Tokyo Area Research Articles

Local Information Sharing System With Wireless Device-to-Device Communications

This study aims to develop a system of device-to-device (D2D) communications for information collection, distribution and sharing among local communities. It establishes a D2D testbed with low power consumption and solar power supply to evaluate the performance of the proposed system. Devices in the system can communicate with each other autonomously without a centralized control device when they are within a certain distance. A single device does not result in a dominant effect for the whole system, which ensures system robustness. To validate the performance of the designed system, a simulation is used to confirm the effectiveness of the system. Moreover, in cooperation with local communities, the system has been developed and deployed in some areas of Tokyo and Kyoto, Japan. The devices were deployed on buses and fixed places along the bus routes. The experimental results show that the proposed system can work with moderate delay latency. Specifically, the latency performance obtained in the field experiments meets the system design criterion quite well, which validates the feasibility and effectiveness of the proposed system. In summary, the proposed D2D local information sharing system can work independently from the cellular system and any other existing wireless network systems, which is expected to provide more proprietary and different wireless services. The paper also gives some ideas for further system improvement.

Geographical Profiles of COVID-19 Outbreak in Tokyo: An Analysis of the Primary Care Clinic-Based Point-of-Care Antibody Testing.

Introduction: The primary care clinic plays a major role in triage for coronavirus disease 2019 (COVID-19), where seroprevalence in the setting of primary care clinic remains less clear. As a point-of-care immunodiagnostic test for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the serosurvey represents an alternative to the polymerase chain reaction (PCR) test to measure the magnitude of COVID-19 outbreak in the communities lacking sufficient diagnostic capability for PCR testing. Methods: We assessed seropositivity for the SARS-CoV-2 IgG between April 21 and May 20, 2020, at 2 primary care clinics in Tokyo, Japan. Results: The overall positive percentage of SARS-CoV-2 IgG was 3.83% (95% confidence interval [CI]: 2.76-5.16) for the entire cohort (n = 1071). The 23 special wards of central Tokyo exhibited a significantly higher prevalence compared with the other areas of Tokyo after classification by residence (P = .02, 4.68% [3.08-6.79] vs 1.83 [0.68-3.95] in central and suburban Tokyo, respectively). In central Tokyo, the southern area showed the highest seroprevalence compared with the other areas (7.92% [3.48-15.01]), corresponding to the cumulative number of confirmed COVID-19 patients by PCR test reported by the Tokyo Metropolitan Government. Conclusion: The seroprevalence surveyed in this study was too low for herd immunity, suggesting the need for robust disease control and prevention. A regional-level approach, rather than state- or prefectural-level, could be of importance in ascertaining detailed profiles of the COVID-19 outbreak.

The Practice on the Initial Education of Construction and Architecture by Students’ Interaction in Kagawa, and its Effectiveness

Kagawa University and Shibaura Institute of Technology are adopted by Cabinet Office for “Interaction Promotion Project for University Students in Rural and Tokyo Area” , and implement “Feel Nice Kagawa ! The Project for Students Living in Udon-Prefecture”. In this project, “Feel Nice Artisanship in Shionoe” was conducted as a short-term educational program to cultivate human resources capable of construction and architecture. “Feel Nice Artisanship in Shionoe” is the project by the students in some universities to give them the initial education in the field of construction and architecture in Kagawa. This paper describes the practice of “Feel Nice Artisanship in Shionoe”, the initial education by students’ interaction in Kagawa, and its effectiveness from questionnaire. This program is regarded as the initial education for construction and architecture. Besides, it showed the possibility to be the initial education for local understanding and other professional fields such as policy planning.

