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Yahata Y.,National Institute of Infectious DiseasesTokyo | Sugita-Konishi Y.,Azabu UniversityKanagawa | Ohnishi T.,National Institute of Health SciencesTokyo | Toyokawa T.,Okinawa Prefectural Nanbu Medical Center | And 3 more authors.
Japanese Journal of Infectious Diseases | Year: 2015

Raw fish consumption is increasing worldwide. Since around the year 2000, western regions of Japan have reported a foodborne disease of unknown cause that occurred after the consumption of flounder. In October 2010, a particularly large outbreak was reported in these regions among in-dividuals who consumed flounder fish that had been raised in aquaculture systems. The median incuba-tion period was 5 h (range, 4–19 h), and the most frequently reported symptom was diarrhea (80z). The risk estimate of the consumption of flounder was significantly higher than that of the development of symptoms (odds ratio = 9.50; 95z confidence interval, 1.59–/). According to a trace-back investigation, all of the flounder responsible for the outbreak were raised in aquaculture systems. Microscopic examination revealed that the median amount of Kudoa septempunctata present in the muscle of flounder fish from the aquaculture farm was 4.5 × 103 spores/g (range, 1.0 × 103 -9.6 × 106 spores/ g). The number of K. septempunctata spores required for the development of illness, as estimated using the Monte Carlo simulation, was 7.2 × 107 spores/g; therefore, thus this might be the minimum ingestion threshold for the development of gastrointestinal symptoms. As a public health measure, the cur-rent study results should be referred to for the prevention of the gastrointestinal symptoms related to the consumption of flounder; the national public health authority has disseminated these results. We con-cluded that K. septempunctata-contaminated flounder fish were associated with the gastrointestinal symptoms of this recent outbreak. © 2015, National Institute of Health. All rights reserved.


Sawada S.,University of Ryukyus | Ishikawa C.,University of Ryukyus | Tanji H.,University of Ryukyus | Nakachi S.,University of Ryukyus | And 15 more authors.
Blood | Year: 2010

Caveolin-1 is implicated in the regulation of signal pathways. Adult T-cell leukemia (ATL) is a T-cell malignancy causatively associated with human T-cell leukemia virus type 1 (HTLV-1). To determine the role of caveolin-1 in leukemogenesis, we examined caveolin-1 expression levels in HTLV-1-infected T-cell lines and ATL cells. These cells expressed high levels of caveolin-1 compared with uninfected T-cell lines and normal peripheral blood mononuclear cells (PBMCs). Caveolin-1-positive ATL cells were detected in ATL lymph nodes and skin lesions, and caveolin-1 was also detected in the plasma of patients with ATL. Infection of a human T-cell line, an epithelial cell line, and normal PBMCs with HTLV-1 induced caveolin-1 expression. The viral protein Tax transcriptionally activated caveolin-1 gene through nuclear factor-κB and cAMP response element binding protein signal pathways. HTLV-1-infected T-cell lines, and ATL cells are known to be resistant to transforming growth factor β (TGF-β)-induced growth inhibition. Caveolin-1 was colocalized with TGF-β type I receptor in HTLV-1-infected T-cell lines and suppressed TGF-β signaling. Caveolin-1 knockdown in an HTLV-1-infected T-cell line exhibited susceptibility to TGF-β. Thus, we describe a new function for Tax, repression of TGF-β signaling through caveolin-1 expression, which may play a critical role in ATL leukemogenesis. © 2010 by The American Society of Hematology.


Fujita J.,University of Ryukyus | Ohtsuki Y.,Matsuyama Shimin Hospital | Higa H.,Okinawa Prefectural Nanbu Medical Center | Azuma M.,Okinawa Prefectural Nanbu Medical Center | And 4 more authors.
Internal Medicine | Year: 2014

Objective: The purpose of this study was to perform clinicopathological evaluations of patients with pure influenza A virus pneumonia. Methods: We performed clinicopathological analyses of four cases of pure influenza A virus pneumonia. Patients: Among the four cases, three were caused by the pandemic (H1N1) 2009 virus. Three patients were analyzed during autopsy, and one underwent transbronchial lung biopsy. Results: We suggest that the interval between influenza virus A pneumonia onset and our analysis affected the pathological findings. Diffuse alveolar damage was observed during the acute phase. After ten days, organizing pneumonia and marked proliferation of premature type II alveolar epithelium were observed. Clinically, intra-alveolar hemorrhage was observed in two patients. Pathologically, hyaline membrane formation and intra-alveolar hemorrhage were observed in all cases. Conclusion: Severe epithelial damage was determined as the main mechanism of respiratory failure caused by influenza A virus pneumonia. © 2014 The Japanese Society of Internal Medicine.


