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Subclavian artery aneurysm is usually rare. We report a case of a right subclavian artery aneurysm with infective endocarditis. A 36-year-old woman was admitted at our hospital due to a cerebral embolism. The echocardiogram showed severe mitral regurgitation with vegetation, and computed tomography (CT) revealed an intrathoracic right subclavian artery aneurysm. The 59×39 mm-sized mass was located distal to the vertebral artery. Mitral valvuloplasty, tricuspid annuloplasty, and aneurysm surgery with extra-anatomical bypass were performed simultaneously. The aneurysm was resected through a median sternotomy and right supraclavicular and subclavicular incisions. Revascularization with transthoracic aorto-axillary extra-anatomical bypass was also performed. The postoperative course was uneventful with no noted complications.

Objectives: Recently, occupational health specialists (OHS) are expected to exert leadership to develop high-quality occupational health activities. This study aimed to develop and investigate the reliability and validity of a scale to measure leadership preparation among OHS (The University of Tokyo Occupational Mental Health [TOMH] Leadership Checklist; TLC)., Methods: Based on literature reviews and interviews among OHS, we created potential items consisting of 54 items with six factors (10 items for self-awareness, 10 items for situational awareness, 9 items for vision, 12 items for mindset, 3 items for performance of one's duties, and 10 items for relationship-building). An online survey was conducted with 300 OHS in Japan to verify the scale's reliability and validity., Results: Consequent to the exploratory factor analysis, using the principal factor method and promax rotation, 51 items across the following five factors were identified; "self-awareness", "situational awareness", "vision", "mindset", and "performance of one's duties". The confirmatory factor analysis showed good fit indices; CFI = 0.877, SRMR = 0.050, and RMSEA = 0.072. Cronbach's α ranged from 0.93-0.96. Additionally, the scores of the TLC were significantly positively correlated with work engagement, job satisfaction, and self-efficacy; contrastingly, they were significantly negatively correlated with psychological distress (p < .05). Furthermore, the participants who had experience leadership without authority indicated significantly higher scores of the TLC and its subscales than those who did not (p < .001)., Discussion and Conclusions: The newly developed TLC appeared to have acceptable levels of reliability and validity. It would be beneficial for OHS to show good leadership.

Purpose: Postoperative atrial fibrillation (POAF) after open heart surgery is common complication. POAF is reported to prolong hospital stay and increase long-term mortality, therefore prevention of POAF is important. It is widely known that beta blocker decrease POAF, and we had used oral beta blocker after open heart surgery. We examined the effect of intraoperative and postoperative administration of intravenous beta blocker( landiolol) for POAF., Method: We evaluated 291 consecutive patients who underwent open heart surgery from November 2016 to November 2018. Those who underwent open heart surgery after November 2017 were 145, and 100 of the patients( group A) had intraoperative and postoperative landiolol administration. Those who underwent open heart surgery before November 2017 were 146, and 100 of the patients (group B) did not have landiolol administration. The primary endpoint was incidence of POAF within 7 days after surgery., Result: There was no significant difference in preoperative character between the groups, other than the ratio of males to females( group A:54 males, 46 females;group B:68 males, 32 females;p<0.05). The incidences of POAF were 20% and 36% in group A and group B, respectively( p<0.05)., Conclusion: Intraoperative and postoperative administration of landiolol is effective for preventing POAF after open heart surgery.

Reactivity to an anisakis allergen component was examined in three patients with a history of an anisakiasis anaphylaxis. Case 1, a 38-year-old man, allergic symptoms appeared 0.5 hours after ingestion, and the component Ani s 1 and 3 were positive. Case 2, a 44-year-old woman, allergic symptoms appeared 4 hours after ingestion, and components Ani s 3 and 12 were positive. Case 3, a 36-year-old woman, developed allergic symptoms 7 hours after ingestion of fish and shellfish, and tested positive for Ani s 1, 4, and 12. Case 3 reacted strongly to both heated and unheated Anisakis extract, while cases 1 and 2 reacted weakly to heated Anisakis extract. The most common allergen was Ani s 12, followed by Ani s 1, when analyzed in conjunction with existing reports on 10 cases. Anisakis IgE was class 3 or higher in all cases. Analysis of 13 cases showed 2 cases sensitized to Ani s 4 and moderate or higher anaphylaxis, while Ani s 4-sensitized patients were reported to be more likely to develop severe disease. It is possible that the patients sensitized to Ani s 4 need to be careful about the severity of their allergic symptoms.

An inter-laboratory study involving 24 laboratories was conducted to validate the modified analytical method for the migration solution of heptane for the determination of bisphenol A migrating from polycarbonate food processing materials. In this study, two concentrations of samples were blindly coded. Each laboratory determined the analyte (bisphenol A, phenol and p-tert-butylphenol) concentration in each sample according to the established protocol. The obtained values were analyzed statistically using internationally accepted guidelines. Horwitz ratios were calculated based on the reproducibility relative standard deviation (RSD R ), which was estimated from the inter-laboratory study, and predicted RSD R , which was calculated using the Horwitz/Thompson equation. Horwitz ratios of the two samples ranged from 0.15 to 0.37 for the three compounds, meeting the performance criteria of less than 2 set by the Codex Alimentarius for analytical method approval. These results showed that this modified analytical method shows good performance as an analytical method for the migration solution of heptane.

