Innate immunity plays a pivotal role in host defense. The trauma of major surgery induces a variety of immunologic alterations in patients, which can lead to subsequent increased susceptibility to postoperative infections. Surgical stress inhibits innate immunity from the time of incision until about the first postoperative day. This is an alert period with susceptibility to bacterial infections. Normal patients regain innate immunity in the first postoperative day. The absence of recovery of innate immunity may cause susceptibility to infection and eventually lead to postoperative complications. Surgical stress causes catabolism, pain, ileus, nausea and vomiting, immunosuppression, increase of cardiac demands and coagulation cascade, and pulmonary dysfunction. Perioperative treatment or remedy will affect these surgical responses. Prevention of surgical site infections (SSI) is very important for clinicians. In the past, we worked with sterilization techniques, prophylactic antibiotics and environmental support such as maintaining body temperature and supplying a high concentration of oxygen. The goal of further clinical studies must be to establish the immunomodulating property of the individual, which is very important for controlling innate immunity and inflammation in each patient. The strategy for minimizing post-surgical infections is to optimize the immune response by maintaining homeostasis through nutritional support, and to reduce the surgical trauma by using minimal invasive surgery, which consequently reduces the stress response and immunesupression.

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A 66 year old woman with end-stage renal disease and liver cirrhosis due to chronic hepatitis C virus infection was introduced to hemodialysis therapy in 2003. In 2007, hepatocellular carcinoma was identified and the patient underwent radio frequency ablation (RFA) and ethanol injection therapy (EIT) under laparotomy. A large vaginal tumor was incidentally found at gynecological examination. Histological diagnosis was diffuse large B-cell lymphoma (Stage IE). During the first course of chemotherapy, the vaginal tumor began to prolapse from the vaginal wall due to an excellent response to the chemotherapy and finally was resected. The patient received another course of chemotherapy followed by radiotherapy. The vaginal tumor was undetectable in the follow-up imaging studies. Although patients with end-stage renal disease are at increased risk for several cancers, the occurrence of malignant lymphoma following hepatocellular carcinoma is rare. Furthermore, lymphomas arising from the female genital tract are very uncommon.

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The storage stability for six ketones was studied on four activated coconut carbons commonly used for air sampling in Japan. As the ratios of the enol form of cyclohexanone and methyl ethyl ketone are high, the ketones showed drastic losses during storage (storage stability), which could be attributed to catalytic oxidation and chemisorption. Moreover, adsorbed water caused a further decrease in recoveries of the ketones from the carbons. Because keto-enol tautomerism and hydration are catalyzed by acid or base, the relationships between the recoveries of the ketones from the carbons and pH in the aqueous solution of the carbons and the ignition residue of the carbons were investigated. As a result, the intensity of acidity or basicity of the carbons correlated with the loss of the ketones during storage, but the ignition residue of the carbons did not. Therefore, these results lead us to the conclusion that a more neutral coconut carbon is more suitable for the collection of aliphatic ketones, and activated coconut carbons are not suitable for cyclohexanone.

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The aspiration of foreign bodies into the bronchus frequently occurs in children as well as in elderly people. Foreign bodies in the airway not only cause chronic cough and pneumonia, but also result in life-threatening conditions, such as dyspnea and cyanosis. This report presents the clinical characteristics of 6 patients with bronchial foreign bodies who were treated between 2006 and 2010, including 4 male and 2 female patients. The age of the patients ranged from 8 to 83 years old. Foreign bodies were located in the right bronchial tree in all the patients. Chest X-rays showed pneumonia or atelectasis in 5 out of 6 patients. The foreign bodies were an artificial teeth or a tooth in 5 patients, and a fish bone in 1 patient. Five patients had fiberoptic bronchoscopy under local anesthesia, although an 8-year-old girl required general anesthesia with a laryngeal mask. Surgery was needed in only one case. Bronchial foreign bodies present a large range of symptoms, from trivial symptoms to irreversible damage to the bronchus and the lung, which can be life threatening. Nonspecific respiratory symptoms may be mistakenly attributed to other medical diagnoses unless there is a clear history of aspiration. However, an early diagnosis is very important, because inflammatory granulation due to long-term impaction of foreign bodies makes its removal difficult.

