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With the rapid progress of the integrated nanophotonics technology, the optical neural network architecture has been widely investigated. Since the optical neural network can complete the inference processing just by propagating the optical signal in the network, it is expected more than one order of magnitude faster than the electronics-only implementation of artificial neural networks (ANN). In this paper, we first propose an optical vector-matrix multiplication (VMM) circuit using wavelength division multiplexing, which enables inference processing at the speed of light with ultra-wideband. This paper next proposes optoelectronic circuit implementation for batch normalization and activation function, which significantly improves the accuracy of the inference processing without sacrificing the speed performance. Finally, using a virtual environment for machine learning and an optoelectronic circuit simulator, we demonstrate the ultra-fast and accurate operation of the optical-electronic ANN circuit.

Approximate computing (AC) has recently emerged as a promising approach to the energy-efficient design of digital systems. For realizing the practical AC design, we need to verify whether the designed circuit can operate correctly under various operating conditions. Namely, the verification needs to efficiently find fatal logic errors or timing errors that violate the constraint of computational quality. This paper proposes a novel dynamic verification methodology of the AC circuit. The key idea of the proposed methodology is to incorporate a quality assessment capability into the Coverage-based Grey-box Fuzzing (CGF). CGF is one of the most promising techniques in the research field of software security testing. By repeating (1) mutation of test patterns, (2) execution of the program under test (PUT), and (3) aggregation of coverage information and feedback to the next test pattern generation, CGF can explore the verification space quickly and automatically. On the other hand, CGF originally cannot consider the computational quality by itself. For overcoming this quality unawareness in CGF, the proposed methodology additionally embeds the Design Under Test (DUT) mechanisms into the calculation part of computational quality. Thanks to the integration of CGF and DUT mechanism, the proposed framework realizes the quality-aware feedback loop in CGF and thus quickly enhances the verification coverage for test patterns that violate the quality constraint. In this work, we quantitatively compared the verification coverage of the approximate arithmetic circuits between the proposed methodology and the random test. In a case study of an approximate multiply-accumulate (MAC) unit, we experimentally confirmed that the proposed methodology achieves the target coverage three times faster than the random test., IOLTS 2021. June 28-30, 2021. Torino, Italy (Virtual)

In animal breeding and genetics, statistical methods have been used for several decades to identify animals with the best genetic potential. One of the foundations for computing accurate estimated breeding values (EBV) is the amount of data that is used in the evaluation system — as the more data points one animal has, the more accurate its EBV is going to be. However, the animal breeding and genetics field periodically faces a big data paradox, where efficient methods have to be developed to handle the amount of data collected over time, given the computing capacity becomes the limiting factor. For instance, running genetic evaluations based on phenotypes and pedigree for a million animals was impossible in 1970. Methods and algorithms evolved to a point where using data for millions of animals was not a problem, until genomic information became available. After the development of single nucleotide polymorphism (SNP) chips for livestock in 2008, genomic information started being used in addition to phenotypes and pedigree to further improve accuracy of EBV. However, each animal is genotyped for around 50,000 SNP, which makes this data dense and difficult to work with. Over 790,000 Angus and 3.4 million Holstein cattle have been genotyped in the US as of April 2020. As the amount of new data considerably increases every week, most of the genomic evaluations are done on a weekly basis. Given that data have to be processed, the computation of EBV cannot take more than four days, which can be challenging depending on the model. In this talk we will discuss the challenges and solutions for successful genomic evaluations in large livestock populations. Finally, perspectives on the use of whole-genome sequence data and high-throughput phenotypes in genomic analysis will be summarized.

TSB performed intentionally is injected with a lot of (20 ml) local anesthetic intrathecally, and it is performed as therapeutic procedures, such as intractable pain in the head, cervix, and upper limbs besides whiplash injury.

Facial nerve block is a therapeutic procedure for the hemifacial spasm and blepharospasm. Facial nerve block is carriedout a method of using neurolytic agents, or a physical compression method which suppresses the facial nerve with the block needle.

We examined the effects of heat stress (HS) on production traits, somatic cell score (SCS) and conception rate at first insemination (CR) in Holsteins in Japan. We used a total of 228 242 records of milk, fat and protein yields, and SCS for the first three lactations, as well as of CR in heifers and in first- and second-lactation cows that had calved for the first time between 2000 and 2012. Records from 47 prefectural weather stations throughout Japan were used to calculate the temperature-humidity index (THI); areas were categorized into three regional groups: no HS (THI < 72), mild HS (72 ≤ THI < 79), and moderate HS (THI ≥ 79). Trait records from the three HS-region groups were treated as three different traits and trivariate animal models were used. The genetic correlations between milk yields from different HS groups were very high (0.91 to 0.99). Summer calving caused the greatest increase in SCS, and in the first and second lactations this increase became greater as THI increased. In cows, CR was affected by the interaction between HS group and insemination month: with summer and early autumn insemination, there was a reduction in CR, and it was much larger in the mild- and moderate-HS groups than in the no-HS group.