Application of Intelligent Transportation Systems (ITS) for Regional Development: Case Studies in Integrated Functional Approach

This paper evaluates the application of Intelligent Transportation Systems (ITS) specifically as a part of regional development. Although ITS has been extensively studied in the context of city-wide developments, research on such developments for the regional enhancement is scarce. Importantly, transportation development for regional areas differs to that of traditional urban provinces. Whilst the transportation developments in urban areas need to concentrate on a range of diverse community requirements, for regional areas, such population are less diverse and more alike. Consequently, developed ITS in the regional areas needs to concentrate on more homogeneous communities and their needs. There are many factors influencing regional transportation developments, however functionality is one of the most critical aspects. Although functionality is an important aspect of all developments, it is considered to be the most crucial factor for regional areas. Fittingly, this paper will examine some of the most important transportation functionality issues for regional areas. To further explore this theme, the surrounding areas of Fukushima and Tokyo were studied to highlight their regional transportation requirements. These two case studies were then compared using factor analysis method. The comparison generally found that, due to its geographical location Fukushima aligned its regional functionalities more broadly. Further, this paper proposes a streamlined approach to analyze the successful application of transportation development in the Fukushima and Tokyo regional areas. To do so, an integrated functional approach was carefully undertaken. The proposed approach specifically focused on incorporating mobility and ITS as the key ingredients for the regional developments. It was found that, such integrated functional approach would therefore increase innovation and productivity as the result of successful application of ITS for regional development.

ADULT ANAPHYLAXIS AT THE DEPARTMENT OF EMERGENCY MEDICINE OF TEIKYO UNIVERSITY HOSPITAL IN AN URBAN AREA OF TOKYO

Anaphylaxis is a severe, potentially fatal, systemic allergic reaction. But its real-world evidence is limited. Both treatment of allergic symptoms and prevention of future anaphylactic episodes are clinically important. We have strongly recommended that patients visit our outpatient allergy clinic. To classify the clinical features and triggers of anaphylaxis in patients (≥16 years old) in an urban area of Tokyo. We used the medical records to analyze patients with anaphylaxis as the primary diagnosis who visited the emergency department in our hospital from January 2015 through December 2017. Among approximately 60000 patients who visited the emergency department, 181 subjects (mean age, 43.0; 44% male) were diagnosed with anaphylaxis. Fourteen of those patients had a systolic blood pressure of lower than 90mmHg. Upon arrival, 126 patients were treated with adrenaline. All patients recovered from the anaphylactic episode. Subsequently, 133 patients visited our outpatient allergy clinic. The trigger of the anaphylaxis were assessed; the most popular trigger was foods (n = 78), followed by drugs (n = 38), insect stings/bites or animal bites (n = 3) and others (n = 11). Adrenaline auto-injectors were prescribed to 84 patients. It is important for patients with anaphylaxis to undergo allergy testing after discharge from an emergency department. Collaboration between emergency medicine and allergy departments may be helpful for improving the patients' QOL through effective instruction and prevention of recurrent anaphylaxis.

