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Networking among regional hospitals recently became required for infection control activities in Japan. In Akita prefecture, we developed a microbiology data warehouse for networking hospital laboratories in 2010. Designated users can easily obtain microbiology data and compare it with other participating hospitals using this system. For example, users are able to compare the MRSA/MSSA ratio in Staphylococcus aureus with other participating hospitals in Akita-ReNICS. The effectiveness and assignment of this system were shown by a questionnaire administrated in 2013. In this paper, we clarify the current state and assignment of Akita-ReNICS and consider its effective application for better infection control activities.

The active involvement of hospital laboratory in surveillance is crucial to the success of nosocomial infection control. The recent dramatic increase of antimicrobial-resistant organisms and their spread into the community suggest that the infection control strategy of independent medical institutions is insufficient. To share the clinical data and surveillance in our local medical region, we developed a microbiology data warehouse for networking hospital laboratories in Akita prefecture. This system, named Akita-ReNICS, is an easy-to-use information management system designed to compare, track, and report the occurrence of antimicrobial-resistant organisms. Participating laboratories routinely transfer their coded and formatted microbiology data to ReNICS server located at Akita University Hospital from their health care system's clinical computer applications over the internet. We established the system to automate the statistical processes, so that the participants can access the server to monitor graphical data in the manner they prefer, using their own computer's browser. Furthermore, our system also provides the documents server, microbiology and antimicrobiotic database, and space for long-term storage of microbiological samples. Akita-ReNICS could be a next generation network for quality improvement of infection control.

PPARgamma is expressed in a variety of immunocompetent cells and has immunoregulatory activities. In line with the in vitro observations that PPARgamma agonists down-regulate inflammatory cytokines production and cellular responses, PPARgamma agonists have protective effects in a variety of mouse model of inflammatory disorders. In this review, we summarize the functional roles of PPARgamma in immunocompetent cells from the perspective of the pathophysiology of allergic diseases. The anti-allergic effects of PPARgamma agonist in vitro and in vivo indicate the possibility that PPARgamma agonists could be new therapeutic modality for allergic disease.

The nuclear receptor PPARgamma exerts a potent anti-inflammatory effects on immune cells and connective tissue cells. Accumulating evidences indicate that pathophysiological contribution of PPARgamma in allergic disease including asthma. Most recently, clinical efficacy and tolerability of PPARgamma agonists for asthma or atopic dermatitis have been reported. PPARgamma agonists seem to be new therapeutic drugs for allergic diseases, although further studies are required. Here we discuss the outlook for clinical significance of PPARgamma agonists for allergic diseases.

Objective: Infection control is essential for health care facilities. Aiming at improving the activity for infection control, increasing number of health care facilities has settled infection control team (ICT) in this decade. However, the quality of infection control activity has not been evaluated., Method: The quality of infection control was investigated in 49 hospitals and 55 welfare institutions for the aged in Akita prefecture using a questionnaire., Result: All the hospitals with more than 400 beds or more had ICT; however, less than 50% of the hospitals with 399 beds or less had ICT. The coverage of full-time specialist for infection control remained at a low level. Collection and analysis of information such as the prevalence of multi-drug resistant microorganisms and the consumption of antibiotics remained at a low level. More than 88% of the facilities hoped for a regional infection control network system to improve infection control activities. Reciprocal help in case of outbreak, education, lectures, sharing rules on infection control, making guidelines and teaching materials for infection control, analysis of infection control-related epidemiological data and getting suggestions and recommendations from authorized infection control specialists were included in the strongly required functions of the network.

Background: Eosinophils are major effector cells in the pathogenesis of allergic inflammation such as bronchial asthma, and eosinophil migration to sites of inflammation is an important step. To date, several approaches have been developed to study eosinophil chemotaxis. Among them, the Boyden chamber method has been widely used, although this system requires a relatively large number of cells, and it usually provides no longitudinal information. In this study, we investigated real-time eosinophil chemotaxis using EZ-TAXIScan, a novel horizontal microchannel device., Methods: Eosinophils were isolated from subjects with mild eosinophilia by modified CD16-negative selection. Eosinophil chemotaxis and migration speed induced by various chemoattractants including eotaxin, RANTES, PAF, and prostaglandin (PGD2) were measured by EZ-TAXIScan. We also determined the time course of chemotaxis using Boyden chambers., Result: By using EZ-TAXIScan, rapid (a few minutes after stimulation) and fast (20-30 microm/min) eosinophil chemotactic responses were observed by stimulation with PAF or PGD2, although eosinophils stimulated with eotaxin or RANTES showed relatively late (60 minutes after stimulation) and slow (15 microm/min) responses. In contrast, using a Boyden Chamber, the chemotactic responses we tested showed a similar time course peaking at 20-60 min., Conclusion: The availability of EZ-TAXIScan for investigation of eosinophil chemotaxis was confirmed. However, it should be noted that EZ-TAXIScan showed a different response to certain chemoattractants compared with the conventional method.

