Studies have shown that postoperative disseminated intravascular coagulopathy (DIC) occurs in some patients with cardiac disease, acute aortic dissection, and ruptured abdominal aortic aneurysm. The specific pathophysiology of DIC in these settings are related to low cardiac function, shock, infection and sepsis as well as activation of coagulation cascade in the aneurysm sac or dissected aorta. A soluble form of recombinant human thrombomodulin (rhsTM) was approved in 2008 for the treatment of DIC. This report describes the safety and efficacy of rhsTM for the treatment of DIC in patients with cardiovascular disease operated in our department. Between October 2010 and March 2012, 35 patients with postoperative DIC were treated with rhsTM. Diagnosis of DIC was based on the diagnostic criteria for DIC of the Japanese Association for Acute Medicine (JAAM). During the first 6 months of the study period, after a diagnosis of DIC was made, the patients were treated with gabexate mesilate and antithrombin III, and if patients showed no improvement with conventional treatment, they received rhsTM for 6 days. During the last 10 months of the study period, patients received rhsTM soon after a diagnosis of DIC was made. Twenty seven patients survived for 28 days after rhsTM treatment, and the mortality rate was 22.9% (8/35). Patients who survived showed improvement in acute phase DIC scores, FDP levels, D-Dimer, fibrinogen and platelet counts during rhsTM treatment, but no improvement was observed in patients who died. No serious adverse events were found up to 28 days after the start of rhsTM administration. In conclusion, this study showed no adverse events of rhsTM, and further studies are needed to confirm that rhsTM administration is an effective therapeutic modality in the management of DIC after cardiovascular surgery.

A clinico-epidemiological analysis was performed of 2,414 consecutive stroke patients who were treated in our hospital during the 6-year period from 1997 through 2003. All the patients were neurologically examined and diagnostic studies were made by use of computed tomography. Cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage accounted for 68%, 22%, and 10% of the stroke cases, respectively. The incidence of these subtypes of stroke in this region during the past 20 years was characterized by a singnificant decrease in cerebral hemorrhage, and an increased proportion of cerebral infarction. Men exceeded women in the incidences of both cerebral infarction and hemorrhage, whereas characteristically women far exceeded men in subarachnoid hemorrhage. The incidence reached a peak in the 70-79 age group regardless of the subtypes of stroke, and 64% of the entire stroke patients were those 70 and older. Women were found to suffer from stroke at much older age than men. As to the site of hemorrhage, putaminal hemorrhage was the most frequent, experienced by 36% of the patients, followed by thalamic hemorrhage in 34% of the patients. Putaminal and pontine hemorrhages predominated in the age groups younger than 60;thalamic, cerebellar and subcortical hemorrhages were predominant in the age groups older than 70. The incidence of these subtypes of hemorrhage during the past 20 years was characterized by a dramatic decrease in putaminal hemorrhage in a younger population, and a significant increase in thalamic, cerebellar, and subcortical hemorrhages in an older population.
Cerebrovascular accident ; Hemorrhage ; seconds ; Age Group Unspecified ; incidence of cases

Objective: In 2018, the Shinjuku City Department of Health detected excess cases of hepatitis A virus (HAV) infection. The objectives of this investigation were to characterize the outbreak, identify transmission routes among inpatient cases and make recommendations to control and prevent HAV infection among men who have sex with men. Methods: Information about cases of HAV infection was collected from the National Epidemiological Surveillance for Infectious Diseases system and inpatient interviews conducted by public health nurses in 2018. Results: There were 131 HAV cases in 2018. Of these, 98% (129/131) were male, of whom 81% (105/129) were men who have sex with men. Hospitalization was required for 40 cases (31%). The age groups with the highest proportion of cases were 30–39 and 40–49 years (each 34%; 44/131). Two cases (2%) had received the second dose of the HAV vaccine, but only 10 days before symptom onset; all others had received no doses. The sequence type subgroup 13, an RIVM-HAV-16–090-like strain, was seen in 51 cases (39%). Of the 40 hospitalized cases, 21 (53%) participated in an interview conducted using a semistructured questionnaire. Altogether, of 21 cases, 12 (57%) had coinfection with HIV, 13 (62%) had casual sexual contact within the preceding 2 months and 10 (48%) had used social networking services (SNS) to find a sexual partner. Discussion: In Shinjuku, this outbreak almost exclusively affected the population of men who have sex with men. The detected outbreak strain has previously been reported in outbreaks among men who have sex with men in Taiwan (China) and Europe. For HAV prevention, the most important measures are raising awareness of the risk of HAV as a sexually transmitted infection via SNS and promoting immunization at the appropriate time.

BACKGROUND: Sedentary behaviors have recently become an important public health issue. We aimed to investigate the relationship between screen time and nutrient intake in children and adolescents. METHODS: The present study was conducted in 2013. Data were collected from children and adolescents aged between 6 and 15 years old in Shika town. Questionnaires were distributed to 1459 subjects, 1414 of whom participated in the study (96.9%). Sedentary behaviors were assessed based on participants' screen behaviors (television (TV) viewing, personal computer (PC) use, and mobile phone (MP) use). The main outcomes were the intake of nutrients from a validated food frequency questionnaire. Analysis of covariance (ANCOVA) was used to examine the significance of differences in nutrient intake estimates. Multivariate linear regression analyses, adjusting for age, BMI, and physical activity, were used to provide parameter estimates (β) and 95% CI for the relationship between screen time and nutrient intake. RESULTS: In boys, longer TV viewing times correlated or tended to correlate with a lower intake of protein, potassium, calcium, iron, vitamin K, vitamin B-2, and total dietary fiber. In girls, longer TV viewing times correlated with a lower intake of protein, sodium, calcium, vitamin D, and vitamin B-2. Longer TV viewing times correlated with a higher intake of n-6 fatty acids in girls. PC use was related or tended to be related to a lower intake of potassium, iron, vitamin K, and folic acid in boys, but not in girls. A relationship was observed between MP use and a lower intake of vitamin K in boys, and MP use and a higher intake of vitamin D in girls. CONCLUSIONS The present results revealed that longer TV viewing times are associated with less protein, minerals, vitamins, and total dietary fiber intake in children and adolescents. It was also revealed that boys with PC use have less minerals and vitamins. These results support the need to design intervention programs that focus on decreasing TV viewing time in both sexes and PC use in boys while encouraging adherence to dietary guidelines among children and adolescents.
Adolescent ; Body Mass Index ; Child ; Cross-Sectional Studies ; Diet ; Energy Intake ; Exercise ; Female ; Humans ; Japan ; Male ; Screen Time ; Sedentary Behavior ; Sex Factors ; Socioeconomic Factors