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Coronavirus disease 2019 (COVID-19) is a severe infectious disease of the respiratory tract caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2, and has a high mortality rate. The disease emerged from Wuhan, China, in late 2019, and spread to Japan, including Hokkaido, in January 2020. In February 2020, 3 children were diagnosed with COVID-19 in Furano, Hokkaido, Japan. During this period, influenza and human metapneumovirus infections were prevalent among children in the Furano region. Two of the 3 patients experienced co-infection with other respiratory viruses, including influenza virus A or human metapneumovirus. To the authors' knowledge, the cases described in the present report were the first pediatric patients with COVID-19 in Japan. In children with COVID-19, the possibility of co-infection with other respiratory pathogens should be considered.

The oropharyngeal swab specimen was superior to the nasopharyngeal swab specimen for the detection of Mycoplasma pneumoniae in children with lower respiratory tract infection. The oropharyngeal loop-mediated isothermal amplification had 100% sensitivity and specificity compared with polymerase chain reaction testing, whereas the oropharyngeal rapid antigen detection test using immunochromatographic assay had relatively low sensitivity (66%) and reasonable specificity (90.7%).

A 64-year-old man had complained of a left scrotal mass and gynecomastia since June 2012. A left testicular tumor was suspected and the patient was referred to our department in December 2013. He presented with bilateral gynecomastia and a painless left scrotal mass that was firm, smooth surfaced, and the size of large hen's egg. Levels of markers of testicular germ cell tumors were all within normal range. Endocrinological examination revealed a marked elevation in serum estradiol (E2) level. The patient underwent high inguinal orchiectomy in December 2013.The pathological diagnosis was a Sertoli cell tumor of the left testis. Immunohistochemistry revealed the expression of aromatase synthesis; we speculated that this E2 production by the tumor caused the gynecomastia.Serum E2 level normalized after the orchiectomy. Owing to the diagnosis of malignancy, retroperitoneal lymph node dissection was performed in January 2014. No lymph node metastasis was found in the specimen. The gynecomastia improved gradually, and the patient has been free of disease since the surgery.

BackgroundRecent research has led to the development of many information technology–supported systems for health care control, including systems estimating nutrition from images of meals. Systems that capture data about eating and exercise are useful for people with diabetes as well as for people who are simply on a diet. Continuous monitoring is key to effective dietary control, requiring systems that are simple to use and motivate users to pay attention to their meals. Unfortunately, most current systems are complex or fail to motivate. Such systems require some manual inputs such as selection of an icon or image, or by inputting the category of the user’s food. The nutrition information fed back to users is not especially helpful, as only the estimated detailed nutritional values contained in the meal are typically provided.ObjectiveIn this paper, we introduce healthiness of meals as a more useful and meaningful general standard, and present a novel algorithm that can estimate healthiness from meal images without requiring manual inputs.MethodsWe propose a system that estimates meal healthiness using a deep neural network that extracts features and a ranking network that learns the relationship between the degrees of healthiness of a meal using a dataset prepared by a human dietary expert. First, we examined whether a registered dietitian can judge the healthiness of meals solely by viewing meal images using a small dataset (100 meals). We then generated ranking data based on comparisons of sets of meal images (850 meals) by a registered dietitian’s viewing meal images and trained a ranking network. Finally, we estimated each meal’s healthiness score to detect unhealthy meals.ResultsThe ranking estimated by the proposed network and the ranking of healthiness based on the dietitian’s judgment were correlated (correlation coefficient 0.72). In addition, extracting network features through pretraining with a publicly available large meal dataset enabled overcoming the limited availability of specific healthiness data.ConclusionsWe have presented an image-based system that can rank meals in terms of the overall healthiness of the dishes constituting the meal. The ranking obtained by the proposed method showed a good correlation to nutritional value–based ranking by a dietitian. We then proposed a network that allows conditions that are important for judging the meal image, extracting features that eliminate background information and are independent of location. Under these conditions, the experimental results showed that our network achieves higher accuracy of healthiness ranking estimation than the conventional image ranking method. The results of this experiment in detecting unhealthy meals suggest that our system can be used to assist health care workers in establishing meal plans for patients with diabetes who need advice in choosing healthy meals.

