The rate of incidence of Tuberculosis (TB) in Indonesia is the ninth highest in the world. Poor environmental conditions, mainly related to air circulation and improper behaviour, were recognized as the risk factors in this country. A case-control study of 69 participants was conducted in the Umbulharjo I Public Health Centre of Yogyakarta during January-August 2019. Data collection was conducted using a tested questionnaire. Analysis was performed using Chi-square and Logistic regression. Three variables were identified as potential risk factors for TB: family history of TB, smoking behaviour, and ventilation condition. The results of the logistic regression test revealed that people who smoke have the greatest risk of TB infection. Health promotion needs to be enforced to educate both patients and their family to prevent the transmission of TB.

Although acute organophosphate (OP) pesticide poisoning is associated with the risk cardiovascular diseases (CVD), the association between chronic occupational OP pesticide exposure and CVD risk is limited. We investigated serum high-sensitivity C-reactive protein (hs-CRP) levels and QTc intervals in 45 agricultural workers who were chronically exposed to OP pesticides and 45 non-exposed subjects. Serum hs-CRP level was determined by enzyme-linked immunosorbent assay (ELISA) and a level >1.0 mg/l was regarded as CVD risk. The QT interval was measured by routine 12-lead Electrocardiogram (ECG) with Lead II rhythm, and QTc was calculated. The median value of the serum hs-CRP level [1.20 (0.67–2.38) vs 0.74 (0.41–1.17) mg/l, P <0.05] and the mean QTc interval (422.71 ± 23.73 vs 396.27 ± 18.48 ms, P <0.0001) was significantly higher in the OP pesticide exposed subjects. Pesticide exposure was significantly associated with CVD risk (Chi-Square χ² = 6.480, P = 0.011) and QTc interval prolongation (χ² = 13.846, P <0.001). A higher risk of CVD (odds ratio = 3.030; 95% confidence interval = 1.276 – 7.197) was observed in the OP pesticide exposed subjects. This study suggested that OP pesticide exposure should be considered as one of the significant risk factors for CVDs.

Several previous studies have investigated the effects of occupational stress on the onset of diabetes mellitus (DM), but there are few studies of occupational stress and DM using the Brief Job Stress Questionnaire (BJSQ), a standard stress check method in Japan. This study aimed to determine the relationship between occupational stress factors and the onset of DM using the BJSQ. We examined 6,620 male company workers aged 40 years and above in 2013, using the BJSQ. Overall, 2,604 subjects with impaired glucose tolerance who were free of mental disorders and DM were followed-up for 5 years and re-examined in 2017. A retrospective data analysis was conducted in 2019. We documented 241 new cases of DM in 2017 (diabetes group). Compared with the non-diabetes group, the subjects in the diabetes group had significantly decreased “skill utilization”. A binomial logistic regression analysis (generalized linear model) revealed that “skill utilization” was associated with the risk of DM development in 2017 (odds ratio, 1.632; 95% confidence interval, 1.061–2.510). Our results showed that low skill utilization might increase the risk of diabetes development in Japanese male workers.

We gave mice a 540 mg/kg dose of LD50 acephate, followed by an assessment of acephate, methamidophos (MP), and choline esterase (ChE) activity for up to 4 hours (hr) in order to investigate the time course of acephate intoxication. At 1 hr, the blood acephate and MP levels were 428 ± 90 µg/ml (mean ± SEM) and 4.2 ± 0.4 µg/ ml, respectively. The liver acephate levels were similar to those in the blood, but the liver MP levels were approximately 3.5 times that of the blood at 1 hr. The brain MP level tended to be higher than the blood MP at 1 hr. These levels decreased gradually over 4 hr, but the brain acephate and MP levels surpassed the blood levels significantly at 4 hr, and after 2 hr, respectively. Serum, liver, cerebrum, cerebellum, and brainstem cholinesterase activity (ChE) were inhibited at 1 hr, and remained inhibited in all but the cerebellum until the end of the experiment. The obtained data were applied to previously reported autopsy cases of acephate intake. Experimental data suggest that brain MP is involved in acute acephate-induced poisoning, even after a reduction in blood acephate. In autopsy cases with suspected acephate poisoning, the MP level in the brain should be considered in addition to the ChE activity to diagnose the cause of death.

In this study, we compare the results of a cross-sectional survey and secular changes between toner-handling workers and non-toner-handling workers, focusing on blood tests, urinalysis, respiratory function tests, and chest imaging results as indices of health effects. Of 116 employees who participated in the survey conducted at an office equipment manufacturer in Japan, 65 male employees who could be followed up for 10 years were included in the analysis. Thirty-eight workers engaged in toner-handling operations were considered toner-handling workers, and 27 not engaged in these operations were considered non-toner-handling workers. The blood tests (WBC, CRP, IgE, KL-6, and SP-D), urinalysis (8-OHdG), respiratory function tests (PEFR, VC, %VC, FEV_1.0, and FEV_1.0%), chest radiography, and chest CT results were compared between both groups. Non-toner-handling workers had significantly higher 8-OHdG/Cre at baseline and KL-6 at year 10 than did toner-handling workers. There were no significant differences between the results of the cross-sectional survey and a longitudinal survey of respiratory function test results. We conclude that there were no adverse health effects due to toner exposure.

