Satellite Tracking of Migration Routes of the Eastern Buzzard (Buteo japonicus) in Japan through Sakhalin.

We satellite-tracked the eastern buzzard (Buteo japonicus) wintering in Japan to delineate both northward and southward migration routes, destinations, and stopover behavior. Twenty-two buzzards were captured and fitted with functional platform transmitter terminals. For these buzzards that departed from the capture sites, we observed a total of 65 northward migrations during 2008-2016 and a total of 55 southward migrations during 2008-2015. In spring, the eastern buzzards migrated eastward along the Seto Inland Sea in the Chugoku region or further inland. In eastern Honshu, they followed two different routes. One was to Hokkaido via the Tsugaru Peninsula from central or northern central Honshu northward along the side of the Sea of Japan in northern Honshu. The other was to Hokkaido via the Shimokita Peninsula, mainly from the Pacific Ocean side of northern Honshu, moving eastward through central Honshu. Of the 17 birds tracked, 10 summered in Sakhalin, three in Hokkaido, three in northern Honshu, and one unknown. In autumn, the buzzards retraced their northward migration routes. Of the 14 birds that were tracked the entire southward migration, 13 (92%) returned to their respective capture sites. One juvenile wintered in an area different from the capture site. Our study contributes to a deeper understanding of the distribution of breeding and wintering grounds and the migration routes of B. japonicus. In addition, the information on migration obtained in this study can contribute toward appropriate environmental impact assessment for wind power facilities in Japan.

Migration Patterns and Characteristics of Eurasian Wigeons (Mareca penelope) Wintering in Southwestern Japan Based on Satellite Tracking.

Understanding migration ecology of Eurasian wigeons (Mareca penelope) is crucial for effective population management, mitigating conflicts with human, and habitat conservation. The objectives of the present study were 1) to determine their migration patterns of Eurasian wigeons in the East Asian flyway, and 2) to identify the key breeding and stopover sites. From 2007 to 2016, a total of the 64 wigeons, which wintered in Japan, were equipped with satellite transmitters. Most Eurasian wigeons migrated to breeding sites in Russia either (a) via a continental route through China, (b) via the Kamchatka Peninsula, or (c) via Sakhalin Island. In spring, many of the Eurasian wigeons (60.98%) migrated via the continental route. In autumn, most Eurasian wigeons (57.14%) migrated through Kamchatka. These differences may be attributable to the influence of Okhotsk Sea air mass on migration decisions due to loop migration. Similarly to the migration of Mallards, Eurasian wigeons employed a "long-stay and short-travel" migration strategy. Eurasian wigeons mainly nested between latitude between 43° to 75°N. From the present findings and the published literature, Eurasian wigeons that winter in Japan are considered to migrate to Russia, China, and the United States during the breeding season, although the main breeding area is in northeastern Russia. A total of 296 important sites to Eurasian wigeons were mapped, and 118 location names with geographic coordinates, and the top five most frequently used sites were identified in each season.

Migration of Tundra Swans (Cygnus columbianus) Wintering in Japan Using Satellite Tracking: Identification of the Eastern Palearctic Flyway.

