A 56-year-old man, who was admitted with cerebral infarction in our hospital, was infected with MRSA, probably through the gastrointestinal endoscopy. Taking advantage of this episode, we reevaluated the procedure of cleaning and disinfection for endoscopes by bacteriological examination. Before encountering the MRSA case, we had routinely used a simple cleaning procedure. After an examination was over, an endoscope was wiped up with ethanol-soaked gauze, sucked an enzymatic detergent, water and positive soap solution through the biopsy-suction channel, and lastly was washed by the automated reprocessor (3-5 minutes for total process), if the patient was free of infectious diseases such as hepatitis B, C and syphilis. In this symple method, bacteria were detected in 10 out of 46 samples from after-cleaning endoscopes. The results were such that we adopted the new procedure for cleaning and disinfection as follows ; after wiping the surface of an endoscope by propanol-wet gauze, an endoscope was washed by neutral detergent manually, and the biopsy-suction channel was brushed up three times. Then, the endoscope was completely immersed in a 2% glutar aldehyde solution. In this procedure, no bacterium was detected in the samples from the endoscopes. However, as the concentration of glutar aldehyde rapidly decreased, it is necessary to use a test strip specific for the minimum effective concentration of glutar aldehyde frequently to monitor the potency of such solution

A 74-year-old man had a right common iliac aneurysm perforating into his inferior vena cava. He showed a pulsating abdominal mass, claudication of the right leg and swelling of both legs. The fistula was preoperatively diagnosed by aortography. The fistula was closed with two interrupted 3-0 monofilament sutures with pledgets within the aneurysm, by clamping all vessels communicating to it. The aneurysm was replaced with a Y-shaped Dacron graft. The postoperative course was uneventful and the patient was discharged on the 17th postoperative day without any leg claudication or swelling of the legs. This complication is rare, with only 7 such reports in Japan. It should be surgically managed as soon as the diagnosis is confirmed. Clamping all vessels communicating to the fistula in closing it is a safe and reliable approach.

For the purpose of relieving stress caused by post operative change in diet due to gastric cancer, a cancer salon which included a cooking class collaborating with doctors, oncology certified nurse specialist, NST registered dietitian, cancer support center nurse, and cook was held. The cancer salon was intended for post gastrectomy patients and their families. There were total of 20 participants（12 patients, 8 families, 8 males and 12 females）, and among them were six couples. We conducted a questionnaire survey of cancer salon to participants whose average age was 64±13.4 years old. All participants responded“good”or“fair”in all items. Among respondents, 61％（n＝11）said it was fun, 88％.（n＝15）said“cooking in the cooking class would be helpful in the future”. Not only learning how to cook, the salon provided an opportunity for participants to interact with each other and exchange information. In addition it helped participants to realize that there are others having the same disease who want to exchange opinions and the disease is not a problem of an individual rather it exists more universally.

Background: Remimazolam is a novel ultrashort-acting benzodiazepine that has recently become available for general anesthesia. However, the incidence of postoperative nausea and vomiting (PONV) associated with remimazolam remains unknown. In this propensity score-matched, retrospective, observational study, we compared the rates of PONV between remimazolam and propofol. Methods: In this retrospective observational study, propensity score-matching was performed to minimize selection bias. Patients who received total intravenous anesthesia with remimazolam or propofol at the Hamamatsu University Hospital between August 2020 and July 2021 were enrolled in the study. Data on patient demographics, anesthetic agents, and PONV within the first 24 h were collected and analyzed. Results: Of the 1,239 patients who met the study selection criteria, 585 received remimazolam and 684 received propofol. After propensity score matching, 333 matched pairs were further analyzed. Patient demographics and the anesthetic agents used were comparable between the matched cohorts. The incidence of PONV was significantly higher in the remimazolam group than in the propofol group (35% vs. 21%, P < 0.001). Conclusions The incidence of PONV is higher with remimazolam anesthesia than with propofol anesthesia. The findings of this study require confirmation in larger prospective randomized controlled trials.

