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Although the surface of the human hands contains high antimicrobial activity, studies investigating the precise components involved and the relationship between natural antimicrobial activity and morbidity in infectious diseases are limited. In this study, we developed a method to quantitatively measure the antimicrobial activity of hand surface components. Using a clinical survey, we validated the feasibility of our method and identified antimicrobial factors on the surface of the human hand. In a retrospective observational study, we compared the medical histories of the participants to assess infectious diseases. We found that the antimicrobial activity on the surface of the hands was significantly lower in the high morbidity group (N = 55) than in the low morbidity group (N = 54), indicating a positive association with the history of infection in individuals. A comprehensive analysis of the hand surface components indicated that organic acids, especially lactic acid and antimicrobial peptides, are highly correlated with antimicrobial activity. Moreover, the application of lactic acid using the amount present on the surface of the hand significantly improved the antimicrobial activity. These findings suggest that hand hygiene must be improved to enhance natural antimicrobial activity on the surface of the hands.

Although the surface of hands in humans is known to harbor high levels of antimicrobial activity, reports investigating the relationship between antimicrobial activity and morbidity in infectious diseases are lacking. Additionally, the precise components involved in this activity are not known. Therefore, in this study, a method was developed to quantitatively measure the antimicrobial activity of the components found on the surface of hands, which was then compared with the medical history of the participants for infectious diseases. As a result, the antimicrobial activity of the surface of the hands was found to be positively associated with the history of infection in individuals. Furthermore, a comprehensive analysis of the components on the surface of hands indicated that organic acids and antimicrobial peptides are highly correlated with antimicrobial activity. The high amounts of lactic acid found on the surface of hands suggested it is an important factor in the hand surface infection barrier. Here we showed that the application of lactic acid within the range of the amounts present on the hand surface was found to significantly improve the antimicrobial activity of the hands. Taken together, these results demonstrate that this new method can be used to quantify antimicrobial activity, which opens new avenues for the development of hand hygiene practices by enhancing the antimicrobial activity on the surface of hands using natural ingredients against pathogens.

This paper presents design study on windage loss reduction for hybrid excitation flux switching motor employing two types of rotor structure. Conventional flux switching motors have a rotor structure with salient poles, by which windage loss at high speed region becomes serious. To reduce the windage loss, two types rotor are built: One is a cylindrical rotor employing iron rib between adjacent salient poles and shrouds placed at both ends in axial direction of rotor body and, the other is only employing the shrouds. Experimental tests using two machines combining with an existing stator and two rotors are conducted. As a result, the rotor with only the shrouds can greatly reduce the windage loss while keeping the maximum torque and power, and motor efficiency at high speed region as it is. From a viewpoint of windage loss reduction, different rotor configurations with and without the shroud are investigated by 3D-FEA based fluid analyses and discussed.

In this paper, we report a newly developed compact model HiSIM-GaN [Hiroshima University STARC IGFET Model for GaN high electron mobility transistors (HEMTs)] including a capacitance model, which accurately captures the contributions originating from the device's field plate (FP) structure. The capabilities of the reported model are demonstrated by reproduction of the measured power efficiency of a boost converter circuit, enabled through separate extraction of the parasitic FP contributions. In addition, physical trap-density modeling is verified to be also of key importance for accurate prediction of the power efficiency.

OBJECTIVE To examine the immunoreactivity of tumors for matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), tissue inhibitors of metalloproteinases 1 and 2 (TIMP-1, TIMP-2), and membrane type MMP 1 (MT-MMP-1), to evaluate the optimum assessment of incidental renal cell carcinoma. METHODS Tumor samples from 120 incidental clear cell renal cell carcinoma (ICRCC) patients without distant metastasis or invasion beyond Gerota's fascia were obtained by surgery. They were immunohistochemically stained for MMP-2, MMP-9, TIMP-1, TIMP-2, and MT-MMP-1. Immunoreactivity for these factors was analyzed by semiquantitative multivariate analysis for cancer-specific survival. RESULTS The cancer-specific 5 and 10-year survival rates were 91.4% and 91.4%, respectively. Univariate analysis revealed that nuclear grade (P = 0.0064) and TIMP-2 (P = 0.034) were significant prognostic factors. Matrix metalloproteinase 9 has a significant relationship with high nuclear grade RCC (P = 0.017) and was found to be an independent prognosticator by Cox multiple regression analysis (P = 0.0028). CONCLUSIONS Nuclear grade and TIMP-2 were significant prognostic factors of ICRCC. Multivariate analysis showed that a nuclear grade greater than 3 was associated with a 566% significant increase in the odds of cancer death. Strong expression of MMP-9 was associated with a 774% increase in the odds of high nuclear grade, with statistical significance. Although ICRCC is well known for having a favorable prognosis, patients with tumors having a high nuclear grade and strongly expressed MMP-9 and TIMP-2 should undergo strict postoperative follow-up.

