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Background: Fulminant myocarditis presentation (FMP) is a rare and severe presentation of myocarditis. The natural history of FMP and its clinical features associated with poor outcomes are incompletely understood because there is a lack of generalizable evidence. Methods: This multicenter retrospective cohort study included patients hospitalized with histologically proven myocarditis who underwent catecholamine or mechanical support from 235 cardiovascular training hospitals across Japan between April 2012 and March 2017. Clinical features and the prognostic predictors of death or heart transplantation within 90 days on the basis of clinical and pathologic findings were determined using the Kaplan-Meier method, log-rank test, and Cox regression analysis. Results: This study included 344 patients with histologically proven FMP (median age, 54 years; 40% female). The median follow-up was 600 days (interquartile range, 36 to 1599 days) and the cumulative risk of death or heart transplantation at 90 days was 29% (n=98). Results from multivariable Cox regression analysis showed that older age, nonsinus rhythm, low left ventricular wall motion ( Conclusions: The results from analyses of data from this multicenter registry demonstrated that patients with FMP are at a higher risk of death or heart transplantation in real-world settings. These observations inform which clinical and pathologic findings may be useful for prognostication in FMP. Registration: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000039763.

BACKGROUND Phlegmonous gastritis (PG) is a rare bacterial infectious disease characterized by neutrophil-based purulent inflammation of the gastric wall. The most representative causative bacterium is Streptococcus pyogenes, followed by Staphylococcus, Pneumococcus and Enterococcus. Hepatic portal venous gas (HPVG) is considered a potentially fatal condition and is rarely associated with PG. CASE SUMMARY The white blood cell count of a 70-year-old woman with acute lymphocytic leukemia in complete remission dropped to 100/mu L after consolidation chemotherapy. Her vital signs were consistent with septic shock. Venous blood culture revealed the presence of Bacillus cereus. Abdominal computed tomography (CT) and esophagogastroduodenoscopy (EGD) showed marked thickening of the gastric wall. As with the other findings, CT was suggestive of HPVG, and EGD showed pseudomembrane-like tissue covering the superficial mucosa. Histopathological examination of gastric biopsy specimens showed mostly necrotic tissue with lymphocytes rather than neutrophils. Culture of gastric specimens revealed the presence of Bacillus cereus. We finally diagnosed this case as PG with Bacillus cereus-induced sepsis and HPVG. This patient recovered successfully with conservative treatment, chiefly by using carbapenem antibiotics. CONCLUSION The histopathological finding of this gastric biopsy specimen should be called "neutropenic necrotizing gastritis".

BackgroundAlthough machine learning-based prediction models for in-hospital cardiac arrest (IHCA) have been widely investigated, it is unknown whether a model based on vital signs alone (Vitals-Only model) can perform similarly to a model that considers both vital signs and laboratory results (Vitals+Labs model).MethodsAll adult patients hospitalized in a tertiary care hospital in Japan between October 2011 and October 2018 were included in this study. Random forest models with/without laboratory results (Vitals+Labs model and Vitals-Only model, respectively) were trained and tested using chronologically divided datasets. Both models use patient demographics and eight-hourly vital signs collected within the previous 48 hours. The primary and secondary outcomes were the occurrence of IHCA in the next 8 and 24 hours, respectively. The area under the receiver operating characteristic curve (AUC) was used as a comparative measure. Sensitivity analyses were performed under multiple statistical assumptions.ResultsOf 141,111 admitted patients (training data: 83,064, test data: 58,047), 338 had an IHCA (training data: 217, test data: 121) during the study period. The Vitals-Only model and Vitals+Labs model performed comparably when predicting IHCA within the next 8 hours (Vitals-Only model vs Vitals+Labs model, AUC = 0.862 [95% confidence interval (CI): 0.855-0.868] vs 0.872 [95% CI: 0.867-0.878]) and 24 hours (Vitals-Only model vs Vitals+Labs model, AUC = 0.830 [95% CI: 0.825-0.835] vs 0.837 [95% CI: 0.830-0.844]). Both models performed similarly well on medical, surgical, and ward patient data, but did not perform well for intensive care unit patients.ConclusionsIn this single-center study, the machine learning model predicted IHCAs with good discrimination. The addition of laboratory values to vital signs did not significantly improve its overall performance.