The ever-changing social implications of the COVID-19 pandemic have resulted in an urgent need to understand the working environments and health status of workers. We conducted a nationwide Internet-based health survey of Japanese workers in December 2020, in the midst the country’s “third wave” of COVID-19 infection. Of 33,087 surveys collected, 6,051 were determined to have invalid responses. The 27,036 surveys included in the study were balanced in terms of geographical area, sex of participants, and type of work, according to the sampling plan. Men were more likely than women to have telecommuted, while women were more likely to have resigned since April 2020. Forty percent and 9.1% of respondents had a K6 score of 5 or higher and 13 or higher, respectively, and they did not exhibit extremely poor health. The present study describes the protocol used to conduct an Internet-based health survey of workers and a summary of its results during a period when COVID-19 was spreading rapidly in Japan. In the future, we plan to use this survey to examine the impact of COVID-19 on workersʼ work styles and health.

A 75-year-old-man experienced liver dysfunction and was diagnosed with decompensated liver cirrhosis. His serum hepatocyte growth factor (HGF) was very high (16.24 ng/ml). Because the etiology was unclear, we considered the possibility of amyloidosis. Biopsy of the mucosa of the stomach, duodenum and rectum demonstrated amyloid deposition. From the findings of Congo red staining and immunohistochemical analyses, we made a diagnosis of systemic amyloid light-chain amyloidosis. Unfortunately, the patient died one month after the diagnosis. We considered that serum HGF was useful for the diagnosis and prediction of prognosis of primary systemic amyloidosis.

Endometrioid carcinoma is the most common histological type of concurrent synchronous cancers of the uterus and ovary. Here we report a case of synchronous seromucinous carcinoma of the ovary and mucinous carcinoma of the endometrium with a literature review. A 51-year-old multiparous female complained of irregular bleeding and shortness of breath. Computed tomography revealed a large pelvic mass that consisted of cystic and solid components, a tumor of the endometrium, and a large amount of pleural effusion. An endometrial biopsy indicated adenocarcinoma, and adenocarcinoma cells were found in the pleural fluid. The patient with advanced ovarian cancer or endometrial cancer with massive pleural effusion received three courses of neoadjuvant chemotherapy (NAC) with paclitaxel and carboplatin followed by interval debulking surgery (IDS). The NAC was effective, and IDS was performed with no gross residual lesions. The post-operative diagnosis was seromucinous carcinoma of the ovary in FIGO (2014) stage IVA (ypT3cNxM1a) and mucinous carcinoma of the endometrium in FIGO (2008) stage IA (ypT1aNXM0). Three courses of postoperative TC therapy were performed, and maintenance therapy with Bevacizumab is ongoing. The patient is well without evidence of recurrence, sixteen months after surgery.

環境圧の不適切な低下で生ずる減圧障害は，気泡が原因の減圧症と肺の気圧外傷後の動脈ガス塞栓症の2つの病態を含んだものである．この治療法では高圧酸素治療の1つである酸素再圧治療が標準的と考えられてきたが，ランダム化比較試験での有効性は確認されていない．この治療の効果を客観的に評価するために，減圧障害のすべての病状，特に神経症状に対する治療効果を文献的に検討した．その結果，重症の減圧障害，なかでも脊髄障害では早期あるいは超早期に酸素再圧治療の有効性を積極的に支持する結果は明らかではなかった．一方で，初期対応としての酸素吸入は高い比率で減圧障害のすべての病状の改善ないし進行防止につながっていた．このような状況のなかで，国際的な高気圧・潜水医学の専門委員会は軽症の減圧障害には酸素再圧治療を行わなくても対処可能としている．今後の課題は減圧障害のなかでも高頻度の脊髄障害に対する酸素再圧治療と酸素吸入との比較検討が必要と考えられる．さらに，わが国で潜水作業や圧気土木作業を規定している高気圧作業安全衛生規則の問題を指摘してきたが，科学的根拠に基づいた改正が必要であると思われる．

症例は59歳，女性である．来院の2年前に視神経炎を生じ加療され，その際に抗AQP4抗体陽性を指摘された．脳脊髄病変は認めず，Neuromyelitis optica spectrum disorders （NMOSD）の診断でPSL 5 mg/日の内服を2年間継続していた．X日に腰痛と尿閉が出現し前医に入院となった．X+1日に意識障害と対麻痺が出現し，当院に救急搬送となった．意識はJCS 2桁で項部硬直を認め，対麻痺と尿閉を認めた．髄液検査で細胞数1,232 /μl，単核球優位の細胞数増多を認めた．頭部MRI検査で脳室周囲と脳梁に多発病変を認め，脊髄MRIでC2からTh5までの長大病変を認めた．NMOSDの再燃と診断し，ステロイドパルス療法を開始，その後プレドニゾロン 1 mg/kg/日の後療法を行った．しかし症状は進行し，四肢麻痺，昏睡状態となり，頭部MRIで脳室周囲の深部白質や大脳脚に新規病巣を認めた．2回目のステロイドパルスに単純血漿交換療法を追加し，徐々に意識状態は改善，左上肢の自発運動が出現したが，重篤な三肢麻痺が残存した．本症例はステロイド内服中にも関わらず，多発脳脊髄病変で再発した重症のNMOSDであった．ステロイドパルス後も疾患の進行を認め，血漿交換療法が有効であり，本症例の病態について文献的考察を交えて報告する．

