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Megumi Hamaguchi,1 Yukari Tsubata,1 Ken Yoshihara,1 Mika Nakao,1 Yoshihiro Amano,1 Kazuhisa Nakashima,1 Takamasa Hotta,2 Tamio Okimoto,1 Shunichi Hamaguchi,3 Akihisa Sutani,4 Takeshi Isobe1 1Division of Medical Oncology and Respiratory Medicine, Department of Internal Medicine, Shimane University, Izumo, Shimane, Japan; 2Department of Respiratory Medicine, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan; 3Department of General Medicine, Shimane University, Izumo, Shimane, Japan; 4Sutani Respiratory Clinic, Izumo, Shimane, JapanCorrespondence: Megumi Hamaguchi, Division of Medical Oncology and Respiratory Medicine, Department of Internal Medicine, Shimane University, 89-1, Enyacho, Izumo-shi, Shimane, Japan, Tel/Fax +81-853-20-2581, Email hs1219@med.shimane-u.ac.jpPurpose: In Japan, both a 23-valent pneumococcal polysaccharide vaccine (PPSV23) and a 13-valent pneumococcal conjugate vaccine (PCV13) are available. Although randomized controlled trials have examined the effects of pneumococcal vaccines, few epidemiological studies have investigated the onset of pneumococcal pneumonia in general practice. In Izumo, Shimane Prefecture, Japan, a public subsidy for PPSV23 inoculation began in November 2012.Patients and Methods: The subjects were pneumonia patients aged 65 and over who were admitted to a hospital in Izumo. This retrospective study analyzed the following data extracted from medical records: pneumococcal pneumonia prevalence, pneumonia severity, mortality rate, PPSV23 vaccination rate, and length of hospital stay. The 2 years before the start of the public subsidy were defined as the early phase, and the 2 years after the subsidy initiation were defined as the late phase. We compared the two phases in terms of PPSV23 vaccination rate, prevalence and severity of pneumococcal pneumonia, and mortality rate.Results: We investigated data from a total of 1188 and 1086 patients in the early and late phases, respectively. The prevalence of pneumococcal pneumonia was 21.0% and 21.3% in the early and late phases, respectively. The mortality rate from pneumococcal pneumonia was 10.4% and 5.4% in the early and late phases, respectively (p = 0.080), indicating a 50% reduction. The PPSV23 vaccination rate (p < 0.001) and the comorbidity rates of chronic respiratory disease (p = 0.022) and chronic renal disease (p < 0.001) were significantly different between the early and late phases.Conclusion: This study showed that the rate of in-hospital deaths due to pneumococcal pneumonia was halved after the PPSV23 vaccine was subsidized. The causal relationship between the pneumococcal vaccination rate and the mortality rate of pneumococcal disease was unclear. Further investigation is deemed necessary.Keywords: Streptococcus pneumoniae, pneumococcal pneumonia, vaccine, PPSV23, PCV13

Megumi Hamaguchi,1 Yasuyuki Taooka,2 Mika Nakao,1 Kazuhisa Nakashima,1 Takamasa Hotta,1 Yukari Tsubata,1 Shunichi Hamaguchi,1 Akihisa Sutani,3 Takeshi Isobe1 1Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Shimane, Japan; 2Respiratory Medicine, Medical Corporation JR Hiroshima Hospital, Hiroshima, Hiroshima, Japan; 3Respiratory Medicine, Sutani Clinic, Izumo, Shimane, JapanCorrespondence: Yukari TsubataDepartment of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo, Shimane, 693-8501, JapanTel +81-853-23-2581Fax +81-853-20-2581Email ytsubata@med.shimane-u.ac.jpBackground: In Japan, the Ministry of Health, Labour and Welfare population dynamics investigation showed a decrease in the number of deaths related to asthma in recent years. In 2016, the mortality rate was 1.2 deaths per 100,000 population. There were regional differences; Shimane Prefecture had a higher mortality rate (1.6 deaths per 100,000 population in 2016) than other prefectures. In this study, to clarify problems in asthma treatment, we evaluated the status of asthma treatment in Shimane Prefecture.Methods: We performed three cross-sectional questionnaire surveys, in October 2006, February 2009, and February 2012. We received responses from 78 clinics and hospitals. Subjects were patients with bronchial asthma over 14 years of age who regularly visited an outpatient clinic. Survey items included smoking status, control status assessed using the Asthma Control Test (ACT), treatment, and medication adherence. Doctors board-certified by the Japanese Respiratory Society were defined as respiratory specialists (RSs) and other doctors were defined as general practitioners (GPs). We compared various factors between the RS and GP groups.Results: Clinical data of 2159 patients were available for analysis. The proportion of patients with ACT score ≥ 20 points increased significantly between 2006 and 2012 in the GP group. The rate of inhaled corticosteroid use increased in the GP group from 63.6% to 76.4%.Conclusion: It was suggested that asthma control and the rate of inhaled corticosteroid use were related. We should continue educating GPs about asthma treatment.Keywords: questionnaire, bronchial asthma, asthma control test, adherence, general practitioners