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It is necessary to consider protective measures, such as dust respirators, against the inhalation of nanoparticle aerosols. Industrial hygienists and workers handling nanomaterials are concerned about the filteration performance of dust respirators in protecting against nanoparticles, the size of which is less than 100nm. We developed a filteration performance evaluating system using titanium dioxide nanoparticle aerosols ranging from 15 to 220nm in diameter. The system, which includes two models of DS1 class and four models of DS2 class, was used to measure the collection efficiencies of dust respirators. These tested dust respirators had been certified by the Japanese government. In the dust respirators, there were no samples that showed less collection efficiency than the standard certified collection efficiency (80% for DS1 and 95% for DS2).

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Systemic lupus erythematosus (SLE) is a representative systemic autoimmune disease characterized by multi-organ manifestation. Although the etiology of the disease remains unclear, the activation of autoreactive T cells and production of antibodies by B cells are mainly involved in the pathological processes of the disease. B cell depletion therapy using anti-CD20 antibody rituximab has shown a rapid onset of effect and prolonged efficacy in refractory SLE, emerging as a promising new agent for the treatment of SLE. We also reported that rituximab is safe for the treatment of active SLE in a domestic pilot study and a multi-center phase Ⅰ/Ⅱ clinical trial. In regard to the mechanism underlying the efficacy of rituximab, it has been reported that the drug caused peripheral depletion of memory B cells and plasma cells. We found that rituximab efficiently depleted naïve and memory B cells and decreased co-stimulatory molecules on B cells and memory T cells. Recovered B cells in patients in long-term remission were dominated by naïve B cells with an increased ratio of naïve T cells, and co-stimulatory molecules remained low. These findings indicate that the reconstitution of the B cell compartment results in the inhibition of T cell activation by memory B cells, which leads to the sustained remission of SLE by rituximab. Although the recent placebo-controlled trials such as EXPLORER with rituximab in SLE did not achieve satisfactory results, other evidence continues to be published in support of the notion that B cell depletion could be useful for refractory SLE. In addition, other B-cell targeted therapies, such as CD22 and agents that interrupt B-T-cell interaction, including belimumab, also have potential of the therapeutic application.

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We report a case of dyshydrosiform pemphigoid. Multiple small bullae were noticed in the bilateral hands and feet of an 85 year old Japanese male about 1 month before admission to hospital, and these lesions gradually worsened and expanded generally. Clinical appearance on the initial examination showed a collection of erosions, bullae, and pustules with haemorrhagic pompholyx. Serum anti-BP180 antibody index was more than 150. Histopathologic appearance of the bullous leision revealed a subepidermal bulla with an inflammatory infiltrate and fibrinous exudate, with aggregated eosinophils, neutrophils, and lymphocytes in the upper dermis. In direct immunofluorescence, the epidermal basement membrane was stained strongly for complement C3 and weakly for IgG. Based on these features, especially from the particular clinical aspects, we finally diagnosed one subtype of bullous pemphigoid, namely dyshidrosiform pemphigoid. Although he got better by orally taking steroids, the eruptions recurred just after tapering off. Thereafter, he died due to worsened general condition partly complicated by pancreatitis.

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We measured the physique and physical fitness of 528 first year female nursing students in order to develop a plan for the health education and health promotion of nursing students. We also conducted a questionnaire survey of their health condition and athletic activities. The results showed that, compared to the national average for the same age group, the female nursing students had lower body weight, greater agility, and less muscle strength. In addition, they had little experience of athletic activities in junior and senior high school, and a high percentage of them were concerned about their physical fitness.

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The medical insurance system in Japan has been focusing on how to reduce the annual increases in medical expenses. In this context, the circumstances in the laboratory department in large hospitals have been growing more strict. Therefore, medical staff working in large hospitals need to know how to reduce the expenditure consumed in laboratory tests. In this paper we report economical loss resulted from physicians' excessive test-orders and suggest how to manage the problem.

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