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In 2014 and 2015, we examined the spatial distribution of cesium-134 (half-life: 2.06 years) from the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) in marine sediments within coastal-basin areas (water depths of 40-520 m) off central Honshu Island (the main island of Japan) in the Sea of Japan. The Cs concentrations in both the surface sediment (0-1 cm depth) and whole-core inventory exhibited wide variations, and were highest at the site closest to the Agano River Estuary area (6.7 Bq/kg-dry and 886 Bq/m, respectively). This indicates that Cs in coastal areas was delivered by riverine suspended solids (SS). Given the spatial variation in Cs concentrations, we believe that Cs partially migrated northeastward within ~50 km along Honshu Island (at water depths shallower than ~140 m), and southwestward, including the Sado Basin area. This is predominantly attributable to the transport of SS by bottom currents and unsteady downward delivery onto the steep slopes of the basin. The total amount of Cs in the study area in 2014 was estimated at approximately 0.6 TBq (decay-corrected to March 11, 2011, date of FDNPP accident). [ABSTRACT FROM AUTHOR]

Laparoscopy provides extensive data for the decannulation of a peritoneal dialysis catheter and is being increasingly used to diagnose encapsulating peritoneal sclerosis. However, there are few reports on the methods of decannulation of peritoneal dialysis catheters. In this study, we examined the laparoscopic findings and postoperative complications of patients undergoing peritoneal dialysis catheter removal. A total of 119 laparoscopic decannulations of peritoneal dialysis catheters were performed between 2003 and 2018 at the Juntendo University Hospital and Juntendo University Nerima Hospital. Laparoscopy was performed during peritoneal dialysis catheter removal by a gastrointestinal surgeon. Patient characteristics such as age, sex, duration of peritoneal dialysis, history of peritonitis and age at the time of peritoneal dialysis termination were assessed. Of these 119 cases, 19 (16.0%) showed adhesion between the peritoneal dialysis catheter and intraperitoneal organs. There were 13 (10.9%) cases involving a tangled omentum, 4 (3.4%) cases involving the small intestine and 2 (1.7%) cases of adhesions extending from the bowels to the abdominal wall. No postoperative complications were associated with the laparoscopic surgery. In these cases, blind decannulation of the peritoneal dialysis catheter may result in injury to the gastrointestinal tract in patients with adhesions. Therefore, we need to pay attention to adhesions between peritoneal dialysis catheters and intraperitoneal organs, and laparoscopy could be a valuable tool in detecting such adhesions and ensuring patient safety., (© 2023 The Authors. Nephrology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Nephrology.)

The importance of a shared decision-making (SDM) approach is widely recognized worldwide. In Japan, hospital accreditation involves the promotion of SDM for patients with end-stage renal disease (ESRD) when considering renal replacement therapy (RRT). This study aimed to clarify the effectiveness and long-term medical benefits of SDM in RRT. Patients with ESRD who underwent dialysis therapy were retrospectively divided into those who visited outpatient clinics specific for ESRD (ESRD clinic) supporting RRT selection with an SDM approach (visited group) and those who did not visit the ESRD clinic (non-visited group). Data of 250 patients (129 in the non-visited group and 121 in the visited group) were analyzed. Mortality was significantly higher in the non-visited group than in the visited group. Not seeing an ESRD specialist was associated with emergent initiation of dialysis and subsequent 1 year mortality. The number of patients who chose peritoneal dialysis as a modality of RRT was significantly larger in the visited group. These findings demonstrate the association between the ESRD clinic, 1 year survival in patients with ESRD after initiating dialysis, and the different RRT modalities. This specific approach in the ESRD clinic may improve the management of patients with ESRD., (© 2023. The Author(s).)

