Search

A newly developed inorganic coagulated filler consisting of SiO2, ZrO2, and Al2O3 was mixed composite containing 1,6-bis-(methacryloyloxy-2-ethoxycarbonylamino)-2,4,4-trimethylhexane (UDMA) and colloidal silica as main ingredients in order to attain the highly esthetic and tough dental resin. Differences in the refractive index between the filler and the matrix before and after curing by a camphorquinone/amine/visible light initiation system were minimized to achieve the high translucency required for the esthetic resin. The refractive index of the filler was adjusted by coagulation of the primary particle at an optimum temperature (1100°C). Flexural strength of the resin was increased by the anchor effect, depending on the surface conditions of the filler. Furthermore, the flexural strength of the resin was found to increase to 250 MPa by post-curing upon heating at 110°C. As a result, the sufficiently translucent and resin in comparison to commercial products (flexural strength ≤220 MPa) was successfully obtained. [ABSTRACT FROM AUTHOR]

Stress is a trigger for depression and PTSD, with current studies suggesting the involvement of microglial hyperactivation and dysfunction in the pathophysiology of these diseases. In this review, we introduced microglial functional changes in animal models, which exhibit fear memory dysregulation that is characteristic of PTSD, and human microglia-focused clinical studies on depression and PTSD. Stress has been found to affect cytokine and neurotrophic factor releases from the microglia, promoting microglia-mediated synaptic phagocytosis. In particular, animal models of PTSD have indicated that abnormal microglial cytokine production engage in decontextualized fear memory, fear extinction deficit, and fear generalization, and impaired microglial phagocytosis may also participate in fear generalization and fear forgetting. It is not possible to evaluate higher mental dysfunction in stress-related psychiatric disorders using model animals alone. PET studies with TSPO ligands, for one, suggest that inflammatory microglial changes are enhanced in depressed patients, whereas these changes are suppressed in PTSD patients. Thus, we conducted a reverse-translational research to explore the involvement of microglia in depression using human peripheral blood. We believe that interactive research in humans and animals is needed to elucidate the pathophysiology of stress-related psychiatric disorders for the development of treatment options for such patients.

We discuss the current status of, and possible countermeasures for, acute drug poisoning among adolescents using OTC drugs. In the last 10 years, 36 patients aged <20 years who overdosed on OTC drugs were examined for the type of drug ingested, its active ingredients in cases of lethal dose intake, and the relevant place of purchase. Patients aged <20 years accounted for 30% of all the cases. The ingestion of multi-ingredient common-cold medication was the highest at 23%, and no ingestion of any first-class OTC drugs was observed. Caffeine accounted for 54% of the cases of lethal dose intake. At 80%, the most common method of drug purchase was from drugstores and other OTC vendors. In recent years, the number of adolescents patients who take lethal doses of OTC drugs has been increasing, and new measures are needed to avoid such cases. School pharmacists and vendors play a major role in reducing the incidences of drug poisoning. As drugs can be easily purchased over the counter, increasing the vendors' awareness of the problem throughout society may be the quickest way to reduce the incidences of acute drug poisoning among adolescents.

This study aimed to evaluate the influence of change in respiratory motion on matchline (ML) and reduction of the effect by increasing ML levels of field matching technique in passive scattering proton therapy for esophageal cancer. To evaluate the influence of respiratory motion in terms of stability, we measured relative dose around ML using a respiratory motion phantom. The relative error was -0.5% when the respiratory motion phantom worked stable, whereas there was obvious change that the relative error was -25.5% when the difference of amplitude between upper field and lower field was one side 3 mm on each cranially and caudally direction. In clinical case of the seven esophageal cancer patients simulated by the treatment planning system, assuming the difference of amplitude was 3 mm, the relative error of maximum (minimum) dose in clinical target volume around ML against the original treatment plan were 5.8±1.2% (-6.0±2.7%), 3.3±0.9% (-3.8±1.0%), and 2.4±0.5% (2.6±0.8%) on average (±SD) when ML levels were 2, 4, and 6, respectively. Increasing ML levels can reduce the influence of respiratory motion.

