INTRODUCTION: The introduction of the mass screening (MS) program measuring urinary catecholamine metabolites at six-months of age for detecting neuroblastoma has resulted in the increase in both number and incidence of patients detected less than one year of age in Japan. The prognosis for infantile neuroblastoma is well known to surpass that for older patients. The prognosis of patients detected by MS has been outstanding. However, in Japan, there has been no consentient guideline of optimal therapeutic management for infants with favorable prognosis. There has been a continuing controversy on the selection of appropriate therapy for neuroblastoma infants, especially those detected by MS. In Japan, based on prognostic factors including N-myc amplification as well as clinical stage, patients with advanced disease receive a consistent therapeutic regimen. In contrast, neuroblastoma infants with favorable biological characteristics and clinical outcome have received variable therapeutic regimens at individual institutions. Resulting from an urgency to assess the status and enforce a consentient as well as an optimal management plan for neuroblastoma infants, the survey and the analysis on a total of 537 cases, including 355 cases detected by the MS program, were conducted and led us to the conclusion that neuroblastoma infants in Japan had been treated comparatively intensive despite excellent prognosis, and further that adjuvant chemotherapy should be avoidable or minimized for patients with such excellent outcomes. Finally, a nationwide prospective study (#9405) has been commenced in Japan to standardize and to optimize therapy for neuroblastoma infants. In the present paper, retrospective considerations and current stategy for neuroblastoma infants in Japan will be discussed.
Chemotherapy, Adjuvant ; Humans ; Incidence ; Infant* ; Japan* ; Mass Screening ; Neuroblastoma* ; Population Characteristics ; Prognosis ; Retrospective Studies

A 77-year-old woman was referred to our hospital for treatment of a ruptured thoracoabdominal aortic aneurysm (TAAA) with a maximum diameter of 7cm. Considering her age and level of daily activity, the placement of an endovascular stent graft was performed as an emergency rescue procedure. For termination of the endoleak from the distal portion of the stent graft detected by CT the next day, another stent graft placement was added after establishment of blood supply to the superior mesenteric and celiac arteries by placing a Y-shaped graft from the abdominal aorta to each artery with success. The patient was discharged from our hospital 25days after surgery with disappearance of endoleak and good graft patency. A hybrid technique with grafting to abdominal branches, followed by placement of stent graft, can be an alternative treatment for such high-risk patients with ruptured TAAA.

It has been five years since TC 249 was established as a new Technical Committee (TC) at the International Organization for Standardization (ISO), specializing in the field of Chinese traditional medicine. In the second Plenary Meeting held in Den Haag (2011), five working groups (WGs) were established within the TC, two of which specialize in standard development of acupuncture needles (WG3) and other medical devices used in traditional medicine (WG4). Japanese delegates have participated in the discussion within these WGs, paying close attention so as to keep the proposals under discussion consistent with existing Japanese standards and certification standards regulated by the Ministry of Health, Labour and Welfare. However, since most of the participants in TC 249 are clinicians or researchers engaged in medical practices, and not experts on domestic/international standards, discussions on harmonization of the submitted projects often become complicated. In this manuscript, four experts (two from academia and two from companies that manufacture acupuncture needles and moxibustion devices) who attended the fourth plenary meeting held in Durban, South Africa, in May 2013, report on the stage of progress of standardization development in WG3and WG4.

Fourteen female handball players who were candidates for Olympic representative team were asked to run 12 minutes, and the relationship between the variation of the urinary components and the variations of the running speed and the heart beats was researched.
The obtained results in short are in the following:
1) The covered distance of the 12-minute running was from 2, 385 meters to 3, 050 meters, and the average was 2, 830±196.6 meters.
2) The heart beat rate quickly recovered for about 5 minutes after running, and then gradually reduced; after 30 minutes the rate was considerably higher than the level before the running in many cases.
3) The urinary volume was obviously less after the running than that before it.
4) The 1-hour after urine including the running time contained much pyruvates and lactates exhausted therein, and then the excretion amount reduced to the previous level. The ratios of Pyruvic acid/Creatinine and Lactic acid/Creatinine showed similar tendencies. The ratio of Pyruvic acid/Creatinine before the running against that after the running showed positive correlation with the running speed more than 230m/min., but showed a negative correlation clearly with the recovering rate of the heart beat after 30 minutes being higher than 60%. It suggests that the excretion of urinary pyruvate increase with more anaerobic factors for energy production under the conditions of the higher speed running and the larger oxygen debt.
5) The urinary citrate obviously decreased just after the running, but in recovered considerably in the urine obtained after 2 hours. The ratio of Citric acid/Creatinine was low just after the running. The variations appears not to be simply due to the reduction of renal clearance.
6) The urinary creatinine tended to reduce in the urine obtained 1-hour after the running, and particularly with the urinary pyruvate more than 50μg/ml there was observed clear negative correlation with creatinine which showed lower concentration with more anaerobic factors; it suggests some reduction of renal clearance.

A 74-year-old man undergone mitral valve plasty. After cessation of cardiopulmonary bypass, bleeding persisted from the cardioplegia injection site and dilatation of the ascending aorta with discoloration was observed. The diagnosis of type A aortic dissection extending to the descending aorta was made by transesophageal echocardiogram. Replacement of the ascending aorta was performed under deep hypothermic circulatory arrest. The postoperative course was uneventful. The false lumen of the aortic arch and descending aorta was thrombosed completely on postoperative computed tomography. Intraoperative aortic dissection is a rare but fatal complication of cardiopulmonary bypass. Prompt recognition and appropriate surgical management are of prime importance.

