Health support activities for residents were held three times during a period from June, 2016 to November, 2017. The residents registered in order to participate through 11 community pharmacies. Participant’s blood pressure values were measured at the venue of health support activities by pharmacists. The blood pressure values in 66 of the 106 participants were analyzed, excluding 40 participants receiving medical treatment. The rate of participants with hypertension, systolic blood pressure (SBP)≧140 mmHg or diastolic blood pressure (DBP)≧90 mmHg, was 32% (21／66). Of those with hypertension, 43% (9／21) had hypertension of a high risk level, SBP≧160 mmHg or DBP≧100 mmHg. Pharmacists provided lifestyle counseling and encouraged them to make changes in order to achieve tighter blood pressure control. The data of their blood pressure values were provided to community pharmacies for continuing support of their blood pressure control. With the pharmacist’s support, the median value of blood pressure of participants who had hypertension decreased in the second event. In addition, 50% (3／6) of participants who attended the second event with hypertension of high risk level, visited the hospital for a consultation with a doctor after getting pharmacist’s advice. These results indicate that greater access to community pharmacists improved blood pressure control of residents with hypertension. However, there were many residents who consider it difficult to use pharmacies without a prescription. Hence, friendly relationship to residents on their utilizing pharmacies is needed for providing them lifestyle counseling such as preventing hypertension by pharmacists.

Introduction: Voriconazole (VRCZ) is a triazole antifungal agent for which therapeutic drug monitoring (TDM) is recommended. At Juntendo University Hospital, the VRCZ TDM implementation rate was 42% between January 2011 and October 2017. Here, we report that modifications to the hospital’s drug ordering system improved the implementation rate of VRCZ TDM.Method: In August 2018, the drug ordering system was modified so that a message appeared on the screen to notify clinicians of the need to monitor VRCZ blood concentrations and to recommend a date for sample collection. In addition, the laboratory orders for VRCZ levels were digitized. We compared two one-year periods before and after implementation of the modifications (August 2017 to July 2018 and August 2018 to July 2019) to verify the effect of the changes.Result: Results showed an increase in the TDM implementation rate: 12 patients (42.8%) received TDM before modification of the system, and 26 patients (92.9%) received TDM after modification of the system. Further, the rate of blood sampling at the recommended time point for estimating blood concentration (day 5-7 after the start of administration) improved after system modification, i.e., blood samples were collected from 18 patients (64.3%) at the steady state point. In contrast, blood samples were collected from only 6 patients (21.4%) before system modification. When blood concentrations deviated from the target range in patients who received TDM, clinicians took appropriate actions, such as reducing drug doses, prescribing drug holidays, or discontinuing medications.Conclusion: A system that provides information related to VRCZ blood concentration measurements can help clinicians provide patients with optimal pharmacotherapy.

OBJECTIVE: The aim of the study is to investigate recurrence of stage I epithelial ovarian cancer. METHODS: Six hundred two patients diagnosed with stage I epithelial ovarian cancer at 4 hospitals between 2000 and 2013 were retrospectively analyzed. Age, surgical procedure, substage, histologic type, adjuvant chemotherapy, recurrence, initial recurrence site (peritoneal dissemination [P], hematogenous recurrence [H], lymphogenous recurrence [L], and others [O]), and frequency of recurrence at each site were investigated retrospectively. RESULTS: Median age was 54 years and median follow-up was 60 months. The stage was IA in 180 cases (30%), IB in 8 (1%), IC1 in 247 (41%), IC2 in 63 (10%), and IC3 in 104 (17%). Systematic lymph node dissection including both pelvic and para-aortic lymph nodes was performed in 224 patients (37%), and 412 patients (68%) received adjuvant chemotherapy. Recurrence occurred in 70 patients (11.6%). The median time to recurrence was 18 months, and the stage was IA in 13 (19%), IB in 1 (1%), IC1 in 24 (34%), IC2 in 9 (13%), and IC3 in 23 (33%) cases. The numbers of recurrence at the P, H, L, and O sites, including overlapping cases, were 49 (70%), 18 (26%), 9 (13%), and 6 (9%), respectively, and recurrence by peritoneal dissemination in the pelvis occurred in 43 cases (61%). CONCLUSION: Recurrence of stage I epithelial ovarian cancer by peritoneal dissemination was frequent, especially in the pelvis. There is a need to elucidate the pathogenesis of peritoneal recurrence and to prepare a treatment strategy to prevent pelvic peritoneal recurrence.
Chemotherapy, Adjuvant ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Seeding ; Ovarian Neoplasms* ; Pelvis ; Recurrence* ; Retrospective Studies*