Nakajima N.,Japan National Institute of Infectious Diseases | Sato Y.,Japan National Institute of Infectious Diseases | Katano H.,Japan National Institute of Infectious Diseases | Hasegawa H.,Japan National Institute of Infectious Diseases | And 17 more authors.
Modern Pathology | Year: 2012

Twenty autopsy cases with 2009 pandemic influenza A (2009 H1N1) virus infection, performed between August 2009 and February 2010, were histopathologically analyzed. Hematoxylin-eosin staining, immunohistochemistry for type A influenza nucleoprotein antigen, and real-time reverse transcription-PCR assay for viral RNA were performed on formalin-fixed and paraffin-embedded specimens. In addition, the D222G amino acid substitution in influenza virus hemagglutinin, which binds to specific cell receptors, was analyzed in formalin-fixed and paraffin-embedded trachea and lung sections by direct sequencing of PCR-amplified products. There were several histopathological patterns in the lung according to the most remarkable findings in each case: acute diffuse alveolar damage (DAD) with a hyaline membrane (four cases), organized DAD (one case), acute massive intra-alveolar edema with variable degrees of hemorrhage (three cases), neutrophilic bronchopneumonia (five cases) and tracheobronchitis with limited histopathological changes in alveoli (four cases). In two cases, the main findings were due to preexisting disease. Influenza virus antigen was only detected in the respiratory tract in 10 cases by immunohistochemistry. The antigen was detected in type II pneumocytes (three cases) in the epithelial cells of the trachea, bronchi and glands (six cases), and in the epithelial cells in both of the above (one case). The four cases with acute DAD presented with antigen-positive type II pneumocytes. In one case, the D222G substitution was detected in the lung as a major sequence, although 222D was prominent in the trachea, suggesting that selection of the viral clones occurred in the respiratory tract. In five cases, the pathogenesis of 2009 H1N1 was confirmed to be viral infection in pneumocytes, which caused severe alveolar damage and fatal viral pneumonia. Further studies on both host and viral factors in autopsy or biopsy materials will be essential to elucidate the other pathogenic factors involved in influenza virus infection. © 2012 USCAP, Inc. All rights reserved.


Okada I.,Yokohama City University | Hamanoue H.,Yokohama City University | Terada K.,Osaka Bioscience Institute | Tohma T.,Okinawa Prefectural Nanbu Medical Center | And 26 more authors.
American Journal of Human Genetics | Year: 2011

Microphthalmia with limb anomalies (MLA) is a rare autosomal-recessive disorder, presenting with anophthalmia or microphthalmia and hand and/or foot malformation. We mapped the MLA locus to 14q24 and successfully identified three homozygous (one nonsense and two splice site) mutations in the SPARC (secreted protein acidic and rich in cysteine)-related modular calcium binding 1 (SMOC1) in three families. Smoc1 is expressed in the developing optic stalk, ventral optic cup, and limbs of mouse embryos. Smoc1 null mice recapitulated MLA phenotypes, including aplasia or hypoplasia of optic nerves, hypoplastic fibula and bowed tibia, and syndactyly in limbs. A thinned and irregular ganglion cell layer and atrophy of the anteroventral part of the retina were also observed. Soft tissue syndactyly, resulting from inhibited apoptosis, was related to disturbed expression of genes involved in BMP signaling in the interdigital mesenchyme. Our findings indicate that SMOC1/Smoc1 is essential for ocular and limb development in both humans and mice. © 2011 The American Society of Human Genetics.


Tadokoro T.,Ryukyu University Hospital | Kakinohana M.,University of Ryukyus | Fukumoto C.,Okinawa Prefectural Nanbu Medical Center | Kawabata T.,Okinawa Prefectural Nanbu Medical Center | Yoza K.,Okinawa Prefectural Nanbu Medical Center
Paediatric Anaesthesia | Year: 2016

