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Rationale: Although proposed as a clinical prompt to sepsis based on predictive validity for mortality, the Quick Sepsis-related Organ Failure Assessment (qSOFA) score is often used as a screening tool, which requires high sensitivity.Objectives: To assess the predictive accuracy of qSOFA for mortality in Brazil, focusing on sensitivity.Methods: We prospectively collected data from two cohorts of emergency department and ward patients. Cohort 1 included patients with suspected infection but without organ dysfunction or sepsis (22 hospitals: 3 public and 19 private). Cohort 2 included patients with sepsis (54 hospitals: 24 public and 28 private). The primary outcome was in-hospital mortality. The predictive accuracy of qSOFA was examined considering only the worst values before the suspicion of infection or sepsis.Measurements and Main Results: Cohort 1 contained 5,460 patients (mortality rate, 14.0%; 95% confidence interval [CI], 13.1-15.0), among whom 78.3% had a qSOFA score less than or equal to 1 (mortality rate, 8.3%; 95% CI, 7.5-9.1). The sensitivity of a qSOFA score greater than or equal to 2 for predicting mortality was 53.9% and the 95% CI was 50.3 to 57.5. The sensitivity was higher for a qSOFA greater than or equal to 1 (84.9%; 95% CI, 82.1-87.3), a qSOFA score greater than or equal to 1 or lactate greater than 2 mmol/L (91.3%; 95% CI, 89.0-93.2), and systemic inflammatory response syndrome plus organ dysfunction (68.7%; 95% CI, 65.2-71.9). Cohort 2 contained 4,711 patients, among whom 62.3% had a qSOFA score less than or equal to 1 (mortality rate, 17.3%; 95% CI, 15.9-18.7), whereas in public hospitals the mortality rate was 39.3% (95% CI, 35.5-43.3).Conclusions: A qSOFA score greater than or equal to 2 has low sensitivity for predicting death in patients with suspected infection in a developing country. Using a qSOFA score greater than or equal to 2 as a screening tool for sepsis may miss patients who ultimately die. Using a qSOFA score greater than or equal to 1 or adding lactate to a qSOFA score greater than or equal to 1 may improve sensitivity.Clinical trial registered with www.clinicaltrials.gov (NCT03158493).

The red-crowned crane ( Grus japonensis ) from eastern Hokkaido is classified as a Special Natural Monument in Japan. In this study, we determined the concentrations of persistent organic pollutants (POPs) in red-crowned crane muscle tissues (n = 47). Polychlorinated biphenyls (PCBs) had the highest median concentration (240 ng/g lipid weight), followed by dichlorodiphenyltrichloroethane and its metabolites (DDTs) (150 ng/g lipid weight), chlordane-related compounds (CHLs) (36 ng/g lipid weight), hexachlorobenzene (HCB) (16 ng/g lipid weight), hexachlorocyclohexanes (HCHs) (4.4 ng/g lipid weight), polybrominated diphenyl ethers (PBDEs) (1.8 ng/g lipid weight), and finally, Mirex (1.5 ng/g lipid weight). Additionally, a positive correlation was found among POP concentrations. No sex differences beyond body parameters were observed. Additionally, red-crowned cranes exhibited a high enantiomeric excess of (+)- alpha -HCH, with enantiomer fractions varying from 0.51 to 0.87 (average: 0.69).

The red-crowned crane (Grus japonensis) is recognized internationally as an endangered species. Migratory populations breed in eastern Russia and northeastern China, whereas the resident population inhabits the island of Hokkaido, Japan. Although the population inhabiting Hokkaido had experienced a severe bottleneck by the end of the 19th century, the population size has recovered to about 1500 and continues to increase now thanks to conservation efforts. A previous study reported that no marked genetic differences were seen in the island population, and that the genetic variation of the whole population on Hokkaido was lower than that of the continental population. However, the precise genetic structure of the island population in the past or near present remains unclear. To better understand the spatiotemporal changes in the genetic structure of the island population, we performed mitochondrial DNA (mtDNA) analyses using stuffed specimens (years 1878-2001) and tissue or blood samples (years 1970-2014). We found three haplotypes in the island population, one of which was a novel mtDNA haplotype in 1997 and 2007 samples. In addition, there was no clear difference in the haplotype frequency through the time span. These results suggest that the low genetic variation of the island population persisted for the last hundred years. It is thus nearly impossible for the island population to recover its genetic variation in isolation. Conservation plans for this species should therefore include the promotion of genetic exchanges between the continental and island populations, such as through artificial introduction to Hokkaido.

