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Background: Blood glucose monitoring (BGM) is essential for glycemic control in diabetic therapy. Followingly, accurate sensors are required for both daily personal and clinical use. The frequency of sensor use in patients with diabetes facilitates the use of disposable components. However, BGM systems are not exempt from green innovation sustainability initiatives., Methods: Clinical study of a high-accuracy green design blood glucose monitor using an innovative optical transmission absorbance system was carried out. Venous blood samples were collected from 104 patients with type II diabetes. The heat resistance of sensor strips was evaluated by storing sensor strips at 25℃ and 60℃ for approximately 3 months. Accuracy of the BGM system was evaluated via the ISO 15197:2013 protocol., Results: The BGM system achieved ±7.1% accuracy in glycemic level measurement, with 84% of all measurements within ±5% of the reference values. Furthermore, the sensor strip demonstrated heat resistance for more than 3 months when stored at 60℃., Conclusions: A new, highly accurate BGM system was developed based on the latest optical measurement system, introducing a rare metal-free "green-strip." The developed BGM system achieved the highest reported accuracy in clinical research, using venous blood from patients with diabetes. The sensor strip also exhibited high heat resistance, reducing limitations on storage conditions.

Comprehensive whole-body counter surveys of Miharu-town school children have been conducted for four consecutive years, in 2011-2014. This represents the only long-term sampling-bias-free study of its type conducted after the Fukushima Dai-ichi accident. For the first time in 2014, a new device called the Babyscan, which has a low (134/137)Cs MDA of <50 Bq/body, was used to screen the children shorter than 130 cm. No child in this group was found to have detectable level of radiocesium. Using the MDAs, upper limits of daily intake of radiocesium were estimated for each child. For those screened with the Babyscan, the upper intake limits were found to be ≲1 Bq/day for (137)Cs. Analysis of a questionnaire filled out by the children's parents regarding their food and water consumption shows that the majority of Miharu children regularly consume local and/or home-grown rice and vegetables. This however does not increase the body burden.

Comprehensive whole-body counter surveys covering over 93% of the school children between the ages of 6 and 15 in Miharu town, Fukushima Prefecture, have been conducted for three consecutive years, in 2011, 2012 and 2013. Although the results of a questionnaire indicate that approximately 60% of the children have been regularly eating local or home-grown rice, in 2012 and 2013 no child was found to exceed the (137)Cs detection limit of 300 Bq/body.

Objective: To investigate the impact in an aging society of the 2011 Great East Japan earthquake on hospitalisation for respiratory disease at the disaster base hospital., Design: Descriptive and cross-sectional study., Setting: Emergency care in Japanese Red Cross Ishinomaki Hospital, a regional disaster base hospital in Miyagi, Japan., Participants: 322 emergency patients who were hospitalised for respiratory disease from 11 March to 9 May 2011, and 99 and 105 emergency patients who were hospitalised in the corresponding periods in 2009 and 2010, respectively., Main Outcome Measures: Description and comparison of patient characteristics and disease distribution in terms of age, time after the disaster and activities of daily living (ADL)., Results: 1769 patients were admitted to our hospital during the study period (compared to 850 in 2009 and 1030 in 2010), among whom 322 were hospitalised for respiratory disease (compared to 99 in 2009 and 105 in 2010). Pneumonia (n=190, 59.0%) was the most frequent cause of admission for pulmonary disease, followed by acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) (n=53, 16.5%), asthma attacks (n=27, 8.4%) and progression of lung cancer (n=22, 6.8%). Compared with the corresponding periods in 2009 and 2010, the increase in the absolute numbers of admissions was highest for pneumonia, followed by AE-COPD and asthma attacks. At hospitalisation, 195 patients were 'dependent' and 54 patients were 'partially dependent'. Respiratory admissions accompanied by deterioration of ADL after the disaster were more frequent in elderly and female patients., Conclusions: After the Great East Japan Earthquake, admissions for pneumonia and exacerbation of chronic respiratory disease in the elderly increased at the disaster base hospital.

The Fukushima Dai-ichi NPP accident contaminated the soil of densely-populated regions in Fukushima Prefecture with radioactive cesium, which poses significant risks of internal and external exposure to the residents. If we apply the knowledge of post-Chernobyl accident studies, internal exposures in excess of a few mSv/y would be expected to be frequent in Fukushima.Extensive whole-body-counter surveys (n = 32,811) carried out at the Hirata Central Hospital between October, 2011 and November, 2012, however show that the internal exposure levels of residents are much lower than estimated. In particular, the first sampling-bias-free assessment of the internal exposure of children in the town of Miharu, Fukushima, shows that the (137)Cs body burdens of all children (n = 1,383, ages 6-15, covering 95% of children enrolled in town-operated schools) were below the detection limit of 300 Bq/body in the fall of 2012. These results are not conclusive for the prefecture as a whole, but are consistent with results obtained from other municipalities in the prefecture, and with prefectural data.

