A Diving Accident Checklist in Izu Peninsula can be Associated with Some Pitfalls.

Objectives: We retrospectively investigated the degree of completion of the checklist during or immediately after diving accident, who were transported by a physician-staffed helicopter emergency medical service (HEMS). Methods: From May 2016 to December 2020, we conducted a retrospective the diving accident checklist review of all patients with diving accident, who were transported by HEMS. If all questions of the diving accident checklist were answered, full marks were 40 points. Subjects were divided into two groups: the Arrest group, which included subjects who became cardiac arrest in prehospital setting, and the Control group. Results: A total of 86 patients with diving accident were transported by the HEMS. Among these patients, there were 16 subjects in the Arrest group and 70 in the Control group. Average total score in the Arrest group were significantly smaller than those in the Control group. Conclusions: Degree of completion of the diving accident checklist in cases with cardiac arrest was low in comparison with cases without cardiac arrest. To improve this, further approach based on several remedies will be required in the future.

Benefits and Drawbacks of Using Hotels as Shelters After a Landslide.

OBJECTIVES: On July 3, 2021, a landslide occurred in part of Atami City, Shizuoka, Japan. METHODS: The government of Shizuoka Prefecture requested the dispatch of Shizuoka Disaster Medical Assistance Teams (S-DMATs). RESULTS: On day 2, the evacuees were evacuated into 2 hotels (A and B). Hotel A accommodated over 570 independent and dependent evacuees. Hotel B accommodated 44 dependent aged individuals, who lived in the same long-term health-care facility, together with their 11 caregivers. The evacuees in hotel B returned to the previous facility on day 10 without any specific medical problems. The evacuees in hotel A were managed in the guest rooms as family units. Individuals requiring care in guest rooms in hotel A became isolated because they could not call for help or walk. Furthermore, hotel guest rooms were not barrier-free. The S-DMATs supported the evacuees. CONCLUSIONS: Independent evacuees received the maximum benefits from the use of a hotel as a shelter. In contrast, it was difficult for dependent evacuees to benefit from the hotel as it is as a shelter when living alone in the hotel. Dependent evacuees required appropriate support to eat, walk, use the toilet, and keep themselves clean when using a hotel as a shelter.

Influence of cigarette smoking on estimated glomerular filtration rate (eGFR) in Japanese male workers.

The link between changes in estimated glomerular filtration rate (eGFR) and cigarette smoking was evaluated in Japanese male workers with a 5-year follow-up. We examined the data of 456 Japanese male workers, aged 22-70 years, who were taking no medications, and from this group, 286 men (43.5±8.2 years) were followed for 5-years. Habits of cigarette smoking were obtained during interviews by well-trained staff. The influence of cigarette smoking on eGFR was evaluated. In the first analysis, there was no significant difference in eGFR between subjects with and without cigarette smoking. In the second analysis, eGFR was significantly reduced after 5 years in all subjects. Changes in eGFR in subjects with cigarette smoking (-1.90±12.31 ml/min/1.73 m²) were significantly smaller than those in subjects without cigarette smoking (-4.97±12.05 ml/min/1.73 m²). At follow-up, we found that eGFR was weakly and negatively correlated with the number of cigarettes smoked (/day). The present study indicated that cigarette smoking may be an important modifiable factor for eGFR in Japanese male workers who are not taking any medications.

Proteomic Analysis of Secretomes of Oncolytic Herpes Simplex Virus-Infected Squamous Cell Carcinoma Cells.

Oncolytic herpes simplex virus type 1 (HSV-1) strain RH2 induced immunogenic cell death (ICD) with the release and surface exposure of damage-associated molecular patterns (DAMPs) in squamous cell carcinoma (SCC) SCCVII cells. The supernatants of RH2-infected SCCVII cells also exhibited antitumor ability by intratumoral administration in SCCVII tumor-bearing mice. The supernatants of RH2-infected cells and mock-infected cells were concentrated to produce Med24 and MedC for proteomic analyses. In Med24, the up- and down-regulated proteins were observed. Proteins including filamin, tubulin, t-complex protein 1 (TCP-1), and heat shock proteins (HSPs), were up-regulated, while extracellular matrix (ECM) proteins were markedly down-regulated. Viral proteins were detected in Med 24. These results indicate that HSV-1 RH2 infection increases the release of danger signal proteins and viral gene products, but decreases the release of ECM components. These changes may alter the tumor microenvironment (TME) and contribute to enhancement of anti-tumor immunity against SCC.

A triplet chemotherapy with cisplatin, docetaxel and gemcitabine in patients with advanced non-small-cell lung cancer: a phase I/II study.

