Mass screening for neuroblastoma in Miyagi Prefecture.

In Japan, aiming at early and preclinical detection of neuroblastoma in infancy a mass screening program for the tumor has been implemented nationwide using urinary tests for catecholamine metabolites, vanillylmandelic acid (VMA) and homovanillic acid (HVA) (Sawada 1990; Sawada et al. 1991). In this report, the results obtained from the screening program in Miyagi Prefecture for the last 6 years are described. The detection rate of neuroblastoma by mass screening was 1:8,377 among 125,652 infants tested in Miyagi Prefecture. All but one patients survived after removal of the primary tumor and none or minimal chemotherapy.     

Clinicopathological features of malignant lymphoma in Japan: the Miyagi Study

The Miyagi Study is an epidemiological study of malignant lymphoma, including immunological and genetic analyses, constructed by a population-based registration system covering Miyagi prefecture, Japan. A total of 1,552 newly diagnosed cases in Miyagi between 2002 and 2008 were enrolled in this study; 75% were B-cell lymphomas, 19% were T-cell and natural killer-cell (T/NK-cell) lymphomas, and 5% were Hodgkin's lymphomas. The most frequent subtype of B-cell lymphoma is diffuse large B-cell lymphoma, followed by follicular lymphoma and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (51%, 24% and 8%, respectively). Thus, follicular lymphoma accounts for 18.2% of newly diagnosed cases in Miyagi; unexpectedly, its frequency is similar to that reported in Western countries. The common subtypes of T/NK-cell lymphoma are peripheral T-cell lymphoma, angioimmunoblastic T-cell lymphoma, and adult T-cell leukemia/lymphoma (30%, 15% and 14%, respectively). Most of the data are similar to those reported in Asian countries, except for follicular lymphoma. We also analyzed the CD20 expression in B-cell lymphomas by flow cytometry for the cell membrane expression and by immunohistochemistry for the cytoplasmic expression. The cell membrane expression of CD20 protein may determine the susceptibility of B-cell lymphomas to anti-CD20 antibody therapy. The lack of CD20 expression was confirmed by both methods in 4 cases of 585 newly diagnosed cases (0.7%) and in 5 of 67 recurrent cases (7.5%). Furthermore, 23 cases (6.5%) showed the discrepancy of CD20 expression between both methods. The Miyagi Study has revealed the latest epidemiological features of malignant lymphoma in Japan.     

Listeria monocytogenes infection with brain abscess formation--the first case in Miyagi Prefecture

A rare type of brain abscess formation caused by infection with Listeria monocytogenes was observed in a 2-year-old boy. The patient did not respond to treatment with various antibiotics. The isolated organisms were found to be sero-type 4b. This is the first report of Listeria monocytogenes infection in Miyagi Prefecture.     

The relation between serum selenium value and cancer in Miyagi,Japan: 5-year follow up study

To determine the relation between serum selenium (Se) values and the development of cancer, we compared serum Se levels among cancer patients, non-cancer patients, and healthy adults. Serum Se values in cancer patients were examined with respect to primary cancer sites separately. We tracked non-cancer patients and healthy people for 5 years after serum collection to examine whether low Se status is a risk factor for cancer. The mean serum Se values in cancer patients were significantly lower than in non-cancer patients. This difference, however, failed to exist in women 50 years of age and less. In the examination of serum Se values with respect to organs with primary cancer, mean serum Se values for 6 organs were significantly lower than those in non-cancer patients and healthy people. However, female breast cancer patients showed a higher value. During the 5 year follow up, patients who developed cancer had lower values than that in subject who remained non-cancer and sex differences were absent. We were unable to rule out low Se status, as a possible risk factor for cancer, a result supported by our 5-year follow-up. In distribution of non-cancer patients classified by serum Se values, the proportion of patients with low serum Se values (80 ppb or less) was relatively high (12%). If low Se status increases the risk of cancer, low Se status as a risk factor for cancer should be considered even in Japan, where Se intake is sufficient.     

