In total, 1256 respondents were included in the analysis. Data were collected on age, sex, experience as a medical doctor, location of workplace, work style, the type of main workplace, and number of full-time doctors in the main workplace. The study examined the attitudes of the respondents toward overtime work and self-training. The respondents were categorized based on experience as a medical doctor. Results According to years of experience, 112 (8.9%), 226 (18.0%), 383 (30.5%), 535 (42.6%) doctors have been working for ≤5, 6-10, 11-19, and ≥ 20 years, respectively. Although 54.5% of doctors with ≤5 years of experience expected the regulation on working hours to improve the quality of medical services, those with ≥20 years of experience expressed potential deterioration. After adjusting for covariates, more years of experience were significantly related with the expectation of deterioration in the quality of medical services. Conclusions The study revealed a generation gap in the views about self-training and overtime work among obstetricians and gynecologists in Japan.

Generation of antigen-specific memory T cells has been analyzed only for few coronavirus disease 2019 (COVID-19) vaccinees, whereas antibody titers have been serologically measured for a large number of individuals. Here, we assessed the anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cellular immune response in a large cohort using interferon (IFN)-γ release assays (IGRAs) based on short-term whole blood culture. The study included 571 individuals who received the viral spike (S) protein-expressing BNT162b2 mRNA SARS-CoV-2 vaccine. Serum IgG titers against the receptor-binding domain (RBD) of S protein were measured. Samples of 28 vaccinees were subjected to flow cytometry analysis of T cells derived from short-term whole blood culture. IFN-γ production triggered by S antigens was observed in most individuals 8 weeks after receiving the second dose of the vaccine, indicating acquisition of T cell memory responses. The frequencies of activated T cell subsets were strongly correlated with IFN-γ levels, supporting the usability of our approach. S antigen-stimulated IFN-γ levels were weakly correlated with anti-RBD IgG titers and associated with pre-vaccination infection and adverse reactions after the second dose. Our approach revealed cellular immunity acquired after COVID-19 vaccination, providing insights regarding the effects and adverse reactions of vaccination.

Medical litigation resulting from medical errors has a negative impact on health economics for both patients and medical practitioners. In medical litigation involving orthopedic surgeons, we aimed to identify factors contributing to plaintiff victory (orthopedic surgeon loss) through a comprehensive assessment.This retrospective study included 166 litigation claims against orthopedic surgeons using a litigation database in Japan. We evaluated the sex and age of the patient (plaintiff), initial diagnosis, diagnostic error, system error, the time and place of each claim that led to malpractice litigation, the institution's size, and clinical outcomes. The main outcome was the litigation outcome (acceptance or rejection) in the final judgment. Acceptance meant that the orthopedic surgeon lost the malpractice lawsuit. We conducted multivariable logistic regression analyses to examine the association of factors with an accepted claim.The median age of the patients was 42 years, and 65.7% were male. The litigation outcome of 85 (51.2%) claims was acceptance. The adjusted median indemnity paid was $151,818. The multivariable analysis showed that diagnostic error, system error, sequelae, inadequate medical procedure, and follow-up observation were significantly associated with the orthopedic surgeon losing the lawsuit. In particular, claims involving diagnostic errors were more likely to be acceptance claims, in which the orthopedic surgeon lost (adjusted odds ratio 16.7, 95% confidence intervals: 4.7 to 58.0, p 0.001). All of the claims in which the orthopedic surgeon lost were associated with a diagnostic or system error, with the most common one being system error.System errors and diagnostic errors were significantly associated with acceptance claims (orthopedic surgeon losses). Since these are modifiable factors, it is necessary to take measures not only for individual physicians but also for the overall medical management system to enhance patient safety and reduce the litigation risk of orthopedic surgeons.

BACKGROUND Japan implemented a large-scale quarantine on the Diamond Princess cruise ship in an attempt to control the spread of the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in February 2020. OBJECTIVE We aim to describe the medical activities initiated and difficulties in implementing quarantine on a cruise ship. METHODS Reverse transcription–polymerase chain reaction (RT-PCR) tests for SARS-CoV-2 were performed for all 3711 people (2666 passengers and 1045 crew) on board. RESULTS Of those tested, 696 (18.8%) tested positive for coronavirus disease (COVID-19), of which 410 (58.9%) were asymptomatic. We also confirmed that 54% of the asymptomatic patients with a positive RT-PCR result had lung opacities on chest computed tomography. There were many difficulties in implementing quarantine, such as creating a dividing traffic line between infectious and noninfectious passengers, finding hospitals and transportation providers willing to accept these patients, transporting individuals, language barriers, and supporting daily life. As of March 8, 2020, 31 patients (4.5% of patients with positive RT-PCR results) were hospitalized and required ventilator support or intensive care, and 7 patients (1.0% of patients with positive RT-PCR results) had died. CONCLUSIONS There were several difficulties in implementing large-scale quarantine and obtaining medical support on the cruise ship. In the future, we need to prepare for patients’ transfer and the admitting hospitals when disembarking the passengers. We recommend treating the crew the same way as the passengers to control the infection. We must also draw a plan for the future, to protect travelers and passengers from emerging infectious diseases on cruise ships.

