Years Of Age In Japan Research Articles

Public Knowledge and Attitude of Caregivers Regarding Leftover Medications for Children under 6 Years of Age in Japan: A Descriptive Study on a Nationwide Exploratory Questionnaire Survey to Caregivers.

Leftover medications are a global concern for harm to health and inadequate medical care costs. However, information on leftover medicines and their inappropriate use in children in Japan is lacking. We aimed to clarify the proportion of leftover and re-use of children's medications in Japan. We conducted a nationwide cross-sectional questionnaire survey using eight web-based domains, which covered parents' demographics, children's demographics, actual practices in handling about leftover (1) acute medication, (2) chronic medication, (3) short-term medicine, (4) antibiotic, and (5) topical medication, and attitudes towards leftover medicine. The questionnaire comprised 40 questions. We obtained responses from 3046 caregivers with children aged under 6 years before elementary school. Among these participants, 95% (2674/2809), 57% (147/256), and 69% (1687/2457) had experience with leftover acute medication use, medication for chronic disease, and short-term medication use, respectively. Instances of leftover antibiotics being given to the child's brother/sister, parents, and child's friends were 8.7, 7.9, and 3.2%, respectively. This trend was similar to other medication categories. In conclusion, most caregivers have experienced leftover medications; however, managing leftover medications depends on their beliefs and is influenced by inadequate knowledge about medications. Most of these cases lead to inadequate use of medications in children. Medical staff, especially pharmacists, need to educate and instruct caregivers on the appropriate use of children's medications.

The Experience of Adolescents and Young Adults in Their Cancer Journeys in Japan: I Try to Move Forward With Feeling That I Would Be Okay With "My Cancer".

Purpose: A cancer diagnosis can greatly affect adolescents and young adults (AYAs), especially those in their late teens and early twenties, who might have their special needs. This study aimed to understand the experiences of the AYAs who were diagnosed between 15 and 24 years of age in Japan, thinking about the care guide supporting them, from the time of their cancer diagnosis through the rest of their lives. Methods: Data were collected using semi-structured interviews, which were audio recorded and transcribed verbatim. Qualitative analysis of the transcripts was used to categorize these into themes for comprehensive interpretation. Results: Twenty AYAs participated; they were diagnosed between the ages 15 and 23 and were 19-29 years old at the time of the interview. In total, 14 core categories were identified, consisting of three themes (1) There is a feeling of distance between the cancer and me, (2) I face "my cancer" in my way, and (3) I feel that I would be okay with "my cancer." Conclusions: AYAs had their way of dealing with cancer while experiencing a distant feeling between themselves and the presence of the disease during their cancer journey. Although the process was not simple, they tried to live their lives in their own way, believing that they would be okay. Nurses must respect and understand that AYAs have a process of facing their own cancer with time and watch over AYAs' experiences to appropriately support them to successfully proceed further.

Association between indoor temperature during winter and falls at home in the past year among community-dwelling older adults: A cross-sectional analysis of the nationwide Smart Wellness Housing survey in Japan

Some studies have reported a higher incidence of falls during winter with similar proportions of indoor and outdoor falls. We investigated the relationship between indoor temperature during winter and falls at home in the past year among community-dwelling older adults. This cross-sectional study enrolled 964 individuals of ≥65 years of age in Japan. Participants answered questions about falls (including trips) at home within the past year, and the living room temperature was measured for 2 weeks during winter. Participants were divided into those living in cold (mean temperature near the floor <12°C), slightly cold (12-17.9°C), and warm (≥18°C) houses. The association between indoor temperature (cold vs. slightly cold vs. warm houses) and falls at home in the past year was examined using a logistic regression analysis adjusted for potential confounding factors. Valid data were obtained from 907 participants (mean age: 72.0±6.3 years), of whom 265,553, and 89 lived in cold, slightly cold, and warm houses, respectively. In the past year, falls occurred once in 325 (35.8%) participants and multiple times in 148 (16.3%) participants. In warm houses, the odds ratio of falling once and multiple times in the past year was 0.49 (p=0.032) and 0.34 (p=0.035), respectively, in comparison to cold houses. Living in cold houses may be associated with an increased risk of falling at home among older adults. Maintaining an appropriate indoor thermal environment during winter may reduce the risk of falling among individuals who spend most of their time at home.

