Search

Airway foreign bodies are typically removed orally using a rigid bronchoscope. We present a rare case of a foreign body at the tracheal bifurcation that required removal via tracheostomy. A child turned pale while eating nuts and was suspected to have choked on a foreign body. CT revealed a foreign body at the tracheal bifurcation. As his respiratory condition was unstable, tracheal intubation and removal were attempted using a rigid bronchoscope. Tracheal obstruction during oral removal resulted in respiratory failure and bradycardia. Following emergency tracheostomy, the foreign body was removed via the tracheal stoma after his respiratory condition stabilised. The patient was discharged 21 days later without neurological sequelae. To avoid hypoxaemia during airway foreign body removal, as in this case, assessing the size of the upper airway and foreign body is necessary. Tracheostomy and foreign body removal through the tracheal opening should be considered proactively.

We report a rare case of intravascular large B-cell lymphoma (IVLBCL) with hypopituitarism and respiratory failure. A man in his 80s presented with hypotension and respiratory failure but was unsuccessfully treated for septic shock. Biological investigations were performed, and he was diagnosed with hypopituitarism due to insufficient secretion of anterior pituitary hormone. Although his condition temporarily improved following hormone replacement therapy, he eventually died of progressive respiratory failure. The lymphoma was only discovered during the autopsy, where it was observed to have spread to the pituitary gland and lung capillaries. Therefore, we concluded that the lymphoma had caused respiratory failure and hypopituitarism. The patient was thus diagnosed with IVLBCL posthumously. In conclusion, IVLBCL can cause hypopituitarism and respiratory failure due to pituitary and pulmonary capillary invasion by lymphoma cells.

Background: Preventing coronavirus disease 2019 (COVID-19) in older people is an important public health issue. The purpose of this study was to investigate the relationship between the level of fear regarding COVID-19 and adherence to COVID-19 prevention measures among community-dwelling older adults. Methods: This study was a cross-sectional survey conducted from July 15 to August 19, 2020, in 127 community-dwelling older adults ≥65 years old in Japan. A questionnaire including participants’ basic attributes (age, sex, body mass index, and family structure), levels of fear regarding COVID-19, increasing adherence to four behaviors (restrictions on going out, maintaining physical distancing, wearing masks, and washing hands) for COVID-19 prevention, and its stress levels was used. We calculated the relationship between the level of fear of COVID-19 and the level of each behavioral change using Spearman’s correlation coefficient (rs). Results: About 95% of older adults displayed fear of COVID-19. Rates of adherence to all four COVID-19 prevention measures increased to approximately 80–95%. However, about 40–55% of older adults were stressed by all behavior modifications except washing hands. The increasing level of fear regarding COVID-19 correlated positively with decreasing frequency of going out (rs=0.280, p=0.001) and increasing frequency of washing hands (rs=0.336, p, Acta medica Nagasakiensia, 66(2), pp.65-70; 2023

A man in his 70s with rheumatoid arthritis presented with seizures and coma and was transferred to our emergency department. Two months prior to admission, he started to take tofacitinib 10 mg/day. On admission, we noted a rash with a blister on the forehead, and herpes zoster was diagnosed. Cerebrospinal fluid examination suggested meningitis. An MRI of the brain showed no abnormality. Based on these findings, he was suspected with herpes zoster meningitis. We discontinued tofacitinib and treated the patient with intravenous acyclovir for 2 weeks. He regained complete consciousness, but right forehead skin lesion, severe vision loss in the right eye and right facial nerve paralysis remained as sequelae. Six weeks after admission, we restarted tofacitinib with oral valaciclovir as antiviral prophylaxis. Two years after admission, we administered Shingrix, an adjuvant recombinant vaccine for herpes zoster, and discontinued oral valaciclovir.

Objective Amid the global spread of antimicrobial resistance, antimicrobial stewardship should be further promoted in the clinical setting. Our previous study suggested an intra-week disproportion of discontinuation of broad-spectrum antibiotics. We therefore explored the generalization of this prescription trend by investi-gating the use of all intravenous antibiotics. Methods A retrospective, observational study. Patients Between January 1, 2018, and December 31, 2020, we collected data on the initiation and discon-tinuation of intravenous antimicrobials on each day of the week and on days after holidays at Okayama Uni-versity Hospital, Japan. We compared the monthly antimicrobial prescription initiation and discontinuation using the Kruskal-Wallis test and Mann-Whitney U-test with Bonferroni correction as a post-hoc procedure. Results Data from 15,293 hospitalized cases were analyzed. The initiation of antimicrobials differed slightly among days of the week, although this trend was clinically insignificant. Compared with the initia-tions, antimicrobial discontinuations were disproportionately biased among the weekdays, tending to occur on Mondays (p Conclusion To further promote antimicrobial stewardship, clinicians should be aware of the influence of behavioral, environmental, and social factors on antimicrobial prescription, which is seemingly beyond medi-cal indications.