The endangered red-crowned crane (Grus japonensis) is a protected species in eastern Hokkaido and injured specimens are treated with medication. The present study aimed at understanding the expression profiles of cytochrome P450 (CYP) 1-3 genes in red-crowned crane tissues. We used 14 individuals found dead in the wild in eastern Hokkaido or in Kushiro City Zoo. Nine CYP1-3 genes expressed in the liver of the red-crowned crane were identified by high-throughput sequencing, and phylogenetically classified as CYP1A5, CYP2C23, CYP2C45, CYP2D49, CYP2G19, CYP2U1, CYP2AC1, CYP3A37, and CYP3A80. Based on the quantitative real-time PCR of 13 samples, the rank order of their median expression levels was as follows: CYP3A37 > CYP2AC1 > CYP2C45 > CYP2D49 > CYP2G19 > CYP1A5 > CYP3A80 > CYP2C23. The tissue distribution of the CYP transcripts indicated that many of the CYP1–3 genes examined were mainly expressed in the tissues where drug metabolism occurs, such as the liver, kidneys, and lungs. We found that CYP3A37 was dominant at the transcript level in the liver, indicating it might play a crucial role in liver physiology and xenobiotic metabolism. Similarly, an “orphan” CYP2AC1 was expressed at relatively high levels in the kidneys and liver, suggesting a possible role in renal and liver physiology and xenobiotic metabolism. Our results establish a foundation for future studies on red-crowned cranes aiming to further understand drug sensitivity and develop medication protocols, but also contribute to national and local projects for the conservation of red-crowned crane.

The red-crowned crane in Japan was once considered extinct due to hunting and habitat destruction in late nineteenth century; however, in 1926, a small group of cranes was rediscovered in the Kushiro Mire in eastern Hokkaido. Since then, various conservation efforts, including artificial feeding during winter, hunting prohibition, and habitat conservation, have increased the population size to >1400 by 2012. Despite such a successful population recovery, the genetic characteristics of the population have not been fully explored. To ensure the long-term persistence and evolutionary potential of cranes, accurate knowledge of the spatial distribution of genetic variation and its underlying causes are necessary. We assessed their genetic structure using 12 polymorphic microsatellite loci and inferred the mechanisms shaping the observed structure. Among the three regional groups in Hokkaido, we found generally low pairwise F ST values and no significant differences in genetic diversity, probably because of the population expansion in the recent past. In contrast, spatial autocorrelation analysis revealed a significant positive kinship at the short distance (0–15 km) and negative kinship at the long distance (155–205 km), showing a pattern of isolation by distance. The presence of isolation by distance on a small spatial scale despite the species’ strong flight ability is probably explained by the recolonization process and restricted dispersal due to natal philopatry in a non-equilibrium condition. Cranes in Hokkaido do not appear to be a panmictic (random mating) population; however they can be considered a single population without genetic discontinuity (i.e. a single management unit). Our findings confirm the importance of considering natal philopatry when developing management strategies such as dispersing cranes into unoccupied areas.

Schwannomas of the colon are rare and difficult to diagnose preoperatively. We report a case of schwannoma of the ascending colon that was resected laparoscopically. A 64-year-old woman was referred to our hospital by her local clinic for further evaluation and management of a submucosal tumor of the ascending colon. A definitive preoperative diagnosis could not be reached despite examinations. Gastrointestinal stromal tumor, leiomyoma and lymphoma were the differential diagnoses. We performed a laparoscopic right hemicolectomy with D2 lymph node dissection. Histological findings with hematoxylin-eosin staining revealed spindle-like tumor cells, and immunohistochemical analysis showed that the tumor was positive for S-100 but negative for c-kit, CD34, smooth muscle actin and desmin, with a Ki-67 index of

The Red-crowned Crane Grus japonensis is an endangered species that has two separate breeding populations, one in the Amur River basin and the other in north and east Hokkaido, Japan. So far, only two (Gj1 and Gj2) and seven (Gj3-Gj9) haplotypes in D-loop of mtDNA were identified in Japan and in the continent, respectively. We obtained feathers from three cranes found in northeast Honshu. The crane in Akita in 2008, which also arrived at west Hokkaido, had a novel haplotype (Gj10). Another crane in Akita in 2009 showed a heteroplasmy (Gj7 and a novel type, Gj12). The third crane in Miyagi in 2010 also showed another type, Gj11. These results suggest that three Red-crowned Cranes appeared in Honshu and west Hokkaido were from the continent.