Hiroki Takahashi,1,* Masafumi Seki,2,4,* Norihisa Yamamoto,2 Shigeto Hamaguchi,2 Masahiro Ojima,1 Tomoya Hirose,1 Kazuhisa Yoshiya,1 Masahiro Toyokawa,3 Isao Nishi,3 Hiroshi Ogura,1 Takeshi Shimazu,1 Kazunori Tomono21Department of Traumatology and Acute Critical Medicine, Osaka University Hospital, Suita, Osaka, Japan; 2Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan; 3Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan; 4Division of Infection Control and Prevention, Tohoku Pharmaceutical University Hospital, Sendai, Japan *These authors contributed equally to this work Abstract: Surveillance is very important to prevent the nosocomial spread of methicillin-resistant Staphylococcus aureus (MRSA), and infection sources and routes have historically been identified using molecular and epidemiological genotyping with pulsed-field gel electrophoresis. However, phage-open reading frame typing (POT) has recently been developed. Here, we investigated whether POT would be useful to survey MRSA outbreaks and transmission. We therefore applied POT to 91 MRSA isolates detected in cultures from inpatients at our hospital between May and October 2014. Among the 91 isolates, 12 POT types comprising 38 isolated MRSA strains were considered as overlapping. Five of them were detected in different wards, whereas the remaining seven were found in the same ward, including the emergency department. Three of seven POT number 93-155-111 strains were detected in the surgical ward, and all of four POT number 93-157-61 strains were detected in the cardiosurgical ward. These data suggested that transmission of the MRSA strains with the same POT-types from the same wards was nosocomial, and that POT accurately and rapidly identified MRSA strains, which allowed effective control of infection and transmission. Keywords: MRSA, active surveillance, POT, nosocomial transmission

Masafumi Seki,1,2,* Hiroki Takahashi,3,* Norihisa Yamamoto,1 Shigeto Hamaguchi,1 Masahiro Ojima,3 Tomoya Hirose,3 Kazuhisa Yoshiya,3 Hiroshi Ogura,3 Takeshi Shimazu,3 Kazunori Tomono1 1Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan; 2Division of Infection Control and Prevention, Tohoku Pharmaceutical University Hospital, Sendai, Japan; 3Department of Traumatology and Acute Critical Medicine, Osaka University Hospital, Suita, Osaka, Japan *These authors contributed equally to this work Abstract: Conventional culture methods to detect methicillin-resistant Staphylococcus aureus (MRSA) take a few days, and their sensitivity and usefulness also need to be improved. In this study, active screening was performed using the polymerase chain reaction (PCR) for colonization with MRSA on admission and follow-up surveillance after admission to an emergency department between June 2012 and August 2012, and the backgrounds of PCR and/or culture-method-positive patients were compared. Among 95 patients, 15 (15.8%) patients were positive for MRSA on PCR and/or culture; 6.3% (6/95) of patients were positive on admission, and 9.5% (9/95) became positive during the stay after admission. The major primary diagnoses in MRSA-positive patients were trauma and cerebrovascular diseases. Nine (60%) of 15 patients were MRSA-positive on both PCR and culture, compared with three (20%) of 15 who were PCR-positive but culture-negative. The other three (20%) of 15 patients were PCR-negative but culture-positive. Furthermore, there was a tendency for younger age and shorter stay to be associated with PCR-positive but culture-negative results. These findings suggest that active surveillance with PCR may be highly sensitive and useful for the early diagnosis of MRSA colonization to prevent nosocomial transmission from the emergency department to the regular inpatient wards of the hospital. Keywords: active surveillance, length of stay, nosocomial transmission, BD GeneOhm MRSA assay, sensitivity, specificity