The patient was a woman in her 90s. Right radical nephrectomy for right renal cell carcinoma had been performed 2 years and 6 months ago. Since then, there had been no recurrence. However, computed tomography during postoperative follow- up period showed a 3 cm mass in the right breast, and the patient was referred to our department. Breast ultrasonography indicated a well-circumscribed, oval, and almost smooth-surfaced tumor, 27 mm in size, located in the D region of the right breast. Results of a core needle biopsy showed metastatic renal cell carcinoma and clear cell carcinoma. Preoperative examination confirmed intramammary metastases of renal cell carcinoma. Given that the patient did not experience systemic metastases, partial mastectomy of the right breast was performed. Metastatic renal cell carcinoma is associated with poor prognosis. Generally, standard treatment in this disease is chemotherapy. However, surgical resection is selected with the aim of improving the prognosis and achieving radical cure of patients with this complication if these patients are in an oligometastatic state and complete resection of metastatic lesions is feasible, as in the present case. To achieve radical cure, the patient underwent partial mastectomy under local anesthesia, which is a relatively minimally invasive surgery.

Three patients with multiple system atrophy (MSA) who have been hospitalized for aspiration pneumonia underwent aspiration prevention surgery. Laryngeal closure was performed in 2 cases, and laryngotracheal separation was performed in 1 case. Two patients were able to continue oral intake. No recurrence of aspiration pneumonia was observed in all cases after the operation for about two years, and the reduction in the number of aspirations at night improved the patient's QOL and reduced the burden on the caregiver. It was considered that the appropriate time for surgery was when communication in vocal language became difficult. It was a time when the loss of vocal function was well accepted in 3 cases. Aspiration prevention surgery may be a useful treatment option because it may contribute to prolonging the prognosis of life by reducing the complications of respiratory infections.

Purpose: We retrospectively evaluated the visualization of pediatric coronary computed tomography angiography (CCTA) images by using the 64-detector row CT scanner between the electrocardiogram-gated helical scan and non-electrocardiogram-gated helical scan., Methods: From January 2015 to March 2019, 100 children who underwent CT angiography examination were retrospectively enrolled. Group A consisted of 50 patients with electrocardiogram-gated helical scan. Group B consisted of 50 patients with non-electrocardiogram-gated helical scan. All patients were scanned using a 64-detector row CT scanner (LightSpeed VCT), and helical scans were acquired. The CT scanning parameters were 0.4-s rotation, 0.625-mm slice thickness, 0.24 (group A) helical pitch (beam pitch), 1.375 (group B) helical pitch (beam pitch), 80 kVp, and 50-300 mA (noise index 40). A retrospective method was used for electrocardiogram gated. To compare the radiation dose, CT volume dose index (CTDI vol ) and dose length product (DLP) displayed on the console were recorded. The visualization scores of the coronary artery images were compared between each group., Results: In group A, CTDI vol and DLP values were 6.74 (1.05-11.97) mGy and 79.87 (15.90-146.65) mGy·cm, respectively. In group B, CTDI vol and DLP values were 0.51 (0.39-0.95) mGy and 8.15 (6.30-17.50) mGy·cm, respectively. There were significant differences in CTDI vol and DLP values between both groups (p<0.05). The visualization rates for the proximal and distal coronary arteries were 88% and 54% for the right coronary artery, 84% and 58% for the left anterior descending artery, and 66% and 30% for the left circumflex branch in group A, respectively. The visualization rates for the proximal and distal coronary arteries were 52% and 0% for the right coronary artery, 56% and 0% for the left anterior descending artery, and 32% and 0% for the left circumflex branch in group B., Conclusion: In 64-row multidetector computed tomography (MDCT), the visualization rates for the proximal and distal coronary arteries were significantly higher in the electrocardiogram-gated scan, but the exposure dose was several times higher in the pediatric CCTA. For accurate diagnosis in pediatric coronary arteries, electrocardiogram-gated helical scan should be performed.

Coronary artery aneurysm with fistula is a relatively rare disease. After surgery, residual coronary fistula is often a problem. To prevent these problems, we perform coronary angiography during surgery, and have good grades. A 70-year-old-woman was admitted to our hospital with a chief complaint of palpitations. Enhanced computed tomography (CT) showed coronary aneurysms. Coronary angiography confirmed the coronary artery aneurysms with fistula to the pulmonary artery. Surgical intervention in the hybrid operating room was performed through median sternotomy with cardiopulmonary bypass. The fistulae were ligated, and the aneurysms were resected. Finally, coronary angiography was performed to confirm that there were no residual shunt aneurysm, or damage to the normal coronary artery, and the operation was completed. Postoperative course was uneventful, and she was discharged on postoperative day 19. Performing coronary angiography during surgery is very useful to confirm the aneurysms are completely closed, coronary artery fistulae are treated, and the coronary arteries are undamaged.

A woman in her 60s was referred to the Department of Gastroenterology with anemia. She had a recurrent transient loss of consciousness 11 years ago, and she was examinated at the cardiology and neurology departments, but the cause was not identified. Epileptic seizures were suspected. Sodium valproate medication was started, and the patient's condition progressed with no recurrence. Esophagogastroduodenoscopy showed a tiny submucosal tumor-like lesion with mild depression in a 21cm thoracic esophagus. Biopsy revealed epithelioid granulomas with multinucleated giant cells in the subepithelial stroma. Computed tomography (CT), positron emission tomography-computed tomography (PET-CT), and magnetic resonance imaging (MRI) showed multiple lesions in the hilar lymph nodes, spleen, and heart that are typical of sarcoidosis. These findings led to the diagnosis of esophageal lesion associated with sarcoidosis. The patient had no subjective symptoms;however, treatment with prednisolone 30mg was started because cardiac sarcoidosis is a risk of death. Gastrointestinal tract involvement in sarcoidosis is rare;esophageal sarcoidosis is particularly rare, and there are few reports on superficial lesions. Here, we report a case of sarcoidosis that was diagnosed from a tiny esophageal lesion.