LCCO<sub>2</sub> AND THERMAL ENVIRONMENT OF LIVING ROOM MODEL FOR PASSIVE SOLAR HOUSE WITH THERMAL MASS

Introduction: Considering the relationship between the environmental load and the environmental quality is very important in design of the ecological housing. Moreover, the importance of study from the viewpoint of lifecycle is increasing. This study aims to clarify relations between LCCO2 and thermal environment in passive solar house with thermal mass. Method: Firstly, the settings for the model of living room with various combinations of window and thermal mass are assumed. The models are mainly based on wooden structure with the wide frontage facing south to gain solar heat. The supposed site is in suburb area of Tokyo, Japan. Three variations of the south window are set by size and position of opening and depth of eaves. Besides, four compositional variations of thermal mass to store solar heat are set by position and amount of reinforced concrete element. Consequently, the twelve models are set for following investigations. Secondly, the amount of embodied CO2 for each model is calculated by LCA tool offered by the Architectural Institute of Japan. Thirdly, the amount of operating CO2 emitted from the air-conditioning load is calculated by the Solar Designer which is a thermal environment simulation tool. Furthermore, the qualities of thermal environment focusing on the change of room temperature on sunny day in winter and summer are investigated by considering the Degree・Hour (D・H) which integrates the fluctuation of room temperature. Finally, the amount of LCCO2 is calculated by combining the embodied and operating CO2, and then, the relationships between LCCO2 and thermal environment quality by D・H are clarified. Results: 1) The model AS which has the smallest thermal mass and window indicates the smallest embodied CO2. On the other hand, the model CL which has the second largest thermal mass and the largest window shows the largest embodied CO2. These are regarded by differences for the repairing cycle of element. 2) The models of A, B and C which have larger thermal mass tend to indicate smaller operating CO2 according to reduction of window size. However, only the model D with the largest thermal mass shows a different tendency that indicates smallest operating CO2 in the case with medium window size. 3) The room temperature’s change tends to become smaller along with increase of thermal mass. However, the model DS which has largest thermal mass and smallest window shows minimum D・H in winter which is a stable environment in low temperature. 4) For the relations between LCCO2 and thermal environment, the models AS, BM, CM and DL which have different combinations of thermal mass and window size indicate smaller LCCO2 with an appropriate D・H combination in winter and summer. Especially, the model AS and DL have contrastive difference for the passive design strategy regarding with the less or more thermal mass and the smaller or larger window for solar gain, in addition to their differences for the combination of embodied CO2 and operating CO2. This result means a “trade-off” relations between LCCO2 and thermal environment and shows alternatives for design regarding the balance of thermal mass and window with proper combination of environmental load and quality.

House price dispersion in boom–bust cycles: evidence from Tokyo

We investigate the cross-sectional distribution of house prices in the Greater Tokyo Area for the period 1986–2009. We find that size-adjusted house prices follow a lognormal distribution except for the period of the housing bubble and its collapse in Tokyo, for which the price distribution has a substantially heavier upper tail than that of a lognormal distribution. We also find that, during the bubble era, sharp price movements were concentrated in particular areas, and this spatial heterogeneity is the source of the fat upper tail. These findings suggest that, during a bubble, prices increase markedly for certain properties but to a much lesser extent for other properties, leading to an increase in price inequality across properties. In other words, the defining property of real estate bubbles is not the rapid price hike itself but an increase in price dispersion. We argue that the shape of cross-sectional house price distributions may contain information useful for the detection of housing bubbles.

Visualized Quantitative Research of Soil Pollution in the Guangdong-Hong Kong-Macao Greater Bay Area

Soil pollution has become a constraint for the Guangdong-Hong Kong-Macao Greater Bay Area to move toward becoming an international first-class bay area. Learning from the three major bay areas of New York, San Francisco, and Tokyo can provide guidance for alleviating the soil environmental pressure in the Greater Bay Area. Based on the relevant literature in the core database of the Web of Science, the current research status of soil pollution in the three major bay areas was analyzed by using co-citation analysis, keywords co-occurrence analysis, and keyword emergence detection. The results showed that the main research topics of soil pollution in the three major bay areas are focused mainly on the source, spatial distribution of and remediation of soil pollutants, bioavailability of soil pollution and its adverse effects on marine organisms, and the role of the marine biotic index in soil pollution assessment. Hotspots in the study of soil pollutants are concentrated in the areas of organic pollution and heavy metal pollution. Toxicity, imposex, and biomarkers are the hot topics in the related marine biological research. By comparing the research status of soil pollution in bay areas at home and abroad, it was found that the study of soil pollution in China's bay areas started relatively late compared with that in the three major bay areas and that the distributions of research area and subject are unbalanced. The intensity of research on the related marine biological research is relatively low. Therefore, carrying out research on the land-sea integration of Guangdong-Hong Kong-Macao Greater Bay Area is an urgent priority. The research field needs to be extended to the related marine biological research. In this way, the study of soil pollution in the Guangdong-Hong Kong-Macao Greater Bay Area can be improved and the problems of soil pollution can be addressed.

