Probiotics are defined as live microorganisms that confer a health benefit on the host when consumed in adequate amounts, such as Lactobacillus, Streptococcus, Enterococcus, Lactococcus, Bifidobacterium, Bacillus, Clostridium, Saccharomyces, Aspergillus, and Escherichia coli species. Previous studies have reported beneficial effects of probiotics on intestinal infections, including Clostridium difficile antibiotic-associated diarrhea, rotavirus infection, traveler's diarrhea, and other bacterial enteric diseases. Although few studies have reported serious adverse effects from probiotics, more evidence-based research is required for an in-depth evaluation of probiotics in medical science.
Aspergillus ; Bacillus ; Bifidobacterium ; Clostridium ; Clostridium difficile ; Diarrhea ; Enterococcus ; Escherichia coli ; Insurance Benefits ; Lactobacillus ; Lactococcus ; Probiotics ; Rotavirus ; Rotavirus Infections ; Saccharomyces ; Streptococcus

The need for medical team care is increasing because of advances in medical care and changing national needs. For more than 20 years medical students at the University of Tsukuba have participated in medical team care practice before bedside learning during the third trimester of their 4th year. The objective of this practice is to understand patients from the nurses' point of view and to learn cooperation between doctors and co-medical staff. We analyzed students reports to study what they had learned. A total of 326 items in 11 categories were specified in the free-response part of the reports. The largest category was “nursing/nurses” and the second largest was “communication/human relations.” The results show that the students learned points other than the General Instruction Objectives and that the practice was extremely effective.

Water Jet flow was projected at normal human aortic walls and human chronic obstructive iliac arteries in the air or in the ordinary saline solution. Ordinary saline solution was used for the jet, which was projected at a pressure of 10kg·f/cm² through a nozzle 0.10mm in diameter. When the Water Jet was projected at the normal aortic intima, damage to the wall was more severe with duration of fluid projection, and projection for ten sec ruprured the elastic fiber of the media. But when the fluid jet projected ordinary saline, damage to the aortic wall was slight and projection for 30sec only dissected the surface of the intima. Water Jet projection in air showed slight effect on thrombi of the chronic obstructive iliac arteries, and projection for 60sec only made small irregular holes in the thrombi. When the Water Jet was projected in ordinary saline solution, however, destructive effects on thrombi were stronger and the projection for 40sec could remove almost all the thrombi for a distance of 2cm, while damage to the initima was very slight. This study demonstrated that fluid jet projection using ordinary saline solution could remove thrombi in chronically obstructive artery safely and effectively and suggested the possibility of the Water Jet angioplasty.

The purpose of this study was to estimate the postoperative growth of untreated segments of the dissected aorta with non-thrombotic communicating false lumen, and also to evaluate the clinical outcome in relation to the aortic enlargement after surgery. Nineteen patients who underwent surgical treatment of aortic dissection were studied with enhanced CT scans and angiograms during the postoperative follow-up period. In Stanford type A patients, mean aortic dilatation rate calculated at the segment showing maximal dilatation was 5.1mm/year during 13-82 months (average, 41 months) after surgery, as a sequela of enlargement of the false lumen. Differences in the aortic dilatation rates between the different segments of the aorta were observed and these were per annum 4.8mm in the ascending aorta, 5.4mm in the transverse aortic arch, 4.3mm in the proximal descending aorta, 2.7mm in the distal descending aorta and 2.4mm in the abdominal aorta. In all patients, major communications were detected at the perianastomotic sites on angiography. In Stanford type B patients, false lumens with small communications were observed to show gradual thrombotic occlusion, but no significant aortic dilatation was detected during the follow-up period (13-70 months, average: 44 months), except three cases of sudden death who had major communications. Nine late events related to dissection, consisting of 4 sudden deaths suspected to be due to aortic rupture, 2 intestinal necroses and 3 cerebral infarctions, occured in 6 patients (32%), among which three patients had undergone arterial fenestration, one of whom had double barrel anastomosis. In the remaining two, major leakages were recognized at distal aortic anastomotic sites on postoperative angiography. The results of this study, we stress the importance of periodic check-ups using enhanced CT scan and if necessary, angiography after surgery of the patients having communicating false lumen. Early detection of progressive aneurysm formation and timely surgical reintervention can yield a good prognosis.

A 64-year-old man was admitted with intermittent high fever of 4 months duration and with three episodes of arterial embolism in the previous 2 months. Several investigations revealed evidence that those episodes involving bilateral popliteal arteries and the left external iliac artery originated from mycotic emboli. Severe mitral insufficiency due to infective endocarditis was also recognized. The ischemic symptoms improved after medical treatment. Despite antibiotic therapy for 4 weeks, inflammatory signs did not subside. Since aneurysm formation of the left external iliac artery at the embolized portion was detected on CT, mitral valve replacement and aneurysmectomy with femoro-femoral grafting were done concomitantly. Inflammatory signs disappeared immediately after the operation. Pathological findings indicated organization of the mitral vegetation and evidence of active infection in the aneurysm wall. Though aneurysmal change of a symptomatic embolized site is not common, the preoperative evaluation of possible associated mycotic aneurysm is important to decide on surgical strategy for infective endocarditis complicated by embolism.

Background: Rotavirus vaccines were introduced in Japan in November 2011. We evaluated the subsequent reduction of the health-care burden of rotavirus gastroenteritis. Methods: We conducted active surveillance for rotavirus gastroenteritis among children under 5 years old before and after the vaccine introduction. We surveyed hospitalization rates for rotavirus gastroenteritis in children in Tsu City, Mie Prefecture, Japan, from 2007 to 2015 and surveyed the number of outpatient visits at a Tsu City clinic from 2010 to 2015. Stool samples were obtained for rotavirus testing and genotype investigation. We assessed rotavirus vaccine coverage for infants living in Tsu City. Results: In the pre-vaccine years (2007-2011), hospitalization rates for rotavirus gastroenteritis in children under 5 years old were 5.5, 4.3, 3.1 and 3.9 cases per 1000 person-years, respectively. In the post-vaccine years (2011-2015), the rates were 3.0, 3.5, 0.8 and 0.6 cases per 1000 person-years, respectively. The hospitalization rate decreased significantly in the 2013-2014 and 2014-2015 seasons compared to the average of the seasons before vaccine introduction (p < 0.0001). In one pre-vaccine year (2010-2011), the number of outpatient visits due to the rotavirus infection was 66. In the post-vaccine years (2011-2015), the numbers for each season was 23, 23, 7 and 5, respectively. The most dominant rotavirus genotype shifted from G3P[8] to G1P[8] and to G2P[4]. The coverage of one dose of rotavirus vaccine in Tsu City was 56.5% in 2014. Conclusion: After the vaccine introduction, the hospitalization rates and outpatient visits for rotavirus gastroenteritis greatly decreased.