Transferrin saturation（TSAT）which is widely used to assess iron metabolism is associated with cardiovascular mortality in the general population. However, the relationship between TSAT at hemodialysis（HD）initiation and the subsequent incidence of ischemic heart disease（IHD）in maintenance HD patients has not been fully studied. We undertook a retrospective cohort study involving 102 patients（70 men; average age, 66.5 years）who initiated HD between 2012 and 2016 and met our criteria. The patients were divided into two groups according to their TSAT levels at HD initiation, i.e., the high-TSAT group（TSAT≥20％）（n＝68）and the low-TSAT group（TSAT<20％）（n＝34）. The median follow-up time was 802.5 days. TSAT showed a significantly positive correlation with levels of serum creatinine and ferritin and a negative correlation with white blood cell count, platelet count, levels of serum total protein and C-reactive protein by using Spearman’s Rank correlation coefficient. By multiple regression analysis, TSAT showed a significantly positive correlation with ferritin and a negative correlation with platelet count. Although serum ferritin levels were significantly lower in the low-TSAT group than in the high-TSAT group, the patient characteristics of the two groups at baseline were not significantly different. There were 16 IHD incidents in both groups following HD initiation. The incidence of IHD events was significantly higher in the low-TSAT group（9/34, 26.5％）compared to the high-TSAT group（7/68, 10.3％）. We analyzed the data using the Kaplan-Meier log-rank test and Cox proportional hazards regression model. Statistical analyses showed that low TSAT levels were significantly associated with IHD events（log-rank, P<0.05）and were an independent predictor for IHD events（hazard ratio, 3.131; P<0.05）. This study shows that low TSAT levels at initiation of HD are independently associated with the subsequent incidence of IHD in maintenance HD patients.

View full abstract

We retrospectively analyzed the pathology and prognosis of 111 pts with acute myeloid leukemia （AML） in the past 10 years in the Showa University Hospital; 52.2％ of the patients was over 65 years old and 28.8％ had a diagnosis of AML with MRC. Overall survival （OS） was 34.5％ and median survival time was 22 months. Multivariate analysis showed that age and gender significantly influenced OS of patients. Except for t（15；17）, the significance of karyotype was limited. SCT did not significantly improve OS of AML. Introduction of a further targeted therapy based on the molecular pathology and a decrease non-relapse mortality in SCT appeared to be important to improve survival of AML of high age elderly.

View full abstract

This study forms the second part of our research on university students' awareness and attitude toward sexual minorities, which started in 2016 and will continue until 2020, aiming to show how young people aged 18 to early 20s feel about sexual minorities. As a follow-up to Sunaga et al. （2017）, who reported the results of a questionnaire conducted via the internet in 2017, this study is a report of the results of our second questionnaire carried out in 2018. The study was conducted on 445 first year university students （response rate 76.6％, male: 129, female: 313, other 3）. Compared to the first report, our results show that although （a） the participants have almost the same amount of experience in having any contact with sexual minority individuals, （b） they have less common knowledge about sexual minority, （c） they feel less disgusted by their neighbor sexual minority people, and （d） male participants and female participants respond to some questions differently, resulting in the increased number of the questions showing a statistically significant difference. The 2017 questionnaire survey was carried out after the participants learned about discrimination and human rights in class. In contrast, the 2018 questionnaire survey was taken before the class. In the paper we also discuss potential influences these differences may have on the results of our study.