Association of Dietary Variety and Appetite with Sleep Quality in Urban-Dwelling Older Japanese Adults.

Although it has been shown that specific foods and nutrients are associated with sleep quality, few studies have examined the association of dietary variety and appetite with sleep quality in older adults. A cross-sectional study was conducted that examined the association of dietary variety and appetite with sleep quality in Japanese adults aged ≥70 years who resided in the metropolitan area of Tokyo, Japan. Data were collected in two steps: a mailed interview survey and an on-site survey. Those who responded to the surveys and met the inclusion criteria were included. Dietary variety, appetite, and sleep quality were assessed using a Dietary Variety Score (DVS), Council on Nutrition Appetite Questionnaire (CNAQ) score, and sleep efficiency, respectively. The sleep efficiency is the ratio of sleep duration to total time in bed (retiring time-awakening time). We defined the individuals with a sleep efficiency less than 75% as having poor sleep quality. Mean DVS and CNAQ score were 3.8 and 29.6 points, respectively. The rate of individuals with poor sleep quality was 11.7%. In the fully adjusted model, the odds ratios (OR) for low sleep efficiency in the middle and highest group categories of the DVS were 0.83 (95% confidence interval [CI], 0.54-1.29) and 0.50 (95% CI, 0.28-0.90), respectively, in reference to the lowest group category (p for trend = 0.023). The OR for low sleep efficiency in the middle and highest group categories of the CNAQ score were 0.73 (95% CI, 0.47-1.14) and 0.54 (95% CI, 0.30-0.96), respectively, in reference to the lowest group category (p for trend = 0.031). The higher DVS and CNAQ scores were significantly associated with higher sleep efficiency. Thus, dietary variety and good appetite might help maintain good sleep quality in urban-dwelling older Japanese adults.

High-resolution 3D earthquake forecasting beneath the greater Tokyo area

We propose an extended 3D space (longitude, latitude, and depth) epidemic-type aftershock sequence (ETAS) model for seismicity forecasts beneath the greater Tokyo area (the Kanto region), which also takes into account the effects induced by the M9 Tohoku-Oki earthquake of 2011. The model is characterized by a number of 3D location-dependent parameters, such as the background seismicity rates, and the productivity rate induced by the Tohoku earthquake. These allow production of high-resolution predictive mappings in zones where hypocenters are densely populated. The optimally inverted 3D spatial images of the characterizing parameters effectively discriminate seismicity features in the crust and near the plate boundaries. The success of the model is demonstrated using short-, intermediate- and long-term probability forecasts of intermediate and large earthquake occurrences beneath the Kanto region.

Scoring and classifying regions via multimodal transportation networks

In order to better understand the role of transportation convenience in location preferences, as well as to uncover transportation system patterns that span multiple modes of transportation, we analyze 500 locations in the Tokyo area using properties of their multimodal transportation networks. Multiple sets of measures are used to cluster regions by their transportation features and to classify them by their synergistic properties and dominant mode of transportation. We use twelve measures collected at five different radii for five distinct combinations of transportation networks to rank locations by their transportation characteristics. We introduce an additional 114 scores derived from the 300 measures to assess, among other things, access to public transportation, the effectiveness of each mode of transportation, and synergies among the modes of transportation. Additionally, we leverage those scores to classify our locations as being train-centric, bus-centric, or car-centric and to uncover geographic patterns in these characteristics. We find that business hubs, despite having low populations, are so conveniently reachable via train and road systems that they consistently achieve the highest sociability and convenience scores. Suburban regions have more serviceable bus systems, but lower connectivity overall resulting in lower reachable populations despite greater local populations. Even though Tokyo has the largest and densest public transportation system in the world we find that the road network consistently dominates the train and bus networks for all accessibility measures.

Changes of absorbed dose rate in air in metropolitan Tokyo relating to radiocesium released from the Fukushima Daiichi Nuclear Power Plant accident: Results of a five-year study.

