RESUMO
Recognition of the wide diversity of organisms that maintain complex haploid-diploid life cycles has generated interest in understanding the evolution and persistence of such life cycles. We empirically tested the model where complex haploid-diploid life cycles may be maintained by subtle/cryptic differences in the vital rates of isomorphic haploid-diploids, by examining the ecophysiology of haploid tetraspores and diploid carpospores of the isomorphic red alga Chondrus verrucosus. While tetraspores and carpospores of this species did not differ in size or autofluorescence, concentrations of phycobiliproteins of carpospores were greater than that of tetraspores. However, tetraspores were more photosynthetically competent than carpospores over a broader range of photosynthetic photon flux densities (PPFDs) and at PPFDs found at both the depth that C. verrucosus is found at high tide and in surface waters in which planktonic propagules might disperse. These results suggest potential differences in dispersal potential and reproductive success of haploid and diploid spores. Moreover, these cryptic differences in ecological niche partitioning of haploid and diploid spores contribute to our understanding of some of the differences between these ploidy stages that may ultimately lead to the maintenance of the complex haploid-diploid life cycle in this isomorphic red alga.
Assuntos
Diploide , Rodófitas , Animais , Haploidia , Estágios do Ciclo de Vida , EsporosRESUMO
The reverse water-gas shift chemical looping (RWGS-CL) process that utilizes redox reactions of metal oxides is promising for converting CO2 to CO at low temperatures. Metal oxides with perovskite structures, particularly, perovskite LaCoO3 are promising frameworks for designing RWGS-CL materials as they can often release oxygen atoms topotactically to form oxygen vacancies. In this study, solid solutions of perovskite LaCo1-xAlxO3 (0 ≤ x ≤ 1), which exhibited high CO production capability and thermal stability under the RWGS-CL process, were developed. Al-substituted LaCo0.5Al0.5O3 (x = 0.5) exhibited a 4.1 times higher CO production rate (2.97 × 10-4 CO mol g-1 min-1) than that of LaCoO3 (x = 0; 0.73 × 10-4 CO mol g-1 min-1). Diffuse reflectance infrared Fourier transform spectroscopy studies suggested that an increase in CO2 adsorption sites produced by the coexistence of Al and Co was responsible for the enhancement of CO production rate. Furthermore, LaCo0.5Al0.5O3 maintained its perovskite structure during the RWGS-CL process at 500 °C without significant decomposition, whereas LaCoO3 decomposed into La2O3 and Co0. In situ X-ray diffraction study revealed that the high thermal stability was attributed to the suppression of phase transition into a brownmillerite structure with ordered oxygen vacancies. These findings provide a critical design approach for the industrial application of perovskite oxides in the RWGS-CL processes.
RESUMO
OBJECTIVES: We examined the effect of local administration of tranexamic acid( TA) on reducing aspirin-induced bleeding in off-pump coronary artery bypass grafting(CABG). METHODS: From July 2009 to January 2011, 88 cases with off-pump CABG were divided into 4 groups:group C including 19 cases without preoperative aspirin or local administration of TA, group A including 23 cases with preoperative aspirin alone, group T including 19 cases with local administration of TA alone, and group AT including 27 cases with both preoperative aspirin and local administration of TA. RESULTS: The bleeding volume after 24 hours in group A was significantly larger than that in group C(p=0.0085). The bleeding volume in group AT was significantly smaller than that in group A (p<0.0001), and the bleeding volume in group T was also significantly smaller than that in group C (p=0.0054). There was no significant difference between group T and AT. CONCLUSIONS: The use of local administration of tranexamic acid indicated the reduction of postoperative bleeding even in patients with preoperative aspirin use.