A 56-year-old woman complaining of right lower abdominal pain was admitted to our hospital. An abdominal computed tomography showed the enlarged appendix tip and a high density area around the appendix to retroperitoneum. The patient was diagnosis with acute appendicitis and underwent emergency laparoscopic appendectomy. Histopathological findings of the resected specimens revealed a component with signet ring cell carcinoma morphology that was positive for neuroendocrine markers by immunohistochemical staining, which led to the diagnosis of goblet cell carcinoid(GCC)of appendix. GCC cells were found to infiltrate the surrounding serosa and Ly positive. An additional laparoscopic ileocecal resection with D3 dissection was performed. In the appendix GCC, additional resection is considered because the lymph node metastasis rate increases(SS/13%)as the depth of wall progresses. Appendiceal tumors including GCC may develop acute appendicitis and may be followed by additional resection. Therefore, it is important to consider how to deal with the first surgery.

Objectives　Few studies have focused on the relationship between smoking habits and occupation in Japan. This study aimed to examine the changes in smoking prevalence by occupation, specifically those occupations defined in the Japan Standard Occupational Classification (JSOC).Methods　We analyzed data from the Comprehensive Survey of Living Conditions, a large nationally representative survey conducted in Japan every three years, between 2001 and 2016. Survey participants were asked whether they (1) "never smoked," (2) "smoked daily," (3) "smoked occasionally but not every day," or (4) "used to smoke daily (before, at least one month)." Participants who answered (2) "smoked daily" or (3) "smoked occasionally but not every day" were considered "current smokers." Age-standardized smoking prevalence was computed based on the JSOC (10 categories: administrative and managerial; professional; clerical; sales; services; security; agriculture, forestry, and fishing; transport; manufacturing, construction, mining, carrying, cleaning, and packaging; and unemployment). The analyses were restricted to workers and unemployed men and women aged 25 to 64 years old.Results　Between 2001 and 2016, the smoking prevalence (of the entire population aged 25 to 64 years old) decreased from 56.0% (95% confidence interval [95% CI]: 55.8-56.3%) to 38.4% (95% CI: 38.1-38.6%) among men, and from 17.0% (95% CI 16.8-17.2%) to 13.0% (95% CI 12.8-13.1%) among women. In 2016, the smoking prevalence for clerical (the lowest smoking prevalence) and transport workers (the highest smoking prevalence) was 27.9% (95% CI: 27.0-28.8%) and 48.3% (95% CI: 46.8-49.7%), respectively, for men, and 9.4% (95% CI: 9.0-9.7%), and 38.5% (95% CI: 32.6-44.5%), respectively, for women. Between 2001 and 2016, the smoking prevalence for men decreased for all occupations, whereas for women, the smoking prevalence decreased for all occupations except for security and for transport workers. The largest reduction rate of smoking prevalence between 2001 and 2016 for men and for women was observed in clerical workers (-21.0%) and sales workers (-7.2%), respectively. We also found that clerical workers had the lowest smoking prevalence across the 5-year age categories for both sexes, especially the younger age, which resulted in the largest differences in smoking prevalence by occupation among men aged 30 to 34 years old.Conclusion　We confirmed that, between 2001 and 2016, the lowest and highest smoking prevalence for both sexes is found among clerical workers and among transport workers, respectively. Although smoking prevalence has declined among working-aged men and women between 2001 and 2016, large differences by occupations consistently exist in Japan. It is necessary to take measures against smoking habits in consideration of their social backgrounds and work environments.

Background: Acute massive pulmonary embolism is a life-threatening disease and the reported rate of mortality is 52%.It is often treated with anticoagulation therapy or thrombolysis, but in case of critically ill patients with shock or cardiac arrest, its effect is limited. Surgical embolectomy is a treatment option for patients with hemodynamic instability. We studied the outcomes of our patients who underwent on-pump beating pulmonary embolectomy for acute pulmonary embolism., Method: We evaluated eight consecutive patients who underwent on-pump beating pulmonary embolectomy for acute pulmonary embolism since May 2012 to September 2016. Our surgical indications were hemodynamic instability, but one patient underwent pulmonary embolectomy without hemodynamic instability because the patient had floating thrombus in the right heart. Three patients experienced cardiac arrest, and two patients were treated with extracorporeal membrane oxygenation (ECMO). Four patients were treated with thrombolysis before surgical embolectomy., Result: All patients underwent on-pump beating pulmonary embolectomy. One patient could not be weaned from cardiopulmonary bypass, and was treated with ECMO after pulmonary embolectomy. The patient died due to low output syndrome, while the other seven patients were rescued. One patient had gastrointestinal bleeding after surgery, but the other patients had developed no major complication including thrombosis, hemorrhage, and prolonged respiratory failure during follow-up of 11.4±16.1 months., Conclusion: Pulmonary embolectomy is effective treatment for acute massive pulmonary embolism. On-pump beating pulmonary embolectomy is useful surgical procedure. Acute pulmonary embolism is often treated with anticoagulation therapy or thrombolysis, but in critically ill patients, surgical pulmonary embolectomy should be considered.