Eimeria gruis and E. reichenowi cause coccidiosis, a major parasitic disease of cranes. By non-invasive molecular approaches, we investigated the prevalence and genetic characterization of pathogens in two Japanese crane habitats; one is Hokkaido inhabited by the endangered red-crowned crane, and the other is Izumi in Kyushu where populations that consist mainly of vulnerable hooded and white-naped cranes migrate in winter. The non-invasively collected faecal samples from each wintering population were first subjected to host genomic DNA-targeted analyses to determine the sample origin and avoid sample redundancy. Extremely high prevalence was observed in the Izumi populations (> 90%) compared with the Hokkaido population (18-30%) by examining 470 specimens by microscopy and PCR-based capillary electrophoresis (PCR-CE), using genetic markers in the second internal transcribed spacer (ITS2). Correspondence analysis of PCR-CE data revealed differences in community composition of coccidia between hooded and white-naped cranes. 18S rRNA and ITS2 sequences were determined from single oocysts excreted by red-crowned and hooded cranes. Phylogenetic analysis of 18S rRNA suggested that E. reichenowi was polyphyletic while E. gruis was monophyletic. Together with PCR-CE data, these results indicate different host specificity among the E. reichenowi type. Our data suggest that E. reichenowi comprises multiple species.

We present the case of a 68-year-old female patient who was diagnosed with cancer of the descending colon in July 1994 and underwent partial resection of the colon (type 2, moderately to well differentiated adenocarcinoma, se, ly1, v1, n(–)). In April 1996, she was admitted to a nearby hospital for symptoms of ileus, which improved at the hospital. However, she was referred to our hospital for melena. In blood test, Hb was 8.7 g/dl, showing anemia, and carcinoembryonic antigen level was elevated to 50.7 ng/ml. Abdominal CT and small bowel series showed only mild expansion of the small bowel, suggesting no obvious occlusion. Abdominal surgery was performed in May 1995 for repeated development of ileus symptoms and suspicion of bleeding from the small bowel. Since the findings of the abdominal surgery showed a circular tumor in the lower ileum, partial resection of the small bowel was performed. Histopathological examination showed type 3, moderately to well differentiated adnocarcinoma, se, ly2, v0, n = 1/13. The principal tumor was located within the subserosa and grew up exclusively through the muscularis propria and the submucosa, into the mucous layer. The mucosa remained slightly on the surface layer. Based on these findings, the patient was diagnosed with metastasis of descending colon cancer to the small bowel. Her prognosis was good, and neither metastasis nor redevelopment of the cancer have been confirmed to date, 11 years and 7 months since the surgery.

Changes in nasopharyngeal bacterial flora in adults with acute upper respiratory tract infection on administration of antimicrobial agents were investigated, and how these changes contrasted with those in children. Many patients with acute sinusitis due to allergies, and patients with malignancy and diabetes mellitus were included in the investigation. The detection rates of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, the major bacteria of acute otitis media (AOM), were 22%, 10%, and 7% respectively, which were significantly lower than those for children. Gram stain examination of nasopharyngeal swab samples showed a significant relation between leukocyte infiltration and the detection amount of S. pneumoniae (P = 0.0086). A significant relation (P = 0.0134) was also observed when H. influenzae was simultaneously detected. No significant change in the three major AOM bacteria present in nasopharyngeal bacterial flora after administration of antimicrobial agents was observed. However, all S. pneumoniae and H. influenzae detected after antimicrobial agent administration had the beta-lactam-resistance gene. It was observed that a significant improvement in leukocyte infiltration occurred 6 to 10 days after antimicrobial agent administration. In contrast, a significant improvement in children was observed at 2 to 5 days. In the adult subjects, this improvement was probably due to spontaneous remission rather than the effect of the antimicrobial agents. Although investigation of the long-term administration of antimicrobial agents was also conducted, its benefits for the patients were not elucidated.

We genetically analyzed eimerian oocysts isolated from the red-crowned crane (Grus japonensis) in Hokkaido, a northern island of Japan. Two types of oocysts of which shapes were similar to Eimeria gruis and E. reichenowi were found. Nearly the total length of the 18S ribosomal RNA gene (about 1.7 kbp in length) was amplified from single oocyst of each type and was sequenced. The respective sequences showed high similarity to those of published partial sequences (349 bp) of E. gruis type oocyst and E. reichenowi type oocyst isolated from the hooded crane (G. monacha) and the white-naped crane (G. vipio) in Izumi, in the southern island of Japan. Phylogenetic analysis indicated that E. gruis type and E. reichenowi type are different species, and suggested that these crane coccidia have evolved independently from the intestinal parasitizing Eimeria species.

This report focuses on changes in the nasopharyngeal bacterial flora before and after administration of antimicrobial agents in 172 cases of acute upper respiratory infection in patients aged 6 years or younger. The antimicrobial agents administered were amoxicillin (AMPC) (34%), clavulanic acid/amoxicillin compound (11%), cefditren pivoxil (CDTR-PI) (43%), and others (12%). Changes in nasopharyngeal bacterial flora were investigated with reexaminations conducted after 2-5 days (day 2-5 subgroup), 6-10 days (day 6-10 subgroup), and 11 days and thereafter. There was a significant reduction in the Streptococcus pneumoniae detected in the group administered AMPC (AMPC group) in the day 2-5 subgroup and the day 6-10 subgroup. There was also a significant decrease in H. influenzae in the group administered CDTR-PI (CDTR-PI group) in the day 2-5 subgroup. From this it was inferred that for the most part significant changes in infectious nasopharyngeal bacteria occurred in the day 2-5 subgroups. However, a significant improvement in the degree of inflammation, as indicated by leukocyte infiltration images for the AMPC group, was observed in the day 2-5 subgroup, and for the CDTR-PI group in the day 6-10 subgroup. On the other hand, in both the antimicrobial agent groups, S. pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were newly detected at reexamination. Furthermore, a difference in the incidence of these bacteria was observed between the 2 antimicrobial agent groups. It was suggested that such phenomena related to the survival of resistant strains or a recurrence otitis media.