Assuntos
Antifibrinolíticos/administração & dosagem , Aspirina/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea , Hemorragia/induzido quimicamente , Hemorragia/tratamento farmacológico , Ácido Tranexâmico/administração & dosagem , Feminino , Humanos , MasculinoRESUMO
Werner's syndrome (WS) is a genetic disorder presenting with premature senility. In the present study, we performed minimally invasive cardiac surgery (MICS)-aortic valve replacement (AVR) on a patient with Werner's syndrome who presented with aortic stenosis. The patient, a 49-year-old Japanese man, was brought to the emergency room with dyspnea during exercise. On echocardiography, severe aortic stenosis was found and surgery was planned. He had poorly controlled diabetes mellitus and underwent MICS-AVR to avoid the risk of sternal osteomyelitis, which resulted in a good outcome. The aortic valve had sclerotic changes and a genetic disease was suspected based on the onset of aortic stenosis at a young age, characteristic appearance, and various signs of aging. Genetic testing led to the diagnosis of WS.
Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Síndrome de Werner , Masculino , Humanos , Pessoa de Meia-Idade , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Síndrome de Werner/complicações , Síndrome de Werner/diagnóstico , Síndrome de Werner/genética , Resultado do Tratamento , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversosRESUMO
Oxyhydrides are promising compounds as supports for ammonia synthesis catalysts because they suppress hydrogen poisoning on the catalyst surface and enhance the ammonia synthesis activity. Herein, we developed a facile method for preparing BaTiO2.5H0.5, a perovskite oxyhydride, on a TiH2 surface via the conventional wet impregnation method using TiH2 and Ba hydroxide. Scanning electron microscopy and high-angle annular dark-field scanning transmission electron microscopy observations revealed that BaTiO2.5H0.5 crystallized as nanoparticles of ca. 100-200 nm on the TiH2 surface. The Ru-loaded catalyst Ru/BaTiO2.5H0.5-TiH2 exhibited 2.46 times higher ammonia synthesis activity (3.05 mmol-NH3 g-1 h-1 at 400 °C) than the benchmark Ru catalyst Ru-Cs/MgO (1.24 mmol-NH3 g-1 h-1 at 400 °C) because of the suppression of hydrogen poisoning. The analysis of reaction orders showed that the effect of suppressing hydrogen poisoning on Ru/BaTiO2.5H0.5-TiH2 was equivalent to that of the reported Ru/BaTiO2.5H0.5 catalyst, thus supporting the formation of BaTiO2.5H0.5 perovskite oxyhydride. This study demonstrated that the selection of appropriate raw materials facilitates the formation of BaTiO2.5H0.5 oxyhydride nanoparticles on the TiH2 surface using the conventional synthesis method.
RESUMO
As the type of anastomotic site is considered to be one of the decisive factors for graft-patency in coronary artery bypass grafting(CABG),our aim is to achieve anastomosis forms that potentially promote long-term graft-patency rates. When an arterial graft is used, side-to-side anastomosis is performed, with its incision length being longer than that of the coronary artery, to achieve a cuff-like anastomosis form. When a vein graft is used, on the other hand, it is incised shorter than the coronary artery to achieve a skirt-like anastomosis form instead of a purse-like one. It is thus expected that reliable anastomosis forms can be observed in postoperative angiography.
Assuntos
Ponte de Artéria Coronária/métodos , Anastomose Cirúrgica/métodos , Humanos , Grau de Desobstrução VascularRESUMO
The Caprellidea (Crustacea) have undergone an interesting morphological evolution from their ancestral gammarid-like form. Although most caprellid families have markedly reduced third and fourth pereopods (the walking thoracic limbs) and pleons (the posterior body parts), one family, Caprogammaridae, has developed pleon with swimming appendages (pleopods), whereas another family, Phtisicidae, possesses well-developed functional third and fourth pereopods. The unique character status of these families implies that there has been reacquisition or multiple losses of both pereopods and the pleon within the Caprellidea lineages. Although the Caprellidea are fascinating animals for the study of morphological evolution, the phylogenetic relationships among the Caprellidea are poorly understood. One obstacle to studying the evolution of the Caprellidea is the difficulty of collecting samples of caprogammarid species. In this study, we obtained live samples of a Caprogammaridae species and confirmed that its pleon and pleopods could perform similar locomotive functions and swimming movements as observed in gammarids. From the phylogenetic analyses on 18S ribosomal RNA gene sequences, we identified three distinct clades of Caprellidea. The ancestral state reconstruction based on the obtained phylogeny suggested that once lost, the third and fourth pereopods were regained in the Phtisicidae, while the pleon was regained in the Caprogammaridae, while we could not exclude the possibility of independent losses. In either case, the caprellid lineage underwent a quite complicated morphological evolution, and possibly the Caprellidea may be an exception to Dollo's law.
