Association between hospital case volume and mortality in non-elderly pneumonia patients stratified by severity: a retrospective cohort study

Background: The characteristics and aetiology of pneumonia in the non-elderly population is distinct from that in the elderly population. While a few studies have reported an inverse association between hospital case volume and clinical outcome in elderly pneumonia patients, the evidence is lacking in a younger population. In addition, the relationship between volume and outcome may be different in severe pneumonia cases than in mild cases. In this context, we tested two hypotheses: 1) non-elderly pneumonia patients treated at hospitals with larger case volume have better clinical outcome compared with those treated at lower case volume hospitals; 2) the volume-outcome relationship differs by the severity of the pneumonia. Methods: We conducted the study using the Japanese Diagnosis Procedure Combination database. Patients aged 18–64 years discharged from the participating hospitals between July to December 2010 were included. The hospitals were categorized into four groups (very-low, low, medium, high) based on volume quartiles. The association between hospital case volume and in-hospital mortality was evaluated using multivariate logistic regression with generalized estimating equations adjusting for pneumonia severity, patient demographics and comorbidity score, and hospital academic status. We further analyzed the relationship by modified A-DROP pneumonia severity score calculated using the four severity indices: dehydration, low oxygen saturation, orientation disturbance, and decreased systolic blood pressure. Results: We identified 8,293 cases of pneumonia at 896 hospitals across Japan, with 273 in-hospital deaths (3.3%). In the overall population, no significant association between hospital volume and in-hospital mortality was observed. However, when stratified by pneumonia severity score, higher hospital volume was associated with lower in-hospital mortality at the intermediate severity level (modified A-DROP score = 2) (odds ratio (OR) of very low vs. high: 2.70; 95% confidence interval (CI): 1.12–6.55, OR of low vs. high: 2.40; 95% CI:0.99–5.83). No significant association was observed for other severity strata. Conclusions: Hospital case volume was inversely associated with in-hospital mortality in non-elderly pneumonia patients with intermediate pneumonia severity. Our result suggests room for potential improvement in the quality of care in hospitals with lower volume, to improve treatment outcomes particularly in patients admitted with intermediate pneumonia severity

Marylosides A-G, Norcycloartane Glycosides from Leaves of Cymbidium Great Flower ‘Marylaurencin’

Seven novel norcycloartane glycosides, maryloside A–G (1–7), were isolated from the leaves of Cymbidium Great Flower ‘Marylaurencin’, along with a known norcycloartane glycoside, cymbidoside (8). These structures were determined on the basis of mainly NMR experiments as well as chemical degradation and X-ray crystallographic analysis. The isolated compounds (1–6 and 8) were evaluated for the inhibitory activity on lipopolysaccharide (LPS) and interferon-γ (IFN-γ)-stimulated nitric oxide (NO) production in RAW 264.7 cells. Consequently, 1 and 3 exhibited moderate activity

Incidence and Risk Factors for Infections Requiring Hospitalization, Including Pneumocystis Pneumonia, in Japanese Patients with Rheumatoid Arthritis

Objective. Rheumatoid arthritis (RA) may be complicated by different infections, but risk factors for these are not fully elucidated. Here, we assessed the incidence of and risk factors for infections requiring hospitalization (IRH) including pneumocystis pneumonia (PCP) in patients with RA. Methods. We retrospectively surveyed all RA patients treated at our hospital from 2009 to 2013, for whom data were available on demographic features, medications, comorbidities, and severity of RA. Multivariate logistic regression analysis was applied to calculate adjusted odds ratios (ORs) for factors associated with the occurrence of IRH. Results. In a total of 9210 patient-years (2688 patients), there were 373 IRH (3.7/100 patient-years). Respiratory tract infections were most frequent (, and additionally 16 PCP), followed by urinary tract infections (). Significant factors for PCP included higher age (≥70 years; OR 3.5), male sex (6.6), underlying lung disease (3.0), use of corticosteroids (4.8), and use of biologics (5.4). Use of methotrexate (5.7) was positively associated with PCP but negatively with total infections (0.7). Additionally, functional disorders and higher RA disease activity were also related to total infections. Conclusions. Risk factors for infection should be taken into account when deciding treatment for the individual RA patient