PURPOSE: We conducted a phase I/II study of triplet chemotherapy consisting of cisplatin (CDDP), docetaxel (DCT) and gemcitabine (GEM) in patients with advanced non-small-cell lung cancer (NSCLC). METHODS: Fifty-three untreated patients with stage IIIB or IV NSCLC were enrolled. All drugs were given on days 1 and 8. The doses of CDDP and DCT were fixed at 40 mg/m(2) and 30 mg/m(2), respectively. In the phase I portion, a dose escalation study of GEM with starting dose of 400 mg/m(2) was conducted and primary objective in the phase II portion was response rate. RESULTS: The maximally tolerated dose (MTD) and recommended dose (RD) of GEM were determined as 800 mg/m(2) because grade 3 non-hematological toxicity (liver damage, diarrhea, and fatigue) developed in three of nine patients evaluated at that dose level. In pharmacokinetic analysis, C (max) and AUC of dFdC and dFdU were increased along with the dose escalation of GEM. However, no relationship between pharmacokinetic parameters and toxicity or response was observed. Objective response rate was 34% and median survival time was 11.7 months. Though major toxicity was myelosuppression, there were no life-threatening toxicities. CONCLUSION: These results indicate that this triplet chemotherapy is feasible and effective in patients with advanced NSCLC.

Acquisition of Lateralized Predation Behavior Associated with Development of Mouth Asymmetry in a Lake Tanganyika Scale-Eating Cichlid Fish.

The scale-eating cichlid Perissodus microlepis with asymmetric mouth is an attractive model of behavioral laterality: each adult tears off scales from prey fishes' left or right flanks according to the direction in which its mouth is skewed. To investigate the development of behavioral laterality and mouth asymmetry, we analyzed stomach contents and lower jaw-bone asymmetry of various-sized P. microlepis (22 ≤ SL<115 mm) sampled in Lake Tanganyika. The shapes of the pored scales found in each specimen's stomach indicated its attack side preference. Early-juvenile specimens (SL<45 mm) feeding mainly on zooplankton exhibited slight but significant mouth asymmetry. As the fish acquired scale-eating (45 mm ≤ SL), attack side preference was gradually strengthened, as was mouth asymmetry. Among size-matched individuals, those with more skewed mouths ate more scales. These findings show that behavioral laterality in scale-eating P. microlepis is established in association with development of mouth asymmetry which precedes the behavioral acquisition, and that this synergistic interaction between physical and behavioral literalities may contribute to efficient scale-eating.

[Effect of oral beta2-stimulant on pulmonary function in asthma patients treated with multiple medications].

This study was designed to evaluate the effect of discontinuing oral beta2-stimulant in patients with asthma who were being treated with multiple medications. Thirty-two asthmatics controlled under multiple medications who had a stable PEF were entered. Patient symptoms, PEF, FEV10, V75,V50, and V25 were evaluated before and after discontinuing beta2-stimulant. Results showed that after discontinuing beta2-stimulant, there was little change in symptoms, PEF, or FEV10, and only two patients had to be re-medicated with oral beta2-stimulant. However, deterioration of V50 and V25 were clearly observed, suggesting that oral beta2-stimulant had an affect on dilatation of the small airway. Based on our data, we should regard that when discontinuing oral beta2-stimulant from combined use, the lung function reflecting the small airway decreases even if no change of symptoms is observed.

[Measurement of peak inspiratory flow with asthma: effect of inhaled beta2-stimulant].

This study was designed to evaluate peak inspiratory flow (PIF) and peak expiratory flow (PEF) in 24 patients with mild asthma. After inhalation of a beta2-stimulant (beta2), PIF significantly increased from 173.0 +/- 67.0 (range 70-300 L/min) to 194.0 +/- 66.7 after 1 minute, and to 199.3 +/- 63.0 after 15 minutes (p < 0.0025, and p < 0.008, respectively). PEF also significantly increased. The previous inhalation of beta2 improved the efficacy of inhalation of dry powder. This evidence should be considered in performing patient education for effective methods of inhalation.

Propionibacterium acnes DNA detected in bronchoalveolar lavage cells from patients with sarcoidosis.

BACKGROUND AND AIM OF THE WORK: The causes of sarcoidosis are unknown. Propionibacterium acnes is so far the only bacterium to be found in sarcoid lymph nodes. We attempted to detect P. acnes DNA in cells recovered by bronchoalveolar lavage (BAL) from patients with sarcoidosis. METHODS: BAL cells from 30 patients with histologically proven sarcoidosis and 30 controls with other lung diseases were examined by a nested polymerase chain reaction (PCR) for 16S rRNA of P. acnes. BAL cells from three recent sarcoid patients and two control patients were also examined by in situ PCR to locate P. acnes DNA. Clinical findings in sarcoid patients with and without positive results by PCR were compared. RESULTS: P. acnes DNA was detected in BAL cells from 21 (70%) sarcoid patients and 7 (23%) control patients. In situ signals of P. acnes DNA were detected in the cytoplasm of 0.2% to 2.8% of alveolar macrophages from sarcoid patients, but from no cells of the control patients. Gallium-67 uptake by lung parenchyma was found in about half of the sarcoid patients with P. acnes DNA, but in none of the other sarcoid patients. More of these patients with such DNA had lung parenchymal shadows in chest X-ray films and were in more advanced stages of the disease than the other sarcoid patients. CONCLUSIONS: Detection of P. acnes DNA in BAL cells was significantly more common in the patients with confirmed sarcoidosis. Detection was associated with some indices of disease activity in the lung.

