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This study proposes a unified optimization framework for strategic planning of shared autonomous vehicle (SAV) systems that explicitly and endogenously considers their operational aspects based on macroscopic dynamic traffic assignment. Specifically, the proposed model optimizes fleet size, road network design, and parking space allocation of an SAV system with optimized SAVs' dynamic routing with passenger pickup/delivery and ridesharing. It is formulated as a multi-objective optimization problem that simultaneously minimizes total travel time of travelers, total distance traveled by SAVs, total number of SAVs, and infrastructure construction cost; thus, both the user-side cost and the system-side cost are taken into account, and their trade-off relations can be explicitly investigated. Furthermore, the problem is formulated as a linear programming problem, making it easy to solve. By leveraging the linearity, we mathematically derive a useful property of the problem: introduction of ridesharing can weakly monotonically and simultaneously decrease the user-side cost and system-side cost. The proposed model is evaluated by applying it to actual travel records obtained from New York City taxi data.

The shared autonomous vehicle (SAV) system is considered as an efficient transportation mode in the future. In the literature, optimization of SAV systems has been extensively studied. However, SAV systems could bring greater social benefits if we could use them with existing public transportation systems, such as bus rapid transit (BRT), in an integrated manner. This study proposes a model of SAV-BRT system, an integrated system that takes advantage of the flexibility of SAVs and the mass transport capability of BRT. The proposed model is based on a dynamic traffic assignment model so that it captures important features of SAV-BRT system, such as endogenous traffic congestion, detour and waiting of SAVs, BRT’s dynamic scheduling. The model is formulated as a multi-objective optimization problem so that trade-off relations regarding the system’s performance can be explicitly analyzed. The behavior of the model is investigated by conducting numerical experiments based on actual travel data obtained from an urban area in Japan. As a result, we confirmed that the model behaves reasonably, and several insights on SAV-BRT systems have been obtained.

Objective We provided diagnostic and therapeutic strategies for Meniere's disease in accordance with Japanese Clinical Practice Guideline of Meniere's disease and delayed endolymphatic hydrops 2nd ed. Tokyo: Kanehara Shuppan; 2020 edited by the Japan Society for Equilibrium Research. Methods The Committee for Clinical Practice Guidelines was entrusted with a review of the scientific literature on the above topic. Clinical Questions (CQs) concerning the treatment for Meniere's disease were produced, and the literature according to each of them including CQ was searched. The recommendations are based on the literature review and the expert opinion of a subcommittee. Results Diagnosis criteria of Meniere's disease are classified into Meniere's disease with typical cochlear and vestibular symptoms, and atypical Meniere's disease with either cochlear symptoms or vestibular symptoms. Treatment of Meniere's disease was composed of lifestyle changes, medications such as anti-vertigo drugs and diuretics, middle ear positive pressure treatment, and selective destruction of the vestibule. Conclusion Meniere's disease is diagnosed based on clinical histories and examination findings after processes of differential diagnosis. Treatment option of the disease should be selected in order of invasiveness, according to the severity of the disease and the response to each treatment.

A reinforcement learning-based dynamic congestion pricing method for morning commute problems is proposed. In this method, tolls are iteratively updated day by day based on observable information such as traffic volume. The advantage of the method is two fold. First, the method does not require travelers personal preferences such as value of time. Second, the method does not require manually designed toll update scheme; instead, the method automatically find the most efficient toll by a data-driven manner. Results of numerical experiments show that the proposed method properly decreased traffic congestion in various types of networks. Especially, in the experiment with a single bottleneck model, total waiting time decreases to nearly zero in about 200 days. One of future issues is more stable coordination among the time zones.

Liposarcoma is a soft tissue neoplasm that commonly develops in the lower extremities and rarely in the head and neck region. Herein, we report the case of a patient with primary liposarcoma that was detected in the mastoid antrum during staged tympanoplasty for cholesteatoma. The tumor adjacent to the attic cholesteatoma was resected completely, and the pathological diagnosis was that of myxoid-type liposarcoma. Because positron emission tomography after the surgery showed no signs of tumor remnants or systemic metastasis, a second-stage surgery was performed 8 months after the first surgery. After confirming that there was no recurrence, tympanoplasty type III with interposition between the stapes and malleus and canal reconstruction was performed. No recurrence was observed for 5 years, and to date, good hearing has been maintained. This is the first report on long-term follow-up of a patient with liposarcoma in the mastoid antrum.

