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This paper reports medical informatics conference held in November 2020, which is under influence of CoVID-19, in hybrid way. The methods taken to ensure presenters, chairpersons, participants, supporting staffs, vendors seamless infrastructure regardless of on line or on site. This made question answer session rich as usual. Some other outcomes newly made possible are reported, such as demonstration shown on big personal screen, much better than slide projector screen, new participants who became able to participate over prefecture boundaries in challenged times.

This paper reports the history, background including politics, current status of Japan's health imaging study and other information sharing. Its realization was slow until the Ministry of Health, Labour and Welfare (MHLW) started paying digital image storage at the same rate as films in 2008. Information sharing was initiated in early 2010s, which was before vendors became ready for Integrating the Healthcare Enterprise (IHE) cross-enterprise document sharing (XDS), with the result that most of 34 large regional sharing systems are in non-standardized protocol. One standardized example is the Hamamatsu area where inexpensive online PDI (portable data for imaging) was introduced.

Multiple 24-hour urine collections are necessary to adequately assess sodium and potassium intake. Here, we assessed kidney function decline for four years after baseline in relation to seven-time averaged 24-hour urinary sodium and potassium excretion (UNaV, UKV), their UNaV/UKV ratio, and their categorical combination in outpatients with chronic kidney disease (CKD). This retrospective cohort study was based on 240 outpatients with baseline CKD stages 3-5, baseline age 20 years or more (median age 72.0 years), and a median follow-up (with interquartile range) of 2.9 (1.4–4.0) years. Outcome was the percentage change in annual slope of estimated glomerular filtration rate (delta eGFR per year). In linear mixed models, percentage changes in delta eGFR per year were -3.26% (95% confidence interval -5.85 to -0.60), +5.20% (2.34 to 8.14), and -5.20% (-7.64 to -2.69), respectively, per one standard deviation increase in the seven-time averaged UNaV and UKV, and their UNaV/UKV ratio. Additionally, percentage changes per year in delta eGFR per year were -16.27% (-23.57 to -8.27) in the middle-to-high UNaV and low UKV group, compared with the low UNaV and middle-to high UKV group. Thus, our study reinforces the observation of opposite associations between GFR decline and urinary excretion rates of sodium (positive) and potassium (negative), respectively. Whether changes in dietary sodium and potassium intake slow GFR decline still requires further study.

Background and Aims Prediction models for renal function decline has already been developed. However, few prediction models can suggest how to control clinical parameters to maintain renal function. The present study aimed to develop a prediction model for renal function decline that can suggest how to control clinical parameters to maintain renal function by an interpretable machine learning in Japanese outpatients with chronic kidney disease (CKD). Method The present study used a retrospective cohort design. The eligible criteria of the present study were outpatients with CKD stage 3, 4, and 5, treated in Daiko-Sunadabashi Clinic in Japan between 2005 and 2019. Among the patients, we analyzed patients whose 24-hour urine samples were collected 3 times and over between 6 and 36 months. The primary outcome was renal function decline defied by glomerular filtration rate (GFR) decreased by >30% from the baseline. As predictors, we used baseline CKD stage and baseline values and change rate from the baseline to the next-to-last observations of the following clinical parameters: urine volume, GFR, quantity of protein in urine, intake of protein and salt, and body mass index (BMI). We used a random forest model with actionable feature tweaking to develop the prediction model with suggesting how to control those clinical parameters. This method has been developed recently and to improve interpretability of the random forest method. This can suggest how to alter predictor values in order to change prediction results from bad to favorable outcome (e.g., changing from predicted decline to predicted maintenance of renal function). Predictability of the prediction model was assessed by accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in training and testing datasets. Results We analyzed 355 participants whose mean age (SD) was 69.2 (13.0) years old. Of the participants, 65.4% were men, 37.5%, 37.2% and 25.3% were CKD stage 3, 4, and 5, respectively. Of the participants, the 80% were included in the training dataset, and the 20% in the testing dataset. Predictability of the developed prediction model was summarized in Table 1, showing the prediction model had good predictability. The developed prediction model suggested that decreasing protein in urine and salt intake, and increasing GFR could be important to change from predicted decline to predicted maintenance of renal function. The prediction model could also suggest how to control those clinical parameters at individual-level (e.g., #53 and #67 patients in Figure 1). Conclusion The present study developed the prediction model for renal function decline with high predictability. The prediction model suggested that decreasing protein in urine and salt intake, and increasing GFR could be important to maintain renal function.