To assess the exposure of flame retardants (FRs) for school-children, organophosphorus flame retardants and plasticizers (PFRs) and organobromine flame retardants (BFRs) were determined in the indoor dust samples collected from elementary schools and domestic houses in Japan in 2009 and 2010. PFRs were detected in all the dust samples analyzed and the highest concentration of total PFRs was thousand-fold higher than that of BFRs. Among the PFRs, tris(butoxyethyl)phosphate (TBOEP) showed the highest concentration with a median (med.) of 270,000 ng g(-1) dry weight (3700-5,500,000 ng g(-1) dry weight), followed by tris(methylphenyl)phosphate (TMPPs)>triphenyl phosphate (TPHP)=tris(1,3-dichloro-2-propyl)phosphate (TDCIPP)=tris(2-chloroisopropyl)phosphate (TCIPP)=tris(2chloroethyl)phosphate (TCEP)>ethylhexyl diphenyl phosphate (EHDPP). Significantly higher concentrations of TBOEP, tri-n-butyl phosphate (TNBP), TPHP, TMPPs, and total-PFRs were found in dust samples from elementary schools than from domestic houses. It might be due to that higher concentrations of TBOEP (as leveling agent) were detected from the floor polisher/wax products collected in those elementary schools. On the other hand, significantly higher concentrations of TCEP, TCIPPs, and total chloroalkyl-PFRs were found in domestic houses than in elementary schools. Exposure assessments of PFRs via indoor dust from elementary schools and domestic houses were conducted by calculating the hazard quotient (HQ). Among PFRs, HQs for TBOEP exceeded 1 (higher than reference dose: RfD) and its highest value was 1.9. To reduce the intake of TBOEP by school-children, it is recommended that the use of floor polisher/wax containing TBOEP be reduced in schools.

In order to elucidate the spatial distribution of brominated flame retardants (BFRs) in the Japanese coastal environment, hexabromocyclododecanes (HBCDs), polybrominated diphenyl ethers (PBDEs) and organochlorines (OCs: PCBs, DDTs, CHLs, HCHs, HCB) were determined in bivalves (oysters and mussels) collected from Japanese coastal waters. HBCDs and PBDEs were detected in all samples analyzed. Concentration ranges of HBCDs were 12–5200 ng g −1 lipid wt., followed by PCBs (20–3100 ng g −1 ) > PBDEs (3.1–86 ng g −1 lipid wt.). The highest concentration of HBCDs was found in the Osaka region. This result indicates that HBCDs are ubiquitous and predominant compounds in bivalves from the Japanese coastal waters. Since no species differences between oysters and mussels were observed for the bioaccumulation properties of HBCDs and PBDEs, oysters could be utilized for BFR contamination monitoring worldwide as an alternative to mussels. Global comparisons between oysters and mussels showed that HBCD concentrations in Japan are among the highest levels reported from Asia and Europe. Estimated dietary exposures of HBCDs and PBDEs through seafood were 0.45–34 ng kg body weight −1 d −1 , and 0.054–6.8 ng kg body weight −1 d −1 , respectively. These exposure levels were more than 1000 times lower than the lowest observable effects or no observable adverse effects levels for HBCDs and PBDEs, respectively.

OBJECTIVE: Saga University has the "Saga Forum of Environment" project conducted in collaboration with the Saga city local government. In this project, a workshop was held to study the sick building syndrome at schools. The purpose of this workshop was to evaluate indoor air pollution levels in elementary and junior high schools in Saga city. METHODS: The levels of aldehydes and volatile organic compounds (VOC) were measured in 96 classrooms of the 49 schools in August. The sampling of these chemicals were performed by the passive sampler method and measured by high-performance liquid chromatograph or gas chromatograph-mass spectrometer by participants of the workshop. RESULTS: In 40% of all classrooms, formaldehyde levels were higher than that of the standard of Japanese Ministry of Education. Relatively high levels of formaldehyde were found in some music classrooms. The origin of formaldehyde was thought to be musical instruments, furniture or wooden floors. A significant correlation was found between formaldehyde level and room temperature. The classrooms with ventilators showed lower levels of formaldehyde than those without ventilators. The levels of most VOCs except that of alpha-pinene were low. CONCLUSION: There is still room for improvement of air pollution in elementary and junior high schools.

