Factors influencing patient disclosure of cancer diagnosis to the family dentist: online survey in Japan.

Oral care during cancer treatment constitutes essential supportive care. We aimed to identify factors associated with cancer patients informing their family dentists about their cancer diagnosis. Using the generated original questionnaire, we conducted a cross-sectional questionnaire study in 500 cancer patients (gastric, colorectal, lung, breast, and prostate cancer) through the Internet from September 10 to 13, 2019. The factors influencing patients' disclosure of their cancer diagnosis to their family dentist were identified by multivariable logistic regression analysis. Nearly half of the respondents (42.2%) informed their family dentist that they had cancer. The disclosing behavior of cancer patients was distinctively associated with their physician's advice (odds ratio [OR] 59.3; 95% confidence interval [CI] 7.7-456.3); 8.6% of all respondents were advised to inform their dentist about their cancer diagnosis. In the group without the physician's advice, good relationship with family dentist was associated with disclosing behavior. This study indicates the need for support for cancer patients to receive appropriate oral care; patients' perceptions of the physician's advice and communication with the family dentist should be motivators for disclosing the cancer diagnosis to dentists. Medical workers involved in cancer care should demonstrate the benefit of medical-dental collaboration in cancer care of patients.

Fracture status of wild cranes (Grus monacha and G. vipio) found dead or in a weak condition at Izumi Plain in Japan.

The Izumi Plain in Kagoshima Prefecture, Japan, is a major wintering ground for wild cranes. Between October 2009 and March 2016, a total of 204 Hooded Cranes Grus monacha and White-naped Cranes G. vipio were found dead or in a weak condition in the plane. Of these, 56 cranes had bone fractures. The rate of incidence of fracture was considered to be higher in White-naped than in Hooded Cranes. Tibia fractures were the most common. The leg and wing fracture numbers were almost equal. Forty six percent of the fracture cases were believed to be caused by collisions with the power line.

Pediatric directors' perception of clinical research education in Japan.

BACKGROUND: Pediatric clinical research in Japan has declined recently, and a new policy requiring manuscripts of residents for the pediatric board examination was established in 2017. However, pediatric faculties appear to be confused about research education in residencies. METHODS: Questionnaires on research activities in residencies were distributed during the spring of 2018 to 500 pediatric directors in all educational hospitals in Japan. We collected data and performed statistical analyses: principal component analysis, multivariate analysis of variance, and multiple comparisons. RESULTS: We received 252 (50.4%) responses and analyzed 243 (61 academic hospitals, 27 children's hospitals, 151 community hospitals, and 4 unknown). About 137 (56.4%) of them supported the new policy. There were three main contentious points on attitudes to pediatric research among respondents: passion for research, particularity about disease research, and public spirit. There was a difference in passion for research between academics and non-academics. A difference in pride in particular research was observed between PhDs and MDs. Differences in public spirit were not associated with scholarly degrees or hospital type. CONCLUSIONS: To promote research education in residencies, pediatric faculties should confirm and share the aim that pediatricians should be scientific physicians with a research mentality developed through research activities and should notice social problems. Through research education, pediatric residents could approach the five outcomes for pediatricians provided by the Japan Pediatric Society: being general physicians, child healthcare supporters, advocates for children, scholars, and professionals.

Contamination Status of Seven Elements in Hooded Cranes Wintering in South-West Kyushu, Japan: Comparison with Red-Crowned Cranes in Hokkaido, Japan.

The hooded crane is designated as an endangered species. The cranes breed primarily in wetlands in southeast Russia and China in summer. Most of the hooded crane population winters in the Izumi plain in Japan. It is difficult to know the contamination status of their habitat because of their vast breeding area. We determined the levels of Cd, Pb, As, (total) Hg, Se, Zn, and Cu in the liver, kidney, and muscle of hooded cranes that were found dead in Izumi in the periods 2003-2006 and 2014-2015 compared with the levels in red-crowned cranes in Hokkaido, Japan, as the only cranes in which these elements had been studied extensively. There were no notable differences between levels of the seven elements in the two periods. Overall, tissue levels of the elements examined in hooded cranes were comparable to those in red-crowned cranes except for Hg and Se. Tissue levels of Hg and Se were clearly lower in hooded cranes than in red-crowned cranes that were found dead from 2000. One lead poisoning case was confirmed. The results suggest that Hooded cranes wintering in Izumi are not extensively contaminated with the seven elements examined.