Object proposal that detects candidate bounding boxes of objects in images is an effective way of accelerating object recognition in the robot/computer vision area. We propose an accurate and fast object proposal method using depth images. Existing proposal methods can be roughly divided into two categories: window scoring and object region extraction. The window scoring methods usually have higher efficiency than object region extraction methods. The previous methods using RGB images detect an excessive number of boxes due to edges of texture objects. These methods also may misdetect overlapping objects as one candidate bounding box. To tackle these problems, we propose a novel and effective objectness measure using depth images. The proposed method evaluates objectness by using depth boundary density difference between inner and outer regions of a candidate bounding box. We also consider the uniformity of the outer boundary density in a candidate bounding box to divide overlapping objects into individual candidate bounding boxes. Our reasonable assumption here is that the depth boundary of an object has a closed loop. Our experiments show significant performance gains over existing RGB and RGB-D object proposal methods on the challenging toy-dataset [1] of complex crowded scenes.

Keypoint matching is challenging especially when objects are non-rigid because underlying deformation is unknown and its complexity is varying. Finding visually similar (less deformed) regions between an image pair is an intuitive and promising approach, but this observation has not been fully exploited in existing methods. In this work, we propose a novel keypoint matching method for non-rigid objects via discovering such visual patterns shared in the image pair. We solve this problem by recursively finding clusters over a graph where each node represents a tentative match and each edge encodes geometric consistency between matches. Our method exploits the local property of target patterns to efficiently build the graph, and extends a local clustering algorithm to take 1-to-l keypoint matching constraints into account. Experimental results on public datasets show the flexibility and the efficiency of our approach to various deformation patterns.

Self-management of meals is a key component of treating diabetes. There are systems that support meal planning by processing the images of meals. Most such systems output the estimated nutrition values of the individual dishes, however, a more intuitive and useful approach is to give patients the motivation to become interested in their meals. Unfortunately, existing systems require the patient to manually input full details of the dishes, or to manually correct the roughly and automatically recognized results output by the systems, which deters the patient from using the system. In this paper, we present a system that predicts the healthiness of the meal and activate the patient's interest in self-management. Unlike conventional image-based methods, which estimate the nutrition via food-category recognition, our proposal predicts if the meal is healthy or not healthy by visually processing all the dishes in the meal. Our system consists of a convolutional neural network(CNN), that is trained by joint classification and ranking loss to replicate the judgement of registered dietitians; the goal is to output predictions of "which meal is healthier". Experiments show that the proposed system can roughly match the ranking results of registered dietitians. The overall ranking error rate for all images examined is 16.4%. The results show that the system learns how to make intuitive assessments of the rate of healthiness from the images themselves. This implies that meal appearance contains valuable clues as to healthiness. Thus the proposed system can be used to detect patients who need to receive more guidance for improving their eating style.

The importance of Streptococcus dysgalactiae subsp. equisimilis (SDSE) in causing sporadic pharyngitis in children remains controversial. The aims of this study were (1) to report the incidence and (2) to compare the epidemiologic and clinical features of patients with SDSE to those with Streptococcus pyogenes (SP).A prospective study was conducted on acute pharyngitis associated with SDSE in children over a 2-year period. SDSE was identified using a phenotypic method, M protein gene (emm) analysis and matrix-assisted laser desorption ionization-time of flight mass spectrometry. Patients with positive SDSE or SP cultures received cephalosporins for 5 days and were followed up. The emm genotyping and specific virulence genes analyses were performed.From 3416 throat cultures, 67 isolates (2.0%) were identified as SDSE and 515 (15.1%) were identified as SP. The mean age of patients with SDSE (8.3 years) was older than those with SP (6.6 years; P0.01). There was minimal seasonal variation in the isolation rates of SDSE. The febrile patients' rates, gender distribution, cervical lymph node adenopathy rates, hospitalization rates, eradication and failure rates and the nonsuppurative sequelae between patients with SDSE and SP were similar. All SDSE isolates possessed important virulence genes. The emm genotyping of SDSE showed high strain diversity.The incidence of acute pharyngitis associated with accurately identified SDSE was 2/15 of that with SP. Epidemiologic and clinical features of acute pharyngitis associated with SDSE are indistinguishable from those with SP, with the exception of age and seasonal variation.