The test-day milk fat-to-protein ratio (TD-FPR) could serve as a measure of energy balance status and might be used as a criterion to improve metabolic stability and fertility through genetic selection. Therefore, genetic parameters for fertility traits, test-day milk yield (TD-MY) and TD-FPR, as well as, their relationships during different stages of lactation, were estimated on data collected from 25 968 primiparous Thai dairy crossbred cows. Gibbs sampling algorithms were implemented to obtain (co)variance components using both univariate linear and threshold animal models and bivariate linear-linear and linear-threshold animal models with random regression. Average TD-MY and TD-FPR were 12.60 and 1.15. Heritability estimates for TD-MY, TD-FPR and selected fertility traits ranged from 0.31 to 0.58, 0.17 to 0.19 and 0.02 to 0.05, respectively. Genetic correlations among TD-FPR and TD-MY, TD-FPR and fertility traits, and TD-MY and fertility traits ranged from 0.05 to -0.44, from -0.98 to 0.98 and -0.22 to 0.79, respectively. Selection for lower TD-FPR would decrease numbers of inseminations per conception and increase conception at first service and pregnancy within 90 days. In addition, cow selection based only on high milk production has strong effects to prolong days to first service, days open and calving interval.

Aims Ephedra preparations are known to cause a false-positive reaction for amphetamine analogs when a Triage® kit is used for urinary drug screening. Maoto, a traditional Japanese herbal medicine that consists of Ephedra herb, cinnamon bark, apricot kernel, and Glycyrrhiza, is used for the treatment of colds and influenza. We compared two urinary drug-screening kits for false-positive reactions for amphetamine analogs after treatment with maoto from five different manufacturers over 12 h. Methods Six healthy adult volunteers received five different preparations of maoto in random order. One packet of maoto was given on each study day. Urine samples were collected before treatment, and at 3, 6, 9, and 12 h after drug treatment. Two urinary drug-screening kits (Triage® and Medical Stat®) were used for testing. Results Twenty-nine of 30 samples produced a false-positive reaction for amphetamine analogs using the Triage® kit at 3 h after treatment. No significant difference was observed among the products of the five pharmaceutical companies (P = 0.5771). All samples produced a negative reaction using the Medical Stat® kit. Conclusions Urine samples that gave false-positive reactions with the Triage® kit gave negative reactions with the Medical Stat® kit. This suggests that comparison of results from the Triage® kit and the Medical Stat® kit may be useful in screening urine samples for amphetamine analogs. The quality of maoto from five pharmaceutical companies appears to be the same with regard to interaction with the drug screening tests, adverse effects, and excretion in the urine.

Device miniaturization due to technology scaling has made manufacturing variability and aging more significant, and lower supply voltage makes circuits sensitive to dynamic environmental fluctuation. These may shorten the time to failure (TTF) of fabricated chips unexpectedly. This paper focuses on critical path isolation, which increases timing slack of non-intrinsic critical paths and decreases timing error occurrence probability in the circuit, and proposes a design methodology of isolated circuits for TTF extension and/or lower voltage operation. The proposed methodology selects a set of FFs for isolation using ILP so that it maximumly reduces the sum of gate-wise failure probabilities. We evaluated MTTF (Mean Time To Failure) of circuits with/without critical path isolation and examined how much supply voltage could be reduced without MTTF degradation. Evaluation results show that circuits with the proposed critical path isolation achieved 25% supply voltage reduction with 1.4% area overhead. With the same supply voltage, MTTF was improved by 14 orders of magnitude.

In Showa University School of pharmacy, 7 competencies for outcome-based education were set up in 2011. We are now creating sequential curriculum in order to achieve these competencies. As a member of team medical treatment, pharmacist must share a patient's information with other members, assess each patient's condition, propose the best medication with evidence, and also check the effect of medication. Therefore, many active practices in a hospital and community and problem-based learning (PBL) tutorials are carried out in curriculum in School of Pharmacy. As a training for the future pharmacists who positively perform primary care with responsibility in community pharmacy, students study the method of clinical assessment (assessment of condition of disease from the patient's complain, and choice of appropriate proposal). Furthermore, the exercise and training of parenteral medication, physical assessment, and first aid, etc. are also taken in the curriculums as new clinical skill. The systematic and gradual interprofessional education curriculum for the team medical education has been carried out aiming at training of active members in medical team in a hospital and community. At this symposium, I will introduce these systematic advanced curriculums for the pharmacist of a new age, and to show the usefulness and learning effect.

Software-based error detection techniques, which includes EDM (error detection mechanisms) transformation, are used for error localization in post-silicon validation. This paper evaluates the performance of EDM for timing error localization with 65-nm test chips assuming the following two EDM usage scenarios; (1) localizing a timing error occurred in the original program, and (2) localizing potential timing errors that vary execution results. Experimental results show that the EDM transformation customized for quick error detection detects 25% of timing errors in the original program in the first scenario and 56% of non-masked errors in the second scenario. However, these hardware measurement results are not consistent with the simulation results of our previous work. To investigate the reason, we focus on the following two differences between hardware and simulation; (1) design of power distribution network, and (2) definition of timing error occurrence frequency. We update the simulation setup for filling the difference and re-execute the simulation. We confirm that the simulation and the chip measurement results are consistent, which validates our simulation methodology.