Purpose: To clarify the family-perceived usefulness of a pamphlet for families of imminently dying patients. Methods: Physicians and/or nurses provided medical and practical information about the dying process using a pamphlet for families of imminently dying patients. We surveyed family members 6 months after the death of the patient about the perceived usefulness. Results: We sent out a questionnaire to 325 bereaved, and obtained an answer from 260 (response rate: 85%). Overall, 81% reported the pamphlet to be “very useful” or “useful”. The experience reported by the bereaved included: “Helped me to understand the dying process” (84%); “Helped me to understand how symptoms and changes occur” (76%), “Useful in preparation for patient's death“ (75%), “Helped me to understand the physical conditions of the patient” (75%), “Helped me to know what I can do for the patient” (74%). Conclusion: “A pamphlet for families of imminently dying patients” may be useful for members of an imminently dying patient's family.

A simplified polymerase chain reaction (PCR) assay was developed for fast and easy screening of mycoplasma mastitis in dairy cattle. Species of major mycoplasma strains [Mycoplasma (M.) bovis, M. arginini, M. bovigenitalium, M. californicum, M. bovirhinis, M. alkalescens and M. canadense] in cultured milk samples were detected by this simplified PCR-based method as well as a standard PCR technique. The minimum concentration limit for detecting mycoplasma by the simplified PCR was estimated to be about 2.5 x 10(3) cfu/mL and was similar to that of the standard PCR. We compared the specificity and sensitivity of the simplified PCR to those of a culture method. Out of 1,685 milk samples cultured in mycoplasma broth, the simplified PCR detected Mycoplasma DNA in 152 that were also positive according to the culture assay. The sensitivity and specificity of the simplified PCR were 98.7% and 99.7%, respectively, for detecting mycoplasma in those cultures. The results obtained by the simplified PCR were consistent with ones from standard PCR. This newly developed simplified PCR, which does not require DNA purification, can analyze about 300 cultured samples within 3 h. The results from our study suggest that the simplified PCR can be used for mycoplasma mastitis screening in large-scale dairy farms.
Animals ; Cattle ; Colony Count, Microbial/veterinary ; DNA, Bacterial/chemistry/genetics ; Disease Outbreaks/prevention & control/veterinary ; Female ; Mastitis, Bovine/diagnosis/*microbiology ; Milk/cytology/*microbiology ; Mycoplasma/genetics/*isolation & purification ; Mycoplasma Infections/diagnosis/microbiology/*veterinary ; Polymerase Chain Reaction/veterinary

Asthma is characterized by chronic airway inflammation with intense eosinophil and lymphocyte infiltration, mucus hyperproduction, and airway hyperresponsiveness. Accumulating evidence indicates that antigen-specific Th2 cells and their cytokines such as IL-4, IL-5, and IL-13 orchestrate these pathognomonic features of asthma. In addition, we and others have recently shown that IL-17-producing CD4+ T cells (Th17 cells) and IL-23, an IL-12-related cytokine that is essential for survival and functional maturation of Th17 cells, are involved in antigen-induced airway inflammation. In this review, our current understanding of the roles of IL-23 and Th17 cells in the pathogenesis of allergic airway inflammation will be summarized.
Asthma ; Cytokines ; Eosinophils ; Inflammation ; Interleukin-13 ; Interleukin-17 ; Interleukin-23 ; Interleukin-4 ; Interleukin-5 ; Lymphocytes ; Mucus ; Neutrophils ; T-Lymphocytes ; Th17 Cells ; Th2 Cells

A reduction in electricity and heating expenses is a major consideration with every hospital in Japan. In our hospital, all the personnel including the members of the facilities division have joined forces to mount the “1,300kW campaign” aimed at cutting down on the amount of maximum instantaneous electric power consumption (demand) from 1,500kW to 1,300kW in one year, and succeeded in curtailing heating and lighting expenses by well over 4 million yen. The key to success was how to control the amount of demand. The cooperation of all the personnel of the hospital was vital. Therefore, it was important to raise the awareness of all the personnel concerning energy conservation. We thought that setting the concrete numerical target “from 1,500kW to 1,300kW” was effective. It is no exaggeration that such a cutback in energy consumption contributes not only to the management of a medical institution but also to the environmental preservation on a global scale. Finally, the medical institutions should put contribution to the community into the basic principles at the time when environmental preservation (ecology), energy consumption reduction, risk management and catastrophic disaster etc. have become topics of conversation.
Hospitals ; Consumption of goods ; Human Resources ; success ; Economic demand