Background Little is known about the clinical effectiveness of neuraminidase inhibitors against H275Y influenza A(H1N1)pdm09 virus. A cluster of H275Y influenza A(H1N1)pdm09 virus with cross-resistance to oseltamivir and peramivir was detected among untreated community patients in Hokkaido, Japan, during the 2013–2014 influenza season. Methods This was a retrospective observational study. Specimens from nasopharyngeal swabs underwent rapid testing and single-nucleotide polymorphism identification on real-time polymerase chain reaction. We collected clinical data from the H275Y group and a 275H wild-type comparison group. All children were given one of four neuraminidase inhibitors. Results Twenty-eight children infected with influenza A(H1N1)pdm09 virus were analyzed. Ten viruses had the H275Y substitution, while the other 18 had wild-type 275H. Mean fever duration after treatment and after onset was 25.3 h (95%CI: 14.1–36.5) and 48.9 h (95%CI: 34.4–63.3) in the H275Y group, respectively, and 26.1 h (95%CI: 18.7–33.6) and 46.3 h (95%CI: 35.7–56.8) in the 275H group, respectively. In the H275Y group, three patients were treated with oseltamivir, one with peramivir, five with zanamivir, and one with laninamivir. All of them had mild symptoms and received only outpatient care. Fever duration was 7.5–21.0 h and 18.0–66.0 h after treatment and after onset, respectively, in the patients treated with oseltamivir and peramivir, and 20.5–42.0 h and 42.0–88.0 h, respectively, in those treated with zanamivir and laninamivir. Conclusion Fever in the H275Y children treated with oseltamivir and peramivir resolved rapidly during the 2013–2014 influenza season.

Aim We aimed to show the status of intracellular elements in sympathetic preganglionic neurons in an autopsy case of a 55-year-old woman with severe sepsis and cardiac dysfunction with anorexia nervosa. Methods Our methods include a case report and pathological examinations of autopsied tissues using synchrotron-generated microbeam X-ray fluorescence analysis. Results A case report of severe sepsis and myocardial dysfunction. The patient had sudden short cardiac arrest without arrhythmia and sequelae, and echocardiogram showed negative inotropic change. The X-ray fluorescence analysis of autopsied tissues indicated an unusually high concentration of cytosolic calcium in sympathetic preganglionic neurons. However, there were no significant pathological findings of damage in the heart or the cardiovascular autonomic nuclei in the central nervous system. Conclusion The data indicate that dysfunction of the sympathetic preganglionic neurons exists in a patient of severe sepsis and cardiac dysfunction with anorexia nervosa.

This paper proposes an articulated pose estimation method based on the pose prior for adaptation that is scene specific. In this research field, various approaches to estimate articulated human pose have been proposed and many researchers have tried to improve pose estimation accuracy for shared datasets. On the other hand, it is not common to use datasets without any labeling for realizing domain adaptation to different scenes even though it is urgently needed. Domain adaptation without labeled data is the key problem because when the user wants to estimate human pose captured in a specific scene, it is too costly to make a labeled dataset for training the estimator. We tackle this problem by proposing the novel approach of using synthetic pose prior, which is made by simulating probable poses in the target scene. We consider the likelihood of human pose distribution generated from various motion capture data sets and environmental knowledge about the scene in addition to training a basic appearance-based pose estimator by using a labeled dataset. Using the likelihood of joint positions specific to the scene, more appropriate results are yielded. In experiments, we adapt an estimator trained by images captured from various perspectives to suit the target images captured from a fixed perspective. As the proposed method takes advantage of the bias caused by fixed perspective, it offers improved estimation accuracy.