Migraine is a multifactorial disease with various factors, such as genetic polymorphisms and personality traits, but the contribution of those factors is not clear. To clarify the pathogenesis of migraine, the contributions of genetic polymorphisms and personality traits were simultaneously investigated using multivariate analysis. Ninety-one migraine patients and 119 non-headache healthy volunteers were enrolled. The 12 gene polymorphisms analysis and NEO-FFI personality test were performed. At first, the univariate analysis was performed to extract the contributing factors to pathogenesis of migraine. We then extracted the factors that independently contributed to the pathogenesis of migraine using multivariate stepwise logistic regression analysis. Using the multivariate analysis, three gene polymorphisms including monoamine oxidase A (MAOA) T941G, methylenetetrahydrofolate reductase (MTHFR) C677T, and tumor necrosis factor beta (TNF-β) G252Α, and the neuroticism and conscientiousness scores in NEO-FFI were selected as significant factors that independently contributed to the pathogenesis of migraine. Their odds ratios were 1.099 (per point of neuroticism score), 1.080 (per point of conscientiousness score), 2.272 (T and T/T or T/G vs G and G/G genotype of MAOA), 1.939 (C/T or T/T vs C/C genotype of MTHFR), and 2.748 (G/A or A/A vs G/G genotype of TNF-β), respectively. We suggested that multiple factors, such as gene polymorphisms and personality traits, contribute to the pathogenesis of migraine. The contribution of polymorphisms, such as MAOA T941G, MTHFR C677T, and TNF-β G252A, were more important than personality traits in the pathogenesis of migraine, a multifactorial disorder.

Moderate to severe migraine attacks are treated with triptans. However, about 25% of migraineurs fail to respond to triptans. We investigated the involvement of gene polymorphisms, personality traits and characteristics of headache, and made a scoring system for prediction of clinical response to triptans in patients with migraine. Gene polymorphisms including serotonin (5-HT)1B receptor G861C and dopamine receptor 2 (DRD2) C939T, personality traits and characteristics of headache were investigated in 46 consistent responders and 14 inconsistent responders to triptans. The multivariate stepwise logistic regression analysis revealed that age, periorbital/deep orbital pain and C/C genotype carrier at DRD2 C939T were significant factors that contributed independently to the negative response to triptans in patients with migraine. Their odds ratios were 6.329 (40–69 vs. 20–39 years, 95% CI 1.441–27.778), 6.772 (no vs. yes, periorbital/deep orbital pain, 95% CI 1.159–39.580) and 14.085 (non-C/C vs. C/C genotype at DRD2 C939T, 95% CI 1.253–166.667), respectively. The predictive index (PI) of clinical response to triptans in patients with migraine was calculated using these three factors. The score in inconsistent responders (1.6 ± 0.6) was significantly higher than that in consistent responders (0.8 ± 0.7, P

Guillain-Barre syndrome is a type of acute inflammatory neuropathy that causes ataxia and is associated with the IgG anti-GM1 antibody. However, the pathogenic role of the IgG anti-GM1 antibody and calcium channels in neuromuscular junctions (NMJs) remains unclear. Thus, the aim of the present study was to investigate the effects of the IgG anti-GM1 monoclonal antibody (mAb) on spontaneous muscle action potentials (SMAPs), and the effects of calcium channel blockers, in a rat spinal cord-muscle co-culture system. In addition, the binding of IgG anti-GM1 mAb to calcium channels was investigated in the rat hemidiaphragm. The frequency of SMAPs in the innervated muscle cells was acutely inhibited by the IgG anti-GM1 mAb; however, this effect was blocked by the N-type calcium channel blocker, ω-conotoxin GVIA (30 nM). Furthermore, the P/Q-type calcium channel blocker, ω-agatoxin IVA (10 nM), was found to partially block the IgG anti-GM1 mAb-induced inhibitory effect in the spinal cord-muscle co-culture system. Immunohistochemical analysis of the rat hemidiaphragm indicated that IgG anti-GM1 mAb binding overlapped with anti-Cav2.2 (α1B) antibody binding in the nerve terminal. In addition, IgG anti-GM1 mAb binding partially overlapped with anti-Cav2.1 (α1A) antibody binding. Thus, the results demonstrated that the IgG anti-GM1 mAb binds to calcium channels in the nerve terminals of NMJs. Therefore, the inhibitory effect of IgG anti-GM1 mAb on SMAPs may involve N-type and P/Q-type calcium channels in motor nerve terminals at the NMJ.