Assuntos
Anfípodes/anatomia & histologia , Anfípodes/fisiologia , Evolução Biológica , Estruturas Animais/fisiologia , Animais , Crustáceos/anatomia & histologia , Crustáceos/fisiologia , Masculino , Filogenia , RNA Ribossômico 18SRESUMO
The patient was a 31-year-old pregnant woman who gave birth to her first child by vaginal delivery 7 years ago. She was diagnosed with Marfan's syndrome based on physical findings; however, the condition was not diagnosed before the onset. The patient developed acute aortic dissection at 28 weeks of pregnancy. A cesarean section was first performed to save the patient's life; then, a total hysterectomy was performed to prevent the risk of postpartum hemorrhage. Furthermore, aortic root replacement was performed using a temporary mechanical valve. The patient and her child have survived without any complications.
Assuntos
Dissecção Aórtica , Síndrome de Marfan , Adulto , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/etiologia , Dissecção Aórtica/cirurgia , Aorta , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Cesárea , Criança , Feminino , Humanos , Síndrome de Marfan/complicações , Síndrome de Marfan/diagnóstico , GravidezRESUMO
To evaluate the usefulness of the COPD questionnaire of the International Primary Care Airways Group (IPAG) for screening the subjects with COPD in a given cohort, the questionnaires were given to subjects aged 40 or older, regardless of smoking habit at a general health check-up program in 4 institutions (Miyagi, Osaka, Okayama and Fukuoka) of the Japan Anti-tuberculosis Association (JATA) prefectural branch from April 1, 2007 to March 31, 2008. The questionnaires scores of 11,166 participants were collated with their FEV1/FVC, with their agreement. The prevalence of cases at high-risk of COPD receiving a score of 17 or more was 27.5%, and airflow limitation defined as FEV1/FVC < 70% was found in 6.5% among these cases, i.e. 2.7% among all subjects. The area under the curve of the receiver operating characteristic (AUC-ROC), sensitivity, and specificity were 0.755, 0.666, and 0.736, respectively. Airflow limitation was observed more frequently in those older than 59, more than 24 pack-years, and frequent wheezes but not in those of cough affected by weather, sputum in the morning, and allergies. Among 4 institutions, sensitivities of airflow limitation varied from 0.581 to 1.000 and these were remarkably elevated to 0.702 and more by excluding the subjects with P x Y0-14. This questionnaire seemed to be effective using a cut-off level of 17 for screening cases at high risk of COPD.
Assuntos
Doença Pulmonar Obstrutiva Crônica/diagnóstico , Inquéritos e Questionários , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Exame Físico , Testes de Função Respiratória , Sensibilidade e EspecificidadeRESUMO
Ocean warming has facilitated the range expansion of commercially important sea urchin species to higher latitudes. Heliocidaris crassispina was recorded to extend northward to Toga Bay along the Oga Peninsula, Japan following an increase in seawater temperatures, and replacement of local sea urchin species Mesocentrotus nudus. In order to identify evidence of adaptation occurring in response to a range extension of H. crassispina to the newly extended environments, we randomly collected 106 H. crassispina in August 2014 in Toga Bay, determined the growth and age composition and examined gonad traits (size, color and development). To confirm the gonad development, 30 H. crassispina with > 30 mm diameter were collected in July, August and September 2017. We found slower growth in the extended range than the central range. More delayed gonad development of males than those of females and a large variety of developmental stages in the acini of testis indicated that the spawning of both sexes of the sea urchins were asynchronous. In terms of gonad color, L* (lightness) values increased with increasing GI, while b* (yellowness) values decreased with increasing age. The population consisted of seven year-classes from 2006 to 2012, suggesting persistent juvenile recruitment. Long-term water temperature data indicated that the range extension of H. crassispina was due to ocean warming, in particular during the summer spawning season.