Neural word vector (NWV) such as word2vec is a powerful text representation tool that can encode extensive semantic information into compact vectors. This ability poses an interesting question in relation to image processing research - Can we learn better semantic image features from NWVs? We empirically explore this question in the context of semantic content-based image retrieval (CBIR). In this paper, we consider cross-modal transfer learning (CMT) to improve initial convolutional neural network (CNN) image features by using NWVs. We first show that NWVs can improve semantic CBIR performance compared to classical word vectors, even if it is with simple CMT models, i.e., canonical correlation analysis (CCA). Next, inspired by a characteristic property of NWVs, we propose a new CMT model and demonstrate that it can improve CBIR performance even further.

Background Mycoplasma pneumoniae (MP) is a major pathogen of lower respiratory tract infection (LRTI) in children. A rapid diagnostic method during the acute phase is required for the prescription of effective antibiotics. Methods A prospective, single-centered study was conducted on community-acquired LRTI in children. We regarded the day of fever onset as the first day of illness. In part 1, we studied 191 patients with signs of LRTI. We compared diagnostic reliability using loop-mediated isothermal amplification (LAMP) assay and serological testing at the first visit. In part 2, we evaluated the clinical characteristics of 117 patients with positive LAMP assay. Results In part 1, 31 patients met the definite MP infection criteria. LAMP assay had a sensitivity of 96.8% and specificity of 100%, whereas enzyme immunoassay had a sensitivity of 38.7% and specificity of 76.9%, and particle agglutination test had a sensitivity of 19.4% and specificity of 93.1%. In part 2, of 106 patients with fever, 100 patients were diagnosed by the day 7 of illness. The diagnosis was made a mean of 3.5 ± 2.1 days after the onset of fever. Conclusions LAMP assay had excellent sensitivity and specificity for the detection of acute MP infection at the first visit. This assay can diagnose MP infection during the very acute phase. LAMP assay is appropriate for genetic point-of-care diagnosis of MP infection in hospital laboratories.

We propose a novel method for the recognition of objects that match a given 3D model in large-scale scene point clouds captured in indoor environments with a laser range finder. Since large-scale indoor point clouds are greatly damaged by noise such as clutter, occlusion, hole, and measurement errors, it is difficult to exactly identify local correspondences between points in a target model point cloud and points in a scene point cloud, based on similarities between local descriptors computed at keypoints on both point clouds. To avoid such a problem, we suggest to utilize sliding window in order to match the input model and pieces of scene point clouds, both of which are represented with Bag-of-Features(BoF). A BoF representation of a window is efficiently calculated by using the integral image, which stores accumulated BoF vectors. Though BoF is robust to partial noises, it does not preserve any spatial information. Then, we propose a method to make a global descriptor of a window which is almost invariant to horizontal rotations of an object inside the divided window and roughly preserves spatial information by dividing sliding window into several parts. Experiments on real world data show that our approach offers better performance than a baseline method in terms of precision and recall.

System integrity monitors, such as rootkit detectors, rely critically on the ability to fetch and inspect pages containing code and data of a target system under study. To avoid being infected by malicious or compromised targets, state-of-the-art system integrity monitors rely on virtualization technology to set up a tamper-proof execution environment. Consequently, the virtualization infrastructure is part of the trusted computing base. However, modern virtual machine monitors are complex entities, with large code bases that are difficult to verify. In this paper, we present a new machine architecture called limited local memory (LLM), which we use to set up an alternative tamper-proof execution environment for system integrity monitors. This architecture builds upon recent trends in multicore chip design to equip each processing core with access to a small, private memory area. We show that the features of the LLM architecture, combined with a novel secure paging mechanism, suffice to bootstrap a tamper-proof execution environment without support for hardware virtualization. We demonstrate the utility of this architecture by building a rootkit detector that leverages the key features of LLM. This rootkit detector can safely inspect a target operating system without itself becoming the victim of infection.