Long-term histopathologic changes after bladder augmentation (BA) in rats using living-related partial bladder transplantation (LPBTx) or conventional ileocystoplasty (ICP) were compared. In this study, BA (n = 37), LPBTx (n = 18), and ICP (n = 19) were performed in 16-wk-old Lewis rats. Five donors and seven nontransplanted normal Lewis rats (controls) were also studied. Rats that survived >10 mo after BA were killed after blood biochemistry and neobladder imaging. Harvested bladders were examined with hematoxylin and eosin and proliferating cell nuclear antigen (PCNA). When the rats were killed, there were 16 rats in the LPBTx group and 12 rats in the ICP group; ICP rats were significantly smaller than LPBTx rats (p < 0.05). Mean duration of follow-up for the LPBTX group was 17.3 mo, for the ICP group was 13.7 mo, for the donor group was 16.1 mo, and for the control group was 19.7 mo. Mean serum pH in the LPBTx group was 7.41 ± 0.78 and in the ICP group was 7.25 ± 0.38. Mean base excess in the ICP group was significantly lower than in the LPBTx group (p < 0.05). Incidence of bladder calculi in the LPBTx group (6.3%) was significantly lower than in the ICP group (33.3%; p < 0.05). There was no dysplasia/malignancy/increase in PCNA in the LPBTx group. PCNA increased in the ICP group, compared with controls (p < 0.05); two (16.7%) of 12 of ICP rats had dysplasia with mitosis. Bladder capacity increased in LPBTx and ICP compared with controls (both p < 0.05). We hope to show that BA using LPBTx may result in a neobladder with fewer complications than BA using ICP; LPBTx may also decrease the risk for malignancy.

To determine whether laparoscopic nephrectomy (LN), open nephrectomy (ON), or observation (OB) is most efficient for managing multicystic dysplastic kidney (MCDK).We performed a retrospective review of the management of our 12-year clinical experience of 32 MCDK patients to analyze the estimated total cost (ETC) of various treatment options and compare them with respect to survival, development of hypertension, and postoperative cosmetic appearance, to determine the most efficient treatment option.There were 12 cases in the LN group, 6 in the ON group, and 14 in the OB group. ETC was lower for ON than for LN. But the length of preoperative observation and length of follow-up after spontaneous regression greatly affected ETC. If MCDK cases were observed5 years with standard investigations performed regularly, ETC was higher for the OB group than for the LN group. In 6/14 (42.9%) of OB cases, MCDK resolved within 5 years, and this subgroup had the lowest ETC up to the time of this review. Six cases initially in the OB group were managed surgically (4 by LN and 2 by ON) in accordance with parental requests, and ETC in these cases was highest. All cases are well after a mean follow-up of 5.7 years, without any impairment of renal function, or hypertension.The decision to operate after lengthy observation increases costs. Overall, the most efficient surgical technique for managing MCDK was LN because of greater patient satisfaction with postoperative cosmesis. We recommend MCDK be treated by LN after a short period of observation.

Background: We evaluated the outcome of radical prostatectomy to provide information about long-term survival following this procedure. Methods: One hundred and twenty-three otherwise healthy Japanese patients with clinically localized tumors underwent radical prostatectomy. Treatment outcomes were measured in terms of clinical progression-free survival, prostate cancer-specific survival and overall survival. Overall survival was compared with expected survival of age-matched Japanese men. Results: For these 123 patients, clinical progression-free survival and prostate cancer-specific survival at 10 years were 72.5% and 86.4%, respectively. Results of Cox multivariate analysis showed that only pathological stage (P = 0.047) and tumor grade (P = 0.009) were independent predictors of clinical progression. Only tumor grade was a statistically significant independent predictor (P = 0.048) in terms of prostate cancer death. Both the 10 and 15-year overall survival rates for these 123 patients were 58.6%, whereas the expected survival of age-matched Japanese men was 65.0% at the 10-year follow up, and 43.8% at the 15-year follow up. Conclusions: The long-term overall survival in this surgically treated group is comparable to the expected survival rate of age-matched Japanese men. These results might be useful in counselling patients with clinically localized prostate cancer.

Inguinal hernia repair is the most common operation performed in pediatric surgical practice. However, this procedure can be difficult, even in the most experienced hands, and result in complications, especially in small infants. Injury to the bladder is one of the known complications of inguinal herniotomy, especially in infants less than 6 months old. We report the long-term follow-up of a case having bladder injury during inguinal hernia repair at the age of 3 months and at the age of 10 underwent sigmoidocolocystoplasty for augmentation of a small, contracted bladder and high-grade vesicoureteric reflux caused by the bladder injury.

Nakada (1988) divided senile postural deformities into four types by visual observation: an extended type, an S-shaped type, a flexed type, and a hand-on-the-lap type. The purpose of this study was to investigate the inter-rater reliability and the discriminant validity of assessing the elderly spinal posture using a posture-measuring device developed by us and dividing postural deformities into the four types of Nakada's classification. Seventy-seven elderly persons (52 women and 25 men) who lived independently participated in the study. The average age of the subjects was 73 years (range, 65 to 84 years). The type of the senile postural deformity was determined by three judges using our posture-measuring device in combination with Nakada's classification. The rate of agreement of the classification was 92.2%. This method had a significantly high rate of inter-rater reliability. The thoracic kyphotic angle was larger in the S-shaped type than in the normal, extended type, and flexed type. The lumbar lordotic angle was also larger in the S-shaped type than in the extended type, flexed type, and hand-on-the-lap type. In the hand-on-the-lap type, the mean of the lumbar lordotic angle was much smaller. The lumbosacral angle was smaller in the extended type than in the normal, S-shaped type, and flexed type. With the analysis of x-ray photographs, this method appeared to have discriminant validity as a measure of senile postural deformity. The combination of our posture-measuring device and Nakada's classification would be useful to classify senile postural deformities in mass examinations.

Purpose: Forme fruste choledochal cyst (FFCC) is a choledochal cyst that has minimal or no dilatation of the extrahepatic bile duct (EHBD) and is associated with pancreaticobiliary malunion (PBMU). The authors reviewed the long-term outcome of their patients with FFCC. Methods: Inpatient and outpatient records of 281 patients with choledochal cyst were reviewed. In this study, minimal dilatation of the EHBD was defined as its maximum diameter being less than 10 mm. Results: There were 17 cases of FFCC identified. In all 17 patients, PBMU was present. The mean age at EHBD excision was 2.9 years. Fourteen patients had hepatico-jejunostomy, and three had hepatico-duodenostomy. The histology of the excised EHBD showed mucosal ulceration/sloughing (in 35.3% patients), fibrosis (52.9%), and inflammatory cell infiltration (41.2%). Over a mean postoperative follow-up period of 9.8 years, there have been no episodes of cholangitis or anastomotic stricture formation. Conclusions: The treatment of choice for FFCC in children is EHBD excision and hepatico-jejunostomy. There is little surgical morbidity if performed carefully.