Characterization of gizzards and grits of wild cranes found dead at Izumi Plain in Japan.

We analyzed the gizzards, and grits retained in the gizzards of 41 cranes that migrated to the Izumi Plain during the winter of 2015/2016 and died there, either due to accident or disease. These included 31 Hooded Cranes (Grus monacha) and 10 White-naped Cranes (G. vipio). We determined body weight, gizzard weight, total grit weight and number per gizzard, and size, shape, and surface roundness of the grits. Average gizzard weights were 92.4 g for Hooded Cranes and 97.1 g for White-naped Cranes, and gizzard weight positively correlated with body weight in both species. Average total grit weights per gizzard were 19.7 g in Hooded Cranes and 25.7 g in White-naped Cranes, and were significantly higher in the latter. Average percentages of body weight to grit weight were 0.8% in Hooded Cranes and 0.5% in White-naped Cranes. Average grit number per gizzard was 693.5 in Hooded Cranes and 924.2 in White-naped Cranes, and were significantly higher in the latter. The average grit size was 2.8 mm in both species. No differences were found in the shape and surface roundness of grits between the two species. To the best of our knowledge, this is the first study on the grits retained in the gizzards of Hooded and White-naped Cranes.

Genetic characterization of low-pathogenic avian influenza viruses isolated on the Izumi plain in Japan: possible association of dynamic movements of wild birds with AIV evolution.

The Izumi plain in Kagoshima Prefecture, Japan, is an overwintering site of endangered cranes (hooded cranes and white-naped cranes) and of many other migratory birds (including wild ducks) that are considered carriers of avian influenza viruses (AIVs). To assess the risks of a highly pathogenic avian influenza outbreak in the crane populations, we tested various environmental samples for AIVs in this area. In the 2014-2015 winter season, we isolated one AIV of the H6N2 subtype from the cranes' roost water and two AIVs of the H11N9 subtype from a crane fecal sample and a cloacal swab of a dead spot-billed duck. Genetic analysis of these AIV isolates indicated that our H6N2 isolate is genetically close to AIVs isolated from wild birds in Southeast Asian countries, except that the PB1 and NS genes belong to the North American virus lineage. All genes of the two H11N9 isolates are related to AIVs belonging to the Eurasian virus lineage. Notably, in our phylogenetic trees, H11 HA and N9 NA genes showing high sequence similarity to the corresponding genes of isolates from wild birds in South Africa and Spain, respectively, did not cluster in the major groups with recent wild-bird isolates from East Asia. These results suggest that AIVs with viral gene segments derived from various locations and bird species have been brought to the Izumi plain. These findings imply a possible association of dynamic movements of wild birds with AIV evolution.

Genome Sequence of Fowl Aviadenovirus A Strain JM1/1, Which Caused Gizzard Erosions in Japan.

This study reports the complete genome sequence of fowl aviadenovirus A strain JM1/1, which caused gizzard erosions in broilers occurring in Japan. The JM1/1 genome is 43,809 bp in length and most closely related to the strain chicken embryo lethal orphan (CELO); moreover, multiple site insertions and deletions were found.

Morphologically abnormal beaks observed in chickens that were beak-trimmed at young ages.

A survey of beak morphological abnormalities was performed on 6,201 chickens (egg-laying hens and chickens for meat production belonging to 25 flocks) brought to a poultry processing plant. The observed abnormalities varied among flocks with occurrence rates ranging from 0.48 to 46.67%. The occurrence was high in flocks subjected to beak trimming and varied significantly according to chicken breed, with the highest rates of abnormalities in a certain chicken breed. The most widely observed abnormalities were: 1) uneven growth of the upper and lower mandibles, mostly with elongation of the lower mandible (accounting for 64.8% of all abnormalities); 2) misalignment of the upper and lower mandibles, causing lateral deviation or crossing (16.3%); 3) sharp or jagged deformities of the mandible tips (10.1%); 4) permanent open beak, a deformity in which the beak did not close completely even when closed (5.8%); and 5) formation of tubercular swellings at the tips of the upper or lower mandibles (3.1%). This is the first report on the occurrence of beak abnormalities in beak-trimmed poultry in Japan.

