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Takanobu Hirosawa,1 Tetsu Sakamoto,1 Shogo Hanai,2 Yukinori Harada,1 Taro Shimizu1 1Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga, Tochigi, Japan; 2Departments of Microbiology and Infectious Diseases, Fujita Health University School of Medicine, Aichi, JapanCorrespondence: Takanobu Hirosawa, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu-cho, Shimotsuga, Tochigi, 321-0293, Japan, Tel +81 282 87 2498, Fax +81 282 87 2502, Email hirosawa@dokkyomed.ac.jpPurpose: The effect of antibiotics administered before blood cultures performed in general internal medicine outpatient settings is not well known.Patients and Methods: We conducted a retrospective case–control study including adult patients who underwent blood cultures in the general internal medicine outpatient department of a Japanese university hospital between 2016 and 2022. Patients with positive blood cultures were included as cases and matched patients with negative blood cultures were included as controls. Univariable and multivariable logistic regression analyses were performed.Results: A total of 200 patients and 200 controls were included. Antibiotics were administered prior to blood culture in 20% of patients (79/400). Oral antibiotics were prescribed to 69.6% of the prior antibiotics (55/79). Prior antibiotic use was significantly lower among patients with positive than negative blood cultures (13.5% vs 26.0%, p = 0.002) and was an independent predictive factor in univariable (odds ratio, 0.44; 95% confidence interval, 0.26– 0.73; p = 0.002) and multivariable (adjusted odds ratio, 0.31; 95% confidence interval, 0.15– 0.63; p = 0.002) logistic regression models for positive blood culture. The area under the receiver operating characteristic (AUROC) curve of the multivariable model for predicting positive blood cultures was 0.86.Conclusion: There was a negative correlation between prior antibiotic use and positive blood cultures in the general internal medicine outpatient department. Therefore, physicians should interpret the negative results of blood cultures performed after the administration of antibiotics with care.Keywords: bacteremia, fever, infection, antibacterial agent, antimicrobial, sepsis

Ren Kawamura, Yukinori Harada, Masashi Yokose, Shogo Hanai, Yudai Suzuki, Taro Shimizu Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, JapanCorrespondence: Taro Shimizu, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan, Tel +8128286-1111, Email shimizutaro7@gmail.comPurpose: The general internal medicine (GIM) department can be an effective diagnostic coordinator for undiagnosed outpatients. We investigated the contribution of GIM consultations to the diagnosis of patients admitted to specialty departments in hospitals in Japan that have not yet adopted a hospitalist system.Patients and Methods: This single-center, retrospective observational study was conducted at a university hospital in Japan. GIM consultations from other departments on inpatients aged ≥ 20 years, from April 2016 to March 2021, were included. Data were extracted from electronic medical records, and consultation purposes were categorized into diagnosis, treatment, and diagnosis and treatment. The primary outcome was new diagnosis during hospitalization for patients with consultation purpose of diagnosis or diagnosis and treatment. The secondary outcomes were the purposes of consultation with the Diagnostic and Generalist Medicine department.Results: In total, 342 patients were included in the analysis. The purpose of the consultations was diagnosis for 253 patients (74%), treatment for 60 (17.5%), and diagnosis and treatment for 29 patients (8.5%). In 282 consultations for diagnosis and diagnosis and treatment, 179 new diagnoses were established for 162 patients (57.5%, 95% confidence interval [CI], 51.5– 63.3).Conclusion: The GIM department can function as a diagnostic consultant for inpatients with diagnostic problems admitted to other specialty departments in hospitals where hospitalist or other similar systems are not adopted.Keywords: diagnosis, diagnostic excellence, consultation, consultative medicine, hospital admission

