Antibiotic susceptibility and genome analysis of Enterococcus species isolated from inpatients in one hospital with no apparent outbreak of vancomycin-resistant Enterococcus in Japan.

To prevent nosocomial infection, it is important to screen for potential vancomycin-resistant Enterococcus (VRE) among patients. In this study, we analyzed enterococcal isolates from inpatients in one hospital without any apparent outbreak of VRE. Enterococcal isolates were collected from inpatients at Hiroshima University Hospital from April 1 to June 30, 2021 using selective medium for Enterococci. Multilocus sequence typing, antimicrobial susceptibility testing, and whole-genome sequencing were performed. A total of 164 isolates, including Enterococcus faecium (41 isolates), Enterococcus faecalis (80 isolates), Enterococcus raffinosus (11 isolates), Enterococcus casseliflavus (nine isolates), Enterococcus avium (12 isolates), Enterococcus lactis (eight isolates), Enterococcus gallinarum (two isolates), and Enterococcus malodoratus (one isolate), were analyzed. We found one vanA-positive E. faecium, which was already informed when the patient was transferred to the hospital, nine vanC-positive E. casseliflavus, and two vanC-positive E. gallinarum. E. faecium isolates showed resistance to ampicillin (95.1%), imipenem (95.1%), and levofloxacin (87.8%), and E. faecalis isolates showed resistance to minocycline (49.4%). Ampicillin- and levofloxacin-resistant E. faecium had multiple mutations in penicillin-binding protein 5 (PBP5) (39/39 isolates) and ParC/GyrA (21/36 isolates), respectively. E. raffinosus showed resistance to ampicillin (81.8%), imipenem (45.5%), and levofloxacin (45.5%), and E. lactis showed resistance to ampicillin (37.5%) and imipenem (50.0%). The linezolid resistance genes optrA and cfr(B) were found only in one isolate of E. faecalis and E. raffinosus, respectively. This study, showing the status of enterococci infection in hospitalized patients, is one of the important information when considering nosocomial infection control of VRE.

[Total Gastrectomy for Gastric Invasion of Multiple Myeloma-A Case Report].

A 65-year-old woman was referred to our hospital for lumbago. The patient was diagnosed with multiple myeloma in 2020. She underwent chemotherapy and radiation therapy, and the disease progression stabilized. In 2022, the patient presented with severe anemia(Hb 4.9 mg/dL), and upper gastrointestinal endoscopy revealed a type 1 tumor in the middle body of the stomach. Computed tomography showed masses in the stomach and pancreas. The patient required a large volume of blood transfusion and underwent total gastrectomy to control the bleeding. Histological examination of the resected specimen indicated infiltration of myeloma cells. The patient died from invasive lesions in other organs, a year after surgery. Usually, extramedullary multiple myeloma lesions occur in the liver, spleen, and lymph nodes. Gastric invasion of multiple myeloma is very rare. Because of poor prognosis, surgery for gastric invasion of multiple myeloma is even rarer. We report a case of gastric invasion of multiple myeloma with a literature review.

The Anti-Inflammatory Effects of Iberin on TNF-α-Stimulated Human Oral Epithelial Cells: In Vitro Research.

Iberin is a bioactive chemical found in cruciferous plants that has been demonstrated to have anticancer properties. However, there have been no reports on its effects on periodontal resident cells, and many questions remain unanswered. The aim of this study was to examine whether iberin had anti-inflammatory effects on human oral epithelial cells, including influences on signal transduction pathway activation in TNF-α-στιµυλατεd χελλσ. Iberin inhibited the production of interleukin (IL)-6 and C-X-C motif chemokine ligand 10 (CXCL10), as well as the expression of vascular cell adhesion molecule (VCAM)-1, inducible nitric oxide synthase (iNOS), and cyclooxygenase (COX)-2 in tumor necrosis factor (TNF)-α-stimulated TR146 cells, a human oral epithelial cell line. Moreover, iberin administration increased the expression of antioxidant signaling pathways, such as Heme Oxygenase (HO)-1 and NAD(P)H quinone dehydrogenase 1 (NQO1). Furthermore, we found that iberin could inhibit the activation of the nuclear factor (NF)-κB, signal transducer and activator of transcription (STAT)3, and p70S6 kinase (p70S6K)-S6 ribosomal protein (S6) pathways in TNF-α-stimulated TR146 cells. In conclusion, iberin reduced inflammatory mediator expression in human oral epithelial cells by preventing the activation of particular signal transduction pathways.

