Direct measurement by homogenous assays has recently been applied to measuring low-density lipoprotein-cholesterol (LDL-C) and has replaced the Friedewald calculation in Japan, but it remains unclear how direct measurement compares with the Friedewald calculation in evaluating hypercholesterolemia. The aim of this study was to determine the effect of the two methods on the diagnosis of hypercholesterolemia. In a total of 1,655 workers from our institution (1,451 men, 43.6 ± 10.2 years; 204 women, 38.3 ± 10.4 years), we investigated the LDL-C levels by the direct and Friedewald methods. In this study, we excluded workers whose triglyceride levels exceeded 400mg/dl (n=18). Direct LDL-C showed a significantly positive correlation with Friedewald LDL-C (R²=0.975, P＜0.0001). On the other hand, the mean direct LDL-C was 5.9mg/dl higher than the mean Friedewald LDL-C (126.7 ± 30.6mg/dl vs. 120.8 ± 30.5mg/dl, P＜0.0001), and direct LDL-C was higher in 89.1% of the study population. The frequency of study subjects diagnosed with hypercholesterolemia, defined as LDL-C ≥ 140mg/dl, was significantly higher in the direct measurement than in the Friedewald calculation (31.7% vs. 25.1%, P＜0.0001). In conclusion, we demonstrated that the direct measurement showed a higher rate of hypercholesterolemia prevalence than the Friedewald calculation indicated. This result suggests that we have to give careful consideration to the method for measuring LDL-C in the clinical diagnosis and management decisions of hypercholesterolemia.

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Oral cancer, a disease associated with major morbidity and mortality, represents a significant worldwide health problem. It is clear that the major etiological factors for oral cancer are tobacco and alcohol exposure. It has been shown that metabolic activation is associated with cancer susceptibility. Various carcinogens and carcinogenic precursors, such as benzopyrene and nitrosamine, have been identified in tobacco smoke, and those are activated or detoxified by two types of metabolic enzymes, phase Ⅰ and phase Ⅱ. There are some polymorphisms for these enzyme genes, the functions of which are modified by the types of polymorphisms. On the other hand, there are some genes besides these enzyme genes related to cancer susceptibility. In this review, we discuss the relationships between polymorphisms concerned with oral cancer. Although there are many reports on the polymorphisms related to oral cancer, the results of these reports are controversial. Further studies are needed to evaluate the interactions between carcinogens and the genetic polymorphisms.

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Pulmonary cryptococcosis is a fungal infection caused by inhalation of Cryptococcus neoformans. Pulmonary cryptococcal infections tend to occur in immunocompromised individuals, although they can occasionally develop even in immunocompetent hosts. This report presents a retrospective clinical study of 8 patients who underwent a surgical resection for pulmonary cryptococcosis between 1999 and 2008. The age of the patients ranged from 49 to 85 years old (mean 62.6). There were 4 male and 4 female patients. All patients except for 1 had no symptoms. Two patients were immuno-compromised hosts undergoing corticosteroid therapy due to myasthenia gravis and rheumatoid arthritis, respectively. There were 7 patients with a single nodule and 1 patient with multiple nodules. The tumors ranged from 9 to 21mm in diameter. None of the patients were definitely diagnosed prior to the surgical resection. The surgical procedures included 5 partial resections, 1 segmentectomy and 2 lobectomies. It is often difficult to make a differential diagnosis between lung cancer and pulmonary cyptococosis, because pulmonary cyptococosis shows similar imaging findings in CT. Therefore, a surgical resection is recommended if an observation of the pulmonary nodes is required to make a differential diagnosis of malignant tumors. All of the patients in the current series showed a good outcome without any relapse including cryptococcal meningitis after a surgical resection.

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There are many gaseous air pollutants found in indoor air. It is very important to precisely measure the concentration of these compounds in order to evaluate the risk to human health and to reduce their concentrations. A diffusive sampling device is suitable for measurement of indoor air, because these are small, light, and can be used without a power supply for the pump. In this study, representative gaseous air pollutants in winter indoor and outdoor air were measured using diffusive sampling devices. Furthermore, the relationship between gaseous air pollutants, secondary formation mechanism, and the outbreak source were examined. The indoor concentrations of aldehydes, nitrogen dioxide and ammonia were higher than outdoor concentrations. By contrast, indoor concentrations of ozone were lower than outdoor concentrations. The indoor concentrations of nitrogen dioxide in 43% houses exceeded the maximum limit stated by environmental law (60ppb). It was suggested that the main emission sources of nitrogen dioxide are kerosene and gas stoves. In addition, it was suggested that carbonyl compounds are formed by interactions between volatile organic compounds (VOCs) and ozone from outdoor air. Formic acid was estimated to be formed by the oxidation of formaldehyde with ozone, because a positive correlation between formaldehyde and formic acid, and an inverse correlation between formaldehyde and ozone, were observed in indoor air.