Temporal dynamics play an important role for video classification. In this paper, we propose to leverage high-level semantic features to open the "black box" of the state-of-the-art temporal model, Long Short Term Memory (LSTM), with an aim to understand what is learned. More specifically, we first extract object features from a state-of-the-art CNN model that is trained to recognize 20K objects. Then we leverage LSTM with the extracted features as inputs to capture the temporal dynamics in videos. In combination with spatial and motion information, we achieve improvements for supervised video categorization. Furthermore, by masking the inputs, we demonstrate what is learned by LSTM, namely (i) which objects are crucial for recognizing a class-of-interest; (ii) how the LSTM model could assist the temporal localization of these detected objects.

We tackle the problem of joint discovery and segmentation of the object of interest from noisy image sets collected via web crawling (e.g., Figure 1). Existing methods [1] [2] [3] employ region-wise comparison in order to separate noise images (images not containing target objects) from the rest, which may be a bottleneck for scaling up to larger datasets. Our idea to avoid such computationally intensive operations is to use image-wise reconstruction errors. Specifically, based on the assumption that images containing target objects are easier to be reconstructed by a pool of target objects than noise images, we first reconstruct each image using a small number of similar target objects. The resulting error is then combined with some other criteria (e.g., saliency) so as to delineate only target object regions. Experimental evaluations on a noisy image dataset [1] demonstrate that our approach achieves state-of-the-art results on every subset of the dataset 5–7 times faster than existing methods.

An incremental attribute discovery method for person re-identification is proposed in this paper. Recent studies have shown the effectiveness of the attribute-based approach. Unfortunately, the approach has difficulty in discriminating people who are similar in terms of the pre-defined semantic attributes. To solve this problem, we automatically discover and learn new attributes that permit successful discrimination through a pair-wise learning process. We evaluate our method on two benchmark datasets and demonstrate that it significantly improves the performance of the person re-identification task.

This study is a nationwide survey of all clinical methicillin-resistant Staphylococcus aureus (MRSA) isolates, including community-acquired MRSA (CA-MRSA), in Japan. A total of 857 MRSA clinical isolates were collected from the 16 institutions throughout Japan that participated in the survey (2008-2009). The drug susceptibility and staphylococcal cassette chromosome mec (SCCmec) typing and the presence of specific pathogenic genes were evaluated. The isolates comprised SCCmec type II (73.6%), type IV (20%), and type I (6%). The percentage of SCCmec type IV isolates was significantly higher in outpatients than in inpatients. Most of the isolated strains were sensitive to vancomycin (VCM, MIC ≤2 μg/mL), linezolid (MIC ≤4 μg/mL), and teicoplanin (MIC ≤8 μg/mL). Although most strains were sensitive to VCM, the MIC value of VCM for SCCmec type II strains was higher than that for SCCmec type IV strains. Only 4 (2.3%) of 171 SCCmec type IV strains were Panton-Valentine leukocidin (lukS/F-PV)-positive. Thus, this result indicates a unique feature of SCCmec type IV strains in Japan. The information in this study not only is important in terms of local public health but will also contribute to an understanding of epidemic clones of CA-MRSA.

頭痛は日常診療で訴えの多い症状の一つであり，漢方治療では頭痛以外の随伴症状などによって，様々な漢方薬を使い分ける。今回，当帰芍薬散が有効な頭痛の症例を報告した。症例1－4は更年期障害，症例5は月経困難症が背景にみられた。症例3では頭痛のほか，めまい，むくみ，手先のしびれなど様々な症状が当帰芍薬散で改善した。また，症例4は呉茱萸湯が無効であり，一方，症例5は呉茱萸湯である程度頭痛は軽快したが，残存した排卵期または月経前と前半の頭痛に対して，当帰芍薬散を併用して症状が改善した。当帰芍薬散を用いた頭痛の11症例をまとめて検討したところ，頭痛は片頭痛が多く，月経や冷えで増悪傾向であった。当帰芍薬散は五苓散や半夏白朮天麻湯と鑑別が必要となることもあるが，当帰芍薬散では月経周期や更年期症状などいわゆる「血証」と関わりのある頭痛で，頭重感またはめまいを訴える比較的虚証の人に有効であると考えられた。

