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In today's highly globalised world, protecting human security is a core challenge for political leaders who are simultaneously dealing with terrorism, refugee and migration crises, disease epidemics, and climate change. Promoting universal health coverage (UHC) will help prevent another disease outbreak similar to the recent Ebola outbreak in west Africa, and create robust health systems, capable of withstanding future shocks. Robust health systems, in turn, are the prerequisites for achieving UHC. We propose three areas for global health action by the G7 countries at their meeting in Japan in May, 2016, to protect human security around the world: restructuring of the global health architecture so that it enables preparedness and responses to health emergencies; development of platforms to share best practices and harness shared learning about the resilience and sustainability of health systems; and strengthening of coordination and financing for research and development and system innovations for global health security. Rather than creating new funding or organisations, global leaders should reorganise current financing structures and institutions so that they work more effectively and efficiently. By making smart investments, countries will improve their capacity to monitor, track, review, and assess health system performance and accountability, and thereby be better prepared for future global health shocks.

Although numerous studies on Functional Independence Measure (FIM) analysis in stroke, orthopedic disease, and spinal cord injury patients have been conducted, it has rarely been done in patients undergoing cardiac rehabilitation (CR).To verify whether the Functional Independence Measure (FIM) score, and its subscale motor FIM and cognitive FIM, during inpatient CR can be a predictor of a patient's readiness for home discharge by establishing an FIM cutoff value.A retrospective, observational cohort studyThis study was conducted at a long-term acute-care hospital.Participants were in-hospital patients undergoing CR (N.=949).Measurements included motor FIM, cognitive FIM, CR period, FIM gain per week, and discharge disposition. The strongest predictor for home discharge was analyzed by using multiple logistic regression analysis, and the cutoff value of the FIM score for home discharge was determined by using receiver operating characteristic (ROC) curves.Discharge to home was possible in 723 patients (76.2%), whereas 226 patients (23.8%) had other outcomes. In univariate analysis, a motor FIM gain per week of five points was achieved in the home discharge group. Multiple logistic regression analysis revealed that Body Mass Index, number of comorbidities, motor FIM at discharge, cognitive FIM gain, and CR period were predictive factors with 89.6% predictive ability. ROC curve analysis showed that the cutoff value was a discharge motor FIM score of 63/64 points with 0.912 areas under the curve.Discharge motor FIM and cognitive FIM gain were predictive factors for home discharge. A motor FIM gain per week of five points and discharge motor FIM score of 64 points at the end of inpatient CR may be important predictors of a patient's readiness for discharge to home.The findings of this study indicate an alternative goal to the activities of daily living in inpatients with cardiovascular disease.

The 2-deoxy-2-[18F] fluoro-D-glucose position emission tomography/computed tomography (FDG PET/CT) findings of condyloma acuminata in a patient with FIGO Stage IB1 cervical cancer who had previously been treated with radical hysterectomy, pelvic chemoradiotherapy, and consolidation chemotherapy is described in this article. This case highlights the importance of considering condyloma acuminata during the differential diagnosis of abnormal vaginal FDG uptake in patients who have been treated for gynecological cancer.

A 64-year-old woman with FIGO Stage IB2 cervical cancer was treated with radical surgery. Six months after her initial surgery, the patient developed calcaneal metastasis. Significant relief in bone pain was achieved with palliative radiotherapy followed by platinum-based combination chemotherapy, and the patient is currently alive with disease at eight months after the development of recurrence. Bone metastasis from uterine cervical cancer is uncommon, especially in the distal appendicular skeleton. Currently, and to the best of the authors' knowledge, calcaneal metastasis derived from cervical cancer has never been reported in English literature. As the prognosis of patients with bone metastasis is dismal and most patients die within a year, treatment should be directed towards improving the patient's quality of life and palliating their symptoms.

We describe a case of FIGO Stage IB2 uterine cervical cancer which showed focal intense bone marrow FDG uptake mimicking bone metastases after the administration of G-CSF This case highlights the importance of avoiding the administration of G-CSF prior to PET imaging.