Diaphyseal forearm fracture management in adolescent patients from 2011 to 2020: A multicenter study of surgery and regional anesthesia trends

BackgroundDiaphyseal forearm fractures are common traumatic injuries among children. There has been much debate on the use of intramedullary nailing (IMN) or plate fixation in the adolescent population (10–16 years of age). Furthermore, as ultrasound technology has advanced, the safety and efficacy of ultrasound-guided axillary brachial plexus block for children has dramatically improved. Therefore, anesthesia options for adolescent patients have increased in recent years. This study aimed to investigate recent surgical and regional anesthesia trends of diaphyseal forearm fractures in patients 10 to 16 years of age in Japan through a multicenter epidemiological survey from 2011 to 2020. MethodsThis retrospective, multicenter study included 226 pediatric patients with diaphyseal forearm fracture aged 10–16 years treated from January 2011 to December 2020. We divided the patients into four groups according to the period in which they were treated: early (2011–2013), middle (2014–2016), late (2017–2019), and COVID-19 (2020). Information from medical records was used to investigate the number of surgeries, types of anesthesia administered, and internal fixation methods used for diaphyseal forearm fracture in adolescent patients during each period. ResultsThe number of surgeries was generally constant in each period but decreased during the COVID-19 period. In the early, middle, late, and COVID-19 periods, the percentages of surgeries performed under regional anesthesia were 67.7, 85.5, 87.0, and 100% respectively (p = 0.003). During the same periods, the percentages of patients receiving IMN were 41.5, 49.3, 58.0, and 66.7%, respectively (p = 0.033). ConclusionThe use of IMN and regional anesthesia to treat diaphyseal forearm fracture in patients 10 to 16 years of age steadily increased during the study period from 2011 to 2020. These results indicate that regional anesthesia is safe, effective, and well-tolerated by adolescent patients. The treatment strategy for diaphyseal forearm fractures in adolescents using regional anesthesia in combination with IMN worked well and was effective during COVID-19. Our evidence suggests this trend will continue. We anticipate that our findings can be extrapolated for upper extremity fractures in adolescent patients beyond the Tokai region of Japan where the study was based.

Community-Acquired Pneumonia Incidence in Adults Aged 18 Years and Older in Goto City, Japan: A Prospective Population-Based Study

Community-Acquired Pneumonia Incidence in Adults Aged 18 Years and Older in Goto City, Japan: A Prospective Population-Based Study

Superior immunogenicity of high-dose quadrivalent inactivated influenza vaccine versus Standard-Dose vaccine in Japanese Adults ≥ 60 years of age: Results from a phase III, randomized clinical trial

BackgroundA high-dose, split-virion inactivated quadrivalent influenza vaccine (IIV4-HD; Sanofi) is being used for the prevention of influenza in multiple countries. This study examined the immunogenicity and safety of the IIV4-HD vaccine administered intramuscularly (IM) compared with a locally licensed standard-dose influenza vaccine (IIV4-SD) administered subcutaneously (SC) in Japan. MethodsThis was a phase III, randomized, modified double-blind, active-controlled, multi-center study in older adults ≥ 60 years of age conducted during the Northern Hemisphere (NH) influenza season of 2020–21 in Japan. Participants were randomized in a 1:1 ratio to receive a single IM injection of IIV4-HD or SC injection of IIV4-SD. Hemagglutination inhibition antibody and seroconversion rates were measured at baseline and day 28. Solicited reactions were collected for up to 7 days after vaccination, unsolicited adverse events up to 28 days after vaccination, and serious adverse events throughout the study. ResultsThe study included 2100 adults ≥ 60 years of age. IIV4-HD given IM induced superior immune responses versus IIV4-SD given SC as assessed by geometric mean titers for all four influenza strains. Superior seroconversion rates were also observed for IIV4-HD compared to IIV4-SD for all influenza strains. The safety profiles of IIV4-HD and IIV4-SD were similar. IIV4-HD was well tolerated in participants, with no safety concerns identified. ConclusionsIIV4-HD provided superior immunogenicity versus IIV4-SD and was well tolerated in participants ≥ 60 years of age in Japan. With superior immunogenicity based on the multiple randomized controlled trials and real-world evidence of trivalent high-dose formulation, IIV4-HD is expected to be the first differentiated influenza vaccine in Japan that offer a greater protection against influenza and its complications in adults 60 years of age and older. Study registrationNCT04498832 (clinicaltrials.gov); U1111-1225–1085 (who.int).