We describe the dehydroxymethylbromination of alkoxybenzyl alcohol by using a hypervalent iodine reagent and lithium bromide in F3CCH2OH at room temperature. Selective monobromination or dibromination was possible by adjusting the molar ratios of hypervalent iodine reagent and lithium bromide.

Background Maintaining a maternity care system is one of the biggest issues in Japan due to the decreasing number of obstetricians, especially in remote areas and islands. The aim of this qualitative study was to explore the challenges in women’s health and maternity care in remote areas and islands for primary care physicians and obstetricians in order to provide an insight necessary to develop a better health care system. Methods We conducted semi-structured interviews with 13 primary care physicians and 4 obstetricians practicing maternity care at clinics/hospitals in remote areas and islands across Japan. Interview data were analyzed, using the modified Grounded Theory Approach, to elucidate the challenges primary care physicians faced in their practice. Results Primary care physicians who engaged in maternity care recognized the following challenges: low awareness of primary care, lack of training opportunities, unclear goal of the training, lack of certification system, lack of consultation system, and lack of obstetricians to offer support. These six challenges along with the specialty’s factors such as sudden changes of patients’ condition were considered to result to the provider’s hesitation and anxiety to engage in the practice. Conclusions This study found six environmental/systemic factors and three specialty’s factors as the main challenges for primary care physicians in providing maternity care in remote areas and islands for primary care physicians in Japan. Increasing the awareness of primary care and developing a maternity care training program to certify primary care physicians may enable more primary care physicians to engage in and provide women’s health and maternity care in remote areas and islands.

Purpose: To investigate the relationship between pre- and postpartum anxiety and self-assessment of perinatal depression (PD) risk in pregnant women. Methods: We recruited volunteers for an anonymous questionnaire survey using an app service for pregnant and nursing mothers (Luna Luna Baby, MTI Co Ltd) from November 19 to 30, 2018. The questionnaire consists of 30 items on anxiety during and after pregnancy. Multivariate logistic regression analysis was performed with age, occupation, history of pregnancy, and self-assessment of PD risk as explanatory variables. All statistical analyses were performed using Stata software, Version 15.0. The study was approved by the ethics committee. Results: A total of 1987 pregnant women responded. In both pregnancy and postpartum periods, women aged 19 years or younger felt the most anxious about their financial situation (17/25, 68%). Women in their 20's to 30's were the most worried about the baby’s safety (1162/1893,60.1%). Those with a higher self-estimated risk of PD tended not to list the baby’s safety as an anxiety item, but listed money, financial situation, and mother's own health as concerns. The percentage of those who worried about the baby’s safety was significantly lower in women with a self-assessed PD risk of 90% or higher. Conclusions: The causes of the anxiety in the pregnancy and postpartum periods a may be correlated with age and risk of PD. Health care providers may need to consider the possibility of PD development in pregnant women with high anxiety regarding their financial conditions, health, or raising children.

BACKGROUND Perinatal depression (PD) is one of the biggest causes of maternal mortality in Japan. OBJECTIVE To investigate the relationships between Internet health literacy among expecting and nursing mothers regarding perinatal depression, health information acquisition behaviors, and anxiety about PD. METHODS Web-based open survey (30 items, about eight minutes) was conducted anonymously between November 19, 2018, and November 30, 2018. The participants are users of “Luna Luna Baby” (MTI Co Ltd), an app service for expecting and nursing mothers. All participants consented to the research. The Japanese version of eHealth Literacy Scale was measured. All statistical analyses were performed using Stata software, Version 15.0 (StataCorp LP, College Station, TX). This study was approved by the Ethics Committee (approval number: 2018-051). RESULTS Valid responses were received from 2,979 individuals (1,987 pregnant women, 969 post-childbirth, and 21 others). More than 50% of participants felt they have a risk of developing PD. Most information about PD was acquired from websites during pregnancy (40.1 to 52.0%), while only 15.0% came from the medical institutions. A high-eHealth Literacy Scale group had a significantly higher awareness about postpartum depression (74.7% vs 48.7%), and fewer feelings that they were developing PD (47.4% vs 58.5%). CONCLUSIONS The result suggest that medical institutions may not provide adequate information about PD during pregnancy and the accurate knowledge of the disease might alleviate the anxieties.