Although G-protein-coupled receptor, GPR30, has been considered as a G-protein-coupled estrogen receptor, conflicting results have been reported and the function of GPR30 in bone remains unresolved. The aim of this study was to clarify the functional role of GPR30 in osteoblasts using its derived cell line.Immunohistochemical study revealed that GPR30 is expressed in human osteoblasts. Human fetal osteoblast cell lines, hFOB cells, which express GPR30 but lack estrogen receptor, were used for the in vitro experiments. Estradiol or raloxifene induced the proliferation of hFOB cells, which was accompanied by the activation of mitogen-activated protein (MAP) kinase. Those proliferative effects were completely abrogated by the transfection of GPR30 small interfering RNA, while the transfection alone did not affect the cell viability.GPR30 is required for the proliferation of hFOB cells induced by estradiol or raloxifene. This proliferative effect was at least partly mediated via MAP kinase activation. These findings revealed a novel function of GPR30 in osteoblasts and might lead to a better understanding of how estrogen and selective estrogen receptor modulators show their osteoprotective effects.

In sudden death cases, aortic or cerebral artery aneurysms are not infrequent, but a mesenteric artery branch aneurysm has not previously been reported. In the present paper, we describe a case of sudden death from the rupture of a giant mesenteric aneurysm.

A 47-year-old woman was diagnosed with extragenital mullerian adenosarcoma with sarcomatous overgrowth. One month after her initial surgery, the patient developed pelvic recurrence, which was completely excised by surgery. However, one month later, the patient developed further recurrences in her pelvis and upper abdomen. A clinical complete response was achieved with three cycles of liposomal doxorubicin and is currently clinically free of disease. So far, including the present case, 23 cases of extragenital mulleian adenosarcoma have been reported in the English literature. Because of the rarity of the reported cases, there are no treatment guidelines based on a good level of evidence. In the current report, through a literature review, we provide information on the activity of pegylated liposomal doxorubicin for extragenital mullerian adenosarcoma with sarcomatous overgrowth.

A dissecting intramural haematoma of the coronary artery is an infrequent cause of sudden and unexpected death. Most cases are women and in a significant number of these women, the haematoma occurred at term to 80 days postpartum. Because the intimal rupture and communication with the lumen were not found in most of the cases, the site of rupture has been considered to be a vasa vasorum. The authors report on a case of one woman who was at a later postpartum period (106 days). The microscopic finding of the dissected coronary artery revealed two intimal tears in a section. The case showed that the dissecting intramural haematoma of the coronary artery is caused not only by the rupture of the vasa vasorum but also by the rupture of the intima.

To realize high-efficiency light-emitting diodes (LEDs), it is indispensable to increase light extraction efficiency. We propose the moth-eye structure on the surface of an LED chip, which consists of periodic cones with a pitch of optical wavelength scale, and enables the significantly enhancement of light extraction efficiency. We have developed a new technique for moth-eye structure fabrication, on the basis of low-energy electron-beam projection lithography (LEEPL), which can be applied to the mass production of LEDs. The moth-eye structure formed at the bottom of a SiC wafer has periodically arranged cones with a 300 nm pitch and a 750 nm height. We also present blue LEDs fabricated on SiC substrates with and without the moth-eye structure, and discuss the effect of the moth-eye structure on the performance of LEDs.

Of 125 children with acute lymphoblastic leukemia (ALL), who had been in continuous remission for three years on chemotherapy, 108 patients received biological response modifiers (BRM) such as Bestatin, N-CWS, OK-432 and/or PSK in order to prevent relapse after treatment suspension. From 20 patients who were treated with PSK, 6 relapsed within 13 months. This relapse rate was quite similar to the rate observed with those children who were off therapy (4 relapses in 17 patients within 13 months). In contrast to these 37 patients, only 3 out of 31 patients who received Bestatin (p less than 0.05) and 8 out of 57 patients who received N-CWS or OK-432 relapsed. Based on these findings, BRMs used in the present study seems to be effective to prevent relapse of leukemia among childhood ALL who have electively stopped chemotherapy.