Adverse Reactions and Attitudes Toward the BNT162b2 COVID-19 Vaccine in Children 5 to 11 Years of Age in Japan.

Adverse Reactions and Attitudes Toward the BNT162b2 COVID-19 Vaccine in Children 5 to 11 Years of Age in Japan.

Null Association Between Isolated Orofacial Clefts and Sleep Duration: A Cohort Study From the Japan Environment and Children's Study.

Although children with orofacial clefts have an increased risk for sleep-disordered breathing, no studies have examined the association of sleep duration. Thus, this study aimed to examine associations between orofacial clefts and sleep duration at 1 month, 6 months, 1 year, and 3 years of age in Japan. A cohort study from the Japan Environment and Children's Study. This study consisted of 91 497 children, including ones with isolated cleft lip and palate (n = 69), isolated cleft lip only (n = 48), and isolated cleft palate only (n = 37), for which recruitment was undertaken during 2011 to 2014. Seep durations (hours per day) at 1 month, 6 months, 1 year, and 3 years of age, as reported by their mothers. In the control group, mean sleep durations and standard deviations at 1 month, 6 months, 1 year, and 3 years of age were 15.2 (2.5), 13.6 (1.9), 12.9 (1.6), and 11.6 (1.2) h, respectively. Compared to the control group, linear regression models reported effect sizes and 95% confidence intervals shorter than 1 h for sleep duration of each type of isolated orofacial cleft at each time point. This study suggested null associations between isolated orofacial clefts and sleep duration at 1 month, 6 months, 1 year, and 3 years of age. Children with isolated orofacial clefts had sufficient mean sleep duration.

Epidemiologic study of patients after Fontan operation based on Medical Aid Program for Chronic Pediatric Diseases of Specified Categories cohort.

Nationwide registry data of patients with single-ventricle physiology have been rarely reported. The Medical Aid Program for Chronic Pediatric Diseases of Specified Categories (Japan) has contributed to the financial support of medical expense for patients younger than 20 years with chronic paediatric disease, and almost all children in Japan who require disease-specific treatment voluntarily apply to this programme. The epidemiology and medium- to long-term outcome of patients following a Fontan procedure were investigated using the database. The usefulness of this epidemiologic investigation in identifying real-world objectives and clinical applications was also examined. A total of 2862 patients who underwent a Fontan operation were identified from 18,589 patients with chronic heart disease registered to the medical aid programme. The details of symptoms, treatment, and somatic growth were evaluated, from which we were able to clarify the nationwide data regarding the current status of post-Fontan patients younger than 20 years. This study elucidated the current status of post-Fontan patients under 20 years of age in Japan. Data analysis of the Medical Aid Program for Chronic Pediatric Diseases of Specified Categories cohort provided useful information towards understanding the comprehensive status of patients with chronic heart disease and contributed to improved disease management.

1562-P: Predictive Risk Factors for Renal Dysfunction and Cardiovascular Disease: An Analysis Using Medical Checkup Data

