The turning on of downlights during nighttime treatment in neonatal intensive care units (NICU) rapidly increases light intensity. Therefore, at Hospital A, we investigated how a change in light intensity from low to high affected 30 premature/low birth weight infants, by turning on downlights in the NICU for 10 s and using a stress scale to compare stress levels before and after the change in light intensity. High-intensity lighting induced tachypnea and brief pauses in breathing, and significantly decreased SpO2 by 0.6% in 58% of the infants. Autonomic stress responses observed in this study were apnea, tachypnea, hiccup, distress, twitching, yawning, and sighing. Motor stress responses were stretching the arms and legs, making a fist, and opening the palm. CNS stress responses were vocalization, scowling, and eye-opening (rapid change from sleep to arousal state). These findings suggest that the change to high-intensity lighting can induce stress symptoms and temporarily suppress breathing, which shortens inspiration as well as the entire respiratory cycle, thereby decreasing SpO2, in many infants in the NICU. Our findings also suggest that a change in light intensity causes stress not only in the autonomic nervous systems but also in other body systems.

Introduction: The career support system was introduced in Okayama University Hospital in 2008, and the number of users has exceeded 150. Methods: To examine changes in perceptions of the system and its users, we conducted a questionnaire survey of supervisors and the colleagues of system users in FY2011 and FY2018. Results: Compared to 2011, the following items were significantly higher in FY2018: "I have experience working with users of the support system", "I think this system is useful for the medical office", and "This system makes the medical office more appealing". In the analysis of the colleagues of system users only, in addition to the aforementioned three items, the item "Users of the system are able to do their jobs to the degree expected" was significantly higher in FY2018. Conclusion: The effectiveness of the career support system is becoming more recognized, and the evaluation of the work content of the system's users has improved.

Objectives: Although a few studies have investigated the relationship between kidney and oral function (number of remaining teeth), their results remain inconclusive. Therefore, this study aimed to investigate the relationship between kidney function and oral health in community-dwelling healthy elderlies and examine the factors associated with kidney function. Materials and Methods: We used cross-sectional data from the Shimane prefecture cohort recruited by the Center for Community-Based Health Research and Education in 2019. We collected clinical data on dental status, background factors and kidney function (estimated glomerular filtration rate [eGFR], mL/min/1.73 m2 and creatinine levels, mg/dL). Results: The study enrolled 481 participants, whose mean age was 66.7±7.4 years, and 223 (46.4%) participants were men. Multivariate analysis revealed significant correlations between eGFR (B=0.17, P=0.04), creatinine (B=–0.54, P<0.01), and the number of remaining teeth. The number of remaining teeth was associated with creatinine and eGFR, which are indicators of kidney function. Conclusion This study suggests that preserving the teeth may prevent decline in kidney function. Dental professionals should provide instructions and professional care to reduce the risk of systemic diseases such as kidney dysfunction.

OBJECTIVESOur objectives were (1) to evaluate whether single spot urine is suitable media for longer-term phthalate esters exposure assessment, and (2) to estimate intake level of phthalate esters of Japanese pregnant women using urinary metabolites as an indicator of prenatal exposure level in their offspring.

METHODSWe analyzed nine metabolites (MMP, MEP, MnBP, MBzP, MEHP, MEOHP, MEHHP, MINP, MnOP) of seven phthalate esters in spot urine samples from 50 pregnant women by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Using four urine samples collected from each of 12 subjects from 50 pregnant women within 5-12 weeks, we compared intra- and interindividual variation in urinary metabolites by calculation of intraclass correlation coefficient (ICC). We estimated daily intakes of 50 pregnant women from their urinary metabolite concentrations.

RESULTSICCs for seven phthalate metabolite concentrations in single spot urine samples were: MMP (0.57), MEP (0.47), MnBP (0.69), MBzP (0.28), MEHP (0.51), MEHHP (0.43), and MEOHP (0.41) in 12 pregnant women. Phthalate ester metabolites had high detection rates in 50 subjects. The mean daily intake ranged from 0.01 to 2 mug/kg per day. The daily intake levels in all subjects were lower than corresponding tolerable daily intake (TDI) set by the European Food Safety Authority (EFSA), though maximum value for DnBP of 6.91 mug/kg per day accounted for 70% of TDI value.

CONCLUSIONSHigher ICCs indicated that phthalate metabolite levels in single spot urine could reflect longer-term exposure to the corresponding diesters of subjects. Although the current exposure level was less than TDIs, further studies and exposure monitoring are needed to reveal the toxicity of phthalate esters to sensitive subpopulation.

Coronavirus disease 2019 (COVID-19) has spread rapidly in Japan. The purpose of this study was to report the clinical experience of our COVID-19 patients early in the pandemic and lessons from our experience. An outpatient fever clinic was established on April 7. Admission of COVID-19 patients was started on July 23. Between April 7 and September 30, there were 364 walk-in outpatients and emergency patients with fever. Polymerase chain reaction test for SARS-CoV-2 RNA or COVID-19 antigen test were performed in all patients, and all results were negative. Twenty patients with COVID-19 were admitted to a newly established dedicated COVID-19 ward. They were discharged well. There were no cases of nosocomial infection at our hospital. Length of hospitalization was correlated with serum ferritin level at admission, serum CRP level at admission, and age. More than half the patients experienced psychological stress, and COVID-19 specialized nurses experienced some stress. It is essential to set up the medical system for COVID-19 according to the trends of the disease. Creation of our original database and our “problem notebook” were useful for treatment and care of COVID-19 patients as well as for mental care of nurses.