Infection control for COVID-19 in hospital examination room.

Healthcare providers are vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) because of their close proximity to patients with coronavirus disease 2019. SARS-CoV-2 is mainly transmitted via direct and indirect contact with respiratory droplets, and its airborne transmission has also been identified. However, evidence for environmental factors is scarce, and evidence-based measures to minimize the risk of infection in clinical settings are insufficient. Using computational fluid dynamics, we simulated exhalation of large and small aerosol particles by patients in an otolaryngology examination room, where medical procedures require the removal of a face mask. The effects of coughing were analyzed, as well as those of humidity as a controllable environmental factor and of a suction device as an effective control method. Our results show that a suction device can minimize aerosol exposure of healthcare workers by efficiently removing both large (11.6-98.2%) and small (39.3-99.9%) aerosol particles. However, for coughing patients, the removal efficiency varies inversely with the particle size, and the humidity notably affects the aerosol behavior, indicating the need for countermeasures against smaller aerosols. Overall, these results highlight the potential and limitation of using a suction device to protect against SARS-CoV-2 and future respiratory infections.

Association of eHealth Literacy With Lifestyle Behaviors in University Students: Questionnaire-Based Cross-Sectional Study.

BACKGROUND: Maintenance of good health and a healthy lifestyle have significant impacts on the lives of university students. However, university students are prone to engage in risky health behaviors, resulting in impaired health status. Electronic health (eHealth) literacy is an important factor in maintaining a healthy lifestyle. However, no studies have assessed the eHealth literacy levels and the associated lifestyle behaviors among university students in Japan. OBJECTIVE: The purposes of this study were to clarify the eHealth literacy level, the participant characteristics associated with eHealth literacy, and the association of eHealth literacy with lifestyle behaviors of students in a Japanese university. METHODS: A questionnaire-based cross-sectional study of 3183 students at a national university in Japan was conducted. eHealth literacy was quantified using the Japanese version of the eHealth Literacy Scale (eHEALS). The association between participant characteristics (gender, school year, department of study, and living status) and eHEALS score was assessed using t tests. Additionally, the associations of eHealth literacy with lifestyle behaviors (exercise, smoking, alcohol consumption, etc.) were evaluated using logistic regression analyses. RESULTS: The mean eHEALS score was 23.6/40 points. The mean eHEALS score for students in medical departments was 27.0/40 points, which was 2.9 points higher than that of nonmedical students (P<.001). Similarly, the graduate school participants had higher scores than the undergraduate students. The proportion of participants who exercised regularly was higher in the high eHEALS score group than in the low score group, with an adjusted odds ratio of 1.39 (P<.001). CONCLUSIONS: The eHealth literacy level of university students in Japan was comparable to that of the general Japanese population. Graduate students, as well as those in medical departments, had higher eHealth literacy. Furthermore, students with higher eHealth literacy had better exercise routines.

[Smoking cessation for COPD].

Smoking cessation is the most effective intervention to prevent the annual decline in lung function in patients with chronic obstructive pulmonary disease. All primary healthcare providers should routinely ask all patients whether tobacco use is active or not, and advise tobacco users to stop smoking. In Japan a treatment of nicotine addiction with varenicline or nicotine patch has been started under health insurance coverage since 2006. About half of the patients taking varenicline could stop smoking. Education on the health risks of smoking in schools for younger ages is essential for prevention of COPD.

Non-superiority of Kakkonto, a Japanese herbal medicine, to a representative multiple cold medicine with respect to anti-aggravation effects on the common cold: a randomized controlled trial.