Masashi Yokose, Yukinori Harada, Shogo Hanai, Shusaku Tomiyama, Taro Shimizu Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, JapanCorrespondence: Taro Shimizu, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Kitakobayashi 880, Shimotsuga, Mibu, Tochigi, 321-0293, Japan, Tel +81 282 86-1111, Email shimizutaro7@gmail.comPurpose: The data on the diagnostic contribution of general internal medicine (GIM) consultations for undiagnosed health problems from specialists are scarce. This study aims to explore the role of generalists as diagnostic medicine consultants in tertiary care settings.Patients and Methods: We conducted a retrospective observational study at a Japanese university hospital. GIM consultations for diagnosis from other departments on outpatients aged ≧ 20 years from January 2018 to December 2020 were included. Data were extracted from electronic medical records. The primary outcome was new diagnosis rates. The secondary outcomes were new diagnosis rates with clinical significance and clinical outcomes at 90 days from the index visit.Results: A total of 328 patients were included. The top five consulting departments were orthopedics (17.0%), cardiovascular (10.3%), otorhinolaryngology (8.8%), neurology (8.8%), and gastroenterology (7.9%). GIM identified 456 chief complaints (CCs), and the top five were fever (10.9%), abnormal laboratory results (8.3%), fatigue (5.9%), and pain (7.4%) or numbness (4.6%) in the extremities. There were 139 (104/328 patients: 31.8%) specialty consultations from GIM, and the top five departments were rheumatology (21.1%), gastroenterology (19.2%), orthopedics (9.6%), psychiatry (9.6%), and neurology (9.6%). In total, 277 new diagnoses were established in 232 patients (70.7%), and 203 patients had new diagnoses with clinical significance (61.8%). Clinical outcomes at 90 days from the time of the index visit were resolution/improvement (60.7%), unchanged/worsened (22.3%), and unknown (17.0%).Conclusion: Over 70% of GIM consultations from other departments established new diagnoses with favorable outcomes in > 60% of the patients.Keywords: consultation, specialists, diagnostic error, diagnostic excellence, diagnostic uncertainty

This article discusses the successful treatment of four patients with refractory systemic lupus erythematosus (SLE) and neuropsychiatric manifestations using anifrolumab, a monoclonal antibody. The patients had various clinical characteristics, including acute confusional state, anxiety disorder, mood disorder, cerebrovascular disease, myelopathy, panniculitis, nephritis, pericarditis, leucopenia, haemolytic anaemia, thrombocytopenia, and aseptic meningitis. Anifrolumab treatment resulted in improvements in symptoms and serological abnormalities, allowing for the tapering of prednisolone without relapse of neuropsychiatric symptoms. The study suggests that anifrolumab may be an effective treatment option for refractory SLE with neuropsychiatric manifestations, although further research is needed. [Extracted from the article]

The High Field Laboratory for Superconducting Materials (HFLSM) and the Tsukuba Magnet Laboratory (TML) has conducted a case study on the development of a 50 T-class hybrid magnet. The 20 T superconducting coil is used as a 20 T outsert for a 25 T water-cooled resistive insert in order to obtain a 45 T hybrid magnet.

Thrombotic microangiopathy (TMA) is a rare, life-threatening condition involving microvascular occlusion in multiple systems ([1]). B-cell depletion therapy with RTX has shown efficacy in several open-labelled studies, but failed to demonstrate benefits in two randomized trials of non-LN and LN patients ([3]). However, the European League Against Rheumatism stated that RTX should be considered in organ-threatening, refractory lupus ([4], [5]), and no guidelines for the treatment of TMA in the patient with LN have been established. [Extracted from the article]

The MJ-class HTS SMES is developed for bridging instantaneous voltage dips using newly developed Bi-2212 cable. Fundamental performance tests are done on bridging instantaneous voltage dips, using a 125 kW resistance and 50 kw motor as imitation loads.

The superconducting magnetic energy storage system (SMES) of output 5 MVA is developed to bridge instantaneous voltage dips. During the field test, it is confirmed that the performance of bridging instantaneous voltage dips by SMEs, the long-term drive reliability and the standby loss charcteristics

A Japanese national project to realize commercially feasible SMES for designated applications is promoted. Model coils for power system stabilization, load fluctuation compensation and frequency control are fabricated and tested.

