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Fear memory has an important role in survival, but excess fear memory could be cause to fear-related disorders such as post traumatic disorder (PTSD). People who undergo a fearful event do not always develop PTSD, suggesting that there are vulnerable factors to develop the disorder. It is believed that sex, in particular female, is one of the factors as it is known that the prevalence rate of PTSD is higher in women than in men. However, the biological mechanisms underlying the sex differences in their prevalence rate remain unclear. Because previous studies reported that patients with fear-related disorders show an impairment of fear extinction, investigation of sex differences in fear extinction may be useful for understanding the greater vulnerability of women to fear-related disorders. Although number of papers investigating sex differences in fear extinction, these reports have increased recently. This review introduces fear extinction, sex differences in fear extinction is low, and the molecular mechanisms of sex differences in fear extinction. In the molecular mechanisms, we focused brain-derived neurotrophic factor (BDNF)-tropomyosin-related kinase B (TrkB) receptor signal which has been investigated by independent research groups.

Various efforts have been made in recent years to deal with the uneven distribution of medical doctors in Japan, but very few studies have paid attention to the influence of local education level. In this study, we investigated the relationship between regional education levels and the uneven distribution of doctors. We conducted a multiple linear regression analysis, setting the number of doctors per 100 thousand population per Health Care Region (HCR) as the outcome variable, and the number of high schools whose deviation value is 60 or more, the number of clinics per 100 thousand population, the number of beds per 100 thousand people, the population aging rate, the rate of treatment (outpatient), the density of population and the existence of medical schools as the explanatory variables. As a result, we found that a HCR with a high school with a deviation value of 60 or more had a significantly higher number of physicians per 100 thousand population (P<0.05), and that two or more such high schools intensified the tendency. Similar results were obtained when using only national and public high schools, and when using the rate, rather than the number, of high schools whose deviation value is 60 or more. It is suggested that, especially in rural areas where the lack of the medical doctors is a critical issue, raising the local education level can be an effective measure to relieve the uneven distribution of doctors.

International immigration into Japan is increasing. It would make sense that investigating the health status of immigrants would be associated with improvements in their health and would be beneficial in building a complete social security system in which minorities can live safely and securely. The objective of this study is to describe the health status of immigrants in Japan and to explore the association between self-rated health status and employment status. As a result, half of those surveyed had some health problem, particularly a lot of mental stress. We did not find a significant relationship between self-rated health status and employment status, but it seems that people who stay in Japan 5 years or more tend to have poor self-rated health status. The factors associated with poor self-rated mental health status were being a non-employee, and having visited a hospital 1 time or more during the past 12 months. A system of mental stress care would be the most necessary health care for international students in Japan.

Vibrio parahaemolyticus, one of the Gram-negative common enteric pathogens, was first isolated in Japan in 1950. Since its discovery, this bacterium has been a major cause of food-poisoning in Japan, and its infection has recently undergone a global expansion. V. parahaemolyticus possesses a classical exotoxin, thermostable direct hemolysin, and two sets of type III secretion systems (T3SSs) that are able to inject effectors directly into host cells, which are its key virulence factors. Exotoxin/effector is exploited by many Gram-negative pathogens, and plays critical roles in pathogenesis by damaging host cells or by modulating host cell functions, through its activity on/in host cells. In recent years, functional activities of T3SS effectors produced by V. parahaemolyticus have been extensively studied, which has substantially increased our understanding of the pathogenic mechanisms of the bacterium. In paricular, some T3SS effectors of V. parahaemolyticus act as cytotoxins and thereby damage host cells. Here, I focus on these cytotoxic effectors of V. parahaemolyticus and describe recent advances in our understanding of their mechanisms of action.

Lymphomatosis cerebri (LC) is a variant of primary central nervous system lymphoma, which demonstrates diffuse white matter infiltrates without showing definite enhanced mass lesions on MR scans. We present a case of seventy-one year-old immunocompetent male who manifested with progressive truncal ataxia and drowsiness. The MRI exhibited diffuse white matter lesions from brainstem to cerebral hemispheres with minimum enhanced lesions at the first presentation. Because the diagnosis of LC was suspected, we performed a brain biopsy from the enhanced lesion near the right thalamus, which revealed diffuse large B cell lymphoma. After he underwent methylprednisolone pulse therapy and methotrexate chemotherapy, he obtained remission. Making a diagnosis of LC is often difficult because image findings resemble those of inflammatory or autoimmune diseases. LC is an important differential diagnosis to be considered in patients presenting with diffuse white matter disease. Performing a brain biopsy at the early phase is essential for the correct diagnosis and the favorable prognosis.

