Creation of the first regional medical resource map for use in a disaster.

Background: Japan is located on the Pacific Ring of Fire and experiences frequent earthquakes. In addition, as the climate is changing due to global warming, heavy rains have caused frequent floods recently. Following the occurrence of disasters, citizens often experience confusion regarding access to healthcare services. Moreover, health professionals often face uncertainty regarding the availability of medical services in their local area. The Tokyo Kita city Pharmacist Association (KPA) independently developed the pharmacist safety confirmation (PSC) and pharmacy status confirmation (PSTC) systems to provide information regarding pharmaceutical resources during a disaster. These systems are very useful; however, they only provide information about pharmacies. Using this system as a base, a regional medical resource (RMR) map was created in cooperation with the Medical Association and Dental Association to provide useful medical resource information for clinicians and citizens during a disaster. Objectives: The study aimed to assess the effectiveness and reliability of the RMR map. Methods: The PSC and PSTC systems were originally invented by the KPA. The systems were employed in the event of actual earthquakes and flood damages and have produced positive results. An RMR map was created as a new resource map system by updating the software and platform of PSC and PSTC, and its reliability and efficacy were verified using drills. Drills were conducted seven times from 2018 to 2021. Results: Out of the 527 member facilities, 450 were registered. The response rate ranged from 49.4% to 73.8% and the system successfully created useful maps. Conclusion: This is the first report on the creation of an effective RMR map that can be used for helping people during disasters in Japan.

Association of eating behaviours with diurnal preference and rotating shift work in Japanese female nurses: a cross-sectional study.

OBJECTIVES: Our study examines differences in eating behaviour between day workers and rotating shift workers, and considers whether diurnal preference could explain the differences. METHODS: Japanese female nurses were studied (39 day workers and 123 rotating shift workers, aged 21-63 years) using self-administered questionnaires. The questionnaires assessed eating behaviours, diurnal preference and demographic characteristics. The questionnaire in the Guidelines for the management of obesity disease issued by the Japan Society for the Study of Obesity was used to obtain scores for the levels of obesity-related eating behaviours, including cognition of constitution, motivation for eating, eating as a diversion, feeling of satiety, eating style, meal contents and temporal eating patterns. The Japanese version of the Morningness-Eveningness (ME) questionnaire was used to measure self-rated preference for the degree to which people prefer to be active in the morning or the evening (ME). RESULTS: The scores for meal contents and temporal eating patterns in rotating shift workers were significantly higher than those in day workers. The ME score of rotating shift workers was significantly lower, indicating greater eveningness/less morningness among rotating shift workers. Multivariate linear regression revealed that the ME score was significantly negatively associated with temporal eating patterns and showed a negative association with the score for meal contents at a trend level, while current work shift was not significantly correlated with the scores. CONCLUSIONS: These results suggest that eating behaviours for rotating shift workers are associated with a more unbalanced diet and abnormal temporal eating patterns and that the associations may be explained by diurnal preference rather than by rotating shift work.

Diffusion-weighted magnetic resonance imaging to differentiate malignant from benign gallbladder disorders.

PURPOSE: To retrospectively evaluate the utility of apparent diffusion coefficient (ADC) and lesion to spinal cord ratio (LSR) in diffusion-weighted magnetic resonance (MR) imaging (DWI) as compared with morphological assessment alone, for differentiating malignant from benign gallbladder disorders. METHODS: This study was approved by the ethics committee, and written informed consent was waived. Ninety-one patients (13 malignancy and 78 benignancy) were reviewed. ADC was calculated using two DW images with different motion-probing gradient strengths (b=0, 1000s/mm(2)). LSR was measured by dividing the signal intensity of a thickened gallbladder wall by the maximum signal intensity of the lumbar enlargement of the spinal cord. In addition, the morphology of the gallbladders was assessed with conventional MR imaging. RESULTS: In receiver operating characteristic curve analysis, the areas under the curves for ADC and LSR were 0.861 and 0.906, respectively. Three morphological findings were considered: a massive formation, a disrupted mucosal line, and the absence of a two-layered pattern. When a combination of two or more of these morphological findings was positive for malignancy, the sensitivity, specificity, and accuracy were 76.9%, 84.0%, and 83.0%, respectively. When a combination of three or more of the above morphological findings together with ADC of less than 1.2 × 10(-3)mm(2)/s or LSR of more than 0.48 were positive for malignancy, these values were 73.0%, 96.2%, and 92.9%, respectively. There were significant differences in specificity and accuracy. CONCLUSION: Use of ADC and LSR in DWI can improve diagnostic performance for differentiating malignant from benign gallbladder disorders.