Objectives: To determine if rat bladders augmented with an acellular Japanese bovine pericardium-derived biomaterial (CardioDISC [CD]) could support bladder reconstruction, and increase bladder volume and compliance. Methods: Female Sprague–Dawley rats were randomly divided into three groups (n = 5 each). After partial cystectomy, bladders were closed without augmentation (non-augmentation) or augmented with porcine small intestinal submucosa (SIS) or CD, both of which are acellular. At 1, 2, 4 and 8 weeks after surgery, bladder volume and compliance were measured. The bladders were then analyzed by immunohistochemistry for smooth muscle actin (SMA), urothelium uroplakin III (UPIII), and nerve fiber S100. Results: At 4 weeks after augmentation, the SMA-positive cells from the host bladder tissues were present near the regions augmented with CD. In addition, S100-positive cells were present within the CD-augmented tissues. At 8 weeks after surgery, the CD-augmented tissues contained layered SMA-positive cells, urothelium uroplakin III -positive urothelium, and S100 fibers, similar to normal bladder tissue. The SIS-augmented bladders showed similar results. At 8 weeks after augmentation, the bladder volume of CD-augmented bladders was larger than that at 4 weeks, while the SIS-augmented bladders were the same as those at 4 weeks. The bladder volume of the non-augmented group did not increase. The bladder compliance of the CD-augmented bladders at 8 weeks was significantly higher than at earlier times. The bladder compliance of neither the non-augmented nor the SIS-augmented groups increased during the study period. Conclusion: Acellular bovine pericardium-derived material could be a suitable biomaterial for bladder augmentations

緒言：大柴胡湯が有効な全身倦怠感や易疲労感の患者タイプを多変量解析により検討した。対象と方法：全身倦怠感や易疲労感を訴え，随証治療にて大柴胡湯を投与した患者53名を対象とした。随伴症状，体質傾向，舌所見，腹部所見，年齢，性別，身長，体重，高血圧・高脂血症・糖尿病の有無，さらに，1カ月後の胸脇苦満の改善の有無を加えた計46項目を説明変数とし，全身倦怠感や易疲労感の改善の有無を目的変数として，多次元クロス表分析により最適な説明変数とその組み合わせを検討した。結果：大柴胡湯によって全身倦怠感や易疲労感を改善できる患者タイプは，「発汗」，「のぼせ」，「喉のつまり感」，「胸の圧迫感」などの自覚症状を伴う人であった。特に，発汗の症状があって治療後に胸脇苦満が軽減する場合に，大柴胡湯による全身倦怠感や易疲労感の改善が最も関連する結果となった。考察：「喉のつまり感」や「胸の圧迫感」などの気うつが背景にあると推測された。発汗は頭を含めた上半身に多い傾向があり，また，大柴胡湯による全身倦怠感や易疲労感の改善は，初診時の胸脇苦満の部位（右，左，両方）よりもむしろ治療後に胸脇苦満の軽減を認める人に認められやすいと考えられた。

緒言：桂枝湯エキスと麻黄附子細辛湯エキスの併用が有効な冷えのタイプを検討した。症例提示：麻黄附子細辛湯エキスに桂枝湯エキスを追加して，胃もたれの軽快とともに，長年の冷えも改善した一例を挙げた。この症例を参考にして当初より同処方を併用し，症例1は冷え，食欲不振，倦怠感や関節の動きが悪い，症例2は冷え，悪寒しやすい，疲れやすい，胃もたれ，風邪を引きやすいなど，症例3では悪寒を伴う全身の冷えや倦怠感，月経痛などが改善した。対象と方法：冷えを訴え，随証治療にて桂枝湯エキスと麻黄附子細辛湯エキスを投与した患者43名を対象とした。随伴症状，体質傾向や診察所見など52項目を説明変数とし，冷えの改善の有無を目的変数として多次元クロス表分析により検討した。結果：「悪風または悪寒」と「全身の冷え」を含む組み合わせが臨床的に最適な効果予測因子となった。考察：悪寒や悪風を伴う全身の冷えがあり，頭痛を訴え，下痢がない場合に有効な可能性が高い。