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The objective of this study was to analyze the outcome of patients with malignant pleural mesothelioma who were treated from 1993 to 2009. We analyzed a total of 28 patients with malignant pleural mesothelioma. All the patients were males, except for two females and the mean age was 64.5 years old. Twelve and 16 of the patients underwent an extrapleural pneumonectomy and a pleural biopsy, respectively. The histological types included 14 epithelial type, 8 biphasic type, and 6 sarcomatoid type. Three patients were classified as stage I, 8 as stage II, 9 as stage III, and 8 as stage IV. Fourteen and eight of the patients underwent systemic chemotherapy and radiotherapy, respectively. The 2-year survival rate of all the patients was 25.7%, and the 2-year survival of the patients with at least one more modalities of the treatments with chemotherapy, radiotherapy and extrapleural pneumonectomy were much higher than those without. We should therefore consider selecting a multimodality treatment for such patients because the administration of either systemic chemotherapy or radiotherapy was found to be associated with a favorable prognosis.

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In this report, we surveyed the occupational stress of psychiatric department nurses who said that the burnout rate was high and the turnover rate of nurses who quit shortly after being hired. Insight into the future of such research is described. In previous research, the occupational stress of psychiatric department nurses varied by each ward function, such as the wards of psychiatric department acute period, the psychiatric department recuperation period and the psychiatric department geriatric period, in which much research concerning the stress of psychiatric department nurses has been reported. However, at present, many of the questionnaire investigations used to measure and evaluate the occupational stress of psychiatric department nurses have not used a standard set up based on knowledge concerning the occupational stress of psychiatric department nurses. Hereafter, in research on the stress of psychiatric department nurses, standards with enough reliability and validity to measure and evaluate the occupational stress of psychiatric department nurses are still being searched for. Also, the development of mental health care in the psychiatric department ward according to these standards is expected.

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The patient was an 87-year-old man whose initial symptom was general fatigue and inappetence. His laboratory data revealed a rise in C-reactive protein (CRP) and white blood cell count (WBC), and CT scan showed suspicious pneumonia. Antibiotics were given to the patient, but his fever and laboratory data were sustained. Follow up examination revealed a high titer (107 U/ml) of myeloperoxidase specific anti-neutrophil cytoplasmic autoantibody (MPO-ANCA). He was diagnosed with MPO-ANCA associated vasculitis. Steroid pulse therapy was started. The patient's clinical symptoms and laboratory data thereafter significantly improved, but after one week the patient's symptom was aggravated and he died. An autopsy was performed, and necrotizing arteritis of the interlobular arteries were found in the kidneys. We found bacterial infective vegetation attached to the aortic valve. Infected thromboembolus and microabscesses were also found in many organs. We report a case of subacute microscopic polyangiitis associated with bacterial endocarditis.

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The Occupational Health Training Center offers the Occupational Health Practical Training Course (PTC) as a part of the postgraduate education of the University of Occupational and Environmental Health (UOEH). In this study, we evaluated the effect of the PTC on its trainees by signed questionnaires handed out before and after the course. Three PTCs are offered annually, and the curriculum consists of 4 divisions: General Health Management, Health Care and Promotion, Work Conditions and Ergonomics, and Work Environment Control. There was an significant affirmative difference in "General interest in Occupational Health Practice (OHP)" between before and after the PTC, but not in "Interest in OHP related to one's clinical specialty". This result implies that, in some clinical fields, it may be difficult to realize a common subject with OHP. We confirmed the presence of significant affirmative differences between before and after the PTC on all questions categorized in both "Acquisition of Knowledge and Skill Related to OHP" and "Awareness of Occupational Physicians' Mission". The results suggested that the PTC had a positive effect on the subjects.

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