Objective: Early prevention of renal dysfunction progression and cardiovascular disease is important in diabetes. We aimed to determine the risk factors for renal dysfunction and cardiovascular disease among medical insurance subscribers between 40 and 74 years of age in Japan. Methods: This retrospective study involved 1585 subjects, including 97 patients with diabetes, who had undergone a specific health checkup in 2013 and 2019. The primary composite outcome included decline in estimated glomerular filtration rate (eGFR) by ≥30%, increase in urine albumin-to-creatinine ratio (UACR) by ≥30 mg/gCre, and increase in the Framingham Risk Score by ≥5%. We categorized the subjects into groups with and without these outcomes. Univariate analysis was conducted using Welch’s t-test, Pearson’s correlation coefficient, and Fisher’s exact test. Based on the univariate analysis, principle component and logistic analyses were performed to determine the predictive risk factors. Results: Significant between-group differences were noted in terms of age, BMI, waist circumference, blood pressure, hemoglobin, hematocrit, triglyceride, HDL-C, LDL-C, AST, ALT, γ-GTP, HbA1c, serum creatinine, eGFR, urine creatinine, UACR, urine protein-to-creatinine ratio, sex, antihypertensive medication, history of anemia, diabetes, smoking, alcohol consumption, weight change, exercise habits, the will to improve and others. Logistic analysis showed that age (odds ratio [95% confidence interval]: 1.04 [1.02-1.06], P &amp;lt;0.0001), HDL-C (0.97 [0.96-0.98], P &amp;lt;0.0001), HbA1c (1.35 [1.12 -1.63], P =0.0015), and male sex (3.90 [2.97-5.11], P &amp;lt;0.0001) were predictive risk factors. Conclusion: Lower HDL-C and higher HbA1c were detected as the risk factors for patients with diabetes and without diabetes. The results of this study indicate that the harmful effects of hyperglycemia and dyslipidemia may have started before the patients actively exhibit metabolic disorders. Disclosure R. Terayama: None. M. Koshizaka: None. T. Shibata: None. T. Ban: None. Y. Maezawa: None. K. Yokote: Research Support; Self; Astellas Pharma Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Merck Sharp &amp; Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Mochida Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Pfizer Japan Inc., Sanofi K.K., Shionogi &amp; Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker’s Bureau; Self; Abbott, Astellas Amgen, AstraZeneca K.K., Bayer Inc., FUJIFILM Pharmaceuticals U.S.A., Inc., Kaken Pharmaceutical Co., Ltd., Sanwa Kagaku Kenkyusho.

Epidemiology of a Femur Shaft Fracture in an Acute Critical Care Center in a Rural Area of Japan

Purpose:Japan has the most rapidly aging population in the world. As of 2017, the number of people ≥65 years of age in Japan was 35.1 million, constituting 27.7% of the total population. The purpose of the study was to investigate the epidemiology in patients with a femur shaft fracture in a rural area with a super-aging population.Methods:Electronic medical charts from January 2011 to March 2019 were retrospectively reviewed for all patients with the main disease of ‘femur shaft fracture’ who had been transported to Numazu City Hospital. Subjects were divided into two groups based on the mechanism of injury: a Low-Energy (LE) group, which included patients who had been injured by falling down or suffered a fracture while walking; and a High-Energy (HE) group, which included patients who had been injured by traffic accidents or free fall from a high place (over 3 m). The variables were compared between the two groups.Results:During the investigation period, there were 58 patients with the femur shaft fracture, including 28 patients in the HE group and 30 in the LE group. The male ratio, injury severity score and ratio of open fracture in the HE group were significantly greater than in the LE group. The age and systolic blood pressure in the HE group were significantly lower than in the LE group.Conclusion:Among patients with femur shaft fracture in the acute critical care center in a rural area of Japan, where the population is super-aging, the frequency of HE and LE femur shaft fracture was almost the same. The fragility of the femur shaft in elderly people may explain this tendency.

Detection of Pediatric Pulmonary Arterial Hypertension by School Electrocardiography Mass Screening.

Rationale: To detect pulmonary arterial hypertension (PAH) at any early stage is a promising approach to optimize the outcome. Objectives: To investigate the impact of school ECG-based screening on detecting idiopathic or heritable (I/H)-PAH in the general pediatric population. Methods: This was a nationwide survey of patients with I/H-PAH newly diagnosed at 3 months to 18 years of age in Japan during 2005-2012. Measurements and Main Results: Eighty-seven eligible patients (age range, 1-16 yr) were recruited. Among 68 (78%) patients diagnosed at greater than or equal to 6 years of age (the age of the first ECG-based screening), 28 (41%) were detected by the ECG-based screening (screening group) and 40 (59%) were recognized by their symptoms (n = 37) or coincidental occasions (n = 3; nonscreening group). In the screening group, the proportion of patients in World Health Organization functional class I/II at diagnosis was higher (96% vs. 60%; P < 0.001), plasma brain natriuretic peptide level was lower (149 ± 290 vs. 398 ± 559 pg/ml; P = 0.045), and 6-minute-walk distance was longer (420 ± 109 vs. 327 ± 104 m; P < 0.001) than the nonscreening group, despite similar values in mean pulmonary artery pressure (58 ± 17 vs. 61 ± 17 mm Hg; P = 0.42) and pulmonary vascular resistance index (18 ± 8 vs. 21 ± 11 Wood units ⋅ m2; P = 0.24) between groups. The proportion of patients on intravenous epoprostenol at the final visit was lower in the screening group than the nonscreening group (14% vs. 50; P = 0.004). Conclusions: These findings suggest that the ECG-based screening detects a unique subpopulation of pediatric patients with I/H-PAH that is associated with already established pulmonary hypertension but without obvious right heart failure and warrants investigating the prognostic significance of this system.