Objectives: In Japan, the population is aging and there is a declining birth rate. It is an important occupational health issue to support the balance between illness treatment (including nursing care, childcare, etc.) and work. Many patients require mental and financial support to help them with their work-treatment balance. In 2016, the Ministry of Health, Labor and Welfare provided guidelines for supporting employee's work-treatment balance, and in 2018, "Consulting Fee" was approved as an insured medical treatment when clinic doctors supported their patients for continuing to work. The request for the consulting fee requires that the clinician and the occupational physician exchange information on the support necessary for the patient to continue working. Generally, occupational physicians obtain medical information from clinicians to give advice on a worker's employment considerations. However, we do not know what kind of workplace information clinicians hope to know when treating their patients. Therefore, we conducted this survey to clarify how occupational physicians could provide useful information to clinicians., Methods: We asked approximately 1,500 occupational physicians from the Occupational Health Subcommittee of the Japan Society for Occupational Health to provide us with a letter sent to their clinician to assist workers. From the collected letters, the structural parts of the letters (titles, greetings, acknowledgments, etc.) were removed. We defined a section as a contextual unit that does not impair the meaning. The prepared sections underwent qualitative inductive analysis using the content analysis method of "Berelson, B.", Results: A total of 103 cases and 178 documents from 42 people were included in the analysis. Extracting descriptions that could be interpreted as providing information, including descriptions related to treatment, employment, and living environment, and opinions and suggestions from occupational physicians resulted in 596 sections. As a result of the qualitative and inductive classification, the information was classified into three large categories that consisted of information provision, opinions of occupational physicians, and information handling, five middle and eighteen small classifications. In addition, some good practices that were considered significant to clinicians were illustrated., Conclusions: We analyzed and categorized the information present in the letters sent by occupational physicians to clinicians. The letter does not need to contain all the information in the category table. However, it is important that it should have the necessary and sufficient information considering the case in question. We believe that this category table will aid occupational physicians in writing letters to clinicians.

Purpose: Foreign bodies such as a surgical gauze can be retained in the body after surgery and in some cases cannot be detected by postoperative radiography. The aim of this study was to develop an object detection model capable of postsurgical detection of retained gauze in the body. The object detection model used deep learning using abdominal radiographs, and a phantom study was performed to evaluate the ability of the model to automatically detect retained surgical gauze., Materials and Methods: The object detection model was constructed using a Single Shot MultiBox Detector (SSD) 300. In total, 268 abdominal phantom images were used: 180 gauze images were used as training data, 20 gauze images were used as validation data, and an additional 34 gauze images and 34 nongauze images were used as test data. To evaluate the performance of the object detection model, a confusion matrix was created and the accuracy and sensitivity were calculated., Result: True-positive (TP) rate, true-negative (TN) rate, false-positive (FP) rate, and false-negative (FN) rate were 0.92, 1.00, 0.00, and 0.08, respectively. Accuracy was 0.96, and sensitivity was 0.92., Conclusion: The object detection model could detect surgical gauze on abdominal phantom images with a high accuracy and sensitivity.

Pharmacists began preparing drug solutions intraoperatively for postoperative analgesia in the Department of Surgery at Chiba University Hospital from May 2014. To verify the usefulness of pharmacists preparing these drug solutions, we conducted a questionnaire survey among 51 anesthesiologists and received 44 responses (recovery rate 86.3%). Burden on the anesthesiologists was significantly reduced both temporally and mentally when the pharmacists prepared the drug solutions compared with when the anesthesiologists did (p<0.01). The anesthesiologists' degree of anxiety about sometimes having to prepare drug solutions alone without any confirmation was also significantly reduced when pharmacists prepared them (p<0.01), which implies the need for a double-check system. In addition, 88.6% of anesthesiologists said that they were reassured with preparations done by the pharmacists under a sterile environment using a clean bench. Overall, 88.6% of anesthesiologists responded that they were satisfied with the preparation of drug solutions by pharmacists. Based on the results of this survey, pharmacists' preparation of drug solutions for postoperative analgesia is considered to be useful in ensuring the quality and safety of medical care because it reduced anesthesiologists' work to prepare the drug solutions, allowing them to concentrate on anesthesia and related work, it established a double-check system between the two staff teams, and it was done under a sterile environment.

In 2010, the in-hospital practical training period for pharmacy students was extended from 4 to 11 weeks. We have conducted questionnaire surveys of these students every year with the aim of reviewing the quality of training by conduction of surveys and evaluations. However, it was not clear whether reviewing based on the questionnaire results improved student satisfaction with the in-hospital practical training. Therefore, the aim of this study was to verify the validity of reviewing based on the questionnaire results by analyzing the data accumulated during the long-term practical training. A questionnaire survey was conducted of 333 5th-year students upon completion of practical training at Chiba University Hospital from 2010 to 2017. Students self-evaluated their attitude toward practical training on a 6-point scale and their satisfaction level for each component of the practical training on a 5-point scale. The students were also allowed to share their feelings about hospital pharmacy work. Repeated review of the training content can facilitate communication with patients, which was lacking at the beginning of the training period. Improved communication led to higher-quality pharmacy practice and increased student satisfaction. Meanwhile, changes to work procedures may reduce student satisfaction unless the training strategy is reviewed accordingly. Because the work of hospital pharmacists is constantly changing, it is considered that the content of the practical training should be revised accordingly through continuous conduction of surveys and evaluations, thereby enabling optimal practical training.

Meningioma and glioma represent two common primary intracranial tumors. However, the coexistence of these two lesions in the same patient at the same location is rare. Here, we present a case of a fibroblastic meningioma with a secondary glioblastoma occurring at the same location. A 67-year-old woman underwent surgery for a left frontal parasagittal meningioma, and the tumor was subtotally removed. Two years and 11 months after the surgery, the patient had a tumor at the same location with invasion into the adjacent brain, suggesting recurrent meningioma with malignant transformation. The resected tumor was confirmed histopathologically as a glioblastoma. Genetic analysis revealed that the isocitrate dehydrogenase 1 and 2 genes were wild type, and the TERT promoter mutation was detected. The gene analysis suggests that the tumor was a de novo glioblastoma, not a secondary glioblastoma from a lower-grade glioma. (Received April 9, 2020; Accepted May 27, 2020; Published October 1, 2020).