Method to Identify Diagnostic Rules for Pancreatic Cancer Using Laboratory Data Based on Bayesian Estimation.

Early diagnosis and treatment of pancreatic cancer is challenging. We attempted to find diagnostic rules for pancreatic cancer from laboratory data in the Osaka University Hospital's data warehouse using Bayesian estimation. We calculated the pretest odds based on the number of laboratory tests and the cutoff value at which the diagnostic accuracy is over 20%. By this method, we identified diagnostic rules of 6 types for one item and 79 types for 2 items. Pancreatic cancer is difficult to detect from only general laboratory tests. However, this method may be promising in early diagnosis.

Cross-institutional document exchange system using clinical document architecture (CDA) with virtual printing method.

Recently one patient received care from several hospitals at around the same time. When the patient visited a new hospital, the new hospital's physician tried to get patient information the previous hospital. Thus, patient information is frequently exchanged between them. Many types of healthcare facilities have implemented an electronic medical record system, but in Japan, healthcare information exchange is often done by paper. In other words, after a clinical doctor prints a referral document and sends it to another hospital's physician, another hospital's doctor receives it and scans to store the EMR in his own hospital's system. It is a wasteful way to exchange healthcare information about a patient. In order to solve this problem, we have developed a cross-institutional document exchange system using clinical document architecture (CDA) with a virtual printing method.

Community-acquired, hospital-acquired, and healthcare-associated pneumonia caused by Pseudomonas aeruginosa.

We describe three types of Pseudomonas aeruginosa pneumonia. Case 1. P. aeruginosa was isolated from the blood and sputum of a 29-year-old male non-smoker who developed severe community-acquired pneumonia (CAP). Piperacillin was initially effective, but fever and lobular pneumonia with cavities developed seven days after discharge. Intravenous piperacillin/tazobactam and tobramycin were administered for four weeks, followed by oral ciprofloxacin for two weeks. He finally recovered, but developed recurrent CAP due to P. aeruginosa despite appropriate antibiotic therapy and immunocompetent status. Case 2. P. aeruginosa was isolated from the blood and sputum of a 57-year-old woman with renal cancer who developed hospital-acquired pneumonia (HAP) after surgical treatment. She recovered after meropenem administration for four weeks. Case 3. A 67-year-old woman with systemic sclerosis and malignant lymphoma who was followed up on an outpatient basis underwent immunosuppressive therapy. Thereafter, she developed pneumonia and was admitted to our institution where P aeruginosa was isolated from blood and sputum samples. Healthcare-associated pneumonia (HCAP) was diagnosed and effectively treated with tobramycin and ciprofloxacin. P. aeruginosa is not only a causative pathogen of HAP and HCAP, but possibly also of CAP.

Unified Modeling Language (UML) for hospital-based cancer registration processes.