Urban rail transit often operates with high service frequencies to serve heavy passenger demand during rush hours. Such operations can be delayed by two types of congestion: train congestion and passenger congestion, both of which interact with each other. This delay is problematic for many transit systems, since it can be amplified due to the interaction. However, there are no tractable models describing them; and it makes difficult to analyze management strategies of congested transit systems in general and tractable ways. To fill this gap, this article proposes simple yet physical and dynamic model of urban rail transit. First, a fundamental diagram of transit system (i.e., theoretical relation among train-flow, train-density, and passenger-flow) is analytically derived considering the aforementioned physical interaction. Then, a macroscopic model of transit system for dynamic transit assignment is developed based on the fundamental diagram. Finally, accuracy of the macroscopic model is investigated by comparing to microscopic simulation. The proposed models would be useful for mathematical analysis on management strategies of urban rail transit systems, such as optimal dynamic pricing for travel demand management.

A trial-and-error congestion pricing scheme finds the optimal toll based only on observable information (e.g., travel time) without information on travelers’ personal preferences that are often unobservable in practice (e.g., value of time, scheduling preference). This paper proposes a trial-and-error pricing scheme for the morning commute problem, also known as the departure time choice problem and Vickrey’s bottleneck model, with day-to-day dynamics. The proposed scheme is guaranteed to find the social optimal congestion toll under somewhat restrictive assumptions. We numerically confirm that the proposed scheme converges to the social optimal toll regardless of the parameter setting, and it decreased the social cost fairly quickly.

In an era of highly developed information and communication technologies, social networks play an important role in all aspects of businesses, including transportation. The use of dynamic ridesharing systems, which are systems in which travelers can find partner(s) to share their upcoming rides in real time, is also expected to be affected by the information propagated by friends on social networks. In this study, we investigate how such information in both online and offline social networks affects travelers’ decisions pertaining to ridesharing over days. Because travelers can choose which information to obtain, we also investigate whether the information collected only from nearby friends (in physical space) affects their decisions. To do this, we formulate a day-to-day behavior-based model of a dynamic ridesharing system. Results obtained from the numerical experiments, which are based on the formulated model, show that with the information propagation on social networks, the more friends that a traveler has, the greater is the number of travelers who use dynamic ridesharing systems.

Small imaging satellites (SISs), which has attracted attention in remote sensing field recently, would provide a novel type of data for traffic state estimation (TSE): that is, spatial distribution of every cars in anywhere on our planet with relatively short time interval. This nature is particularly useful to complement connected vehicle (CV) data, which is sampled but time-continuous data. This paper proposes an ensemble Kalman filter-based TSE method using SIS and CV data. The proposed method endogenously estimates the fundamental diagram of traffic flow and penetration rate of CVs based only on SIS and CV data, making the method completely free from roadside detectors. The accuracy of the proposed method is verified by numerical simulation.

"Sharing economy", including car-sharing and ride-sharing, will change our society and transport in the near future. To effectively introduce ride-sharing service into our society, we need to determine route and schedule of vehicles based on users’ activity. We also need to understand how users’ activity patterns affect the performance of this sharing service, and we have to evaluate social benefit of introducing ride-sharing service. The objective of this study is to investigate how the ride-sharing service would be successfully operated in the above context. The optimal vehicle routing and scheduling problem which satisfies all the users’ activities is formulated as an integer linear programming problem. By using the proposed model, numerical experiments are conducted with different types of activity patterns. Then, efficiency of the optimized ride-sharing service is examined by comparing its performance with those of car-sharing service and fully private-owned car transport. The results show spatial and temporal distribution of users’ activity patterns will have great effects on the performance of ride-sharing services.