Arteriosclerosis and allergy are increasingly common diseases. The pathogeneses are both based on changes in lifestyle and chronic inflammation. Herein we discuss cross talk between the two seemingly unrelated diseases, focusing on obesity and various related molecules, including adipokines, peroxisome proliferator-activated receptors (PPARs), C reactive protein (CRP), and soluble adhesion molecules.

Recent automation in clinical laboratories affords healthcare providers with numerous options in terms of physiological tests. However, the role of the clinical laboratory in the field of equilibrium functional tests is not clearly defined. Therefore, we conducted a questionnaire survey to define the role of clinical laboratories in general hospitals. We present the results of our investigation and the approach employed by the clinical laboratory of our hospital. Rates of healthcare providers desiring the conduct of equilibrium functional tests by clinical laboratories were 78% and 70% in otolaryngology and neurosurgery departments, respectively; moreover, 92% of technologists from clinical laboratories responded that an equilibrium functional test can be performed upon request. Furthermore, 84% of clinical laboratory staff members and 77% of staff from neurosurgery departments agreed that implementation of a system allowing each department to request equilibrium functional tests from the clinical laboratories is necessary. This finding was indicative of the high demand for equilibrium functional tests by clinical laboratories. Therefore, equilibrium functional tests offered by clinical laboratories not only reduce the workload of the otolaryngology department, but also result in a major contribution with respect to management of the entire hospital in terms of high quality examination findings and allocation of healthcare providers in other departments.

Infection Control Committee (ICC) of Akita University Hospital was established in 1980's, when methicillin-resistant Staphylococcus aureus (MRSA) spread in teaching hospitals in Japan. After 20 years from the establishment of ICC, we needed to shake up some of the outdated infection control systems. Infection Control Team (ICT) was established in 2002 to reinforce ICC. ICT was consisted of five infection control doctors (ICD), two infection control nurses (ICN), two medical technicians in bacteriological division of clinical laboratory, one pharmacist and three administrative officials in the hospital. Monitoring of multiple drug-resistant pathogens, antibiotic use, surgical site infections and bloodstream infections are mandatory. Personnel training and educational activity are also required. After the establishment of ICT, inappropriate use of antibiotics and prevalence of MRSA were dramatically decreased. The hospital saved more than 30,000,000 yen annually. However, with a great regret, we experienced an outbreak of MRSA in a department of our hospital in 2003. MRSA infection was judged as a cause of death in three patients in the outbreak. MRSA was thought to transmit via medical personnel since pulsed-field gel electrophoresis revealed common genotype in 11 out of 15 patients studied. Prevention of healthcare-associated infections is a crucial in the management of hospitals. In this paper, we verified the efforts to control the outbreak and analyzed factors interfering infection control activities. A crucial role of a clinical laboratory in controlling healthcare associated infections was also discussed.

Medical costs associated with hospital-acquired infection is a critical problem for hospital management. The introduction of the Diagnosis Procedure Combination (DPC) system requires the re-evaluation of the cost-effectiveness of any medical procedure including the usage of antibiotics. Achieving high cost-effectiveness and quality of medical service are essential for hospitals to survive the current changes in medical systems. Inappropriate use of antimicrobial agents results in unnecessary exposure to medication, persistent or progressive infection, emergence of resistance, and increased costs. We undertook an observational pre and post-intervention study to assess whether a comprehensive antimicrobial management program developed by the new ICT installed 2002 in Akita University Hospital could reduce the use of antibiotics. Annual total amounts of antibiotics and anti-MRSA antibiotics, and the number of patients undergoing long-term treatment with antibiotics, fell dramatically. This ICT approach thus reduced antibiotic costs, contributed to infection control, and improved the quality of antibiotic prescription.

Technological advances in molecular biology, as well as in genetic engineering, have created a revolutionary movement in both clinical and diagnostic methodologies. With progress in human genome analysis, the genes responsible for various diseases have been analyzed at a rapid pace. Research involving respiratory disease is no exception. Emphasis in this area has shifted from respiratory physiology to molecular biology. One example is cystic fibrosis(CF). However, CF is relatively rare in Japan. Furthermore, the search for universal genes that trigger bronchial asthma has not been successful. Genetic testing for respiratory disease has not been conducted as a component of general, routine clinical tests in Japan, due to the aforementioned reasons. Therefore, I would like to take this opportunity to introduce genetic respiratory diseases, the present state of genetic testing and prospects for the future.