Amid the effects of global warming, Tokyo has become an increasingly hot city, especially during the summertime. To prepare for the upcoming 2020 Summer Olympics and Paralympics in Tokyo, all participants, including the athletes, staff, and spectators, will need to familiarize themselves with Tokyo’s hot and humid summer conditions. This paper uses the wet-bulb globe temperature (WBGT) index, which estimates the risk of heat illness, to compare climate conditions of sports events in Tokyo with the conditions of the past three Summer Olympics (held in Rio de Janeiro, London, and Beijing) and to subsequently detail the need for establishing appropriate countermeasures. We compared WBGT results from the past three Summer Olympics with the same time periods in Tokyo during 2016. There was almost no time zone where a low risk of heat illness could be expected during the time frame of the upcoming 2020 Tokyo Olympics. We also found that Tokyo had a higher WBGT than any of those previous host cities and is poorly suited for outdoor sporting events. Combined efforts by the official organizers, government, various related organizations, and the participants will be necessary to deal with these challenging conditions and to allow athletes to perform their best, as well as to prevent heat illnesses among staff and spectators. The sporting committees, as well as the Olympic organizing committee, should consider WBGT measurements in determining the venues and timing of the events to better avoid heat illness and facilitate maximum athletic performance.
Carbamazepine (CBZ) is the most frequent culprit drug for severe cutaneous adverse drug reactions (ADR), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug-induced hypersensitivity syndrome (DIHS). A strong association between human leukocyte antigen (HLA)-B*1502 and CBZ-induced SJS ⁄ TEN has been reported in Han Chinese, Thai, Malaysian and Indian populations, but not in Caucasian or Japanese populations. Recent studies showed an association between HLA-A*3101 and CBZ-induced ADR in Caucasian and Japanese populations. We conducted a case-control study to determine HLA genotyping of patients with CBZ-induced ADR in a Japanese population. Fifteen patients with CBZ-induced ADR and 33 subjects who had taken CBZ for more than 3 months without evidence of any ADR as a control were enrolled. In addition, the results of a CBZ-induced lymphocyte stimulation test were compared between the groups. A strong association was found between HLA-A31 and CBZ-induced ADR (P < 0.001), and a weak association was found between HLA-A11 and HLA-B51 with CBZ-induced ADR. No HLA-B*1502 was found in either patients or control subjects. The mean CBZ-induced lymphocyte stimulation index was significantly high in patients with CBZ-induced ADR compared with CBZ-tolerant patients (P < 0.001); however, no significant difference was seen between HLA-A31-positive subjects and HLA-A31-negative subjects in either group. These findings suggest that HLA-A31 is strongly associated with CBZ-induced ADR in the Japanese, but does not determine CBZ-induced lymphocyte proliferation.
The aim of this study was to determine complication rates and possible risk factors of expert-performed endotracheal intubation (ETI) in patients with trauma, in both the prehospital setting and the emergency department. We also investigated how the occurrence of ETI-related complications affected the survival of trauma patients. This single-center retrospective observational study included all injured patients who underwent anesthesiologist-performed ETI from 2007 to 2017. ETI-related complications were defined as hypoxemia, unrecognized esophageal intubation, regurgitation, cardiac arrest, ETI failure rescued by emergency surgical airway, dental trauma, cuff leak, and mainstem bronchus intubation. Of the 537 patients included, 23.5% experienced at least one complication. Multivariable logistic regression analysis revealed that low Glasgow Coma Scale Score (adjusted odds ratio [AOR], 0.93; 95% confidence interval [CI], 0.88–0.98), elevated heart rate (AOR, 1.01; 95% CI, 1.00–1.02), and three or more ETI attempts (AOR, 15.71; 95% CI, 3.37–73.2) were independent predictors of ETI-related complications. We also found that ETI-related complications decreased the likelihood of survival of trauma patients (AOR, 0.60; 95% CI, 0.38–0.95), independently of age, male sex, Injury Severity Score, Glasgow Coma Scale Score, and off-hours presentation. Our results suggest that airway management in trauma patients carries a very high risk; this finding has implications for the practice of airway management in injured patients.
Objectives: To reveal the effect of age and other factors on perceived anxiety over radiation exposure among decontamination workers in Fukushima Prefecture, Japan. Methods: A survey questionnaire was sent to 1505 workers, with questions regarding age, presence of a written employment contract, previous residence, radiation passbook ownership, presence of close persons for consultation, knowledge of how to access public assistance, and a four-point scale of radiation-related anxiety (1= "Very much," 2= "Somewhat," 3= "A little bit," and 4= "None" ). The relationships between the degree of anxiety and variables were analyzed using the chi-square test and residual analysis. Results: In all, 512 participants responded to the questionnaire. The mean age of participants was 46.2 years (SD: 13.1, range: 18-77). Of them, 50, 233, 168, and 61 workers chose "Very much," "Somewhat," "A little bit," and "None," respectively, on the anxiety scale. Chi-square test showed that participants aged 61 years and over had higher degrees of anxiety (p<0.001). Ordinal logistic regression showed that the degree of anxiety increased if they did not have a written contract (p=0.042) or persons to consult (p=0.034) and if they routinely checked the dose rate (p=0.046). Conclusions: Decontamination workers who do not have a written contract or who are in socially isolated situations have greater anxiety over radiation exposure. Thus, it is important to both create supportive human relationships for consultation and enhance labor management in individual companies.
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