Background: Prophylactic granulocyte-colony stimulating factor(G-CSF)is necessary for some cancer patients receiving anti-cancer drugs. However, it is difficult for cancer patients in rural areas to receive G-CSF as outpatients because of inconvenient official transport, lack of public support, and low activity levels due to age. To resolve this problem, we began conducting a critical path(G-path)with regional medical institutions from 2011., Methods: We retrospectively surveyed the clinical records of cancer patients receiving prophylactic G-CSF using G-path at our hospital., Results: Eighty-two patients who were administered a total of 254 cycles of chemotherapy were examined between January 2011 and December 2016. Diseases included malignant lymphoma(n=64), pancreatic cancer(n=7), soft tissue sarcoma(n=5), and others(n=6). The median age of the patients was 70(range: 24-94)years. Fifty-three patients visited medical offices, and 31 patients visited regional hospitals. In 245 of 254(96%)cycles, planned G-CSF administration was performed. In 37 of 254(15%)cycles, infectious episodes developed, but patients needed hospitalization for only 5 cycles(2%)., Conclusion: Cooperation between clinics and hospitals using G-path reduced ambulatory burden and prevented severe infection. Cooperation in supportive care may allow for equal accessibility to cancer treatment.

A 49-year-old man was hospitalized with infectious mononucleosis-like symptoms, hepatosplenomegaly, and circulating abnormal lymphocytes. Hepatosplenic T-cell lymphoma was suspected, and bone marrow aspiration and liver biopsy were performed. The pathological diagnosis was T-cell lymphoma. When explaining malignant lymphoma to the patient, he disclosed his Men Who Have Sex with Men (MSM) status. HIV RNA test showed a markedly high viral load, and TCR gene rearrangement was negative. In view of these results, the patient was diagnosed with acute HIV infection. The previous lack of information concerning his MSM status led to a misdiagnosis, highlighting the relevance of this case to raise awareness of the importance of previously interviewing the patient.

Approximately 20% of diabetic patients develop diabetic cataracts. As lens proteins are known to be only slightly metabolized during the lifetime, cataracts are difficult to recover from once they have progressed. Therefore, the daily intake of natural compounds would be an important strategy for the prevention of diabetic cataracts. Aphanothece sacrum Okada (Asa) is a freshwater blue-green algae endemic to Japan. It has been eaten since the Edo period in Kyushu. In this study, the inhibitory effects of Asa on the pathogenesis of diabetic cataracts were evaluated. Furthermore, the inhibitory effects of Asa on the formation of N ε -(carboxymethyl) lysine (CML), an oxidation-dependent advanced glycation end-product, were also measured. After 3-month administration, the CML contents in the lens were measured by liquid chromatography tandem mass spectrometry using an internal standard of CML or lysine. Asa significantly inhibited the progression of cataractogenesis and accumulation of CML in diabetic lens compared with the normal diet group. These results suggested that daily intake of Asa reduces oxidative stress and prevents the pathogenesis of cataracts.

The case is a 64-year-old male who had a past history of herpes simplex virus encephalitis (HSE) two years prior to his admission. He was admitted to our hospital due to severe pneumonia and sepsis. Several days later, he developed HSE again. It has been known that immunosuppressive state called immune paralysis occurs in the patient with sepsis due to the amplification of anti-inflammatory responses after the initial hyper-inflammatory phase, which increases the susceptibility to various latent viruses including herpes simplex virus. In the present case, we consider that the severe infection may trigger the recurrence of HSE through the viral reactivation due to immune paralysis. When we see a patient suffering from severe infection who had a past history of HSE, we should keep in mind that such a patient may have a risk of the recurrence of HSE.