カンケイ ドウブツ アオゴカイ Perinereis aibuhitensis キョダイ ヘモグロビン ノ グロビンサ ニ フクマレル ケウナ SSケツゴウ

The extracellular hemoglobin (Hb) from the polychaete Perinereis aibuhitensis consists of four types of 144 globins and two types of 36 linker chains，having a molecular mass of about 3,500 kDa. There are two types of globin subunits: monomer chain a and disulfide-bondedt rimer AbB. The amino acid sequences of the four globin chains (a，A ，b ，B ) were already reported，previously (Yamanaka，M. et al. Natural Science Research of Tokushima University, 19, 63-92, 2005). The site of disulfide bonds in the globin subunits have been investigated. Each globin chain contains an intrachain disulfide bond between N-terminal and C-terminal Cys residues. In addition，the interchain disulfide bonds were found between chains A and b，and b and B. Therefore，it is elucidated that the chain b is situated at the center of disulfide-bonded trimer，such as A-b-B.The sites of disulfide-bonds determined all could be suitably fitted to the tree dimensional structure of each subunit in a model without stretching or twisting. It was also confirmed that there is no free Cys residue in Peinereis globins. The positions of Cys residues of Perinereis globin sequences were compared wIth those of other 27 chains derived from the homologous Hbs. Among 31 sequences，Cys residues were distributed in six sites. The sites 1 and 2 are located at the N-terminal region of amino acid sequences，the sItes 3 and 4 at the central region，and the sites 5 and 6 at C-terminal region. Furthermore，the Cys distribution was categorized into eight patterns. Perinereis Hb has four patterns I，IV，VII，VIII，be ing lack of the central sites 3 and 4. It should be noted that the pattern II includes the unique globins from Hbs of Lamellibrachia，Riftia and Oligobrachia that carry H2S to the symbiotic bacteria，suggesting that these globin chains might carry H2S in vivo. The phylogenetic tree of 31 globin chains derived from the giant Hbs is divided into two families A and B， as already poited out by us Previously. The family A indudes pattern I-V，whereas the family B includes V- VIII

Case-based similar image retrieval for weakly annotated large histopathological images of malignant lymphoma using deep metric learning

In the present study, we propose a novel case-based similar image retrieval (SIR) method for hematoxylin and eosin (H&E)-stained histopathological images of malignant lymphoma. When a whole slide image (WSI) is used as an input query, it is desirable to be able to retrieve similar cases by focusing on image patches in pathologically important regions such as tumor cells. To address this problem, we employ attention-based multiple instance learning, which enables us to focus on tumor-specific regions when the similarity between cases is computed. Moreover, we employ contrastive distance metric learning to incorporate immunohistochemical (IHC) staining patterns as useful supervised information for defining appropriate similarity between heterogeneous malignant lymphoma cases. In the experiment with 249 malignant lymphoma patients, we confirmed that the proposed method exhibited higher evaluation measures than the baseline case-based SIR methods. Furthermore, the subjective evaluation by pathologists revealed that our similarity measure using IHC staining patterns is appropriate for representing the similarity of H&E-stained tissue images for malignant lymphoma

Influence of post-disaster evacuation on incidence of hyperuricemia in residents of Fukushima Prefecture: the Fukushima Health Management Survey

Aim: After the Great East Japan Earthquake, over 160, 000 residents in Fukushima Prefecture were forced to evacuate the area around the Fukushima Daiichi power plant following nuclear accident there. Health problems in these evacuees have since become a major issue. We have examined the association between evacuation and incidence of hyperuricemia among residents in Fukushima. Methods: We conducted a cohort study of residents aged 40–90 years without hyperuricemia at the time of the Fukushima disaster. Among 8173 residents who met the inclusion criteria before the disaster, 4789 residents (men: 1971, women: 2818; follow-up duration: 1.38 years; and follow-up rate: 58.6%) remained available for follow-up examinations at the end of March 2013. The main endpoint was incidence of hyperuricemia, defined by the Japanese committee guidelines, using local health data from before and after the disaster. We divided participants by evacuation status and compared outcomes between groups. Using a logistic regression model, we estimated the odds ratio for incidence of hyperuricemia, adjusting for potential confounders, age, gender, waist circumference, physical activity, and alcohol consumption. Results: Incidence of hyperuricemia was higher in evacuees (men 10.1%; women 1.1%) than in non-evacuees (men 7.4%, women 1.0%). Evacuees had higher body mass index, waist circumference, triglycerides, LDL-cholesterol, fasting plasma glucose, HbA1c, and lower HDL-cholesterol after the disaster than non-evacuees. We found that evacuation was associated with incidence of hyperuricemia (adjusted odds ratio: 1.38; 95% confidence interval: 1.03-1.86). Conclusion: This is the first study to demonstrate an association between evacuation after a disaster and increased incidence of hyperuricemia

Research Activities in the Department of Occupational Therapy

Even though the purpose of the services provided by occupational therapy is to help and to support the daily life of clients, the actual services extend to a wide range of daily activities. Thus, research in occupational therapy covers a wide range of activities which can be modified and changed according to the needs of clients. Research activities conducted by clinical psychologists and English teachers who staff the Department of Occupational Therapy at Aino University are also summarized below. [1. Research in Occupational Therapy for Physically Handicapped.] We are involved in a study of the efficient motion analysis in the activity of daily life (ADL) in part with the staff of the Department of Clinical Engineering. We analyze the muscle tone under various locomotive operations by quantifying muscle tone with surface electro-myography (EMG). We have studied the brain network related to memory and learning in the training tasks that enable effective learning skills and their clinical application