Early detection of third-generation cephalosporin-resistant bacteria in blood culture tests influences the choice of antimicrobial agents. We report on our hospital’s system for early reporting of third-generation cephalosporin-resistant bacteria and its utility. The hospital operates a 24-h simple cefpodoxime (CPDX) testing system, where the content of a sample container with a positive blood culture result is smeared on a CA Sheep Blood Agar/VCM Chocolate EX II fractionation medium, and an antibiotic susceptibility test (AST) disk (Sensi-Disk CPDX) is placed at the center of the medium and incubated. The presence or absence of third-generation cephalosporin-resistant bacteria is estimated from the diameter of the growth inhibition zone. The physician in charge of AST makes comments on the chart based on the simple CPDX test results. The sensitivity of the simple CPDX test for detecting third-generation cephalosporin-resistant bacteria, based on AST results, was 95.5%. Among patients with failed antimicrobial therapy, the rate of switching antimicrobials before the AST results were known was 57.9% in cases where there were comments made by the physicians in charge of AST, compared with 42.9% in cases without comments. These results suggest that the simple CPDX test enables early and accurate detection of third-generation cephalosporin-resistant bacteria, facilitating early switching of antimicrobial agents through collaboration with physicians in charge of AST.

Mitochondria activation factor (MAF) which is high-molecular weight polyphenol contained in black tea and oolong tea can increase the mitochondrial membrane potential. MAF supplementation to mice facilitates endurance running performance after 9-week endurance training and muscle hypertrophy induced by synergist ablation. In this study, we examined the effect of oral MAF supplementation on overall physical fitness (expressed as physical fitness age) in physically active middle-aged and older women. This study is a randomized double-blind placebo-controlled trial implemented between January and May 2019 at three fitness facilities in Ibaraki, Japan. Seventy middle-aged women aged 55 to 69 years were randomly assigned into placebo (n = 35) and MAF groups (n = 35). The placebo participants took cornstarch-containing capsules, and the MAF participants took MAF-containing capsules twice a day for 80 days consecutively. During the intake period, all participants were instructed to follow 30-min circuit training program at least twice a week. Physical fitness age was computed with eight physical fitness items assessing upper-extremity muscle strength, locomotion, and postural change. The physical fitness age decreased by 1.48 years (95% confidence interval [CI]: -2.66, -0.30) in the placebo group and 3.01 years (95% CI: -4.16, -1.86) in the MAF group. The reduction was greater in the MAF group, but did not reach statistical significance (p = 0.06). The combination of 80-day of MAF intake and circuit exercise showed beneficial results. However, our results did not indicate clear effects on physical fitness age because of low statistical power. Further studies are necessary to reveal the effects of MAF supplementation.

BACKGROUND/AIMS: The pharmacokinetics of tacrolimus (TAC) is known to be largely influenced by single-nucleotide polymorphisms (SNPs) in CYP3A5. Patients starting TAC require careful dose adjustment, owing to the wide range of optimal dosages, depending on their CYP3A5 expression status. Here, we evaluated whether individualization of TAC dosages based on CYP3A5 SNPs would improve its therapeutic efficacy in ulcerative colitis. METHODS: Twenty-one patients were prospectively treated, with their initial dosage adjusted according to their CYP3A5 status (0.1, 0.15, and 0.2 mg/kg/day for CYP3A5*3/*3, CYP3A5*1/*3, and CYP3A5*1/*1, respectively). Their clinical outcomes were compared with those of patients treated with a fixed dose (0.1 mg/kg/day). RESULTS: The first blood trough level of CYP3A5 expressors, CYP3A5*1/*3 or CYP3A5*1/*1, and the overall rate in achieving the target blood trough level within a week in the individualized-dose group were significantly higher than those in the fixed-dose group (5.15±2.33 ng/mL vs. 9.63±0.79 ng/mL, P=0.035 and 12.5% vs. 66.7%, P=0.01). The remission rate at 2 weeks in the expressors was as high as that in the nonexpressors, CYP3A5*3/*3, in the individualized-dose group. CONCLUSIONS: Individualized TAC treatment is effective against ulcerative colitis regardless of the CYP3A5 genotype.
Colitis, Ulcerative ; Cytochrome P-450 CYP3A ; Genotype ; Humans ; Pharmacokinetics ; Polymorphism, Single Nucleotide ; Prospective Studies ; Tacrolimus ; Ulcer

