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Norihiro Saito,1– 3 Junichiro Tsuchiya,1,3 Masamichi Itoga,1,2 Yuji Okamura,1,4 Hiromasa Tsuyama,1,4 Masahiko Kimura,1,3 Fumio Inoue,1,3 Toshiyuki Kimura,1 Hiromi Ozaki,1 Yuka Tono,1,4 Satoko Minakawa,1,3 Hirofumi Tomita2,3,5 1Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, Aomori, Japan; 2Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan; 3Division of Clinical Laboratory, Hirosaki University Hospital, Hirosaki, Aomori, Japan; 4Division of Pharmacy, Hirosaki University Hospital, Hirosaki, Aomori, Japan; 5Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanCorrespondence: Norihiro Saito, Division of Infection Control and Prevention, Hirosaki University Hospital, 53 Hon-cho, Hirosaki, Aomori, 036-8563, Japan, Tel +81-172-33-5111, Email norihiro@hirosaki-u.ac.jpObjective: This study aimed to identify factors that should be focused on by the antimicrobial stewardship team for treating patients with sepsis, by investigating the mortality of patients with sepsis within 30 days and the mortality-related factors in our hospital over a 10-year period from the perspective of appropriate antimicrobial use.Methods: Factors associated with 30-day mortality were investigated using hierarchical multiple logistic regression in 1406 patients with pathogen-identified sepsis in Hirosaki University Hospital. These factors were clinical data, microbiological data, antimicrobials used in empiric and definitive therapies, presence/absence of ineffective use, underdosing as evaluated using Monte Carlo simulation, and practice of de-escalation.Results: The ineffective use of antimicrobials in empiric therapy and the underdosing and ineffective use in definitive therapy were significantly associated with 30-day mortality (odds ratio [OR] = 2.70, 3.72, and 3.65, respectively). Multiple blood culture sampling was inversely associated with these inappropriate antimicrobial uses. Every year, the 30-day mortality rate has been decreasing, in line with the increase in multiple blood culture sampling and de-escalation; the inappropriate use of antimicrobials has also decreased.Conclusion: Multiple blood culture sampling, proper choice of antimicrobial, and using an adequate dose in definitive therapy could decrease the 30-day mortality rate in patients with sepsis and these factors could be supported by the antimicrobial stewardship team.Keywords: sepsis, antimicrobial stewardship, Monte Carlo simulation, de-escalation

Norihiro Saito, Masamichi Itoga, Satoko Minakawa, Hiroyuki Kayaba Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, 036-8562, JapanCorrespondence: Norihiro SaitoDepartment of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki City, Aomori, 036-8562, JapanTel +81-0172-33-5111Email norihiro@hirosaki-u.ac.jpBackground: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are often used to treat outpatients with psychogenic somatoform symptoms but prove ineffective in some cases. The metabolite 3-hydroxybutyrate (3HB) is currently attracting attention as a marker of the severity of depression. We investigated whether serum 3HB levels in patients with psychogenic somatoform symptoms can predict the effectiveness of sertraline and venlafaxine.Patients and Methods: Physical and psychiatric problems were assessed in 132 outpatients, and symptomatic response and serum 3HB concentrations were examined before and after treatment with sertraline (50 mg/day) or venlafaxine (75 mg/day).Results: In 30.3% of patients with psychogenic symptoms, serum 3HB was above the upper limit of normal (< 80 μmol/L). According to multiple logistic regression analysis, only episodes of suicidal ideation showed a significant positive association with elevated 3HB (odds ratio 10.2; 95% confidence interval (CI) 2.46– 42.2). The sensitivity of 3HB for the effectiveness of sertraline or venlafaxine for psychosomatic symptoms was 44.6%, but specificity was 93.9%. Hierarchical multiple logistic regression analysis identified 3HB as a better predictor of the effectiveness of medication (odds ratio 10.0; 95% CI, 2.49– 40.3) than episodes of suicidal ideation.Conclusion: The present findings suggest that high serum 3HB levels in patients with psychogenic somatoform symptoms may be associated with suicidal ideation and the effectiveness of sertraline and venlafaxine at low to intermediate doses. The 3HB level may be a good predictor of the effectiveness of medication. Examination of serum 3HB levels may lead to earlier and more appropriate administration of sertraline and venlafaxine.Keywords: 3-hydroxybutyrate, psychogenic somatoform symptoms, sertraline, venlafaxine

It is known that the fatigue resistance of concrete decreases when the concrete is saturated with water and that the compressive strength increases with increasing water content at low temperatures below the freezing point of water. However, there have been few systematic studies on the influence of the ambient temperature and moisture content on the fatigue resistance of concrete. In the present study, static loading and fatigue tests were carried out on concrete cylinders to determine their fatigue resistance under compression. The test methods had been conducted to considered environmental temperatures and water contents. The results indicated that at room temperature, the static compressive strength decreases with increasing moisture content. In contrast, at a low temperature, the compressive strength of the samples increased with increasing moisture content. Furthermore, regardless of the temperature, the fatigue resistance decreased as the moisture content increased.