A 37-year-old female patient with myotonic dystrophy was scheduled for laparoscopic cholecystectomy for gall stone under general anesthesia with continuous propofol infusion. Rocuronium was administered with careful monitoring using TOF- Watch®, measuring train-of-four count (Tc), TOF ratio (Tr), and posttetanic count The total amount of rocuronium was 70 mg ; 0.6 mg .kg⁻1 for anesthetic induction and 0.3 mg .kg⁻1 when Tc exceeded 1. When the operation was completed, Tc was 4, Tr was uncountable and she showed reaction to calling her name. Then sugammadex 2 mg .kg⁻1, rapidly antagonized the neuromuscular block, such that the Tr recovered to 100% but tidal volume was 250 ml in 3 minutes. Additional dorsage of sugammadex, 2 mg .kg⁻1, was required for tidal volume to recover to 530 ml. After 20 minutes of first administration of sugammadex, we extubated the tracheal tube without respiratory depression. To avoid respiratory depression, we did not use postoperative opioids. Intraoperative transversus abdominis plane block and postoperative thoracic epidural block with ropivacaine were successful for postoperative pain relief.

Preoperative simulation of vascular anatomy has been widely accepted in order to reduce surgical complications and improve postoperative outcomes. In esophagectomy, preservation of the bronchial artery (BA) was shown to reduce postoperative pulmonary complications. However, some anomalous BA branching patterns have been reported and these can make BA preservation difficult during surgery. Recently, the clinical utility of preoperative three-dimensional computed tomography angiography (3D-CTA) has been reported as a form of preoperative anatomical simulation. Consequently, the BA was safely preserved and efficient lymph node (LN) dissection was achieved. In surgery for gastric cancer, tracing the inner dissectable layer is necessary for LN dissection. Particularly in laparoscopic total gastrectomy with spleen preservation, there is considerable variation in the vascular anatomy of the splenic artery, splenic vein, and short gastric artery. Therefore, preoperative 3D-CTA could improve the safety of this procedure. Recently, the number of dissected LNs has been shown to be increased after introduction of 3D-CTA in laparoscopic surgery for both esophageal and gastric cancer, which showed that preoperative anatomical simulation could achieve more radical LN dissection. As a future perspective, intraoperative navigation systems could become more practical guides for endoscopic surgery for upper gastrointestinal cancer.

We report a case of so-called "surfer's myelopathy" involving a 15-year-old girl. Preceding episodes of vaccination and infection were absent. She experienced back pain during a surfing class for beginners, followed by weakness in both legs, which progressed to paraperesis. Then, 2 days later, sensory disturbance and bladder/rectal disturbance also developed. Spinal MRI revealed a ischemic lesion compatible with anterior spinal cord syndrome. A combination of methylprednisolone pulse therapy and high-dose intravenous immunoglobulin therapy was effective leaving no residual dysfunction. The acute onset during the surfing class and characteristic MRI findings led to the diagnosis of surfer's myelopathy. Although rarely reported, warnings are warranted to prevent surfer's myelopathy and avoid the progressive deterioration of neurological dysfunction.

During the arterial phase acquisition of Gd-EOB-DTPA examinations, use of a small volume of the Gd-EOB-DTPA may make it difficult the encoding center of the k-space, and produce blurring. The previous studies revealed the encoding technique of the k-space was one of the most important reasons. However, there is no report to discuss the reasons with quantitative evaluations. The purpose of this study was to quantitatively evaluate the characteristics of the artifacts using different k-space encoding techniques (centric-view ordering (CVO) and sequential-view ordering (SVO)) for liver dynamic MRI in computer simulation study. This simulation study consists of the following steps. First of all, the creation of a time intensity curve, and original simulation images at certain points among the one phase dynamic scanning. Secondly, creation-simulated MR echo data from the created original images using FFT, and encoding simulated k-space using the simulated MR echo data. Finally, a reconstruction of simulated dynamic MR images from the simulated k-space, and to evaluate each simulated MR images, we measured modulation transfer functions (MTFs) from the bar patterns of the reconstructed images. The results of the CVO simulation indicated that the bar patterns were blurring compared to the images encoded by the SVO. The results of the SVO simulation indicated that the bar patterns were not enhanced at late scan timings. In addition, the results of MTFs indicated that there was no edge enhancement at all scan timings and both encoding techniques. In conclusion, it is possible to quantitatively evaluate the characteristics of artifacts using MTF, which was measured by the bar patterns, in liver dynamic MRI.