Usefulness of procalcitonin for severity assessment in patients with acute cholangitis.

BACKGROUND: The aim of the present study was to examine the usability of procalcitonin (PCT) for severity assessment in patients with acute cholangitis (AC). METHODS: Serum PCT concentrations were measured on admission in patients with AC. Patients were classified with mild, moderate, or severe AC based on severity assessment guidelines. RESULTS: We included 159 treatment-naïve patients with AC (95 males, 64 females) in this study. The median PCT concentrations were 0.08 ng/mL (interquartile range (IQR) 0.04 - 0.18 ng/mL), 0.37 ng/mL (IQR 0.15 - 1.85 ng/mL), and 5.56 ng/mL (IQR 3.59 - 25.89 ng/mL) in patients with mild, moderate and severe AC, respectively. PCT concentrations were significantly higher in patients with severe AC than in patients with moderate AC (p < 0.0001), and in patients with moderate AC than in patients with mild AC (p < 0.0001). The areas under the receiver operating characteristic curves for PCT to discriminate patients with moderate and severe AC were 0.84 (95% CI 0.77 to 0.92, p < 0.001) and 0.86 (95% CI 0.78 to 0.92, p < 0.001), respectively. CONCLUSIONS: Serum PCT concentrations were elevated in patients with AC and may be a useful parameter for the severity assessment of AC.

Induction of clinical remission with adalimumab-methotrexate combination therapy in a patient with rheumatoid arthritis and concomitant hepatitis C virus infection.

The patient described here is a 49-year-old woman who had hepatitis C virus (HCV) infection and rheumatoid arthritis (RA). Her RA had been successfully managed with methotrexate for about 10 years. After a sustained virological response was achieved with interferon therapy, treatment with adalimumab was instituted. This resulted in a rapid and sustained remission that lasted for more than a year, without HCV reactivation. The results in this case suggest that a sequential strategy, with initial HCV clearance followed by the targeting of remission with biologics, may be a favorable option in patients with RA and concomitant HCV infection.

Effect of life-long dietary n-6/n-3 fatty acid ratio on life span, serum lipids and serum glucose in Wistar rats.

Types of dietary lipid affect the life span of rats. In this study, we investigated the influence of the life-long dietary n-6/n-3 ratio on life span and serum lipid and glucose levels. A semi-purified diet adjusted to a constant saturated : monounsaturated : polyunsaturated fatty acid ratio and an n-6/n-3 ratio of 1 (R1), 4 (R4) or 16 (R16) was fed to rats (n=33) from 4 wk of age until death. There were no significant differences in the food intake or body weight, nor were there survival curve or mean life span variations among the 3 groups. The serum cholesterol levels after feeding the test diet for 6 and 12 mo were significantly lower in the R1 group than in the other groups, and the serum triacylglycerol levels were significantly lower than those in the R16 group. However, no significant differences were noted in the serum cholesterol or triacylglycerol level after feeding for 18 mo among the 3 groups. A significantly higher serum glucose level was noted in the R1 group only at 18 mo of test diet ingestion, compared to that in the R4 group. The results suggest that the influence of the dietary n-6/n-3 ratio on the serum lipid and glucose levels varies, depending on the duration and life stage of feeding. Our findings further suggest that the life span of Wistar rats is not affected even if the ratio of dietary n-6/n-3 changes from 1 to 16.

Enrichment with air-sandwiched method of on-line collection/concentration using chelating resin and simultaneous determination of trace elements by inductively coupled plasma atomic emission spectrometry.

The application of inductively coupled plasma atomic emission spectrometry (ICP-AES) to the forensic sample was studied. On-line collection/concentration method of the sample with chelating resin column (TE-05) and air-sandwiched method to isolate the analyte zone at the highest concentration of an eluent was coupled with ICP-AES. The limits of detection (LODs) were much improved to 35 fold (Co): from Sc, 0.15 ng ml(-1) to Ni, 1.99 ng ml(-1), and the concentration efficiency was 7-14 times. This method was applied to the concrete with about 10mg of samples. Major elements (Al, Fe, Mg) measured by conventional/ICP-AES and trace elements measured by this method, such as Cd, Co, Ni, and Pb were determined without matrices interference. Four concrete samples can be discriminated by comparing the content profiles of the trace elements and the major elements.

Minimization of sample volume with air-segmented sample injection and the simultaneous determination of trace elements by ICP-MS.