Car-borne surveys were carried out in metropolitan Tokyo, Japan, in 2015, 2016, 2017 and 2018 to estimate the transition of absorbed dose rate in air from the Fukushima Daiichi Nuclear Power Plant accident. Additionally, the future transition of absorbed dose rates in air based on this five-year study and including previously reported measurements done in 2014 by the authors was analyzed because central Tokyo has large areas covered with asphalt and concrete. The average absorbed dose rate in air (range) in the whole area of Tokyo measured in 2018 was 59 ± 9 nGy h-1 (28–105 nGy h-1), and it was slightly decreased compared to the previously reported value measured in 2011 (61 nGy h-1; 30–200 nGy h-1). In the detailed dose rate distribution map, while areas of higher dose rates exceeding 70 nGy h-1 had been observed on the eastern and western ends of Tokyo after 2014, the dose rates in these areas have decreased yearly. Especially, the decreasing dose rate from radiocesium (Cs-134 + Cs-137) in the eastern end of Tokyo which is mainly covered by asphalt was higher than that measured in the western end which is mainly covered by forest. The percent reductions for the eastern end in the years 2014–2015, 2015–2016, 2016–2017 and 2017–2018 were 49%, 21%, 18% and 16%, and those percent reductions for western end were 26%, 18%, 6% and 3%, respectively. Additionally, the decrease for dose rate from radiocesium depended on the types of asphalt, and that on porous asphalt was larger than the decrease on standard asphalt.

P5607Clinical characteristics and treatment strategy for acute aortic dissection in Tokyo Acute Aortic Disease Super-Network System

Abstract Introduction Acute aortic dissection (AAD) is one of the most fatal cardiovascular diseases. The prevalence of AAD is reported to be low. The clinical data of AAD from representative cardiovascular centers are not enough to show the whole range of clinical feature of AAD. We have to know the exact prevalence and clinical pictures of AAD under the new system, the Tokyo AAD Super-Network System (TAAD-SNS), for strategy of emergency transport and treatment of AAD which would cover the entire metropolitan area of Tokyo. TAAD-SNS started in 2011, and after slight modification, the new system of AAD re-started in 2013. The aim of this study is to elucidate the whole range of clinical characteristics and recent trends of treatment of AAD. Methods Out of 73 hospitals included in Tokyo CCU Network system, 41 hospitals are chosen for TAAD-SNS. These hospitals provide around-the-clock surgery. In this system, the availability of surgical division is monitored in real time. All of the patients suspected of AAD are transferred directly or from primary care hospital to the hospitals of TAAD-SNS. Results After exclusion of 237 patients with cardiopulmonary arrest on arrival, 4877 consecutive patients (2923 male, mean age of 69±14 y/o) were admitted to the hospitals with diagnosis of AAD from 2013 to 2016. Prevalence of AAD in Tokyo was about 10 patients per 100,000 populations in every year. After exclusion of 37 patients undetermined into type A or B, 4840 patients (2694 with type A and 2146 with type B) were analyzed. Among the type A patients, 1752 (65%) were classified into type of patent false lumen (classic-type), 721 (27%) of closed false lumen (intramural hematoma: IMH-type), and 221 (8%) were undetermined. Among the type B, 880 (41%) were classified into classic-type, 1129 (53%) of IMH-type, and 137 (6%) were undetermined. Both among type A and B, mean ages were younger in classic-type than in IMH-type (type A: 66±14 vs. 73±12 y/o, p<0.05; type B: 64±15 vs. 72±12 y/o, p<0.05). Prevalence of male population and risk factor of hypertension was higher in type B than in type A both among classic-type and IMH-type. Systolic blood pressure at the emergency room was lower in type A than in type B among both classic-type and IMH-type (classic-type: 124±34 vs. 161±38 mmHg, IMH-type: 130±51 vs. 163±56 mmHg). In-hospital mortality of surgical treatment for type A classic-type and type A IMH-type, conservative strategy for type B classic-type and type B IMH-type was 9.6%, 4.2%, 3.1% and 1.7%, respectively. Stentgraft implantation for type B AAD started and shows a favorable in-hospital mortality compared to the operative treatment (Stentgraft vs. surgery in type B classic-type: 7.8% vs. 6.5%, in type B IMH-type: 10.7% vs. 11.8%, respectively). Conclusion Our study showed that prevalence of AAD was 2–3 times higher than previous reports. We should consider to choose the treatment strategy according to the type of AAD, A or B, classic-type or IMH-type. Acknowledgement/Funding Tokyo Metropolitan government