Microglia-immune cells in the brain-have recently been highlighted to understand the pathophysiology of psychiatric disorders such as schizophrenia, depression, and autism. In this review paper, we introduce the microglia hypothesis for psychiatric disorders. In addition, we introduce our novel translational research approach to psychiatric disorders using microglia-like (iMG) cells directly induced from human blood, these iMG cells can be produced from peripheral monocytes within two weeks using two cytokines: granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-34 (IL-34).

Background: Burnout is a psychological condition that may occur after being exposed to excessive and prolonged work-related stresses. Previous studies have demonstrated that the rate of burnout among physicians may be higher compared to other occupations ; and espe- cially psychiatric trainees would have a higher risk of burnout because of limited clinical expe- rience, the burden of heavy duties and longer work-hours etc. In this study, we report the findings from Japanese data obtained as part of the international study of burnout syndrome among psychiatric trainees (BoSS International)., Methods: This study was initiated by members of the European Federation of Psychiatric Trainees (EFPT) and the European Psychiatric Association-European Early Career Psychia- trists (EPA-EECP). The total number of participating nations was 22 countries. A national coordinator recruited study collaborators all over Japan and psychiatric trainees working at their medical institutes were invited to participate in BoSS International by e-mail. The sub- jects were requested to answer the on-line questionnaire anonymously. Consent was obtained when making a list of potential participants at each institute and reconfirmed on the first page of the on-line questionnaire. Answering the questionnaire was deemed to constitute consent., Results: Total number of participants to BoSS International was 7,525 from 22 countries and regions. Of them, 1,980 psychiatric trainees fully completed answering the questionnaire (response rate (RR) 26.0%) including 95 Japanese trainees (RR 41.5%). The mean age of 95 Japanese psychiatric trainees (male rate 67.4%) enrolled in BoSS International was 31.8?4.8 year-old. Their mean clinical experience was 2.9 ?4.4 years. The mean weekly working hours were 72.3?27.1, which was the longest of the 22 participating countries/regions ; while weekly clinical supervision by a mentor was only 3.8?9.0 hours. Regarding the severity of burnout, assessed by using the Maslach Burnout Inventory-General Survey (MBI-GS) consisting of three factors (emotional exhaustion, cynicism, and low sense of professional efficacy): 41 Japanese psychiatric trainees (42.0%) meet the criteria of severe burnout syndrome in this study ; with emotional exhaustion scores of 2.20 and higher, and cynicism of 2.00 and higher. Signifi- cant differences were found on the PHQ-9 score and mean length of supervision between those participants with presence and absence of severe burnout syndrome by using Student's t-test., Conclusion: Statistical analyses of the whole data (n=1,980) revealed that the risk of burnout was higher for trainees who were younger, without children, and had not opted for psychiatry as a first career choice. Further analyses after adjustment for socio-demographic characteristics and country difference still demonstrated severe burnout was associated with long working hours, less supervision, and not having regular rest. The analyses of Japanese data showed similar tendencies, although statistical significance was not observed. Burnout among psychiatry trainees may be linked to drop-out from the training program and malprac- tice in clinical settings. We should be aware of the higher risk of burnout in residents and the importance of regular and sufficient supervision to prevent burnout.

Background: We compared retrospectively postoperative analgesia of two concentrations of levobupivacaine by local spraying in radical repair of inguinal hernia., Methods: Subjects were patients undergoing unilateral inguinal hernia repair under general anesthesia in five months. The group receiving 0.25% levobupivacaine was Group 0.25%LEV, while the group receiving 0.5% levobupivacaine was Group 0.5%LEV. Levobupivacaine was sprayed over the wound before the external oblique muscle aponeurosis suture and the skin suture. The analgesic effect was evaluated for pain at rest (the time of departure operation room, 1, 2, 3, 4 hours later and the next day) and when walking (4 hours later and the next day) by using the Numerical Rating Scale. We also assessed the use of rescue dose., Results: Group 0.25% LEV included 29 cases and Group 0.5% LEV included 34 cases, and there were no significant differences in demographic data. There were no significant differences between the two groups with the pain at rest and walking. Rescue dose was used in 3 cases of the both groups., Conclusions: In inguinal hernia repair, it is possible that local spraying of 0.25% levobupivacaine exerts the same effect as 0.5% levobupivacaine.