Genome-wide association studies (GWASs) have identified >100 susceptibility loci for schizophrenia (SCZ) and demonstrated that SCZ is a polygenic disorder determined by numerous genetic variants but with small effect size. We conducted a GWAS in the Japanese (JPN) population (a) to detect novel SCZ-susceptibility genes and (b) to examine the shared genetic risk of SCZ across (East Asian [EAS] and European [EUR]) populations and/or that of trans-diseases (SCZ, bipolar disorder [BD], and major depressive disorder [MDD]) within EAS and between EAS and EUR (trans-diseases/populations). Among the discovery GWAS subjects (JPN-SCZ GWAS: 1940 SCZ cases and 7408 controls) and replication dataset (4071 SCZ cases and 54479 controls), both comprising JPN populations, 3 novel susceptibility loci for SCZ were identified: SPHKAP (P(best) = 4.1 × 10(−10)), SLC38A3 (P(best) = 5.7 × 10(−10)), and CABP1-ACADS (P(best) = 9.8 × 10(−9)). Subsequent meta-analysis between our samples and those of the Psychiatric GWAS Consortium (PGC; EUR samples) and another study detected 12 additional susceptibility loci. Polygenic risk score (PRS) prediction revealed a shared genetic risk of SCZ across populations (P(best) = 4.0 × 10(−11)) and between SCZ and BD in the JPN population (P ~ 10(−40)); however, a lower variance-explained was noted between JPN-SCZ GWAS and PGC-BD or MDD within/across populations. Genetic correlation analysis supported the PRS results; the genetic correlation between JPN-SCZ and PGC-SCZ was ρ = 0.58, whereas a similar/lower correlation was observed between the trans-diseases (JPN-SCZ vs JPN-BD/EAS-MDD, r(g) = 0.56/0.29) or trans-diseases/populations (JPN-SCZ vs PGC-BD/MDD, ρ = 0.38/0.12). In conclusion, (a) Fifteen novel loci are possible susceptibility genes for SCZ and (b) SCZ “risk” effect is shared with other psychiatric disorders even across populations.

Depressive symptoms are a serious problem in workplaces. Hospital staff members, such as newly licensed registered nurses (NLRNs), are at particularly increased risk of these symptoms owing to their limited experience. Previous studies have shown that a brief program-based cognitive behavioral therapy program (CBP) can offer effective treatment. Here, we conducted a longitudinal observational study of 683 NLRNs (CBP group, n = 522; no-CBP group, n = 181) over a period of 1 year (six times surveys were done during this period). Outcomes were assessed on the basis of surveys that covered the Beck Depression Inventory-I (BDI). The independent variables were CBP attendance (CBP was conducted 3 months after starting work), personality traits, personal stressful life events, workplace adversity, and pre-CBP change in BDI in the 3 months before CBP (ΔBDIpre-CBP). All factors were included in Cox proportional hazards models with time-dependent covariates for depressive symptoms (BDI ≥10), and we reported hazard ratios (HRs). Based on this analysis, we detected that CBP was significantly associated with benefit for depressive symptoms in all NLRNs (Puncorrected = 0.0137, HR = 0.902). To identify who benefitted most from CBP, we conducted a subgroup analysis based on the change in BDI before CBP (ΔBDIpre-CBP). The strongest association was when BDI scores were low after starting work and increased before CBP (Puncorrected = 0.00627, HR = 0.616). These results are consistent with previous findings, and indicate that CBP may benefit the mental health of NLRNs. Furthermore, selective prevention based on the pattern of BDI change over time may be important in identifying who should be offered CBP first. Although CBP is generally effective for all nurses, such a selective approach may be most appropriate where cost-effectiveness is a prominent concern.