Assuntos
Ouriços-do-Mar/crescimento & desenvolvimento , Ouriços-do-Mar/fisiologia , Diferenciação Sexual/fisiologia , Aclimatação , Animais , Mudança Climática , Feminino , Gônadas/fisiologia , Japão , Masculino , Reprodução/fisiologia , Ouriços-do-Mar/metabolismo , Estações do Ano , Água do Mar/química , TemperaturaRESUMO
Members of the amphipod suborder Caprellidea exhibit degenerated abdomens and pereopods 3 and 4. Some genera of Podoceridae (Gammaridea, Corophioidea) such as Dulichia also show reduced abdomens and pereopods and thus are generally regarded as a sister group of the Caprellidea. In addition, one of the caprellid families, the Caprogammaridae, exhibits abdominal segments that are similar to those of the podocerids, as well as rudimentary pereopods 3 and 4, which are more consistent with those of other caprellids. Therefore, an evolutionary scheme has been suggested on the basis of the gradual degeneration of the pereopods and abdomen: [Dulichia, (caprogammarids, caprellids)]. However, the Phtisicidae (Caprellidea) contradict this hypothesis because they exhibit well-developed pereopods 3 and 4, along with degenerated abdomens. Therefore, previous studies have suggested that the Phtisicidae and other caprellids may be polyphyletic. We examined the phylogenetic position of the Phtisicidae and other caprellid amphipods, using 18S rRNA gene sequence data. The results strongly indicate that the Phtisicidae and other caprellid families form a monophyletic clade. However, a close phylogenetic relationship among Dulichia (Corophioidea) and taxa belonging to the Caprellidea was not definitively supported. This study is the first to use molecular data to investigate the phylogenetic relationships among the Caprellidea.
Assuntos
Anfípodes/genética , Filogenia , RNA Ribossômico 18S/genética , AnimaisRESUMO
An 88-year-old woman developed an acute massive pulmonary embolism after off-pump coronary artery bypass surgery. She experienced dyspnea while walking on the sixth day after operation. Her chest radiograph showed pleural effusion. Initially, she was treated for heart failure due to bypass graft occlusion. A repeat echocardiogram revealed enlargement of the right ventricle. Multislice computed tomography showed a massive embolus in the pulmonary artery. Surgical embolectomy was performed, and her postoperative course was easy. Recently, the incidence of pulmonary embolism in Japanese people has been rising. In addition, widespread implementation of off-pump coronary artery bypass compromises the protective effect against pulmonary embolus after cardiac surgery. Although the incidence of pulmonary embolism after coronary artery bypass surgery is still low in Japan in comparison to that in Western countries, prophylaxis against pulmonary embolism after off-pump coronary artery surgery is becoming more important.
Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Embolia Pulmonar/etiologia , Doença Aguda , Idoso de 80 Anos ou mais , Estenose Coronária/cirurgia , Embolectomia , Feminino , Humanos , Balão Intra-Aórtico/efeitos adversos , Embolia Pulmonar/cirurgia , ReoperaçãoRESUMO
As tuberculosis incidence is still high (23.3 per 100,000 in 2004) and infection control measures in hospitals are not so complete that about 8 or more nosocomial group infections are reported annually in these 10 years in Japan. Another reason of rather frequent occurring of group infection is that actual status of tuberculosis infection of medical staff remained unclear for long time because diagnosis of tuberculosis infection is almost impossible due to so wide and so long implementation of BCG vaccination in this country. To improve the present circumstances, the author has discussed on the recent theory and control measures of infection control introducing examples of nosocomial infections and results of studies carried out in many countries in these 10 years.