Migration through the Eastern Palearctic (EP) flyway by tundra swans (Cygnus columbianus) has not been thoroughly documented. We satellite-tracked the migration of 16 tundra swans that winter in Japan. The objectives of this study were 1) to show the migration pattern of the EP flyway of tundra swans; 2) to compare this pattern with the migration pattern of whooper swans; and 3) to identify stopover sites that are important for these swans' conservation. Tundra swans were captured at Kutcharo Lake, Hokkaido, in 2009-2012 and satellite-tracked. A new method called the "MATCHED (Migratory Analytical Time Change Easy Detection) method" was developed. Based on median, the spring migration began on 18 April and ended on 27 May. Autumn migration began on 9 September and ended on 2 November. The median duration of the spring and autumn migrations were 48 and 50 days, respectively. The mean duration at one stopover site was 5.5 days and 6.8 days for the spring and autumn migrations, respectively. The number of stopover sites was 3.0 and 2.5 for the spring and autumn migrations, respectively. The mean travel distances for the spring and autumn migrations were 6471 and 6331 km, respectively. Seven migration routes passing Sakhalin, the Amur River, and/or Kamchatka were identified. There were 15, 32, and eight wintering, stopover, and breeding sites, respectively. The migration routes and staging areas of tundra swans partially overlap with those of whooper swans, whose migration patterns have been previously documented. The migration patterns of these two swan species that winter in Japan confirm the importance of the Amur River, Udyl' Lake, Shchastya Bay, Aniva Bay, zaliv Chayvo Lake, zal Piltun Lake, zaliv Baykal Lake, Kolyma River, Buyunda River, Sen-kyuyel' Lake, and northern coastal areas of the Sea of Okhotsk.

CT-diagnosed emphysema and prognosis of chronic airflow obstruction: a retrospective study.

OBJECTIVE: CT-diagnosed emphysema is associated with poor prognosis in chronic obstructive pulmonary disease (COPD). Its clinical impacts on prognoses of asthma with chronic airflow obstruction (CAO) are not well known. We sought to compare mortalities and prognostic factors in COPD and asthma with CAO by the presence or absence of CT-diagnosed emphysema. DESIGN: Retrospective cohort study. SETTING: Referral centre hospital for respiratory disease. PARTICIPANTS: 1272 patients aged over 40 years with CAO (January 2000 to December 2011). CAO was defined as a forced expiratory volume in 1 s/forced vital capacity <0.7 after bronchodilator use throughout the observation period. PRIMARY AND SECONDARY OUTCOME MEASUREMENTS: Overall mortality served as the primary endpoint. We compared mortalities and prognostic factors of COPD and asthma subgroups with or without emphysema. Secondary endpoints were the prevalence of COPD and asthma in patients with CAO. RESULTS: Overall, diagnoses included COPD with emphysema in 517 (40.6%) patients, COPD without emphysema in 104 (8.2%) patients, asthma with emphysema in 178 (13.9%) patients, asthma without emphysema in 169 (13.3%) patients, other respiratory diseases (RD) with emphysema in 128 (10.1%) patients, and other RD without emphysema in 176 (13.8%) patients. Patients with asthma without emphysema had the best prognosis followed by those with asthma with emphysema, COPD without emphysema and COPD with emphysema. Each subgroup had distinct prognostic factors. Presence of emphysema was an independent risk factor for de novo lung cancer among patients with CAO. CONCLUSIONS: Patients with asthma with CAO have a better prognosis than patients with COPD. The presence of CT-diagnosed emphysema predicts poor prognosis in COPD and asthma with CAO.

Adenovirus pneumonia in an immunocompetent adult.

Adenovirus pneumonias are reported relatively commonly in pediatric or immunocompromised patients, but the clinical presentation of adenovirus pneumonia in immunocompetent hosts is not well known. We treated an immunocompetent 42-year-old man with mild adenovirus pneumonia following pharyngitis and conjunctivitis. Diagnosis was established on the basis of chest radiologic findings, detection of adenovirus type 7 DNA by PCR assay in material obtained from bronchoalveolar lavage (BAL), and a greater than fourfold rise in adenovirus-specific antibody titers during the course of illness. The patient's self-limiting symptoms improved within 2 weeks, and chest radiologic findings improved within 4 weeks. PCR assay of material obtained by BAL was useful for the rapid diagnosis of adenovirus pneumonia.

The first case of bloodstream infection by Candida intermedia in Japan: the importance of molecular identification.