OBJECTIVE: Hospital-based cancer registry involves complex processing steps that span across multiple departments. In addition, management techniques and registration procedures differ depending on each medical facility. Establishing processes for hospital-based cancer registry requires clarifying specific functions and labor needed. In recent years, the business modeling technique, in which management evaluation is done by clearly spelling out processes and functions, has been applied to business process analysis. However, there are few analytical reports describing the applications of these concepts to medical-related work. In this study, we initially sought to model hospital-based cancer registration processes using the Unified Modeling Language (UML), to clarify functions. METHODS: The object of this study was the cancer registry of Osaka University Hospital. We organized the hospital-based cancer registration processes based on interview and observational surveys, and produced an As-Is model using activity, use-case, and class diagrams. After drafting every UML model, it was fed-back to practitioners to check its validity and improved. RESULTS: We were able to define the workflow for each department using activity diagrams. In addition, by using use-case diagrams we were able to classify each department within the hospital as a system, and thereby specify the core processes and staff that were responsible for each department. The class diagrams were effective in systematically organizing the information to be used for hospital-based cancer registries. Using UML modeling, hospital-based cancer registration processes were broadly classified into three separate processes, namely, registration tasks, quality control, and filing data. An additional 14 functions were also extracted. Many tasks take place within the hospital-based cancer registry office, but the process of providing information spans across multiple departments. Moreover, additional tasks were required in comparison to using a standardized system because the hospital-based cancer registration system was constructed with the pre-existing computer system in Osaka University Hospital. Difficulty of utilization of useful information for cancer registration processes was shown to increase the task workload. CONCLUSION: By using UML, we were able to clarify functions and extract the typical processes for a hospital-based cancer registry. Modeling can provide a basis of process analysis for establishment of efficient hospital-based cancer registration processes in each institute.

Template-based data entry for general description in medical records and data transfer to data warehouse for analysis.

General descriptions in medical records are so diverse that they are usually entered as free text into an electronic medical record, and the resulting data analysis is often difficult. We developed and implemented a template-based data entry module and data analyzing system for general descriptions. We developed a template with tree structure, whose content master and entered patient's data are simultaneously expressed by XML. The entered structured data is converted to narrative form for easy reading. This module was implemented in the EMR system, and is used in 35 hospitals as of October, 2006. So far, 3725 templates (3242 concepts) have been produced. The data in XML and narrative text data are stored in the EMR database. The XML data are retrieved, and then patient's data are extracted, to be stored in the data ware-house (DWH). We developed a search assisting system that enables users to find objective data from the DWH without requiring complicated SQL. By using this method, general descriptions in medical records can be structured and made available for clinical research.

[Effects of size-equivalence and symmetry in enumeration tasks].

Previous research has shown that in enumeration tasks, "subitizing" is a rapid and an accurate process used with 1-4 items, and that "counting" is a slow and an inaccurate process used with over four items. It has been suggested that the former task is preattentive, whereas the latter task is attentive. We investigated whether item-size invariance and pattern symmetry affected subitizing and counting speeds. Participants enumerated dots, which were continuously presented, as quickly and as accurately as possible. Results of Experiment 1 indicated that the variance of dot-size was independent of enumeration time, suggesting that the variance in attentional allocation to each dot affected neither subitizing nor counting processes. Results of Experiment 2 indicated that pattern symmetry did not increase the capacity for subitizing, but increased the speed of counting. These results suggest that the capacity of subitizing is four items regardless of item-size invariance and pattern regularity. Moreover, the pattern configuration affected the speed of counting, whereas item features did not.

Arterial chemoinfusion therapy through an implanted port system for patients with unresectable intrahepatic cholangiocarcinoma--initial experience.

Arterial chemoinfusion therapy through an implanted port system was performed for patients with unresectable intrahepatic cholangiocarcinoma (ICC). Eleven patients with unresectable ICC were studied. Seven patients had stage-IV disease, two had stage-III disease, and two had stage-II disease. The mean tumor size was 7.0+/-2.6 cm (range 3.8-13.5 cm). A catheter and port system was percutaneously implanted, and anticancer drugs featuring fluorouracil were administered via the infusion system every 1-2 weeks on the outpatient basis in all patients except 2. Arterial chemoinfusion therapy was repeated 12-84 times per patient (mean 51 times). Partial and minor responses were achieved in sevenents (64%). Disease was stable in two patients (18%), and progressed in the other two patients (18%). Tumor growth was controlled during a mean period of 14.5 months in seven responders and two patients with stable disease. The survival rates were 91% at 1 year, 51% at 2 years, 20% at 3 years, and 10% at 4 years, respectively. The mean survival period was 26 months. Toxicity such as cholangitis and pancytopenia was found in three patients (27%). This treatment seems to improve the prognosis of patients with unresectable ICC and deserves further studies.