Assuntos
Controle de Doenças Transmissíveis , Infecção Hospitalar/prevenção & controle , Instalações de Saúde , Gestão de Riscos , Tuberculose/prevenção & controle , Microbiologia do Ar , Controle de Doenças Transmissíveis/métodos , Infecção Hospitalar/transmissão , Diagnóstico Precoce , Humanos , Japão , Isolamento de Pacientes , Roupa de Proteção , Gestão de Riscos/métodos , Teste Tuberculínico , Tuberculose/diagnóstico , Tuberculose/transmissão , Ventilação/métodosRESUMO
Tuberculosis situation in a certain country or area is decided by 1) tuberculosis prevalence of the past during around 40 years, 2) socio-economic situations of the country, and 3) tuberculosis control program. The trend of tuberculosis situation is changing forming "tuberculosis spiral" shown in Fig 1. TB situations of the several countries in the world were discussed to show the factors influencing on them from the standpoint of view mentioned above. The trends of TB epidemiology of the 47 prefectures in Japan were analyzed more deeply. The 47 prefectures were divided into the following 3 groups. The first group consists of rural prefectures where TB incidence is not so high and decreasing rather rapidly. TB was not so prevalent in the past 40 years or more, compared with other prefectures belonging to the other group. The second group is composed of intermediate prevalent prefectures because of rather high prevalence of tuberculosis in the aged, due to the rather high prevalence of tuberculosis in the past. The big cities and prefectures near by are forming the third group. Prevalence of tuberculosis among the young, jobless, homeless, foreign-born and so on is high, and tuberculosis is decreasing slowly. Divergence of tuberculosis epidemiology between these three groups is becoming wider recently. The spiral of tuberculosis, mentioned above, could be observed clearly by the analysis of the trend of tuberculosis in these 42 years in 47 prefectures. The author is considering that tuberculosis control program in the world has developed as follows. After the World War 2nd, classical tuberculosis control program had been carried out in the world (the classical TB control period, 1948-1963), new realistic tuberculosis control program had been launched in 1964 according to the 8th Experts Report of WHO (the realistic TB control period, 1964-1990). However tuberculosis did not decrease as expected, and the simple and clear tuberculosis control program aiming 85% or more cure rate, later by DOTS strategy (DOTS period, 1991-1999). And to expand and strengthen tuberculosis control program more and more, the Stop TB Partnership has been started in 2000 (the Stop TB period, 2000-). In Japan, tuberculosis control program has been carried out by Anti-Tuberculosis Law enacted in 1951, revising according to the situations. However, remainder of the classical tuberculosis control program, such as high rate of hospitalization, long duration of hospitalization and so on, is still existing. The author concluded that it is important to improve tuberculosis control program according to the epidemiological situation of the area, because tuberculosis situation is different by area to area and will become more profound in the future.
Assuntos
Tuberculose/epidemiologia , Adulto , Idoso , Humanos , Japão/epidemiologia , Pessoa de Meia-Idade , Prevalência , Tuberculose/prevenção & controleRESUMO
Tuberculosis outbreak is defined as group infection more than 20 persons had been infected with tubercle bacilli in Japan, provided one person developed disease is counted as 6 persons had been infected. Outbreak is to be reported compulsory to the Ministry of Health, Welfare and Labor. A total of 365 outbreaks of tuberculosis have been reported in these 10 years during 1994 and 2004. Out of them, large scale outbreak more than 10 persons have developed disease were 41 (11.2%). Results of contact surveys has reported that 0.36% of newly registered smear positive cases had caused tuberculosis outbreak, 1.1% had resulted small scale group infection (5 to 19 persons had been infected), although majority of the bacteriology positive cases didn't infected even one person. To make clear the mode of airborne infection with tubercle bacilli more clearly, the author has discussed the results of quantitative model on droplet nucle infection by Riley RL and others, nosocomial infection of smallpox virus in Germany in 1970, the results of analysis of airflow at the sites of outbreaks at business office and middle school in Japan, and so on. Finally, the author has reviewed the development of research on annual risk of tuberculosis infection in Japan and discussed about the present problems of risk of tuberculosis infection in Japan.