A fundamental diagram (FD), also known as flow–density relation, is one of the most important principles in traffic flow theory. It would be valuable if an FD could be calibrated by using GPS-equipped probe vehicles; since they can continuously collect data from wide spatiotemporal area, compared to traditional fixed sensors. This paper proposes methods for calibrating an FD from trajectories of sampled vehicles. We formulate a method that identifies values of a free-flow speed and a critical density of a tri-angular FD, while it relies on exogenous assumptions on FD's functional form and a value of its jam density. Then, a heuristic algorithm for FD calibration in actual traffic environment is developed based on the proposed method. It was validated using traffic data generated by microscopic traffic simulator. The results suggested that the proposed methods can calibrate an FD precisely and robustly. It implies that FDs in road sections on which congestion happens frequently can be calibrated using probe vehicles, if probe vehicle data were collected for a long period. Therefore, the proposed methods would contribute to significant improvement of applicability of probe vehicle-based traffic management methods.

Automated and connected vehicles (ACVs) have received a great deal of attention. Indeed, their full market penetration will be desirable in terms of traffic efficiency, as ACVs can efficiently drive by precisely and instantaneously communicating, recognizing, and reacting to other ACVs. However, it is not yet certain whether traffic efficiency is improved in mixed traffic where ratio of manual vehicles is substantially high. This is because, for example, ACVs in mixed traffic may require excessive safety clearance, as they have to rely on relatively imperfect vision/radar-based vehicle recognition. Meanwhile, relative benefit of ACVs compared to manual vehicles would be proportional to travel time (because the most significant merit of ACVs for their driver is comfortable in-vehicle experience) and therefore severity of congestion. Consequently, equilibrium states of a myopic car market may suffer severer congestion and higher social cost than the current state—this is congestion paradox. This kind of phenomena can be considered as a consequence of market penetration of a good with network externality or social interaction, where market penetration of ACVs is endogenously determined based on their cost/benefit which depend on current number of ACVs users. This study analyzes this problem under idealized conditions. Specifically, a theoretical model of endogenous market penetration of ACVs considering changes in value of time, travel time, and transportation fare, which are the most direct impacts of ACVs to the society, is formulated. Then, its market dynamics is analyzed. Finally, strategic policies to avoid congestion paradox and achieve social optimum are proposed.

Objective: The peak-to-peak amplitude of the p13-n23 wave in cervical vestibular evoked myogenic potential can increase after furosemide administration in patients with Meniere's disease [furosemide-loading VEMP (FVEMP) testing]. The examination is used to test for the presence of endolymphatic hydrops; we investigated factors that may influence the results.Methods: Forty-two subjects (23 males and 19 females, aged 24–70 years) with unilateral definite Meniere's disease who underwent FVEMP testing were retrospectively studied. Possible factors associated with the results of FVEMP testing were studied using logistic regression analysis.Results: Ages, sex, affected side, stage, disease duration, and mean hearing level of pure tone audiometry did not influence the results of FVEMP testing in the univariate analysis (p > 0.05). Number of days since the last vertigo attack [odds ratio (OR): 1.07, p = 0.031] and frequency of vertigo attacks per month (OR: 0.42, p = 0.003) were significantly associated with the results of testing. Multivariate analysis showed that both days since the last vertigo attack < 7 (OR: 0.13, p = 0.04) and frequency of vertigo attacks per month ≥ 2 (OR: 0.06, p = 0.004) were risk factors for negative results on FVEMP testing.Conclusion: This study found that recent and frequent vertigo attacks produced negative findings on FVEMP testing in Meniere's disease. This apparently irrational finding can be explained by the consequences of membranous labyrinth rupture during vertigo attacks, where the altered saccular resonance due to EH cannot be recovered by furosemide administration because of the dissolving dehydration effect that occurs through communication between the endolymphatic and perilymphatic spaces. In addition, the impairment of sensory cells that is caused by endolymph and perilymph mixing upon rupture does not improve upon furosemide administration. FVEMP testing results may provide us with pathophysiological information regarding the membranous labyrinth.