In our first report, we investigated nasopharyngeal bacterial flora related to penicillin-resistant Streptococcus pneumoniae (PRSP) and β-lactamase-negative ampicillin-resistant Haemophilus influenzae (BLNAR) and their relation to acute upper respiratory tract infection (AURTI). This report analyzes the results of a study of nasopharyngeal bacterial flora before the administration of antimicrobial agents in 172 AURTI patients aged 6 years or younger. In addition to Gram staining, microscopic observation, and culturing, a polymerase chain reaction (PCR) method was used to identify PRSP (gPRSP) and BLNAR (gBLNAR) drug-resistant genes. Of the patients analyzed, 90% had acute otitis media (AOM) and were aged 2 years or younger. The antimicrobial agents administered were amoxicillin (34%), clavulanic acid/amoxicillin (11%), cefditren pivoxil (CDTR-PI) (43%), and others (12%). This was particularly true for patients administered CDTR-PI, among whom there were many who had already suffered one or more episodes of AOM by the age of 1 year or younger, and many in which gPRSP were detected (P < 0.01). There was a significant relation between the degree of nasopharyngeal inflammation indicated by leukocyte infiltration images and the amount of S. pneumoniae and H. influenzae detected, which are the main pathogenic bacteria causing AOM (P < 0.01). In addition to leukocyte infiltration images, there were cases in which shedding of ciliated cells was observed and/or giant monocytic cells. Both nasopharyngeal leukocyte infiltration images and/or shed cell findings observed in infant AURTI cases are important indices for the prompt detection of gPRSP and/or gBLNAR and appropriate doses of antimicrobial agents.

イレウスで発症し,大腸内視鏡検査で術前に質的診断が可能であった虫垂癌の1例を経験した.症例は49歳女性.下腹部痛と腹満感で入院.腹部単純レントゲン写真でイレウスを呈しておりイレウス管挿入.腹部CT検査では回盲部に腫瘤陰影が認められた.注腸造影検査では盲腸の膨らみが悪く回盲部の病変が疑われ,大腸内視鏡検査を施行した.虫垂開口部に隆起性病変が認められ,同部位の生検でMucinous adenocarcinoma, group5の診断をえた.虫垂癌の診断にて手術を施行した.

2001年1月から2004年12月の4年間に原発性虫垂癌を6例経験した.過去5年間に原発性虫垂癌を5例以上まとめて報告している他の4施設の39症例を加えて計45症例とし,その臨床像,予後について検討した. 45症例の組織型の内訳では腺癌が28例 (62%), 粘液嚢胞腺癌が13例 (29%), その他の癌が4例 (9%) であった.深達度ss以上の症例が38例 (85%) であった.リンパ節転移陽性例は全体の38%であった.組織型別の生存曲線では腺癌,粘液嚢胞腺癌ともに5年生存率は50～60%と推定され,腺癌と粘液嚢胞腺癌の生存曲線に統計学的有意差は認めなかった.

空腸潰瘍穿孔のため緊急手術を行ったガストリノーマの1例を経験した. 症例は46歳の男性で, 8年前に十二指腸潰瘍穿孔で手術, 7年前に副甲状腺腺腫で手術, 十二指腸潰瘍に対し内服治療中であったが平成15年6月初旬に消化管穿孔のため緊急手術を施行した. 空腸潰瘍の穿孔であった. 全身状態が落ち着いた後, セクレチンテスト, 腹部血管造影検査, 選択的動脈内刺激剤注入試験 (SASI test), 血清ガストリン値6,514pg/mlなどでガストリノーマと診断した. 平成15年8月中旬に膵頭十二指腸切除術を施行, 術後の病理組織学検査で悪性のガストリノーマの診断を得た. ガストリノーマに起因する原発性空腸潰瘍穿孔は比較的まれであった. 抗潰瘍薬に抵抗性の患者は血中ガストリン値の測定が必要であると再認識した.