Handheld fetal Doppler device for assessing heart rate in neonatal resuscitation.

BACKGROUND: The use of neonatal three-lead electrocardiograms (Neo-ECG) is suggested for the assessment of heart rate (HR) in neonatal resuscitation, but primary childbirth facilities (i.e. maternity clinics or maternity homes) are not sufficiently equipped for this. The aim of this study was to therefore to confirm the potential of a handheld fetal Doppler device (FDD), widely used to assess HR in labor room resuscitation, and to compare its equivalency to Neo-ECG. METHODS: In low-risk full-term infants, HR was measured five times per minute in minutes 1-5 after delivery using the FDD and Neo-ECG, and their equivalence compared. The equivalence margin was set at a HR difference of <±5 beats/min and <±5%. Moreover, the times at which HR was displayed were measured for both methods. RESULTS: FDD and Neo-ECG HR correlated strongly (r = 0.977) in 155 measurements in 33 cases. The mean HR difference was -0.123 beats/min (95%CI: -0.594 to +0.345), and the logarithmic transformation of the HR ratio was -0.0003 (95%CI: -0.0020 to +0.0015). The mean HR difference and HR ratio were within the equivalence margin. For HR assessment using the FDD, 155 of 165 measurements (93.9%) could be obtained in <10 s. CONCLUSIONS: In HR assessment, FDD is a valid substitute for Neo-ECG in primary childbirth facilities that are not sufficiently equipped for Neo-ECG.

Characterization of variant infectious bursal disease virus from a broiler farm in Japan using immunized sentinel chickens.

We attempted the isolation of variant infectious bursal disease (IBD) viruses by using sentinel chickens immunized with inactivated classical-type IBD vaccine. Immunized sentinel chickens with high levels of neutralizing antibodies and non-immunized sentinel chickens were raised together with broiler chickens in a commercial farm. Severe atrophy of the bursa of Fabricius was observed from the second week after cohabitation in non-immunized sentinel chickens. However, in immunized sentinel chickens and broiler chickens, atrophy was observed from the third week after cohabitation. The IBD virus (IBDV) isolated from the bursa of Fabricius of immunized sentinel chickens, designated as strain IBDV TY2, showed severe atrophy of the bursa in infected SPF chickens. Antiserum to the IBDV TY2 strain showed higher neutralizing activity to heterologous IBDV strains than did antiserum to the K strain vaccine virus. Phylogenetic analysis revealed that the nucleotide sequences encoding the hypervariable region of virus protein 2 of the IBDV TY2 strain did not cluster with the classical, variant or very virulent IBDV groups. Based on these results, we suggest that the IBDV TY2 strain may constitute a novel variant type of IBDV.

Consumer Perception of Inpatient Medical Services.

Although it is currently popular to reflect consumers' perspectives to medical service management, insufficient attempts have been made to understand detailed perception of the consumer side of medical services to promote medical services' evaluation from the consumer viewpoint. The aim of this study was to descriptively reveal how consumers perceive medical services that they receive, focusing on inpatient medical services. We conducted semi-structured interviews with 10 adults who experienced hospitalization of five or more days. Constant comparative analysis was performed on the obtained descriptive data. We identified 1) medical procedures, 2) explanations from medical professionals, 3) behavior of medical service providers, 4) somatic sensations, and 5) self-perceived physical conditions as target factors that medical service consumers perceived during hospitalization. The response to the perceived target factors, "compared with the expectation that the consumer had before the hospitalization," suggests that it is an important medical service consumer reaction to check if the service met their expectations for perceived factors. The response to the medical services perception targets suggested that medical service consumers are involved in medical services and interested in various perception targets. The expectations that medical service consumers have prior to hospitalization can largely influence inpatient medical services evaluation.

Gallus gallus coxsackievirus and adenovirus receptor facilitates the binding of fowl adenovirus serotype 1 in chickens.