Self-injury resulting in amputation among vascular patients: a retrospective epidemiological study.

In the course of 24 months, 164 nontraumatic vascular amputees were accepted for prosthetic rehabilitation; 120 (73%) were diabetic and 44 (27%) non-diabetic. Subjects were divided into two groups, the first consisting of 114 with spontaneous foot infection or gangrene and the second of 50, of whom 44 were diabetic and six had peripheral arterial disease on its own. Sixty-five per cent of all amputees had fewer than nine years of formal education and 46% were in the low-income bracket, but no significant relationship was found between mechanism of self-injury and level of education and income. All patients in the second group were able to detail ways in which they had injured their feet. The relationship between the mechanism of self-injury and the presence of diabetes mellitus was found to be highly significant. By instructing in better self-care it may be possible to prevent or at least postpone amputation in these patients.     

Twelve-year survey (2001–2012) of the antimicrobial susceptibility of Streptococcus pneumoniae isolates from otorhinolaryngology clinics in Miyagi Prefecture,Japan

IntroductionStreptococcus pneumoniae is one of the most common bacteria causing otorhinolaryngological infections, such as acute otitis media and upper respiratory tract infection. Our group surveyed the drug susceptibility profile of S. pneumoniae isolates from otorhinolaryngology patients.Materials and methodsA total of 41,069 S. pneumoniae isolates were detected at Miyagi Medical Association Health Center between May 2001 and December 2012. Specimens were obtained from patients at 40 otorhinolaryngology outpatient clinics in Miyagi Prefecture, Japan. The minimum inhibitory concentrations (MICs) of 8 antimicrobial agents were measured using the broth microdilution method according to Clinical and Laboratory Standards Institute guidelines.ResultsIn children aged 0–2 years old, the MIC₅₀ values of penicillins decreased after 2010 (PCG: 1 μg/ml (2010) to 0.06 μg/ml (2012); ABPC: 1 μg/ml (2010) to 0.25 μg/ml (2012)). The prevalence of penicillin-resistant S. pneumoniae (PRSP) decreased from 35.2% (2010) to 14.6% (2012) in rhinorrhea specimens and from 43.4% (2010) to 14.3% (2012) in otorrhea specimens. Susceptibility to cephems (ceftriaxone and cefditoren) and carbapenems (panipenem) also showed improvement after 2010. For macrolides (clarithromycin) and lincosamides (clindamycin), MIC₅₀ values increased in all age groups during the study period, and a high level of resistance was seen until 2012. There were no marked changes of susceptibility to fluoroquinolones (LVFX) during the study period.ConclusionImprovement of susceptibility of S. pneumoniae to β-lactams occurred after 2010 in Miyagi Prefecture, Japan.     

Initial symptoms in pulmonary embolism differ from those in pneumonia: a retrospective study during seven years.

OBJECTIVE: To compare initial symptoms in pulmonary embolism with community-acquired pneumonia and relate to C-reactive protein and pulmonary infiltrates in order to improve the clinical assessment at the emergency department. METHODS: A retrospective review of patients with pulmonary embolism diagnosed in the clinic for infectious diseases (CID), (n=25), and a randomized sample of patients with pulmonary embolism diagnosed in the department of medicine (n=64), and a randomized sample of patients with community-acquired pneumonia (n=54) diagnosed in the clinic for infectious diseases. RESULTS: Initial symptoms in pulmonary embolism, dominated by dyspnoea and/or pleuritic chest pain were significantly different from those in community-acquired pneumonia, dominated by fever, chills and/or cough (P<0.001). On admission, C-reactive protein and body temperature were significantly higher and pulmonary infiltrates were more common in pneumonia compared with randomized pulmonary embolism patients. Twenty-five patients with a final diagnosis of pulmonary embolism were erroneously suspected of having lung infection, owing to increased C-reactive protein, presence of pulmonary infiltrates and/or high fever. However, they had classical symptoms of pulmonary embolism. CONCLUSIONS: Pulmonary infiltrates, high fever and a high level of C-reactive protein can deceive the physician to suspect pneumonia instead of pulmonary embolism. Classical initial symptoms ought to direct the physician in diagnosing pulmonary embolism. We emphasize a detailed patient history of initial symptoms.     