The effect of the quantity of water ingested concomitantly with drugs, on the absorption of AS-924, a novel prodrug-type cephem antibiotic, was studied in five healthy adult volunteers by a cross-over method, using cefteram-pivoxil (CTER-PI) as the control drug. In addition, the effect of milk on the absorption of AS-924 was also investigated. The absorption of CTER-PI was significantly reduced when administered together with 30 ml of water compared with its absorption when administered together with 150 ml of water, whereas no such reduction was found in the case of AS-924. Ingestion of milk did not significantly affect the absorption of AS-924. These results confirm that absorption of AS-924 after oral administration is not likely to be affected by the quantity of water taken concomitantly with the drug, nor by milk.

The efficacy of intravenous injection of FK463, a novel water-soluble lipopeptide, was evaluated in mouse models of disseminated candidiasis and aspergillosis and was compared with those of fluconazole (FLCZ) and amphotericin B (AMPH-B). In the candidiasis model, FK463 significantly prolonged the survival of intravenously infected mice at doses of 0.125 mg/kg of body weight or higher. In disseminated candidiasis caused by Candida species, including FLCZ-resistant Candida albicans , FK463 exhibited an efficacy 1.4 to 18 times inferior to that of AMPH-B, with 50% effective doses (ED 50 s) ranging from 0.21 to 1.00 mg/kg and 0.06 to 0.26 mg/kg, respectively, and was much more active than FLCZ. The protective effect of FK463 was not obviously influenced by the fungal inoculum size, the starting time of the treatment, or the immunosuppressed status of the host. The reduction in efficacy was less than that observed with FLCZ or AMPH-B. The efficacy of FK463 was also evaluated in the disseminated candidiasis target organ assay and was compared with those of FLCZ and AMPH-B. Efficacies were evaluated on the basis of a comparison between the mean log 10 CFU in kidneys in the groups treated with antifungal agents and that in control group. A single dose of FK463 at 0.5 mg/kg or higher significantly reduced the viable counts in kidneys compared with the numbers of yeast cells before treatment, and its efficacy was comparable to that of AMPH-B, while FLCZ at 4 mg/kg showed only a suppressive effect on the growth of C. albicans in the kidneys. In the disseminated aspergillosis model, FK463 given at doses of 0.5 mg/kg or higher significantly prolonged the survival of mice infected intravenously with Aspergillus fumigatus conidia. The efficacy of FK463 was about 2 times inferior to that of AMPH-B, with ED 50 s ranging from 0.25 to 0.50 mg/kg and 0.11 to 0.29 mg/kg, respectively. These results indicate that FK463 may be a potent parenterally administered therapeutic agent for disseminated candidiasis and aspergillosis.

症例は23歳の女性で, 離乳食開始時より食後の嘔吐を認められていた. 徐々に嚥下困難が進行し, 6歳時に先天性食道狭窄症と診断されたが, 合併奇形は認められていない. 以後, 近医で内視鏡検査, 食道造影にて経過観察をし, 時にbougieを行っていた. 22歳時の検査にて内視鏡ファイバーが通過困難となり, 手術目的にて当院外科入院となった. 当院での内視鏡検査にて切歯より約30cmと40cmの部位2か所に狭窄が認められた. 平成10年11月12日, 右開胸開腹食道亜全摘, 胸腔内胃管食道吻合, 胆摘, 幽門形成が施行された. 病理組織診断にて2か所の狭窄とも筋性線維性食道狭窄症と診断された. 本症例は狭窄部が2か所認められたこと, 保存的治療が無効であったことより食道亜全摘術が施行された. 成人例の先天性食道狭窄症の報告は少なく, また, 2か所に狭窄を有した筋性線維性狭窄は本邦での報告がなくまれな症例である.

The currently available antifungal drugs for the treatment of deep-seated mycoses are limited to amphotericin B (AMPH-B), azole compounds, and flucytosine. AMPH-B remains the drug of choice for the treatment of most fungal diseases because it has broad-spectrum and potent fungicidal activity, but it is well known to be toxic (16). Although the azole antifungal agents are considered to be less toxic than AMPH-B, their efficacies against deep-seated, life-threatening mycoses are not satisfactory. In addition, it has been reported that the frequency of isolation of multiazole-resistant strains of Candida species other than Candida albicans is increasing (6). Therefore, there is a critical need for new antifungal agents which are fungicidal, have a broad spectrum of activity and have fewer side effects. Inhibition of glucan synthesis is an attractive target for antifungal agents, since the absence of homologous enzymes in humans may afford a high degree of selectivity for fungi (5). Moreover, an inhibitor of glucan synthesis could possess activity against fungi resistant to other antifungal agents (7, 17, 19). These considerations have led to the development of the echinocandin LY303366 by Eli Lilly & Company and the related pneumocandin MK-0991 by Merck Research Laboratories. Both of these compounds have been introduced into clinical trials (2, 14). The MICs of these compounds for various yeast isolates were determined in accordance with the standard reference method, recently developed by consensus through the National Committee for Clinical Laboratory Standards (9, 12). The guidelines for antifungal susceptibility testing of yeasts were applied to in vitro susceptibility testing of various filamentous fungi (8, 13, 15, 19). Under standard conditions, both LY303366 and MK-0991 displayed substantial activities against Candida and Aspergillus species. FK463 is a semisynthetic derivative of {"type":"entrez-nucleotide","attrs":{"text":"FR901379","term_id":"525229666"}}FR901379, a water-soluble echinocandin-like lipopeptide with a sulfonate moiety, isolated from the culture broth of Coleophoma empedri (T. Iwamoto, N. Sakamoto, M. Yamashita, M. Ezaki, S. Hashimoto, T. Furuta, M. Okuhara, and M. Kohsaka, Program Abstr. 33rd Intersci. Conf. Antimicrob. Agents Chemother., abstr. 371, 1993). In order to define clearly the in vitro antifungal activity of FK463, we determined the susceptibilities of several clinically important pathogenic fungi under the conditions mentioned above.