Objective. To examine blood-flow change and recovery of sensibility in the dental pulp of maxillary incisors in patients undergoing a single-segment Le Fort I osteotomy. Study Design. Fifty-four maxillary incisors in 14 patients were examined preoperatively and at 1 to 7 days, 14 days, 3 months, 6 months, and 12 months postoperatively. The pulpal blood flow (PBF) was measured by laser Doppler flowmetry, and the pulpal sensibility (PS) was investigated by electrodiagnostics. Results. The mean PBF dropped to its lowest value at 1 day postoperatively and subsequently increased except for a temporary drop on day 4. The PS was negative in all the examined teeth from 1 day to 14 days after surgery. Subsequently, the rate of the teeth with positive PS increased. At 3 months postoperatively, the PS recovered in half of the examined teeth. The PBF value on day 1 was significantly higher in the teeth with positive PS at 3 months postoperatively than in those with negative PS at 3 months postoperatively. Conclusion. These results suggest that the decrease of the PBF in the maxillary incisors on 1 day after a single-segment Le Fort I osteotomy may affect the recovery of the PS in the short term after surgery. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:660-4)

Risk factors of urethral recurrence after neobladder in bladder cancer patients were studied. Between 1977 and 2001, 73 patients (male 58, female 15) underwent neobladder as a treatment for bladder cancer. The observation time after cystectomy ranged from 2 to 254 months (median 60.5). Ten (17.2%) of 58 male patients had urethral recurrence and of the 10, 8 patients had multiple bladder cancers including bladder neck. Urethral recurrence was found by macrohematuria, follow-up cystourethroscopy, and inguinal lymph node swelling. Only one who complained of macrohematuria had positive urinary cytology. Of 58 male patients, 5 underwent total nephroureterectomy for renal pelvic or ureteral cancer before radical cystectomy, and 3 of the 5 had urethral recurrence. Two of 10 patients with urethral recurrence died with cancer, and they had renal pelvic or ureteral cancer. The five-year cause specific survival was 83% for patients with urethral recurrence, and 79% for those without urethral recurrence, respectively. Urethral recurrence did not have a significant effect on survival. The patients with multiple bladder cancers including bladder neck, and renal pelvic or ureteral cancer before radical cystectomy, have high risks for urethral recurrence. Urinary cytology has limited value for the detection of urethral recurrence.

Background: No significant differences in gross and light- microscopic features have been reported between preclinical and overt Cushing’s adenomas. In this study, the ultrastructural differences between the two syndromes was attempted to be clarified. Methods: Two preclinical Cushing’s syndrome adenomas and two overt Cushing’s syndrome adenomas obtained from surgical extirpation were examined in an electron microscopic study. Results: Light microscopically, the adenomas of both syndromes were composed predominantly of clear cells, with few compact cells. Ultrastructurally, the prominent differences were of development in each organelle: the preclinical Cushing’s adenomas had undeveloped mitochondria, which were smaller in size and had sparse cristae, lysosomes and polysomes, whereas the overt Cushing’s adenomas contained well-developed mitochondria which were larger in size and were filled with abundant cristae, smooth endoplasmic reticulum (SER), lysosomes and polysomes. Conclusions: Preclinical Cushing’s syndrome adenomas were ultrastructurally characterized by a reduced number of cellular organelles such as mitochondria and SER, which are necessary to synthesize glucocorticoid hormones. However, examination of a greater number of adenomas will be required to be able to draw conclusions on the ultrastructural differences between the two syndromes.

A high-brightness electron accelerator system with a photocathode RF gun and an all-solid stable laser for the photocathode was installed, and a commissioning test was performed to generate short-pulse X-ray beams by the Thomson scattering method. Electron energy was boosted by a linear accelerator (linac) up to 14 MeV. Energy dispersion of the electron beams was measured to be 0.7% (rms). The normalized emittance of the electron beam was 4 πmm-mrad with a 0.4 nC bunch charge. The electron beam size at the interaction point, where the electron beams and high peak power laser light interacted, was measured to be 100 µm (rms). Good stability in the spatial and temporal domains was also obtained.

Background: hepatic functional reserve is determined by the function and number of hepatocytes, as well as hepatic blood flow. In Japan, endoscopic injection sclerotherapy is often performed prophylactically in patients with high-risk esophageal varices. We examined the effects of blocking portosystemic shunts by this treatment on hepatic circulation and hepatocyte function as evaluated by 99mTc-GSA scintigraphy (HH15, LHL15), an examination via asialoglycoprotein receptors on hepatocytes. Methods: forty-nine patients who underwent prophylactic treatment of esophageal varices were divided into two groups; one having esophageal varices alone and the second having other collateral circulation in addition to esophageal varices. Asialoscintigraphy and general liver function tests were performed both before and after treatment in each group and the data were statistically analyzed. Results: In the group having esophageal varices alone, serum total bile acid significantly decreased at 62.2% and ICGR15, HH15, and LHL15 were slightly improved at -10.9, -3.0, and +4.7%, respectively, after sclerotherapy (P0.01). However, Child-Pugh's score was not changed after sclerotherapy. In the group having additional collaterals, no parameters were changed after sclerotherapy. Conclusion: we demonstrate that HH15, LHL15, and ICGR15 are partially influenced by hepatic circulation but are mainly determined by the function of hepatocytes, whereas serum total bile acid is markedly influenced by hepatic circulation.