AIMS Recent studies have revealed that the interplay between polygenic risk scores (PRS) and large copy number variants (CNV; >500kb) is essential for the etiology of schizophrenia (SCZ). To replicate previous findings, including those for smaller CNV (>10kb), the PRS between SCZ patients with and without CNV were compared. METHODS The PRS were calculated for 724 patients with SCZ and 1178 healthy controls (HC), genotyped using array-based comparative genomic hybridization and single nucleotide polymorphisms chips, and comparisons were made between cases and HC, or between subjects with and without 'clinically significant' CNV. RESULTS First, we replicated the higher PRS in patients with SCZ compared to that in HC (without taking into account the CNV). For clinically significant CNV, as defined by the American College of Medical Genetics ('pathogenic' and 'uncertain clinical significance, likely pathogenic' CNV), 66 patients with SCZ carried clinically significant CNV, whereas 658 SCZ patients had no such CNV. In the comparison of PRS between cases with/without the CNV, despite no significant difference in PRS, significant enrichment of the well-established risk CNV (22q11.2 deletion and 47,XXY/47,XXX) was observed in the lowest decile of PRS in SCZ patients with the CNV. CONCLUSION Although the present study failed to replicate the significant difference in PRS between SCZ patients with and without clinically significant CNV, SCZ patients with well-established risk CNV tended to have a lower PRS. Therefore, we speculate that the CNV in SCZ patients with lower PRS may contain 'genuine' risk; PRS is a possible tool for prioritizing clinically significant CNV because the power of the CNV association analysis is limited due to their rarity.

The selective deprotection of a benzoyl group was very important methodology in the field of organic synthesis. Various methods for debenzoylation were investigated and developed in the past six decades, but more useful and selective strategies are now being strongly desired. In response to this strong demand, we developed the novel and selective deprotection of a benzoyl group by use of samarium(II) dibromide and a proton source. This deprotective reaction proceeded smoothly and the desired compound was obtained in good to excellent yields. In this paper, we will report the details of this deprotective reaction.

Measurements of glycated proteins such as serum fructosamine, glycated hemoglobin, and glycated albumin (GA) are increasingly used to complement serum glucose concentration for better management of diabetes mellitus. For example, the degree of glycemic control in diabetic cats can be determined by evaluating fructosamine concentration. Unfortunately, fructosamine tests are currently not performed in Japan, and as such, the measurement of GA may serve as a replacement test. The objectives of the current study were 2-fold. First, serum GA and fructosamine level were evaluated for positive correlation in cats as a preliminary gauge on whether serum GA use is applicable. Second, a GA percentage reference range was determined from healthy control cats for possible future diagnostic use. A positive correlation was determined for fructosamine and GA in both normal and diabetic cats. Moreover, the serum GA percentage reference interval based on control cats was determined to be 7.5–13.9% (95% nonparametric interfractile interval). Interestingly, no significant difference in serum GA percentages was observed between samples from diabetic cats with excellent glycemic control and control cats. However, good, fair, and poor glycemic control diabetic cats resulted in a significant increase in serum GA percentages in comparison to control cats. Therefore, these results indicate that serum GA may be a useful glycemic control indicator that could substitute for fructosamine to monitor glycemic control in diabetic cats.

Objectives: This paper illustrates a high speed clinical data retrieving system, from 10 years of data of operating hospital information system for the purposes of research, evidence creation, patient safety, etc., even incorporating time sequence of causal relations. Methods: Total of 73,709,298 records of 10 years at Hamamatsu University Hospital (as of June 2008) are sent from HIS to retrieval system in HL7 v2.5 format. Hierarchical variable length database is used to install them. Results: A search for “listing patients who were prescribed Pravastatin (Mevalotin and generic drugs, any titer)” took 1.92 seconds. “Pravastatin (any) prescribed and recorded AST >150 within two weeks” took 112.22 seconds. Searching conditions can be set to be more complex, connected by Boolean operator and/or. This system called D*D is in operation at Hamamatsu University Hospital since August 2002. It is used for 48,518 times (monthly average of 703 searches). Neither searching, nor background export of data from HIS caused delay of routine operating CPOE. Conclusions: Search database outside of routine operating CPOE, with daily export of order data in HL7 v2.5 format, is proved to provide excellent search environment without causing trouble. Hierarchical representation gives high-speed search response, especially with time sequence of events.