Usher syndrome is an autosomal-recessive disorder that causes bilateral sensorineural hearing loss, retinitis pigmentosa (RP), and occasionally vestibular dysfunction. Usher syndrome types 1, 2, and 3 can be distinguished by differences in audiovestibular features. The objectives of this retrospective study were to evaluate 26 patients with Usher syndrome clinically. The 26 patients (male: 12 cases, female: 14 cases) with Usher syndrome, with a clinical diagnosis based on symptoms of bilateral sensorineural hearing loss and RP, had been registered from 13 hospitals as a multicenter study. We assessed the clinical history and performed audiovestibular and ophthalmologic examinations, and genetic testing. Eleven of the patients were classified as having Usher type 1 (38.5%), 6 with Usher type 2 (23.1%), and 9 with Usher type 3 (38.5%). However, many patients with atypical Usher type 1 (70%) and type 2 (83.3%) were found compared with Usher type 3 (10%). The conductive rate of vestibular examinations including the caloric test (50%) was low. There were many variations in the clinical symptoms in Usher syndrome patients, therefore the classification of Usher types 1, 2, and 3 has been complicated. We have proposed a flowchart for the diagnosis of Usher types 1, 2, and 3.

Pseudomyxoma peritonei (PMP) is a rare condition of mucinous ascites associated mainly with mucinous tumors of appendix or ovary. PMP often recurs after treatment and may eventually cause death by abdominal visceral dysfunction via compression with mucinous ascites. Although radical peritonectomy and hyperthermic intra-peritoneal chemotherapy are becoming popular globally, the optimal treatment of PMP has not been established in Japan. We conducted a retrospective multicenter study to clarify the optimal treatment and the prognostic factors of PMP. A total of 23 patients with PMP were analyzed in the Tohoku Gynecologic Cancer Unit (TGCU). Clinical and follow-up data were retrieved and a central pathology review was performed. The median follow-up period was 46 months. Eleven patients underwent complete resection. There were 7 deaths out of 13 recurrences/progressions in this period. All the recurrence/progression was confined to the abdomen. Unexpectedly, neither radical peritonectomy nor hyperthermic intra-peritoneal chemotherapy had been performed, indicating that both radical peritonectomy and hyperthermic intra-peritoneal chemotherapy are not yet popular in Japan. The medians of overall survival and disease-free period were 166 months and 30 months, respectively. Univariate and multivariate analyses revealed that the only prognostic factor was macroscopic residual tumor (P=0.022). Although chemotherapy was not a prognostic factor (P=0.16), those who received intra-peritoneal chemotherapy tended to have a better prognosis than those who received systemic or no chemotherapy (P=0.064). In conclusion, the macroscopic residual tumor is an important prognostic factor in Japanese patients with PMP.

Cogan's syndrome is characterized by non syphilitic interstitial keratitis and Meniere's syndrome-like audiovestibular function disorder, as well as various systemic manifestations, including fever, arthralgia, vasculitis, and aortitis. We report the case of atypical Cogan's syndrome with aortitis; the patient's symptoms caused by active inflammation, including inflammatory ocular manifestations, audiovestibular symptoms, and aortitis, were improved by early administration of corticosteroids, however, her reduced visual acuity was not improved because of post-inflammatory change in her left eye.

The peripheral structures of bromides on dodecyltrimethylammonium bromide (DTAB) and hexadecyltrimethylammonium bromide (HTAB) micelles have been studied by X-ray absorption fine structure (XAFS) at the Br-K edge. The XAFS spectra indicate that water is a dominant scattering group for Br- even in these micellar solutions. However, the oscillation intensity decreases with increasing micellar concentration, suggesting that the bromides are dehydrated to some extent when they are bound to the micelles. A XAFS analysis routine gives unusually short Br-O (water) distances and is inapplicable to the present systems. This comes from the structure of the first coordination shell, in which two or more scattering paths are involved. The second scattering group is obviously the head group of the surfactants forming the micelles. The detailed analysis has allowed us to estimate the hydration number of the bromides bound on the DTAB and HTAB micelles (N = ca. 4.2). The assumption that all of the bromides form direct ion-associates with the head groups causes the contradiction to the results of the XAFS analyses. This strongly implies that some of the bromides partitioned into the micelle are completely hydrated as far as their first coordination shell is concerned. Assuming that the maximum hydration number of the bromides bound to the head groups of the micelle is three, 40% of the bromides partitioned into the micelle are completely hydrated.

