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We develop room acoustic prediction and evaluation tools for designers to be used in halls and conference areas where the design of acoustical performance is essential. The designers, with no specialized knowledge of acoustics, are able to examine the tools at an early stage of the project. The interface tool consists of the 3D CAD software-Rhinoceros, and its plug-in tool-Grasshopper. The designers first build a room model on Rhinoceros and locate the sound source and the receiver points in the model. They then set the calculation conditions via Grasshopper, such as room use and type of interior finishes. Next, room sound propagation is calculated using the ray tracing method in the external python programs. Then, acoustic indices, such as the average sound absorption coefficient and clarity, are predicted. These indices are automatically evaluated according to the room use, and the evaluated results are visualized in the room model on Rhinoceros. This paper outlines these tools and exhibits the agreement of predicted and measured indices in a small hall. These tools are applied to a lecture room with complicated ceiling ribs, and an office with a stairwell, which are difficult to examine by the conventional reverberation formula.

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".

Bing-Neel syndrome (BNS) is a rare disease manifestation of Waldenström's macroglobulinemia characterized by abnormal lymphoplasmacytoid cells infiltration of the central nervous system. In September 2019, a 46-year-old man presented to a previous hospital with hand tremors, nausea, and dysuria. Demyelination of cerebral white matter and the spinal cord was discovered using MRI. Steroid pulse therapy was used to treat inflammatory demyelinating disease, and it provided temporary relief, but the symptoms returned when the steroids were stopped. He was referred to our hospital in June 2020, for further evaluation with the possibility of hematological malignancy. BNS was diagnosed based on the presence of abnormal lymphoplasmacytoid cells in the bone marrow and cerebrospinal fluid (CSF), as well as the presence of the MYD88

AIM Disease characteristics of primary biliary cholangitis have changed recently. However, detailed studies on the subject have been limited. Therefore, we aimed to clarify disease characteristics of patients with recent primary biliary cholangitis using the cohort from Niigata University and 21 affiliated hospitals. METHODS Overall, 508 patients were enrolled in this study from 1982 to 2016, divided into three cohorts according to their year of diagnosis: ≤1999, 2000-2009 and ≥2010. We compared differences in clinical characteristics, response to ursodeoxycholic acid and prognosis. RESULTS The male-to-female ratio increased incrementally from 1:16.4 (≤1999) to 1:3.8 (≥2010) (P

The patient was a 68-year-old woman, diagnosed with acute myelomonocytic leukemia with normal karyotype and FLT3-ITD-negative status in May 2019. She had achieved complete remission (CR) after "7+3" intensive induction chemotherapy and maintained CR by consolidation chemotherapy. However, she relapsed with swelling of the lips and gums in January 2020. She did not achieve CR by salvage chemotherapy with cytarabine-aclarubicin-G-CSF regimen. Comprehensive genomic analysis of leukemic cells revealed the presence of FLT3-N676K mutation, which was undetectable by companion diagnostics at the time. Complete remission with incomplete count recovery was obtained on day 28 after initiation of gilteritinib monotherapy, and the lip and gum swelling improved rapidly. However, she relapsed on day 106 after gilteritinib administration, and gilteritinib was discontinued. Genomic analysis at recurrence revealed NRAS mutation for the first time. Finally, the patient died of the uncontrolled primary disease. This is a case in which comprehensive gene mutation analysis was useful in determining a treatment strategy.

In this real-world clinical study, in which we determined eligibility for allogenic hematopoietic stem cell transplantation by prognostic factors and minimal residual disease status, we retrospectively evaluated cytogenetic, genetic, and clinical features in 96 patients with core-binding factor acute myeloid leukemia (CBF-AML) including 62 patients with RUNX1/RUNX1T1 and 34 patients with CBFβ/MYH11. Multivariate analyses for 5-year overall survival (OS) in CBF-AML patients revealed that age of 50 years or older (HR: 3.46, 95% CI 1.47-8.11, P = 0.004) and receiving 2 or more induction cycles (HR: 3.55, 95% CI 1.57-8.05, P = 0.002) were independently associated with worse OS and that loss of sex chromosome (LOS) was independently associated with better OS (HR: 0.09, 95% CI 0.01-0.71, P = 0.022). At the time of complete remission, all 21 karyotyped patients with LOS had a normal karyotype. Furthermore, in all 9 patients with LOS who had a mosaic of metaphase cells with and without t(8;21) or inv(16), the metaphase cells without t(8;21)/inv(16) showed a normal karyotype. These results proved that LOS was not age-related and physiological, but rather a neoplastic chromosomal abnormality.