Objectives: This study aimed to consider the appropriate occupational health system for Japanese enterprises in the Philippines based on information on the regulations and development of specialists., Methods: We collected information using an information-gathering checklist. Along with literature and internet surveys, we conducted interviews by visiting local business sites, central government agencies in charge of medical and health issues, and educational institutions with specialized occupational physician training curricula., Results: Occupational health administration in the Philippines is managed by the Department of Labor and Employment, which issues the Occupational Safety and Health Standards that specify the legal requirements for occupational health. A new law(Republic Act 11058),enacted in 2018 to strengthen the Occupational Safety and Health Standards, has newly established a penalty provision in case of violations. Professional personnel responsible for occupational health are grouped as safety officers and occupational health personnel, including occupational physicians and occupational nurses; training is conducted at the Occupational Safety and Health Center of the Department of Labor and Employment and educational institutions. The basic medical insurance system and the workers' compensation system are operated by the Philippine Health Insurance Corporation and Social Security Committee, respectively, both of which are government agencies., Conclusions: We confirmed that occupational health activities in the Philippines are based on government regulations, namely, the Occupational Safety and Health Standards. In addition, the enactment of a new law calls for strict compliance with corporate occupational health activities. To manage proper occupational health activities at overseas workplaces, Japanese corporations should clarify corporate-wide policies and support local employers in complying with regulations and utilizing highly specialized personnel.

Objectives: This study aimed to collect and assess information about occupational health in India, for Japanese enterprises., Methods: We conducted a preliminary survey through literature reviews and internet search engines. We then conducted interview-based surveys at a central government agency, an international organization, the Japanese embassy, educational and research institutions, and Japanese enterprises in India. This information was categorized into: (1) organizations, legal and inspection systems in occupational health, (2) occupational health management and specialists in workplaces, (3) occupational health-related activities in workplaces resulting from legal obligations, and (4) healthcare and workers' compensation systems., Results: The Indian Ministry of Labour and Employment is primarily responsible for occupational safety and health. There are four main acts of legislation covering occupational safety and health in the factories, ports, mines, and construction sites. The Factories Act, 1948, mandates the establishment of an occupational health center and a safety committee in the factories; the appointment of factory medical officers and safety officers. These medical officers must possess an Indian medical degree, and undertake a three months' course to obtain an Associate Fellow of Industrial Health certificate. The rules and regulations under this act differ in each Indian state. Low-wage workers are registered with a medical insurance scheme. Most workers are covered by workers' compensation schemes, although the number of reported occupational injuries are low., Conclusions: Japanese enterprises should consider the local conditions of occupational health in India because of the different legalities and occupational health status in each state. Regardless of the Factories Act, 1948, stipulating a variety of occupational health-related activities, inadequate legal compliance is suspected to be common because of the ineffective labor inspection requirements and a shortage of specialists on human resources. The study also revealed a deficient social security system. Therefore, the internal educational support for specialists, external support from the company headquarters in Japan, and the local institutions in India; and the systemic support for effective occupational health-related activities are required for improving the status of occupational health in the factories in India.

Objectives: To investigate the systems and actual practices of occupational safety and health risk management in China., Methods: First, we gathered basic information through a literature review using an academic search engine (Japan Medical Abstracts society, Pubmed, and Google Scholar), as well as a general search on the Internet. Next, we conducted field surveys at a graduate school for public health, providers of occupational health services (e.g. medical examinations, working environment measurements), and local workplaces of a Japanese construction machinery company in China. This information was analyzed in terms of legal framework, professional staff, working environment measurements, medical examinations, occupational diseases, and occupational health service providers., Results: Health and safety-related matters have become codified in Chinese workplaces as a result of safety laws and measures to prevent occupational diseases. While the country does have safety and hygiene officers, they lack official frameworks for occupational physicians and nursing professionals. The employers are not obligated to appoint medical professionals. While general medical examinations are not provided for under Chinese law, businesses are obligated to bring in external providers of occupational safety to perform special medical exams and working environment measurements. Occupational diseases are on the rise; pneumoconiosis comprises roughly 80% of cases. In addition, occupational health technical service providers have specialized staff and are not permitted to perform medical examinations or other services without government accreditation., Discussion/conclusion: There are great disparities in specialist knowledge about health and hygiene between company staff and external organizations, thus running the risk of corporate health and safety policies existing only on paper. This issue demands greater utilization of public health physicians in Chinese workplaces and support from Japanese professionals who understand how occupational safety and health risk management operate in China.

A 73-year-old man was admitted with the chief complaint of upper abdominal discomfort.After close examination, he was diagnosed with a huge stomach gastrointestinal stromal tumor(GIST)that occupied the upper left abdomen with a maximum diameter of 150 mm.The patient was referred to our department for surgery.The border between the tumor and spleen was unclear on CT images.As the diaphragm was thinned due to compression by the tumor, gastrectomy with splenectomy and partial resection of the diaphragm was planned.For the diaphragmatic defects, a simple closure was considered at first. However, artifacts have a high risk of infection when the defect holes are too large.Therefore, in this case, we attempted to repair the diaphragm hole with the autologous fascia lata.Intraoperatively, while the tumor was resected with 1 more layer of the diaphragm, the diaphragm itself was thinned, resulting in a defect hole of about 60×80 mm.Therefore, an 80×110mm fascia lata was harvested, and the diaphragm was repaired.Fascia lata can be conveniently harvested as a free graft.In addition, the fascia of the thigh has the advantage of being more resistant to infection than artificial materials.In addition, there was no functional failure due to collection, and special plastic surgery techniques and tools were unnecessary.Thus, it is a useful reconstruction material for general surgeons.Here we report the details of the surgery along with a review of the literature.