The ventrolateral striatum (VLS), a subregion of the ventral striatum (VS), possesses distinct neuronal Ca

The total petroleum hydrocarbon concentration decrease at the initial and final bioremediation across different variable and the comparative effect of roots and stem of Cisuss populnea biosorbent were studied. 25 g of soil was weighed into different plate, contaminated with about 10 ml of crude oil, the plate was labeled as BI, CI DI, BF, CF and DF (stem), (root) across 3 g, 6 g, and 9 g variables and A (soil and crude oil mixture) as control for initial and final bioremediation. 1 g of each contaminated soil sample was extracted using mechanical shaker at room temperature and the extracts were analyzed using GC/MS the results showed that the initial treatment of stem biosorbent were 358.47455 ppm, 248.02045 ppm, 249.97273 ppm respectively and the final treatment after 4 weeks of biodegradation were 173.40636 ppm, 70.44364 ppm, 45.60818 ppm and control 757.39864 ppm. The total effect removal of Total petroleum hydrocarbon obtained were 51.6%, 75.2% and 81.8%, while the initial treatment of the root biosorbent were 366.72762 ppm, 347.75909 ppm, 337.04227ppm, after 4 weeks of biodegradation, the Total petroleum hydrocarbon concentration decreases to 143.6982 ppm, 60.05455 ppm, 52.21045 ppm and control 757.39864 ppm and the effect removal were 60.8%, 82.7% and 84.5%.

The total petroleum hydrocarbon concentration decrease at the initial and final bioremediation across different variable of cisuss populnea leave biosorbent. 25 g of soil was weighed into different plate, contaminated with about 10 ml of crude oil, the plate was labeled as BI, CI DI, BF, CF and DF (leave) across 3 g, 6 g, and 9 g variables and A (soil and crude oil mixture) as control for initial and final bioremediation. 1 g of each contaminated soil sample was extracted using mechanical shaker at room temperature and the extracts were analyzed using GC/MS the results showed that the initial treatment of leave biosorbent were 706.4482 ppm, 544.2509 ppm, 347.75909 ppm respectively. After 4 weeks of biodegradation, the concentration decreases to 310.4318 ppm, 117.8105 ppm, 60.05455pmm and control 757.39864 ppm respectively. The Total removal efficiencies of Total petroleum hydrocarbon were 56.2%, 78.4%, and 82.7% for the treatments of 3 g, 6 g, and 9 g of leaves sorbent

Herein, we report the major factor for deamination reaction rate acceleration, i.e., hydrophilicity, by using various 5-substituted target cytosines and by carrying out deamination at high temperatures. Through substitution of the groups at the 5′-position of the cytosine, the effect of hydrophilicity was understood. It was then used to compare the various modifications of the photo-cross-linkable moiety as well as the effect of the counter base of the cytosine to edit both DNA and RNA. Furthermore, we were able to achieve cytosine deamination at 37 °C with a half-life in the order of a few hours.

Introduction In the standardization of panoramic radiography quality, the education and training of beginners on panoramic radiographic imaging are important. We evaluated the relationship between positioning error factors and multiple image analysis results for reproducible panoramic radiography. Material and methods Using a panoramic radiography system and a dental phantom, reference images were acquired on the Frankfurt plane along the horizontal direction, midsagittal plane along the left–right direction, and for the canine on the forward–backward plane. Images with positioning errors were acquired with 1–5 mm shifts along the forward– backward direction and 2–10° rotations along the horizontal (chin tipped high/low) and vertical (left–right side tilt) directions on the Frankfurt plane. The cross-correlation coefficient and angle difference of the occlusion congruent plane profile between the reference and positioning error images, peak signal-to-noise ratio (PSNR), and deformation vector value by deformable image registration were compared and evaluated. Results The cross-correlation coefficients of the occlusal plane profiles showed the greatest change in the chin tipped high images and became negatively correlated from 6° image rotation (r = −0.29). The angle difference tended to shift substantially with increasing positioning error, with an angle difference of 8.9° for the 10° chin tipped low image. The PSNR was above 30 dB only for images with a 1-mm backward shift. The positioning error owing to the vertical rotation was the largest for the deformation vector value. Conclusions Multiple image analyses allow to determine factors contributing to positioning errors in panoramic radiography and may enable error correction. This study based on phantom imaging can support the education of beginners regarding panoramic radiography.