A 65-year-old Chinese man with diabetes mellitus was admitted to our hospital complaining of bloody sputum, fever, and dyspnea. Despite antibiotic treatment, his condition deteriorated, necessitating mechanical ventilation. Diffuse alveolar hemorrhage was suspected, and steroid therapy was initiated. Although his condition improved and he was extubated, the fever recurred twice, and on both occasions blood cultures yielded yeasts. The yeasts were misidentified as Cryptococcus humicola with a commercially available phenotype test (API ID32C), which did not match the clinical profile, and molecular identification was then performed. The isolates were identified as Candida intermedia by molecular phylogenetic analyses of the chromosomal regions coding for the D1/D2 domain of the large-subunit 26S rRNA gene. The patient responded well to several antifungal agents and was discharged on the 34th hospital day. To our knowledge, this is the first case of C. intermedia infection reported in Japan, and the tenth case reported in the international medical literature.

[A case of pulmonary dirofilariasis with a single nodule on an apical lesion of the right upper lobe].

A 75-year-old man with chronic gastritis and gastro-esophageal regurgitation syndrome was admitted to our hospital complaining of continuous productive cough, and an abnormal shadow was noted on a chest X-ray film. Chest computed tomography revealed a nodule 2.8 cm in diameter with a regular margin on the right apex. Fiberoptic bronchoscopy was performed, but did not yield a definitive diagnosis. We suspected primary lung cancer, and therefore, lung partial resection was performed under thoracoscopic surgery. The intraoperative pathological findings revealed inflammatory granuloma with necrosis, and pulmonary dirofilariasis was finally diagnosed. Pulmonary dirofilariasis is an important differential diagnosis in elderly patients with a chest abnormal nodular shadow. Lesions have been reportedly observed in the peripheral portion of the right lower lobe in many previous reports. However, in this case, a nodular lesion was noted in the right apex.

[A case of scleritis as the initial clinical manifestation of limited Wegener's granulomatosis].

A 63-year-old man who was transferred to our hospital had noticed ocular hyperemia, and 2 months later headache, dry cough, nose bleeds and fever. Chest X-ray film showed bilateral infiltrating shadows. He was given a diagnosis of pneumonia at the previous hospital, where antibiotics were administrated with no effect. High-resolution chest computed tomography (HRCT) on admission revealed consolidations distributed predominantly in the bilateral lower lobes and multiple nodules. Consolidations were also mainly distributed around bronchovascular bundles and at subpleural areas. We suspected Wegener's granulomatosis because of his eye lesion and HRCT findings. Ophthalmologic examination after admission revealed bilateral scleritis. The proteinase 3-antineutrophil cytoplasmic antibody level was 51.4 IU/ml. Thoracoscopic lung biopsy (left S8) showed eccentric granulomatous necrotizing vasculitis, which was consistent with Wegener's granulomatosis. We finally diagnosed this case as limited type Wegener's granulomatosis without renal involvement. We administrated both 60 mg/day prednisolone and 100mg/day cyclophosphamide for initial treatment. After this treatment, he remarkably improved. Scleritis was the initial clinical presentation in this case of Wegener's granulomatosis.

[Hypersensitivity pneumonitis induced by Hypsizigus marumoreus].

We present the case of a 53-year-old woman who was employed at a mushroom (Pleurotus eryngii and Hypsizigus marumoreus) cultivation factory for 15 years. She was admitted to our hospital because of fever and dry cough. Chest radiography and CT scanning revealed diffuse ground glass opacity and centrilobular nodules in both lung fields. Serum KL-6 was elevated. In the bronchoalveolar lavage fluid, the CD4/CD8 ratio was reduced, and the lymphocyte fraction was very high. Transbronchial lung biopsy specimens showed lymphocyte alveolitis. After admission, the patient's symptoms improved rapidly without medication. Although these findings are compatible with hypersensitivity pneumonitis, it was difficult to identify a causative antigen. Serum antibody against Trichosporon was positive. A lymphocyte stimulation test of the peripheral blood was positive against extracts of P. eryngii and H. marumoreus. Furthermore, precipitins against the extracts of H. marumoreus were detected by a double immunodiffusion test. Therefore, we decided to conduct a challenge test using H. marumoreus. As an inhalation provocation test with H. marumoreus conducted in a sickroom caused the same clinical symptoms and signs as experienced in the workplace, we diagnosed hypersensitivity pneumonitis caused by H. marumoreus. A provocation test, in which antigen exposure is limited using a closed space, such as a sickroom, was simple, safe and effective for determining the antigen causing hypersensitivity pneumonitis.