The application of inductively coupled plasma mass spectrometry (ICP-MS) to forensic chemistry was studied. The developed method, air-segmented sample injection (ASSI) coupled with ICP-MS, allowed the determination of about 25 elements at the sub-ppb level with only 0.2 ml of a sample solution. The optimum sample flow rate was found to be 0.4 ml min(-1), along with a sample suction time of 30 s. The proposed method was validated by determining trace elements in river-water certified reference material (SLRS-4) issued by National Research Council Canada. The analytical results of the proposed method were in good agreement with the certified values. This method was successfully applied to a human hair sample, the volume of which was 3 ml.

Cine magnetic resonance imaging evaluation of peristalsis of small bowel with longitudinal ulcer in Crohn disease: preliminary results.

OBJECTIVE: To evaluate peristalsis of the small bowel with a longitudinal ulcer in Crohn disease using cine magnetic resonance imaging (MRI). METHODS: Fifteen patients with suspected or diagnosed Crohn disease were examined by cine MRI using a multislice and multiphase method. Inclusion criteria were pathological evidence of Crohn disease and confirmation of longitudinal ulceration in the small bowel by ileocolonoscopy, single- or double-contrast radiography of the small bowel, or surgery. Six of these patients were included in this study. Cine MRI findings of the small bowels were retrospectively reviewed by 2 radiologists. RESULTS: Asymmetric involvement or mesenteric rigidity with antimesenteric flexibility was seen in all patients by cine MRI. This finding was not seen in normal small bowel segments. A combination of ileocolonoscopy and contrast radiography detected longitudinal ulcers in 5 of the 6 patients, and surgery revealed ulceration in the remaining patient. CONCLUSIONS: Cine MRI was a feasible approach for detecting a longitudinal ulcer in small-bowel Crohn disease.

Synthesis of cross-linked chitosan modified with the glycine moiety for the collection/concentration of bismuth in aquatic samples for ICP-MS determination.

A chelating resin, cross-linked chitosan modified with the glycine moiety (glycine-type chitosan resin), was developed for the collection and concentration of bismuth in aquatic samples for ICP-MS measurements. The adsorption behavior of bismuth and 55 elements on glycine-type chitosan resin was systematically examined by passing a sample solution containing 56 elements through a mini-column packed with the resin (wet volume; 1 ml). After eluting the elements adsorbed on the resin with nitric acid, the eluates were measured by ICP-MS. The glycine-type chitosan resin could adsorb several cations by a chelating mechanism and several oxoanions by an anion-exchange mechanism. Especially, the resin could adsorb almost 100% Bi(III) over a wide pH region from pH 2 to 6. Bismuth could be strongly adsorbed at pH 3, and eluted quantitatively with 10 ml of 3 M nitric acid. A column pretreatment method with the glycine-type chitosan resin was used prior to removal of high concentrations of matrices in a seawater sample and the preconcentration of trace bismuth in river water samples for ICP-MS measurements. The column pretreatment method was also applied to the determination of bismuth in real samples by ICP-MS. The LOD of bismuth was 0.1 pg ml(-1) by 10-fold column preconcentration for ICP-MS measurements. The analytical results for bismuth in sea and river water samples by ICP-MS were 22.9 +/- 0.5 pg ml(-1) (RSD, 2.2%) and 2.08 +/- 0.05 pg ml(-1) (RSD, 2.4%), respectively.

Functionalization of chitosan with 3-nitro-4-amino benzoic acid moiety and its application to the collection/concentration of molybdenum in environmental water samples.

A chitosan resin functionalized with 3-nitro-4-amino benzoic acid moiety (CCTS-NABA resin) was newly synthesized for the collection/concentration of trace molybdenum by using cross-linked chitosan (CCTS) as base material. The carboxyl group of the moiety was chemically attached to amino group of cross-linked chitosan through amide bond formation. The adsorption behavior of molybdenum as well as other 60 elements on the resin was examined by passing the sample solutions through a mini-column packed with the resin. After the elution of the elements collected on the resin with 1M HNO(3), the eluates were analyzed by inductively coupled plasma-mass spectrometry (ICP-MS) and atomic emission spectrometry (ICP-AES). The CCTS-NABA resin can adsorb several metal ions, such as vanadium, gallium, arsenic, selenium, silver, bismuth, thorium, tungsten, tin, tellurium, copper, and molybdenum at appropriate pHs. Among these metal ions, only molybdenum could be adsorbed almost completely on the resin at acidic regions. An excellent selectivity toward molybdenum could be obtained at pH 3-4. The adsorption capacity of CCTS-NABA resin for Mo(VI) was 380mgg(-1) resin. Through the column pretreatment, alkali and alkaline earth metals in river water and seawater samples were successfully removed. The CCTS-NABA resin was applied to the adsorption/collection of molybdenum in river water and seawater samples. The concentrations of molybdenum in river water samples were found in the range of 0.84 and 0.95ppb (ngg(-1)), whereas molybdenum in seawater was about 9ppb. The validation of the proposed method was carried out by determining molybdenum in the certified reference materials of SLRS-4, CASS-4, and NASS-5 after passing through the CCTS-NABA resin; the results showed good agreement with the certified values.