Coxsackievirus and adenovirus receptor (UXADR) is an integral membrane protein that serves as a receptor for coxsackie B viruses and adenovirus types 2 and 5. Previous studies demonstrated that Fowl adenovirus (FAV) can also utilize Homo sapiens CXADR to infect cells. FAV is a double-stranded DNA virus of the family Adenoviridae. FAV causes inclusion body hepatitis and hydropericardium syndrome in chickens. In addition, FAV serotypes 1 and 8 have recently been shown to cause gizzard erosion in chickens. These chicken diseases and growth insufficiency caused by FAV infection result in great economic loss. Thus, identifying and characterizing the viral receptor would further enhance our understanding of the mechanisms underlying virus infection and histocompatibility. Here, in order to determine the FAV receptor in chickens, we investigated the effect of the recently identified Gallus gallus CXADR (ggCXADR) on FAV infection. Overexpression of ggCXADR in CHO cells resulted in increased FAV binding and expression of early FAV genes. However, the propagation of infectious viruses in CHO cells expressing ggCXADR was not detected. These findings provide the basis for further studies aimed at elucidating the infection mechanism of FAV. Further research is required to characterize the additional host factors involved in FAV infection and life cycle.

Effect of pH adjustment by mixing steroid for venous pain in colorectal cancer patients receiving oxaliplatin through peripheral vein: a multicenter randomized phase II study (APOLLO).

PURPOSE: The aim of this phase II clinical trial was to evaluate the preventive effect of dexamethasone mixing injection for venous pain in patients with colorectal cancer during chemotherapy. MATERIALS AND METHODS: Patients were randomized to receive a 2-h intravenous infusion of oxaliplatin 130 mg/m(2) on day 1 followed by capecitabine 1000 mg/m(2) (or S-1 40-60 mg/m(2)) twice daily on days 1 through 14 of every 3 weeks with or without dexamethasone 1.65 mg at the infusion on day 1. RESULTS: A total of 53 patients were enrolled. The analysis population consisted of 49 patients (arm A, with dexamethasone N = 24; arm B, without dexamethasone N = 25). The incidence of venous pain ≥grade 2 based on the CTCAE version 4.0 was 33.3 % in arm A and 56.0 % in arm B (relative risk 0.60; 95 % CI 0.31-1.16). The incidences based on the verbal rating scale for arms A and B were 50.0 and 64.0 %, respectively (relative risk 0.78; 95 % CI 0.48-1.28). CONCLUSION: The primary endpoint was not met in this preliminary study.

Physicians' perception of the "Guidelines for Obstetrical Practice in Japan" and the reasons for different compliances.

The "Guidelines for Obstetrical Practice in Japan" are the first consensus-based guidelines in the field of obstetrics and were published in 2008 owing to an obstetric medical care crisis in Japan. The Guidelines describe appropriate methods for obstetric care and were based on consensus among obstetricians in Japan. Originally, the Guidelines were not intended to be a rulebook to limit physician discretion; however, from a medical care litigation standpoint, medical practices that conform to the Guidelines are following the "medical standard". The present study aimed to investigate obstetricians' perceptions of the Guidelines, to assess the degree of compliance, and to consider the implication of physician discretion in medical litigation. A questionnaire exploring the perception of the Guidelines was completed by 341 obstetricians was conducted from February 2009 until May 2009; questionnaires were evaluated using simple aggregation, correlation analysis, and principal component analysis. Although more than 80% of physicians responded that content of the Guidelines was appropriate, only 34.7% complied with recommendation level A. Our findings suggest that the rate of compliance to the Guidelines should be improved, reasons for noncompliance should be clarified, and Guidelines that are easier for patients to understand should be drafted.

Isolation and characterization of influenza A viruses from environmental water at an overwintering site of migratory birds in Japan.