Background: Choosing catecholamines, such as norepinephrine and dopamine, for perioperative blood pressure control is essential for anesthesiologists and intensivists. However, studies specific to noncardiac surgery are limited. Therefore, we aimed to evaluate the effects of postoperative norepinephrine and dopamine on clinical outcomes in adult noncardiac surgery patients by analyzing a nationwide intensive care patient database. Methods: The Japanese Intensive care PAtient Database (JIPAD) was used for this multicenter retrospective study. Adult patients in the JIPAD who received norepinephrine or dopamine within 24 h after noncardiac surgery in 2018–2020 were included. We compared the norepinephrine and dopamine groups using a one-to-one propensity score matching analysis. The primary outcome was in-hospital mortality. Secondary outcomes were intensive care unit (ICU) mortality, hospital length of stay, and ICU length of stay. Results: A total of 6,236 eligible patients from 69 ICUs were allocated to the norepinephrine (n = 4,652) or dopamine (n = 1,584) group. Propensity score matching was used to create a matched cohort of 1,230 pairs. No differences in the in-hospital mortality was found between the two propensity score matched groups (risk difference: 0.41%, 95% CI [−1.15, 1.96], P = 0.608). Among the secondary outcomes, only the ICU length of stay was significantly shorter in the norepinephrine group than in the dopamine group (median length: 3 vs. 4 days, respectively; P < 0.001). Conclusions In adult patients after noncardiac surgery, norepinephrine was not associated with decreased mortality but was associated with a shorter ICU length of stay than dopamine.

Dengue fever (DF) is a major public health concern in the Dominican Republic. In recent years, several epidemics of DF have been reported to the Pan American Health Office (PAHO), but the extent of the epidemics has not been clearly understood yet. Therefore, we conducted a nationwide seroepidemiology of dengue (DEN) infection. At the same time, we conducted an interview survey to assess public awareness regarding the disease. The serum samples were collected at seven main cities in the Dominican Republic and screened for DEN antibody with a commercial ELISA kit. A total of 2007 serum specimens were examined. The prevalence of DEN antibody in the seven cities varied between 43.1 and 89.7%. Neutralization (N) test carried out on the ELISA-positive serum from Samana, one of the high antibody-prevalent cities, revealed that all the sera showed positive to at least two DEN serotypes. Geometric mean N titers against DEN-1, 2, 3 and 4 were 40.5, 463.7, 59.9 and 454.4 respectively. No difference in antibody prevalence was observed between males and females. It appeared that a high level of awareness regarding DF did little affect DEN prevalence. Strong, concrete public health strategies that motivate the local community to combat DF are required.

Kampo physicians in the Showa era, such as ARAKI Seiji and OTSUKA Keisetsu, had called raw ginger as the herbal medicament “ginger”, and processed or unprocessed dried ginger as the medicament “processed gin­ger”. However, many Kampo physicians in the present Japan call unprocessed dried ginger as the medicament “ginger”, and processed dried ginger as the medicament “processed ginger”. The aim of this study is to investi­gate the background of the process of this change from the Showa era to the present. We searched the defini­tions of the medicaments “ginger” and “processed ginger” in successive Japanese Pharmacopoeia editions and other related books describing these definitions. In Japanese Kampo medicine before the Showa era, the herbal medicament “ginger” had referred to raw ginger, and the medicament “processed ginger” had referred to proc­essed or unprocessed dried ginger. However, after the Heisei era, the medicaments “ginger” and “processed ginger” have referred to unprocessed dried ginger and processed dried ginger, respectively. And the raw ginger has been called as “preserved ginger”.

Bovine abortion, diarrhea, and respiratory disease complexes, caused by infectious agents, result in high and significant economic losses for the cattle industry. These pathogens are likely transmitted by various vectors and reservoirs including insects, birds, and rodents. However, experimental data supporting this possibility are scarce. We collected 117 samples and screened them for 44 bovine abortive, diarrheal, and respiratory disease complex pathogens by using Dembo polymerase chain reaction (PCR), which is based on TaqMan real-time PCR. Fifty-seven samples were positive for at least one pathogen, including bovine viral diarrhea virus, bovine enterovirus, Salmonella enterica ser. Dublin, Salmonella enterica ser. Typhimurium, and Neospora caninum; some samples were positive for multiple pathogens. Bovine viral diarrhea virus and bovine enterovirus were the most frequently detected pathogens, especially in flies, suggesting an important role of flies in the transmission of these viruses. Additionally, we detected the N. caninum genome from a cockroach sample for the first time. Our data suggest that insects (particularly flies), birds, and rodents are potential vectors and reservoirs of abortion, diarrhea, and respiratory infectious agents, and that they may transmit more than one pathogen at the same time.
Animals ; Birds ; Cattle ; Cockroaches ; Diarrhea Viruses, Bovine Viral ; Diarrhea ; Diptera ; Disease Reservoirs ; Disease Vectors ; Enterovirus ; Enterovirus, Bovine ; Genome ; Insects ; Neospora ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Rodentia ; Salmonella enterica ; Virulence Factors