It is generally known that meningioma has histological pleomorphism and ossification is one of them. In the cases of spinal meningioma, osteoblastic type is rare. We encountered two different types of ossified spinal meningioma. Two cases of ossified spinal meningioma are reported in this paper. One case is that of a 45-year-old male who had a sudden transient tetraparesis with a tumor located in the upper cervical spinal column. The tetraparesis was caused by the patient's head having been hit. Another case is a 74-year-old female, who had progressive paraparesis and hypesthesia in her lower extremities, with a tumor located in the 9th thoracic spinal column. The MRI findings in these cases suggested that an ossified area was included in the tumor. We performed surgical therapy in both cases, and an operative finding was that these tumors had a very hard component. Histopathological diagnosis in both cases was meningioma. The former included isolated matured bone tissue with fat marrow mixed with the tumor tissue, and the latter included scattered matured lamellar bone tissue. These tumors are considered to be osteoblastic in type.

We studied 27 external-to-internal carotid (EC/ IC) bypass tracts in 24 patients using magnetic resonance angiography (MRA). We diagnosed patency of the bypass by comparing MRA with and without selective presaturation on the bypass by comparing MRA with and without selective presaturation on the bypass vessel. Fifteen bypasses in 14 patients were also studied by conventional angiography within a week interval, and patency of the bypass was correctly diagnosed by MRA in all but one case. For further assessment of blood distribution, presaturation on the circle of Willis was set on nine sites in 8 patients, which clarified the anterograde flow distribution. We conclude that MRA using presaturation is a useful, non-invasive assessment of the bypass patency and blood circulation after EC/IC bypass surgery.

The surgical results in 37 patients with cervical myelopathy due to ossification of the posterior longitudinal ligament of the cervical spine were described. This series consisted of 32 patients who underwent anterior decompression with anterior cervical fusion using bone grafts obtained from cervical vertebral bodies, and 5 patients who underwent expansive laminoplasty or laminectomy as a method of posterior decompression. 6 out of 32 patients with anterior cervical fusion were operated on at one level, 18 at two levels and 8 at three levels. The patients were out of bed within two days and treated using a soft collar for 3 months. In all patients, the symptoms improved postoperatively. Postoperative X-ray films showed solid bone fusion in all patients with anterior cervical fusion at a mean follow up time of one year and nine months (range 6 months to 3 years 6 months). Anterior angulation was found in one (3%) out of 32 patients who underwent anterior cervical fusion. Concerning the method of operation, the authors think that anterior decompression is to be recommended for cases with ossification within three consecutive vertebrae and posterior decompression should be applied to cases in which anterior decompression is very difficult. If necessary, a two-stage combined decompression is recommended.

In sudden death cases, aortic or cerebral artery aneurysms are not infrequent, but a mesenteric artery branch aneurysm has not previously been reported. In the present paper, we describe a case of sudden death from the rupture of a giant mesenteric aneurysm.

MR angiography studies using the presaturation technique were performed in 7 patients who had received extra-intracranial (EC-IC) bypass surgery. With presaturation on the bypass vessels, disappearance of intracranial vascular signals suggests bypass effect. In our studies, good bypass effect was shown in 3 cases and poor effect in 2 cases, which correlates well to concurrent angiography. In two cases, bypass effect was shown only in a few cortical branches of MCA, but angiography confirmed recanalization of occluded internal carotid artery in one case, and growth of large network of transdural anastomoses in the other.

We present a case of dissection of the extracranial vertebral artery with prominent occipital pain and elements of the lateral medullary syndrome. Arteriography showed a string and pearl sign. Magnetic resonance imaging allowed visualization of an intramural thrombus associated with a narrow vascular lumen. The distal portion of the diseased artery was ligated and vascular reconstruction using an interposed radial artery graft was performed. Pathological studies confirmed the diagnosis. The diagnostic roles of angiography and magnetic resonance imaging, and therapeutic strategies are discussed.