We measured the concentrations of cesium isotopes ( 133 Cs, 134 Cs, and 137 Cs) in zooplankton samples collected in waters off the east coast of Japan from May 2015 to June 2020. By combining these data with those obtained previously from May 2012 to February 2015, we evaluated the long-term impacts of the Fukushima Dai-ichi Nuclear Power Plant accident on marine zooplankton. Relatively high 137 Cs concentrations in zooplankton, exceeding 10 Bq/kg-dry weight, were sporadically observed until June 2016, regardless of year or station. After May-June 2017, 137 Cs concentrations decreased to below 1 Bq/kg-dry at most stations, and by May 2020, concentrations were below 0.5 Bq/kg-dry except those off Fukushima Prefecture. Since the accident, the 137 Cs/ 133 Cs atom ratios of zooplankton samples were higher than those of ambient seawater until 2019, but in May-June 2020 the ratios matched those of seawater except off Fukushima Prefecture. Highly radioactive particles were not detected in zooplankton samples by autoradiography using imaging plates after May-June 2017, although they were before. Therefore, the persistence of elevated 137 Cs/ 133 Cs ratios in zooplankton relative to seawater for nine years after the accident was probably due to the incorporation of highly radioactive particles (cesium-bearing particles or clay-mineral aggregates with highly adsorbed radiocesium) onto/into zooplankton for several years after the accident. However, since at least May-June 2017, these elevated ratios have likely been caused by small highly radioactive particles (or larger particles disaggregated into small pieces) entering the ocean from land via rivers or directly discharged from the Fukushima Nuclear Power Plant. Microplastics enriched with radiocesium with higher 137 Cs/ 133 Cs ratios than seawater may have also contributed 137 Cs to the zooplankton., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Peritoneal dialysis (PD) catheter exit-site care is critically important for the prevention of catheter-related infections (CRIs) and subsequent peritonitis. The postoperative management of the site is particularly essential because it has an open wound that is always adjacent to a PD catheter tube. This study aimed to examine the effectiveness of negative-pressure wound therapy (NPWT) for postoperative PD catheter exit sites. Thirty patients with end-stage renal disease who underwent simultaneous PD catheter insertion and exit-site formation were randomly assigned to receive NPWT (NPWT group) or conventional dressing (non-NPWT group) for the first seven postoperative days. The exit-site scores on the seventh postoperative day was lower in the NPWT group than in the non-NPWT group (p = 0.0049). Analysis of variance F statistic for the effect of NPWT over 180 days was highly significant (11.482595, p = 0.007). There were no statistically significant differences between the time to first CRI and PD-related peritonitis between the two groups. There was one case of CRI with relapsing peritonitis and catheter loss in the non-NPWT group. These findings demonstrate the association between NPWT and low exit-site score. NPWT can be recommended for the management of PD catheter exit sites in the early postoperative period., (© 2022. The Author(s).)