This paper proposes a method of estimating a traffic state based on probe vehicle data that contain spacing and position of probe vehicles. The probe vehicles were assumed to observe spacing by utilizing an advanced driver assistance system, that has been implemented in practice and is expected to spread in the near future. The proposed method relies on the conservation law of the traffic flow but is independent of a fundamental diagram. The conservation law is utilized for reasonable aggregation of the spacing data to acquire the traffic state, i.e., a flow, density and speed. Its independence from a fundamental diagram means that the proposed method does not require predetermined nor exogenous assumptions with regard to the traffic flow model parameters. The proposed method was validated through a simulation experiment under ideal conditions and a field experiment conducted under actual traffic conditions; and empirical characteristics of the proposed method were investigated.

Probe vehicles provide some of the most useful data for road traffic monitoring because they can acquire wide-ranging and spatiotemporally detailed information at a relatively low cost compared with traditional fixed-point observation. However, current GPS-equipped probe vehicles cannot directly provide us volume-related variables such as flow and density. In this paper, we propose a new probe vehicle-based estimation method for obtaining volume-related variables by assuming that a probe vehicle can measure the spacing to its leading one. This assumption can be realized by utilizing key technologies in advanced driver assistance systems that are expected to spread in the near future. We developed a method of estimating the flow, density, and speed from the probe vehicle data without exogenous assumptions on traffic flow characteristics, such as a fundamental diagram. In order to quantify the characteristics of the method, we performed a field experiment at a real-world urban expressway by employing prototypes of the probe vehicles with spacing measurement equipment. The result showed that the proposed method could accurately estimate the 5 min and hourly traffic volumes with probe vehicle penetration rate of 3.5% and 0.2%, respectively.

The fundamental diagram (FD), also known as the flow–density relation, is one of the most fundamental concepts in the traffic flow theory. Conventionally, FDs are estimated by using data collected by detectors. However, detectors’ installation sites are generally limited due to their high cost, making practical implementation of traffic flow theoretical works difficult. On the other hand, probe vehicles can collect spatially continuous data from wide-ranging area, and thus they can be useful sensors for large-scale traffic management. In this study, a novel framework of FD estimation by using probe vehicle data is developed. It determines FD parameters based on trajectories of randomly sampled vehicles and a given jam density that is easily inferred by other data sources. A computational algorithm for estimating a triangular FD based on actual, potentially noisy traffic data obtained by multiple probe vehicles is developed. The algorithm was empirically validated by using real-world probe vehicle data on a highway. The results suggest that the algorithm accurately and robustly estimates the FD parameters.

This paper proposes a method of estimating the traffic state based on new probe vehicle data that contain the spacing and position of probe vehicles. In this study, the probe vehicles were assumed to observe spacing by utilizing an advanced driver assistance system, which has been implemented in practice and is expected to spread in the near future. The proposed method relies on the conservation law of traffic flow but is independent of the fundamental diagram. The conservation law is utilized for reasonable aggregation of the spacing data to acquire the traffic state, namely flow, density and speed. Its independence from the fundamental diagram means that the method does not require any predetermined assumptions with regard to the traffic flow model parameters. The estimation performance was validated through a field experiment conducted under actual traffic conditions. The results confirmed that the proposed method can estimate the traffic state precisely, even if the probe vehicle penetration rate is quite low.

Objective— To determine whether n-3 fatty acids (n-3) influence arterial cholesterol delivery and lipoprotein lipase (LpL) levels in insulin-resistant mice. Methods and Results— Insulin resistance contributes to risk of cardiovascular disease. It was previously reported that saturated fat (SAT) diets increased, but n-3 diets decreased, arterial low-density lipoprotein (LDL) cholesterol deposition from LDL total and selective uptake; this was associated with increased or decreased arterial LpL, respectively. Insulin receptor transgenic knockout mice (L1) were fed a chow, SAT, or n-3 diet for 12 weeks. Double-fluorescent boron dipyrromethene (BODIPY)–cholesteryl ester (CE) and Alexa dye-labeled human LDL were injected to separately trace LDL-CE and LDL–apolipoprotein B whole particle uptake. In contrast to SAT, n-3 diets markedly reduced all plasma lipids, ameliorating progression of insulin resistance. As opposed to SAT, n-3 reduced arterial LDL uptake, CE deposition, and selective uptake. Disparate patterns of CE deposition between diets were comparable with arterial LpL distribution; SAT induced high LpL levels throughout aortic media; LpL was limited only to intima in n-3–fed mice. Conclusion— n-3 diets diminish arterial LDL-cholesterol deposition in mice with insulin resistance, and this is associated with changes in arterial LpL levels and distribution.