We report the rare case of a 68-year-old man, who was admitted to our hospital with a diagnosis of aortic arch anastomotic pseudoaneurysm, with concomintant aortic root enlargement and coronary artery stenosis. Eleven years previously, at age 56, he underwent total arch replacement with island reconstruction for chronic aortic dissection. We performed redo total arch replacement, aortic root replacement and coronary artery bypass, making use of a cardiopulmonary bypass with cannulation through the right subclavian artery, femoral artery and femoral vein before resternotomy. We also used selective cerebral perfusion. Postoperatively, the patient temporarily required reintubation ; however, he was discharged in good condition on the 50th post-operative day. The case suggests that island reconstruction has the potential to cause an aortic arch pseudoaneurysm, particularly after a long postoperative period of time. Therefore, thorough postoperative care strategy is required. We also need to consider surgical reconstructive techniques which eliminate vascular lesions as much as possible at the time of the primary surgery, particularly in cases of chronic aortic dissection.

Background: A 30-60 min rest after exercising is generally recommended before taking a bath. Although this was considered an appropriate bathing method, effects of pre-bath rest on recovery from exercise fatigue remain unclear. Here, we aimed to examine the effects on fatigue recovery of pre-bath rest after a workload, with the focus on changes in lactic acid levels. Methods and Results: Ten healthy adult men increased their blood lactic acid levels through a treadmill workload performed in accordance with the Bruce method, then took either a 60-min post-workload rest followed by a 10-min full-immersion 38°C bath (Experiment A) or a 10-min full-immersion 38°C bath followed by a 60-min rest (Experiment B). Body temperature, blood pressure, pulse rate, and blood lactic acid level were measured at three time points: before workload (Test 1), after workload (Test 2), and after bathing/resting (Test 3). Decreases and percent decreases in blood lactic acid levels were calculated by comparing Test 3 results with Test 2 results. These calculated values and the measured values in three tests were compared between Experiment A and Experiment B using paired-t test. There were no significant differences in maximum systolic blood pressure, maximum diastolic blood pressure, maximum workload attained, and maximum pulse rate measurements between Experiment A and Experiment B. Differences in systolic blood pressure and diastolic blood pressure measurements in Tests 1, 2, and 3 were not significant. The pulse rates measured at the final measurement (Test 3) were significantly higher in Experiment A than in Experiment B (90.4 ± 18.2 bpm vs 79.6 ± 11.6 bpm, p = 0.04). No significant differences were observed in other measurement timings. The body temperature measurements at the final measurement were slightly higher in Experiment A than in Experiment B (36.4 ± 0.4 vs 36.1 ± 0.3°C, p = 0.05). No significant differences were observed in other measurements. Blood lactic acid levels before workload (Test 1) were significantly higher in Experiment A (6.6 ± 4.7mmol/L) than in Experiment B (2.0 ± 1.4 mmol/L, p = 0.02), but those at other measurement points (Test 2 and Test 3) were similar. Neither decreases nor percentage decreases in blood lactic acid levels differed between Experiment A and Experiment B. Conclusions: Resting before a post-exercise bath did not change the decreases or percent decreases in blood lactic acid levels after bathing at 38°C, suggesting negligible effects of pre-bath resting on recovery from exercise fatigue.

OBJECTIVE: To retrospectively evaluate the frequency and risk factors for developing thrombus in a systemic vein such as the infrarenal inferior vena cava or the iliac vein, in which a balloon-occluded retrograde transvenous obliteration (B-RTO) catheter was indwelled. MATERIALS AND METHODS: Forty-nine patients who underwent B-RTO for gastric varices were included in this study. The B-RTO procedure was performed from the right femoral vein, and the B-RTO catheter was retained overnight in all patients. Pre- and post-procedural CT scans were retrospectively compared in order to evaluate the development of thrombus in the systemic vein in which the catheter was indwelled. Additionally, several variables were analyzed to assess risk factors for thrombus in a systemic vein. RESULTS: In all 49 patients (100%), B-RTO was technically successful, and in 46 patients (94%), complete thrombosis of the gastric varices was achieved. In 6 patients (12%), thrombus developed in the infrarenal inferior vena cava or the right common-external iliac vein. All thrombi lay longitudinally on the right side of the inferior vena cava or the right iliac vein. One of the aforementioned 6 patients required anticoagulation therapy. No symptoms suggestive of pulmonary embolism were observed. Prothrombin time-international normalized ratio and the addition of 5% ethanolamine oleate iopamidol, on the second day, were related to the development of thrombus. CONCLUSION: Development of a thrombus in a systemic vein such as the inferior vena cava or iliac vein, caused by indwelling of the B-RTO catheter, is relatively frequent. Physicians should be aware of the possibility of pulmonary embolism due to iliocaval thrombosis.
Adult ; Aged ; Aged, 80 and over ; Balloon Occlusion/*methods ; Catheters, Indwelling/*adverse effects ; Esophageal and Gastric Varices/etiology/*therapy ; Female ; Femoral Vein ; Humans ; International Normalized Ratio ; Iopamidol/administration & dosage ; Male ; Middle Aged ; Oleic Acids/administration & dosage ; Prothrombin Time ; Retrospective Studies ; Risk Factors ; Statistics, Nonparametric ; Tomography, X-Ray Computed ; Treatment Outcome ; Venous Thrombosis/drug therapy/*etiology/*radiography