Background— An estimated 275 000 patients undergo heart valve replacement each year. However, existing solutions for valve replacement are complicated by the morbidity associated with lifelong anticoagulation of mechanical valves and the limited durability of bioprostheses. Recent advances in tissue engineering and our understanding of stem cell biology may provide a lifelong solution to these problems. Methods and Results— Mesenchymal stem cells were isolated from ovine bone marrow and characterized by their morphology and antigen expression through immunocytochemistry, flow cytometry, and capacity to differentiate into multiple cell lineages. A biodegradable scaffold was developed and characterized by its tensile strength and stiffness as a function of time in cell-conditioned medium. Autologous semilunar heart valves were then created in vitro using mesenchymal stem cells and the biodegradable scaffold and were implanted into the pulmonary position of sheep on cardiopulmonary bypass. The valves were evaluated by echocardiography at implantation and after 4 months in vivo. Valves were explanted at 4 and 8 months and examined by histology and immunohistochemistry. Valves displayed a maximum instantaneous gradient of 17.2±1.33 mm Hg, a mean gradient of 9.7±1.3 mm Hg, an effective orifice area of 1.35±0.17 cm 2 , and trivial or mild regurgitation at implantation. Gradients changed little over 4 months of follow-up. Histology showed disposition of extracellular matrix and distribution of cell phenotypes in the engineered valves reminiscent of that in native pulmonary valves. Conclusions— Stem-cell tissue-engineered heart valves can be created from mesenchymal stem cells in combination with a biodegradable scaffold and function satisfactorily in vivo for periods of >4 months. Furthermore, such valves undergo extensive remodeling in vivo to resemble native heart valves.

21歳の女性で, 左下肢のCRPS type I に対し, 抗うつ薬投与中に精神症状を示した症例を経験した. 精神症状はおもに神経ブロック後に生じ, 3～4時間に及ぶせん妄状態を示した. 抗うつ薬増量後には, 神経ブロック時以外にも頻回に精神症状を認めるようになったが, 抗うつ薬中止後約2週間で消失した. 本症例の精神症状の発現機序は不明であるが, 抗うつ薬の副作用として精神症状が出現する可能性を考慮しなければならない.

Objective: We examined the influence of shunt size on regulation of the pulmonary blood flow in a canine model of a univentricular heart because specific guidelines regarding suitable shunt size in the Norwood operation remain undetermined. Methods: Beagle dogs (n = 8) 3 to 7 months old and weighing 3.0 to 5.0 kg were used. Atrial septectomy and patch closure of the tricuspid valve were performed, and a systemic-pulmonary arterial shunt was created by interposing a 3.5- or 4.0-mm graft between the right subclavian artery and main pulmonary artery. After cardiopulmonary bypass, hemodynamic variables including pulmonary and systemic blood flow were measured consecutively according to physiologically respiratory manipulations. The ratio of shunt size to body weight ranged from 0.80 to 1.33 mm/kg (1.08 ± 0.16 mm/kg). Results: Each dog with a ratio of shunt size to body weight of 0.8 to 1.1 showed significant negative correlation between the pulmonary/systemic blood flow ratio and arterial Pco 2 , but those with a ratio of shunt size to body weight of 1.1 to 1.4 did not. Consequently each dog with a ratio of shunt size to body weight of 0.8 to 1.0 got adequate systemic flow, whereas a ratio of 1.0 to 1.4 resulted in inadequate systemic flow and acidic status. Similar phenomena were shown with the grouped data on relationship between the pulmonary/systemic blood flow ratio and inspired oxygen fraction. Conclusions: These findings imply that when the ratio of shunt size to body weight is 0.8 to 1.1, the pulmonary/systemic blood flow ratio is controllable by physiologic respiratory manipulations. Larger shunts make pulmonary blood flow excessive and uncontrollable. We recommend that a ratio of shunt size to body weight of 0.9 to 1.0 be considered a useful index for suitable systemic-pulmonary arterial shunt in the Norwood operation. J Thorac Cardiovasc Surg 2003;125:71-8

Purpose. For assessment of the antinociceptive potency of antidepressants, we compared the antinociceptive effects of serotonin selective reuptake inhibitors (SSRIs) and classical tricyclic antidepressants (TCAs) in rats. We also attempted to elucidate the monoamine receptor subtypes predominantly involved in the antinociceptive effect of antidepressants. Methods. Male Wistar rats received SSRIs (sertraline, fluvoxamine, and citalopram) or TCAs (imipramine and desipramine) intraperitoneally, and the reaction time until pain response in the hot plate test and licking time in the formalin test were measured 60 min later. We also observed the effects of prazosin (an α1 antagonist), WB-4101 (a selective α1A antagonist), yohimbine (an α2 antagonist), WAY-100635 (a selective 5-HT1A antagonist), and ketanserin (a 5-HT2 antagonist), which were simultaneously administered with imipramine or desipramine, on the antidepressant-induced antinociceptive effect in the formalin test. Results. In the hot plate test, desipramine, 20 mg·kg−1, but not imipramine or sertraline, produced a significant increase in reaction time. In the formalin test, desipramine and imipramine produced significant reductions in the licking time at over 5 mg·kg−1 and at over 10 mg·kg−1, respectively. These reductions were nearly complete at 20 mg·kg−1. On the other hand, both SSRIs induced significant reductions in the licking time only at 20 mg·kg−1. Prazosin, WB-4101, and ketanserin significantly antagonized the antinociceptive effect of 10 mg·kg−1 of imipramine. However, imipramine-induced antinociception was not affected by yohimbine and WAY-100635. Prazosin and ketanserin also significantly suppressed antinociception by 5 mg·kg−1 of desipramine. Conclusion. These findings suggest that classical TCAs are likely to have a therapeutic advantage over SSRIs for pain control. In addition, it is likely that central α1 adrenoceptors and 5-HT2 receptors are predominantly involved in imipramine- and desipramine-induced antinociception.