Environmental Tobacco Smoke Exposure among Children at 7 Years of Age in Japan: Associated Factors and Urinary Cotinine Levels

AbstractIntroduction: Child exposure to environmental tobacco smoking (ETS) remains as a major issue, with adverse health consequences such as obesity, neurobehavioral disorders. This study aimed t...

Adult Attachment Patterns Modify the Association Between Social Support and Psychological Distress.

Introduction: Social support is an important protective factor for psychological distress, and adult attachment patterns—which are the basis of human relationships—may modify the association between social support and psychological distress. The objective of this study was to investigate whether adult attachment patterns modify the association between social support and psychological distress.Methods: A commercial online survey service was used to collect data from 1648 men and women of 30–69 years of age in Japan. We assessed the association between social support and psychological distress, as measured by the Kessler Psychological Distress Scale (K6), and stratified it by adult attachment patterns using multiple linear models. Adjustments were made for age, sex, presence of a spouse and child in the household, level of education, employment, and household income.Results: There was a significant interaction effect between social support score and a dismissing attachment pattern on psychological distress (p = 0.015); social support was associated with reduced level of psychological distress only in participants with a secure attachment pattern (β:−0.86, 95% CI: −1.56 to −0.16), whereas the point estimate was of opposite sign in participants with a dismissing attachment pattern (β:1.02, 95% CI: −0.32 to 2.37).Conclusions: Higher social support reduced the risk of distress among participants with secure attachment. On the contrary, social support can be harmful for those with a dismissing attachment pattern. Our results suggest that further assessment of adult attachment patterns is needed to maximize the positive effects of social support to prevent psychological distress.

Phenotypes of childhood wheeze in Japanese children: A group-based trajectory analysis.

Exploring patterns of childhood wheeze may help to clarify the etiology and prognosis of respiratory diseases. The purpose of this study was to classify phenotypes of wheezing in children up to 9years of age in Japan and to evaluate the individual and environmental risk factors for these phenotypes. Wheeze was evaluated at approximately 1-year intervals based on the mothers' recollection of their child's wheezing or whistling in the chest during the preceding 12months. The children were aged 1-9years. In total, 1116 children who had at least five measures of wheezing at all nine time points were used for identifying trajectories. Trajectories were identified with group-based trajectory analysis. A multinomial logit model was built to evaluate the relationships between phenotypes and risk factors. Five typical trajectories were identified. The probability of group membership was 43.7%, 32.2%, 6.2%, 8.6%, and 9.2% for the never/infrequent wheeze, transient early wheeze, school-age-onset wheeze, early-childhood-onset remitting wheeze, and persistent wheeze trajectories, respectively. Infant tobacco exposure increased the odds of membership in the transient early wheeze trajectory compared to the never/infrequent wheeze trajectory. Using the group-based trajectory modeling approach, we identified five trajectories of childhood wheeze development in a Japanese population. The trajectories shown here are based on formal statistical modeling rather than on subjective classification, and an assessment of its precision suggested that the model has high assignment accuracy.