Altered antioxidant status has been implicated in schizophrenia. Microglia are major sources of free radicals such as superoxide in the brain, and play crucial roles in various brain diseases. Recent postmortem and imaging studies have indicated microglial activation in the brain of schizophrenia patients. Animal models that express some phenotypes of schizophrenia have revealed the underlying microglial pathology. In addition, minocycline, an antibiotic and the best known inhibitor of microglial activation, has therapeutic efficacy in schizophrenia. We have recently revealed that various antipsychotics directly affect microglia via proinflammatory reactions such as oxidative stress, by in vitro studies using rodent microglial cells. Based on these findings, we have suggested that microglia are crucial players in the brain in schizophrenia, and modulating microglia may be a novel therapeutic target. In this review paper, we introduce our hypothesis based on the above evidence. The technique of in vivo molecular redox imaging is expected to be a powerful tool to clarify this hypothesis.

In order to secure airway during awake craniotomy, we used i-gel to perform positive-pressure ventilation in 7 patients for their anesthetic management. During removal of a tumor around the motor speech center, anesthetic management including asleep-awake-asleep technique was applied for speech testing. The technique, insertion and re-insertion of i-gel, was needed and it was easy in all the patients. During positive-pressure ventilation, peak pressure, tidal volume both for inspiration and expiration, and endtidal-CO2 were not markedly altered. Leakage around i-gel, and its differences between inspiration and expiration were negligible, while the tidal volume was adequate. We conclude that i-gel is useful for anesthetic management for awake craniotomy procedure for both securing airway and ventilation.

Background: We conducted a retrospective study to evaluate the relationship between post-thoracotomy pain syndrome (PTPS) and early postoperative analgesia with multimodal analgesia administered via a combination of patient-controlled epidural analgesia (PCEA) and nonsteroidal anti-inflammatory drugs (NSAIDs) in patients who had undergone video-assisted lobectomy for lung cancer., Methods: A total of 73 adult patients were divided into 2 groups: group A included 12 patients (16.4%) with PTPS, and group B included 61 patients without PTPS. All patients received postoperative multimodal analgesia via a combination of NSAIDs and PCEA with a mixture of 2 microg x ml(-1) fentanyl and 1.5 mg x ml(-1) ropivacaine. For statistical analyses, unpaired t-test, Mann-Whitney test and chi square test were used and considered P significant if lower than 0.05., Results: Pain intensity was measured on a 100-mm non-graduated visual analogue scale (VAS), and it was significantly greater in group A (8 mm) than that in group B (2 mm). There was no significant difference between groups in pain intensity during movement, with a VAS score of 33 mm in group A and 35 mm in group B. The number of PCEA bolus injections given to patients was significantly higher in group A (3 times) than in group B (2 times). The duration of PCEA was also significantly longer in group A (4 days) than in group B (3 days). There was no significant difference in the rate of NSAIDs usage between the 2 groups, Conclusions: This study demonstrated a significant difference in early postoperative pain intensity between patients with PTPS and those without. We conclude that there is a possibility of intervention in the early postoperative period in patients who underwent thoracic surgery.

While the etiology of schizophrenia remains unclear, there has been a growing amount of evidence pointing to neuroinflammation, which is characterized by an increased serum concentration of several pro-inflammatory cytokines and an increase of microglia in the brain of schizophrenics. Microglia respond rapidly to even minor pathological changes in the brain and may contribute directly to neuronal degeneration by producing various pro-inflammatory cytokines and free radicals. In many aspects, the neuropathology of schizophrenia has recently been reported to be closely associated with microglial activation. Our "Microglia Hypothesis of Schizophrenia" may shed a new light on the therapeutic strategy for schizophrenia.

The Mental Health First Aid (MHFA) program is a training program for non-health professionals that deals with persons with a mental health crisis (Kitchener & Jorm, 2006). The MHFA-Japan team was established in 2007, and a founding member completed a MHFA training program in Melbourne, University of Australia. We consulted with Jorm and Kitchener, and started a Japanese study of the program. Providing the MHFA program for gatekeepers in Japan could help them assess risk factors and refer patients for professional care, and contribute to suicide prevention. Our team cooperated with the gatekeeper training program of the cabinet office of the Japanese government. In addition, this program is applied in instructional activities in the area of the Great East Japan Earthquake.