Summary Objectives: This paper illustrates a high speed clinical data retrieving system, from 10 years of data of operating hospital information system for the purposes of research, evidence creation, patient safety, etc., even incorporating time sequence of causal relations. Methods: Total of 73,709,298 records of 10 years at Hamamatsu University Hospital (as of June 2008) are sent from HIS to retrieval system in HL7 v2.5 format. Hierarchical variable length database is used to install them. Results: A search for “listing patients who were prescribed Pravastatin (Mevalotin and generic drugs, any titer)” took 1.92 seconds. “Pravastatin (any) prescribed and recorded AST >150 within two weeks” took 112.22 seconds. Searching conditions can be set to be more complex, connected by Boolean operator and/or. This system called D*D is in operation at Hamamatsu University Hospital since August 2002. It is used for 48,518 times (monthly average of 703 searches). Neither searching, nor background export of data from HIS caused delay of routine operating CPOE. Conclusions: Search database outside of routine operating CPOE, with daily export of order data in HL7 v2.5 format, is proved to provide excellent search environment without causing trouble. Hierarchical representation gives high-speed search response, especially with time sequence of events.

The receiving characteristics of electromagnetic interference on the power-ground line of an inverter IC—in other words, its electromagnetic susceptibility—was measured to investigate the dependence of susceptibility on the operating condition of electric and electronic equipment. It was confirmed that the receiving characteristics of the electromagnetic disturbance are different in the driving state of IC. The differences in the susceptibility at High and Low states were also obtained by simple circuit simulation.

症例は69歳の女性で, 高度の貧血で発症した. 上部消化管造影検査や内視鏡検査, 腹部CTで胃体上部大彎から胃内外に発育する腫瘍を認めた. 術前に確定診断が得られず, 広義の胃間葉系腫瘍として手術を施行した. 腫瘍は基部を有し, それから3方向に発育していた. 基部の胃壁を全層性に切除して標本を摘出した. 切除標本の病理検査では, 大部分は粘液性, 一部線維性の基質の中に紡錘形の異型細胞と多核巨細胞が存在する悪性線維性組織球腫様の所見であった. しかし, 腫瘍のごく一部に脂肪細胞と非定型的な脂肪芽細胞を認めたことから脱分化型脂肪肉腫と診断された. 胃原発の脂肪肉腫は, 本邦, 欧米合わせて31例の報告しかないが, 脱分化型の報告はない. 本例が胃に発生した脱分極型脂肪肉腫の初めての例と思われたので報告する.

乳癌による髄膜転移は非常に稀であり, 予後不良の疾患でもある. 今回われわれは, 左下肢麻痺で発症し, 急速に神経症状が進行した乳癌髄膜癌腫症の1例を経験した. 症例は67歳, 女性. 平成8年10月4日, 左乳癌 (T2 N0 M0 Stage II) に対して胸筋温存乳房切除術 (Bt+Ax+Ic) を施行した. 平成13年より胸骨傍リンパ節再発, 局所再発を繰り返し, 腫瘍切除, 放射線治療, 化学療法を施行されていた. 平成18年5月16日, 左下肢麻痺が出現, 脊髄MRIにて第7頸髄～第6胸髄に髄膜の肥厚を認めた. 髄液細胞診にて腺癌細胞が疑われたため, 髄膜癌腫症と診断した. 左下肢麻痺は脊髄圧迫によるものと考えられた. 治療としてMTX髄腔内投与, 脊髄外照射を施行した. 髄液所見, MRI所見は改善を認めたが, 下肢麻痺の改善は認めなかった. 髄膜癌腫症の予後は非常に不良であるが, 早期診断, 治療によりその後のQOLを改善できる可能性が考えられた.

