Kobe City Research Articles

Detection of Legionella spp. in influent wastewater in Kobe City, Japan

ABSTRACT Legionella is an important waterborne pathogen that causes Legionnaires' disease (LD). Several outbreaks associated with wastewater treatment plants (WWTPs) have been reported in recent years; however, the prevalence of Legionella in WWTPs in Japan has rarely been investigated. In this study, we investigated the distribution of Legionella in influent wastewater collected from two WWTPs in Kobe, Japan between April 2023 and March 2024. The concentrations for Legionella in all seasons varied between 104 and 106 copies/100 mL in all seasons. Among the 10 Legionella species detected in the influent wastewater, Legionella pneumophila was the most commonly isolated. Genotyping revealed that pathogenic L. pneumophila strains were widely distributed in the influent wastewater in Japan with genetic diversity. LD is one of the most important infectious diseases during natural disasters. This study highlights the importance of influent wastewater as a potential source of LD in Japan, where natural disasters occur frequently.

Microbiological profiles and clinical outcomes of critically ill surgical patients with lower gastrointestinal perforation in Japan: a single-center retrospective observational study

BackgroundLower gastrointestinal perforation (LGP) is a surgical emergency disease that can result in secondary bacterial peritonitis. Microbiological studies on LGP are rare. The present study aimed to ascertain the microbiological profile of LGP in patients admitted to the intensive care unit (ICU) at our institute after surgery. In addition, we investigated whether initial empirical therapy with vancomycin was associated with in-hospital mortality, duration of ICU stay, and duration of ventilator support.MethodsThis single-center, retrospective, observational study was conducted at Kobe City Medical Center General Hospital, Japan. The study population included all patients diagnosed with LGP who were admitted to the ICU after emergency surgery between 2017 and 2023. The primary outcome assessed was the microbiological profile of microorganisms isolated from ascites fluid and blood of the participants. The secondary end-points were in-hospital mortality, duration of ICU stay, and duration of ventilator support. We performed univariate and multivariate regression analyses to evaluate the end-points.ResultsDuring the study period, 89 patients were included in the analysis. The most commonly identified pathogen from the ascites cultures was Escherichia coli (65.2%), followed by Enterococcus spp. (51.7%). E. faecium was identified in 16 (18.0%) ascites samples. The microbiological profile of critically ill patients with LGP admitted to the ICU after surgery was similar to that of previous studies on intra-abdominal infection (IAI). Therefore, the initial empirical therapy in the IAI guidelines is more appropriate for LGP. Multivariate regression analysis suggested that the combination of initial empirical therapy with vancomycin was not associated with in-hospital mortality (odds ratio [OR] = 0.96, 95% confidence interval [CI] 0.23–3.00, p = 0.955), duration of ICU stay (coefficient=-0.92, 95% CI -3.04–1.21, p = 0.393), or duration of ventilator-support (coefficient=-9.03, 95%CI -49.69–31.63, p = 0.659).ConclusionThe microbiological profile of critically ill patients with LGP admitted to the ICU after surgery was similar to that of previous studies on IAI. However, the frequency of E. faecium in the present study was higher than that in previous studies. Initial empirical therapy with drugs such as meropenem in combination with vancomycin for E. faecium was not associated with in-hospital mortality, duration of ICU stay, and duration of ventilator support, after adjusting for confounding factors.

The effects of the COVID-19 pandemic on the activities of Initial-phase Intensive Support Team for Dementia in Kobe City.

This study aimed to review the activities of the Kobe City Initial-phase Intensive Support Team for Dementia pre- and during the coronavirus disease 2019 (COVID-19) pandemic, to compare the characteristics of the target population and the performance of the team's activities, and determine the impact of the pandemic on the team's project. The summary data obtained at the time of consultation, team activities, and participants' characteristics were extracted from 662 participants who started to receive support between April 2018 and March 2022. Statistical analysis was performed by dividing the participants into the following two groups: pre- and during COVID-19 pandemic groups. There was no significant difference in the number of new cases or cases that led to a dementia diagnosis between the pre- and during COVID-19 pandemic groups. However, there were significant differences in the number of home visits and rate of introduction of medical care between the two groups. In our study population, the number of participants with financial management difficulties and delusions increased and the number of participants who refused visitations slightly decreased. The Kobe City Initial-phase Intensive Support Team was able to continue its activities during the pandemic partly because the team is an independent, dedicated team. During the pandemic, there was an increase in the number of participants who were isolated because they were deprived of opportunities to interact with others, and who developed delusions and other psychiatric symptoms. Despite this situation, the professional team responded quickly through individual assessment of the individual needs by continuous outreach, taking into account the infection situation, and thus this outreach team functioned well even under the COVID-19 pandemic.