Clinical features of probable medication-overuse headache: a retrospective study in Japan

This study examined the clinical picture of probable medication-overuse headache (MOH) and the presence of any features peculiar to Japan. In a retrospective study of 47 patients, type of primary headache, type of medicine overused, method and result of withdrawal were investigated. Among the 47 patients, 80.9% had migraine only, and 85.1% overused combination medications. While 36 patients (76.6%) succeeded in withdrawal, five patients (10.6%) failed. One patient (2.1%) had not improved by 2 months after withdrawal and was diagnosed with chronic migraine and chronic tension-type headache without MOH. The remaining five patients (10.6%) dropped out. All dropout patients were recommended abrupt inpatient withdrawal, but chose abrupt outpatient withdrawal. As features peculiar to Japan, many patients with probable MOH overused combination analgesics, particularly females.     

Molecular epidemiological analysis of Mycobacterium tuberculosis modern Beijing genotype strains isolated in Chiba Prefecture over 10 years

IntroductionThe prevalence of the phylogenetic groups of Mycobacterium tuberculosis Beijing genotype has been reported to be similar in different areas of Japan. However, recent reports from rural areas of Japan show a low prevalence of modern Beijing strains, suggesting that the distribution of modern Beijing strains may have changed recently. Therefore, multi-locus variable number of tandem repeats analysis (MLVA) and draft whole genome sequence (DWGS) analysis were carried out to investigate the prevalence of particular genotype strains.MethodsNine hundred and ninety modern Beijing strains were studied using minimum spanning tree (MST) analysis and neighbor-net analysis of MLVA and WGS data.ResultsAn MST of M. tuberculosis Beijing genotype strains reconstructed from 12 loci-MLVA data showed two large complexes with the J₁₂-0006 MLVA pattern. In one of the complexes, strains with the pECT07 pattern produced by 24 loci-MLVA and its SLVs were most prevalent. DWGS analysis was carried out for pECT07 and its SLV strains. Neighbor-net and MST analyses of the DWGS data showed that pECT07 and its SLV strains were grouped in separate clusters. When all the combinations of two of the tested strains were analyzed, MST analysis showed that only 9 (1.7%) of the 528 pairs of tested strains had 5 or less SNPs.ConclusionsThe results of this study suggested that pECT07 and its variants were prevalent among M. tuberculosis modern Beijing strains in Chiba Prefecture, but the prevalence of those strains may not have been due to an earlier large-scale latent outbreak.     

梅毒感染及其流行特征的回顾性研究

目的分析梅毒检测结果,以了解梅毒的感染及其流行特征。方法收集728例确诊梅毒且未经治疗的患者。将其按年龄、性别、梅毒种类进行分类并进行回顾性分析。结果 728例梅毒患者中,隐性梅毒446例（61.26%）,显性梅毒211例（28.98%）,神经梅毒32例（4.40%）,先天梅毒39例（5.36%）。梅毒平均检出率为1.49%。女性患者332例（45.60%）,男性396例（54.40%）。男性梅毒患者以20~60岁年龄段多见,而女性以20~50岁年龄段居多。显性梅毒主要发生于20~40岁年龄段;隐性梅毒则在20~60岁多发。结论梅毒检出率逐年上升,以隐性梅毒的增幅最高,青壮年为主要发病群体。     

Management of the patients with hypopharyngeal cancer: eight-year experience of Miyagi Cancer Center in Japan