気管支喘息に対する漢方治療では，咳や痰の性状や呼吸困難の程度などを指標として，通常，臓腑の立場からは「肺」へのアプローチをを選択することが多いと思われる。さらに，気管支喘息の増悪因子がある場合は，その要因を排除することも大切である。今回，便通異常を伴って気管支喘息の症状が悪化した患者において，便通の改善を図ったところ，患者の咳嗽や呼吸困難などの症状が軽快した3症例を経験したので報告した。漢方では「肺」と「大腸」は表裏関係をなすとされるが，どのような気管支喘息患者の場合に，便通調整を考慮するのが有効であるかを検討した報告は少ない。今回の3症例から，便通が安定している軽症の気管支喘息患者が，突然，気管支喘息症状の悪化とともに便通異常を認めた場合に，「肺」に直接作用する処方だけではなく，その表裏関係にある「大腸」の作用を整える治療をすることが有効であるのではないかと推測された。

介護者が抱える諸症状に抑肝散およびその加味方が有効であった8症例について報告した。症例1はのぼせ，ほてり，集中できないなどの多彩な症状に抑肝散加芍薬，症例2は不眠および背中の痛みに抑肝散加味方，症例3は不眠に抑肝散合芍薬甘草湯，症例4はイライラや動悸に抑肝散，症例5は不安，不眠に抑肝散，症例6は手掌の湿疹に抑肝散加味方，症例7は目の奥の痛みと頭痛に抑肝散加陳皮半夏合芍薬甘草湯，そして，症例8は頸・肩こり，下痢，動悸，不眠，倦怠感などの症状が抑肝散加陳皮半夏（合芍薬甘草湯）を処方して症状が軽快した。愁訴は多岐に渡るが，その背景には，介護による慢性的かつ持続的なストレスが共通し，情緒系，筋，眼などと関係が深い肝の機能が障害されていると考えられた。また，症例5，6，7，8では，介護される者と介護者の双方に抑肝散を同時に服用させたところ，両方に効果がみられた。原典では「子母同服」とある。介護には，精神的・身体的健康状態が互いに影響を及ぼし合うような濃厚な人間関係があり，母子関係に通じるのではないかと思われた。本来の親子関係とは逆転するが，日常生活の面倒を看てもらう観点から介護される側を「子」，面倒を看る側を「母」ととらえ，「子母同服」の考え方が応用できると考えられた。

抑肝散およびその加味方の有効な頭痛の患者タイプを検討した。対象は，随証治療にて抑肝散およびその加味方を投与した頭痛の患者45人（男性6人，女性39人，中央値38歳，範囲25－68歳，片頭痛34例，緊張型頭痛6例，混合型頭痛5例）とした。年齢，性別，身長，体重と，初診時に認められた体質傾向と随伴症状からなる31項目を説明変数とし，頭痛改善の有無を目的変数として，多次元クロス表分析により最適な説明変数とその組み合わせ検討した。この結果，単変量解析では，抑肝散による頭痛改善に有効な情報は，「眼痛」，「背中の張り」，「目の疲れ」，「イライラ」の順であった。多変量解析では，「眼痛」，「イライラ」，「背中の張り」の組み合わせが，抑肝散による頭痛改善を予測する一番よいモデルとなった。古典的考察を加え，抑肝散およびその加味方は「肝」と関連する頭痛において治療効果を期待できると考えられた。また，抑肝散およびその加味方は，呉茱萸湯で軽快するもののストレスによって再び増悪する頭痛にも有効で，ストレスなどの頭痛発作の誘因や増悪因子を抑えるはたらきがあると推察された。従来，抑肝散には緊張興奮型などの腹証が重要視されてきたが，本研究では興味深いことに，むしろ背部所見に頭痛改善と強い相関を認めた。これまで抑肝散に関する背部所見の有用性について述べた報告はなく，今後は抑肝散証では背診も重要となることが示唆された。