Assuntos
Tuberculose/transmissão , Surtos de Doenças , Humanos , Tuberculose/epidemiologiaRESUMO
We report a new method of posterior middle scallop (P2) augmentation for ischemic mitral regurgitation to achieve deep coaptation. First, P2 was divided straight at the center and partially detached from the annulus in a reverse T shape. A narrow pentagon-shaped section of pericardium was sutured to the divided P2 and annular defect. The tip of the pentagon was attached directly to the papillary muscle, thus creating a very large P2 scallop. A standard-sized ring was placed. We adopted this technique in 2 patients with advanced ischemic cardiomyopathy, and no mitral regurgitation was observed during a 1-year follow-up.
Assuntos
Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Isquemia Miocárdica/complicaçõesRESUMO
The hypothesis of protandrous (male to female) sex change was tested for the first time in a rhynchocinetid shrimp, Rhynchocinetes uritai, with an analysis of life-history traits. Samples were taken monthly for 2 years in Oura Bay, Japan, using a combination of bait and refuge traps. Breeding was seasonal but extended from spring through autumn, with female-phase individuals (FPs) producing broods successively, with their ovaries maturing for a new spawn during incubation of a previous brood. Females incubated numerous (â¼500-4000) embryos that suffered insignificant mortality before hatching. Recruitment of juveniles after planktonic larval development began in summer and peaked during the autumn, with negligible recruitment during winter and spring. Cohort analysis confirmed the hypothesis of protandric sex change in this species, with juveniles maturing into the male phase (MP) during their first reproductive season at an age of 6-10 mon, depending on the time of recruitment. Sex change occurred during the following winter when transitional individuals matured into FPs during their second reproductive season at an age of ≥18 mon. Two cohorts were followed from recruitment until the end of the study, indicating a life span of 21-25 mon. Aside from its sexual system, this sex-changing species showed no obvious differences in reproductive and other life-history traits from those of gonochoric species from similar latitudes and habitats.
Assuntos
Decápodes/fisiologia , Processos de Determinação Sexual , Animais , Decápodes/crescimento & desenvolvimento , Feminino , Japão , Masculino , Reprodução , Estações do AnoRESUMO
BCG vaccination has been given to infants and children so extensively and repeatedly for more than 55 years in Japan that it is very difficult, or often impossible to diagnose tuberculosis infection by tuberculin testing. On the other hand, as the treatment of latent tuberculosis infection has become more and more important recently, diagnosis of infection is becoming more and more important at the occasions of contact survey. However, understanding of the health care workers about transmission of tuberculosis is incomplete frequently at present. This is the reason why the author has written this review. The author has described on the history of the progress of droplet nuclei infection theory, infectivity of tuberculosis by bacteriological status of the patients, importance of cough, susceptibility of the host, and environmental factor concerning transmission of tubercle bacilli in this issue.