A 28-year-old man was transferred to our emergency room for dyspnea and wheals on the entire body. He had eaten landlocked ayu fish (Plecoglossus altivelis) the so-called "koayu fish", from Lake Biwa, and had immediately experienced a stomachache. Wheals and dyspnea developed one hour later and were successfully treated with intravenous corticosteroids. The patient was examined for koayu fish and related allergens by skin prick and allergen-specific immunoglobulin E (IgE) (ImmunoCAP ® ) tests. Positive skin prick results were obtained for Lake Biwa koayu fish (raw and heated) as well as for standard skin test allergens (prepared by Torii pharmaceuticals) including shrimp, crab, and squid. Negative prick test results were observed for regular ayu fish and other fish such as horse mackerel, sardine, salmon, mackerel, codfish, and tuna. Allergen-specific IgE tests (ImmunoCAP ® ) showed positivity for shrimp, crab, ticks, moths, and mosquitoes, while ImmunoCAP ® tests were negative for the allergen components rGad c 1 (pollackparvalbumin) and rPen a 1 (shrimp tropomyosin). Moreover, enzyme-linked immunosorbent assay (ELISA) tests were negative for mackerel parvalbumin and collagen. We considered this case to be of anaphylaxis caused by koayu fish from Lake Biwa and speculated that a novel koayu-specific antigen might have been the cause of the condition.

In this study, we evaluated the efficiency of fly ash (FA) recycling technology, produced from a coal-fired power plant, with the capability to adsorb cesium ion[Cs(I)] and strontium ion [Sr(II)] from aqueous phase. Zeolite was produced from FA by hydrothermal treatment in an alkaline solution. Zeolite 12, 24, and 48 have a Garronite structure. Moreover, the specific surface area of Zeolite was greater than that of FA. Zeolite 12 demonstrated the adsorption capability of Cs(I) and Sr(II) from aqueous phase. Adsorption isotherms data fitted both the Langmuir equation (correlation coefficient: >0.895) and the Freundlich equation (correlation coefficient: >0.881). In addition, the kinetic data fitted the pseudo-second-order model when compared to the pseudo-first-order model. Cs(I) and Sr(II) were selectively adsorbed by Zeolite 12 in complex solution system. Our findings indicate that Zeolite can be produced from FA by hydrothermal treatment in an alkaline solution and shows the capability to adsorb Cs(I) and Sr(II) from aqueous phase. Therefore, Zeolite can be useful adsorbent for purification in water environments.

Purpose: To compare the contrast enhancement between bolus-tracking (BT) and test-bolus (TB) methods in coronary computed tomography angiography (CCTA)., Method: We enrolled 300 patients who underwent CCTA by BT (245 mg I/kg main bolus) or TB (77.4 mg I/kg test bolus with 245 mg I/kg main bolus) methods. In group BT (n=150), scanning was started automatically 5-second after contrast enhancement exceeded a predefined threshold of 150 Hounsfield units (HU). In group TB (n=150), TB peak attenuation plus 2-second was used as a delay. We recorded the CT number in the ascending aorta and determined whether the CT number was equivalent in two groups. For the equivalence test, we adopted 70 HU as the equivalence margin. The standard deviation (SD) in the CT number and the rate of patients with an acceptable CT number were compared. We also compared total iodine dose and total dose length product (DLP)., Result: The CT number of the ascending aorta was 437.6±68.9 HU in group BT and 438.9±69.7 HU in group TB; the 95% confidence interval for the difference between the groups was from -11.6 to 20.2 HU and within the range of the equivalence margins. The SD of the CT number and the rate of patients with acceptable CT number did not differ significantly between the two groups (p=0.857 and p=0.614, respectively). Total iodine dose in group TB was significantly higher than in group BT (p<0.001), and total DLP was not statistically significant (p=0.197)., Conclusion: The contrast enhancement between BT and TB methods in CCTA was equivalent, and the distribution was not significantly different between the two groups.

Purpose: To compare the radiation dose and image quality using the conventional method for performing the front and side scout view and a new method for performing the side scout view, and then correct the table height at the scan isocenter and perform the front scout view., Methods: We retrospectively analyzed fifty-six children who had underwent computed tomography (CT) examination between June 2014 and August 2018. We divided them into two groups. The conventional method was performed in 3 steps: 1. obtain the front scout view, 2. obtain the side scout view, and 3. main scan. Without table position correction, the new method was performed in 4 steps: 1. obtain the side scout view with table position correction, 2. patient correction at the scan isocenter, 3. obtain the front scout view, and 4. main scan. We used a 64-row CT scanner (LightSpeed VCT; GE Healthcare). Scan parameters were tube voltage 80 kV, automatic tube current modulation, noise index 16, slice thickness 5 mm, rotation time 0.4 s/rot, helical pitch 1.375, and reconstruction kernel standard. We recorded the volume dose index (CTDI vol ) and dose length product (DLP) on the CT console and compared the radiation dose in both groups. To evaluate the image quality in both groups, the mean standard deviation of CT number (SD value) was measured within an approximately 5-10 mm 2  circular region of interest. We measured the scan length of the pediatric patient and accuracy of pediatric positioning at the CT examination. A grid was displayed on the CT axial image, taken to evaluate the error from the scan isocenter during alignment, and the error between the height of half the body thickness and the scan isocenter was recorded., Results: Scan lengths were median (minimum-maximum) values of 16.2 cm (10.8-21.5 cm) and 16.8 cm (11.5-23.0 cm). There were no significant differences in the scan length between both groups (p=0.47). In the group with table position correction, median (minimum-maximum) values for CTDI vol , DLP and SD value were 0.40 mGy (0.3-0.7 mGy), 7.6 mGy･cm (4.4-11.5 mGy･cm), and 24.0 HU (18.3-37.5 HU), respectively. In the group without the table position correction, median (minimum-maximum) values for CTDI vol , DLP and SD value were 0.40 mGy (0.3-0.6 mGy), 7.1 mGy･cm (4.2-13.8 mGy･cm), and 20.3 HU (11.3-28.8 HU), respectively. There were no significant differences in the CTDI vol  and DLP values between both groups (p=0.42 and p=0.44, respectively); however, there were significant differences in the SD value in both groups (p<0.01). The error for the accuracy of pediatric positioning was 0 mm (0 to 0 mm) and 10 mm (-16 to+59 mm) using the conventional and new methods (p<0.01), respectively., Conclusions: It was suggested that the optimum image could be obtained during CT scan with automatic tube current modulation by using this potential new method (1. obtain the side scout view, 2. patient correction at the scan isocenter, 3. obtain the side scout view, and 4. main scan).