Objective and Methods: We analyzed the clinical effects of treatment for Mycobacterium tuberculosis infection for 1 year in our specialized hospital in 2011. Two hundred and ninety-six (296) patients were admitted and received treatment., Results: Two hundred and fifty-six patients (86.5%) were started on the standard treatment with 3 drugs (isoniazid [INH, rifampicin [RFP], and ethambutol [EB] or streptomycin [SM]) or 4 drugs (INH, RFP, EB or SM, and pyrazinamide [PZA]). One hundred and seventy-one patients (66.8%) continued receiving the standard treatment during the admission period. Of 160 cases who could continue 4 drugs, under 80 year-old patients were 127 cases (76.0%), but over 80 year-old patients were 33 cases (49.3%). The mean duration for negative conversion of sputum culture was 40.6 days. Liver dysfunction due to 4 drugs (INH, RFP, EB, and PZA) was noted in 8.5% of patients. Eighteen of the 296 patients had multi-drug resistant tuberculosis (MDR-TB). Each MDR-TB patient received individualized treatment. Moreover, 7 of the MDR-TB cases were treated surgically., Discussion: Treatment of TB had taken long time, and some patients could not continue the treatment owing to the adverse effects of drugs. Hence, it is important to monitor adverse effects of drugs in each patient.

Background: Mycobacterium kansasii is the second most common nontuberculous mycobacterial pulmonary disease pathogen in Japan. Fibrocavitary disease is characteristic of M. kansasii pulmonary disease in male patients., Objective: To clarify the clinico-microbiological characteristics of M. kansasii pulmonary disease in recent years in a Tokyo hospital specializing in mycobacteriosis., Methods: A retrospective chart review was performed on 77 M. kansasii culture-positive cases from January 2003 to December 2010. Sequence analysis of the hsp65 gene using PCR-restriction enzyme pattern analysis (hsp65-PRA) was used to identify bacterial genotypes., Results: Seventy-four cases fulfilled the diagnostic criteria for inclusion. Female patients comprised 22% of cases (16 cases, 63.2 ± 24.6 years of age) and were older than male patients (58 cases, 55.5 ± 17.5 years of age). Although the peak distribution among men was patients in their 50s, female patients showed a bimodal distribution with increased occurrence in older women. Radiological examination showed that approximately 90% of male and younger female patients had fibrocavitary disease. However, elderly female patients tended to have nodular bronchiectatic disease. Genotype analysis revealed that all bacterial strains from both genders were subtype I., Conclusions: Compared to previous reports, the number of female patients with M. kansasii pulmonary disease had increased, with an unusual age distribution. These different age-related radiological findings might be due to host factors.

A 54-year-old woman with hematemesis was referred to our hospital. She had a history of liver cirrhosis and diabetes mellitus. After inserting a Sengstaken-Blakemore tube, we performed endoscopic variceal ligation for ruptured esophageal varices. On the third day of admission, she developed septicemia and necrotizing fasciitis caused by Bacillus cereus. She was successfully treated with early debridement of both lower extremities and intravenous treatment with vancomycin, ciprofloxacin, and clindamycin. Although B. cereus is an attenuate bacterium, it can occasionally cause fatal infection in immuno-compromised individuals, such as those with liver cirrhosis.

The Diagnosis Procedure Combination (DPC) is a case-mix classification system that is linked with a lump-sum payment system for inpatient care reimbursement. The key objectives of introducing the DPC system are to implement an electronic claim system and to provide transparency of hospital performance. The DPC data include discharge abstract and administrative claims data. The unique advantage of the DPC data is the inclusion of detailed process data and several clinical data that can be applied to clinical studies. In this report, we explain the structure and contents of the DPC database, and discuss the applicability of the DPC data to clinical studies, comparing them with the US Nationwide Inpatient Sample database.