Resurgence of Kawasaki Disease Following Relaxation of Coronavirus Disease 2019 Pandemic Restrictions in Japan

ObjectivesTo compare the number and incidence of Kawasaki disease (KD) patients in years 2 through 4 of the coronavirus disease 2019 (COVID-19) pandemic, and determine the impact of 3 years of implementation infection control measures and their subsequent relaxation on the epidemiology of KD in Japan. Study designWe conducted a population-based, cohort study including consecutive KD patients in Kobe City between 2021 and 2023. We compared the incidence of KD cases, in relation to timing of infection control measures, as well as infectious disease cases based on a regional surveillance system. Data from a previous 2016 through 2020 study were used for comparison. ResultsA total of 566 children with KD were identified during the study period. During the infection control period in 2021 to 2022, the incidence of KD remained low compared with the pre-pandemic level (281.3 and 327.5/100,000 children aged 0-4 years in 2021to 2022 and 2016 through 2019, respectively), but a recovery trend began in the 0-1-year age group. During the relaxation period in 2023, the incidence of KD increased across a wide age range, reaching the highest recorded in Japan (426.7/100,000 children aged 0-4 years), and the median age of onset increased to age 30 months. The resurgence of KD coincided with the patterns for multiple infectious diseases in 2023. The seasonality of KD observed before the pandemic was altered. ConclusionsKD resurged in 2023 after relaxation of the prolonged COVID-19 pandemic restrictions in Japan. This phenomenon coincided with the rise of multiple infectious diseases, and supports the pathogenesis of KD being triggered by infectious agents.

Contiguity of underutilized lands: Dynamic simulation taking their temporary uses into account

In Japan, shrinking densely built-up cities face the dual issue of lacking open spaces and increasing underutilized lands, such as vacant lots, lots with vacant houses, and parking lots. These unused land patches can be temporarily repurposed as open spaces for evacuation and recreation. However, identifying such clump is methodologically challenging. To address this issue, lot geometry is utilized. The study thus aims to investigate the frequency and size of contiguous underutilized lands, called the contiguity of underutilized lands, at a specific time point and under their temporary uses. A densely built-up area in Kobe city, Japan, was selected for the empirical case study. A comparison with simulation results shows that the observed static contiguity of underutilized lands tends to be more substantial than a uniformly random distribution. It shows a certain feasibility of a temporary use policy conducted in the case site. Specifically, when considering the temporary uses of underutilized lands, the maximum area of contiguous temporary open spaces is 583 m2, meeting the area requirement for a redevelopment project in Kobe. Utilizing parking lots can further extend the maximum area up to 945 m2. Nevertheless, policy makers need to promote the joint development of privately owned lots facing a wide roadway, as these are unlikely to become temporary open spaces. This study contributes not only to providing new methods for land use change simulation using lot geometry to analyse the contiguity of underutilized lands under their temporariness but also to demonstrating the feasibility and limitations of a temporary use policy.

Risk stratification and prognosis prediction using cardiac biomarkers in COVID-19: a single-centre retrospective cohort study

ObjectiveThere is a need for a robust tool to stratify the patient’s risk with COVID-19. We assessed the prognostic values of cardiac biomarkers for COVID-19 patients.MethodsThis is a single-centre retrospective...