[Beta 2-adrenoceptor polymorphism and effects of inhaled beta 2-stimulant (procaterol) and an anti-cholinergic drug (oxitropium) on the airway resistance].

It has been suggested that the Arg 16/Gly 16 allele at codon 16 of beta 2-adrenoceptor polymorphism plays a role in down-regulating the stimulus of bronchodilatation caused by beta 2-agonists. This study was designed to evaluate the difference of bronchodilator responsiveness to beta 2-agonist (procaterol) and anti-cholinergic drug (oxitropium) between those who have Arg 16/Gly 16 allele (hetero type) and those who have Gly 16/Gly 16 allele (variant type) at codon 16 of in healthy women. Airway resistance and other pulmonary function tests were measured by a body plethysmography before and 5, 10, 15, 20, and 30 minutes after inhalation of procaterol or inhalation of procaterol and oxitropium. In healthy women inhaled procaterol, percent changes of respiratory airway resistance compared with values before inhalation were -2.8 after 5 minutes, -7.5 after 10 minutes, -11.2 after 15 minutes, -15.4 after 20 minutes, and -12.6 after 30 minutes. In healthy women inhaled porcaterol and oxitropium, percent changes of respiratory airway resistance compared with values before inhalation were -14.5 after 5 minutes, -18.9 after 10 minutes, -17.0 after 15 minutes, -20.8 after 20 minutes, and -20.4 after 30 minutes. Patterns of decrease of respiratory airway resistance differed between women who have Arg 16/Gly 16 allele (hetero type) and those who have Gly 16/Gly 16 allele (variant type). In women who have Gly 16/Gly 16 allele (variant type), although acute decrease of respiratory airway resistance was observed, the duration of bronchodilator effect by inhaled procaterol and oxitropium was shorter than those observed in Arg 16/Gly 16 allele (hetero type). The present study showed inhalation of procaterol and oxitropium had a differential bronchodilator effect in healthy women, depending on their genotype of beta 2-adrenoceptor polymorphism at codon 16.

[Acute effect of inhaled beta(2)-agonists with different type of intrinsic activity on airway resistance in healthy volunteers].

Inhaled beta(2)-agonists (long-acting as well as short acting) are used world-wide for the relief of asthma symptoms. However, there are few reports which have evaluated the additive effect of short-acting beta(2)-agonists to long-acting beta(2)-agonists on airway resistance measured by a plethysmography. This study was designed to evaluate the additive effect of inhaled short-acting beta(2)-agonists (protecarol) to long-acting beta(2)-agonists (salmeterol) on airway resistance in normal healthy volunteers (S+P group). In addition, to compare the effects of beta(2)-agonists which have different types of intrinsic activities, acute effect of inhaled procaterol adding to procaterol was also evaluated (P+P group). Seven healthy volunteers (all male and all non-smokers) were entered in this study. Pulmonary function was measured by a body plethysmography. Forced expiratory volume per 1 second (FEV1), the maximum flow rate at 25% (V(.) 25), the maximum flow rate at 50% of forced vital capacity (V(.) 50), and airway resistance were measured before and after inhalation of salmeterol (1 dry powder, 50 microg) or procaterol (2 puffs, 20 microg). Sixty minutes after inhalation of salmeterol, or 15 minutes after inhalation of procaterol, inhalation of procaterol (2 puffs, 20 microg) was added, and then pulmonary function was monitored. FEV1, V(.) 25, and V(.) 50 were significantly increased after inhalation of salmeterol as well as procaterol. In addition, airway resistance decreased significantly after inhalation of salmeterol as well as procaterol. In the S+P group, additional decrease of airway resistance after inhalation of procaterol was relatively small compared with the P+P group. In conclusion, although additional bronchodilatoric effects were observed in the S+P and P+P group, the effects seemed to be different based on the intrinsic activity of each beta(2)-agonist.

[beta 2-adrenoceptor polymorphism and effect of inhaled beta 2-stimulant (procaterol) on airway resistance measured by body plethysmography in healthy volunteers].

