救急隊員が実施する蘇生処置に対する受益者の支払意思額 : 仮想市場調査法を用いた調査

Background: Japanese emergency medical services (EMS) can be used by anyone for free. Recently, EMS usage has increased; the increased costs and the prolonged time for ambulance transport have become recent social problems. Objective: We surveyed the willingness to pay (WTP) for resuscitation provided by EMS. Methods: In November 2011, men and women (3160) aged 20 - 59 years were asked to assume that they were experiencing a cardiopulmonary arrest (CPA), and their WTP for EMS services was assessed in the following three situations: Case A, ambulance transport alone; Case B, chest compression in addition to ambulance transport; and Case C, artificial ventilation through chest compression and intratracheal intubation, in addition to ambulance transport. We calculated the mean WTP for each case. Results: The WTP for Case A, B, and C were ¥6,696 ($65.0), ¥16,081 ($156.1), and ¥27,505 ($267.0), respectively. The WTP for Case B was significantly higher in respondents aged 40 - 59 years compared to those aged 20 - 39 years. The WTP for case B and C were significantly higher in males compared to females. WTP was significantly lower in students than it was in private employees. Although women’s intention to pay was higher than that of men, their WTP was lower than that of men. Public employees’ and students’ intention to pay was significantly lower than that of private employees. Conclusions: Our study provides information about the optimal fee for EMS, which will be useful for discussions on the feasibility of introducing a fee for EMS in Japan.博士（医学）・甲第678号・平成30年3月15日Copyright © 2017 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0

Significant association between high serum CCL5 levels and better disease‐free survival of patients with early breast cancer

Analysis of anticancer immunity aids in assessing the prognosis of patients with breast cancer. From 250 operated breast cancers, we focused on serum levels of C-C motif chemokine ligand 5 (CCL5), which is involved in cancer immune reactions. Serum levels of CCL5 were measured using a cytometric bead-based immunoassay kit and CCL5 expression in cancer cells was determined using immunohistochemical staining. In addition, mRNA in cancer and stromal cells was analyzed by microdissection and comparison with the public dataset. Disease-free survival (DFS) of patients with high CCL5 levels (cut-off, 13.87 ng/mL; n = 192) was significantly better than those with low CCL5 levels (n = 58; hazard ratio, 0.20; 95% confidence interval, 0.10- 0.39; P < .0001). An improved overall survival was observed in patients with high CCL5 levels compared to those with low CCL5 levels (P = .024). On the contrary, high immunohistochemical expression of CCL5 in cancer cells was significantly associated with decreased DFS. As serum CCL5 levels did not correlate with CCL5 expression in cancer cells and the relative expression of mRNA CCL5 was elevated in stromal cells in relation to cancer cells, serum CCL5 might be derived not from cancer cells, but from stromal cells. Expression of CCL5 in serum, but not in cancer cells, might contribute to improved patient prognosis mediating through not only immune reaction, but through other mechanisms. Determination of circulating CCL5 levels could be useful for predicting patient prognosis

抗原誘発性Th1・Th2サイトカイン産生に対する性ホルモンの影響の性差

The incidence, severity and prognosis of asthma can be affected by a number of factors, including the patient\u27s age and sex. Clinical observations and epidemiologic studies indicate that the prevalence and severity of asthma is higher among boys than girls, but that the ratio inverts after puberty. The reversal of the male/female prevalence of asthma at puberty strongly suggests a role of sex hormones. However, the mechanisms underlying the gender differences in the prevalence of asthma are not clear. Recently, we suggested that the sex differences were due to those in not only sex hormones but also lymphocyte functions based on findings in a murine model of allergic asthma. Therefore, we investigated the effect of sex hormones on antigen-induced cytokine production by lymphocytes to further investigate these gender differences. Splenocytes from ovalbumin (OVA)-sensitized female mice produced more IL-5, Th2 cytokine, than those from OVA-sensitized male mice, upon simulation with OVA. Progesterone decreased the production of IFN-g, Th1 cytokine, by splenocytes from both sensitized male and female mice. 17β-estradiol had no effect on Th1 and Th2 cytokine production by splenocytes from both mice. However, 5a-dihydrotestosterone decreased the production of Th2 cytokines by splenoytes from sensitized female mice but not these from male mice. Our findings suggest that lymphocytes from males and females have different sensitivities to sex hormones in antigen-induced cytokine production

Impact of Temperature in Summer on Emergency Transportation for Heat-Related Diseases in Japan

Background: In Japan, the demand for emergency transportation for people with heat-related illness has recently increased. The purpose of this study was to investigate the relationship between incidents of heat-related illness and the daily maximum temperature. Methods: The daily maximum temperatures in Japan's 11 districts over the past 10 years were classified into four categories, with cutoff points at the 50th, 75th, 95th, and higher than 95th percentiles. We then conducted a logistic regression analysis of emergency transportation demand in each temperature category by age group, using the 50th percentile as the reference category for each area. Results: There were 42,931 cases of emergency transportation due to heat-related diseases during the study period. Classified by age, 12.5%, 43.4%, and 44.1% of cases involved children, adults, and elderly people, respectively. The analysis showed that the number of cases of emergency transportation for people with heat-related diseases (per 100,000 people; corresponding to a 1.0°C increase in the daily maximum temperature) was 0.016–0.106 among children (24.9–169.9 children required emergency transportation for heat-related diseases), from 0.013 to 0.059 among adults (19.8–98.2 adults required emergency transportation), and from 0.045 to 0.159 among elderly persons (30.0–145.4 elderly people required emergency transportation). The risk was highest for elderly persons, followed by children and finally adults. Cases of emergency transportation due to heat-related illness increased by 2.4–8.9 times when the daily maximum temperature was approximately 1.5°C above the mean daily maximum temperature. In fact, the daily maximum temperature had a larger effect than the daily relative humidity level on emergency transportation for people with heat-related diseases. Conclusion: Public health organizations and health-care services should support elderly people and children, two high-risk groups for heat-related diseases