Lower weight gain and higher expression and blood levels of adiponectin in rats fed medium-chain TAG compared with long-chain TAG.

Previous studies demonstrated that, compared with long-chain TAG (LCT), dietary medium-chain TAG (MCT) could improve glucose tolerance in rats and humans. It has been well established that adiponectin acts to increase insulin sensitivity. The effects of dietary MCT on adiponectin serum concentration and mRNA levels in adipose tissue were studied in rats. Male Sprague-Dawley rats were fed a diet containing 20% MCT or LCT for 8 wk. After 6 wk of dietary treatment, an oral glucose tolerance test was performed. Rats fed the MCT diet had less body fat accumulation than those fed the LCT diet (P < 0.01). The cell diameter of the perirenal adipose tissue, one of the abdominal adipose tissues, was smaller (P < 0.01) in the MCT diet group. The serum adiponectin concentration was higher (P < 0.01) in the MCT diet group than in the LCT diet group. The adiponectin content in the perirenal adipose tissue was higher (P < 0.01) in the MCT diet group. The MCT-fed group had a higher adiponectin mRNA level in their perirenal adipose tissue (P < 0.05). The increase of the plasma glucose concentration after glucose administration (area under the curve) was smaller (P < 0.01) in the MCT diet group than in the LCT diet group. These findings suggest that dietary MCT, compared with LCT, results in a higher serum adiponectin level with transcriptional activation of the adiponectin gene in rats. We speculate that improved glucose tolerance in rats fed an MCT diet may be, at least in part, ascribed to this higher serum adiponectin level.

[A case of advanced gastric cancer acquired long-term response two years or more by treatment with oral anticancer drug TS-1].

A 66-year-old male with massive ascites was diagnosed as advanced gastric scirrhous cancer at Musashino Red Cross Hospital. We detected the adenomatous cancer cells from his ascites, and an X-ray photograph of his stomach showed less capability of expansion in the upper gastrointestinal series. We attempted treatment with oral anticancer drug TS-1 with the patient's consent and achieved a long-term response of two years or more.

Core promoter/pre-core mutations are associated with lamivudine-induced HBeAg loss in chronic hepatitis B with genotype C.

BACKGROUND/AIMS: To clarify the factors associated with the efficacy of lamivudine. METHODS: Variables including basic core promoter (BCP) and pre-core (PreC) mutations were evaluated in 60 chronic hepatitis B e antigen (HBeAg)-positive patients with genotype C. Thirty patients were treated with lamivudine and the remaining 30 patients were age- and sex-matched controls. RESULTS: Severe fibrosis was significantly more frequent in patients with the BCP-mutant/PreC-wild (MW) and BCP-mutant/PreC-mutant (MM) patterns compared to BCP-wild/PreC-wild (WW) pattern (P=0.02). The cumulative rates of HBeAg loss at 6, 12 and 18 months were significantly higher in the lamivudine group (14.2, 36.3, and 60.9%) compared with the control group (17.6, 17.6, and 24.5%, P=0.03), and was especially pronounced in patients with the MW pattern (P=0.04). The rate of lamivudine-related HBeAg loss was significantly lower in patients with the WW pattern (P=0.03). Factors correlating with HBeAg loss were histological fibrosis and activity, hepatitis B virus-DNA levels, BCP/PreC mutation and lamivudine therapy. Multivariate analysis revealed BCP/PreC mutations and fibrosis were independent factors for HBeAg loss. CONCLUSIONS: With specific reference to the genotype C, we found earlier HBeAg loss was expected in patients carrying MM and MW patterns, while the efficacy of lamivudine was limited in patients with the WW pattern.

Assessment of Kupffer cells by ferumoxides-enhanced MR imaging is beneficial for diagnosis of hepatocellular carcinoma: comparison of pathological diagnosis and perfusion patterns assessed by CT hepatic arteriography and CT arterioportography.