1) The faculty development at each medical school from 2003 through 2005 was analysed.
2) The major themes in faculty development were problem based learning, tutorial, computer based testing, and clinical training.
3) Faculty development is considered an effective way to enhance the contributions of faculty members to medical education.

Clinical training programs play an extremely important role in the new postgraduate clinical training system introduced in 2004 because facilities for clinical training now include various health-related institutions in addition to the university hospitals and special hospitals for clinical training used in the previous system. Although educational goals have been established by the Ministry of Health, Labour and Welfare, trainees may have difficulty achieving these goals, even under the guidance of staff at the various facilities. There are differences in the function and quality of health-related institutions in the community. For the practical and convenient application of educational goals, we have attempted develop a “model program” to supplement the objectives indicated by the learning goals with more specific objectives. These supplementary objectives can be modified by individual institutions. We hope that this “model program” contributes to the development of objectives for each institution and helps improve the quality of the postgraduate training system in Japan.

Purpose : This study was undertaken to clarify the effect of heme-iron supplementation on the prevention of iron-deficiency anemia in male collegiate distance runners.Methods : Forty-one male collegiate runners were divided into three groups, consisting of a heme-iron group (HI), a citrate-iron group (CI), and a non-iron group (NI). Iron tablets (heme-iron or citrate-iron) were administered at a dose of 7 mg per day for two months. The blood components and nutritional intakes were estimated before and after the intervention.Results : The nutritional intakes did not differ among the three groups. The red blood cell, hemoglobin, hematocrit, ferritin, Glutamic-Pyruvate Transferase and γ-Glutamyl Transpeptidase levels were unchanged throughout the experimental periods. After the intervention, the serum iron levels significantly decreased in the NI group but not in the iron-supplemented groups, while the reticulocytes counts increased among the three groups.Conclusion : The small amount of heme-iron supplementation was thus found to have a preventive effect on iron deficiency anemia without causing any negative side affects.

Little is studied about traditional healers‘ perceptions toward and practice of uvulectomy, which is known as a traditional surgical practice mainly in Africa and which sometimes results in severe complications. This study aimed to clarify the perceptions toward and practice of uvulectomy and the other traditional healing practices of traditional healers in a Congolese refugee camp in Tanzania. Interviews were conducted with 149 traditional healers, comprised of 59 registered, 68 non-registered and 22 faith healers. A total of 1.7% of the registered healers and 8.8% of the non-registered healers had ever conducted uvulectomy on children (a median of 2 months to a median of 3 years of age) and had received cash or domestic fowls equivalent to US$1-3 per operation. Although over 80% of the respondents believed traditional treatments to be more effective than modern medicine, less than 20% considered uvulectomy beneficial and in fact about 40% considered it to be harmful. The respondents raised cough, vomiting, appetite loss and other symptoms as an indication for uvulectomy, and death, bleeding, throat pain and other symptoms as harmful effects associated with uvulectomy. In this camp, the healers also performed other surgical procedures, such as male and female circumcision, tattoos and scarification. In conclusion, only a limited number of the traditional healers believed that uvulectomy is beneficial and performed it on infants and young children, and these were mainly non-registered healers who had relatively little collaboration with modern health professionals. In refugee settings where modern health professionals might not be familiar with traditional healing, it is considered crucial to assess the risks of ongoing traditional practices and to strive to achieve more strategic communication between modern and traditional health providers.