Objectives— We previously reported that saturated fat (SAT)-enriched diets increase arterial cholesteryl ester (CE) deposition, especially from LDL-selective uptake (SU), and this was associated with increased arterial lipoprotein lipase (LpL). We now question how n-3 fatty acid rich diets influence arterial cholesterol delivery and arterial LpL levels. Methods and Results— C57BL/6 mice were fed chow or eucaloric high-fat diets enriched in SAT or fish oil (n-3) for 12 weeks, and then injected with double radiolabeled or fluorescent-labeled human LDL to separately trace LDL-CE and LDL-apoB uptake. SAT and n-3 diets increased plasma cholesterol levels similarly; n-3 diets lowered plasma triglyceride concentrations. SAT increased arterial LDL-SU with significantly higher CE infiltration into aortic media. In contrast, n-3 markedly reduced total LDL uptake and CE deposition and abolished SU with LDL localized only in aortic intima. Disparate patterns of CE deposition between diets were consistent with distribution of arterial LpL—SAT diets induced higher LpL levels throughout the aorta; n-3 diets decreased LpL levels and limited LpL expression to the aortic intima. Conclusions— n-3 rich diets decrease arterial total LDL delivery and abrogate LDL-SU in parallel with changing arterial wall LpL expression and distribution.

Because the mechanisms of (n-3) fatty acid-enriched triglyceride-rich particle [(n-3)-TGRP] uptake are not well characterized, we questioned whether (n-3)-TGRP are removed via "nonclassical" pathways, e.g., pathways other than an LDL receptor and/or involving apolipoprotein E (apoE). Chylomicron-sized model (n-3)-TGRP labeled with [ 3 H]cholesteryl ether were injected into wild-type (WT) and CD36 knockout (CD36-/-) mice at low, nonsaturating and high, saturating doses. Blood clearance of (n-3)-TGRP was determined by calculating fractional catabolic rates. At saturating doses, blood clearance of (n-3)-TGRP was slower in CD36-/- mice relative to WT mice, suggesting that in part CD36 contributes to (n-3)-TGRP uptake. To further examine the potential nonclassical clearance pathways, peritoneal-elicited macrophages from WT and CD36-/- mice were incubated with (n-3)-TGRP in the presence of apoE, lactoferrin, and/or sodium chlorate. Cellular (n-3)-TGRP uptake was measured to test the roles of apoE-mediated pathways and/or proteoglycans. ApoE-mediated pathways compensated in part for defective (n-3)-TGRP uptake in CD36-/- cells. Lactoferrin decreased (n-3)-TGRP uptake in the presence of apoE. Inhibition of cell proteoglycan synthesis by chlorate reduced (n-3)-TGRP uptake in both groups of macrophages, and chlorate effects were independent of apoE. We conclude that although CD36 is involved, it is not the primary contributor to the blood clearance of (n-3)-TGRP. The removal of (n-3)-TGRP likely relies more on nonclassical pathways, such as proteoglycan-mediated pathways.

Regulation of cholesterol metabolism in cultured cells and in the liver is dependent on actions of the LDL receptor. However, nonhepatic tissues have multiple pathways of cholesterol uptake. One possible pathway is mediated by LPL, an enzyme that primarily hydrolyzes plasma triglyceride into fatty acids. In this study, LDL uptake and tissue cholesterol levels in heart and skeletal muscle of wild-type and transgenic mice with alterations in LPL expression were assessed. Overexpression of a myocyte-anchored form of LPL in heart muscle led to increased uptake of LDL and greater heart cholesterol levels. Loss of LDL receptors did not alter LDL uptake into heart or skeletal muscle. To induce LDL receptors, mice were treated with simvastatin. Statin treatment increased LDL receptor expression and LDL uptake by liver and skeletal muscle but not heart muscle. Plasma creatinine phosphokinase as well as muscle mitochondria, cholesterol, and lipid droplet levels were increased in statin-treated mice overexpressing LPL in skeletal muscle. Thus, pathways affecting cholesterol balance in heart and skeletal muscle differ.

