フィリピンにおける公衆衛生に関する留学記

As a second-year resident at the University of Tokushima Hospital, I report on my experience of overseas training in the Philippines under the training program of the National Institute of Health Sciences. The National Institute of Health Sciences is an institution that conducts education, investigation, and research related to health, medical care, and welfare, and I trained for two months in the Department of Clinical Training in Community Health, Specialty Course III. In addition to the out-of-hospital training at the Ministry of Health, Labour and Welfare, Chiba Prefectural Government, and National Institute of Infectious Diseases, the one week overseas training in the Philippines（Manila） consisted mainly of lectures and training on mosquito-borne infectious diseases, zoonosis, and parasites at the University of the Philippines, Philippine General Hospital, Suburban Health Center, and WHO Western Pacific Office. Infectious diseases are very different from those in Japan. The actual observation made us understand that rabies and parasitic infections are raging in the Philippines due to the sanitary conditions of the living environment, which is very different from that of Japan. By learning about the medical system at overseas medical facilities, we were able to rethink deeply about the merits of the Japanese medical system and the direction it should take in the future from various perspectives

Symptomatic Developmental Venous Anomaly with an Increased β2-microglobulin Level in Cerebrospinal Fluid: A Case Report

Background: Gadolinium-enhanced magnetic resonance imaging (MRI) can be used to observe the progression of cerebral infarction, which sometimes mimics malignant brain tumors. While the β2-microglobulin (β2MG) level in blood plasma or cerebrospinal fluid (CSF) is useful for the diagnosis of malignant tumors or degenerative diseases, these results may create confusion regarding a definitive diagnosis, because it is not a specific marker. We present a rare case of symptomatic developmental venous anomaly (DVA), accompanied by transient, irregular, enhanced cerebral lesions and elevated β2MG in the CSF. Case Description: A 56-year-old woman developed dysarthria and underwent MRI, which revealed a right frontal hyperintense area around a previous lesion on diffusion-weighted imaging (DWI). She was treated based on the tentative diagnosis of an ischemic cerebrovascular event, and symptoms subsided in 3 days. MRI on day 7 revealed an enlargement of the hyperintense area on DWI. Post-gadolinium MRI showed multiple, enhanced patchy areas in the right frontal lobe and an abnormally large vein connected to dilated medullary venules, indicating DVA. Magnetic resonance angiography showed no stenosis or arterial occlusion. The β2MG level in the CSF was elevated at 2,061 μg/l, and a differential diagnosis from malignant tumor was required. However, MRI on day 23 revealed total disappearance of the enhanced lesions and a decrease in the high intensity area on DWI. Considering the clinical course, the DVA was symptomatic because of the perfusion disturbance. Conclusion: Careful evaluation is necessary when considering the associated pathologies and potential complications of DVA if detected near a gadolinium-enhanced lesion

Detrimental effect of anemia after mechanical thrombectomy on functional outcome in patients with ischemic stroke

BackgroundAnemia can occur due to an aspiration maneuver of blood with thrombi during mechanical thrombectomy (MT) for stroke. However, the association between postoperative anemia and stroke outcomes is unknown.MethodsIn a registry-based hospital cohort, consecutive patients with acute ischemic stroke who underwent MT were retrospectively recruited. Patients were divided into the following three groups according to their hemoglobin (Hb) concentrations within 24 h after MT; no anemia (Hb concentrations ≥13 g/dL for men and ≥ 12 g/dL for women), mild anemia (Hb concentrations of 11–13 g/dL and 10–12 g/dL, respectively), and moderate-to-severe anemia (Hb concentrations <11 g/dL and < 10 g/dL, respectively). A 3-month modified Rankin Scale score of 0–2 indicated a favorable outcome.ResultsOf 470 patients, 166 were classified into the no anemia group, 168 into the mild anemia group, and 136 into the moderate-to-severe anemia group. Patients in the moderate-to-severe anemia group were older and more commonly had congestive heart failure than those in the other groups. Patients in the moderate-to-severe anemia group also had more device passes than those in the other groups (p < 0.001). However, no difference was observed in the rate of final extended thrombolysis in cerebral infarction ≥2b reperfusion or intracranial hemorrhage among the groups. A favorable outcome was less frequently achieved in the moderate-to-severe anemia group than in the no anemia group (adjusted odds ratio, 0.46; 95% confidence interval, 0.26–0.81) independent of the baseline Hb concentration. A restricted cubic spline model with three knots showed that the adjusted odds ratio for a favorable outcome was lower in patients with lower Hb concentrations within 24 h after MT.ConclusionModerate-to-severe anemia within 24 h after MT is independently associated with a reduced likelihood of a favorable outcome.Clinical trial registrationhttps://www.clinicaltrials.gov, NCT02251665

Multiple redox state control of fullerene at room temperature through interfacial electrochemistry of ionic liquids

Control of the redox states of highly charged C60 anions in two ionic liquids (ILs) was investigated using cyclic voltammetry and differential pulse voltammetry. Highly charged reduced states of C605− and C606− could be produced and detected at room temperature by using an electrochemical interface between a multilayered C60 adlayer on a Au(111) electrode and N-butyl-N-methylpyrrolidinium-based IL, whereas a tributylmethylammonium-based IL provided less than four redox waves of C60. The multiple redox states of C60 were precisely controlled by a step-by-step, one-electron redox process. The results of the present study suggest that both a wide potential window and the interaction between C60 anions and IL cations are important for controlling the multiple redox states of C60 at room temperature. Keywords: Ionic liquid, Fullerene, Redox state control, Au(111