Encapsulated intracerebral hematomas mimicking a brain tumor have been reported as a rare occurrence. An additional case with a characteristic feature found on computed tomography (CT), and a clinical course is described. CT scans revealed a high density mass with peripheral low density in the brain. A hematoma was successfully removed and found to have a thick and multilobular fibrous capsule associated with cavernous hemangioma. Repeated hemorrhage due to vascular malformation was considered to have contributed to the formation of the capsule. Increasing awareness of the possibility of an encapsulated intracerebral hematoma as a clinical and pathological entity, would enable us to make a correct diagnosis and to select proper treatment. A thorough survey of occult vascular malformation is necessary in surgery.

We have examined expression of the smg p25A (a ras p21-like GTP-binding protein) gene in neural crest-derived tumor cell lines and neuroblastoma tissues. The human neuroblastoma cell lines GOTO, IMR-32, NB-1, and SK-N-SH expressed the 1.6-kilobase smg-25A mRNA. SH-SY5Y and SH-IN, variant cell lines with a neuronal phenotype derived from SK-N-SH, expressed much more smg-25A mRNA than did SH-EP1, a variant line with an epithelium-like phenotype also derived from SK-N-SH. The primitive neuroectodermal tumor cell lines SK-N-MC and KU-SN and the Ewing's sarcoma cell lines RD-ES and SK-ES expressed the smg-25A mRNA to a much smaller extent than did neuroblastoma cell lines. Of 15 human neuroblastoma specimens tested, 13 expressed the smg-25A mRNA to various extents. When the relative ratio of the smg-25A mRNA level to the glyceraldehyde-3-phosphate dehydrogenase mRNA level was compared among neuroblastoma tumor tissues, the value was significantly higher in tumors histologically diagnosed as ganglioneuroblastoma. The smg-25A mRNA was not detected in the tissues of Hodgkin's lymphoma, Wilms' tumor, Ewing's sarcoma, or undifferentiated sarcoma of the liver. These results suggest that the smg-25A mRNA level is closely related to the neuronal differentiation state of tumors derived from the neural crest.

An approach to the comparison of fuzzy subsets or fuzzy numbers is proposed and studied. A function-type index J/sub ij/( alpha ), indicating a degree of dominance of a fuzzy subset A/sub i/ over the other A/sub j/, is derived from an alpha -cut of the difference of the two subsets compared. This index can be converted to a single-valued version F/sub ij//sup 0/ by way of a alpha -weighted averaging over alpha for a quick reference to the conclusion of comparison. Linguistic descriptions of the results of comparison and a fuzzy ordering relation are discussed. For the case of trapezoidal membership functions the shapes of J/sub ij/( alpha ) are classified and the formulas to calculate J/sub ij//sup 0/ are obtained. >

A 7-year-old boy was admitted to Hokkaido University Hospital complaining of headache and vomiting. On admission he was slightly confused and presented Parinaud's sign. CT scan revealed abnormal high density mass with contrast enhancement effect at the pineal region and obstructive hydrocephalus. Laboratory studies showed the normal value of human chorionic gonadotropin and no trace of alpha-fetoprotein. Germinoma was most suspected based on the findings of CT scan and laboratory studies. The radiation therapy was carried out for a month and CT scan taken after the radiation therapy revealed marked reduction of the size of the tumor at the pineal region, and he was discharged. But he was re-admitted 3 months after the discharge complaining of headache and vomitting again. CT scan showed the recurrence of the tumor and laboratory studies showed abnormal high value of A.F.P. After the ventriculo-peritoneal shunt, the sub-occipital craniectomy was performed by the Stein's approach, and the tumor was removed. Pathologically the tumor was a typical yolk sac tumor. This case is a very interesting case because it suggests an alternation of the element of the germ cell tumor by the radiation therapy. At first admission, germinoma was the main element of the tumor judging from the effectiveness of the radiation therapy and laboratory studies. But the main element of the tumor seemed to have changed to yolk sac tumor after the radiation therapy. The relation between the tumor markers and the types of the germ cell tumor and histopathological characters of the intracranial germ cell tumor were discussed.