A compact pulse radiolysis system using a photocathode RF gun was installed at Sumitomo Heavy Industries. Some performance tests were conducted concerning the electron beam and the laser pulse. The energy and the per-pulse charge of the electron beam were measured to be 1.75 MeV max. and 1 nC. The fluctuation of the charge was restricted within 2%. The pulse widths of the electron pulse and the analyzing laser pulse were 20 ps and 15 ps, respectively. The timing jitter between electron pulse and the laser pulse was ±5.7 ps. Based on these measurements, the all-over time resolution can deduced to be about 25 ps.

Le Fort I osteotomy has been established by many studies and is generally used, but hypoesthesia of the dental pulp, the most common complication, occurs in almost all patients. As such, we examined dental pulp sensibility, pulpal blood flow, and histological changes, to elucidate the process of functional recovery of dental pulp after Le Fort I osteotomy. Monkeys (Macaca fusucata) were used in this study. The animals underwent Le Fort I osteotomy in their unilateral maxillae. Histological and angiographic examinations were performed to observe the postoperative changes in the maxillae and dental pulp. Postoperative pulpal blood flow was examined using a laser Doppler flowmetry. Postoperative pulpal blood flow, by a laser Doppler flowmetry, and dental pulp sensibility, by electrodiagnostics, in patients who underwent Le Fort I osteotomy, were also examined. Although nerve fibers observed in the dental pulp of the maxilla degenerated and disappeared by one week postoperatively, they reappeared sparsely from two to three months after osteotomy, and there were abundant nerve fibers by one year postoperatively. In the angiographic examination, blood supply to the maxillary dental pulp was maintained throughout the postoperative period. In the examinations of laser Doppler flowmetry and dental pulp electrodiagnostics, ischemia in the dental pulp for three or four days after osteotomy might delay the recovery of dental pulp sensibility. These results suggested that blood flow in dental pulp at three or four days after surgery may affect the recovery of dental pulp sensibility.

A compact chemical analysis (pulse radiolysis) apparatus using a BNL-type s-band photocathode RF gun (GUN-IV) is now under development at Sumitomo Heavy Industries (SHI). Using the apparatus, fast chemical reactions induced by 3.5 ps pulse of electron beam can be analyzed by means of time-resolved photo-absorption spectroscopy with 10 ps laser pulses in the wavelength range of 210–2000 nm. The high-precision control of RF phase makes 10 ps of time-resolution possible for the analysis.

To examine the role of total parenteral nutrition (TPN) in predisposing infants to infection caused by coagulase-negative staphylococci.Total parenteral nutrition is an important means of providing essential nutrients to newborn infants. However, its use has been associated with complications, particularly infection caused by coagulase-negative staphylococci. Recent data suggest that TPN may modulate immune function; however, reports directly indicating impaired immunity against coagulase-negative staphylococci during TPN are limited.Study 1 involved 31 infants younger than 4 months who had undergone surgery and were not receiving antibiotics; 20 were receiving TPN and 11 were receiving a normal enteral diet. An in vitro whole blood model was used to measure the host bactericidal activity against coagulase-negative staphylococci. Bacterial killing and phagocytosis were measured after a 45-minute challenge with viable coagulase-negative staphylococci. In study 2, whole blood killing and intracellular killing of coagulase-negative staphylococci were measured in five newborn infants (younger than 2 months) who were receiving long-term TPN (10 days), five control infants receiving a normal enteral diet, and five healthy adults.In study 1, infants receiving a normal enteral diet showed a high capacity to ingest and kill coagulase-negative staphylococci. In contrast, the blood of infants receiving long-term TPN showed a reduction in coagulase-negative staphylococci phagocytosis and killing. There were significant negative linear correlations between the duration of TPN and killing of coagulase-negative staphylococci and phagocytosis of coagulase-negative staphylococci. In study 2, infants receiving long-term TPN had lower whole blood killing and intracellular killing than infants receiving a normal enteral diet and healthy adult volunteers. These data seem to indicate a neutrophil dysfunction mediated by TPN in infancy.Host defense mechanisms, including phagocytosis and killing of coagulase-negative staphylococci, are impaired during long-term TPN. The impaired bactericidal activity seems to be related to defective intracellular killing in neutrophils. These findings may explain the high rate of septicemia caused by coagulase-negative staphylococci in infants receiving TPN.

Background: Studies have shown that total parenteral nutrition (TPN) in infancy is associated with impaired immunity. The causes of this acquired immunodeficiency are poorly understood. Bacterial infection is a major complication of TPN suggesting neutrophils may be affected by this feeding modality. Purpose: The aim of this study was to test the hypothesis that TPN-related impaired bactericidal activity is related to impairment of neutrophil function, particularly intracellular killing. Methods: Studies were performed in five infants (age 10 days), five control infants who received a normal enteral diet, and five healthy adults. Patients on long-term TPN were clinically stable with no evidence of sepsis. The experimental study used an in vitro whole-blood model of septicaemia. Coagulase-negative staphylococci were the bacterial challenge. Whole-blood killing of coagulase-negative staphylococci was measured after 45 minutes using the Miles-Misra technique. Neutrophils were separated from whole blood after 15, 30, 45, and 60 minutes of bacterial challenge. The survival rate of the bacteria within the neutrophils was analysed by flow cytometry and the percentage of the bacteria killed by neutrophil intracellular killing assessed at each time-point. Results: Whole-blood killing was significantly lower ( P = .05) in infants who received long-term TPN (33.3%) compared with control infants (69.7%) and adults (67.7%). In all subjects studied, neutrophil intracellular killing increased with incubation time. At each time point the intracellular killing in infants on long-term TPN was significantly lower ( P Conclusion: Future strategies to prevent TPN-related infection should aim to minimise this acquired neutrophil dysfunction.