Urban scale pedestrian simulation in Kobe City center

We attempted to construct a digital twin of Kobe City center, from the aspect of pedestrian traffic simulation. Policy evaluation was conducted using traffic demand based on mobile phone population statistics provided by NTT DOCOMO, INC., CrowdWalk, an agent-based pedestrian simulator, and manually edited map obtained from Open Street Map to implement pedestrian signals. Background pedestrian population was estimated to be 6509, and 10,000 evacuees are assumed in the Shinko area. All of them are assumed to evacuate into three stations, JR Sannomiya, Hankyu Sannomiya, and Motomachi. The evacuation time was originally simulated to be 25,685 s without any aided policies. As a policy, splitting the evacuation route reduced the evacuation time into 17,780 s which is 69% of the original. In addition, removing signals reduced the time furthermore into 9550 s, 37% in total. Only removing the signal resulted 12,475 s, which is a reduction to 52% of the original.

Dams overtopping scenarios from catastrophic landslides in mountains’ headwaters Case study in Kobe City, Japan

As a Mw 8.0 Nankai Trough Earthquake is predicted with an 80% probability of occurrence within the next 30 years, the efficiency of check dams in the mountains above Kobe City is a crucial question when considering co-seismic landslide disaster risk management. In the present contribution the author aimed to define which subsection of the Sumiyoshigawa watershed may be more prone to generate impacts in downstream Kobe City from catastrophic landslides in the headwaters. For this purpose, the present state of the check dams network was analysed from the 2018 LiDAR (Light Detection and Ranging) data, considering the progressive infilling of the structures. As a result, the capacity of the dams in 2018 dropped by about 1/10 of the original designed capacity, arguably because of the heavy rainfall events in 2014 and 2018. Despite this evolution, however, landslides > 20,000 m3 starting from only one tributary can fill all the dams and flow downstream. From this data, it is possible to prioritize dam curation programs, especially because population ageing and shrinking is reducing the manpower and the funds available to maintain the check dams.

Large wood remobilization in Asakura (North Kyushu, Japan): Adapting strategies to climate change and rural population depletion

In the aftermath of the heavy rainfall events of 2017 in North Kyushu, Asakura (Japan), driftwood-related disaster risk has proven to be as real as it was in 1933, when wood-laden debris-flow invaded the city centre of Kobe City near Sannomiya station. Despite a temporary truce obtained thanks to extensive Sabo dam constructions, climate change, the return of forest on agricultural land due to rural exodus and an ageing population are once again increasing driftwood hazard and disaster risk. In the face of these novel challenges, new management strategies may need to be considered, and the present contribution aims to propose a new approach to driftwood hazards and disaster risk. For this purpose, the present contribution is analysing the 2D hydrodynamic of scenario-based floods on driftwood deposited after the 2017 heavy-rainfall event in Asakura. The boundary conditions for the simulation were generated using UAV photogrammetry calibrated against existing DEM data to generate a DEM at 25 cm horizontal resolution and an orthophotographs at 5 cm resolution. The results show that with the new river configuration (post-2017), an instantaneous peak flow of 90 m3/s is necessary to flood the areas where the driftwood has stopped with a water depth of >40 cm. This is 9 times the mode discharge calculated from the inlet geometry. The majority of the driftwood is thus not an immediate hazard, and leaving the wood instead of removing it should be considered as a management strategy whenever it is feasible. Recent research in Western Europe and Northern America has already shown the importance of driftwood for biodiversity and wildlife, and combining both environmental and hazards and disaster risk objectives may be a solution. For this purpose, the authors propose that medium-size ditch and artificial “abandoned channels” could be created in order to trap the wood in the floodplain, so that the cost from removing the wood can be alleviated, horizontal trapping could complement vertical trapping at slit dams, and the local wildlife could benefit from the wood decomposition in the floodplain.