Co thin films are prepared on GaAs(111) substrates at temperatures ranging from room temperature to 600 ºC by radio-frequency magnetron sputtering. The growth behavior and the detailed resulting film structure are investigated by in-situ reflection high-energy electron diffraction and X-ray diffraction. In early stages of film growth at temperatures lower than 200 ºC, Co crystals with metastable A2 (bcc) structure are formed, where the crystal structure is stabilized through hetero-epitaxial growth. With increasing the film thickness beyond 2 nm, the metastable structure starts to transform into more stable A1 (fcc) structure through atomic displacements parallel to the A2{110} close-packed planes. The crystallographic orientation relationship between the A2 and the transformed A1 crystals is A1{111} || A2{110}. When the substrate temperature is higher than 400 ºC, Ga atoms of substrate diffuse into the Co films and a Co-Ga alloy with bcc-based ordered structure of B2 is formed.

We investigated the effect of retinal traction caused by epiretinal membranes (ERMs) on aniseikonia and retinal microstructures in 81 unilateral ERMs. Retinal traction was quantified by measuring the maximum depth of the retinal fold (MDRF) using en face optical coherence tomography (OCT) images. Measurements included the mean inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), central retinal thickness (CRT), and interocular ratios of the foveal avascular zone (FAZ) area (FAZ ratio). Significant correlations were found between the preoperative MDRF and preoperative aniseikonia (P < 0.001), INL thickness (P < 0.001), CRT (P < 0.001), and FAZ ratio (P = 0.003). Preoperative aniseikonia was significantly correlated with preoperative INL and OPL-ONL thicknesses (P < 0.001 and P = 0.020, respectively) and CRT (P = 0.003). Multiple regression analysis revealed that preoperative aniseikonia was significantly associated with preoperative MDRF, INL, and OPL-ONL thicknesses (P = 0.029, 0.006, and 0.006, respectively). Twenty-nine eyes underwent membrane peeling, resolving all retinal folds 6 months postoperatively. A significant correlation was observed between preoperative MDRF and postoperative aniseikonia (P = 0.011). Our findings suggest that retinal traction by ERM is significantly associated with aniseikonia both pre- and postoperatively, alongside other OCT parameters., (© 2024. The Author(s).)

Objective Patients in whom coronavirus disease 2019 (COVID-19) was suspected or confirmed between January 1, 2020, and October 31, 2021, were enrolled from Japanese hospitals in this multicenter, retrospective, observational study. Methods Data on the treatment administered (including conventional and Kampo medicine) and changes in common cold-like symptoms (such as fever, cough, sputum, dyspnea, fatigue, and diarrhea) were collected from their medical records. The primary outcome was the number of days without a fever (with a body temperature <37°C). The secondary outcomes were symptomatic relief and the worsening of illness, defined as the presence of a condition requiring oxygen inhalation. The outcomes of patients treated with and without Kampo medicine were compared. Patients We enrolled 962 patients, among whom 528 received conventional and Kampo treatment (Kampo group) and 434 received conventional treatment (non-Kampo group). Results Overall, after adjusting for the staging of COVID-19 and risk factors, there were no significant between-group differences in the symptoms or number of days being afebrile. After performing propensity score matching and restricting the included cases to those with confirmed COVID-19 who did not receive steroid administration and initiated treatment within 4 days from the onset, the risk of illness worsening was significantly lower in the Kampo group than in the non-Kampo group (odds ratio=0.113, 95% confidence interval: 0.014-0.928, p=0.0424). Conclusion Early Kampo treatment may suppress illness worsening risk in COVID-19 cases without steroid use. Further randomized controlled studies are needed to confirm the clinical benefit of Kampo medicine for COVID-19.

Background: Spread of vancomycin-resistant Enterococcus (VRE) is a global concern as a significant cause of healthcare-associated infections. A series of VRE faecium (VREf) outbreaks caused by clonal propagation due to interhospital transmission occurred in six general hospitals in Aomori prefecture, Japan., Methods: The number of patients with VREf was obtained from thirty seven hospitals participating in the local network of Aomori prefecture. Thirteen hospitals performed active screening tests for VRE. Whole genome sequencing analysis was performed., Results: The total number of cases with VREf amounted to 500 in fourteen hospitals in Aomori from Jan 2018 to April 2021. It took more than three years for the frequency of detection of VRE to return to pre-outbreak levels. The duration and size of outbreaks differed between hospitals according to the countermeasures available at each hospital. Whole genome sequencing analysis indicated vanA-type VREf ST1421 for most samples from six hospitals., Conclusions: This was the first multi-jurisdictional outbreak of VREf sequence type 1421 in Japan. In addition to strict infection control measures, continuous monitoring of VRE detection in local medical regions and smooth and immediate communication among hospitals are required to prevent VREf outbreaks., (© 2022. The Author(s).)