A possible spurious correlation was found between human papillomavirus (HPV) vaccination introduction and birth rate change in the United States. Thus, the effects of HPV vaccination needed to be followed carefully at an international level. The birth rate change in the US might be representative of the trend of the introduction of new contraception methods and advancing maternal age.

Presently we, Keio Endocrine and Metabolite Survey (KEMS) study group conducted a questionnaire sur- vey with respect to panic values in the laboratories belonging to Keio University-associated hospitals. As to the initial setting, most of the laboratories answered to play a leading role in preparing the necessary matters to implementation of panic values and revise them corresponding to physician's request on each occasion. In almost all laboratories, they did not verify whether the notification procedure does work to exert appropriate clinical action. The numbers of critical values answered by the 18 laboratories distributed widely in the test items (8-39) and their critical limits (10-68). As to the critical limits, the lower limits of serum K and blood glucose converged among the laboratories, however, the limits of other test items diverged. The results of the present survey regarding to critical values, although being in small scale, may submit the im- portant issue to be solved in near future. [Short Communication].

Background Japan implemented a large-scale quarantine on the Diamond Princess cruise ship in an attempt to control the spread of the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in February 2020. Objective We aim to describe the medical activities initiated and difficulties in implementing quarantine on a cruise ship. Methods Reverse transcription–polymerase chain reaction (RT-PCR) tests for SARS-CoV-2 were performed for all 3711 people (2666 passengers and 1045 crew) on board. Results Of those tested, 696 (18.8%) tested positive for coronavirus disease (COVID-19), of which 410 (58.9%) were asymptomatic. We also confirmed that 54% of the asymptomatic patients with a positive RT-PCR result had lung opacities on chest computed tomography. There were many difficulties in implementing quarantine, such as creating a dividing traffic line between infectious and noninfectious passengers, finding hospitals and transportation providers willing to accept these patients, transporting individuals, language barriers, and supporting daily life. As of March 8, 2020, 31 patients (4.5% of patients with positive RT-PCR results) were hospitalized and required ventilator support or intensive care, and 7 patients (1.0% of patients with positive RT-PCR results) had died. Conclusions There were several difficulties in implementing large-scale quarantine and obtaining medical support on the cruise ship. In the future, we need to prepare for patients’ transfer and the admitting hospitals when disembarking the passengers. We recommend treating the crew the same way as the passengers to control the infection. We must also draw a plan for the future, to protect travelers and passengers from emerging infectious diseases on cruise ships.

(2009). Englishization in Asia: Language and Cultural Issues. Asian Englishes: Vol. 12, No. 2, pp. 84-87.

A survey was conducted to understand the nature and management of persons with speech-language-hearing (SLH) and related disorders in facilities of child welfare and the elderly in Nobeoka city, last year.This study we evaluated a case of 39-vear-old female with head injured in facility of welfare elderly in Nobeoka city for SLH. The results indicated treble hearing loss, ataxic dysarthria, aphasia and memory disorder. We performed therapy for dysarthria, aphasia and memory disorder in SLH clinic of our university.For SLH who couldn’t come to our university we plan a remote diagnostic system. Then it was concerned it was necessary to evaluate 3 aspects such as SLH at least and treat them. It is hoped to establish the system of the evaluation and management of SLH and related disorders in these facilities in Nobeoka city.

We reported a case of child with language retardation who has laryngomalacia and hearing impairment. He has a three problem as follows … 1. Severely sensorineural deafness. 2. Tracheostoma for maintaining airway. 3. Instability of health condition. The most severe problem was a delay of language development by hearing loss. We planned his therapy program developing communication ability, containing hearing, language abilities.

We report the use situation of clinic for persons with speech, language and hearing disorders (clinic), which we are performing. The number of the candidates for investigation is 67 who proposed to clinic from November 26, 2000 to December 5, 2001. There were 47 (70%) men and there were 27 women (30%) among users. Children before attendance at school were 38 (57%), after attendances at school were 27 (40%). Adults were 2 (3%).Result of evaluation: Language retardation were 43 (86%), hearing loss were 4 (8%), one person (2%) was organic articulation disorder, doubt of learning disorders was l (2%), one person (2%) was diagnosed progress observation. It was aphasia with two adults (100%). Language retardation (43) had a complication. It was broken down into mental retardation were 19 (43%), autistic disorder were 13 (30%), cerebral palsy 8 (18%), hearing loss were 4 (9%).In clinical of children the special concrete correspondence united with each feature is important. And we need to do an introduction of clinic to welfare facilities of the elderly.Currently department of speech, language and hearing therapist students can observe clinic in response to requests. Various clinical data are used for a study of new clinical tests and training method.