The 238 Pu, 239+240 Pu, 241 Am, 242 Cm, 243+244 Cm and 90 Sr concentrations in seafloor surface sediments collected at three sampling stations off the Fukushima Daiichi Nuclear Power Plant (FDNPP) site during the period from 2012 to 2019 were determined to elucidate the impacts of the FDNPP accident onto their concentrations in coastal sediments and to discuss the sources of the measured radionuclides. The 239+240 Pu, 241 Pu and 241 Am concentrations and 240 Pu/ 239 Pu atom ratios in a sediment core were also determined to allow comparison of their inventories between this study and previously reported values and to identify the Pu sources. The 238 Pu, 239+240 Pu, 241 Am and 90 Sr concentrations showed no remarkable temporal variations; no significant increases in concentrations after the FDNPP accident were observed; these concentrations were comfortably within the previously reported concentration range; and no detectable 242 Cm and 243+244 Cm amounts were observed in surface sediments. The observed 238 Pu/ 239+240 Pu activity ratios were approximately two orders of magnitudes lower than those for the damaged FDNPP reactor core inventories and the observed values in terrestrial samples after the accident. The 239+240 Pu, 241 Pu and 241 Am inventories in the sediment core were 389 ± 5, 503 ± 33 and 214 ± 3 Bq m -2 , respectively. The 239+240 Pu inventory was about an order of magnitude greater than the expected cumulative deposition density of global fallout from atmospheric nuclear weapons testing due to an enhanced scavenging effect. The 240 Pu/ 239 Pu atom ratios in the sediment core ranged from 0.239 to 0.246 with a mean value of 0.242 ± 0.002; these ratios were clearly greater than the mean global fallout ratio of 0.18. The results for 238 Pu/ 239+240 Pu activity ratios and 240 Pu/ 239 Pu atom ratios reflected a mixture of global fallout and Pacific Proving Grounds (PPG) close-in fallout Pu rather than Fukushima accident-derived Pu. The sediment column inventory for 239+240 Pu originating from the PPG close-in fallout was calculated as 166 Bq m -2 , which corresponded to 43% of the total inventory. A significant amount of the PPG-derived Pu has been transported by ocean currents and then preferentially scavenged in the coastal waters of Japan., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The number of patients with end-stage renal disease (ESRD) has been increasing, with dialysis treatment being a serious economic problem. To date, no report in Japan considered medical costs spent at the initiation of dialysis treatment, although some reports in other countries described high medical costs in the first year. This study focused on patient status at the time of initiation of dialysis and examined how it affects prognosis and the medical costs. As a result, all patients dying within 4 months experienced emergent dialysis initiation. Emergent dialysis initiation and high medical costs were risk factors for death within 2 years. High C-reactive protein levels and emergent dialysis initiation were associated with increasing medical costs. Acute kidney injury (AKI) contributed most to emergent dialysis initiation followed by stroke, diabetes, heart failure, and short-term care by nephrologists. Therefore, emergent dialysis initiation was a contributing factor to both death and increasing medical costs. To avoid the requirement for emergent dialysis initiation, patients with ESRD should be referred to nephrologists earlier. Furthermore, ESRD patients with clinical histories of AKI, stroke, diabetes, or heart failure should be observed carefully and provided pre-planned initiation of dialysis.

The spatial variations of low-level 134 Cs concentrations (activities) in seawater off the Japanese Archipelago, particularly in the eastern East China Sea (ECS), in 2018 and 2019 were examined. The 134 Cs concentrations, decay-corrected to the date of the Fukushima Dai-ichi Nuclear Power Plant accident, in seawaters were 0.5-2.0 mBq/L. High 134 Cs concentrations (1.1-2.0 mBq/L) of the Kuroshio Current subsurface water (densities of 25-26σ θ ) in the eastern ECS could indicated the contribution of the subtropical mode water from the Pacific Ocean side, and total column inventories were 330-426 Bq/m 2 . In contrast, as indicated by the same 134 Cs concentration level at the surface of the eastern ECS and Sea of Japan, larger portions of the subsurface waters remained in the ECS and Yellow Sea side in response to the existence of the shallow Tsushima Strait., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: Most guidelines in different countries recommend waiting more than 2 weeks for the initial cannulation of an arteriovenous fistula (AVF) after its creation. Although an experienced examiner can subjectively determine if an AVF is ready for early cannulation, there is a lack of objective information to guide whether early cannulation is appropriate or how early cannulation may affect an AVF's primary patency. The current study examined the relationship between the initial cannulation and the prognosis of AVF, considering ultrasonography (US) findings., Methods: This retrospective observational study enrolled 103 patients with end-stage renal disease who had started hemodialysis therapy from 2013 to 2015 at the Juntendo University Hospital. All patients had been given a primary AVF before or after the initiation of dialysis, had undergone US examinations both before and 7 days after surgery, had initially cannulated the AVF at ≥7 days after surgery, and were observed for over 1 year., Results: The factor associated with the loss of primary patency was a resistance index of brachial artery ≥0.65 on US examination at 7 days after surgery. There was no significant difference in patency rate between the early (within 14 days after surgery) and late initial cannulation groups (≥15 days after surgery)., Conclusion: Because a resistance index <0.65 on US findings at 7 days after surgery was a good indicator for predicting an excellent patency rate when we performed first cannulation of AVF located in the forearm within 2 weeks after its creation, 1-week postoperative US evaluation may provide crucial information., (© 2020 International Society of Nephrology. Published by Elsevier Inc.)