A design of a cryocooler-cooled 19 T superconducting magnet that contains a Bi2223 insert coil composed of 25 double pancake coils, Nb(sub 3)Sn coils using a Nb(sub 3)Sn wire reinforced with nb-Ti-Cu compound is presented. A preliminary experiment is carried out in order to examine the influence of the bending strain upon a maximum permissible hoop stress of Ag-sheathed Bi223 tape conductor.

A cryo-cooled large magnetic field gradient superconducting magnet as the insert magnet for a large bore cryo-cooled superconducting magnet is developed in order in order to study magnetic levitation. The findings indicate that this cryo-cooled magnet system quenched from the insert magnet, but could achieve nearly 1050 T(sub 2)/m.

A cryogen-free 19 T superconducting magnet with a 52-mm room temperature bore is developed. The mechanical properties are investigated for oxide superconducting Bi-2223 tapes.

A reduced-cost SMES system has been designed, and a CIC conductor for it has been fabricated and tested.

A project to develop a high-temperature superconducting split magnet for silicon single-crystal growth applications was begun in 1997. Test results for a full-scale magnet are reported.

The mechanical behavior of superconducting coil for SMES was investigated both experimentally and analaytically.

Research describing ac losses in cable-in-conduit superconducting coils is presented. In particular magnetic field long current loops with long time constants are analysed with reference to the cable strand positions.

Improvements to the superconducting properties of Bi-2122 round wire in large capacity Rutherford cables were made.

The AC loss testing of the 100 kWh SMES model coil is discussed and results reported.

Pulse losses in superconducting coils of 1kWh/1MW superconducting magnetic energy storage are investigated.

A mass flow quench detection system is being development for the 100kWh SMES forced-flow model coil, and measurement of response times after quench revealed the link between quench detection time and joule heat of conductor.

A 1MJ cryocooler-cooled split magnet is being developed with Ag-sheathed Bi2223 tapes for used in Si single-crystal growth applications.

Legendre polynomials have been used in studying the stray field outside a solenoid. The stray field outside a thin solenoid coil can be expanded in a series of Legendre polynomials in cylindrical coordinate where an observation point is designated as R(sub p).Results indicate that the term of a stray field decreasing as r(sub p) raised to the negative third power can be cancelled out as long as the summation of magnetic moments from all coils is zero. The higher order of the stray field can vanish if the coil arrangement is optimized.

A 40 T compact hybrid magnet consisting of a 16 T outer superconducting magnet and a 24 T inner resistive magnet is conceptually designed. A highly strengthened superconducting magnet with a 360 mm room temperature bore can be made using newly developed [(Nb,Ti).sub.3]Sn wires with Cu-Nb or Cu-[Al.sub.2][O.sub.3] reinforcing stabilizer, and as a result the coil weight is outstandingly reduced by about 70 %. A poly-Bitter resistive magnet which generates 24 T in a 14 mm room temperature bore is realized consuming 8 MW power.

We have completed the fabrication of a 40 T class hybrid magnet system including a 15 MW dc power supply, a 15 MW water-cooling system, a helium liquefier/refrigerator, and a hybrid magnet composed of an outer superconducting magnet and an inner water-cooled magnet. We are now beginning to test the system; this paper describes the first results. The outer superconducting magnet is designed to be cryogenically stable at 4.2 K and to generate background fields up to 15 T in a room temperature bore of 400 min. The maximum operating current and the maximum stored energy are 1476 A and 63.3 MJ, respectively. So far, we have tested the superconducting magnet to 14.2 T without quenching. We have fabricated two kinds of inner water-cooled magnets (Insert A and Insert B), which are designed to generate additional fields up to 25 T and 20 T in clear bores of 30 mm and 50 mm, respectively, in a background field of 15 T. We have tested the hybrid magnet system to 32.1 T using Insert B, and to 35.7 T using Insert A.