We took culture of throat swab from 77 subjects who were negative for infection of HBV, HCV, HIV and syphilis infection before and after endoscopy. Moreover, the existence of bacterium including Helicobacter pylori at overcoat of endoscopic instrument was investigated right after examination and after disinfection of endoscope. Povidoneiodine, 70% alcohol and 1% benzalkonium chloride was used as a disinfectant for endoscope, and it took less than 10 minutes to wash by hand to disinfection. alpha-haemolytic streptococci, Staphylococcus epidermids, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Candida, Pseudomonas aeruginosa and MRSA were cultured in throat swab. The rate of adhesion of bacterium especially such as Candida, K. pneumoniae and S. epidermids to endoscope was considerably high. 23 of 77 subjects had H. pylori infection, and the adhesion of H. pylori to endoscope was found to be 65.2% of the subjects. On the contrast, no bacterium was detected from the endoscopic instrument after careful disinfection. These findings stress the importance of postoperative disinfection of the endoscope to prevent the chance to acquire bacterial infection.

Approximately 100 A thick, mirror‐like, ordered tungsten layers were fabricated on (100) GaAs with chemical vapor deposition, using a precursor. Native oxides on GaAs were reduced with pretreatment in a chemical vapor deposition chamber of tungsten. Secondary ion mass spectrometry and Rutherford backscattering spectroscopy analyses indicate tungsten‐GaAs mixed layer not thicker than 20 A. The chemical vapor deposited tungsten was applied to fabrication of state of the art, low resistance contacts to GaAs layers grown with molecular layer epitaxy. Optimization of GaAs doping, pretreatment, and tungsten chemical vapor deposition conditions were necessary to obtain low contact resistance. Contact resistance, measured with the transmission line method, was to Te doped n‐type GaAs and below to C doped p‐type GaAs. Electrically active donor/acceptor concentrations in GaAs layers grown by molecular layer epitaxy were about one order of magnitude lower than expected from literature trend lines for these contact resistance. © 1999 The Electrochemical Society. All rights reserved.

The 4.2 K photoluminescence (PL) spectra of undoped bulk 〈100〉 InP grown by the liquid-encapsulated vertical Bridgman (LE–VB) techniques are characterized by three kinds of recombination peaks. A peak exhibited near band-gap energy is attributed to the recombination of bound excitons (BEs). At the low energy side of BEs, a series of peaks with the same energy interval are due to the recombination of donor–acceptor (DA) pairs with their longitudinal–optical (LO) phonon replicas, which is associated with the Zn acceptor. Recombination of deep levels (DLs) is characterized by a broadband with fine structure at the higher energy side, which seems to be associated with the recombination of native defects and their phonon replicas. The lattice relaxation of DA recombination is smaller while the recombination intensity of DLs is stronger as compared the 4.2 K PL spectra of the LE–VB crystals with those of seed crystals grown by the liquid-encapsulated Czochralski (LEC) technique. At room temperature, only a broa...

Here we report a rare case of Trousseau’s syndrome in a patient with gastric cancer with multiple intramural metastases and metastasis to the small intestine. A 70 year-old male complaining of appetite loss and weight loss of 7 kg within 3 months was admitted to hospital. Esophagogastroduodenal endoscopy revealed an advanced gastric cancer at the pylorus almost occluding the outlet of the stomach, and multiple ulcerative lesions throughout the stomach. A biopsy showed poorly differentiated adenocarcinoma. The patient underwent total gastrectomy. During surgery, part of the distal ileum was found to be abnormally firm and approximately 1 m of the ileum with the cecum colon was resected. Pathologic examination confirmed poorly differentiated adenocarcinoma at the pylorus and multiple intramural metastases in most other areas of the stomach. Lymph node metastases were confirmed in 12 out of 40 harvested regional lymph nodes including one positive paraaortic lymph node. The resected ileum contained multiple tumors with ulceration. Massive lymphatic invasion in the stomach and the small intestine was observed, which strongly suggested lymphatic spread of the gastric cancer. The patient was discharged on post-operative day 21; however, 2 months after surgery, he developed multiple cerebral thromboembolisms and died 2 weeks later.