We investigated the possible association of serotonin (5-HT) 2A receptor gene A-1438G polymorphism in Japanese patients with migraine. Genotyping of 5-HT(2A) A-1438G polymorphism was performed by polymerase chain reaction-restriction fragment length polymorphism in patients with migraine (male 17 : 3 with aura and 14 without aura, female 65 : 17 with aura and 48 without aura) and controls (male 31, female 84). The distribution of 5-HT(2A) A-1438G genotype frequency between migraine patients and controls did not differ. These results suggest that the A-1438G polymorphism of the 5-HT(2A) receptor gene is not a direct risk factor for migraine; however, the incidence of the A/A genotype between migraine with aura (MA) and without aura (MO) was significantly different. The 5-HT(2A) A-1438G polymorphism may be involved in determining the subtypes of migraine in Japanese.

Background . Despite long-standing, widespread use of cryopreserved allografts, the basic cellular biology of these tissues is still yet unknown. The present investigation was undertaken to study cryopreserved heart valves from the standpoint of cytosolic esterase and mitochondrial dehydrogenase activities. Methods . Cryopreserved porcine aortic cusps were observed in an unfixed fresh condition with a confocal laser scanning microscope using fluorescent dye. Porcine cusps and cultured human umbilical vein endothelial cells were divided into three groups, including fresh, cold-preserved, and cryopreserved specimens, and cytosolic esterase activity and mitochondrial dehydrogenase activity were analyzed in each. Results . Confocal laser scanning microscope findings disclosed a widely distributed fluorescence in the cusp. Cytosolic esterase activity within human umbilical vein endothelial cells (28% ± 9.0%) after cryopreservation was significantly less than that it was in the cusps (72% ± 21%). Mitochondrial dehydrogenase activity of cryopreserved human umbilical vein endothelial cells and that of cusps fell to 44% ± 6.1% and 64% ± 17% respectively; the difference between the two values was not significant. Conclusions . Cryopreservation appeared to produce serious damage to cytosolic and mitochondrial functions of endothelial cells. The cytosolic function of cusps, mainly consisting of fibroblasts, was comparatively preserved after cryopreservation, but mitochondrial function of the cusps was more diminished.

Mouse forced swimming is one of the behavioral depression models and repeated electroconvulsive shock (ECS) treatment has been used to human depression. In order to investigate the mechanism of the anti-depressive effect induced by repeated ECS, we investigated the effect of repeated ECS with the mouse forced swimming model. The 5 times par-day ECS remarkably increased the typical anti-depressive behavior climbing 24 hours after the final treatment. The anti-depressive activity was declined by a dopamine 1 antagonist SCH-23390 at the doses of 1 and 0.1 mg/kg, but not by the other dopamine, serotonin and adrenoceptor antagonists at the dose of 1 mg/kg. The present findings strongly suggest that the late anti-depressive effect of repeated ECS is mediated by the dopamine 1 receptor activity. The present findings will also contribute to the further investigations of the effect of repeat ECS treatments on human depression.

We experienced a case of a 38-year-old woman with a persistent cough, 24 years after repair of absent pulmonary valve syndrome with anomalous origin of the left pulmonary artery. The right pulmonary artery was massively dilated, thus it caused the compression of the bronchi, which was thought to result in her respiratory symptom. This dilatation of the right pulmonary artery seemed to have progressed because of the following two reasons. The first is the pulmonary hypertension caused by the late reconstruction of the left pulmonary artery. The second is residual pulmonary stenosis and regurgitation after the initial operation without a pulmonary valve insertion. We performed a reoperation consisting of reconstruction of the right ventricular outflow tract using a valved conduit and plication of the right pulmonary artery. Her postoperative course has been without any complications and satisfactory for the past 2 years.

It has been suggested that plasma sulfoconjugated dopamine (DA) may serve as a source or reservoir for free DA in plasma. Moreover, it has also been reported that the plasma levels of conjugated DA may be used as an index predicting heart failure in patients with heart disease. Therefore, in the present study, we have measured the plasma levels of free and sulfoconjugated DA in patients with congenital heart disease who underwent total corrective operations. The patients were divided into two groups with (6 patients with tetralogy of Fallot, TOF) or without (5 patients with ventricular septal defect without pulmonary hypertension, VSD) cyanosis (mean age of 2.11 years). Blood samples were collected before and after operation from the patients, and plasma free and sulfoconjugated DA levels were measured using high performance liquid chromatography. Preoperative levels of free DA in patients in both groups were higher than the level in age matched control subjects. The plasma level of conjugated DA in TOF was higher than that in the controls and was the highest in VSD before operation. DA infusion early after operation caused a rise in plasma free and conjugated DA, however, the levels of increased free DA were lower in the VSD than in the TOF group. After discontinuing DA infusion, the plasma levels of free DA remained higher, while those of conjugated DA decreased to a level lower than the preoperative values in both groups. As the plasma levels of free and sulfoconjugated DA vary with hemodynamics, it was assumed that the difference in the plasma sulfoconjugated DA level between the groups before operation was due to the influence of pulminary blood flow on catecholamine homeostasis. Since the decrease in conjugated DA has been postulated to be an index of sustained heart failure, it is conceivable that it takes a long time for patients who underwent cardiac operations in infancy to recover from heart failure.