Association of perinatal factors with neurodevelopmental referrals in a population-based cohort study in Japan

Although the causes of neurodevelopmental disorders remain unknown, several environmental risk factors have attracted considerable attention. We conducted a retrospective, longitudinal, population-based cohort study using data from infant health examinations of children born to mothers with pregnancies between April 1, 2014 and March 31, 2016 in Kobe City to identify the perinatal factors associated with neurodevelopmental referrals in 3-year-old children. There were 15,223 and 1283 children in the normal and referral groups, respectively. Neurodevelopmental referrals at the health checkup for 3-year-old children were significantly associated with the lack of social support during pregnancy (adjusted odds ratio [aOR] 1.99, 99% CI 1.14–3.45, p = 0.001), history of psychiatric consultation (aOR 1.56, 99% CI 1.10–2.22, p = 0.001), no social assistance post-delivery (aOR 1.49, 99% CI 1.03–2.16, p = 0.006), Edinburgh Post-natal Depression Scale (EPDS) score ≥ 9 (aOR 1.36, 99% CI 1.01–1.84, p = 0.008), infant gender (male) (aOR 2.51, 99% CI 2.05–3.06, p < 0.001), and cesarean delivery (aOR 1.39, 99% CI 1.11–1.75, p < 0.001). In conclusion, this exploratory study in the general Japanese population identified six perinatal factors associated with neurodevelopmental referrals in 3-year-old children: infant gender (male), cesarean section, maternal history of psychiatric consultation, EPDS score ≥ 9, lack of social support during pregnancy, and no social assistance post-delivery.

Thermal Environment Simulation Using MSSG Model Focusing on Green Spaces and Sea Breeze in Sannomiya Area, Kobe City

Thermal Environment Simulation Using MSSG Model Focusing on Green Spaces and Sea Breeze in Sannomiya Area, Kobe City

Study on Land Use Realities in “People and Nature Coexistence Zones” within the Urbanization Control Area of Kobe City

Study on Land Use Realities in “People and Nature Coexistence Zones” within the Urbanization Control Area of Kobe City

Correlation Between Dosimetric Parameters and Local Control in Definitive Radiotherapy for Head and Neck Cancers.

Radiotherapy (RT) outcomes are generally reported based on stage, patient background, and concomitant chemotherapy. This study aimed to investigate the effects of the prescribed dose to gross tumor volume (GTV) and the calculation algorithm on local control in definitive RT for head and neck (H&N) cancers using follow-up images after RT. This study included 154 patients with H&N cancers treated by Volumetric Modulated Arc Therapy at the Kobe City Medical Center General Hospital. Patients were classified into those receiving definitive RT (70 Gy of irradiation) and those not receiving it. Follow-up images were used to categorize the patients into the responders and non-responders groups. In the non-responders group, follow-up images were imported into the treatment planning system, and the contours of the residual or recurrent areas (local failure) were extracted and fused with computed tomography-simulated images for treatment planning. Dose evaluation parameters included maximum dose, dose administered to 1% of the volume, dose administered to 50% of the volume, dose administered to 99% of the volume (D99%), and minimum dose (Dmin) administered to the GTV. The doses to the GTV were compared between responders and non-responders. D99% exhibited significant differences between local failure and responders and between local failure and non-responders. Dmin showed significant differences between responders and non-responders and between responders and local failure. This study emphasizes the importance of verifying dose distribution in all slices of treatment planning, highlighting the need for precise assessment of the dose to the GTV in head and neck cancers.

Community Re-development with butterfly garden at the Tamondai district, Kobe city

Community Re-development with butterfly garden at the Tamondai district, Kobe city

Tooth Loss as a Predictor of Long-Term Care Requirements in the Elderly: A Study in Kobe City, Japan.

The Kobe project, which utilizes prospective data from the national health insurance system, focuses on early detection and preventive strategies through the Frail Kenshin health check-up program. Previous research has underscored the correlation between tooth loss and the decline in physical and cognitive functions. In this study, using Kobe project data, we examined the link between remaining teeth and long-term care needs in individuals aged 64-65 years, with primary and secondary objectives involving various health parameters and quality of life. We analyzed baseline data from a prospective study conducted alongside the Frail Check program for generally healthy individuals aged 64-65 yearsto examine the relationship between the number of remaining teeth and various health indicators. This study focused on citizens aged 64-65 years to identify those at risk of needing long-term care by the age of 65 years. Data from 1,530 participants were obtained, excluding eight individuals for specific reasons. At the end of the follow-up period, 41 (2.7%) individuals required supportand 15 (1.0%) needed long-term care alone. The data revealed a significant association between the number of remaining teeth and the need for long-term care or support, as demonstrated by the Cochran-Armitage trend test (p<0.001). Although trends were noted for nutrition and total Cognitive Functional Instrument Self scores, they did not reach statistical significance. Additionally, a decrease in the number of remaining teeth was significantly associated with worse European Quality of Life Five Dimensions (EQ-5D-5L) visual analog scale scores, mobility, and regular activities (p<0.001). Tooth loss indicates the potential long-term care needs of older adults. Monitoring oral health is crucial for addressing care requirements.