The aim of this study is to evaluate the results of treatment for hypopharyngeal cancer and indicate the future prospect of the treatment. Seventy-four patients with squamous cell carcinoma of the hypopharynx admitted to Miyagi Cancer Center from 1993 through 2000 are reviewed. Sixty-four patients received radical treatment, and 10 patients received palliative treatment or no treatment. The cancer was advanced (stages III and IV) in 82% of all the patients. The overall 5-year survival rate of all the patients was 38%. The overall 5-year survival rate of 64 patients received radical treatment was 43%. The ten patients who received palliative treatment or no treatment died of cancer within 16 months. Fifty-two out of the 74 patients underwent neck dissection for the neck lymph node involvement; forty of the 52 patients underwent ipsilateral neck dissection and 12 underwent bilateral neck dissection. Four out of the 40 patients, who underwent ipsilateral neck dissection alone, developed late contralateral regional recurrence but were successfully treated by contralateral neck dissection at the time of recurrence. Twenty-three out of 74 patients had multiple primary cancers synchronously or metachronously (31%). Cause of the death of six patients out of 74 patients was confirmed to be primary cancers other than hypopharyngeal cancer, as judged by physicians in other department or other hospitals. Most of the patients died due to distant metastasis from hypopharyngeal cancer or other primary cancers. We therefore conclude that contralateral elective neck dissection which is frequently chosen for the treatment of hypopharyngeal cancer surgery is unnecessary. Even if locoregional control is accomplished, distant metastasis or multiple primary cancers emerge and make prognosis poor. To improve the prognosis, we should develop some strategy against hypopharyngeal cancer for each patient. New strategies including chemoprevention and surgery against distant metasistasis are necessary.     

Change of antimicrobial susceptibility of group B streptococci over 15 years in Japan

We compared antimicrobial susceptibility patterns of 206 group B streptococcal (GBS) strains isolated from pregnant women and six from neonates/infants with invasive infection during the two periods 1985-1986 and 1999-2000. All strains in both periods were susceptible to the penicillins, cephalosporins and carbapenem tested. Seven (3%) isolates were resistant to erythromycin and three (1%) were resistant to clindamycin. There were no significant differences between the two study periods in the incidence of GBS resistant to the 14 antibiotics tested. These results showed that penicillins are still the first choice to prevent vertical transmission of GBS in Japan.     

Emergency department rectal temperatures in over 10 years: A retrospective observational study

BACKGROUND:

Fever in patients can provide an important clue to the etiology of a patient''s symptoms. Non-invasive temperature sites (oral, axillary, temporal) may be insensitive due to a variety of factors. This has not been well studied in adult emergency department patients. To determine whether emergency department triage temperatures detected fever adequately when compared to a rectal temperature.

METHODS:

A retrospective chart review was made of 27 130 adult patients in a high volume, urban emergency department over an eight-year period who received first a non-rectal triage temperature and then a subsequent rectal temperature.

RESULTS:

The mean difference in temperatures between the initial temperature and the rectal temperature was 1.3 °F (P<0.001), with 25.9% of the patients having higher rectal temperatures ≥2 °F, and 5.0% having higher rectal temperatures ≥4 °F. The mean difference among the patients who received oral, axillary, and temporal temperatures was 1.2 °F (P<0.001), 1.8 °F (P<0.001), and 1.2 °F (P<0.001) respectively. About 18.1% of the patients were initially afebrile and found to be febrile by rectal temperature, with an average difference of 2.5 °F (P<0.001). These patients had a higher rate of admission (61.4%, P<0.005), and were more likely to be admitted to the hospital for a higher level of care, such as an intensive care unit, when compared with the full cohort (12.5% vs. 5.8%, P<0.005).