The effect of amiloride, a potent inhibitor of Na+/H+ exchange, on ischaemic reperfused rat hearts was studied in order to investigate whether Na+/H+ exchange or Na+/Ca2+ exchange is involved in ischaemia-reperfusion injury, When hearts were pre-ischaemically loaded with 100 microM amiloride, recovery of left ventricular developed pressure was significantly better than in control hearts, whereas recovery of heart rate at 30-min reperfusion was unaffected. Amiloride pretreatment also decreased creatine phosphokinase activity in the coronary effluent and completely abolished occurrence of ventricular arrhythmias during reperfusion. It also inhibited intracellular Na+ accumulation early in reperfusion (within 5 min), whereas in the late stage (from 5 to 30 min), Ca2+ overload was inhibited. The findings suggest that Na+/H+ exchange participates mainly in the early stage of reperfusion injury and the Na+/Ca2+ exchange system, secondary to Na+/H+ exchange, in the late stage. The reduction in post-ischaemic cardiac dysfunction induced by amiloride pretreatment may be attributable to inhibition of the resultant Ca2+ accumulation during reperfusion.

顔面神経麻痺患者は外来受診患者総数の12.6% (817名)に相当し,うち7.0% (57名)が再発性顔面神経麻痺であった.再発性麻痺患者に関し性差はなく,罹患側では同側再発に比し反対側再発のほうが高頻度であった.発症年齢は成壮年層に集中していた.また,家族内発生の頻度も高くなんらかの遺伝的要素が関与していると考えられた.従来顔面神経麻痺の誘因あるいは素因にあげられている糖尿病に罹患している患者は少なく,高血圧,肝機能障害の既往をもつ患者の比率のほうが高かった.今回の検討より顔面神経麻痺再発の因子として,遺伝的形態学的素因,血管性変化,肝機能障害などが考えられることが示唆された.

ペインクリニックにおける加療中に,造血器悪性腫瘍が発見された2症例を経験した.[症例1]50歳,女性.左口唇周囲の小水疱と,左下顎部のしびれ・疼痛などを主訴に受診した.この症候はnumb chin syndromeとよばれ,進行した悪性腫瘍の存在を示唆する症候群であった.精査により,バーキット型急性リンパ性白血病と診断されたが第43病日に死亡した.[症例2]74歳,女性.骨粗霧症と胸推圧迫骨折による腰背痛のために加療していたが,初診より7ヵ月を経てから多発性骨髄腫と診断された.化学療法は奏効し,初診後2年を経た現在,疼痛とADLの改善が得られている.未診断のまれな悪性疾患に由来する疼痛にも留意すべきである.

The aim of the study was to determine the optimal size and technique for construction of the systemic-to-pulmonary arterial shunt which will provide suitable pulmonary blood flow in first-stage Norwood palliation for hypoplastic left heart syndrome in neonates. Our clinical experience suggested that an arterial oxygen tension of about 30 mm Hg immediately after cardiopulmonary bypass, with the patients being ventilated at the lowest possible mean airway pressure with an FiO2of 1.0, provided a suitable pulmonary-to-systemic flow ratio. We also aimed to clarify the characteristics of pulmonary blood flow in accordance with the size of the shunt and the change in the pulmonary vascular resistance in a simplified rigid model of the Norwood procedure. A hole of2.0 mm diameter proved adequate to provide a suitable pulmonary blood flow of 200−300 mlx002F;min in the presence of a pressure gradient of 20−40 mm Hg between the systemic and pulmonary circulations in neonates weighing 3 kg. A short central shunt with a prosthesis of4 mm in diameter produced an excessive flow of pulmonary blood. Our data suggest that using a smaller shunt than that commonly used is necessary to decrease the early and intermediate postoperative mortality. A prosthesis of 3.0 or 3.5 mm in diameter arising from the brachiocephalic artery would be acceptable and can be recommended for first-stage Norwood palliation in small infants, especially in view of the operative difficulties encountered in taking down the shunt at the time of subsequent operations.

Background and Objectives We describe the use of mandibular nerve block for the management of bilateral trismus associated with hypoxic-ischemic encephalopathy. Case Report The patient was a 65-year-old man with bilateral trismus due to hypoxic-ischemic encephalopathy. Despite his impaired consciousness, we performed fluoroscopically guided bilateral mandibular nerve block. The bilateral symptoms were sufficiently improved, without obvious side effects, by injecting a local anesthetic near the right mandibular nerve and a neurolytic near the left mandibular nerve. Conclusions Mandibular nerve block may be an effective treatment for patients with bilateral trismus due to ischemic-encephalopathy, even when consciousness is impaired.