Prevalence and genetic distribution of Legionella spp. in public bath facilities in Kobe City, Japan.

Legionella is an important waterborne pathogen that causes legionellosis. Public baths are considered the primary cause of legionellosis infection in Japan. We investigated the prevalence and genetic distribution of 338 Legionella spp. isolates from 81 public bath facilities, including 35 hot springs and 46 other facilities, through annual periodic surveillance in Kobe, Japan, from 2016 to 2021. In addition, the genotypes of nine clinical strains of unknown infectious source from the same period were compared to those of bathwater isolates. We elucidated the differences in the distribution of Legionella species, serogroups, and genotypes between hot springs and other public baths. Legionella israelensis, L. londiniensis, and L. micdadei colonized hot springs along with L. pneumophila. The minimum spanning tree analysis based on multiple-locus variable number tandem repeat analysis (MLVA) also identified four major clonal complexes (CCs) in L. pneumophila SG1 and found that CC1 of the four CCs is a specific novel genotype with the lag-1 gene in hot springs. The same MLVA genotypes and sequence types as those of the clinical strains were not present among the strains isolated from bath water. Thus, our surveillance is useful for estimating the sources of legionellosis infection in Japan and developing prevention strategies.

Safety and blood levels of daratumumab after switching from intravenous to subcutaneous administration in patients with multiple myeloma.

The intravenous administration (IV) of daratumumab sometimes causes an infusion reaction and needs a long infusion time. Recently, a subcutaneous formulation (SC) of daratumumab, which has fewer infusion reactions and shorter administration time, was approved. However, because SC has a fixed dose, overdosing is a concern for patients with low body weights. In this study, we investigated the safety and blood levels of daratumumab after switching from IV to SC in patients with multiple myeloma (MM). Patients who switched from IV to SC of daratumumab between June 2021 and May 2022 at Kobe City Medical Center General Hospital were included in the study. Blood daratumumab levels were measured using liquid chromatography-tandem mass spectrometry. Safety after switching from IV to SC was evaluated for six months and graded according to the Common Terminology Criteria for Adverse Events, version 5.0. The median body weight of ten patients included in the analysis was 57.4kg (range: 45.0-74.4). Blood daratumumab levels were significantly increased after switching to SC (p = 0.002); median through concentration at the last IV dose was 403.6μg/mL (range: 96.3-776.3) and that at the third SC dose was 557.1μg/mL (range: 288.3-997.2). Grade 1-2 injection site reactions were observed in six patients (60.0%) after switching to SC. A new grade 3 adverse event was observed in only one patient (neutropenia). The blood levels of daratumumab were significantly increased after switching from IV to SC in patients with MM; however, the dosage was tolerable.

Helicobacter cinaedi Infections in Emergency Departments: A Descriptive Study.

Helicobacter cinaedi, a Gram-negative spiral bacterium, is a rare cause of bacteremia in humans. Unfortunately, little is known about H. cinaedi infections in emergency departments (EDs). We aimed to describe the clinical features of H. cinaedi infections in the ED. We conducted a descriptive study at the ED of Kobe City General Hospital (KCGH) in Japan between November 2011 and December 2020. We included all ED patients with H. cinaedi infections. We retrospectively obtained the patient data from electronic medical records and described the patient characteristics, clinical course, and management of H. cinaedi infections. A total of 22 patients in the ED were diagnosed with H. cinaedi infections, and all of them were detected through blood cultures. The chief complaints were vague: fever (18/22, 81.8%), chills (10/22, 45.5%), and localized pain or tenderness (8/22, 36.4%). Patients with complicated cases were also reported in the ED; three patients had vertebral osteomyelitis, two had infected aortic aneurysms, and another two had infected cysts (renal cystand pancreatic cyst with concomitant empyema). Tetracycline (minocycline) was primarily prescribed and administered intravenously in five of 15 (33.3%) and orally in nine of 20 (45.0%) patients. Only one (4.5%) patient required surgical interventions. None of the patients died in the hospital. We reported the clinical features of H. cinaedi infections in the ED. Although some patients developed complicated infections, the prognosis was not poor under appropriate treatment, and most of them were successfully treated with antibiotics, primarily tetracycline.