OBJECTIVE: Kakkonto, a Japanese herbal medicine, is frequently used to treat the common cold not only with a physician's prescription, but also in self-medication situations. This study aimed to examine whether Kakkonto prevents the aggravation of cold symptoms if taken at an early stage of illness compared with a well-selected Western-style multiple cold medicine. METHODS: This study was a multicenter, active drug-controlled, randomized trial. Adults 18 to 65 years of age who felt a touch of cold symptoms and visited 15 outpatient healthcare facilities within 48 hours of symptoms onset were enrolled. The participants were randomly assigned to two groups: one treated with Kakkonto (Kakkonto Extract-A, 6 g/day) (n=209) and one treated with a Western-style multiple cold medicine (Pabron Gold-A, 3.6 g/day) (n=198) for at most four days. The primary outcome of this study was the aggravation of cold, nasal, throat or bronchial symptoms, scored as moderate or severe and lasting for at least two days within five days after entry into the study. RESULTS: Among the 410 enrollees, 340 (168 in the Kakkonto group and 172 in the Pabron group) were included in the analyses. The proportion of participants whose colds were aggravated was 22.6% in the Kakkonto group and 25.0% in the Pabron group (p=0.66). The overall severity of the cold symptoms was not significantly different between the groups. No harmful adverse events occurred in either group. CONCLUSION: Kakkonto did not significantly prevent the progression of cold symptoms, even when prescribed at an early stage of the disease.

Phase I study of cisplatin and irinotecan combined with concurrent hyperfractionated accelerated thoracic radiotherapy for locally advanced non-small cell lung carcinoma.

BACKGROUND: Irinotecan, when combined with cisplatin, is an effective treatment for advanced non-small cell lung cancer (NSCLC). This constitutes a rationale for conducting a phase I study of chemoradiotherapy including this combination for locally advanced NSCLC. PATIENTS AND METHODS: Patients with locally advanced NSCLC and a performance status of 0 or 1 were eligible. The protocol consisted of escalating doses of irinotecan on days 1 and 15, and daily low-dose cisplatin (6 mg/m(2) daily for a total dose of 120 mg/m(2)) combined with concurrent hyperfractionated accelerated thoracic irradiation (1.5 Gy twice daily for a total dose of 60 Gy). RESULTS: The maximum tolerable dose was 50 mg/m(2) of irinotecan, and the dose-limiting toxicity was esophagitis. Tumor response was observed in 50% of cases, and the median survival time of the 12 patients enrolled was 10.1 months, including two patients with 5-year disease-free survival. A pharmacokinetics study demonstrated an accumulation of total platinum, but not of free platinum, during the 26-day treatment period. CONCLUSION: The recommended dose for phase II studies was determined.

[Pulmonary infection with Nocardia species: a report of 10 cases].

OBJECTIVE: To investigate the clinical features of pulmonary nocardiosis. PATIENTS AND METHODS: We retrospectively reviewed ten consecutive patients (5 men, 5 women; aged 25 to 80 years (average 49.3 years)) with confirmed bacteriological pulmonary nocardiosis from 1998 to 2003. Patients were divided into two groups: infected (8 patients) and isolated (2 patients). RESULTS: All patients had predisposing factors and/or pulmonary disease. Six were immunosuppressed by steroid therapy with or without other immunosuppressive drugs. The overall survival rate among infected patients was 75.0% (6/8), but the survival rate of patients who were diagnosed speedily by a gram-stain procedure was 85.7% (6/7). CONCLUSIONS: Although pulmonary nocardiosis is difficult to diagnose, prompt use of the gram-staining procedure and appropriate treatment appeared to improve survival. And new diagnostic method is desirable.

In vitro conversion of irinotecan to SN-38 in human plasma.

Irinotecan is an active cytotoxic agent for various cancers, and is converted to SN-38, its most active metabolite, by carboxylesterase converting enzyme (CCE) in vivo. Although the primary metabolic site is in the liver, ex vivo studies have proven that irinotecan is also converted to SN-38 in intestines, plasma and tumor tissues. The present study attempted to elucidate the in vitro conversion efficiency in human plasma, and to examine possible inter-individual variability and its clinical significance. Plasma samples were taken from 57 patients with lung cancer, 3 patients with benign pulmonary diseases and 9 healthy volunteers. After addition of 157 mM irinotecan to plasma, time courses of SN-38 concentration, measured by high-performance liquid chromatography (HPLC), were investigated. All subjects showed linear increase in SN-38 concentration during the first 60-min period, followed by a plateau. Mean and standard deviation of the conversion rate in the first 60 min were 515.9 +/- 50.1 pmol/ml/h (n = 69), with a coefficient of variation of 0.097. Although most of the subjects showed comparable conversion rates, 3 subjects had significantly higher conversion rates. In conclusion, the results of this study suggest that the enzyme activity of CCE in human plasma may show inter-individual variability.