View full abstract

Since Mount Fuji was registered as a World Heritage Site, the number of tourists travelling to Japan has increased. This has also resulted in an increasing number of emergency hospital visits by tourists. The data on the necessity of emergency hospital visits by foreign tourists is lacking. In this study, we examined the medical records pertaining to emergency hospital visits by foreign tourists for the development of future policies and management measures. A retrospective survey of emergency hospital visits by foreign tourists from 2015 to 2017 was conducted. The total numbers of foreign tourists who visited hospitals as patients were 154, 149, and 171 in 2015, 2016, and 2017, respectively. The mean age was 36 （0-89） years, comprising 223 males and 251 females. The time of hospital visits were usual working hours for 205 patients （43.2％） and at night time or during holidays for 269 patients （56.8％）. Emergency hospital visits were identified for the complaints of internal medicine requirement, such as a cold （168 cases）; trauma, such as bone fracture and dislocation （166 cases）, which together comprised the most common reason for the visit; urological diseases, such as bladder infection and urinary tract stone （22 cases）, and gynecological diseases, such as abnormal vaginal bleeding （21 cases）. Pediatric visits were also substantial （64 cases）. There was one case of cardiopulmonary arrest upon arrival. The survey of emergency hospital visits by foreign tourists in Japan showed that the vast majority of patients visited the hospital for internal medicine and trauma, with more visits during hospital off hours than during working hours. As the number of foreign tourists is likely to increase, measures to meet the demand for emergency services are urgently needed.

View full abstract

Showa University Northern Yokohama Hospital was established in 2001 as a regional core hospital located in the Northern Yokohama area. We aimed to consider the future prospects of oral surgery in Showa University Northern Yokohama Hospital and therefore carried out a clinico-statistical survey of the patients in the eight years after opening. The results of the survey showed that the total number of new patients from 2011 to 2019 was 14,856. Regional and hospital referred new patients were 6,935 and 7,921, respectively. In regional request patients, the number of teeth and periodontal disease is the highest at 4,175 cases （68.0%）, 560 cases for oral mucosal disease （8.1%）, 408 cases for cystic disease （5.9%） and 350 cases for neoplastic disease （5.1%）. The rate of oral surgical disease has increased. In hospital request patients, the perioperative period oral function management was increased with 4,407 cases （55.8%）. Hospitalized patients increased during this eight-year period, and the total number of hospitalized patients was 747. The most frequent classification was dental-periodontal disease. The average number of days in hospital was 3.57. Compared to the number of days in hospital by disease classification, the number of days in hospital tended to increase in the order of oral mucosal disease, inflammatory disease, and trauma. A collaboration system of vicinity medical facilities has been developed, and the emphasis is placed on the role as a secondary medical institution. As dental professionals we assist in contribution to the medical teams of other occupations.

View full abstract

Postoperative respiratory complication is a major source of postoperative morbidity. Intraoperative lung injury should be avoided, considering the etiological factors of the adverse effects on the healthy lung. The lung is not physiologically functioning during anesthesia due to positive pressure ventilation, making the lung vulnerable to adverse factors, including infection, fluid load, and leukocyte activation. We have studied the contributing perioperative factors for postoperative hypoxia, suggesting lung injury. A consecutive patient cohort, who underwent gastroenterological surgeries, was retrospectively examined. We have defined postoperative hypoxia as<300 PaO₂/FiO₂（P/F）. Perioperative factors including basic backgrounds, anesthesia methods, dose of remifentanil, infusion volume and serum albumin were picked up for the statistical analysis. The enrolled patients amounted to 418, and 150 patients were picked up among 168 patients admitted to ICU. The average P/F value was 497±119 in the non-hypoxic group（n＝138）, while it was 270±34 in the hypoxic group. Three patients postoperatively required respiratory management by ventilator use. A logistic regression analysis revealed the amount of intraoperative crystalloid as a statistically significant factor contributing to postoperative hypoxia（odds ratio 2.304，95％CI（1.052-5.048），P＝0.037）. The conventional concept recommends that sufficient fluid be supplied intraoperatively, including the estimating amount of one-third space loss, insensible vapor, and others. Recently, the concept has gradually changed, so as to avoid fluid overload. Our results support the concept with the aim to minimize the positive fluid balance to avoid postoperative respiratory distress.