The patient was a 65-year-old man who developed dyspnea after 6 courses of S-1 and oxaliplatin(SOX)chemotherapy for advanced stomach cancer. The chemotherapy regimen consisted of SOX chemotherapy. The patient developed hypoxemia, and chest radiography revealed ground-glass opacity in both lungs. Bronchoscopy and DLST led to a diagnosis of druginduced lung injury caused by S-1. Although steroid pulse therapy was administered, the patient's condition deteriorated rapidly and was ultimately fatal. Based on the clinical course and histopathological findings, a DAD-type lung disorder was diagnosed. This description of a DAD-type drug-induced lung injury caused by S-1, for which histopathological findings were available in the early stages, is clinically valuable. We report this case along with a review of the relevant literature.

Objectives: The employee participatory approach is an effective method for improving work environments. However, there are some challenges in executing this method in each workplace because of such factors as a lack of employee interest or motivation to commit to the activity. Research was conducted to clarify readiness factors to improve the workplace environment using an employee participatory approach. Additionally, we developed a checklist to efficiently measure the readiness factors., Methods: A pool of readiness items for the employee participatory approach was created from expert consensus and interviews with practitioners. A total of 300 Japanese workers (150 men; 150 women) responded to a survey after being recruited by an internet research company. After exploratory factor analysis (EFA), path analysis with categorical variables was conducted by the robust maximum likelihood method with defined readiness as an endogenous variable and resource for readiness as an external variable, then threshold (θ) and path coefficients (γ) were estimated. We set the level of the item according to the threshold per item, and the highest pass coefficients for each level with 0.60 or more items were adopted in the checklist. Finally, the relationship between each level and the readiness and related items (psychosocial factors, work engagement, and psychological stress responses in the workplace) was confirmed in the ANOVA., Results: As a result of the EFA, a three-factor structure with 71 items was developed. The path analysis extracted the first factor (workplace acceptability) with three items and the second factor (supervisor's leadership) with two items. The third factor, preferences for the workplace, was judged insufficient because the relevant item was not adequately related to the readiness state. Finally, the checklist was created to determine four levels judged by the five items. Significant differences were observed in each level and readiness state by ANOVA., Conclusions: To facilitate the participatory approach method, it was suggested that the status of workplace acceptance, supervisor's leadership, and preferences for the workplace might be important. In addition, using the checklist developed in this study, it is possible to assess the readiness state for improving the work environment using an employee participative approach, as well as to set promotion targets in each workplace.

The patient, a woman in her 70s, was diagnosed with occlusive ileus caused by sigmoid colon cancer.She underwent transanal stent placement to release the occlusion.Subsequent detailed testing revealed a 70×60mm mass on the dorsal side of the pancreas and PET-CT indicated an SUVmax 18.2 FDG uptake. EUS-FNA was performed twice.However, the mass was unable to be definitively diagnosed.The patient was then referred to our hospital.She underwent laparoscopic sigmoid colectomy and laparoscopic biopsy of the mass for sigmoid colon cancer.The patient progressed well postoperatively and was discharged home on postoperative day 9.The postoperative diagnosis was colon cancer(S, Type 2, 58×50 mm, tub2, pT4a [SE], pN1, Stage Ⅲa)and the biopsied mass was found to be a nodal marginal zone B-cell lymphoma according to histopathological testing.After undergoing chemotherapy at our hematology department, she has experienced no recurrence.

A simultaneous analytical method based on LC-MS/MS was developed for the determination of flufenacet and its metabolites, [(4-fluorophenyl)(1-methylethyl) amino]oxo-acetic acid and [N-(4-fluorophenyl)-N-(1-methylethyl) acetamide]-2-sulfinylacetic acid, in agricultural products. The compounds were extracted from samples with methanol. The crude extracts were purified using Bond Elut C18 and InertSep GC/PSA, then determined by LC-MS/MS. The average recoveries (n=5) from 4 kinds of agricultural products (wheat, soybean, potato and tomato) spiked at the level of the MRLs or the uniform limits (0.01 μg/g) were 70.6-97.0%, and the relative standard deviations were less than 5%. The lower limits of quantitation of flufenacet and its metabolites were 0.01 μg/g.