Iwate Prefecture has the second largest area and the second lowest population density in Japan, therefore needing a system that can supply medical service efficiently. Although there are nine Secondary Medical Districts (SMD) and fourteen hospitals subject to the Diagnosis Procedure Combination (DPC hospitals) in Iwate, four of the DPC hospitals are concentrated in Morioka SMD, the biggest area and administrative center in Iwate, and the other areas have only a few DPC hospitals. To consider the whole concept of cancer care in Iwate, we analyzed lung, stomach, liver, colon, and breast cancer from DPC data published by the Ministry of Health, Labor and Welfare (MHLW). We analyzed the monthly number of patients and estimated the number of patients that each SMD and DPC hospital was capable of receiving, finding that the trend of consultation is different depending on the type of cancer. We consider that the DPC hospitals should think strategically about their functional compartmentalization, and that the local government should revise the regional health care planning.

From April 9 to 16, 2011, I joined the first medical team at Ishinomaki as one of the supporting volunteers of Japan Primary Care Association for the 2011 East Japan Earthquake. I participated in launching the intensive care temporary clinic at Yugakukan. Yugakukan was one of the shelters set up right after the earthquake and tsunami on March 11, 2011. Later, it became the care unit for inpatients moved from Ishinomaki City General Hospital, which was crushed by the tsunami. Patients ranged in age and needs: from infant to elderly, and those needing internal and/or surgical medication or artificial dialysis. Under such conditions, we, as the first medical team members dispatched to the shelter, were concerned with the assessment of refugees and establishment of the management system of the shelter. Through the activities, I realized the utmost importance of "networking". In this paper, the role of pharmacists in disaster medicine, preparation for disaster medicine, and the role and function of pharmacists in community medicine under normal conditions will be demonstrated in relation to this keyword.

Statutory Sick Pay, Jobseeker's Allowance, and Employment and Support Allowance are employment-related benefits in the United Kingdom (UK). They correspond to the Injury and Disease Allowance and Unemployment Insurance in Japan. The Government of the UK is determined to reform the benefit system to make it fairer and to improve financial work incentives, using the slogan "Welfare to Work". Against this background, the government of the UK united some non-contributory benefits into a new "Universal Credit" scheme, which started in April 2013. The labor policy was also reformed to improve work incentives, for example by abolishing the Flexible New Deal program and uniting all the "Welfare to Work" policies into the "Work Programme". These reforms are useful for reconsidering the labor and employment-related policy and benefit system of Japan.

How to control the increasing health expenditures is a common problem in the developed countries. The main causes of this increase are ageing of the society and medical innovation. The UK government has introduced a market oriented health reform in order to balance the increasing expenditures and the quality of care. For example, they have introduced the GP Fundholding, Private Financial Initiative (PFI) for construction of public hospital, and personal budget system (a patient owns a budget for buying health services in the deregulated market). However, there is little evidence indicating the effectiveness of these programs. On the other hand, it is important to strengthen the labor policy in order to maintain the social security system. For example, programs for increasing the employment rate and those for increasing productivity work sharing are such policies. From this viewpoint, the EU countries have introduced a series of active employment policies, i.e., job training for unemployed persons and work sharing. Furthermore, as other authors report in other articles of this volume, the government of the UK has introduced the Fit for Work (FFW) program that intends to medically support workers.

The Industrial Injuries Disablement Benefit (IIDB) is a benefit for people who are disabled either as a result of an accident at work or because of a prescribed disease. IIDB does not cover the self-employed, military personnel, or certain kinds of trainees. "Prescribed diseases" are defined by the Department of Work and Pension in a list of diseases covered by IIDB. Delivery of medical services, such as the medical treatment benefit in Japan, is not included in this scheme because most medical services are provided for in the scheme of the National Health Service (NHS). Prevention Projects, such as the Follow-up Medical Examination Benefits in Japan, are also not included. Benefits for people who have Pneumoconiosis (including asbestosis) are provided in the IIDB scheme.

The Statement of Fitness for Work (Fit Note) policy was started in the UK in 2010 in order to promote return to work after sickness absence. Fit Note is issued by General Practitioners (GP). We conducted an interview survey of 2 occupational physicians working in the UK to ascertain the impact of the introduction of Fit Note on occupational health in the UK. They regard the low coverage of occupational health services in the UK, especially among small companies and self-employed workers, as a serious issue. Fit Note was regarded as a tool to induce GPs to participate in occupational health services, and it is expected that they will be new partners in occupational health. The English occupational physicians evaluated the Fit Note system highly, and believe that the increasing participation of GPs in occupational health services will be a steady advancement in occupational health in the UK.