[Primary ciliary dyskinesia. A case report and comparison with 4 previous cases].

We encountered a 59-year-old man, whose chief complaints were sputum and dyspnea on effort. He had suffered from sinusitis since childhood, and chest computed tomography showed bronchiectasis. Electron microscopic examination of bronchial mucosa biopsied by bronchoscopy showed defect of the inner dynein arm in most of his cilia. We diagnosed primary ciliary dyskinesia. Seminal analysis showed no abnormalities, and the etiology of infertility remains unclear. The present case is the fifth case treated at our hospital. In this paper, we compared this case with 4 cases (2 cases of Kartagener's syndrome and 2 cases of primary ciliary dyskinesia without situs invertus) of our hospital, and findings of previous reports. Primary ciliary dyskinesia should be included in the differential diagnosis even in cases of mild bronchiectasis or normal mobility of sperm. Primary ciliary dyskinesia has more variety in radiological and clinical findings than has been recognized.

Adult-onset Still's Disease With Pulmonary Involvement.

BACKGROUND: Only a few earlier pathologic reports exist describing adult-onset Still's disease (AOSD) with pulmonary involvement. We report a case of AOSD with pulmonary involvement producing an organizing pneumonia pattern as seen on transbronchial lung biopsy (TBLB). CASE: A 67-year-old man was referred with fever, cough, and multiple joint pains. Chest x-ray revealed an infiltration in the right upper lung field, and chest high-resolution computed tomography showed a consolidation in the right upper lobe segment. The patient did not respond to multiple antibiotics, and remittent fever over 38°C persisted. The patient also developed a salmon-pink rash. AOSD was diagnosed according to specific diagnostic criteria. Organizing pneumonia was diagnosed by TBLB histology and radiologically, and the lesions were thought to be due to pulmonary involvement of AOSD. Treatment with prednisolone and a nonsteroidal anti-inflammatory drug immediately improved the parenchymal lesions. CONCLUSIONS: AOSD can produce lung involvement. TBLB is useful in the diagnosis of pulmonary lesions.

[Clinical features of mixed infections in patients with Streptococcus pneumoniae pneumonia].

We retrospectively analyzed the severity, the mortality and the initial antimicrobial therapy in 195 patients with Streptococcus pneumoniae pneumonia (SPP). Of these, 59 (30.3%) patients had mixed pneumonia. In patients with mixed SPP, the three most frequent pathogens were influenza virus (27 patients), Haemophilus infuluenzae (14 patients), and Mycoplasma pneumoniae (8 patients). Of these, 21 (35.5%) patients were classified as severe or very severe according to the Japanese Respiratory Society diagnostic criteria among 59 patients of mixed SPP. Severe and very severe pneumonia was significantly associated with mixed infections (P = 0.018). The initial antimicrobial therapy was classified as beta-Lactam alone (113 patients), combination therapy including a beta-Lactam (72 patients), and a fluoroquinolone alone (10 patients). If we limit out study to mild-moderate pneumonia, initial combination therapy was significantly effective in patients with mixed SPP. Even in pneumonia caused by Streptococcus pneumoniae, further efforts to identify etiology are necessary.

[A case of rheumatoid arthritis complicated with methotrexate-induced pneumonitis and pneumocystis pneumonia].