Reliability of the respiratory rate and oxygenation index for successful high-flow nasal cannula support in coronavirus disease pneumonia: a retrospective cohort study

BackgroundHigh-flow nasal cannula (HFNC) therapy is an important non-invasive respiratory support in acute respiratory failure, including coronavirus disease (COVID-19) pneumonia. Although the respiratory rate and oxygenation (ROX) index is a simple and useful predictor for HFNC failure and mortality, there is limited evidence for its use in patients with COVID-19 pneumonia. We aimed to evaluate the ROX index as a predictor for HFNC failure in patients with COVID-19 pneumonia. We also evaluated the ROX index as a predictor for 28-day mortality.MethodsIn this single-center, retrospective, cohort study, 248 patients older than 18 years of age with COVID-19 pneumonia received HFNC therapy for acute respiratory failure. The ROX index was evaluated within 4 h from the start of HFNC therapy. Past medical history, laboratory data, and the ROX index were evaluated as predictors for HFNC failure and 28-day mortality.ResultsThe ROX index < 4.88 showed a significantly high risk ratio for HFNC failure (2.13 [95% confidence interval [CI]: 1.47 – 3.08], p < 0.001). The ROX index < 4.88 was significantly associated with 28-day mortality (p = 0.049) in patients with COVID-19 pneumonia receiving HFNC therapy. Age, chronic hypertension, high lactate dehydrogenase level, and low ROX index showed significantly high risk ratio for HFNC failure. C-reactive protein level and low ROX index were predictors of 28-day morality.ConclusionThe ROX index is a useful predictor for HFNC success and 28-day mortality in patients with COVID-19 pneumonia receiving HFNC therapy.Trial registrationAn independent ethics committee approved the study (Research Ethics Review Committee of Kobe City Medical Center General Hospital [number: zn220303; date: February 21, 2022]), which was performed in accordance with the Declaration of Helsinki, Guidelines for Good Clinical Practice.

Pharmacist-Urologist Collaborative Management for Patients with Renal Cell Carcinoma Receiving Pazopanib Monotherapy.

Pazopanib is one of recommended treatment for metastatic renal cell carcinoma (RCC). Despite its effectiveness, patients often difficult to continue pazopanib treatment due to adverse events (AEs). We established an ambulatory care pharmacy practice that enables pharmacist-urologist collaboration to manage patients with RCC. This study evaluated the usefulness of this collaborative management. We retrospectively reviewed the medical records of 51 consecutive patients with metastatic RCC receiving pazopanib at the Kobe City Medical Center General Hospital between April 2014 and December 2020. Our collaborative management was implemented in October 2016. The time to pazopanib discontinuation was compared between patients who started pazopanib before (n = 30) and after (n = 21) the implementation of the collaborative management. A multivariate Cox regression analysis was performed to analyze the factors associated with pazopanib discontinuation. In the collaborative management, the oncology pharmacists had a total of 245 face-to-face patient consultations, and provided 286 suggestions [according to supportive care in pazopanib treatment (214 suggestions) were most frequent], and 236 (82.5%) were accepted by urologists. The median time to discontinuation (6.1 months vs. 2.4 months, p = 0.024) was significantly longer in the after group. Multivariate analysis showed that collaborative management (hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.26-0.88, p = 0.017), and Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2 at pazopanib initiation (HR 3.87, 95% CI 1.47-9.13, p = 0.008) were significantly associated with pazopanib discontinuation. These results suggested that, compared to conventional management, collaborative management is effective at prolonging the time to pazopanib discontinuation.