The Statement of Fitness for Work, so called Fit Note, was introduced in the UK in 2010. Physicians issue Fit Note to workers when requested. The Fit Note provides the physician's advice about the worker's fitness for work when he or she has health problems, writing their advice of either "may be fit for work" or "not fit for work" on the form. The Fit Note also records details of the functional effects of workers' condition. Then the Fit Note is used to consider and arrange support from employers in order for workers to return to work. This paper reports the general background and practical implementation of Fit Note based on a literature review and interviews from general practitioners, occupational physicians, and physiotherapists in the UK.

In order to manage occupational exposure, it is necessary to define exposure. In terms of administrative management however, shift work is difficult to define because there is a wide variance of working schedules which do not belong to ordinal day time work. Thus, many countries define night work, which is easier to define based on night working time for administrative management, rather than shift work. On the other hand, the term "night work" has not been so common in medical research compared to the term "shift work". Further, those two words were used in nearly same context among medical researchers in many cases. Given the current situation, for the purpose of promoting occupational health, it is reasonable to treat those two medical and administrative words as synonymous in order to make full use of medical evidence with linkage to the current administrative system.

There has been an emergent issue of health inequalities in Japan. Tackling health inequalities has been put on the primary agenda in the revised national health promotion campaign, so called "Kenko-Nippon-21"(Healthy Japan 21), which was announced in 2012. Against the background of this social movement, the present article argues how occupational health can contribute to health inequality issue based on the knowledge of public health and social epidemiology.Firstly, we reviewed a brief sketch of health inequality at occupational settings including position, job, and employment status. Secondly, we de scribed a conceptual model of a causal pathway of occupational class and health, based on the idea of life-course approach, and models such as cumulative model, trigger model and latent effect/sensitive period model. Finally, we proposed that health impact assessment as a tool to mitigate health inequality related to occupational policy.

The French Labor law defines the role and its allocation criteria of the occupational physician (OP) the same as in Japan. In France, occupational medicine is one of the medical specialties. The OP resident must follow the 4 years clinical training before certification. After having finished their residency, they are entitled to work for the occupational health service office of a company or company association (in the case of small and medium sized companies). The most important characteristics of the French system is that they cover all workers regardless of company size. The main role of the OP is prevention of work related diseases and accidents. They are not allowed to do clinical services except for emergency cases. Their main activities are health examinations, health education, patrol and advice for better working condition. Formerly, it was rather difficult to attract the medical students for OP resident course because of its prevention oriented characteristics. A growing concern about the importance of health management at the work site, however, has changed the situation. Now, the number of candidates for OP resident course is increasing. Their task has expanded to cover mental health and other life style related diseases. The 2011 modification of law redefines the role of the OP as a director of an occupational health service office who has a total responsibility of multidisciplinary services. The French and Japanese occupational health systems have many of similarities. A comparative study by researchers of UOEH is expected to yield useful information.

The clinical pathway (CP) is a schedule of a standard set of treatments for a particular clinical condition. The horizontal axis of the CP indicates hospitalization days and the vertical axis indicates a set of procedures for each day. Using the CP, medical staff (i.e., physicians and nurses) and patients can have a clear image of the content of treatment and its schedule, and can understand the tests, operation schedules and the aim of the discharge day, and avoid excessive or deficient tests and care. The health care service can function smoothly as a team because it is clear who is responsible for what. However, it requires a considerable amount of time and work for medical staff to evaluate clinical activities based on the established CP, to monitor the appropriateness of the CP, and to modify its content if necessary. Because of this, it is not rare for hospital staff to stop using CPs. In this study, we tried to develop a method to systematically evaluate the appropriate level of CP based on Diagnosis Procedure Combination (DPC) data. Furthermore, we developed a methodology to formulate a new CP based on DPC data. The present study has clarified that management staff can support medical staff in CP - based clinical evaluation and CP development by using the DPC data. This kind of partnership between management and medical staffs should contribute to the standardization and amelioration of clinical quality.