To investigate the clinical significance of the radiographic assessment of Kupffer cells and hemodynamics in the diagnosis of hepatocellular nodules, both magnetic resonance (MR) imaging enhanced by ferumoxides and CT hepatic arteriography (CTHA)/CT arterioportography (CTAP) were undertaken for 118 patients with 158 primary nodular hepatocellular lesions. The radiographic findings were analyzed in the context of the pathological diagnosis. Among nodules presumed to be pre- or early HCC by CTHA/CTAP, all 13 hyperintense nodules identified by MR imaging (MRI) were found pathologically to be hepatocellular carcinoma (HCC). In contrast, in 14 hypointense nodules, no advanced (moderately or poorly differentiated) HCC was pathologically identified and none of these progressed to advanced HCC during the follow up period (mean: 24 months). Instead, 78% of these cases were pathologically confirmed as dysplastic nodules. For the 16 lesions undetectable by CTHA/CTAP, four of eight (50%) hypointense nodules turned out to be dysplastic nodules and one hyperintense lesion was HCC. Signal intensity by ferumoxides-enhanced MRI showed a strong correlation with the increase or decrease of Kupffer cells assessed by immunohistochemistry. Assessment of Kupffer cells by ferumoxides-enhanced MRI is beneficial for the accurate diagnosis of primary hepatocellular nodules that are considered borderline or early stage HCC by their hemodynamic profile.

Interferon-stimulated gene expression and hepatitis C viral dynamics during different interferon regimens.

BACKGROUND/AIMS: To address the molecular mechanism for enhanced antiviral efficacy associated with a frequent dosing of interferon (IFN)-beta. METHODS: Serum hepatitis C viral (HCV) dynamics, double-stranded RNA-activated protein kinase (PKR) mRNA and MxA mRNA levels in peripheral blood mononuclear cells (PBMC) were analyzed serially in 140 patients who were randomly assigned to a twice daily (3 MU bid) or once daily (6 MU qd) administration group. RESULTS: In twice daily group, the rate of HCV decline during the second phase was 2-fold greater than in the once daily group (P=0.04). Peak PKR and MxA gene expression levels in the first phase (observed 4 h after a single administration) were 2-fold higher in the once daily group. However, the expression in the second phase was maintained at a significantly higher level in the twice daily group. Initial and peak expression levels were related to initial viral load. Basal expressions in PBMC were significantly correlated with those in the liver tissue (PKR, r=0.81; MxA, r=0.75, respectively, P<0.0001). CONCLUSIONS: Our data suggest that elimination of HCV-infected cells is enhanced by twice daily dosing of IFN-beta, and that this enhanced effect is associated with a higher intracellular expression of PKR and MxA during the second phase.

A case of primary leiomyoma of the liver in a patient without evidence of immunosuppression.

A 31-year-old Japanese male was admitted to our hospital for investigation of an asymptomatic nodular lesion of the liver detected by abdominal ultrasonography (US) during a routine medical examination. Computed tomography (CT) revealed a single, hypovascular mass 35 mm in diameter, within the left lobe of the liver. The tumor demonstrated hypointensity on T1-weighted, and hyperintensity on T2-weighted magnetic resonance (MR) imaging. Hematological and biochemical investigations were normal. There were no abnormalities of the gastrointestinal or urinary tracts. A left lateral segmentectomy of the liver was performed. Pathological examination of the nodule revealed a primary leiomyoma of the liver, with positive immunohistochemical staining for vimentin and desmin antigens. Primary leiomyoma of the liver is rare, with the majority of cases associated with immunodeficiency disorders. This patient had no evidence of any underlying disease. Primary leiomyoma of the liver should be considered when a nodular lesion is found in a patient without evidence of viral hepatitis.

Larger diet-induced thermogenesis and less body fat accumulation in rats fed medium-chain triacylglycerols than in those fed long-chain triacylglycerols.

It has been previously shown that a diet containing medium-chain triacylglycerols (MCT) leads to less body fat accumulation as compared to a diet containing long-chain triacylglycerols (LCT). We investigated the involvement of diet-induced thermogenesis in the accumulation of body fat in rats fed a diet containing MCT. Twelve male Wistar rats were administered 1 g of MCT or LCT by gavage, and their oxygen consumption was measured for 6 h (experiment 1). Forty male Wistar rats were fed a diet containing 10% MCT or LCT for 6 wk, and their body composition was determined (experiment 2). In experiment 1, oxygen consumption increased to a greater extent after MCT administration than after LCT administration. Diet-induced thermogenesis was significantly (0.67 +/- 0.14 kcal) larger after the administration of 1 g of MCT. In experiment 2, there were no differences in food intake or carcass protein content between the LCT group and MCT group. However, carcass fat and intra-abdominal fat content were significantly lower in rats fed MCT than in those fed LCT. We calculated that ingestion of 1 g of MCT decreased body fat by 0.94 +/- 0.27 kcal relative to the ingestion of LCT. These results suggest that the larger diet-induced thermogenesis observed in rats fed MCT, compared to that of those fed LCT, is one of the main factors involved in the suppression of body fat accumulation in rats fed MCT.