Serum lipid profiles of young Japanese women with iron deficiency without anemia

PurposeWe aimed to evaluate the association between iron deficiency without anemia (IDNA) and serum lipid profiles in young women of around 20 years of age. MethodsThis study included non-anemic (hemoglobin ≥ 12 g/dL) female volunteers aged 18 to 22 years who were not taking mineral/vitamin supplements and living in the metropolitan area of Tokyo, Japan. These volunteers were classified into two groups based on their sFer (serum ferritin) levels: normal group (sFer ≥ 20 ng/mL, n = 36) and IDNA group (sFer < 20 ng/mL, n = 29). Venous blood samples were obtained from the antecubital veins of these volunteers after 10–12-h fasting to measure the hematological and biochemical parameters, including lipid levels and iron status. The results of each group were compared using Student’s t-test or the Mann–Whitney U test (for inhomogeneous variance). ResultsThe serum cholesterol levels varied depending on the iron status in the women. Serum high-density lipoprotein cholesterol (HDL-C) levels in the IDNA group were significantly higher (P = 0.006) than that in the normal group. However, the levels of total cholesterol (T-CHO), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) were not significantly different between the groups. Serum LDL-C levels were positively and significantly correlated with sFer levels in the IDNA group (Kendall’s rank correlation 0.264, P = 0.044), but not in the normal group. The sFer level was not correlated with serum HDL-C in both groups. The reason for the high serum HDL-C levels in young women with IDNA is not yet clear. Compared to the normal group, the frequency of eating bread containing bran was significantly higher (P = 0.031) and that for yogurt was significantly lower (P = 0.040) in the IDNA group. The proportion of the women who were susceptible to infection, which was measured using the Cornell Medical Index, was significantly higher in the IDNA group than in the normal group. Among those susceptible to infection, the serum HDL-C level of the volunteers in the IDNA group was significantly higher than that of the volunteers in the normal group (P = 0.024). ConclusionsOur findings suggest that lipid parameters may be associated with IDNA and susceptibility to infection. Further research is needed to elucidate the mechanisms underlying the changes in the serum cholesterol levels in individuals with IDNA and the clinical significance of these findings.

Retrospective cohort study of the efficacy and safety of dabigatran: real-life dabigatran use including very low-dose 75\u2009mg twice daily administration