Shigeto Hamaguchi,1,* Masafumi Seki,1,* Norihisa Yamamoto,1 Tomoya Hirose,2 Naoya Matsumoto,2 Taro Irisawa,2 Ryosuke Takegawa,2 Takeshi Shimazu,2 Kazunori Tomono11Division of Infection Control and Prevention, 2Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan *These authors contributed equally to this workAbstract: Haemophilus influenzae type b was once the most common cause of invasive H. influenzae infection, but the incidence of this disease has decreased markedly with introduction of conjugate vaccines to prevent the disease. In contrast, the incidence of invasive infection caused by nontypable H. influenzae has increased in the US and in European countries. Neutrophil extracellular traps (NETs) are fibrous structures released extracellularly from activated neutrophils during inflammation, including in pneumonia, and rapidly trap and kill pathogens as a first line of immunological defense. However, their function and pathological role have not been fully investigated. Here, we report a case of fatal nontypable H. influenzae infection with severe pneumonia and bacteremia in an adult found to have a vast amount of NETs in his sputum. The patient had a two-day history of common cold-like symptoms and was taken to the emergency room as a cardiopulmonary arrest. He recovered temporarily, but died soon afterwards, although appropriate antibiotic therapy and general management had been instituted. Massive lobular pneumonia and sepsis due to nontypable H. influenzae was found, in spite of H. influenzae type b vaccine being available. His sputum showed numerous bacteria phagocytosed by neutrophils, and immunohistological staining indicated a number of NETs containing DNA, histone H3, and neutrophil elastase. This case highlights an association between formation of NETs and severe respiratory and septic infection. An increase in severe nontypable H. influenzae disease can be expected as a result of “athogen shift”due to increased use of the H. influenzae type b vaccine in Japan.Keywords: neutrophil extracellular traps, sepsis, pneumonia, Haemophilus influenzae, type b, nontypable

Plasma-liquid interactions represent a growing interdisciplinary area of research involving plasma science, fluid dynamics, heat and mass transfer, photolysis, multiphase chemistry and aerosol science. This review provides an assessment of the state-of-the-art of this multidisciplinary area and identifies the key research challenges. The developments in diagnostics, modeling and further extensions of cross section and reaction rate databases that are necessary to address these challenges are discussed. The review focusses on non-equilibrium plasmas.

The nonlinear evolution of resistive double tearing modes (DTMs) with safety factor values q=1 and q=3 is studied with a reduced cylindrical model of a tokamak plasma. We focus on cases where the resonant surfaces are a small distance apart. Recent numerical studies have shown that in such configurations high-m modes are strongly unstable and may peak around m similar to 10. In this paper, it is first demonstrated that this result agrees with existing linear theory for DTMs. Based on this theory, a semiempirical formula for the dependence of m(peak) on the system parameters is proposed. Second, with the use of nonlinear simulations, it is shown that the presence of fast growing high-m modes leads to a rapid turbulent collapse in an annular region, where small magnetic island structures form. Furthermore, consideration is given to the evolution of low-m modes, in particular the global m=1 internal kink, which can undergo nonlinear driving through coupling to fast growing linear high-m DTMs. Factors influencing the details of the dynamics are discussed. These results may be relevant to the understanding of the magnetohydrodynamic activity near the minimum of q and may thus be of interest for studies on stability and confinement of advanced tokamaks.(c) 2007 American Institute of Physics.

Performance tests are carried out on the subcooling system for the Large Helical Device (LHD) helical coils. The studies have shown that the coil temperature is around 3.6 K under a steady heat load of 100 W from outside of the coil case in the system, which has maintained the above performance.

The cryogenic stability of the Large Helical Device (LHD) helical coils is improved by installing an additional cooler like subcooled helium at 3.0 K. The temperature rise by excitation is analyzed as it is required for maintaining low temperatures for better heat transfer.

The R&D coil is developed for Large Helical Device (LHD) pool-cooled superconducting magnets and the stability tests are performed in saturated sub-cooled helium. The current propagation becomes higher at the lower temperature and it exceeds 11.7 kA in subcooled helium of 3.5 K as a temperature inside the R&D coil.

The sub-cooled He I is used as a coolant for superconducting magnets of the LHD (Large Helical Device) coils and their stability is tested. The helium temperature distribution in the cooling channels of the R & D coil is measured under steady state conditions and the transient helium temperature change in the channels is observed in stability tests.

A Large Helical Device (LHD) coil and sub-cooled helium test facility is designed and tested. Studies reveal that the saturated liquid helium could be cooled from 4.4 K to 3.0 K in eight hours and maintained at 3.0 K.

High temperature superconducting current feeders were developed for a large-scale superconducting experimental fusion system.

Helical coils for the Large Helical Device were studied to determine excitation properties and cryogenic stability.

The first excitation of helical coils of the Large Helical Device has successfully taken place.