Vasospasm after clipping of an acute ruptured aneurysm plays an important role in its prognosis. An effective therapy for vasospasm has not been established. We had attempted to remove the subarachnoid clot, which probably caused vasospasm, by ventriculo-cisternal irrigation and had not so good results (A: a group without decompression). Therefore, we have performed a therapy combined ventriculo-cisternal irrigation with external decompression (B: a group with decompression). We wish to report the efficacy of external decompression for an acute ruptured aneurysm. Evaluation of the outcome is due to Table 2. 55% of A group and 80% of B group have a better grade than "fair". Furthermore, a significant difference lies between A and B group associated with symptomatic vasospasm (brain ischemia caused by vasospasm). Namely, A group has all poor or dead cases but B group has 80% of the cases better than "fair". We concluded that relieving ICP by external decompression could suppress the aggravation of the post operative symptomatic vasospasm.

Although decrease of ICP and CBF occurring following arousal from sleeping is a wellknown phenomenon, its exact mechanism is poorly understood at the present time.

The authors reported 3 cases of dural arterio-venous malformation (AVM) in the posterior fossa and discussed mainly on surgical treatment. Case 1: 53-year-old man was admitted to our clinic with complaints of amnesia, visual impairment, dysarthria and gait disturbance. Neurological examination on admission disclosed slight disturbance of consciousness, bilateral papilledema, horizontal nystagmus, dysarthria and ataxic gait. Contrast CT showed a presence of vermiform irregular high density with enlarged ventricle, indicating phlebectasia in the brainstem and the cerebellum. Angiograms revealed a presence of dural AVM at the straight sinus fed by branches of external carotid artery and vertebrobasilar circulation with appearance of phlebectasia due to increase in straight sinus pressure on later phase. Dural sinus isolation for the affected sinus was performed under large occipital craniotomy which was initially reported by Hugosson and Bergström. Case 2: 55-year-old man was admitted to our hospital with complaint of gait disturbance. Neurological examination at the time of admission disclosed signs of raised intracranial pressure and caudal cranial nerves disturbance. Bruit synchronized with radial pulse was audible over the left occipital region. Angiograms showed a presence of dural AVM at the left transverse and sigmoid sinus with many feeding arteries and abnormal venous returns. Isolation of the involved sinuses was performed as same as in case 1. Case 3: 39-year-old woman was admitted to our clinic with complaints of protrusion of eyes and uncomfortable machinery noise over the right retromastoid region.(ABSTRACT TRUNCATED AT 250 WORDS)

Not a little difficulties lie in extraction of useful information by visual inspection alone from massive amount of data contained in multichannel polygraphic recordings of electroencephalography (EEG). Therefore, an effort to summarize conventional EEG and to demonstrate it semi-quantitatively has been made by many investigators and recently topographic mapping of EEG (TME), which is able to display equipotential maps of square roots of power spectra over each frequency band on computer-driven color video screen, has been designed. This system was clinically applied to the 16 patients who developed cerebrovascular disease with supratentorial lesions. (1) Slow wave focus was more obviously visualized on delta and/or theta bands of TME compared to visual inspection of conventional EEG in 8 cases out of 16. Also, suppression of alpha wave was beautifully demonstrated in 12 cases out of 16. The fact indicates that TME is useful as a sensitive detector of suppressed neuronal function. (2) Improvement of both TME and clinical signs after oxygenation at high pressure (case 3), carotid endarterectomy (case 1) and bypass surgery (case 6) were well correlated. The fact indicates that TME is one of the acceptable objective parameters for assessment of efficacy of various therapies. (3) TME was employed as a test evaluating effectiveness of bypass operation. This test was performed by compressing anastomosed superficial temporal artery (STA) for 10 minutes and change of TME after compression of STA was observed. In case 2 and 15, suppression of alpha activity was obviously noted in the occipital area ipsilateral to the STA compression following compression of STA, which suggested that these 2 cases depend hemodynamically on the anastomosed STA.(ABSTRACT TRUNCATED AT 250 WORDS)