Background: We compared postoperative analgesia provided by local instillation of 0.75% ropivacaine with that by intravenous fentanyl and flurbiprofen., Methods: Twenty-nine adult patients undergoing an inguinal hernia repair procedure under general anesthesia were randomly divided into Groups F and R according to the method of postoperative analgesia. Those in Group F were administered fentanyl and flurbiprofen, while Group R was given a local instillation of 0.75% ropivacaine (20 ml) into the wound. Non-steroidal anti-inflammatory drugs (NSAIDs, oral loxoprofen 60 mg or rectum delivery of diclofenac at 25 mg) were administered according to patient request after the operation. The Prince Henry pain scale, and the use of NSAIDs and complications were also examined., Results: There were no significant differences between the groups for demographic data. In Group R, the pain score was significantly lower from arrival at the ward to bedtime and the frequency of NSAID use was also significantly lower. No complications were seen in either group., Conclusions: Local instillation of 0.75% ropivacaine is safe and effective, and provides adequate analgesia for a long period in adult patients following an inguinal hernia repair procedure.

The psychiatric specialist certification system of the Japanese Society of Psychiatry and Neurology was established in 2005, with a transitional period that ran until 2008. A three-year postgraduate training scheme was started in connection with the new psychiatric specialist certification system, and the first formal examination under the new system was held in 2010. A resident desiring certification as a psychiatric specialist must purchase a psychiatric specialist certification handbook and present it when taking the examination. There are many differences between the new examination and the transitional period examination, in terms of both the handbook and the number of case reports to be submitted. Results of a survey conducted on 360 psychiatrists belonging to either university or national hospitals, all of whom had undergone psychiatric training within the past eight years, revealed that there was currently a lack of knowledge, and low rate of utilization, of the handbook. The primary author was in the first cohort of those who began postgraduate psychiatric training in a university hospital and subsequently took the first examination administered after the transition period. The author has maintained that, based on personal experience, a number of issues need improvement, such as the large number of grading items to be signed off on by supervising psychiatrists, and complications involving the outline of cases to be experienced. Additionally, it was thought to be difficult for supervisors who had obtained their specialist certification via the transitional period examination to have an adequate understanding of the outline of the new examination. Therefore, it is important that residents themselves take a more assertive attitude to becoming specialists. In the future, in order to establish a sound specialist certification system, the results of this survey of physicians who took the new examination should be taken into account.

The new 2 year compulsory residency training program, which includes rotation to each department and requires 1 month of psychiatric training for all residents, started in April 2004 in Japan. In August to September belonging 2008, we conducted an attitude survey of psychiatrists with 10 or fewer years of experience to 15 institutions to clarify the problems and present condition of primary psychiatric training. Psychiatrists (92%) who experienced the new residency program were satisfied with it, and 41% decided to become a psychiatrist after the primary psychiatric training. We compared the training periods and training institutions. Psychiatrists who experienced training for 3 months or more rate themselves higher with regard to pharmacotherapy, and those who underwent training in private psychiatric hospitals rate themselves higher with regard to their understanding of psychiatric disorders. It was suggested that the introduction of primary psychiatric training has promoted motivation to become a psychiatrist and that the length of the training period and type of institution lead to differences in the acquisition of psychiatric skills. Psychiatrists who train residents thought that the skill that residents most needed to acquire was intervention for suicidal patients, but, for residents, this was the least useful item in their training. It was suggested that, in the current situation, there is an insufficient acquisition of learning items. In 2010, psychiatric rotation will change from a required to an elective subject, but residents will still have the opportunity to select it. We need to consider how to devise a short-term but effective primary psychiatric training program in which residents can acquire the basics of primary care psychiatry.

