Molecular epidemiology of rotaviruses emerged a little over 25 years ago as a fascinating branch of science that utilized then cutting-edge technology of RNA polyacrylamide gel electrophoresis. Molecular epidemiology, as I have observed it closely almost since its dawn, is an ever-evolving discipline which has incorporated the advances of the related sciences including molecular evolutionary biology and ecology, while it is firmly and deeply rooted in the edifice of epidemiology of infectious diseases. Rotavirus is a non-enveloped virus possessing 11 segments of double-stranded RNA as the genome and belongs to the Reoviridae family. The consequences of rotavirus infections in terms of mortality are different depending on whether children live in the developing countries or they live in the developed countries, and this difference comes mostly from the availability of proper medical intervention. A second generation rotavirus vaccine has just been licensed in Mexico and will hopefully be used widely among countries where the burden of the disease is the highest. One potential threat to the existing and future rotavirus vaccines is the extreme diversity of strains circulating among children across the world, and it is the key to understand how rotaviruses maintain themselves in nature. Molecular epidemiology of rotaviruses helps address such questions and has demystified the way in which they evolve including interspecies transmission of rotaviruses. A few examples are provided from the work that my colleagues and I did over the course of my career in an attempt to give a feel of molecular epidemiology of rotaviruses.

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Since the early 1990s the video-assisted thoracic surgery (VATS) has been used for lobectomy, which is the standard procedure performed for early stage lung cancer. Recent developments in video systems and improvements in endoscopic instruments have allowed VATS to become established as a useful minimally invasive surgery for intra-thoracic disease. The progress seen in VATS lobectomy for lung cancer has been the subject of many recent reports that have tried to compare the current status of VATS lobectomy to conventional thoracotomy lobectomy by focusing on the indications, surgical techniques, prognosis, postoperative pain, and morbidity of the procedures. The results of the present review substantiate the impression that VATS lobectomy for stage I lung cancer patients has matured to become an established, safe and reliable surgical technique, with a long term survival at least the same as that of a conventional lobectomy. Furthermore, VATS lobectomy offers an advantage with respect to the patient's postoperative quality of life.

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We assessed 12 young adults with hemiplegic cerebral palsy, aged from 14 to 33 years, by intellectual quotient (IQ) and magnetic resonance imaging (MRI), and obtained the following findings. First, the IQ scores were relatively lower than those predicted by their social activities. Second, there were two cases who seemed to have right or bilateral hemisphere representatives of language; their IQ scores were within normal range, while MRI demonstrated extensive brain damages including usual ones in language areas. Third, IQ scores and MRI findings were correlated to some extent; however, a case of limited brain damage on MRI had low IQ score, while five cases of brain damage located excluding their language areas had normal or high IQ scores.
The results of the present study indicate the necessity of follow-up MRI for prospective observation of the brain damage acquired at or around birth.

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To identify the effect of local treatments for hepatocellular carcinoma (HCC) in our associated institutes in Nagasaki prefecture, we performed a comparative study of hepatic resection and local ablative therapies, including alcohol injection, microwave coagulation and radio-frequency ablation. We examined the patient demographics, outcomes and tumor-free and overall survival between a hepatectomy group (n=210) and a local ablative therapy group (n=52). In the ablative therapy group, there were significantly more patients with cirrhosis and poorer hepatic function than in the hepatectomy group (p<0.001). Larger tumors and vascular involvement in the hepatectomy group were significantly more frequent than in the ablative therapy group (p<0.001 and p=0.002, respectively). The multivariate Cox regression analysis indicated no significant difference either in the time to the first recurrence of tumor after surgery or in mortality between ablative therapy and hepatectomy. By making full use of various modalities in each specialty, the satisfactory HCC treatment could be achieved at this stage.

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The purpose of this study was to elucidate the factors that influence the clinical evaluation of the depth of tumor invasion in patients with T1 (tumor invasion of mucosa or submucosa) gastric cancer. The depth of tumor invasion was determined in 593 patients with gastric cancer. Patients were divided into two groups based on the agreement between clinical and pathological evaluation of depth of tumor invasion. Of 320 patients with clinical T1 gastric cancer, consistent diagnoses were made in 308 (96.2%) patients (consistent diagnosis group) while inconsistent diagnoses were made in 12 (3.8%) patients (inconsistent diagnosis group). In the clinical T1 gastric cancer, multivariate logistic regression analysis revealed that the disagreement between the clinical and pathological evaluation of the depth of tumor invasion was independently related to two variables; tumor location (upper stomach) and maximum tumor diameter (≥30 mm). For clinical T1 gastric cancer with ≥30 mm in maximum tumor diameter located in the upper stomach, caution should be exercised when selecting therapy.

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In the comparison of municipalities with respect to the medical human resources, not only the number of physicians but also the distribution of their medical practice is important. The objective of the present study was to develop an index appropriate for comparing relatively small municipalities regarding the distribution of physician's medical practice and to apply it to Nagasaki Prefecture, Japan. We modified the specialization coefficient using Bayesian smoothing technique and used it as an index for comparing all municipalities except one in Nagasaki Prefecture. We computed the modified specialization coefficient using the number of physicians by medical practice and municipality as of the end of 2000. The modified specialization coefficient showed a considerable uniformity in the proportion of physicians among municipalities, while a relatively large variation among municipalities was observed in the proportion of pediatricians and psychiatrists.

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A 30-year-old woman with pseudo-Bartter's syndrome was referred to our department because of hypokalemic symptoms caused by outrageous abuse of furosemide and by KCl infusion administered to compensate for it. As an attempt to break this vicious cycle, we first tried to change furosemide with azosemide, a long-lasting loop diuretics, to avoid acute excessive diuresis and excretion of potassium. Administration of losartan effectively attenuated the concentration of extremely activated plasma aldosterone. Administration of spironolactone reduced aldosterone breakthrough induced by losartan and the patient was released from both furosemide and KCl. Blocking renin-angiotensin-aldosterone system demonstrated to be an effective treatment for pseudo-Bartter's syndrome by the improvement of the total body potassium level which was decreased before treatment.

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