高齢者の社会参加活動の継続を支援するには，自らの意志で移動できる手段を確保・整備することが求められ，その一つに電動カートが挙げられる．本研究は，地域で生活する高齢者が，電動カートを移動手段として活用するに至った経緯や電動カートを使ってどのような生活を送っているのかを明らかにすることを目的とした．研究方法として半構成的面接を行い，得られたデータを質的記述的に分析した．電動カートを移動手段の一つとして活用した経緯として，≪自動車運転免許の返納≫，≪下肢の障害による移動手段の喪失≫，≪電動カートへの興味と他者からの勧め≫，≪家族の協力状況≫の4サブカテゴリを含む【移動手段の確保】，電動カートを活用した日常生活の実際として，≪簡単な運転操作と安全装備≫，≪危険予測時の対応≫，≪危険のない現状≫，≪電動カート使用継続の意思≫の4つのサブカテゴリから構成された【安全な利用】と，≪行動範囲の維持・拡大≫，≪他者との交流≫，≪自分で買い物をする楽しみ≫の3つのサブカテゴリを含む【活動と参加】のカテゴリが抽出された．電動カートの活用がその人らしい生活に繋がっている一方で，事故が起こらないような取り組みを行う必要性が示唆された．

乳癌術後長期経過後に再発した肺転移3例を経験したので報告する．症例1：77歳女性．15年前に右乳癌に対して乳房温存療法を施行された．他疾患加療中のCTにて左肺下葉に結節を指摘され当院にて手術を施行した．術中迅速病理検査はカルチノイドの診断であり，胸腔鏡下左肺下葉切除を施行した．最終病理検査では乳癌肺転移と診断された．症例2：88歳女性．23年前に左乳癌に対して乳房切除術を施行された．その後のCTにて左肺上葉に結節を指摘され，胸腔鏡下左肺上葉部分切除を施行した．病理診断は乳癌肺転移であった．症例3：78歳女性．29年前に右乳癌に対して右乳房切除術を施行された．腹痛時に施行したCTにて右肺上葉の結節を指摘され，胸腔鏡下左肺上葉切除を施行した．術後病理検査で乳癌肺転移と診断された．乳癌の肺転移はしばしば画像検査で原発性肺癌と区別が難しい場合が多く，乳癌の既往があれば無病生存期間15年以上経過していても乳癌再発の可能性を考慮することが必要である．

症例は86歳女性．右大腿骨頚部不全骨折のため当院整形外科に入院中であった．突然の右下腹部痛，嘔吐が出現し，腹部造影CTでは盲腸外側に小腸のclosed loopを認めた. 盲腸周囲ヘルニアによる腸閉塞と診断し，同日腹腔鏡下手術を施行した．盲腸外側の陥凹部に回腸が10 cm程度陥入しており，外側型盲腸周囲ヘルニアと診断した．ヘルニア門を切開後，脱出腸管を整復し，ヘルニア嚢は十分に開放した．陥入腸管に壊死の所見はなく，切除は行わなかった．腹部造影CTにて盲腸と陥入腸管の特徴的な位置関係により盲腸周囲ヘルニアの術前診断がなされ，早期単孔式腹腔鏡手術にて治療が可能であった．

高齢者の尊厳を守ることは，高齢者のケアを行う上で不可欠なことである．高齢者がケア場面のどのような状況で羞恥を感じるかを把握するために調査を行った．調査内容は，病院内で看護師や患者が日常的に遭遇する場面を表現したイラスト計12枚を使用した．イラストは著者らが独自に作成した．対象は，A県の老人福祉施設4施設を利用する60歳以上の高齢者を対象とした．要介護度3以下で，かつ認知症のない43名に対して調査を行い，有効回答は41名であった．その結果，1.高齢者は，周囲に人がいる場合では，おなじ処置や動作でも羞恥を強く感じる．2.高齢者は，移動する際，松葉杖を使う場合よりも車いすで援助を受ける方が羞恥を強く感じる．3.清拭では，周囲に人がいる場合でもそれほど羞恥が強まらなかった．4.家族の面会において，男性は周囲に人がいる場合で羞恥が高くなった．これらのことより，高齢者は，医療者以外の人に処置や動作を見られることに羞恥が高いということが考えられた．また，車いすで移動することは，身体的な衰えを他者に見られるので羞恥が高くなると考える．男性は性別役割が弱くなるような場面を人に見られることで羞恥が高くなるのではないかと推測された．高齢者の日常的に遭遇する場面における羞恥心は，性差や医療従事者以外の人の有無により相違があることが明らかになった．