BackgroundDabigatran is a direct thrombin inhibitor and an anticoagulant that is prescribed to prevent ischemic stroke and systemic embolism in non-valvular atrial fibrillation. Dabigatran (150 mg twice daily) is non-inferior to warfarin for the prevention of stroke and systemic embolism. A dose reduction to 110 mg twice daily should be considered for patients with decreased renal function, elderly patients, and those with a history of gastrointestinal bleeding. A small number of patients are prescribed 75 mg twice daily; however, excessive dose reduction below that indicated on the package insert may decrease the effectiveness of dabigatran. In this study, we investigated the incidence of thromboembolic events and hemorrhagic complications in patients receiving different doses of dabigatran, including patients receiving the very low-dose of 75 mg twice daily.MethodsFive hospitals in Meguro and Setagaya areas of Tokyo were included in this study. The subjects were patients receiving dabigatran in the hospitals from March 2011 to February 2014. Thromboembolic events (stroke, systemic embolism, and transient cerebral ischemic attack) and hemorrhagic complications occurring before December 2014 were retrospectively evaluated.ResultsA total of 701 subjects received dabigatran during the study period: 187 patients (26.7%) received 150 mg twice daily (normal dose), 488 patients (69.6%) received 110 mg twice daily (low-dose), and 26 patients (3.7%) received 75 mg twice daily (very low-dose). Thromboembolism occurred in 4 (2.1%), 11 (2.3%), and 3 patients (11.5%), in the normal dose, low-dose, and very low-dose groups, respectively. The odds ratio of the 75 mg dose to the 150 and 110 mg doses was 5.73 (95% CI, 1.55–21.2; p = 0.009), and the incidence with the 75 mg dose was higher than that with the other doses. Although the number of events was limited, it should be noted that 3 patients in the very low-dose group had thromboembolic events.ConclusionsThe results suggest that sufficient anticoagulation efficacy may not be maintained when the dabigatran dose is excessively reduced to 75 mg twice daily.

Demographic and geographical characteristics of pediatric patients presenting to a convenient clinic at a large railway station in a metropolitan area of Tokyo.

There is an increasing demand for medical provision systems that are friendly for working mothers with sick children in Japan. The aim of this cross-sectional, observational study was to analyze the demographic characteristics of pediatric patients presenting to a convenient care clinic, which was located in a large railway station and offered primary care with after-hours accessibility in a metropolitan area of Tokyo.We analyzed anonymous data for patients who had visited the pediatric department at a clinic between August 2013 and June 2016. Data regarding patients’ sex, age, time of visit, waiting time, presence or absence of an appointment, diagnosis, and addresses were collected from electronic health and billing records.Overall, 8091 patients visited the department 45,388 times. The numbers of visits by patients who resided within 2, 5, and 10 miles of the clinic were 37,160 (84.6%), 42,336 (96.4%), and 43,399 (98.8%), respectively. No seasonal variation in the number of visits was observed. Male patients visited the clinic 23,742 times (52.3%) and the patients’ median age was 3 years (interquartile range, 1–6). Most visits occurred on Mondays, and 5643 (15.2%) and 4790 (12.9%) patients visited the clinic when consultations began at 10 am and 3 pm, respectively. Approximately 20% of weekday visits occurred after 6 pm, when other pediatricians’ offices were typically closed. Children older than 7 years of age visited the clinic more frequently after 6 pm. The overall median waiting time was 650 seconds (interquartile range, 429–1020). The 3 most common diagnoses were upper respiratory tract infection (27,173), asthmatic bronchitis (23,744), and allergic rhinitis (10,556). The number of individuals who were referred to other medical institutions was 284 (0.6%).The majority of patients were children aged 1 to 4 years living near the clinic and 80% of visits were during the daytime. However, children older than 7 years of age visited the clinic more frequently after 6 pm. The convenience of the clinic contributed to the fulfillment of the medical needs of children with mild illnesses whose mothers were in full-time employment.

Atypical profile of aortic injury associated with blunt trauma in the metropolitan area of Japan

BackgroundAortic injury caused by blunt trauma is a critical medical condition that requires extraordinary caution in the treatment. It is often caused by direct hit and high-speed deceleration in motor...