The patient was a 79-year-old male. In December 2002, US findings suggested hepatocellular carcinoma, and he was admitted. Liver biopsy led to a diagnosis of well-differentiated hepatocellular carcinoma. Radio frequency ablation (RFA) was performed. Then, regional relapse was detected, and treatment was repeated. However, follow-up with periodic imaging was continued based on the patient's wishes. RFA was completed in December 2005, and TAI in February 2006. In December 2007, abdominal swelling occurred. CT revealed pleural effusion/ascites and nodular tumor in the adipose tissue of the parietal peritoneum and mesentery around the liver. The patient died due to rapid deterioration. Autopsy revealed a tumor involving the liver surface to the peritoneum, suggesting cancerous peritonitis. Histopathologically, liver cancer showed sarcoma-like changes, directly infiltrating the liver surface to the peritoneum. Hepatocellular carcinoma with sarcoma-like changes and peritoneal dissemination is rare. In the present case, it was possible to compare imaging changes with autopsy findings. We report this patient and review the literature.

Background: Plasma levels of D-dimer, soluble fibrin monomer complex (SFMC) and FDP were measured in 40 patients for orthopedic lower extremity surgery, using a recently established monoclonal antibody to clarify if these markers are good indicator of deep vein thrombosis(DVT)., Methods: Subjects were 20 patients for total hip arthroplasty (THA) or total knee arthroplasty (TKA) (group A) and 20 patients for hip fracture surgery (group F). D-dimer, SFMC and FDP were measured at induction of anesthesia., Results: Preoperative values of D-dimer, FMC and FDP in group F were higher than those in group A, and these values in group F were higher than normal values., Conclusions: It is concluded that plasma levels of D-dimer, SFMC and FDP in the patients with hip fracture were higher than those in the patients scheduled for TKA or THA in perioperative period. These suggest that the patients with hip fracture have high risk of DVT.

Background: Gum elastic bougie (GEB) is one of the most useful devices for patients whose tracheas are difficult to intubate during anesthetic induction. But no previous study has evaluated the effects of the types of the tracheal tube. We hypothesized that wire-reinforced tracheal tubes were superior to standard tracheal tubes in the success rate of tracheal intubation when using GEB. We compared these two different types of tracheal tubes in using GEB., Methods: Forty patients were subjected and randomly allocated into two groups; patients intubated with standard tracheal tubes (Group , n = 20) and those with wire-reinforced tracheal tubes (Group S, n = 20). Measured variables were intubation time defined as elapsed time from mouth opening to removal of GEB from tracheal tube, heart rate (HR), and systolic blood pressure(SBP). We also compared trial times of intubation and pharyngeal or laryngeal bleeding as a minor side effect., Results: Trachea was successfully intubated in the frist attempt in 37 patients (92.5%), and the rest of the patients were all intubated at second trial. Intubation times of Group P and Group S were 41.5 +/- 13.9s and 41.3 +/- 11.1s, respectively. There were no significant differences in HR and SBP between the groups., Conclusions: The type of tracheal tube would not affect the success rate and time of intubation when using gum elastic bougie.

Background: The AirWay Scope (AWS), which is equipped with a wide-angle LCD monitor, has been developed to achieve accurate and safe tracheal intubation under various conditions, including emergency settings. However, since bright sunlight degrades the image quality of LCDs, we investigated its usefulness outdoors in bright sunlight., Methods: A single anesthesiologist intubated a mannequin with an AWS and conventional direct laryngoscope indoors and in sunlight outdoors, using 6 trials for each condition. Success rate, Cormack grade, and intubation time from device insertion to removal were recorded., Results: Indoors, all tracheal intubations with both devices achieved Cormack grade 1 and were successful. Outdoors, all the laryngoscopes achieved Cormack grade 1 and intubation was successful, whereas intubation with the AWS was successful in 3 trials, while 2 esophageal intubations and 1 failure also occurred. In addition, sunlight deteriorated the image quality of the LCD and Cormack grade could not be determined. The intubation times for the AWS and laryngoscope indoors were 8.7+/-1.8 and 17.0+/-6.5 sec, and outdoors were 18.7+/-9.0 and 21.3+/-4.9 sec, respectively., Conclusions: Our findings indicate that successful tracheal intubation with an AWS is difficult to achieve in bright sunlight.