We studied the recent tendency of 2295 patients with vertigo and dizziness who visited the neurotological clinic in Hyogo College of Medicine between 1994 and 2002. Also, we compared 191 patients in 1994 with 380 patients in 2002.A total of 60% of the patients were diagnosed with vertigo of peripheral vestibular origin, those with central or systemic origin accounted for 12%, and unknown origin for 28% in 2002. Most patients with peripheral vestibular origin were suffering from BPPV (26%), and Meniere's disease (18%). The percentage with peripheral vestibular origin increased from 36% to 60% between 1994 and 2004, and there was a significant increase in Meniere's disease. The percentage with central or systemic origin decreased from 34% to 12%.The age distribution of all patients showed a peak in the sixth decade in 2002 and showed an aging tendency compared to 1994. The number of women with Meniere's disease increased over widespread ages between 1994 and 2002. Most patients with Meniere's disease, BPPV, and of unknown origin were under sixty. Although only 5% of patients were diagnosed with cerebrovascular disease (including vertebro-basilar insufficiency, and cerebral infarction), 79% were over 60 years old.About 60% of the patients were referred from other physicians both in 1994 and 2002. The percentage of patients from other otolaryngologists increased from 5% to 22% between 1994 and 2002.

We report herein the design and synthesis of a series of potent and selective GPR119 agonists. Our objective was to develop a GPR119 agonist with properties that were suitable for fixed-dose combination with a DPP4 inhibitor. Starting from a phenoxy analogue (1), medicinal chemistry efforts directed toward reducing half-life and increasing solubility led to the synthesis of a series of benzyloxy analogues. Compound 28 was chosen for further profiling because of its favorable physicochemical properties and excellent GPR119 potency across species. This compound exhibited a clean off-target profile in counterscreens and good in vivo efficacy in mouse oGTT.

Accumulating evidence in both humans and animal models clearly indicates that a group of very-long-chain polyunsaturated fatty acids, the n-3 fatty acids (or omega-3), have distinct and important bioactive properties compared with other groups of fatty acids. n-3 Fatty acids are known to reduce many risk factors associated with several diseases, such as cardiovascular diseases, diabetes, and cancer. The mechanisms whereby n-3 fatty acids affect gene expression are complex and involve multiple processes. As examples, n-3 fatty acids regulate 2 groups of transcription factors, such as sterol-regulatory-element binding proteins and peroxisome proliferator-activated receptors, that are critical for modulating the expression of genes controlling both systemic and tissue-specific lipid homeostasis. Modulation of specific genes by n-3 fatty acids and cross-talk between these genes are responsible for many effects of n-3 fatty acids.

A 15-year-old male complained of vertigo and was brought to our clinic on April 3, 2002. He showed rightward nystagmus with right fixation and rightward spontaneous nystagmus. Caloric test showed canal paresis of the left ear. Although there was a past history of acute lymphocytic leukemiam, he was in complete remission. Therefore, he was diagnosed as having vestibular neuritis of the left ear and treated with prednisolone. Balance problem improved for one week. However, he complained of recurrent dizziness on April 26, and left facial palsy on April 30. MRI showed enhancement in the posterior cranial fossa and cranial nerve (III, V, VI, VII, VIII, X nerve). He was diagnosed as having having relapsing leukemia with involvement of the central nervous system, and treated with intraspinal administration of methotrexate (MTX). Thereafter, dizziness and facial palsy were improved. In this case, lesion of the cranial nerve demonstrated on MRI differed from neurological symptoms. When patient having a past history of leukemia complain of vertigo, we must suspect relapse of leukemia, even if he/she was in complete remission.