We evaluated the impact of discontinuing universal preadmission screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) on the occurrence of nosocomial clusters of coronavirus disease 2019 (COVID-19) during the SARS-CoV-2 o (omicron) variant period. No increasing trend in nosocomial clusters was observed during community-based surges before and after discontinuation. This finding supports the safety of the practice change.

Aim We investigated whether or not postoperative complications (POCs) themselves have a negative survival impact or indirectly worsen the survival due to insufficient adjuvant chemotherapy in a pooled analysis of two large phase III studies performed in Japan Patients and methods The study examined the patients who enrolled in 1304, phase III study comparing the efficacy of 6 and 12 months of capecitabine as adjuvant chemotherapy for stage III colon cancer patients and in 882, a phase III study to confirm the tolerability of oxaliplatin, fluorouracil, and l-leucovorin in Japanese stage II/III colon cancer patients. In our study, POCs were defined as the following major surgical complications: anastomotic leakage, pneumonia, bowel obstruction/ileus, surgical site infection, postoperative bleeding, urinary tract infection, and fistula. Patients were classified as those with POCs (C group) and those without POCs (NC group). Results A total of 2095 patients were examined in the present study. POCs were observed in 169 patients (8.1%). The overall survival (OS) rates at 5 years after surgery were 75.3% in the C group and 86.5% in the NC group (p = 0.0017). The hazard ratio of POCs for the OS in multivariate analysis was 1.70 (95% confidence interval, 1.19 to 2.45; p = 0.0040). The time to adjuvant treatment failure (TTF) of adjuvant chemotherapy was similar between the groups, being 68.6% in the C group and 67.1% in the NC group for the 6-month continuation rate of adjuvant chemotherapy. The dose reduction rate of adjuvant chemotherapy and adjuvant treatment suspension rate were also similar between the groups (C vs. NC groups: 45.0% vs. 48.7%, p = 0.3520; and 52.7% vs. 55.0%, p = 0.5522, respectively). Conclusion POCs were associated with a poor prognosis but did not affect the intensity of adjuvant chemotherapy. These results suggested that POCs themselves negatively influence the survival.

To investigate the safety and survival benefits of portal vein and/or superior mesenteric vein (PV/SMV) resection with jejunal vein resection (JVR) for pancreatic ductal adenocarcinoma (PDAC).Few studies have shown the surgical outcome and survival of pancreatic resection with JVR, and treatment strategies for patients with PDAC suspected of jejunal vein (JV) infiltration remain unclear.In total, 1260 patients who underwent pancreatectomy with PV/SMV resection between 2013 and 2016 at 50 facilities were included; treatment outcomes were compared between the PV/SMV group (PV/SMV resection without JVR; n = 824), PV/SMV-J1 V group (PV/SMV resection with first jejunal vein resection; n = 394), and PV/SMV-J2,3 V group (PV/SMV resection with second jejunal vein or later branch resection; n = 42).Postoperative complications and mortality did not differ between the three groups. The postoperative complication rate associated with PV/SMV reconstruction was 11.9% in PV/SMV group, 8.6% in PV/SMV-J1 V group, and 7.1% in PV/SMV-J2,3 V group; there were no significant differences among the three groups. Overall survival did not differ between PV/SMV and PV/SMV-J1 V groups (median survival; 29.2 months vs. 30.9 months. p = 0.60). Although PV/SMV-J2,3 V group had significantly shorter survival than PV/SMV group who underwent upfront surgery (p = 0.05), no significant differences in overall survival of patients who received preoperative therapy. Multivariate survival analysis revealed that adjuvant therapy and R0 resection were independent prognostic factors in all groups.PV/SMV resection with JVR can be safely performed and may provide satisfactory overall survival with the pre-and postoperative adjuvant therapy.