Radiocesium concentrations were measured in seawater and sediment samples collected in the swash zones in Ishikawa and Niigata prefectures, off the coast of Japan Sea opposite to the side where TEPCO Fukushima dai-ichi Nuclear Power Plant (FDNPP) is located in September 2016 and August 2017, five to six years after the accident. Cs-134 in the seawater samples was detected, suggesting the intrusion of FDNPP-derived radiocesium in both swash zones. FDNPP-derived radiocesium was appeared to be transported by the Tsushima Warm Current. In the surface sediments only 137 Cs was detected during the sampling period. We could not find out the presence of the FDNPP-derived radiocesium in the corresponding sediment on the swash zones; however, detected radiocesium in those sediments was assumed to be influenced by 137 Cs of FDNPP-derived radiocesium little for Ishikawa area and some for Niigata area., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Thirty-five patients with end-stage gynecological cancer, twelve taken care for at home care and 23 taken care for at our hospital, were compared. The life span after recurrence was significantly (p < 0.05) longer in the group taken care for at home. The number of persons living with the patient was also significantly (p < 0.01) larger in the group taken care for at home. Moreover, the hospitalization in the end stage of the disease was significantly (p < 0.01) shorter in the group taken care for at home. The average hospitalization in the end was for 6.5 days. Four patients died at their home. Average period the 12 patients stayed at home was 52.7 days. Following matters are important in order to provide home care. 1. We must know the biological characteristics of the cancer. 2. It is important that it does not lose the timing to which shift to the home care, keeping good doctor-patient relationship. 3. Limit of the therapy against cancer and importance of treatment at home should be carefully and clearly explained to the patient.

In the two-stage model of controlling cellular senescence in cultured human fibroblasts, retinoblastoma (Rb) and p53 proteins may be key factors regulating the mortality stage 1 mechanism. In addition, the critical loss of telomeric DNA due to the end-replication problem may result in the mortality stage 2 mechanism. Cells which acquire telomerase activity can overcome the M2 mechanism by stabilizing telomere length and thus become immortal (telomere hypothesis). At present it is known whether cellular immortality is a prerequisite for all human cancers. To investigate this question and the applicability of the two-stage model to human cancers, we analysed the relationship between alterations of telomere length and other genetic changes in lung cancer. Among 60 primary lung cancer tissues, telomere length alterations were observed in 16 tumors (26.7%) including 14 with short and two with elongated telomeres. Ten of them revealed allelic loss of both p53 and Rb genes, and remaining six showed no abnormalities in both genes. We propose that inactivation of both p53 and Rb genes may promote cell divisions causing telomere shortening in lung cancer as in the two-stage model, while there may be another pathway to overcome both M1 and M2 mechanisms, especially for adenocarcinoma.

Findings of bronchoalveolar lavage fluid (BALF) were compared among three groups of patients: rheumatoid arthritis (RA) with or without interstitial lung disease (ILD), and collagen disease other than RA accompanied by ILD. Regardless of the presence or absence of associated ILD, the RA groups showed higher numbers of neutrophils in BALF with a mean number about 10 times that of the collagen disease group. In contrast, the percentages of lymphocytes in the RA groups were lower than that in the collagen disease group. Classification of alveolitis on the basis of BALF findings revealed neutrophil type (N) in 55% of the RA patients and lymphocyte type (L) in 25%. In the collagen disease group, N was found in 15.4%, and L in 38.5%. Regarding the lymphocyte subsets, many patients with RA accompanied by ILD had a CD 4/8 ratio of 1 or great. These findings suggest that highly characteristic neutrophil alveolitis is present in the pulmonary interstitium from the initial stage of RA.