The Izumi plain in Kagoshima prefecture, Japan, is an overwintering site of more than 10,000 cranes. The wet paddy areas are artificially created to provide roosting sites for the cranes every winter. Since wild ducks, known to be a natural reservoir of influenza A viruses, also overwinter in this area, the cranes' roost water likely serves as a source of influenza A virus infection. To assess this potential risk, we collected 126 water samples from the cranes' roost in the 2012/2013 winter season for virus isolation. We isolated six influenza viruses of three subtypes (H3N8, H4N6, and H4N8) from the water samples collected in the months of November and December. Genetic analysis of our isolates indicated that these viruses were genetically similar to the low-pathogenic avian influenza viruses circulating among Eurasian waterfowl. These findings suggest the possibility of the cranes becoming infected with the avian influenza viruses that are present in their roost water.

Effectiveness of setting numerical targets in the surgical training of residents: a trial to achieve an optimal balance.

During the past 10 years, residency training in otorhinolaryngology-head and neck surgery (ORL-HNS) in Japan, especially at university hospitals, has emphasized subspecialization, resulting in insufficiencies in basic surgical techniques with an extreme bias toward acquiring subspecialty surgical case experience. To address this problem, we developed a target-oriented program intended to achieve a more balanced approach to surgical training and performed a 1-year trial of the program at the Jikei University School of Medicine. Fourteen residents with 1 to 4 years of ORL-HNS experience completed the trial. Each resident's competencies in six basic surgical procedures were assessed on the basis of the number of cases handled by the resident, and each resident's case selection bias after implementation of the target-oriented training was examined. The case selection bias in the trial group residents was reduced and their balance in case experience was shown to be improved in comparison with that in control group residents who were trained in the conventional way. In addition, opinion surveys of the participants and supervising otorhinolaryngologists (trainers) indicated that they felt that the new training system had been effective in improving the balance in case experience and improving motivation, and creating greater awareness of training goals and progress.

Effect of litter moisture on the development of footpad dermatitis in broiler chickens.

Broiler chicks were reared on either wet litter or dry litter to compare the development of footpad dermatitis (FPD). Broilers reared on wet litter first developed FPD at 14 days of age. Their FPD scores increased sharply after 21 days of age, reaching 2.92 at 42 days. In broilers reared on dry litter, FPD was first observed at 28 days of age, and the FPD score was only 0.70 at 42 days. When 21- or 28-day-old broilers that had been reared on wet litter and had developed FPD were moved to dry litter, the progression of FPD was suppressed or delayed. These results suggest that reducing litter moisture is effective in preventing FPD and suppressing disease progression.

Correlation between doctor's belief on the patient's self-determination and medical outcomes in obtaining informed consent.

We employed a questionnaire survey to assess attitudes toward informed consent (IC) among hospital doctors. Based on the result of the correlation analysis, the following two hypotheses were identified. The first hypothesis is that "the doctor's belief that the patient's self-determination is possible promotes cure of illness by obtaining IC." The second hypothesis is that "the doctor's belief that the patient's self-determination is possible has a positive influence on patient's quality of life by obtaining IC." We clarified the rationale for explaining these two hypotheses by applying cross tabulation analysis, discriminant analysis and principal component analysis (PCA). The doctors were divided into two groups in terms of their position on the patient's self-determination. One group of doctors believed the possibility of patient's self-determination, and the other did not. Through our statistical analyses, the characteristics that discriminate these two groups were identified. It was revealed that the former group placed a great importance on the hospitality value, while the latter placed an importance on the service value. Agreement or rejection of the concept of IC has been demonstrated as a key distinguishing factor between the two groups. The results of PCA showed that the doctor's belief on the patient's self-determination in obtaining IC had a significant effect on medical outcomes, and the two above-mentioned hypotheses were revealed.

Relationship between severity of footpad dermatitis and carcass performance in broiler chickens.

The relationship between the severity of footpad dermatitis (FPD) and growth performance parameters (live weight, condemnation rate, leg meat yield and breast meat yield) was investigated in a total of 63 million broiler chickens that were processed over a period of 1,053 days between 2008 and 2012 at a full-scale processing plant in Kagoshima Prefecture, Japan. FPD scores and carcass data were summarized daily and analyzed to determine their correlations. It was found that FPD severity was positively correlated with the condemnation rate and negatively correlated with the live weight and leg meat yield. These results indicate that controlling FPD may play an important role in reducing condemnations while improving live weight and leg meat yields.