There exists an international consensus on the importance of family-centered care (FCC) in intensive care settings and the evaluation of collaboration between nurses and families; however, FCC is currently practiced blindly in Japan. In this study, we developed a Japanese version of the questionnaire, Factors that Influence Family Engagement (QFIFE-J) and examined its reliability and validity. A web-based survey was conducted with 250 nurses working in the intensive care unit (ICU). Exploratory and validatory factor analyses were used to ascertain factor validity. Criterion-related validity was tested using correlation analysis with the ICU Nurses’ Family Assistance Practice Scale. Internal consistency and reproducibility were verified for reliability. Following exploratory and confirmatory factor analyses, a 15-item measure emerged comprising four factors: “ICU environment”, “nurses’ attitudes”, “nurses’ workflow”, and “patient acuity”. Confirmatory factor analyses showed a generally good fit. Cronbach’s α for the overall scale was 0.78, indicating acceptable internal consistency. The intraclass coefficient for test–retest reliability was 0.80. It was found that the QFIFE-J was reliable and valid and may help determine the factors that promote or inhibit FCC. Additionally, this study has also clarified the current status and family support related issues in ICUs in Japan.

Granulicatella species are rare, nutritionally variant streptococci that cause infective endocarditis. Their clinical and microbiological characteristics remain unknown. We reviewed five years of Granulicatella cases in our hospital database (Jan 2017-Jun 2022), finding 6 Granulicatella adiacens cases and 1 Granulicatella elegans case. Clinical backgrounds and bacteremia sources were diverse; 3 cases developed polymicrobial bacteremia. Antimicrobial testing showed non-susceptibility to penicillin G in 4 of 7 cases (57.1%), and high susceptibility to carbapenems and vancomycin in all cases. Determining optimal antibiotic therapy for Granulicatella infections is vital in this era of antimicrobial resistance.

A sensitivity analysis for the horizontal localization scale is performed for a numerical weather prediction (NWP) system that uses a 30-s update to refresh a 500-m mesh with observations from a new-generation multiparameter phased array weather radar (MP-PAWR). Testing is performed using three case studies of convective weather events that occurred during August–September 2019, with the aim to determine the most suitable scale for short-range forecasting of precipitating convective systems and to better understand model behavior to a rapid update cycle. Results showed that while the model could provide useful skill at lead times up to 30 min, forecasts would consistently overestimate rainfall and were unable to outperform nowcasts performed with a simple advection model. Using a larger localization scale, e.g., 4 km, generated stronger convective and dynamical instability in the analyses that made conditions more favorable for spurious and intense convection to develop in forecasts. It was demonstrated that lowering the localization scale reduced the size of analysis increments during early cycling, limiting the buildup of these conditions. Improved representation of the localized convection in the initial conditions was suggested as an important step to mitigating this issue in the model.

Indwelling urethral catheters (IUCs) are used to measure urine volume, keep patients on bed rest, or keep the groin area clean in patients with acute myocardial infarction (AMI). However, the association between IUC use and in-hospital urinary-related complications is unknown.This was a single-center retrospective analysis of 303 patients admitted to our hospital in 2018-2020 who had AMI without cardiogenic shock. An IUC was inserted in the emergency room upon initiation of invasive catheter treatment and removed as soon as possible. The primary outcome was in-hospital adverse urinary event (IHAUE), which consisted of in-hospital urinary tract infection and in-hospital gross hematuria.Of 303 patients, 243 patients (80.2 %) underwent IUC insertion. A lower proportion of patients with IUCs were male (72 % vs. 85 %, p = 0.044). A higher proportion had Killip classification 2 or 3 (13 % vs. 0 %, p = 0.003) or ST-elevation myocardial infarction (65 % vs. 32 %, p 0.001). IHAUEs occurred significantly more commonly in patients with IUCs than without IUCs (11 % vs. 2 %, p = 0.023). Kaplan-Meier analysis showed that IHAUEs occurred more frequently in patients with IUCs than patients without IUCs (log-rank test p = 0.033). Furthermore, IUC use longer than the median of 2 days was associated with a higher odds ratio (OR) for IHAUE when compared with those without IUC use (OR, 3.65; 95 % confidence interval, 1.28-10.4; p = 0.015). There were no significant differences in in-hospital mortality by IUC status.IUC use is associated with a higher risk of IHAUEs in patients with uncomplicated AMI. Routine IUC use might not be recommended.