A clinical study was carried out on pazufloxacin (PZFX) in 137 patients including shigellosis, Salmonella enteritis, enteropathogenic Esherichia coli enteritis and cholera, and carriers of these pathogens. Antibacterial activity of PZFX against clinical isolates, fecal concentration of PZFX and effects of PZFX on fecal microflora were also investigated. The overall clinical efficacy rate was 97.2%. The bacteriological efficacy rates were 98.2% against Shigella spp., 81.8% against Salmonella spp., 50% against Vibrio cholerae O1, and 100% against E. coli, V. parahaemolyticus, Aeronomas spp., Plesionomas shigelloides and V. cholerae non-O1, respectively. Side effect (epigastralgia) was observed in 1 of 130 cases (0.8%). The rate of abnormal laboratory findings was 11.2% (11/98). These were mainly elevation of GOT and/or GPT and increased eosinophils. The clinical usefulness rate was 95.2%. The MIC90 values of PZFX against Shigella spp., Salmonella spp. and E. coli were 0.025, 0.025 and 0.025 micrograms/ml, respectively. The results of fecal drug concentration and the effects on fecal microflora in one patient were compatible with those obtained in healthy volunteers.

Effects of the experience of copulation and cohabitation with a pregnant female on male parental behavior were examined in ICR-strain male mice. The experience of copulation and/or cohabitation with a pregnant female promoted parental behavior, although the cohabitation with a pregnant female per se failed to inhibit infanticide in male mice. Therefore, it is possible that the facilitation of parental behavior is caused by a motivation independent from that of the inhibition of infanticide in male mice. As to the facilitation of parental behavior, the effect of copulation was stronger than that of cohabitation with a pregnant female, and these 2 effects seem to be additive. It is possible that there are 2 independent mechanisms for the facilitation of parental behavior in male mice.

The efficacy, safety and usefulness of balofloxacin (BLFX) for patients with acute infectious enteritis and the carriers mainly shigellosis, were investigated. The drug was administered at a daily dose of 200 mg twice a day for 3 days to patients with cholera, 7 days to patients with Salmonella enteritis and 5 days to patients with other conditions of infectious enteritis including shigellosis; 1. The efficacy was analyzed in 89 of the 135 patients who received the administration (43 patients with shigellosis, 14 with Salmonella enteritis, 8 with enteropathogenic/ enterotoxigenic Escherichia coli enteritis, 3 with cholera, 7 with enteritis with other pathogenic bacteria, 6 with polymicrobial infectious enteritis and 8 with acute enteritis that was pathogen-negative). 2. In patients bearing symptoms and who thus could be analyzed for drug efficacy, the drug was markedly effective or effective 50/52 (96.2%). 3. Bacteriologically, the drug was effective for Shigella spp. in 41 (100%) of 41, Salmonella spp. in 12 (85.7%) of 14, and enteropathogenic/enterotoxigenic Escherichia coli in 8 of 8 cases. 4. Adverse effects were seen in 5/133 patients (3.8%) receiving the drug, including two cases of skin eruption, one of the numbness of the hands, one of oral aphtha, and one of nausea. In patients for whom laboratory findings were available, 20/115 (17.4%) showed abnormalities, mainly elevations of GOT and/or GPT, but these were slight. 5. In terms of subjective reports of usefulness, 51/82 (62.2%) were markedly satisfied, and 73/82 (89.0%) were either satisfied or markedly satisfied. 6. The influence of administration of BLFX on fecal concentration and intestinal microbial flora was investigated in 2 patients with acute infectious enteritis. Results approximately equivalent to such flora levels in healthy subjects were obtained. These results suggest that BLFX is highly useful for infectious enteritis such as that caused by shigellosis.

Minocycline has been thought to induce “black thyroid”, a condition marked by discoloration due to brown deposits. However, its effect on thyroid function in humans is still obscure. We conducted a prospective study of thyroid hormone levels in 17 patients who were administered 200 mg minocycline daily for 10 days. We found that minocycline significantly reduced the serum total thyroxine level (8.43±0.61 to 7.09±0.45 μg/dl, mean ± SEM;P