In the Hanshin area, there is one otolaryngological emergency clinic; however, it is not open at night except for during New Year's holidays. To examine problems associated with emergency medicine in otolaryngology, we surveyed otolaryngological emergency patients at Takarazuka Municipal Hospital. The subjects were 242 outpatients who visited the emergency clinic of otolaryngology at Takarazuka Municipal Hospital between April, 2004 and March, 2005. They included 122 males and 120 females, ranging from 0 to 94 years old. One hundred and one patients (41.7%) were less than 10 years old. The five most frequent diseases were acute otitis media (including 1 acute mastoiditis) (30.2%), the presence of a foreign body (15.7%), acute pharyngitis (including acute tonsillitis and acute epiglottitis) (12.4%), epistaxis (11.6%), and balance problems (11.2%). Nine patients in total (3.7%) were admitted. The average number of patients coming to the hospital during night duty was 2.6 on week days, 6.3 on Saturday, 4.2 on Sunday, and 4.7 on holidays. During day duty, it was 1.3 on Saturday, 2.4 on Sunday, and 2.3 on holidays. The time when most patients visited was 8 p.m. on holidays and 9 p.m. on week days. Thirty five patients (14.5%) visited 1 a. m. Most of the patients came from Takarazuka City (41.3%), and the majority were from the Hanshin area (95.0%). Administration of primary emergency medicine in otolarynogology depends on the otolaryngologists on duty in hospitals, and thus their work is difficult. It is therefore necessary to establish their work-load.

Economic efficiency has recently been required even in public hospitals. Medical fees from health insurance account for most of the medical income of our hospital. Medical fees were counted in units of points, with one point equaling 10yen. However, it is unclear how many points are omitted in determining medical fees to be paid by health insurance. This study investigated the extent of such omissions.The subjects were all outpatients who consulted the Department of Otolaryngology of Takarazuka Municipal Hospital between January 24 and 28, 2005. Following the completion of daily work, we examined the slip sheets actually used to calculate payments and determined the omissions. In our department, when a doctor completes the treatment and/or examination, the nurse checks the appropriate items in slip sheets.Omissions were found on slip sheets for 40 of 372 patients (10.8%). Based on the total reward receipts (322, 988 points), 5298 points (1.6%) had been omitted. Omissions for balance tests, middle ear fiberscopy and laryngoscopy were particularly common.The loss associated with this were estimated as about 2, 360, 000yen annually. The reason for omissions appeared to be the lack of presence of a nurse during treatment and/or examinations and poor knowledge of nurses about otolaryngological care.

Objective— Sterol-regulatory element-binding proteins (SREBPs) regulate transcription of genes of lipid metabolism. Ceramide decreases transcriptionally active SREBP levels independently of intracellular cholesterol levels. Mechanisms of the ceramide-mediated decrease of SREBP levels were investigated. Methods and Results— Experiments were performed in Chinese hamster ovary cells. Inhibition of ceramide synthesis with myriocin, cycloserine, or fumonisin decreases levels of transcriptionally active SREBP and reduces SRE-mediated gene transcription. When ceramide synthesis is increased through exogenous sphingosine or inhibition of sphingosine kinase, SRE-mediated gene transcription is increased. The important role of ceramide synthesis in SRE-mediated gene transcription is confirmed in LY-B cells that do not synthesize ceramide de novo. LY-B cells fail to increase SRE-mediated gene transcription in sterol depletion. Conclusions— Ceramide synthesis correlates with the generation of transcriptionally active SREBP and SRE-mediated gene transcription. Inhibition of ceramide synthesis decreases levels of transcriptionally active SREBP and SRE-mediated gene transcription. It is hypothesized that the process of ongoing ceramide synthesis contributes to the physiological processing of SREBP, perhaps affecting ER-to-Golgi trafficking. Taken together, modification of ceramide synthesis could be a novel target for drug development in the pharmacologic modification of SRE-dependent pathways.