Each prefectural government must formulate a Regional Health Care Plan (RHCP) which will be enforced from 2013 to 2017. During this period, in Health Care Regions (HCRs) where the population is less than 200,000, the inflow rate of inpatients is less than 20%, and the outflow rate of inpatients is more than 20%, each prefecture is required to reconsider the size of any such secondary HCR. They should consider natural conditions such as geographical characteristics, social conditions such as traffic, patient flow of each area, access time to core hospitals, et cetera. In this study, we analyzed the situation of the Kiso secondary HCR of Nagano prefecture, based on the 2010 Diagnosis Procedure Combination (DPC) data that was distributed by the Ministry of Health, Labour and Welfare. According to a Geographic Information System (GIS) analysis, the Kiso HCR is self-sufficient for most emergency care and cancer treatments, even though this area is classified as a rural HCR. As this research indicates, DPC data is a useful resource for HCR planning.

Objective: Working group on JJ1017 nuclear medicine domain extension code in the Japanese Society of Nuclear Medicine has created nuclear medicine extension codes keeping the integrity with JJ1017. The objective of this study was to investigate the usefulness of nuclear medicine extension codes in real clinical settings., Method: Nuclear medicine examinations of each institution were extracted from the examination master table and then the target subset of examinations to be coded with JJ1017 were identified. For this subset, working process was conducted, during which the followings compared conformity rate, application rate of representative frequently code set and compliance rate of nuclear medicine extension codes., Results: Without using representative frequently code set, it was difficult to invent the same code for the same examination. By using the representative frequently code set, the same code expression could be invented for the same examination. Furthermore, using nuclear medicine extension codes additionally, these which could not be appropriately coded with representative frequently code set alone., Conclusion: Nuclear medicine extension codes keeping the integrity with JJ1017, was proved to be useful to improve the accuracy of coding.

Ciguatoxins (CTXs) responsible for ciguatera fish poisoning (CFP) in Amami Islands, Kagoshima, Japan in 2008 were determined by LC-MS/MS analysis. Ciguatoxin-1B (CTX1B), 54-deoxyCTX1B, and 52-epi-54-deoxyCTX1B were detected in Variola louti and Lutjanus monostigma. The toxin profile distinctly differed from that of a CFP-related fish from Miyazaki, which mainly contained ciguatoxin-3C type toxins. Toxin profiles were species-specific, as observed in fish from Okinawa. The LC-MS/MS and mouse bioassay (MBA) methods produced comparable data, though 54-deoxyCTX1B was not taken into consideration owing to the lack of toxicity data. To improve assessment, toxicity data for this compound are needed. A reef fish caught on the same occasion and judged nontoxic by MBA (<0.025 MU/g) was found to contain low levels of CTX, indicating a potential risk for CFP.

Epidemics of infectious diseases often occur in hospital wards handling patients with severe motor and intellectual disabilities. However, the causative pathogens are not identified in half of these epidemics. Recently, an epidemic occurred in 2 wards consecutively in the National Hospital Organization Ehime Hospital in March-April, 2010. In this epidemic, 18 of 40 patients in one ward and 14 of 60 patients in another ward showed symptoms, and human metapneumovirus (HMPV) was detected from pharyngeal and/or nasal swabs of 4 patients. Phylogenetic analysis of the viral genomes showed that the virus belonged to subgroup B2, and the same virus had spread consecutively in 2 wards. High fever lasted for 5.3 days on average in the 32 inpatients, was mostly over 38 degrees C and was accompanied by productive coughs. In the 4 patients in whom human HMPV was detected, the number of peripheral blood lymphocytes decreased but that of monocytes increased. Pneumonia developed in two patients as shown by chest radiography, and an increased number of peripheral blood neutrocytes and increased CRP levels were noted. Of the 151 inpatients, anti-human HMPV antibody was found in the sera of 143 (95%), and the relationship between high fever and antibody titer was not significant, indicating that HMPV infection could recur in spite of the presence of specific antibodies. Because human HMPV is highly prevalent, and causes high fever and pneumonia, hospital staff should be vigilant for any signs of this virus in hospital wards and take steps to prevent infection in long-term inpatients.