An 80-year-old man was transferred to our hospital because of blunt traumatic aortic arch injury caused by a fall. Computed tomography (CT) revealed a pseudoaneurysm and mediastinal hematoma around the aortic arch, right hemothorax, left hemopneumothorax, lung contusion and spine fractures. His hemodynamic condition was stable but he required mechanical ventilation because of severe hypoxemia. Surgery was postponed until twelve days after the injury, when his lung function improved and active bleeding decreased. During surgery we found that the intimal disruption extended to half of the circumference of the aortic arch, and thus performed total arch replacement under deep hypothermic circulatory arrest and selective cerebral perfusion. The patient suffered respiratory failure and pneumonia postoperatively as well as multiple cerebral infarctions. He was referred to a rehabilitation center on postoperative day 130.

In 13 patients who underwent left ventriculography both before and after operation, we investigated regional wall motion of the left ventricle (LV) with the centerline method in LV aneurysmectomy. There were no significant differences between preoperative predicted and postoperative ejection fraction. No significant differences were observed between preoperative predicted and postoperative regional wall motion of all segments in all cases and cases without significant stenosis who did not undergo revascularization of the right coronary artery. Postoperative regional wall motion of the inferior wall was significantly better than the preoperative predicted one in cases who underwent revascularization of the right coronary artery with significant stenosis. It is considered that revascularization of the right coronary artery with significant stenosis in LV aneurysmectomy was effective for the improvement of regional wall motion of the inferior wall.

In the previous papers, we reported the effects of electronic moxibustion on immune response of experimental rats to the exogeneous antigens, human γ-globulin.
The results supported the theory, “non-specific heat aggregeted autologous tissue protein stimulation therapy” presented by Dr. Shimetaro Hara in 1933.
Therefore, in this paper we chose two kinds of antigens, one is the T-cell dependent antigen, dinitrophenylated keyhole limpet hemocyanin (DNP-KLH), the other is the T-cell independent antigen dinitrophenylated Ficoll (DNP-Ficoll) to analyse the mechanism of electronic moxibustion whether it enhances the immune response or not.
Using 9 weeks old femal SLC-Wistar rats, we administered the electronic moxibustion according to the method reported in the previous papers. Following daily moxibustion for 8 weeks, antigens were giver twice at intervals of one week together with Freund's complete adjuvant. And 4 days later from the last antigen stimulation direct, DNP plaque forming cells in the spleen were counted.
The results obviously showed daily electronic moxibustion for 8 weeks enhanced immune response against the T-cell dependent antigen (DNP-KLH) stimulated rats but no effect on the immune response to the T-cell independent antigen (DNP-Ficoll) stimulated rats.
The daily electronic moxibustion for 4 weeks to rats failed to show any effective results against both antigens stimulation.
The responses of spleen cells against mitogenic lectins, PHA, Con A and PWM were analysed 3 days after the incubation with lectins by tritiated thymidine up takes into cells. The results also showed the animal group received the electronic moxibustion for 8 weeks manifested higher response against the one of T-cell mitogens, Con A compared with either the group received the electronic moxibustion for 4 weeks or the control group, not received any treatment.
These results suggested that the immune activation mechanism exhibited by the electronic moxibustion is via the activation of T-cell function and the electronic moxibustion does not act on B cell nor antibody forming cells.
The direct effects on the animal skin by the electronic moxibustion were shown exactly the same physical characteristics as the conventional moxibustion method as reported in the previous papers. Therefore, we could expect the similar T-cell activation effect on the immune response by the conventional moxibustion.
But from our results to get such a T-cell activation by the electronic moxibustion, it has been necessary to administrate the electronic moxibustion daily at least for more than 4 weeks.
Next we would like to make clear what kinds of subpopulation in the T-cell populations are activated by the electronic moxibustion.
Before the clinical administration of the electronic moxibustion as one of immune activators, it is necessary to investigate further about the optimal amounts of the moxibustion, effects of the moxibustion on the cellular immunity or tumor immunity.