Hepatic encephalopathy due to extrahepatic portosystemic shunt

Clinicians should recognize extrahepatic portosystemic shunt as a cause of refractory or intermittent hepatic encephalopathy. Treatment strategies should be individualized according to patients' anatomic and hemodynamic status

Trends in the incidence and mortality of legionellosis in Japan: a nationwide observational study, 1999-2017

This study examined temporal trend, seasonality, and geographical variations of legionellosis incidence and mortality in Japan. This nationwide observational study used the Japanese Vital Statistics and Infectious Diseases Weekly Report (1999-2017) data to calculate legionellosis crude and age-adjusted incidence and mortality rates per 100,000 population by age and sex. Incidence was compared among the 4 seasons and regional incidence among 47 prefectures. Of 13,613 (11,194 men) people with legionellosis in Japan, 725 (569 men) were fatal. Increasing incidence trend occurred from 0.0004 (1999) to 1.37 (2017) per 100,000 population. People aged >= 70 years accounted for 43.1% overall; men's age-adjusted incidence rate was consistently approximately five times higher than for women. Significantly higher incidence occurred in summer than in winter (p=0.013). Geographically, highest incidence (>= 2.0 per 100,000 population) occurred in Hokuriku District, with increasing trends in Hokkaido and middle-part of Japan. Estimated fatality rates decreased consistently at 5.9% (95% confidence interval: - 8.1, - 3.5) annually, from 1999 to 2017, with no trend change point. Increasing legionellosis incidence occurred in Japan during 1999-2017, with declining estimated fatality rates. In this aging society and warming world, disease clinical burden may further deteriorate in future due to increasing incidence trends

Verbal to visual code switching improves working memory in older adults: an fMRI study

The effect of verbal to visual code switching training on working memory performance was investigated in individuals aged 63 and older. During verbal working memory task performance, the training group (n = 25) was introduced to a verbal to visual code switching strategy while the control group (n = 25) was not exposed to such a strategy. Working memory recognition accuracy was enhanced only in the training group. To explore the neural substrates underlying these strategy effects, fMRI was used to measure brain activity in both groups during working memory task performance before and after an attention training period. In a comparison between pre- and post-training sessions, results showed increased activation in the anterior cingulate cortex (ACC). Relative to the control group, the post-training group exhibited increased activation in the left and right inferior parietal lobules (IPLs) and right superior parietal lobule (SPL). These findings suggest that use of a verbal to visual code switching strategy may assist older individuals in the maintenance of information in working memory

Simultaneous hot and cold thyroid nodules: Which is malignant?

Physicians should be aware of the risk of malignancy in patients with toxic multinodular goiter. Radionuclide scan cannot be used to predict the malignant potential of thyroid nodules. A comprehensive evaluation of imaging studies is needed

Barium appendicitis

We have presented a case of barium appendicitis, which is a rare complication of barium enema studies. Barium sulfate is used widely for gastrointestinal radiographic studies and is associated with few complications. Clinicians need to be fully aware of this complication

Characterization and Conduction Mechanism of Highly Conductive Vanadate Glass

This paper reviews recent studies of highly conductive barium iron vanadate glass with a composition of 20 BaO ∙ 10 Fe2O3 ∙ 70 V2O5 (in mol %). Isothermal annealing of the vanadate glass for several ten minutes at a given temperature, higher than glass transition temperature or crystallization temperature, caused an increase in σ. Substitution of CuI (3d10), ZnII (3d10) and CuII (3d9) for FeIII (3d5) was investigated to elucidate the effect of electron configuration on the conductivity (σ). A marked decrease in the activation energy of conduction (Ea) was also observed after the annealing. Values of Ea were correlated to the energy gap between the donor level and the conduction band (CB) in the n-type semiconductor model. Isothermal annealing of ZnII-substituted vanadate glass (20 BaO ∙ 5 ZnO ∙ 5 Fe2O3 ∙ 70 V2O5) at 450 °C for 30 min showed an increase in σ from 2.5 × 10–6 to 2.1 × 10–1 S cm–1, which was one order of magnitude larger than that of non-substituted vanadate glass (3.4 × 10–2 S cm–1). Under the same annealing condition, σ’s of 2.0 × 10–1 and 3.2 × 10–1 S cm–1 were observed for 20 BaO ∙ 5 Cu2O ∙ 5 Fe2O3 ∙ 70 V2O5 and 20 BaO ∙ 5 CuO ∙ 5 Fe2O3 ∙ 70 V2O5 glasses, respectively. These results demonstrate an increase in the carrier (electron) density in the CB, primarily composed of anti-bonding 4s-orbitals

Interest in Infectious Diseases specialty among Japanese medical students amidst the COVID-19 pandemic: A web-based, cross-sectional study

IntroductionThe emergence of the novel coronavirus disease of 2019 (COVID-19) has led to huge disruptions in the medical field and society. The significance of training and education for experts has been increasingly acknowledged in Japan, where the number of infectious disease (ID) specialists is reportedly insufficient. In this paper, we report the results of a web-based survey that was conducted to reveal the ways in which the COVID-19 pandemic has influenced medical students' awareness of ID specialists and future career choices. MethodThis cross-sectional descriptive study was conducted in March 2021 and targeted 717 medical students belonging to Medical School of Okayama University, Japan. The questionnaire consisted of four questions meant to assess students' knowledge and future intentions of becoming ID specialists. ResultsWe obtained 328 eligible questionnaires (response rate: 45.7%). Of 227 (69.2%) students who were aware of ID specialists, 99 (43.6%) answered that they came to know about them only after the pandemic, 12 (3.7%) answered that their interest in being an ID specialist arose during the pandemic, while 36 (11.0%) responded that they would rather not become ID specialists. At the time of the survey, 5 students (1.5%) were aiming to become ID specialists. ConclusionWe observed a very low rate of interest to be an ID specialist among medical students. The experience of the pandemic does not seem to have influenced Japanese medical students to choose ID as a specialty for their careers. Continuous efforts to increase the number of ID specialists are necessary in Japan as a countermeasure against the coming pandemic

DEVELOPMENT OF JAPANESE VERSION OF THE CANCER WORRY SCALE AND EXAMINATION OF ITS VALIDITY AND RELIABILITY.

The aim of this study was to develop a Japanese version of the Cancer Worry Scale (CWS-J) using a university student sample. Results showed that CWS-J had a one factor structure. An internal consistency check and test-retest correlation indicated that the scale had sufficient reliability. Although part of convergent validity was not sufficiently established, correlations with the Penn State Worry Questionnaire, Short Health Anxiety Inventory and Hospital Anxiety and Depression Scale were mostly consistent with the hypothesis, which generally supports the discriminatory and convergent validity of CWS-J. These results indicated that the scale has the required reliability and validity to measure university students’ cancer worry

An Elderly Male with Primary Sjögren’s Syndrome Presenting Pleuritis as the Initial Manifestation

Primary Sjögren’s syndrome (SS) is an autoimmune disease that usually affects the exocrine glands in mid-dle-aged women. Fifteen percent of SS patients experience severe systemic extraglandular complications, and pleuritis is one of the rare complications of SS. We report the case of an elderly Japanese man who initially pre-sented with a prolonged fever and chest pain and was finally diagnosed with primary SS-associated pleuritis. Of the nine reported cases of primary SS that initially presented with pleuritis, up to six cases were elderly males. This case highlights the complication of pleuritis among elderly males with primary SS