We describe a prototype seminar, inspired by the problem-based learning tutorial system, on pediatric emergency practice for young physicians working in 7 pediatric emergency centers in Yokohama. The seminar was received favorably by the participants, especially as an opportunity for individual learning. We expect that the seminar will contribute to the standardization of emergency practice in these pediatric centers and the establishment of an interhospital network.

Objective: The hospital is changing its formulary reference from paper-based to intranet.  There was concern that both paper-based and intranet versions of the formulary would be necessary.  Revising the paper-based hospital formulary each time package inserts are revised is difficult.  For your review we report on the creation of the iPhone® electronic formulary which enables rapid off-line formulary retrieval and easy updates while at the same time providing low cost service in a light device.
Methods: The CSV (Comma Separated Value) of the hospital formulary dictionary was made using a standard personal computer.  The CSV data file was converted using JAMES2DIC into a HTML file format.  Next, the converted HTML file is transformed into the EPWING (Electronic Publishing WING) format using EBStudio.  Finally, we forward the EPWING dictionary file from the personal computer to the iPhone®.  The retrieval becomes possible by using EBPocket for iOS of EPWING/electronic book viewer software for the iPhone®.  The number of items was assumed to be 29 items thought for a lot of inquiries to exist.
Results: We compared the paper-based formulary with the iPhone® electronic formulary.  As a result, the iPhone4® electronic formulary shortened the retrieval time, was smaller, lighter, and excellent at a lower price.
Conclusion: The iPhone4® electronic formulary enables the user to perform complex full-text searches and retrieve information at a much higher speed than is possible with paper based formularies.  It has the additional advantage of seamless integration and deployment of formulary additions or reference material revisions.  We believe we have successfully created a practical electronic formulary.

Introduction: This study reports on a case of SAPHO syndrome in a patient in the palliative care unit who had multiple bone metastases of an unknown primary carcinoma. Case: A 74 year old male presented with broken eleventh thoracic and third lumbar vertebrae. Magnetic resonance imaging (MRI) revealed multiple lesions, which were thought to be bone metastases of a carcinoma, in the thoracic and lumbar spine. Attempts to identify the location of the primary lesion were unsuccessful. Therefore, the differential diagnosis was multiple bone metastases of an unknown primary carcinoma. The patient was transferred to the palliative care unit. The patient’s condition remained largely unchanged for several years; therefore, a second set of clinical examinations was conducted. Computed tomography revealed sternocostoclavicular hyperostosis, and there was symmetric uptake on bone scintigraphy. Further MRI studies revealed that the spinal lesions were comparatively reduced, leading to a diagnosis of SAPHO syndrome. Discussion: SAPHO syndrome is a rare, benign disease that presents as a variety of osteoarticular disorders with specific dermatoses. SAPHO syndrome is difficult to diagnose; therefore, it is important to consider it as a differential diagnosis in patients with bone lesions.

　　Epidermal growth factor receptor (EGFR) gene mutation examination is now performed in most medical institutions in order to select the molecular targeted medicine for lung cancer. It became clear that the positive rate of the biopsy material was lower than that of the surgical sample in this hospital. The cause was attributed to false negatives due to low tumor cell content in biopsy specimens. We investigated the presence of the mutation using surgical samples and preoperative biopsy specimens from the same patients in 13 cases. Furthermore, we investigated the tumor cell content of the biopsy specimens by cell counting. Results showed that 3 of 6 biopsy specimens that were associated with positive surgical samples were judged to be negative. The tumor cell content was less than 5% in all negative cases. Regarding EGFR gene mutation examination, we should carefully determine tumor cell content when using biopsy specimens.

Coffee administration has been shown to increase maximum voluntary contraction and muscular endurance. However, no study has addressed the association between daily consumption of coffee with muscular function. This cross sectional study aimed to investigate the association between frequency of coffee consumption (CC) in daily life and muscle strength among a population of working adult men. This cross sectional study included men (n = 516, mean age: 47.1) who participated in an annual health examination conducted in Sendai. The monthly frequency of coffee consumed was reported by a brief-type self-administered dietary history questionnaire. Leg extension power (LEP) was measured as an index of muscle strength. Subjects were divided into tertile levels according to CC. Analysis of covariance was used to examine the relation between the tertile levels of CC and LEP. After adjustment for potential confounders (including all lifestyle factors), the adjusted means (95% confidence interval) of LEP across the tertiles of CC were 17.4 (16.6 - 18.1) for the lowest tertile, 17.9 (17.4 - 18.5) for the mid tertile, and 18.9 (18.3 - 19.5) for the highest tertile (p for trend = 0.007). Higher frequency of monthly coffee consumption was associated with higher muscle strength.

Anti-lipopolysaccharide (LPS) antibody administration has the potential benefits of neutralizing and consequently controlling rumen-derived LPS during subacute ruminal acidosis. Four Holstein bulls were used in this crossover study with a 2-week wash-out period. Anti-LPS antibody (0 or 4 g) was administered once daily for 14 days. Significantly lower ruminal LPS and higher 1-h mean ruminal pH were identified in the 4 g group. However, blood metabolites, acute-phase proteins, cytokines, and hepatic transcriptomes were not different between the two groups. Therefore, anti-LPS antibody administration mitigated ruminal LPS release and pH depression without accompanying responses in acute-phase inflammation or hepatic transcriptomic expression.