The patient developed Stage Ⅳ transverse colon cancer at the age of 72 years and was treated with an 8-course XELOX regimen(capecitabine and oxaliplatin)every 3 weeks after resection. Six years and 9 months after the end of treatment, at the age of 79 years, WBC levels were found to have markedly increased to 10×104/µL in the patient, and acute leukemia was suspected; subsequently, the patient was hospitalized. Bone marrow was aspirated and analyzed, and the results showed that 95% of leukemic cells were positive for esterase staining. Chromosomal examination revealed t(6 ; 11)(q27 ; q23), ie, the diagnosis of therapy-related acute myeloid leukemia(t-AML)with 11q23 abnormality. CR was achieved by chemotherapy, but the disease soon recurred; the patient died 7 months after the onset of t-AML, with the cause being t- AML with 11q23 abnormality that developed 6 years and 9 months after treatment for colorectal cancer with oxaliplatin and capecitabine without undergoing MDS. Since there is a possibility of leukemia induction following oxaliplatin treatment, more such cases need to be monitored in the future.

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.

Background Organ/space SSI is a significant clinical problem. However, early detection of organ/space SSI is difficult, and previous predictive models are limited in their prognostic ability. We aimed to develop and validate a prediction model of organ/space surgical site infection (SSI) using postoperative day 3 laboratory data in patients who underwent gastrointestinal or hepatopancreatobiliary cancer resection. Methods This retrospective cohort study using a single-center hospital data from April 2013 to September 2017 included all adult patients who underwent elective gastrointestinal or hepatopancreatobiliary cancer resection. The primary outcome was a presence of organ/space SSI including anastomotic leakage, pancreatic fistula, biliary fistula, or intra-abdominal abscess. We developed and validated a logistic regression model to predict organ/space SSI using laboratory data on postoperative day (POD) 3. Similar models using laboratory data on POD 1 or 5 were developed to compare the predictive ability of each model. Results A total of 1578 patients were included. Organ/space SSI was diagnosed in 107 patients, with median diagnosis days of 6 (interquartile range, 4–9 days) after surgery. A prediction model using five commonly measured variables on POD 3 was created with the area under the curve (AUC) of 0.883 (95%CI 0.819–0.946). The AUC of a model with POD 1 laboratory data was 0.751 (95%CI 0.655–0.848), while that of POD 5 laboratory data was 0.818 (95%CI 0.730–0.906). Conclusions Laboratory data on POD 3 could forecast organ/space SSI precisely. Further prospective studies are warranted to investigate the clinical impact of this model.

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.

The association between serum alpha-fetoprotein (AFP) levels during and after interferon (IFN) therapy and the development of hepatocellular carcinoma (HCC) was evaluated in patients with chronic hepatitis C (CHC). A total of 263 patients treated by IFN with or without ribavirin were enrolled in the study. Serum AFP levels during and after IFN therapy were investigated retrospectively, and statistical analysis was performed to identify the factors associated with HCC development. During IFN therapy, serum AFP levels significantly decreased, regardless of virologic response to treatment. Increased serum AFP levels (or=10 ng/ml) at the end of IFN therapy (EOT) was a close-to-significant variable affecting the development of HCC (P = 0.057), and a significantly higher cumulative incidence of HCC was seen in patients with increased serum AFP levels at EOT (P = 0.021). Serum AFP level at EOT is a possible predictor of HCC in CHC patients after IFN therapy.

We have investigated interaction between humic acids and heavy metal ions by fluorescence spectroscopy. The humic acids examined are Aldrich humic acid (AHA) and Dando humic acid (DHA), and heavy metal ions are Cu 2+ and Pb 2+ . The binding constants between the humic acids and the heavy metal ions are obtained by a conventional fluorescence quenching technique. The two prominent bands in the fluorescence spectra of the humic acids give different binding constants, implying that the two bands are originated from different fluorescent species in the matrices of the humic acids. This was confirmed by two-dimensional correlation analysis based on the quenching perturbation on the fluorescence spectra. Two prominent cross peaks corresponding to the two fluorescence bands are obtained in the asynchronous maps, indicating that the two fluorescence bands belong to different species. The order of the response of the two fluorescence bands to the quenching perturbation is also elucidated based on Noda’s rule.

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.

System embodiment of digital optical computing using the state-of-art technologies is an important issue to promote researches on practical applications. Although design and fabrication of smart pixel devices take an important position in the development, we should explore potential candidates for future system construction.

To elucidate the role of alpha 2-adrenoceptors in transcriptional control in the rat brain, we localized the Fos-like immunoreactivity (Fos-LI) induced by alpha 2-adrenoceptor agonists and by an antagonist. Injections of yohimbine (5 mg/kg, i.p.) into rats led to the induction of Fos-LI in areas with a dense alpha 2-adrenoceptor binding such as the locus coeruleus, the bed nucleus of stria terminalis, the central nucleus of amygdaloid complex, the paraventricular nucleus, the nucleus tractus solitarius, and ventrolateral medulla oblongata. Clonidine (500 micrograms/kg, i.p.) suppressed the Fos expression by yohimbine in these nuclei, and clonidine (100 micrograms/kg, i.p.) or guanabenz (4 mg/kg, i.p.) induced Fos-LI in oxytocin neurons in the paraventricular and supraoptic nuclei in the hypothalamus. Thus, the alpha 2-adrenoceptor is involved in transcriptional control via Fos expression in neurons related to autonomic and other functions.

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