To determine the most appropriate treatment strategy for neonates with coexisting congenital heart diseases (CHD) requiring surgery, 408 neonates treated in our department between 2002 and 2009 were retrospectively reviewed. Of the 408 neonates, 37 (9.1%) had coexisting CHD. Among the pediatric diseases requiring surgery, esophageal atresia (46.7%), anorectal malformation (24.1%), and tracheobronchial anomalies (75.0%) were frequently associated with CHD, and the survival rate among patients with coexisting CDH was 24.3%, about 2-fold higher than among those without coexisting CHD. Clinical observations in the present series suggested that fatal conditions such as tracheoesophageal fistula should be repaired immediately after birth, followed by palliative cardiac surgery to stabilize the circulatory status if necessary. Thereafter, radical repair of cardiac and pediatric anomalies should be performed, taking into account the balance between surgical stress and cardiac reserve. For this purpose, proper assessment of surgical stress and cardiac function and collaboration among specialists in relevant fields are essential during the perinatal period to determine the treatment strategy for patients with multiple-organ anomalies.

A 68-year-old man had been followed up since March, 1997 because of a cystic tumor of the pancreas head. The patient developed obstructive jaundice and was admitted to our hospital in June, 2007. The tumor size on CT scan had increased from 3.6 cm to 5.9 cm during the 10-year period. After endoscopic biliary drainage, pancreatoduodenectomy was performed. Pathological diagnosis of the resected specimen was serous cystadenoma. Serous cystadenoma of the pancreas is known as a benign tumor with indolent progression and is likely to be symptomatic if the tumor size exceeds 4 cm. However, biliary obstruction is a rare complication of serous cystadenoma. We report this rare case here with references to the literature.

Background: The Diagnosis Procedure Combination (DPC) is a national administrative case-mix classification system for acute inpatient care which was launched in Japan in 2003. This system was designed to increase the standardization and transparency of medical information. The system has collected medical information in a unified format nationwide from acute hospitals. Significant parts of the data has been published by Ministry of Health, Labour and Welfare, including average length of hospital stay and number of patients by disease and hospital. This information is valuable for medical consultation in occupational health settings., Objectives: This article provides an overview of the DPC system and how to utilize the data from the perspective of occupational health practitioners.

A 61-year-old man with the chief complaint of pressure with swallowing was referred to our hospital with type 3 cardiac gastric cancer. Gastrofiberscope showed type 3 cardiac cancer with esophageal invasion. On the abdominal computed tomography, there was evidence of lymph node swelling in the lesser curvature and multiple liver metastases. Blood tumor markers were elevated: CEA 200 ng/mL, CA19-9 2,490 U/mL. He was diagnosed as unresectable advanced gastric cancer UE-circ, type-3, c-T3N2H1P0M1, Stage IV. A biopsy revealed adenocarcinoma (tub2-por1). We started bi-weekly docetaxel and S-1 combination chemotherapy(DOC 40 mg/m2 day 1, 14, S-180 mg/m2 day 1-7, 14-21). After completion of the first course of this combination therapy, his feeling of pressure was relieved and CT showed reduction of multiple liver lesions and lymph node metastases, indicating partial response. No regrowth was seen for 7 courses of the therapy. Regarding toxicity, grade 2 nausea and grade 1 nail pain were observed. After 7 courses, because of serum CEA elevation, bi-weekly CPT-11/CDDP therapy (CPT-11 60 mg/m2, CDDP 30 mg/m2) was administered followed by weekly PTX therapy (65 mg/m2 day 1, 7, 14; total of 4 weeks). To date, 17 months after administration of chemotherapy, he has been treated on an outpatient basis. Biweekly DOC/S-1 therapy can be novel antitumor therapy which can be conducted safely in an outpatient setting for advanced gastric cancer.

Formaldehyde or formalin is indispensable not only as a preservative but also as a disinfectant of cadavers for gross anatomy. It has recently attracted a great deal of attention as a health hazard for students and lecturers. To reduce the concentration of formaldehyde gas (FAG), we improved a novel local ventilation system of the push-pull type. This is the first report dealing with the effects of this ventilation system on the health of students before (over 1 ppm) and after (0.1 ppm) the installation. The percentages of students with lacrymal symptoms or airway irritation were reduced to a third of what they were before the installation. In particular, the number of those with continuously strong symptoms was reduced to a sixth of the pre-installation levels. This local ventilation system draws in fresh air from outside, and directs it to the breathing zone of the students, effectively reducing their symptoms.