Assuntos
Tuberculose/transmissão , Microbiologia do Ar , Animais , Tosse/microbiologia , Surtos de Doenças , Transmissão de Doença Infecciosa , Suco Gástrico/microbiologia , Humanos , Hospedeiro Imunocomprometido , Mycobacterium tuberculosis/isolamento & purificação , Saliva/microbiologia , Escarro/microbiologia , Tuberculose/microbiologiaRESUMO
In the previous paper (Kekkaku. 2004; 79: 509-518), the author has made a review on (1) development of droplet nuclei infection theory, (2) experimental basis and (3) epidemiological evidence of droplet nuclei infection, and has discussed about the factors influencing on tuberculosis infection. Various mode of transmission of tubercle bacilli from nonpulmonary sources was reviewed in the present paper, such as (1) infection from cutaneous tuberculosis, (2) infection in the bacteriology laboratory, (3) infection by needle stick, (4) transmission by bronchoscopic examination, (5) tuberculosis infection in the autopsy room, (6) infection followed vaccination and/or cortico-steroid injection therapy, (7) congenital tuberculosis, and (8) other rare transmission of tuberculosis. Moreover, three topics concerning tuberculosis infection were discussed, they are (1) tuberculosis infection risk index, (2) highly infectious case, and (3) virulence and infection. Infection risk index is the product of smear positivity (expressed by Gaffky Grading) by duration of cough (expressed by month). This index is being used widely at the occasion of contact survey at present in Japan so that instructions for use were discussed.
Assuntos
Tuberculose/transmissão , Acidentes de Trabalho , Autopsia , Broncoscópios/microbiologia , Surtos de Doenças , Transmissão de Doença Infecciosa , Feminino , Humanos , Transmissão Vertical de Doenças Infecciosas , Laboratórios , Masculino , Troca Materno-Fetal , Mycobacterium tuberculosis/patogenicidade , Gravidez , Risco , Tuberculose/epidemiologia , Tuberculose/microbiologia , Vacinas contra a Tuberculose/efeitos adversos , VirulênciaRESUMO
The system of tuberculosis (TB) case-finding by mass miniature radiography (MMR) was established and expanded for almost all Japanese citizens in the 1950s. And, as stipulated by the TB Prevention Law, periodic mass screenings for schools, inhabitants, employees and institutions have been carried out. Among those aged over 25 years, the proportion of people screened by MMR was estimated to be 60.3%. This means that about 54 million people aged over 25 years are receiving medical service with MMR every year. However, the detection rates of TB cases by MMR have declined markedly compared with those in 1950s. As of 1998, the detection rate was 0.03 per 1,000 for school children and students, 0.06 per 1,000 for employees, and 0.16 per 1,000 for inhabitants. The proportion of cases detected by MMR among newly notified TB cases was 12.8% in 1998, and this ratio has been almost constant for the last 10 years. This ratio was greater among young adult TB cases. Approximately 20% of notified TB cases aged 20-39 years were detected by MMR for employees. Although the purpose of MMR is to find the cases before discharging TB bacilli, 35.1% of the cases were bacteriologically confirmed, and this proportion was greater among elderly TB cases. The Japan Anti-Tuberculosis Association (JATA) has been carrying out MMR for a long time. Eight selected branches of JATA that has been doing high quality case-finding reported 228 TB cases out of 965,440 inhabitants aged over 40 years examined by MMR in 1996. Based on these results, the cost per TB case detected by MMR was calculated. The cost was 4.4 millions yen (yen) per case for all forms of TB, yen 2.3 millions for male, yen 8.4 millions for female, yen 7.3 millions for those aged 40-49 years and yen 1.8 millions for those aged over 80 years. TB detection rate by MMR for inhabitants was correlated with TB incidence rate in various areas, and based on this correlation, the cost was calculated for various incidence rates. For all forms of TB, the cost was yen 4.0 millions per case for an incidence rate of 30 per 100,000, and yen 6.7 millions for an incidence rate of 20 per 100,000. MMR is not economically cost-effective even among elderly people and in areas with incidence rate less than 50 per 100,000, because the medical expense for a TB patient treated under hospitalization for 2 months and outpatient's clinic for 4 months is approximately yen 0.9 millions in 1996. The decision making in continuation or abolition or limitation of MMR should be discussed from a wide range of cost-effectiveness analyses as well as from the view of public health service and willingness of people. For the purpose of decision making, this study provides the detection rates; the costs stratified by sex, age and incidence; and the proportion of cases detected by MMR among newly notified TB cases by age-group and bacteriological status.