Coronary artery multiple fistulae of the left ventricular chamber are extremely rare congenital malformations. We report on 13-year-old monozygotic twin brothers who have identical abnormalities of coronary flow reserve as well as the same morphological findings of multiple coronary fistulae of the 3 major coronary arteries to the left ventricular chamber. The left circumflex coronary artery (LCX) had abundant fine communications with the left ventricular chamber and had a higher flow rate than the left anterior-descending coronary artery. The coronary flow reserve obtained from the LCX was lower than the normal value matched for the same age group. The increased shunt flow resulted in enlargement of the left ventricular chamber. This is the first report of coronary flow characteristics in children with multiple coronary fistulae.

Density functional theory calculations were conducted on the title reactions with explicit inclusion of a variety of water molecules, H-CO-NMe2+MeOH+(H2O)n-->H-CO-OMe+HNMe2+(H2O)n. Geometries of transition states, reactant-like complexes and product-like ones were determined by the use of RB3LYP/6-31G(d) SCRF=dipole. Concerted paths were examined with n=0-3. Their Gibbs activation energies are larger than the experimental value. Stepwise paths were also investigated with n=2-4. The n=4 model has the energy close to the experimental value. However, when the catalytic water molecules were added to the n=4 one, the stepwise path was switched to the concerted one. A systematic comparison of the concerted path with n=2+1, 2+2, 2+3, 2+4, 2+5, 2+4+4, and 2+5+5 models was made, and the water-dimer based reaction path was found to be most favorable. The contrast between the concerted path of the amide solvolysis (and hydrolysis) and the stepwise one of the ester hydrolysis was discussed in terms of the frontier-orbital theory.

Shiga toxin-producing Escherichia coli (STEC) are important enteropathogens causing severe diseases such as hemorrhagic colitis and hemolytic-uremic syndrome in humans. The majority of STEC strains of serogroups O157, O26, or O111 associated with severe cases of these diseases possess a pathogenicity island termed the locus of enterocyte effacement (LEE). LEE, which is responsible for the formation of attaching-and-effacing lesions on intestinal epithelial cells, is important for the full virulence of STEC. Nonetheless, LEE-negative STEC strains have repeatedly been reported to be associated with severe diseases in humans. In this study, we characterized adhesion to cultured epithelial cells of certain LEE-negative STEC isolated from humans with or without bloody diarrhea. Several LEE-negative STEC belonging to serogroup O91 showed an unusual, chain-like adhesion pattern to HEp-2 cells. Using Tn5-based transposon mutagenesis, we identified the gene essential for the chain-like adhesion phenotype of this O91 STEC strain. Sequence analysis of the Tn5-inserted allele identified a novel chromosomal open reading frame (ORF) encoding a polypeptide with a high degree of similarity to the E. coli immunoglobulin-binding (Eib) proteins EibA, -C, -D, -E, and -F. Therefore, the ORF was designated EibG. Laboratory E. coli strain MC4100 transformed with a multicopy plasmid carrying eibG showed chain-like adhesion to HEp-2 cells, and whole-cell lysates of the strain bound to human-derived immunoglobulin G (IgG) Fc and IgA. These results indicate that EibG acts as an IgG Fc- and IgA-binding protein, as well as an adhesin of LEE-negative STEC.

The gene function of the locus of enterocyte effacement (LEE) is essential for full virulence of enterohemorrhagic Escherichia coli (EHEC). Strict control of LEE gene expression is mediated by the coordinated activities of several regulatory elements. We previously reported that the ClpX/ClpP protease positively controls LEE expression by down-regulating intracellular levels of GrlR, a negative regulator of LEE gene expression. We further revealed that the negative effect of GrlR on LEE expression was mediated through GrlA, a positive regulator of LEE expression. In this study, we found that the FliC protein, a major component of flagellar filament, was overproduced in clpXP mutant EHEC, as previously reported for Salmonella. We further found that FliC expression was reduced in a clpXP grlR double mutant. To determine the mediators of this phenotype, FliC protein levels in wild-type, grlR, grlA, and grlR grlA strains were compared. Steady-state levels of FliC protein were reduced only in the grlR mutant, suggesting that positive regulation of FliC expression by GrlR is mediated by GrlA. Correspondingly, cell motility was also reduced in the grlR mutant, but not in the grlA or grlR grlA mutant. Because overexpression of grlA from a multicopy plasmid strongly represses the FliC level, as well as cell motility, we conclude that GrlA acts as a negative regulator of flagellar-gene expression. The fact that an EHEC strain constitutively expressing FlhD/FlhC cannot adhere to HeLa cells leads us to hypothesize that GrlA-dependent repression of the flagellar regulon is important for efficient cell adhesion of EHEC to host cells.