To evaluate the usefulness of plasma dopamine-beta-hydroxylase (DBH) activity as an index of sympathetic nerve activity during cardiac operations, we examined the serial changes in plasma DBH activity, in relation to the plasma noradrenaline (NA) level and hemodynamic parameters, in patients who underwent cardiac surgery. The plasma DBH activity decreased significantly after cardiopulmonary bypass, and remained low during dopamine (DA) infusion until 72 h after the operation. However, recovery of the hemodynamic parameters, being the mean arterial pressure, heart rate and cardiac index, was seen as early as 1-3 h postoperatively. It was therefore assumed that the plasma DBH activity takes a long time to recover after an operation. The time-course changes in the plasma NA level were quite different from the changes in DBH activity, with an apparent negative correlation being observed between them. Thus, there is a possibility that exogenously administered DA, as well as increased plasma NA, might inhibit DBH activity during cardiac surgery. Moreover, since catecholamines are often administered upon completion of cardiac surgery, measurement of the plasma catecholamine level would be inappropriate for evaluating real sympathetic nerve activity. From the results of this study, it is surmised that measurement of the plasma DBH activity could be useful for estimating the intrinsic sympathetic nerve activity of patients who have undergone cardiac surgery.

In many cases, a new railway line is planned beneath existing structures of an urban terminal station. The underpinning method has been developed to respond to such needs. However, this conventional method involves a number of steps and is costly and time-consuming. The steps are: (1) Constructing the cast- in-situ diaphragm walls to keep off the underground water; (2) Supporting the existing structures with the cast- in-situ piles; (3) Excavating the soil under the existing structures; (4) Constructing structures for the new railway; (5) Transferring the loads of the existing structures from the temporary piles onto the newly constructed structure; and (6) Removing the temporary piles. In introducing a new subway line beneath Nagoya station, which is one of the major terminals in Japan, the Central Japan Railway Company made use of temporary structures, cast- in-situ diaphragm walls and piles, as elements of the new structures adopting new measures to increase the accuracy of underground construction. It is suggested that this method can save considerable construction time and cost.

Surface dose monitoring in patients and physicians during 29 uterine artery embolisation (UAE) procedures was performed using photoluminescence dosemeters and thermo-luminescence dosemeters. Organ or tissue doses were measured with an anthropomorphic phantom using UAE exposure conditions averaged from the 29 cases, and effective doses were estimated for the patient. Entrance surface dose of the patients at the maximum dose position ranged from 121.5 to 1650 mGy. Estimated doses ranged from 3.16 to 43 mGy for the ovary and from 3.8 to 51.8 mGy for the uterus. The effective dose was 1.09-14.8 mSv. Monitored doses on the body surface of physicians were relatively high in the upper arm (5.41+/-1.52 to 163+/-17.25 microGy) and the hand and fingers (0.85+/-1.18 to 222+/-16.4 microGy).

This paper describes the morphometric analysis of preoperative aspiration materials from breast cancers to define cytological predictors of recurrence and malignancy grade. Subjects were 65 patients with primary invasive ductal carcinoma of the breast, of which 36 were cancer free at least for 5 years from radical operation (cancer free group) and 29 had distant recurrences in 5 years (recurrence group). Morphological factor of nuclei was calculated for each group. Nuclear area itself had no relation with prognosis. Coefficiency variant of nuclear area (NA·CV) was calculated. NA·CV of recurrence group was higher than that of cancer free group, as shown in these figures, 39.8±7.9% and 25.5±4.6% respectively. NA·CV was most variable prognostic indicator among the several prognostic factors, for example tumor size (T'), histological type, and lymph nodal status. By using morphometry and calculating NA·CV, cytological nuclear pleomorphism was evaluated objectively. The prognosis and malignancy grade of the breast cancer can be probably presumed at preoperative period.

Sleep bruxism (SB) has been believed to be related to stress and psychosocial factors, however their implicit relationship has remained unclear. This study was conducted on patients visiting our clinic with SB and masticatory muscle disorders (MMD) for the purpose of clarifying personality and behavioral traits. This study was conducted on patients of MMD visiting our clinic. The Rosenzweig Picture-Frustration study was performed on each patient. Twenty-seven (27) patients were divided into two groups: 17 patients with SB and 10 patients without. The SB group showed a significantly lower level of E (extrapunitive) reaction than the nonSB group. SB patients showed a significantly higher level of M (impunitive) reaction than those without SB. Concerning the directions of aggression, the percentage of E-A (extraaggression) was significantly lower in SB patients than in those without. On the other hand, the percentage of I-A (intraaggression) was significantly higher in patients with SB than those without. Our study found a new aspect of the patients with MMD and SB: they are not only intraaggressive, but are also unable to be extrapunitive and extraaggressive. Consequently, they are unable to demonstrate adequate self-assertiveness in stressful situations.