CONCLUSIONS:

There are significant differences between rectal temperatures and non-invasive triage temperatures in this emergency department cohort. In almost one in five patients, fever was missed by triage temperature.KEY WORDS: Rectal temperatures, Oral temperatures, Axillary temperatures, Emergency department     

Healthcare burden of recurrent Clostridioides difficile infection in Japan: A retrospective database study

This retrospective database study aimed to assess the healthcare burden of hospitalization cost and duration associated with recurrent Clostridioides difficile infection (rCDI) by comparison with C. difficile infection (CDI) in Japan, using a health claims database of 270 acute care hospitals. Overall, 5423 hospitalized patients, with a record of one hospital-onset, healthcare facility-associated primary CDI episode within the 180-day period, from its onset between January 2012 and September 2016, were included. Of these, 353 had at least one rCDI and 5070 had no rCDI. Compared with those with no rCDI, the median total cost of hospitalization for patients with rCDI was JPY 1,184,371 (USD 11,691) higher (JPY 2,489,424 [interquartile range {IQR}: 1,597,424–4,008,751] compared with JPY 1,305,053 [624,033–2,549,569]). In addition, rCDI resulted in twice longer hospitalization duration in median compared with CDI (79 days [IQR: 53–117] compared with 40 days [20–74]). Based on a generalized linear regression model with a Gamma distribution and a logarithmic link function, the estimated mean of cost and duration of hospitalization for patients with rCDI were JPY 1,284,519 (95% confidence limit: ?95,532–2,664,569) (USD 12,679) higher and 20.3 days (?9.5?50.0) longer, compared with patients with no rCDI. The estimated mean difference in cost was higher in older patients and patients with diseases resulting in an immunosuppressive state. Higher costs and longer hospitalization for rCDI impose a great burden on healthcare system as well as patients, highlighting the importance of preventing recurrence of CDI.     

汉语神经语言学研究15年

TheHanlanguageisonlyapureideographiclanguageandisusedbyagreatdealofpeople（about１／５oftheworldpopulation）intheworldnowadays．Ithasuniquecharactersinphysiology，psychologyandlinguisticsandisdifferentfromphoneticalphabetlanguageinwesternworld．Afterclinicalandexperimentalresearchof１５years，wecametoaresultwhichcouldbeconfirmedthepointsofviewmentionedabove犤１，２犦．１Subjectsandmethods１．１ClinicalstudiesMorethan２０００casesofstrokeweread－mittedtoourhospitalfrom１９８３to１９９８．Them…     

Isolates and antibiotic susceptibilities of endogenous bacterial endophthalmitis: A retrospective multicenter study in Japan

Endogenous bacterial endophthalmitis, also called metastatic endophthalmitis, is a rare bacterial endophthalmitis derived from distant infectious foci via the bloodstream. This infection can potentially cause not only severe visual disturbance, but also loss of the eyeball or death, as most patients are immunocompromised. This retrospective Japanese multicenter study analyzed 32 eyes in 25 definitive cases. Twelve patients (48.0%) had diabetes mellitus. Typical ocular findings were vitreous haze (87.5%), cells in the anterior chambers (62.5%) and retinal infiltrates (50.0%). Elevated body temperature (64.0%), high serum C-reactive protein (96.0%) and leukocytosis (52.0%) were also frequently observed. Culture positivity rates for intraocular fluid were higher in the vitreous (62.5%) versus aqueous humor (28.6%). High positivity rates were also observed for blood (57.1%) and central venous catheters (100%). The most common pathogen was Staphylococcus aureus (10 cases), including methicillin-resistant S. aureus (4 cases). The next most common pathogen was Klebsiella pneumoniae (7 cases), which was highly associated with liver abscess. Compared to a previous 1991 national multicenter study, there has been a fourfold increase in the ratio of S. aureus. Antibiotic susceptibility tests revealed that all Gram-positives were susceptible to vancomycin and all Gram-negatives were susceptible to third-generation cephalosporins, imipenem/cilastatin, gentamycin and levofloxacin. Prognostic factors influencing poor visual outcome included poor initial visual acuity (p < 0.01), K. pneumoniae (p = 0.027) and gram-negative bacteria (p = 0.014) as the causative bacteria. Intravitreal antibiotic injection in combination with vancomycin and ceftazidime may be applicable for use as part of the standard treatment regimen for EBE.