A 62-year-old woman with rheumatoid arthritis was given 4 mg/body methotrexate (MTX) every week and 5 mg prednisolone every day. She developed a severe cough starting in the evening after starting taking MTX and after a fever of 38 degrees and dyspnea appeared the patient was hospitalized. On admission, chest CT findings showed diffuse ground glass attenuation. Pathological findings of specimens obtained by transbronchial lung biopsy showed alveolitis with epithelioid cell granuloma. As a section of the specimen did not show cyst staining by Grocott stain, MTX-induced pneumonitis was diagnosed. The same day, methylprednisolone pulse therapy was started and trimethoprim-sulfamethoxazole (TMP-SMX) was given simultaneously, while MTX was discontinued. On hospital day 3, subsequent data showed a high serum level of beta-D glucan and a positive PCR result for Pneumocystis jiroveci in bronchoalveolar lavage fluid (BALF). Additional section of the specimen showed eosinophilic foamy areas on HE staining and cysts measuring 8 microm, consistent with the Pneumocystis jiroveci lesions by Grocott stain. We present a case of rheumatoid arthritis complicated by methotrexate-induced pneumonitis in which pneumocystis pneumonia was demonstrated by clinical and pathological findings.

Spring migration routes of mallards (Anas platyrhynchos) that winter in Japan, determined from satellite telemetry.

Wild birds, in particular waterfowl, are common reservoirs of low pathogenic avian influenza viruses, and infected individuals could spread the viruses during migrations. We used satellite telemetry to track the spring migration of the mallard ducks ( Anas platyrhynchos ) that winter in Japan. We studied their migration routes, distribution of stopover and breeding sites, and timing of migration movements. We tracked 23 mallards from four different wintering sites. Nine of the 23 mallards reached presumable breeding sites, where migration terminated. The migration routes of the birds greatly differed not only among the wintering sites but also within the same wintering site, although the general feature of the routes was shared among birds within the same wintering site. The mallards used several stopover sites, and they typically stayed for a long period (about one to four weeks) at a site between migration intervals of two to three days. Stopover sites were located in northeast Japan, the eastern coastline of South Korea and North Korea, and the interior of Far Eastern Russia. Mallards from three different wintering sites used a stopover area near the middle part of the Ussuri river in Russia. The terminal sites, which were presumably also breeding sites, were distributed widely over northeast Asia and Far Eastern Russia. These results suggest that mallards that winter in Japan originate from breeding areas widely distributed across eastern Asia. Mallards could potentially transmit avian influenza viruses between Japan and a broad region of northeastern Asia.

[Etiology and outcome of community-acquired pneumonia in relation to age and severity in hospitalized adult patients].

The aim of this study was to determine the etiology and outcome of community-acquired pneumonia (CAP) in relation to age and severity in hospitalized patients. Overall, 652 consecutive patients with CAP were studied retrospectively during a 4-year period from 2002. Severity of pneumonia was classified according to the guidelines of the Japanese Respiratory Society (JRS 2005) and American Thoracic Society (ATS 2001). The etiology was identified in 401 of 652 (61.5%) cases. The four most frequent pathogens were Streptococcus pneumoniae (26.2%), influenza virus (12.4%), Mycoplasma pneumoniae (10.9%), and Haemophilus influenzae (5.9%). The most common pathogen in the younger (15-44 years) group and very severe patients (JRS) was Mycoplasma pneumoniae (38.4%) and influenza virus (28.6%), respectively. The three most frequent pathogens in severe CAP patients (ATS) were Streptococcus pneumoniae (29.0%), influenza virus (17.4%), and Legionella species (13.0%). The overall mortality was 6.4%. The mortality of CAP patients among aged 1544, 45-64, 65-74, and 75 years or older was 1.4%, 3.3%, 6.9% and 9.3%, respectively. The mortality of mild, moderate, severe, and very severe patients (RS) was 0%, 4.1%, 15.5%, and 53.6%, respectively. The mortality of non-severe and severe patients (ATS) was 1.8% and 23.9%, respectively. Age and severity had influence on the prevalence of the main microbial pathogens. Streptococcus pneumoniae remained the most important pathogen that needs consideration in initial antibiotic therapy in patients with CAP of all ages and severities. Pathogens identified in patients with severe CAP in Japan were similar to those of Western countries, except for the high incidence of the influenza virus.