View full abstract

Infants who have mild respiratory distress need close observation, because some infants develop a severe condition. We followed the clinical pathway to determine whether these infants can be rooming-in or need intensive care. We assessed the following characters of infants who have mild respiratory distress: the rate of using this clinical pathway, and the rate, reasons and factors of deviation from the clinical pathway. We reviewed medical records（from December 2016 to March 2018）of infants who were delivered at>35 weeks gestation and>2,000g birth weight and developed mild respiratory distress. We reviewed the following variables: delivery mode, gestational age, birth weight, Apgar score, diagnosis at the time of admission, the time from delivery to admission, and final diagnosis of infants who deviated from the clinical pathway. A total of 1,287 infants were born in our hospital and 63 of them had this clinical pathway. Of these 63 infants, 48％ showed this clinical pathway within 1 hour from delivery and 20 infants（32％）deviated from this clinical pathway. The biggest reason for deviation was that they could not be weaned of oxygen therapy（35％）. The second reason of deviation was that gasping could not be resolved（25％）. Of the deviated cases, 7 and 4 infants who deviated cases developed transient tachypnea newborn and meconium aspiration syndrome, respectively. No infant for whom this clinical pathway was successfully resolved, was admitted to NICU after rooming-in. This clinical pathway is effective for the detection of condition change in an early stage.

View full abstract

In my research concerning the pharmacists’ professionalization process in the Meiji period, I obtained “YAKUZAISHI” published in 1893 which had been thought not to exist. The aim of this report is to introduce this journal contribution to prior research or other historical research. The cover, index and the back cover of “YAKUZAISHI” No. 46 published in 1893, were almost the same as No. 45 published in 1892. The number of pages in the main body of this book was 21 pages, much less than those of No. 1 to No. 45, and nevertheless, there were many pages of advertising in it. Although there is no article on the final publication in “YAKUZAISHI” No. 46, by guessing from the delay of the publication, the small number of body pages, the large number of advertising pages and the small number of participants attending the Tokyo Pharmaceutical Association in December 1892, it is thought that the continued publication of “YAKUZAISHI” by the Tokyo Pharmaceutical Association was canceled due to financial problems. This possibility was also suggested in a previous study concerning “YAKUZAISHI” from 1889 to 1892, but the investigation of “YAKUZAISHI” No. 46 published in 1893 made its possibility more reliable.

View full abstract

Apparent life-threatening events （ALTEs） are induced by various triggers; they are diagnosed when a healthy infant is identified with conditions such as apnea and cyanosis and is cured by subsequent treatment. We report a case of an ALTE thought to be triggered by an hMPV infection. A 48-day-old boy presented with inspiratory wheezing for several hours before hospital admission at the emergency department of our hospital due to apnea after feeding. He was diagnosed with an ALTE due to hMPV pneumonia on chest X-ray and hMPV antigen （genotype subtype YA1） detected in tracheal secretions. He was discharged from the hospital without any sequelae. We must consider pertussis and respiratory syncytial virus as well as hMPV infection when we examine the ATLE.

View full abstract

Few studies have reported on the relationship between the number of pharmaceutical inquiries and incident occurrence status on prescribed injections. Therefore, this study aimed to investigate the details of inquiries, which were implemented, concerning prescriptions for injectable medicines for inpatients with respect to incidents at Showa University Hospital. To analyze and assess the influence of incidents, we utilized the criteria of National University Hospital Medical Safety Management Council, which was eight categories from level 0 to 5 including 3a, 3b, 4a and 4b. Over a four-year period, pharmaceutical inquiries by pharmacists were 1,592 of 585,771 injection prescriptions. Subsequently 1,173 of those were changed （73.7％）. However, fourteen incidents which had not implemented inquiry were reported as follows: 2 in level 0, 8 in level 1, 2 in level 2, 2 in level 3a. In conclusion, we found that pharmaceutical inquiries for injectable medicines by pharmacists might not always be adequate.

View full abstract