To elucidate the connection between blood flow and the localized genesis and development of atherosclerosis and thrombosis at the bifurcation and curving portion of the human cerebral artery, detailed studies of the flow patterns were carried out by directly observing and photographing the behavior of tracer particles flowing through the isolated transparent segment of the middle cerebral artery, prepared from a human subject post-mortem. It was found that a standing recirculation zone consisting of a pair of complex spiral secondary flow, located on both sides of the common median plane of the bifurcation, was formed in the lateral side of the daughter vessels over wide ranges of inflow Reynolds numbers, Re0, and flow rate ratios, Q1/Q0, The formation and the size of the recirculation zone were largely dependent on Q1/Q0, as well as on Re0. Also a eddy formation was observed in the inner side at the curving portion as well as at the bifurcation of the middle cerebral artery. The results suggest that, under physiological conditions, a standing recirculation zone exists in the bifurcation and bending portion of the middle cerebral artery, thereby affecting local mass transfer and interactions of blood cells with the vessel wall, which may lead to the incidence of atherosclerosis and thrombosis in these region.

There have been only a few reports of asymptomatic aneurysm clinically treated up to the present. The authors incidentally found eight cases of intracranial aneurysm: five cases with brain tumor, one with brain abscess and the remaining three with head injury. It may be considered that the careful observation of angiograms could reveal more asymptomatic aneurysms. The ideal treatment of aneurysm should be direct operation before rupture. But it is difficult to find out them before the onset of signs and symptoms of subarachnoid hemorrhage or cranial nerve involvement. The only chance of finding asymptomatic aneurysm is brought about by paying special attention to aneurysm even in angiography for other intracranial diseases such as tumors, head injuries, vascular diseases and so on. It was thus concluded that incidentally-discovered aneurysm should be directly treated if the prognosis of the original disease is thought to be good. The authors operated on four aneurysms of three patients and operative result was excellent.

We reported two cases of germinoma originating in the basal ganglia among the 50 cases of intracranial germinoma which were experienced at the Department of Neurosurgery, Hokkaido University Hospital. (Case 1) A 8-year-old boy was admitted to our hospital in October 1977, because of precocious puberty and left hemiparesis. Plain CT showed an irregularly-defined high density lesion in the right basal ganglia, which had several low density spots and was moderately enhanced on contrast CT. Endocrinological examination by radioimmunoassay revealed abnormally high level of serum luteinizing hormone and scanty level of serum follicle stimulating hormone. Beta-subunit of human chorionic gonadotropin (HCG) showed 46.4 ng/ml. Following radiation, the lesion on CT disappeared and beta-subunit turned to be in the normal range. It was concluded that the precocious puberty was due to hypersecretion of HCG by the tumor. About 2 years after the first admission, the tumors were disseminated to the spinal cord, followed several months later by the intracranial recurrence. The neurosurgical exploration was performed to both intracranial and spinal tumor lesions, which were proved to be germinoma by histological examination. Postoperative course was uneventful without recurrent signs. (Case 2) A 10-year-old boy was admitted to our hospital with 6-month history of right hemiparesis in February, 1979. CT at the first admission disclosed a slight high density lesion in the left basal ganglia, which had low density area suggesting cyst formation and was moderately enhanced on contrast CT. CT after one year showed multiple cysts in the tumor and displacement of neighboring structures. In February, 1980, a piece of the tumor was removed under bifrontal craniotomy and histologically diagnosed to be germinoma. Following radiation, the tumor disappeared on CT and his clinical features improved. In August, 1981, no recurrent signs were noted. From our 2 cases and review of the literature, it can be concluded that germinoma originating in the basal ganglia is rare and have high radiosensitivity as well as germinoma arising in the other sites, and common symptoms and signs are hemiparesis in all cases, not accompanied by intracranial hypertension in the early stage.