Background: Interferon-gamma release assays (IGRAs) more accurately diagnose Mycobacterium tuberculosis (Mtb) infection than the tuberculin skin test. To prevent outbreaks in medical facilities, early detection and treatment of Mtb infection (including latent tuberculosis infection (LTBI)) is important in healthcare workers. Therefore, the IGRAs have considerable utility for Mtb infection control in medical facilities. In Japan, two IGRAs are commercially available, QuantiFERON®-TBGold In-Tube assay (QFT-GIT) and T-SPOT®.TB (T-SPOT). However, it remains unclear if diagnostic yields of LTBI by both IGRAs are equivalent in healthcare workers. Methods: We performed both QFT-GIT and T-SPOT simultaneously in healthcare workers with a high risk of LTBI (excluding active tuberculosis) between December 2012 and February 2013. Results: Among 313 subjects (excluding 2 cases with indeterminate T-SPOT), 6 (1.9 %) and 12 (3.8 %) were QFT-GIT positive and T-SPOT positive, respectively. There was no significant concordance of results between the QFT-GIT and the T-SPOT (p=0.064 and Kappa=0.43, 95% confidence interval 0.082-0.78). Among 10 discordant cases between two IGRAs, 8 cases had IGRAs’ results near the cutoff values. Conclusion: Without a diagnostic gold standard for LTBI, it is difficult for us to further assess which test is more accurate and more suitable for the diagnosis of LTBI. However, to diagnose LTBI of healthcare workers with IGRAs’ results near the cutoff values, we should consider clinical context, such as contact level, as well as the results of IGRAs.

A survey was conducted to understand the nature and management of persons with speech-language-hearing (SLH) and related disorders in facilities of child welfare and the elderly in Nobeoka city. The questionnaire was sent to 84 facilities and approximately a half of the facilities (51.2%) responded. No speech therapist (ST) was employed in these facilities. SLH disorders were identified in the 16.9% of individuals who resided in and commuted to these facilities. Overall, language disorders, i.c., language delay and aphasia, were the most frequently identified SLH disorder, followed by dysphagia and hearing disorders in the facilities for the elderly and articulation disorders in the child welfare facilities. The post-onset period of SLH and related disorders was seldom known. SLH therapy was taken only for 3.4% individuals. Paraprofessionals had involved for the management of SLH and related disorders. It is assumed that no formal evaluation was conducted in these facilities. Some paraprofessionals had joined a study group (16% of the facilities). It is hoped to establish the system of the evaluation and management of SLH and related disorders in these facilities in Nobeoka city.

We conducted preliminary investigation of the current status in the evaluation of language and hearing functions in part of health examination for infants and young children in Miyazaki prefecture, A survey form as mailed to the 45 regional offices in Miyazaki prefecture, and 25 responses were received (56%).The frequency of examinations per year varied from 4 to 24 among the regions. The examination took two ways, mass and individual examinations. Many respondents felt necessity to improve the language and hearing examination, and a participation of speech-language-hearing therapists was sought in some regional offices.However, speech-language-hearing therapists were not known enough in the offices in charge of the examination.It is urgent to develop reliable screening test and asking questionnaire on language and hearing functions. In the future, speech-language-hearing therapists should be involved in health examination for infants and young children.We are planning further investigations in large scale.

To obtain fundamental knowledge on the development of micro analyses for constituents in water, the discrimination of three varieties of commercial natural mineral water, ultra pure water and deionised water, was attempted using near infrared (NIR) spectroscopy. Both the original NIR spectra and their second derivatives were almost identical to each other for these five types of water and it was difficult to discriminate between their spectra visually. However, the use of discriminant analysis enabled the five kinds of waters to be distinguished. Principal component analysis for the second derivative spectra revealed that the independent variables of the discriminant analysis were identical with the wavelength regions affected by ionic hydration. For the discrimination of water, the original spectra were more suitable than the second derivative spectra because the baseline variation of the original spectra had the useful information for the analysis.

Triaging of patients with chest pain to rule out acute myocardial infarction is important. Myoglobin is thought to be an effective marker for this purpose in the early hours after the onset of symptoms because it is released into the blood shortly after myocardial damage (1)(2)(3). The Cardiac Reader (Roche) provides a platform for the quantitative immunologic measurement of whole-blood myoglobin. The measuring range of the Cardiac Reader for myoglobin is 30–700 μg/L, and the upper reference limit is 80 μg/L. In a previous study, the within-series CV (the mean value of 20 within-run CVs with 20 instruments) was 5–10% and was almost constant throughout the measuring range (4). The assay system is thought to be suitable for near-patient use because of its easy operation and the short assay time. We observed two cases whose blood myoglobin concentrations showed falsely low values with this method. Case A was an 84-year-old male in cardiogenic …