Three-Year Prospective Follow-up of Potential Pediatric Candidate for Intestinal Transplantation

Intestinal transplantation (ITx) is a treatment for refractory intestinal failure (IF). However, the indications for and timing of ITx are still controversial because the course of IF is unknown. We performed a prospective multi-institutional cohort study to identify the prognostic factors for referral to an ITx facility. Patients under 18 years of age in Japan who suffered from IF and had received parenteral nutrition for longer than 6 months were enrolled in this study. They were followed up for 3 years. Seventy-two patients were followed. The mean age at the beginning of the study was 7.0 years. Diagnoses were short gut syndrome (n = 25), motility disorder (n = 45), and other (n = 2). The overall 3-year survival rate was 95%. The 3-year survival rate was 86% in patients with intestinal-failure-associated liver disease (IFALD) (n = 6) compared to 97% in those without IFALD (n = 66) (P = .0003). Furthermore, the 3-year survival rates of patients who did and did not meet the criteria for ITx were 82% (n = 11) and 97% (n = 62), respectively (P = .034). Six (44%) of 14 patients whose performance status (PS) was ≥3 at enrollment were dead or still had a PS ≥ 3 at 3 years. This study indicates that IFALD is a poor prognostic factor in pediatric patients with IF. Our indication for ITx, namely the presence of IFALD or loss of more than 2 parenteral nutrition access sites, seems to be applicable.

Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation

BackgroundTriple antithrombotic therapy with warfarin plus two antiplatelet agents is the standard of care after percutaneous coronary intervention (PCI) for patients with atrial fibrillation, but this therapy is associated with a high risk of bleeding.MethodsIn this multicenter trial, we randomly assigned 2725 patients with atrial fibrillation who had undergone PCI to triple therapy with warfarin plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and aspirin (for 1 to 3 months) (triple-therapy group) or dual therapy with dabigatran (110 mg or 150 mg twice daily) plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and no aspirin (110-mg and 150-mg dual-therapy groups). Outside the United States, elderly patients (≥80 years of age; ≥70 years of age in Japan) were randomly assigned to the 110-mg dual-therapy group or the triple-therapy group. The primary end point was a major or clinically relevant nonmajor bleeding event during follow-up (mean follow-up, 14 months). The trial also tested for the noninferiority of dual therapy with dabigatran (both doses combined) to triple therapy with warfarin with respect to the incidence of a composite efficacy end point of thromboembolic events (myocardial infarction, stroke, or systemic embolism), death, or unplanned revascularization.ResultsThe incidence of the primary end point was 15.4% in the 110-mg dual-therapy group as compared with 26.9% in the triple-therapy group (hazard ratio, 0.52; 95% confidence interval [CI], 0.42 to 0.63; P<0.001 for noninferiority; P<0.001 for superiority) and 20.2% in the 150-mg dual-therapy group as compared with 25.7% in the corresponding triple-therapy group, which did not include elderly patients outside the United States (hazard ratio, 0.72; 95% CI, 0.58 to 0.88; P<0.001 for noninferiority). The incidence of the composite efficacy end point was 13.7% in the two dual-therapy groups combined as compared with 13.4% in the triple-therapy group (hazard ratio, 1.04; 95% CI, 0.84 to 1.29; P=0.005 for noninferiority). The rate of serious adverse events did not differ significantly among the groups.ConclusionsAmong patients with atrial fibrillation who had undergone PCI, the risk of bleeding was lower among those who received dual therapy with dabigatran and a P2Y12 inhibitor than among those who received triple therapy with warfarin, a P2Y12 inhibitor, and aspirin. Dual therapy was noninferior to triple therapy with respect to the risk of thromboembolic events. (Funded by Boehringer Ingelheim; RE-DUAL PCI ClinicalTrials.gov number, NCT02164864.)

Immunogenicity and safety of the 13-valent pneumococcal conjugate vaccine compared to the 23-valent pneumococcal polysaccharide vaccine in elderly Japanese adults

Streptococcus pneumoniae is a major cause of severe disease worldwide, particularly in the elderly population. Due to increasing life expectancy in Japan and elsewhere, an effective vaccine which offers the possibility of prolonged protection is required. Protein conjugated pneumococcal vaccines, which have the ability to boost immunity (immunologic memory) on natural exposure or revaccination, may meet these requirements. An unconjugated 23-valent pneumococcal polysaccharide vaccine (PPSV23) has been available for decades; however data on protection against pneumonia are inconsistent. For the first time, a randomized, modified double-blind trial comparing the 13-valent pneumococcal conjugate vaccine (PCV13) with PPSV23 was conducted in PPSV23-naive adults ≥65 years of age in Japan. This study showed that statistically significantly greater functional antibody responses as measured by opsonophagocytic assays 1 month after vaccination were elicited in the PCV13 group (n = 366) compared with the PPSV23 group (n = 367) for 9 of the 12 serotypes in common with both vaccines and for serotype 6A, unique to PCV13. Local reactions collected within 14 days of vaccination were more frequent in the PCV13 (57.5%, 211/367) than PPSV23 (44.9%, 166/370) group, although severity was generally mild to moderate; systemic and adverse events were similar across groups. There were no treatment-related serious adverse events. Consistent with global studies comparing PCV13 with PPSV23, PCV13 use in Japanese subjects was safe and well-tolerated and elicited greater functional immune responses than PPSV23 for the majority of PCV13-serotypes. PCV13 has the potential to protect against pneumococcal disease in Japanese elderly adults.