Background: Systemic inflammation is associated with poor functional outcomes. However, the effects of improved inflammation on functional indicators remain unclear. This study aimed to clarify the relationship between improvements in systemic inflammation and activities of daily living in patients after stroke. Methods: This retrospective cohort study included patients post stroke with systemic inflammation upon admission. Systemic inflammation was defined as a modified Glasgow Prognostic Score (mGPS) score of 1–2. Improvement in systemic inflammation was defined as a reduction in mGPS score or blood C-reactive protein (CRP) levels during hospitalization. The primary outcomes were the motor items of the Functional Independence Measure (FIM-motor) at discharge. We applied multiple linear regression analysis to examine whether reduced systemic inflammation was associated with outcomes after adjusting for confounding factors. Results: Of the 1,490 patients recruited, 158 (median age of 79 years; 88 men) had systemic inflammation on admission and were included in the study. Among these patients, 131 (82.9%) and 147 (93.0%) exhibited reduced mGPS and CRP levels, respectively. The median change in CRP was 2.1 mg/dL (interquartile range, 1.1–3.8). Multivariate analysis revealed that improvements in mGPS (β=0.125, p=0.012) and CRP levels (β=0.108, p=0.108) were independently and positively associated with FIM-motor at discharge. Conclusions Improvement in systemic inflammation was positively associated with functional outcomes in patients post stroke. Early detection and therapeutic intervention for systemic inflammation may further improve outcomes in these patients.

Background: Systemic inflammation is associated with poor functional outcomes. However, the effects of improved inflammation on functional indicators remain unclear. This study aimed to clarify the relationship between improvements in systemic inflammation and activities of daily living in patients after stroke. Methods: This retrospective cohort study included patients post stroke with systemic inflammation upon admission. Systemic inflammation was defined as a modified Glasgow Prognostic Score (mGPS) score of 1–2. Improvement in systemic inflammation was defined as a reduction in mGPS score or blood C-reactive protein (CRP) levels during hospitalization. The primary outcomes were the motor items of the Functional Independence Measure (FIM-motor) at discharge. We applied multiple linear regression analysis to examine whether reduced systemic inflammation was associated with outcomes after adjusting for confounding factors. Results: Of the 1,490 patients recruited, 158 (median age of 79 years; 88 men) had systemic inflammation on admission and were included in the study. Among these patients, 131 (82.9%) and 147 (93.0%) exhibited reduced mGPS and CRP levels, respectively. The median change in CRP was 2.1 mg/dL (interquartile range, 1.1–3.8). Multivariate analysis revealed that improvements in mGPS (β=0.125, p=0.012) and CRP levels (β=0.108, p=0.108) were independently and positively associated with FIM-motor at discharge. Conclusions Improvement in systemic inflammation was positively associated with functional outcomes in patients post stroke. Early detection and therapeutic intervention for systemic inflammation may further improve outcomes in these patients.

Background: Systemic inflammation is associated with poor functional outcomes. However, the effects of improved inflammation on functional indicators remain unclear. This study aimed to clarify the relationship between improvements in systemic inflammation and activities of daily living in patients after stroke. Methods: This retrospective cohort study included patients post stroke with systemic inflammation upon admission. Systemic inflammation was defined as a modified Glasgow Prognostic Score (mGPS) score of 1–2. Improvement in systemic inflammation was defined as a reduction in mGPS score or blood C-reactive protein (CRP) levels during hospitalization. The primary outcomes were the motor items of the Functional Independence Measure (FIM-motor) at discharge. We applied multiple linear regression analysis to examine whether reduced systemic inflammation was associated with outcomes after adjusting for confounding factors. Results: Of the 1,490 patients recruited, 158 (median age of 79 years; 88 men) had systemic inflammation on admission and were included in the study. Among these patients, 131 (82.9%) and 147 (93.0%) exhibited reduced mGPS and CRP levels, respectively. The median change in CRP was 2.1 mg/dL (interquartile range, 1.1–3.8). Multivariate analysis revealed that improvements in mGPS (β=0.125, p=0.012) and CRP levels (β=0.108, p=0.108) were independently and positively associated with FIM-motor at discharge. Conclusions Improvement in systemic inflammation was positively associated with functional outcomes in patients post stroke. Early detection and therapeutic intervention for systemic inflammation may further improve outcomes in these patients.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have increased the rate of presenteeism among front-line physicians. Presenteeism is the term used to describe attendance at work despite ill health that would normally prompt rest or absence from work. This study aimed to examine the associations between COVID-19 clinical practice and presenteeism among physicians. METHODS: A cross-sectional study was conducted from December 2021 to January 2022. The questionnaires were distributed to 21,737 employed physicians who were members of the Japan Medical Association. Presenteeism was measured by the Work Functioning Impairment Scale. Multiple logistic regression analysis was used to evaluate the association between COVID-19 clinical practice and presenteeism. RESULTS: Overall, 3,968 participants were included in the analysis, and presenteeism was observed in 13.9% of them. The rate of presenteeism significantly increased with both the number of COVID-19 patients treated and the percentage of work time spent treating these patients (both P values for trend < 0.001). In comparison to those not currently engaged in the treatment of COVID-19 patients, presenteeism was significantly higher among front-line (adjusted odds ratio [aOR] = 1.71, 95% confidence interval [CI]: 1.16-2.53) and second-line physicians supporting those in the front-line (aOR = 1.45, 95% CI: 1.17-1.78). There was no association between involvement in COVID-19 vaccination services and presenteeism. CONCLUSIONS The burden on front-line and second-line physicians in COVID-19 clinical practice must be minimized. Employed physicians also need to recognize the importance of communicating with their workplaces about presenteeism.
Humans ; COVID-19/epidemiology* ; Presenteeism ; Japan/epidemiology* ; Cross-Sectional Studies ; COVID-19 Vaccines ; Physicians ; Surveys and Questionnaires