Anti-lipopolysaccharide (LPS) antibody administration has the potential benefits of neutralizing and consequently controlling rumen-derived LPS during subacute ruminal acidosis. Four Holstein bulls were used in this crossover study with a 2-week wash-out period. Anti-LPS antibody (0 or 4 g) was administered once daily for 14 days. Significantly lower ruminal LPS and higher 1-h mean ruminal pH were identified in the 4 g group. However, blood metabolites, acute-phase proteins, cytokines, and hepatic transcriptomes were not different between the two groups. Therefore, anti-LPS antibody administration mitigated ruminal LPS release and pH depression without accompanying responses in acute-phase inflammation or hepatic transcriptomic expression.

Background: The relationships between the postpartum subacute ruminal acidosis (SARA) occurrence and predicted bacterial functions during the periparturient period are still not clear in Holstein cows. Objectives: The present study was performed to investigate the alterations of rumen fermentation, bacterial community structure, and predicted bacterial functional pathways in Holstein cows. Methods: Holstein cows were divided into the SARA (n = 6) or non-SARA (n = 4) groups, depending on whether they developed SARA during the first 2 weeks after parturition.Reticulo-ruminal pH was measured continuously during the study period. Reticulo-ruminal fluid samples were collected 3 weeks prepartum, and 2 and 6 weeks postpartum, and blood samples were collected 3 weeks before, 0, 2, 4 and 6 weeks postpartum. Results: The postpartum decline in 7-day mean reticulo-ruminal pH was more severe and longer-lasting in the SARA group compared with the non-SARA group. Changes in predicted functional pathways were identified in the SARA group. A significant upregulation of pathway “PWY-6383” associated with Mycobacteriaceae species was identified at 3 weeks after parturition in the SARA group. Significantly identified pathways involved in denitrification (DENITRIFICATION-PWY and PWY-7084), detoxification of reactive oxygen and nitrogen species (PWY1G-0), and starch degradation (PWY-622) in the SARA group were downregulated. Conclusions The postpartum SARA occurrence is likely related to the predicted functions of rumen bacterial community rather than the alterations of rumen fermentation or fluid bacterial community structure. Therefore, our result suggests the underlying mechanisms, namely functional adaptation of bacterial community, causing postpartum SARA in Holstein cows during the periparturient period.

The number of patients with osteoporosis is an estimated 12,800,000 in Japan. Osteoporosis represents a risk factor for becoming bedridden, and also for increased mortality. It would thus be important to take measures to prevent non-examination and treatment interruption as their rate is high. We recruited participants at a health-supporting event for local residents at our pharmacy on April 14, 2019 and obtained consent from 40 individuals to participate in this study. At this event held by a pharmacy, we conducted bone density measurement and osteoporosis-related preventive education by pharmacists, considering the influence the event had on health-related awareness and behavior in the local residents. Knowledge of osteoporosis was higher after than before the events. Participant health and lifestyle awareness was not observed between before the event and one month after the event. However, one month after the event, several changes could be observed in the behavior of 79.4% (27/34) of the participants. Based on these results, bone density measurement and osteoporosis-related preventive education by pharmacists are suggested to increase osteoporosis-related knowledge among local residents and to promote behavior change related to healthcare and osteoporosis.

BACKGROUND/AIMS: There is no consensus for using endoscopic papillary large balloon dilation (EPLBD) in patients without dilatation of the lower part of the bile duct (DLBD). We evaluated the feasibility and safety of EPLBD for the removal of difficult bile duct stones (diameter ≥10 mm) in patients without DLBD. METHODS: We retrospectively reviewed the records of 209 patients who underwent EPLBD for the removal of bile duct stones from October 2009 to July 2014. Primary outcomes were the clearance rate and additional mechanical lithotripsy. Secondary outcomes were the incidence of complications and recurrence rate. RESULTS: Fifty-seven patients had DLBD (27.3%), and 152 did not have DLBD (72.7%). There were no significant differences in the overall success rate or the use of mechanical lithotripsy. Success rate during the first session and procedure time were better in the DLBD than the without-DLBD group (75.7% vs 66.7%, 48.1±23.0 minutes vs 58.4±31.7 minutes, respectively). As for complications, there were no significant differences in the incidence of pancreatitis, perforation or bleeding after endoscopic retrograde cholangiopancreatography. The recurrence rate did not differ significantly between the two groups. CONCLUSIONS: EPLBD is a useful and safe method for common bile duct stone removal in patients without DLBD.
Bile Ducts* ; Bile Ducts, Extrahepatic* ; Bile* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Consensus ; Dilatation* ; Hemorrhage ; Humans ; Incidence ; Lithotripsy ; Methods ; Pancreatitis ; Recurrence ; Retrospective Studies