Abstract 195: Kawasaki Disease in a four-year-old girl with History of Acute Myeloid Leukemia; Report of a Case and Literature Review

Background: Kawasaki disease (KD) and acute myeloid leukemia (AML) both occur predominantly in young children. However, considering that the incidence rate of cancer during 0-14 years of age in Japan is 10.1 per a hundred thousand and that of KD during 0-4 years of age is 260 per a hundred thousand, there is little possibility of the same individual developing 2 diseases. Both inside and outside Japan we found at least 19 case reports of KD some relevant to cancer. Herein, we report a case of KD in a four-year-old Japanese girl with history of AML. Case report: A four-year-old Japanese girl was diagnosed with KD at 3 days of illness. She had the medical history of AML-M7 at her age of 1. She had no chimeric genes and was classed as intermediate risk. She had been treated following JPLSG AML05 protocol including etoposide, cytarabine (Ara-C), mitoxantrone, idarubicin, methotrexate (MTX), hydrocortisone (HDC) and triple intrathecal therapy (Ara-C, MTX and HDC). More than 2 years had passed without recurrence since her last chemotherapy. When we diagnosed her as KD, laboratory findings showed WBC 15.5 х103/μl with 85% neutrophils, hematocrit 33.7%, platelet count 19.1x10 6 /μl, CRP 10.5mg/dl, serum albumin 3.8g/dl and BNP 12.2pg/ml. She responded well to IVIG (2g/kg) plus prednisolone (2mg/kg/day) and ASA (30mg/kg/day). Although BNP transiently had increased to 151.8pg/ml at 5 days after onset, neither coronary arterial abnormalities nor myocardial complications were detected at 1 year of illness. Conclusions: We experienced the rare case of KD in a four-year-old Japanese girl with history of AML. She responded well to IVIG and any cardiovascular complications were not detected at 1 year of illness. Referring to only this case, it is unclear whether the history of AML could influence developing and progress of KD or not. The possibility of the same individual developing KD during 0-4 years of age and cancer during 0-14 years of age would be 2.6 per 10 million in Japan. However, among three hundred thousand cumulative patients of KD in Japan, 14 cases have been reported that they had developed cancer during 0-14 years of age. To discuss the relation to character of cancer, chemotherapy and severity or compilations of KD, more case should be evaluated.

90歳以上の超高齢者における大腸癌スクリーニング内視鏡検査は必要か？

高齢者の大腸内視鏡検査（CS）数が増加している．当院のCSを受けた超高齢者90歳以上の患者の平均寿命と検査満足度の実態調査を行った．【対象と方法】2005年から2008年までの4年間に当院でCSを受けた当時90歳以上の78患者を対象として5年以上経過した2013年に追跡調査し，平均生存期間中央値（MST）をKaplan-Meier法を用いて対照群（当院で追跡できた年齢性別が合致した上部内視鏡検査患者群）と比較検討した．【結果】アンケート回収できた56例の検査時平均年齢91.7±1.6（90〜98）歳，MSTは3.7年で対照群と比し有意差を認めなかった．さらにグループ分けした治療群（外科/内視鏡治療）でもMSTは3.7年であった．【結論】CSを受けた90歳以上の超高齢者の平均生存期間は約4年程度であり，対照群と有意差を認めなかった．また90歳以上では有症状からでも十分なCS検査効果があると思われたが，検査を受けた患者とその家族のCS満足度は高い．今後，本邦における90歳以上のCS患者の増加が予想されるが，自覚症状のない高齢者にスクリーニングCSを何歳まで勧めるべきか平均余命を含めた議論も必要である．