Background Dynamic variables based on the heart-lung interaction induced by positive pressure ventilation have not been shown to be useful in assessing cardiac preload in pediatric patients. Objective To evaluate whether stroke volume variation (SVV) obtained from the FloTrac/Vigileo™ monitoring system can reflect a change in blood volume during the blood removal and fluid replacement protocol in acute normovolemic hemodilution (ANH). Methods Sixteen pediatric patients scheduled for elective cranioplasty were recruited. In the ANH protocol, 10 ml·kg-1 blood removal and fluid replacement were performed. SVV, heart rate, mean blood pressure, and femoral venous pressure were recorded. Differences at four time points (T0: baseline, T1: 5 ml·kg-1 blood loss, T2: 10 ml·kg-1 blood loss, and T3: after fluid replacement) during ANH were compared. The blood volume (EBV) was estimated as 70 ml·kg-1 at T0 and decreased to 60 ml·kg-1 at T2. Results Of the 16 patients, four were excluded and 12 were analyzed. Significant differences in all of the parameters were observed between each time point. The SVV significantly increased after the blood removal and decreased after the fluid replacement (P < 0.01, Bonferroni adjustment). In addition, the increases in SVV during the blood removal, T0-T1 and T0-T2, were 70% ± 40% and 159% ± 91%, respectively. SVV showed a significant correlation with EBV during the blood removal in ANH (rs = -0.68, 95% confidence interval -0.73 to -0.63, P < 0.001). Conclusion Stroke volume variation obtained from the FloTrac/Vigileo™ monitoring system revealed a strong correlation with EBV during ANH without surgical stimulation. The usefulness of this device as an indicator of cardiac preload under hypovolemic or normovolemic conditions in children during surgery remains to be determined. © 2016 John Wiley & Sons Ltd.


Nishizeki O.,Okinawa Prefectural Nanbu Medical Center
Japanese Journal of Plastic Surgery | Year: 2015

A new idea for correcting lateral ray polysyndactyly of the toes was devised. A dorsal rectangular flap was designed after anatomic evaluation of the web space. Revision of the skin from the tip of the sixth toe and a zigzag skin excision from the lateral wall of the fourth toe were recommended to provide a more natural appearance to these toes. The spared skin was given in one piece and was a sufficient size for the raw surface in the web space, which was limited within a small area of the lateral wall of the fourth toe. The author applied this technique in six patients. In all cases, the fifth toe was discarded. The spared skin was sufficient for the skin defect in all patients, except for one case with no skin graft and primary closure. After an average follow-up of 14 months, postoperative results were good to excellent.


Shinjo M.,Okinawa Prefectural Nanbu Medical Center | Shinjo T.,Okinawa Prefectural Nanbu Medical Center
Japanese Journal of Clinical Ophthalmology | Year: 2012

Purpose: To report intraoperative floppy iris syndrome in 3 cases who had a history of treat ment with systemic risperidone, an antipsychotic agent. Method: We reviewed cases who received cata ract surgery by us during the past 68 months. Results: History of systemic risperidone was present in 11 eyes of 6 cases. Intraoperative floppy iris syndrome was present in 5 eyes of 3 cases (45%). The series comprised 3 eyes of 2 males and 2 eyes of one female. They were aged 69, 71 and 75 years respectively. Conclusion: Cataract patients with past history of risperidone intake may manifest intraoperative floppy iris syndrome.


Sashida Y.,Okinawa Prefectural Nanbu Medical Center | Arashiro K.,Okinawa Prefectural Nanbu Medical Center
Journal of Plastic Surgery and Hand Surgery | Year: 2010

We report the successful repair for tracheoinnominate fistula, in which the innominate artery was interposed with a synthetic graft and the pectoralis muscle was used as a seal against infection. We know of 10 other reported cases. © 2010 Informa UK Ltd.


Imaizumi A.,Okinawa Prefectural Chubu Hospital | Ishida K.,Okinawa Prefectural Chubu Hospital | Arashiro K.,Plastic Surgery KC | Nishizeki O.,Okinawa Prefectural Nanbu Medical Center
Journal of Plastic Surgery and Hand Surgery | Year: 2013

Composite grafting, grafting without microvascular anastomoses, has been widely performed for distal fingertip amputation in children with variable results, whereas successful replantation of these amputations using microsurgical technique has been reported. However, most of these reports included a wide age-range and a mix of different amputation levels. This study reviewed our cases of paediatric digital amputation, in order to verify the value of distal fingertip replantation over composite grafting, especially in early childhood. Seventeen young children (aged 3 years and 8 months on average), with single-digit fingertip amputations in Tamai zone I were reviewed from 1993-2008. Each amputation was subdivided into three types: distal, middle, and proximal. There were three distal, 13 middle, and one proximal type zone I amputations. All were crush or avulsion injuries. All three distal-type cases were reattached as primary composite grafts with one success. For middle-type cases, the survival rate of primary composite graft without exploration for possible vessels for anastomosis was 57%. On exploration, suitable vessels for anastomosis were found 50% of the time, in which all replantations were succeeded. The remaining cases were reattached as secondary composite grafts, with one success using the pocket method. Consequently, the success rate after exploration was 67%. The only one proximal-type amputation was failed in replantation. For the middle-type zone I amputation in early childhood, replantation has a high success rate if suitable vessels can be found. Therefore, exploration is recommended for amputations at this level with a view to replantation, irrespective of the mechanism of injury. © 2013 Informa Healthcare.

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