本来は病院の体制として画像診断医師の常勤が理想であるが，著しく不足している昨今，その充足は極めて難しい。当院では従来，宅配便で最寄りの医療機関へCTフィルムを送り診断を依頼していたが，平成15年5月より遠隔画像診断システム(SECOM HOSPI-NET)を導入した。診断依頼書とCT画像をISDN回線で送信し，翌日に診断結果を同回線で受信する。このシステムの導入により画像診断医師不在施設でも，よりタイムリーな画像診断情報を得ることが可能となった。ここではシステムの使用経験を通して，送受信の方法などの概要と診断報告書の信頼度，また，従来の宅配法と比較しての迅速性，経済性，作業効率などに利便性があったので報告する。

症例は79歳,男性.左半身不全麻痺と全身の紫斑を主訴に当科受診.頭部CT検査にて左頭頂葉に血腫を認め,血小板数が0.2×104/μlと減少していた.特発性血小板減少性紫斑病(ITP)と診断し,ステロイド投与, γグロブリン大量療法および免疫抑制剤投与を行ったが,血小板数の増加がみられなかったため,脾臓に対する放射線照射を施行したところ,血小板数が16×104/μlと増加し,症状の改善を認めた.治療抵抗性のITPに対して脾臓への放射線照射が有効と考えられた.

A simple and rapid method for the simultaneous determination of carbadox (CDX) and quinoxaline-2-carboxylic acid (QCA), the most persistent metabolite, in swine tissues has been developed by HPLC with photodiode array detection. The drugs were extracted with 0.3% metaphosphoric acid-MeOH (7:3, v/v), and the extracts were cleaned up with a Bond Elut C18 cartridge. The HPLC separation was performed on a Wakosil-II 5C18 RS column (150×4.6mm i. d.) with a gradient system of 0.01M phosphate buffer (pH 2.5)-MeCN as the mobile phase, at the flow-rate of 0.6ml/min. The calibration graphs were rectilinear from 0.5 to 50ng for CDX and QCA. The recoveries of CDX and QCA from swine muscle and liver fortified at the level of 0.1μg/g were 85.0-94.3%, with high precision. The limits of detection were 0.005-0.01μg/g for CDX and QCA. Further, a preliminary investigation was carried out in order to determine the toxic metabolite desoxy-carbadox.

B型慢性肝炎79例の肝生検組織87標本について連続切片を作製し,pre-S2抗原,HBs抗原ならびにHBc抗原をPAP法で検索した.87例の肝組織標本中pre-S2抗原は70例,HBs抗原は71例,HBc抗原は49例で陽性であった.肝細胞内におけるpre-S2抗原の局在様式は,HBs抗原と同様に細胞質び漫型,封入体型,膜型の3つのパターンを呈した.pre-S2抗原は,HBs抗原が染色された71標本中70標本で観察ができ,さらにそのうち69標本では,HBs抗原と同様の組織内分布および細胞内局在様式を示した.肝組織中のHBc抗原の有無およびその局在様式は,血中HBe抗原・抗体およびDNAPとの関連が認められたが,pre-S2抗原およびHBs抗原の分布ならびに局在は,HBe抗原・抗体,DNAP活性との間に関連性は認めなかった.

The Department of Hygiene Kyushu Dental College The average numbers of existed deciduous teeth, permanent teeth eruption and average ages for permanent teeth eruption was investigated and population of school children and pupils in Hagi city consisting of 1186 males and 1200 females from 6 to 15 years old. Comparison was made with the data obtained respectively from groups of 2071 males and 1947 females from 6 to 15 years old and living in Tokuyama city as examined in 1956 by Shindo, and also from groups of 989 males and 909 females, 6 to 14 years old and living in Saga city as examined in 1958 by Shigyo.The results were summarized as follows.1. The average numbers of existing deciduous teethHagi city: Male>FemaleMale. Female:Tokuyama city>Hagi city≈Saga city2. The average numbers of erupted permanent teethHagi city: Male FemaleMale:Tokuyama city>Hagi city≈Saga cityFemale:Tokuyama city≈Hagi city≈Saga city