Previous studies have shown that total parenteral nutrition (TPN) influences host immunity, but the mechanism is unclear. This study explored the effect of TPN solution on neutrophil phagocytosis and whole-blood cytokine production in response to coagulase-negative staphylococci in vitro challenge.Blood samples were taken from five enterally fed infants (age6 months) and six healthy adults. Samples were incubated for 45 minutes with four isovolemic solutions: (A) control (saline), (B) TPN (0.1 microL/mL of blood), (C) TPN (1 microL/mL), (D) TPN (10 microL/mL). Solution C (1 microL/mL) corresponded to TPN-blood ratio used in clinical practice. After incubation, blood was challenged with coagulase-negative staphylococci. Neutrophil phagocytosis was measured by flow cytometry after 40 minutes of bacterial challenge, and tumour necrosis factor alpha (TNF-alpha) was measured by enzyme-linked immunosorbent assay (ELISA) after 2 hours of bacterial challenge.In infant blood, TNF-alpha production after coagulase-negative staphylococci challenge was impaired after the addition of a "physiological" dose of TPN solution (1 microL/mL of blood) as well as "supranormal" doses (10 microL/mL of blood). In adult blood, a similar effect was observed only after the addition of a supranormal dose of TPN. In both the infant and adult blood, there was no direct effect of TPN solution on neutrophil phagocytosis.These results suggest that infants are more susceptible than adults to TPN-related depression of cytokine production. The level of proinflammatory cytokines may be important in the host defence against bacterial infection.

Parenteral nutrition (PN) is associated with a risk of septicaemia. This may be caused by impairment of immune function related to PN. The authors investigated the effects of the addition of enteral feedings to PN on the immune status of human newborn infants.Ten surgical infants (age less than 6 months) requiring PN were studied in two consecutive phases: (A) after 31.1+/-6.0 days (mean +/- SEM) of PN with no enteral feeding (total PN); and (B) after 4.7+/-1.1 days from the addition of small volumes of enteral feeding to PN. Full blood count and liver function tests were not significantly different between phases A and B. A control group (n = 9) of infants receiving a normal enteral diet was also studied. Host bactericidal activity against coagulase-negative staphylococci (CNS) was measured by an in vitro whole blood model. Bacterial killing was measured after a 45-minute bacterial challenge using the Miles-Misra technique. Tumour necrosis factor-alpha (TNF-alpha) was measured by enzyme-linked immunosorbent assay (ELISA) after 2 hours of bacterial challenge.The lowest level of CNS killing (37.7+/-5.2%), was observed in patients receiving total PN. This increased significantly after the addition of small enteral feeds (52.0+/-4.6%, P.005) approaching the levels measured in controls (65.1+/-3.4%). TNF-alpha production was low during total PN (1467+/-297 pg/mL) and rose significantly after the addition of minimal enteral feeds (4,661+/-1,311 pg/mL, P.05). The increase in CNS killing after the addition of small enteral feeds in patients on PN was significantly correlated with the duration of enteral feeding (r = 0.8, P = .006).These results indicate that the introduction of small volumes of enteral feed improve the impaired killing of CNS and the abnormal cytokine response observed during total PN. This implies that stimulation of the gastrointestinal tract may modulate immune function in neonates and prevent bacterial infection.

This case of hepatocellular carcinoma (HCC) with alcoholic liver fibrosis, which was not associated with hepatitis viruses, was accompanied by hypoglycaemia. The immunoreactive insulin level was low and other hormonal examinations were almost normal. Immunohistochemical studies showed a high level of insulin-like growth factor II (IGF2) peptide in the HCC section and the size heterogeneity of serum IGF2 investigated by western blot revealed a large form at approximately 15 kDa. These results suggest that the HCC with alcoholic liver fibrosis produced IGF2 and that the hypoglycaemia was caused by tumour-associated IGF2.

The aim of this study was to review the cases 200 children and 40 adults who had cyst excision combined with hepaticoenterostomy (CEHE) for choledochal cyst, with particular emphasis on post-CEHE complications and their surgical management. Patients who had CEHE at the age of 15 years or less were defined as children, and those aged 16 years or older were defined as adults. The mean age when patients became initially symptomatic was 3 years in children and 26 years in adults. Eleven adults became symptomatic as children (< or = 15 years of age). The mean age of CEHE in children and adults was 4.2 years and 35 years, respectively. The time interval between the onset of initial symptoms and CEHE was significantly less in children than in adults (P < .0001). Of the 200 children, 176 had primary CEHE, and 24 had secondary CEHE converted from cystoenterostomy or other biliary surgery. Seventy children had intraoperative cyst endoscopy, which enabled us to examine the proximal intrahepatic bile ducts for stenosis and debris, and to wash out debris, protein plugs, and stones from the intrapancreatic ducts. Of the 40 adults, 22 had primary CEHE, 18 had secondary CEHE. The mean follow-up period was 10.9 years in children and 10.7 years in adults. The number of patients with post-CEHE complications in children and adults was 18 (9.0%) and 17 (42.5%), respectively. The post-CEHE complication rate in children was significantly lower than in adults (P < .0001). The 18 children had 25 post-CEHE complications such as cholangitis, intrahepatic bile duct stones, pancreatitis, stone formation in the intrapancreatic terminal choledochus or pancreatic duct, and bowel obstruction. Twenty-seven post-CEHE complications developed in the 17 adults including 2 cases of cholangiocarcinoma. There were no post-CEHE complications in the 70 children who had intraoperative cyst endoscopy. No stone formation was seen in the 145 children who had CEHE at the age of 5 years or less. Eight stone formations were seen in seven (12.7%) of the remaining 55 children aged over 5 years. Stones developed in seven (17.5%) adults. The incidence of post-CEHE stone formation in children aged 5 years or less was significantly lower than in other children and adults (P < .0001). Reoperation was required in 15 children: revision of hepaticoenterostomy in 4, percutaneous transhepatic cholangioscopic lithotomy (PTCSL) in 1, excision of intrapancreatic terminal choledochus in 2, endoscopic sphincterotomy of the papilla of Vater in 1, pancreaticojejunostomy in 1, and laparotomy for bowel obstruction in 6. Ten adults required reoperations: revision of hepaticoenterostomy in 2, PTCSL in 2, left hepatic lobectomy in 1, endoscopic sphincterotomy in 2, exploratory laparotomy in 2, and adhesiolysis in 1. The authors conclude that early diagnosis followed by CEHE is the treatment of choice for choledochal cyst, and intraoperative cyst endoscopy is recommended as a valuable adjunct to CEHE.