This study was designed to evaluate, in healthy volunteers, differences of bronchodilator responsiveness to a beta 2-agonist between those with the Arg 16/Gly 16 allele and those with the Gly 16/Gly 16 allele at codon 16 of beta 2 adrenoceptor polymorphism. Peak flow and pulmonary functions were measured by body plethysmography after the inhalation of procaterol. In the Arg 16/Gly 16 group, the resulting acute increase of V 25 and acute decrease of airway resistance were greater, and the bronchodilator effect of a single inhaled beta 2-agonist was longer, than those observed in the Gly 16/Gly 16 group. The present study showed that a single inhalation of procaterol has a varying bronchodilator effect on healthy adults, depending on the genotype of beta 2 adrenoceptor polymorphism at codon 16.

[Low-dose multi-slice CT (LMCT) assessment of pulmonary emphysema in public-school teachers].

Although rates of emphysematous change in smokers have been reported previously, the precise effects of smoking on emphysematous change have not been established because the study subjects of previous reports were heterogeneous. This study was designed to determine the incidence of emphysematous change identified by LMCT imaging in public-school teachers. We reviewed 1776 consecutive subjects (ages from 31 to 61 years) who had undergone LMCT scanning during health care examinations. In addition, their replies to questionnaires about smoking were obtained. Emphysematous change was found by LMCT imaging in 22 male smokers. In these 22 smokers, the scores of emphysematous change according to Goddard's method was well correlated with smoking history. According to the questionnaires, the smoking rates of male and female teachers were 56.7% and 4%, respectively. Eighty-five percent of the teachers worked in offices separated from smokers. Most smokers wished to quit smoking and most teachers knew the risk of nicotine as well as the rate of smoking among high school students. However, knowledge of the relationships between smoking and lung cancer, myocardial infarction, and subarachnoid hemorrhage were not adequate. Our present study clearly demonstrated the incidence of emphysematous change in school teachers. In addition, early exposure to information about the risks of smoking is believed to be important for students, but school teachers did not have enough of such information.

The role of interleukin-8 in interstitial pneumonia.

OBJECTIVE: A variety of inflammatory cells accumulate in the lungs of patients with interstitial lung disease. The potential for IL-8 to be released from these cells into the lungs of patients with idiopathic interstitial pneumonia (IIP), interstitial pneumonia with collagen vascular disease (IP-CVD), sarcoidosis (SAR) and hypersensitivity pneumonitis (HP) was investigated. METHODOLOGY: IL-8 levels were assessed by enzyme-linked immunosorbent assay in BAL fluid and serum, and the expression of IL-8 in the lungs of these patients was evaluated by immunohistochemistry. RESULTS: Serum IL-8 levels were significantly elevated in patients with IIP (P < 0.05) and SAR (P < 0.01). In BAL fluid, the IL-8 level was significantly higher in patients with IIP (P < 0.05), IP-CVD (P < 0.01), SAR (P < 0.01) and HP (P < 0.01). In several cases, IL-8 level correlated with neutrophil density. The IL-8 immunopositive cells were type II pulmonary epithelial cells and alveolar and interstitial macrophages in patients with IIP and IP-CVD. CONCLUSIONS: IL-8 is likely to be a key factor in the pathogenesis of fibrosis of the lung and in lung injury.

Spontaneous regression of metastatic endometrial stromal sarcoma.

Spontaneous regression of malignancy is rare and there appear to be no reports of spontaneous regression of endometrial stromal sarcoma. We report a rare case of metastatic endometrial stromal sarcoma that regressed spontaneously. A 58-year-old woman was admitted to hospital in January 1996 when her chest radiograph showed multiple nodular shadows in the left lower lung field. Computed tomography of the chest revealed bilateral nodules. Segmentectomy of the left lower lobe was performed by thoracoscopy. She had a past history of uterine myoma with metrorrhagia for which she had undergone a hystero-oophorectomy 10 years earlier. She also had a vaginal polyp removed 1 year earlier. The lung pathology was studied and the surgical specimens of the uterus and vagina were re-examined. The diagnosis was endometrial stromal sarcoma primarily arising in the uterus. The vaginal polyp and the pulmonary nodules were considered to be metastases. Samples of lung and vaginal tissues were positive for both estrogen and progesterone receptors. The patient was discharged without treatment in February 1996 and followed up in the outpatient clinic. The tumor shadow measuring 2 mm in diameter on admission was enlarged to 4 mm in diameter 1 year later. Surprisingly, spontaneous regression of the lung disease occurred at 33 months, the tumor size decreasing to 2 mm in diameter and to 1 mm at 46 months. No evidence of tumor enlargement was detected at the last follow-up in July 2001. Although the precise mechanism of tumor regression is unknown, metastatic endometrial stromal sarcoma may spontaneously regress.