Sudden sensorineural hearing loss is an important otologic disorder, and some patients are even hospitalized for treatment. In this study, we investigated the factors affecting the hearing prognosis. We also analyzed whether hospitalization induced a good prognosis.Between January 1989 and September 1997, 196 patients with sudden sensorineural hearing loss came to the Department of Otolaryngology, Hyogo College of Medicine within two weeks from the onset. There were 91 males and 105 females, and their ages ranged from 10 to 79 (mean 50.6) years. The grading system and improvement score depended on the research group on sudden deafness of the Japanese Ministry of Health and Welfare (1984, 1998).The cure rates of the V character type, the low tone type, dip type and unfixed type were over 50%, whereas those of the high tone type, completly deafness and profoundly deafness were under 30%. The recovery rate was 100% in the teenage group, and 41.7% in the 70-year-old group, in which the younger group had a better hearing prognosis. The cure rate was 51.9% in grade 1 and 13.2% in grade 4, indicating that, the lower the grade, the higher the cure rate. Dysequilibrium was reported by 29.1% of all patients, and by over 50% of the completly deafness and the profoundly deaf patients. The recovery rate in the no dysequilibrium group was higher (60.4%) than that in the dysequilibrium group (24.6%)(p

1年以上経過観察し得た急性低音障害型感音難聴30例32耳について聴力予後, 聴力の推移について検討した。 観察期間は14-136カ月 (平均45.0カ月) であった。 聴力の推移は, その特徴より9型に分類された。 単発例は6耳 (18.7%) で全例が治癒した。 聴力の推移は発作から治癒までの期間が短期である型と, 短期間の発作を繰り返し治癒までに長期を要した型とがみられた。 再発例は32耳中26耳 (81.3%) であった。 再発治癒例には再発して治癒までの期間に長期化が見られる型とみられない型とがみられた。 メニエール病への移行は5耳 (15.6%) と高率にみられた。 初回発作から移行までは最短でも14カ月であり, 長期観察によりメニエール病へ移行する症例は増加すると考えられた。 最終観察時の治癒率は62.5%であった。 急性低音障害型感音難聴の長期予後は必ずしも良好とはいえず, 長期観察が必要であると考えられた。

It is generally known that cerebral infarction commonly occurs in elderly people. Rarely, cerebral infarction may occur in young adults due to complications such as collagen disease, heart disease, and dissecting aneurysm. We recently encountered a 32-year-old man who had occasionally complained of occipital pain after drinking alcohol since April 1999. As he also experienced sudden onset of vertigo with occipital pain, he went to the Department of Otolaryngology, Takarazuka City Hospital on April 14, 1999. Left-ward horizontal-rotatory spontaneous nystagmus was presented as shown in vestibular dysfunction. There were not any cerebellar signs, but left trigeminal hypesthesia suggested a central nervous system disorder. Moreoever, we found disturbances of touch, temperature, and pain sensations on the right upper and lower extremities.MRI showed an infarction in the left lateral medulla oblongata. Vertebral angiography showed an aneurysm in the distal and proximal segments of the left posterior inferior cerebellar artery. These findings indicated that medullary infarction was caused by dissecting aneurysm of the vertebral artery.In the present case, it was suggested that the intima of the vertebral artery rapidly deteriorated due to the dehydration resulting from excessive alcohol intake, and that neurological examination should be performed even in juvenile vertiginous cases.

Pontine hyperintense lesions seen on T2-weighted MRI were thought to be related to disequilibrium. Some of these lesions have a low signal on T1-weighted imaging, while others have an iso-signal. The purpose of this study was to clarify the relationship between neurological findings and pontine lesions detected by MRI. The subjects were 11 patients (6 males, 5 females; age range: 30 to 83 years [mean: 64.1 years]) with pontine hyperintense lesions identified on T2-weighted MRI. We compared the clinical signs and the MRI findings. Six of the patients had low-intensity areas on T1-weighted images, and the other 5 had iso-intensity areas. Six patients complained of vertigo, and 5 complained of dizziness. Eight complained of positionaly evoked disequilibrium. Positional nystagmus was seen in 4 patients. In 9 patients, abnormalities were found on the ENG test, including the saccadic eye movement test, ETT, and OKP. Numbness on the lips occurred in 2 patients, and cerebellar signs were present in 4. None of the patients had facial paralysis. Disequilibrium originating in the central nervous system was suggested in 10 patients. Clinical examinations revealed similar findings in patients with a low signal on T1-weighted MRI and those with an iso-signal. Our results indicate that pontine lesions identified by T2-weighted MRI cause vertigo or dizziness, and, in most cases, these lesions cause abnormal neurological or neurological abnormalities.