New measurement method for characteristic impedance of Printed Circuit Board was developed and its usability was demonstrated. This method is based on a conventional TDR method, but using burst sinusoidal wave modulated by step pulse as a input signal instead of direct step pulse. Characteristic impedances of 5m semi-rigid cable and 28cm Microstrip PCB are measured at 70 MHz-350MHz frequency randge using this new method. For the long cable the characteristic impedance can be measured consistently with the conventional method between 200MHz to 350MHz. For the short microstrip line however the measured values fluctuate in some extent. The reason for obtained results are discussed.

褐色細胞腫と消化器癌の合併例の報告はまれである. 今回, われわれは直腸癌に合併した無症候性異所性褐色細胞腫の1例を経験したので報告する. 症例は60歳の女性. 下腹部痛, 便通異常のため受診し, 大腸内視鏡検査, 注腸造影検査で直腸癌と診断された. 術前の腹部CT検査で下腸間膜動脈根部近傍の大動脈周囲に腫瘍を認め, リンパ節転移と診断した. 術中, 大動脈周囲の腫瘍摘出時に著しい高血圧と摘出後の血圧低下を認めた. 術後の病理組織学的検査で直腸癌と異所性褐色細胞腫と診断された. 褐色細胞腫は術前および術中に適切な血圧管理および輸液療法を行わないと危険であり, 時に致命的となる. 直腸癌にともなう大動脈周囲腫瘍も認めてもリンパ節転移とはかぎらず, その腫瘍の大きさや部位, 第1群リンパ節腫脹の有無などからその他の原因や疾患も考慮する必要があると考えられた.

The antitumor effects of non‐steroidal anti‐inflammatory drugs, tenoxicam and piroxicam, against sarcoma 180 cells cultured in 7‐week‐old male mice were examined in vitro under ultrasonic irradiation. The survival rate of tumor cells when tenoxicam or piroxicam was added to sarcoma 180 suspension under ultrasonic irradiation was significantly lower than that when ultrasound alone was applied. Furthermore, when L‐histidine, a scavenger of singlet oxygen and hydroxyl radical, or D‐mannitol, a scavenger of hydroxyl radical, was used concurrently, the survival rate of tumor cells was significantly higher with L‐histidine. From the above findings, it is surmised that tenoxicam and piroxicam increase the antitumor effects of ultrasound by increasing the production of singlet oxygen and other active oxygen species.

The antitumor effect of intra-tumoral injection of Cepharanthin, a biscoclaurin alkaloid extracted from Stephania cephalanta Hayata, and staphylococcal enterotoxin B was evaluated using F344 male rats bearing transplantable rat osteosarcoma, S-SLM. A macroscopic lung metastatic nodule of tumor was transplanted into the subcutaneous back space, and 0.5 mg of Cepharanthin and 2 pg of staphylococcal enterotoxin B were injected into the tumor on days 12, 13 and 14. On day 28, all animals were killed with an overdose of pentobarbital sodium, and the transplanted tumors and lungs were examined. The wet weight of the lungs of the rats treated with Cepharanthin and staphylococcal enterotoxin B was significantly lower, and apoptosis in the lung metastatic nodules was significantly higher than that of the control or that of rats treated with only Cepharanthin or staphylococcal enterotoxin B. In the transplanted tumors, infiltration of TRAP (tartrate-resistant acid phosphatase)-positive multinucleated giant cells was prominent in the rats treated with Cepharanthin and staphylococcal enterotoxin B. These findings indicate that intra-tumoral injection of Cepharanthin and staphylococcal enterotoxin B induced infiltration of TRAP-positive multinucleated giant cells within the transplanted rat osteosarcoma, and reduced lung metastasis.