Tokyo’s Kyōshō Jūtaku: Nature through the Inside, Outside and the In-Between

Born out of conversations with Japanese architects, as well as intimate spatial encounters with small houses (kyōshō jūtaku) in Tokyo, this paper discusses the way in which nature emerges and functions within fourth generation small housing design. Japan’s relationship with nature has generated many interconnecting architectural layers over centuries, arising out of culture, religion and the practicalities and consequences of the country’s economy, climate and experiences of natural disasters. These layers have fostered a deep and complex connection to land, and as a result, there is still a high value placed on owning one’s own plot, no matter how small. Despite how most city-based plots are often accompanied by high taxes and complicated building regulations; the lure of the land prevails.&#x0D; Due to domestic plot sizes rapidly reducing after the burst of the Bubble Economy in 1992, kyōshō jūtaku became a reality for those wanting to remain within the greater Tokyo area. A consequence of this reduction was that Tokyoites had less domestic contact with nature, as gardens became a luxury that most could not afford. Therefore, architects designing kyōshō jūtaku began to creatively consider new and innovative ways nature could be reclaimed and experienced through design. Through discussing examples of Tokyo’s kyōshō jūtakuin relation to inside, outside and the in-between, this paper traces how current connective and fluid manifestations of nature contribute to the destabilisation of the public-private boundary. It demonstrates how nature plays a fundamental role in building more open relationships with the city, relationships which in turn allow small houses to function as critical micro-spaces within Tokyo’s thriving urban ecology.

Efficacy and Safety of Mechanical Thrombectomy for Occlusion of the Second Segment of the Middle Cerebral Artery : Retrospective Analysis of the Tama-REgistry of Acute endovascular Thrombectomy (TREAT).

The efficacy of mechanical thrombectomy in the treatment of occlusions of the second segment of the middle cerebral artery (M2) has not been firmly established. This study analyzed data from patients who had undergone mechanical thrombectomy for the first segment of the middle cerebral artery (M1) and M2 occlusion from the Tama-REgistry of Acute endovascular Thrombectomy (TREAT) between January 2015 and March 2017, which is amulticenter database in the Tama area of Tokyo, Japan. The M1 and M2 occlusions were compared in order to evaluate the safety and efficacy of M2 thrombectomy. Atotal of 515 patients were registered, whereby 160 patients with M1 occlusion and 51patients with M2 occlusion were included. While the puncture-to-reperfusion time was longer in the M2 occlusions (median 43min, range 30-61 min vs. median 60min, range 38-79 min, p = 0.01), no significant differences were seen in the proportion of patients with successful reperfusion, postoperative hemorrhagic complications and good outcome (modified Rankin scale ≤2 at 90days). Younger age was the only independent factor associated with good outcome in patients with M2 occlusions as determined by the multivariate analysis (p = 0.033, odds ratio 0.91, 95% confidence interval 0.83-0.99). The outcome and the safety profile of mechanical thrombectomy for M2 occlusions are favorable and comparable to those of the M1 occlusion thrombectomy.

Worsening renal function, adverse clinical events and major determinants for changes of renal function in patients with atrial fibrillation: a Japanese multicenter registry substudy

Objective: To explore factors related to changing renal function and the prognostic effect of worsening renal function in patients with atrial fibrillation (AF).Methods: The present substudy was based on the SAKURA AF Registry, a Japanese multicenter prospective observational registry that includes 3267 AF patients from 63 institutions in the Tokyo area. Worsening renal function was defined as an estimated glomerular filtration rate (eGFR) decrease equaling more than 20% of the patient’s baseline eGFR.Results: During a median 39.3 month follow-up period, patients’ eGFR decreased annually by a mean value of 1.07 mL/min/1.73 m2. Multivariable analysis showed that age ≥75 years, body weight ≤50 kg, a history of heart failure and initially preserved renal function (creatinine clearance [CrCl] ≥ 60 mL/min) were significantly associated with a decrease in eGFR, whereas a history of AF ablation was associated with a maintain in eGFR. The 194 patients with worsening renal function were at significantly increased risk of death, stroke and major bleeding (adjusted hazard ratios [HRs]: 2.06, 1.97 and 2.23, respectively).Conclusion: Age ≥75 years, body weight ≤50 kg, a history of heart failure and initially preserved renal function appear to promote renal dysfunction in patients with AF, but a history of AF ablation seems to have a favorable effect. Worsening renal function seems to increase AF patients’ risk of adverse clinical events. Renal function can decline quickly; thus, early intervention including AF ablation is warranted.