Objective. The purpose of this study was to evaluate postoperative stability in prognathic patients with mandibular asymmetry who were treated with sagittal split ramus osteotomy of the mandible. Study design. Ten asymmetric (group I) and 11 symmetric (group II) patients were examined. An appliance for repositioning the proximal segment was applied, and the bony segments were fixed with titanium screws. Cephalograms were obtained preoperatively, 2 to 3 days postoperatively, and 3 and 6 months after surgery. Changes in the positions of the standard points were examined on lateral cephalograms, and changes in the widths of the gonion points were examined on posteroanterior cephalograms. Results. Statistical analysis revealed no significant difference between the two groups. In addition, there was no significant difference between the postoperative changes in the widths of the gonion points on the deviated and nondeviated sides in group I. Conclusions. This study suggests that application of an appliance for repositioning the proximal segment can minimize postoperative skeletal changes in patients with asymmetry.

Changes in preoperative and postoperative temporomandibular joint (TMJ) symptoms in patients with prognathism who underwent sagittal split ramus osteotomy (SSRO) of the mandible, including repositioning of the proximal segment and titanium screw fixation, were evaluated. Symptoms (sounds and pain) of the TMJ were checked preoperatively and 3, 6, 12 (1 year), and 24 (2 years) months after surgery. As of 1 or 2 years after surgety, TMJ sounds had resolved in about 70% of the patients with preoperative joint sounds. As of 6 months after the operation, joint pain had also resolved in all patients who had this sympotom preoperatively. On the other hand, joint symptoms developed in only about 5% of the patients who had no preoperative joint symptoms as of 1 or 2 years after surgery. In conclusion, the results of this study suggest that most of the preoperative TMJ symptoms in patients with prognathism resolve after SSRO with repositioning of the proximal segment and titanium screw fixation, although the preoperative condylar position should be maintained.

運動練習が及ぼす，Open Taskの性質を持った多関節運動パターンの変化の構造を分析する事を目的に，標的志向運動課題についての運動練習を通した運動学的変数の変化を観察，検討した。4名の健常男性を対象に投球動作の手関節および肘関節における矢状面上の関節角度変化および筋活動を測定した。肘関節と手関節の協調を示す変数の標準偏差は運動練習により低下した。また，手関節と肘関節の運動範囲および運動速度は運動練習により増大した。肘関節と手関節問の変数の相関は運動練習を通して運動速度で増加し，運動範囲で減少した。しかし，各変数の変化は個体間，変数間，関節間で多様な傾向を示し，投球動作時の運動パターン変化の一般的傾向を結論することは困難であった。

This paper presents a newly developed compact model HiSIM-GaN [Hiroshima University STARC IGFET Model for GaN high electron mobility transistors (HEMTs)]. The developed model includes two specific features of GaN-HEMT to reproduce the power efficiency accurately. One is the two-dimensional electron gas induced at the heterojunction, which is modeled by considering the potential distribution across the junction including the trap density contribution. The second feature is the field plate, which is introduced to delocalize the electric-field peak that occurs at the electrode edge. Using HiSIM-GaN, device characteristics have been simulated. It is demonstrated that measured DC/AC characteristics are well reproduced with the developed model. The model has also been applied to analyze circuit characteristics of a boost converter. It is shown that the waveform is well reproduced by considering one half of the trap density extracted with measured DC characteristics due to the time constant of trap events. Furthermore, it is verified that the power efficiency as a function of the load current is predicted within an accuracy of 1%. Influence of the trap density and the field plate on circuit performances is also discussed.

Purpose: The aim of this study was to review the outcome of a protocol the authors proposed for preventing Roux-en-Y hepatico-jejunostomy (RYHJ) related complications. Methods: In 1986 the authors adopted the following protocol for improving RYHJ to minimize risks for RY-related complications: (1) end-to-end anastomosis if possible; (2) if end-to-side anastomosis is unavoidable, the common hepatic duct should be anastomosed as close as possible to the closed end of the blind pouch (BP); (3) careful selection of the vascular supply to the RY jejunal limb; (4) length of the RY jejunal limb should not be predetermined, but individualized; (5) approximate the native jejunum to the RY limb. The authors reviewed 92 children who had surgery for CC (mean age at surgery, 4.1 years) at our institution between 1986 and 2002 to assess the effectiveness of their recommendations. Results: After the adoption of the authors' recommendations for RYHJ, they have experienced no RYHJ-related complications after a mean follow-up period of 7.6 years (range, 4 months to 16 years). Conclusions: RYHJ in children is different from that in adults, because the RY limb or BP can grow and elongate as the child grows. The authors' recommendations appear to have successfully prevented RY-related complications up to the time of this review, and they highly recommend their use.