A clinical study was conducted on fleroxacin (FLRX) in 143 patients and carriers with infectious enteritis (shigellosis, Salmonella enteritis, Campylobacter enteritis, pathogenic Escherichia coli enteritis, Vibrio parahaemolyticus enteritis, cholera, multiple bacterial infections, pathogen-negative enteritis). Furthermore, its antibacterial activity against clinical isolates, fecal concentration and effect on fecal microflora were conducted. FLRX was administered orally in doses of 200 mg once a day (200 mg group) or 300 mg once a day (300 mg group) for 3 days to cholera, for 7 days to Salmonella enteritis and for 5 days to the other infectious enteritis. The clinical efficacy rates were 100% in both the 200 mg and 300 mg groups. The bacteriological efficacy rates were 100% against Shigella spp., Salmonella spp., pathogenic E. coli, V. parahaemolyticus and V. cholerae O1, and 63.6% against Campylobacter spp. in the 200 mg group. The rates of the 300 mg group were 93.3% against Shigella spp., and 100% against Campylobacter spp. and pathogenic E. coli. As adverse effects, skin rash was observed in 1 case each in both groups (1.1%, 2.1%). Abnormal laboratory findings consisted of 1 case of increased eosinophils and 1 case of elevated GOT and GPT levels in the 200 mg group (2.8%), and 1 case of elevated GPT in the 300 mg group (2.9%). The clinical usefulness rates were 92.9% and 93.3% in the 200 mg and 300 mg groups, respectively. Antibacterial activity was somewhat inferior to that fo ciprofloxacin and equal to or better than that of norfloxacin, demonstrating MIC90 values against Shigella spp., Salmonella spp., pathogenic E. coli, V. parahaemolyticus and Campylobacter spp. of 0.1, 0.2, 0.1, 0.2 and 0.78 micrograms/ml, respectively. Peak fecal concentrations of the drug were 49.0 micrograms/g and 274.4 micrograms/g in the 200 mg group, and 43.3 micrograms/g and below the detection limit (5.0 micrograms/g) in the 300 mg group. With respect to fecal microflora (4 cases), a decrease in Enterobacteriaceae was observed in 3 cases during dosing. But this change showed a tendency to recover after completion of dosing. No effects were observed on anaerobic bacteria.

Red-crowned cranes (Grus japonensis) are native to eastern Hokkaido (island population), in contrast to the mainland, which migrates between the Amur River basin and eastern China–Korea peninsula. During the 1990s we found that Red-crowned cranes in Hokkaido were highly contaminated with mercury: however, the source was unknown. We investigated the time trend of mercury contamination in Red-crowned cranes. Total mercury levels in the livers and kidneys from cranes dead in the 2000s were lower than those dead in the 1990s. Feather is a major pathway of mercury excretion for many bird species and is used as an indicator of blood mercury level during feather growth. As internal organs from the specimens collected before 1988 were not available, we analyzed the flight feather shavings from stuffed Red-crowned cranes dead in 1959–1987 and found that the mercury level of feathers from cranes dead in the 1960s and 1970s was not more than those from the cranes dead in the 2000s. These results suggest that mercury contamination in Red-crowned cranes in Hokkaido decreased temporally during the 1990s–2000s. This indicates the possible occurrence of some mercury pollution in Red-crowned cranes’ habitat in this region in the 1990s or before.

The solvent extract and the headspace of Hedychium coronarium Koenig flowers were investigated by GC and GC/MS. A volatile concentrate of the solvent extract which was obtained by simultaneous distillation and extraction (SDE) was fractionated by column chromatography and analyzed by GC and GC/MS. Of the 175 compounds identified, linalool, methyl benzoate, cis-jasmone, eugenol, (E)-isoeugenol, jasmin lactone, methyl jasmonate, methyl epi-jasmonate, indole, nitriles and oximes were found to make a great contribution to the scent of the flowers. Total of 113 compounds were identified in the headspace. The daily and the seasonal changes of the odor characteristics of H. coronarium flowers were considered. Qualitative differences of the volatiles obtained by thermal and solvent desorption of the headspace traps were also discussed.

The pharmacokinetic and microbiological data of roxithromycin, an oral semisynthetic macrolide, and its clinical use in respiratory infections in Japanese patients are reviewed. In healthy men the maximum plasma concentration (Cmax) and area under the plasma concentration-time curve (AUC) of roxithromycin increase with increasing dosage, as does urinary drug excretion. The drug’s Cmax and half-life are increased compared with erythromycin, josamycin and miocamycin. Maximum sputum and plasma drug concentrations were higher in patients with chronic bronchitis receiving roxithromycin 150mg than in those receiving erythromycin 400mg. Uptake of roxithromycin into polymorphonuclear cells was proportionally greater than that of erythromycin and josamycin. Roxithromycin showed good in vitro activity against respiratory pathogens, including intracellular pathogens such as Legionella pneumophila and Mycoplasma pneumoniae, although it had only about one-quarter of the activity of erythromycin against Staphylococcus aureus and Streptococcus pneumoniae. High success rates were obtained in patients with acute pneumonia (79%) and chronic obstructive airways disease (75%) receiving roxithromycin in a noncomparative trial in 378 patients with respiratory tract infection, and roxithromycin and miocamycin showed similar efficacy in a double-blind study.