A 52-year-old woman with early-onset diabetes mellitus, severe diabetic retinopathy, and a family history of a dominant inheritance pattern was referred to our hospital. Direct sequencing revealed a novel mutation in the HNF-4alpha gene (R244Q). The position of the mutation in the amino-acid sequence of the gene is well conserved among species and transcriptional activity of the mutant gene was significantly reduced. Therefore, a diagnosis of maturity-onset diabetes of the young (MODY)-1 was made. Genetic testing enabled early diagnosis of diabetes in the patient's 20-year-old daughter, which we consider to be important for the prevention of diabetic complications.

A 62-year-old male presented with a rare intraosseous meningioma with intradural extension manifesting as frequent vomiting and floating sensation that had persisted for 3 months. Neuroimaging detected a mass lesion that was mainly located extradurally in the right posterior fossa with a daughter lesion inside the dura. He underwent surgical excision of the mass lesion. Craniectomy exposed the main lesion of the tumor just beneath the thinned outer table of the skull, and in the extradural space, with the daughter lesion penetrating the dura. Both portions of the tumor were resected. There was no attachment to the adjacent dura mater. Histological examination showed meningotheliomatous meningioma containing scattered bony tissue. This intraosseous meningioma probably originated from the occipital bone with a small intradural extension caused by mechanical compression.

A 28-year-old man was admitted to hospital for investigation of a 2-week history of angina occurring on exertion. Coronary angiography showed an isolated left coronary ostial stenosis and left main trunk plasty was performed 2 weeks later. The pathological diagnosis of the left coronary ostial stenosis was fibromuscular dysplasia, which makes this a rare case.

The relationship between family history of gastric carcinoma and gastric carcinoma in Japanese under 40 years of age was analyzed. The subjects were 108 gastric carcinoma patients (86% were diffuse type) at 9 hospitals in the Kanto area of Japan. Firstly, incidence of gastric carcinoma among the parents of the subjects were compared with that in the general population. Observed/expected (O/E) ratios (P-value) were 1.8 (0.06) for all subjects, 1.3 (0.62) for male subjects, 2.1 (0.04) for female subjects, 0.5 (0.41) for early carcinoma, 2.6 (P<0.01) for advanced carcinoma, 2.3 (0.22) for intestinal-type carcinoma and 1.7 (0.13) for diffuse-type carcinoma. Association between gastric carcinoma and parents' history of gastric carcinoma was strong among women and regarding advanced carcinoma, and the difference in O/E ratios between early and advanced carcinoma was remarkable. Secondly, factors related to advanced-stage gastric carcinoma were analyzed. Histological type (diffuse and intestinal types) was not related, but family history of gastric carcinoma among parents and grandparents was related to advanced stage, and the relationship was independent of other factors. The odds ratio (95% confidence interval) was 3.3 (1.1-9.9). Family history may be related to stage of gastric carcinoma through its relationship to the manner or speed of the tumor's progression. We hypothesis that some genetic factor exists which is involved both in progression from early to advanced stage and in occurrence of gastric carcinoma.

The electrophysiological effects of intravenous administration of disopyramide (1.5 mg/kg) were studied in 26 patients with sinus node dysfunction (SND). Disopyramide shortened spontaneous cycle length (SCL) in 12 patients and lengthened it in 4. Maximum sinus node recovery time (max SRT) was prolonged in 9 patients and shortened in 6. Estimated sinoatrial conduction time (SACT) was prolonged in 4 and shortened in 4 out of 10 patients in whom this measurement was possible. However, these changes were not statistically significant. Neither were there any significant changes in PA and AH intervals nor refractory periods of the AV node. HV intervals and refractory periods of the atrium at matched cycle length were significantly lengthened. Atrial echo beats and atrial premature beats disappeared in 7 of 12 patients treated with disopyramide. In all of these 7 patients atrial refractory period were increased. Thus, the disappearance of atrial echo beats and atrial premature beats was thought to be due to a prolonged atrial refractoriness. In 4 patients who had supraventricular arrhythmias without having either marked prolongation of max SRT or episodes of syncope, disopyramide was administered orally for a long term, during which these arrhythmias and symptoms disappeared and sinus rate increased. These results suggest that disopyramide is useful in patients with SND and supraventricular arrhythmias.

Syrian golden hamsters were administered 8-nitroquinoline, at a concentration of 0.05%, in a 10% ethanol solution as drinking water for 104 weeks. The animals were kept under observation until 112 weeks of age when the experiment was terminated. Both control and treated groups developed tumors in a pattern indistinguishable from that usually observed in Syrian golden hamsters. Thus the result of this experiment indicates that 8-nitroquinoline given orally at a concentration of 0.05% is not carcinogenic in Syrian golden hamsters.