The authors present 3 cases of proximal hypospadias associated with bilateral undescended testes (UDT) in which the gubernaculum was used to reinforce the neourethra to prevent urethrocutaneous fistula. This is the first report of the gubernaculum being used to reinforce the neourethra. The technique is simple and should be applicable to any hypospadias patient with concomitant UDT, especially in severe hypospadias. Good outcome is likely because of the excellent blood supply of the gubernaculum.

Serial data links are often designed targeting a specific transmission medium. High-speed links using different predetermined transmission media have been demonstrated in the past [1–3]. This, however, restricts user's ability to use an integrated link interface with other transmission media once the chip is fabricated. For example, traditional transceivers for copper interconnects typically transmit baseband data, which is incompatible with a free-space wireless channel that is bandpass in nature and often uses RF carriers. A multi-modality transceiver block compatible with different transmission media is highly desirable as it offers great versatility by allowing the exact same interface circuitry to be used with different transmission media. Such a versatile interface can relax the board and system design requirements and enable the reuse of the same transceiver core with different media, reducing the time and cost overhead of re-designing and re-manufacturing.

Of 238 patients with Crohn's disease seen at our clinics from April 1973 to August 1988, 203 patients were selected for this study, since they fulfilled the following criteria: they had been followed up for more than 6 months as outpatients or had been treated as inpatients for more than 1 month. They were studied to elucidate: (a) the different types and incidence of various complications, (b) the factors related to complications present at the time of diagnosis, (c) predictors of new complications arising after diagnosis, and (d) the cumulative incidence of complications occurring during the course of the disease from the times of onset and diagnosis. Of the intestinal complications, perianal fistula was most common (33%), followed by strictures with dilatations of the proximal bowel (21%), and internal fistula (14%). Of the extraintestinal complications, menstrual disturbance was the most common (18% of the female patients), followed by arthritis (10%), and aphthous stomatitis (10%). As for the factors influencing complications present at the time of diagnosis, the pattern of bowel involvement was significantly correlated with the presence of intestinal stricture, while the erythrocyte sedimentation rate was significantly correlated with the presence of perianal fistula. A significant predictor of new complications arising after diagnosis was the general well-being of patients at the time of diagnosis. Patients who, at diagnosis, already have complications such as stricture, abdominal abscess, internal or external fistula, massive hemorrhage, and free perforation or anal lesions are more likely to develop new complications in addition to those present at diagnosis, compared with patients without any complications at diagnosis (P = 0.055).

We conducted a basic study of Millimeter-wave Intra-Connect Systems from the aspects of module implementation and transmission characteristics. We made small transmitter (TX) and receiver (RX) modules with on-board Yagi antennas using a resin material, and investigated the characteristics of the antennas. We also studied the relation of the transmission characteristics to module arrangement and the use of parallel metal plates as a simple case model. We confirmed extension of transmission distance by using the Yagi antenna with gain and sandwiching the modules between parallel plates.

We report the case of a 31-year-old woman who suffered lipiduria after selective transcatheter arterial embolization for renal angiomyolipoma (AML). Computed tomography confirmed cystic liquefactive necrosis with fat-fluid level in AML. Although the process by which AML fat tissue excretion occurs is not clear, we speculated that the infarcted AML was connected to the urinary collection duct system and subsequently its adipose component was excreted into the urine.

Rhabdomyosarcoma is an extremely rare malignant tumor but in the head and neck region, it is one of the most common malignancies of the mesenchymal tissue. A case of a 18-year-old male with embryonal rhabdomyosarcoma of the left maxillary sinus is presented. He was referred to our clinic because of the left nasal obstruction and gum swelling.A final histopathological diagnosis was established by several staining methods including H & E, PTAH, Azan-Mallory and silver stains, by immunohistochemical examination with antimyoglobin and anti-actin antibodies, and by electronmicroscopy. In the absence of cross striations this case was diagnosed to have an undifferentiated type of embryonal rhabdomyosarcoma. Whole left maxillectomy including removal of the eye ball and orbit was performed. Postoperatively, the patient recieved 55 Grays by Linac irradiation and VAC therapy (VCR, AMD, CPM) as a chemotherapy. He has been well for 18 months and there has been no evidence of local recuerrence or metastatic disease.

The first and second branchial arch syndrome is a rare anomaly characterized by hypoplasia of mandibular ramus, temporomandibular joint and ear. The hypoplasia involving both skeletal and soft tissues results in severe facial asymmetry increasing progressively. The present paper reports a case of this anomaly.A 28 year-old female was admitted. Clinical examination showed hypoplasia of the middle and lower thirds of the left side of the face, canted mouth and malformed ear. Chin was significantly deviated to the left and retropositioned. Radiographic and CT examinations revealed hypoplasia of left mandibular ramus and angle, coronoid process, temporomandibular joint, muscles of mastication and parotid salivary gland. Intraoral evaluation showed canted occlusal plane with rigid interdigitation of occlusion. Both anteroposterior and lateral cephalometric analyses disclosed three-dimensional hypoplasia and deviation of the upper and lower jaws: that is, upward and posteromedial displacement of the affected malar bone and maxilla, upward and medial displacement of the affected temporomandibular joint, mandibular ramus and angle, deviation to the affected side and retroposition of the chin and the dental midline, canted occlusal plane and so forth.The first treatment consisted of Le Fort I osteotomy, sagittal splitting osteotomy and genioplasty. This corrected the frontal and sagittal asymmetry, but the transverse asymmetry remained because the middle and lower thirds of the unaffected side of the face protruded farther and those of the affected side was more hollowed by the first reatment. At the second treatment iliac bone onlay graft was done on the affected mandibular ramus and angle, and masseter muscle myotomy and posterior and inferior border resection ostectomy of mandible were accomplished on the unaffected side. The two-stage surgery resulted in alignment of the occlusal plane with a more symmetrical face.