This paper describes a rare case of retroperitoneal abscess due to idiopathic perforation of the ascending colon, which was successfully cured by ultrasonography guided puncture drainage. A 73-year-old man was admitted to the hospital because of a fever, right back pain and diarrhea. On physical examination slight tenderness was demonstrated in the right abdomen. An abdominal CT revealed a retroperitoneal abscess and the ascending colon was connected with it. The patient was diagnosed as idiopathic perforation of the ascending colon, because enema performed 4 months earlier revealed no abnormalities. Physical examination was slight and the abscess was limited in right retroperitoneal space, and so he was treated with ultrasonography guided puncture drainage and conservative therapy. About two months after the drainage, the abscess had disappeared.

Congenital factor XI deficiency is a rare hereditory coagulation disorder which was first reported by Rosenthal and his coworkers in 1953. Only forty-old families of the disease have been reported in Japan, but operated cases in such patients were very few. In this paper a successful gastrectomy for gastric cancer in a patient with this hereditory disease is described. A 70-year-old man with factor XI deficiency (factor XI activity: less than 1%), who did not show bleeding tendency preoperatively, underwent subtotal gastrectomy for gastric cancer. Before surgery fresh frozen plasma and fresh blood (about 25ml/kg) was supplied to maintain intraoperative factor XI activity at more than 50%, and subtotal gastrectomy with node dissection was performed. For postoperative 7 days transfusion with fresh frozen plasma (5ml/kg) was given to maintain the activity at about 30%. This replacement therapy saved the patient from intra- and postoperative bleeding tendency and postoperative complications.

Barium titanate precursor gel was successfully obtained by a sol-gel process with the use of barium acetate and titanium isopropoxide as starting materials. The calcination process of the barium titanate gel was characterized by FTIRPAS, TG-DTA, XRD and acid extraction method. These analyses indicate that barium acetate was distributed uuiformly in the gel matrix formed by hydrolysis and polymerization of titanium isopropoxide. The barium titanate was formed rapidly at higher temperatures than 823-873K resulted from the reaction between titanium oxide and barium carbonate or barium oxide.

In veterinary medicine, coagulase-positive staphylococci (CoPS) other than Staphylococcus aureus have frequently been misidentified as being S. aureus strains, as they have several phenotypic traits in common. There has been no reliable method to distinguish among CoPS species in veterinary clinical laboratories. In the present study, we sequenced the thermonuclease ( nuc ) genes of staphylococcal species and devised a multiplex-PCR (M-PCR) method for species identification of CoPS by targeting the nuc gene locus. To evaluate sensitivity and specificity, we used this M-PCR method on 374 staphylococcal strains that had been previously identified to the species level by an hsp60 sequencing approach. We could successfully distinguish between S. aureus , S. hyicus , S. schleiferi , S. intermedius , S. pseudintermedius , and S. delphini groups A and B. The present method was both sensitive (99.8%) and specific (100%). Our M-PCR assay will allow the routine species identification of CoPS isolates from various animal species for clinical veterinary diagnosis.

During a 11 year period (1976-1987) a total of 454 patients with early gastric cancer underwent surgical resection, and nine of them died of rcurrence. In order to clarify risk factors involved in the recurrence, the 9 patients were clinicopathologocally compared with those without recurrence. The results as follows. Depth of invasion: submucosa 3.0% and mucosa 1.2%. Gross type: IIa 1.9%, IIc 1.9% and IIa + IIc 4.9%. Histologic type: pap 3.1%, tub1 1.9%, tub2 2.5% and por 1.8%. Location of the lesion: C 4.9%, M 1.6% and A 1.7%. Lymph node metastasis: positive 7.5% and negative 1.5%. Lymphatic invasion: positive 3.7% and negative 1.5%. Blood vessel invaion: positive 6.3% and negative 1.8%. Those results indicated that the risk factors might include were submucosal invasion, mixed type in gross appearance, lymph node metastasis, lymphatic invasion and Blood vessel invasion. The recurred cases predominatly showed the hematogenous pattern of recurrence.