PURPOSE Our purpose was to examine perioperative alterations in hemodynamic changes with head-up tilt (HUT) in patients undergoing endoscopic thoracic sympathectomy (ETS). METHODS The subjects were 11 patients with essential hyperhidrosis scheduled to undergo ETS (ETS group) and 9 age-matched volunteers undergoing minor surgery (control group). HUT was performed (40 degrees; 5 min) before and after the surgery, under nitrous oxide anesthesia. Orthostatic hypertension and hypotension in response to HUT were defined as changes of 10% or greater in systolic blood pressure. RESULTS The increase in heart rate in response to HUT was significantly reduced after surgery in the ETS group (from 34 +/- 18 to 14 +/- 11 beats.min(-1); P < 0.001), but not in the control group (from 23 +/- 18 to 22 +/- 12 beats.min(-1); P = 0.911). Orthostatic hypertension disappeared completely after ETS (from 5 of 11 to none of 11 patients; P = 0.035), whereas the prevalence of orthostatic hypotension increased significantly after ETS (from 3 of 11 to 9 of 11 patients; P = 0.030). In the control group, the prevalence of neither orthostatic hypertension nor orthostatic hypotension changed after surgery. CONCLUSIONS ETS attenuates autonomic circulatory response under nitrous oxide anesthesia.

A glycolipid having GalNAc alpha1-3GalNAc in the terminal increases a behavior climbing in a depression model, mouse forced swimming. Antidepressants, which sometimes induce hypomanic state in patients, increase the glycolipid and an anti-manic substance lithium decreases the glycolipid in mice. We detected the humoral GalNAc alpha1-3GalNAc-lipid reactivity of humans in different affective states. Although the reactivity was also showed in serums of the depression patients and the volunteers without affective disorders, the reactivity was remarkably increased in serums of hypomania patients. These strongly suggest that the humoral glycolipid increased the activities of the hypomania patients, but did not relate to the decrease of the activities in the depression patients.

We attempted to determine which monoamine receptor subtypes are predominantly involved in antidepressant-induced antinociception. Antinociceptive effects were evaluated by using formalin tests with rats. Antidepressants acting as potent inhibitors of norepinephrine reuptake (nisoxetine, nortriptyline, and maprotiline) or inhibiting reuptake of both norepinephrine and serotonin (5-HT) (imipramine and milnacipran) induced dose-dependent antinociception. Simultaneous intraperitoneal administration of antidepressants and either prazosin (alpha(1) antagonist) or ketanserin (5-HT(2) antagonist) significantly antagonized antinociceptive effects. Fluvoxamine (selective serotonin reuptake inhibitor) induced antinociception less potently than other antidepressants and was significantly antagonized by ketanserin, but not prazosin. Ondansetron (5-HT(3) antagonist) significantly antagonized antinociception by 10 mg/kg of imipramine. In contrast, SDZ-205,557 (5-HT(4) antagonist) markedly enhanced antinociception by small-dose (2.5 mg/kg) imipramine. Imipramine-induced antinociception was significantly antagonized by intracerebroventricular administration of prazosin or ketanserin, but not by yohimbine (alpha(2) antagonist) or ondansetron, and was significantly enhanced by intracerebroventricularly administered SDZ-205,557. These findings suggest that alpha(1) adrenoceptors and 5-HT(2) receptors in the brain are involved in antidepressant-induced antinociception. In addition, the results suggested functional interactions between noradrenergic and serotonergic neurons as mechanisms for antidepressant-induced antinociception.Formalin tests of rats treated with antidepressants and antagonists of monoamine receptors indicate that alpha(1) adrenoceptors, serotonin (5-HT)(2) receptors, and 5-HT(3) receptors are involved in antidepressant-induced antinociception, suggesting functional interactions between noradrenergic and serotonergic neurons as mechanisms of antidepressant-induced antinociception.

We investigated the behavioral effects of Chinese herbal medicines in the forced swimming test. One of these medicines, Kami-shoyo-san, induced an antidepressive climbing behavior in mice. An effective substance detected to be an O-linked glycoside with the sugar chain structure GalNAc alpha 1-3GalNAc was separated. The behavioral effect was dose-dependently decreased by the dopamine 2 antagonist sulpiride, but not by the dopamine 1 antagonist SCH-233960. Investigated Chinese herbal medicines, including Kami-shoyo-san, have been used for human depression. These facts suggest that glycoside is one of the antidepressant-like substances of Chinese herbal medicines.

We demonstrated emotional piloerection in mice given conditioned fear stress by means of a pass-through apparatus. The emotional piloerection was first assessed in mice of different ages. The results showed that the piloerection changed with age. Pharmacological studies showed that the piloerection was inhibited by an alpha 1-adrenoceptor antagonist prazosin, but, surprisingly, was not inhibited by anxiolytic diazepam. These findings strongly suggest that the neuronal system of piloerection is different from that of freezing behavior, and that the neuronal system of piloerection develops with age.

A tumor of the upper corneal limbus was detected in a 56-year-old male approx 2 months after an upper lid incision. After the tumor was extracted, pathological tests revealed it to be an epidermal inclusion cyst. Although acquired characteristics could be considered the cause of the cyst, because it was noticed only after the injury, this is doubtful because the tumor increased in size within a very short period of time after the operation.