We propose an event extraction method from traffic image sequences. This method extracts moving objects and their trajectories from image sequences recorded by a stationary camera. These trajectories are mapped to 3D virtual space and physical parameters such as velocity and direction are estimated. After that, traffic events are extracted from these trajectories and physical parameters based on case-frame analysis in the field of natural language processing. Our method facilitates to describe events easily and detect general traffic events and abnormal situations. The experimental results of actual intersection traffic image sequence have shown the effectiveness of the method.

We propose a Push-Style Design Support System (PSDSs), which prevents product failures caused by improper design. While a designer is writing a specification document, PSDSs automatically shows design knowledge related to the contents in real time. The document check process can perform a highly precise check by comparing the structurized contents of the document with the structurized design knowledge flexibly, by referring to ontology data (Electronic parts DB and thesaurus dictionary). Unlike conventional expert systems using causal chains as design knowledge, the design knowledge of PSDSs is simple and easy to create. Experimental results of applying PSDSs to the design of electric circuits, 36% of the check results were the effective check that the relative low-skilled designer was not conscious of. In addition, 12% were effective check results that the experienced designer had not noticed.

We report a case of bile duct stones in which piezoelectric extracorporeal shockwave lithotripsy (ESWL) was highly effective for the clearance of stones. A 16-year-old girl, who had undergone excision of a choledochal cyst when she was 3 years old, presented a spiking fever and colic abdominal pain. Radiological investigations showed two large stones incarcerating to the proximal end of hepatico-jejunostomy anastomosis. Massive debris was also present in intrahepatic bile duct proximal to the anastomosis. She underwent piezoelectric ESWL with an EDAP LT02 lithotripter. An average of 40 min ESWL session was repeated at intervals of 2 or 3 days. Neither anesthetic nor sedative treatment was required. By the end of the sixth session, the stones incarcerated were fragmented and the debris in the intrahepatic bile duct was completely eliminated. We conclude that piezoelectric ESWL is a less invasive, effective and repeatable method, therefore, it could be a treatment of choice for bile duct stone formation after choledochal cyst excision.

Carcinomatous meningitis from urothelial carcinoma of the bladder and ureter is rare. A 77-year-old man with invasive bladder cancer and right ureter cancer had been treated with 3 courses M-VAC (methotrexate, vinblastine, epirubicin, cisplatin) chemotherapy. After chemotherapy we performed radical cystectomy and right nephroureterectomy (ileal-neobladder) (TCC, G3, pT3, N0, M0). Sixteen months after operation, patient complained of anorexia, muscular weakness, stiff neck. CT of chest and abdomen, and bone scintigraphy showed no metastasis. Brain CT and MRI showed hydrocephalus but no evidence of parenchymal metastasis. Because we suspected carcinomatous meningitis, we performed lumbar puncture. Cerebrospinal fluid cytology revealed class V (urothelial carcinoma). Patient died 6 days after diagnosis of carcinomatous meningitis.

1. (1) We have bee successful in establishing a conversion formula that can establish the random vibration test conditions based on the measured values of the peak accumulated. 2. (2)We learned that, not only the main components of engine vibrations, but other components are also important in the phenomena of contact wear, from the fact that the evaluation tests based on random vibrations could reproduce contact wear far better that the sime wave sweep test.

We report a case of methicillin-resistant Staphylococcus aureus ilio-psoas abscess (IPA) in a neonate. This case has clinical importance because this neonate had toxic shock syndrome-like exanthematous disease, known as NTED, before developing IPA. A high index of suspicion is required for IPA if a neonate presents with limb disuse and fever of unknown origin. Our case required surgical drainage, since ultrasound-guided percutaneous needle aspiration failed.

To evaluate the relationship between neuroendocrine differentiation (NED) status and hormone refractory prostate cancer (HRPC) following hormone therapy based on immunohistochemical study.Seventy-two prostate cancer specimens obtained at radical prostatectomy and 21 prostate cancer autopsy specimens from patients who died from HRPC after androgen deprivation therapy were examined for NED status using an antibody against chromogranin A. These specimens were classified into 3 arms: 38 radical prostatectomy specimens from patients with no neoadjuvant hormone therapy (Group 1); 34 from patients with neoadjuvant hormone therapy for 3 to 6 months (Group 2); and 21 autopsy specimens from patients with HRPC following androgen deprivation therapy for more than 1 year (Group 3). Staining of prostatic carcinoma was scored as: 0 = no staining; 1 = staining cells10%; 2 = staining cells 10-20%; and 3 = staining cells20%. Differences in scores among the groups were compared using the Kruskal-Wallis rank test. Multivariate analysis using a logistic regression model was performed to examine whether NED status was associated with pathological stage (pT), grade and group.Forty-nine (53%) tumors had CgA stained cells. NED status increased with longer duration of hormone therapy (p0.0001). The mean staining score (and standard deviation) was 0.4+/-0.7 in Group 1, 0.7+/-0.7 in Group 2, and 1.4+/-1.1 in Group 3, respectively. By multivariate analysis Group 3 had a relative risk of 5.46 (95%CI 1.28-23.29) for NED compared to the other groups. But other variables were not related to NED. HRPC following Long-term hormonal therapy was the only independent predictor of NED.The results of this study demonstrated that NED status was significantly increased in patients with HRPC following long-term androgen deprivation therapy, but it could not be discriminate whether the increase of NED is attributable to condition of hormone refractoriness or long-term hormonal therapy.