Renal mucinous tubular and spindle cell carcinoma (MTSCC) is a rare, renal epithelial neoplasm that is an established subtype in the World Health Organization 2004 classification. A 75-year-old-woman was diagnosed as having atypical mycobacterial infection and hepatitis C. Computed tomography showed a hypovascular mass 35 mm in diameter in the left kidney. The renal tumor was diagnosed as MTSCC by pathological examination of the renal biopsy specimen. The patient underwent laparoscopic left radical nephrectomy via a retroperitoneal approach. Pathological findings showed left renal carcinoma (MTSCC, pT3aN0M0), and we did not perform adjuvant therapy. The patient developed lung nodules one month after the operation that were diagnosed as lung metastasis by pathological examination of a bronchoscopic biopsy specimen. She then developed progression of lung metastasis, mediastinal lymph node metastasis and bone metastasis. We explained the necessity of therapy, but she refused therapy and died of disease progression four months after the operation. MTSCC is thought to have a relatively good prognosis, but care must be taken because, as in our case, tumor progression can occur rapidly.

Primary small cell carcinoma of the urinary tract is a relatively rare disease that is associated with a poor prognosis. The median overall survival time of patients with primary bladder disease is 19.6 month to 1.7 years, and that of patients with small cell carcinoma of the upper urinary tract is 15 months. Generally, curative surgery with chemotherapy according to the type of small cell lung carcinoma is a preferred treatment. However, standard treatment has not been established yet because the number of cases is small. We herein report the clinical features and outcome of four patients with primary small cell carcinoma of the urinary tract between 2007 and 2018 at our institution and review the literature.

G-protein-coupled receptors (GPCRs), which constitute a highly diverse family of seven transmembrane receptors, respond to external signals and regulate a variety of cellular and physiological processes. GPCRs are encoded by about 800 different genes in human and they represent the largest family of drug targets in clinical trials, which accounts for about 30% of approved drugs acting on 108 unique GPCRs. Signaling through GPCRs can be optimized by enriching receptors, selective binding partners, and downstream effectors in discrete cellular environment. The primary cilium is a ubiquitous organelle that functions as a sensory antenna for surrounding physical and chemical stimuli. Primary cilium's compartment is as little as 1/10,000th of the total cell volume. Therefore, the ciliary membrane is highly enriched for specific signaling molecules, allowing the primary cilium to organize signaling in a highly ordered microenvironment. Recently, a set of non-olfactory GPCRs such as somatostatin receptor 3 and melanin-concentrating hormone receptor 1 (MCHR1) have been found to be selectively targeted to cilia on several mammalian cell types including neuronal cells both in vitro and in vivo approaches. Moreover, investigations into the pathophysiology have implicated GPCR ciliary signaling in a number of developmental and cellular pathways. Thus, cilia are now considered as an increasingly important connection for GPCR signaling. This review summarizes our current understanding of the signaling pathways though ciliary GPCR, especially feeding- and mood-related GPCR MCHR1, along with specific biological phenomenon as cilia length shortening.

Purpose: A three-dimensional (3D) image from computed tomography (CT) angiography is a useful method for evaluation of complex anatomy such as congenital heart disease. However, 3D imaging requires high contrast enhancement for distinguishing between blood vessels and soft tissue. To improve the contrast enhancement, many are increasing the injection rate. However, one method is the use of fenestrated catheters, it allows use of a smaller gauge catheter for high-flow protocols. The purpose of this study was to compare the pressure of injection rate and CT number of a 24-gauge fenestrated catheter with an 22-gauge non-fenestrated catheter for i.v. contrast infusion during CT., Methods: Between December 2014 and March 2015, 50 newborn patients were randomly divided into two protocols; 22-gauge conventional non-fenestrated catheter (24 newborn; age range 0.25-8 months, body weight 3.6±1.2 kg) and 24-gauge new fenestrated catheter (22 newborn; age range 0.25-12 months, body weight 3.3±0.9 kg). Helical scan of the heart was performed using a 64-detector CT (LightSpeed VCT, GE Healthcare) (tube voltage 80 kV; detector configuration 64×0.625 mm, rotation time 0.4 s/rot, helical pitch 1.375, preset noise index for automatic tube current modulation 40 at 0.625 mm slice thickness)., Results: We compared the maximum pressure of injection rate, CT number of aortic enhancement, and CT number of pulmonary artery enhancement between both protocols. The median injection rate, CT number of aortic enhancement, and CT number of pulmonary artery enhancement were 0.9 (0.5-3.4) ml/s, 455.5 (398-659) HU, and 500.0 (437-701) HU in 22-gauge conventional non-fenestrated catheter and 0.9 (0.5-2.0) ml/s, 436.5 (406-632) HU, and 479.5 (445-695) HU in the 24-gauge fenestrated catheter, respectively. There are no significantly different between a 24-gauge fenestrated catheter and 22-gauge non-fenestrated catheters at injection rate and CT number. Maximum pressure of injection rate was lower with 24-gauge non-fenestrated catheters (0.33 kg/cm 2 ) than 22-gauge non-fenestrated catheters (0.55 kg/cm 2 ) (p<0.01Conclusion: A 24-gauge fenestrated catheter performs similarly to an 22-gauge non-fenestrated catheter with respect to i.v. contrast infusion and aortic enhancement levels and can be placed in most subjects whose veins are deemed insufficient for an 22-gauge catheter.

Wnt ligands activate β-catenin-dependent canonical and -independent non-canonical signaling pathways. Recent studies established importance of Wnt/β-catenin signaling in bone accrual. Antibodies against the Wnt inhibitor sclerostin and those against the Wnt inhibitor Dickkopf-1 have been shown to be effective for increasing bone mass. In addition to their effects on bone formation, roles of Wnt signals in bone resorption are gradually clarified. In this review, we would like to introduce recent advances in roles of Wnt signals in osteoclast formation and functions and regulation of sclerostin expression by osteoclasts.