釣藤散が有効な頭痛の患者タイプを多変量解析により検討した。51名の頭痛患者に対して随証治療にて釣藤散を投与し，このうち1カ月間服用した46名（男性13人，女性33人，中央値48歳，範囲19－77歳，片頭痛31例，緊張型頭痛14例，混合型頭痛1例）を対象とした。随伴症状，体質傾向，舌所見，腹部所見，年齢，性別，身長，体重，高血圧の有無の計38項目を説明変数とし，頭痛改善の有無を目的変数として，多次元クロス表分析により最適な説明変数とその組み合わせを検討した。この結果，単変量解析では，重要な順に「朝の頭痛」，「めまい・ふらつき感」，「不眠」，「体重」，「耳鳴」，「舌下静脈怒張」となった。これは，「朝の頭痛」という口訣を統計学的に支持する結果となった。多変量解析では，「朝の頭痛」，「舌下静脈怒張」と「頸肩こり」の組み合わせが，釣藤散による頭痛改善を予測する最適なモデルとなった。抑肝散証では「背中の張り」を重視するのに対して，釣藤散では「頸肩こり」が頭痛改善を予測する情報として有用であったことは，両者の鑑別に役立つものと考えられた。

In order to realize a Shogi program that can select natural moves, in this paper, we propose a method for predicting natural moves based on the flow of preceding moves. We extracted the sequence of moves appearing frequently in the game records of professional Shogi players and compared them with the game records of Shogi programs. We proposed a method that considers the flow of preceding moves, relates them to the extracted sequences, mentioned above, and overestimates them when selecting the next move. We conducted an experiment with experts to evaluate the effectiveness of the proposed system. Further, we discussed the nature of moves using the results of this experiment.

A 25-year-old man was referred to our hospital with left flank pain, and computed tomography (CT) and magnetic resonance imaging (MRI) revealed large retroperitoneal masses. Physical examination revealed many café-au-lait spots and superficial neurofibromas, and a diagnosis of neurofibromatosis type 1 (von Recklinghausen's disease) was made. The tumor was resected, and the pathological diagnosis was malignant peripheral nerve sheath tumor (MPNST). Six months after the operation, lung metastases were detected. Surgical resection was incomplete, as there were too many lesions. He received four courses of chemotherapy with carboplatin and etoposide, and the metastatic lung lesions were markedly decreased. After chemotherapy, complete resection of the remaining lung lesions was performed, and there has been no recurrence to date.

The definitive version is available at www.blackwell-synergy.com., Article, INTERNATIONAL JOURNAL OF UROLOGY. 12(8): 728-732 (2005)

Objectives : We evaluated serial changes of electrical and mechanical parameters of atrial remodeling in dogs subjected to rapid atrial pacing. Background : Prolonged rapid atrial excitation causes electrical and mechanical remodeling, which contributes to persistence of atrial fibrillation and clot formation. However, the temporal relationship between these two types of atrial remodeling remains unknown. Methods : In 8 dogs, rapid pacing at 400 ppm was continued for 14 days. The electrophysiologic and transesophageal echocardiographic studies were performed on the day before and after 2, 7, and 14 days of rapid pacing, then 1 and 7 days after the cessation of pacing. These were compared with sham-operated dogs (instrumented but not paced, n =6). Results : With rapid pacing, there was an immediate shortening of the effective refractory period (ERP) and decreases in the transmitral atrial wave velocity (MAV) and the left atrial appendage emptying velocity (LAAV). In contrast, conduction velocity (CV) decreased and the left atrial appendage area (LAAA) increased progressively over 14 days. During the recovery, ERP, MAV, and LAAV returned to the baseline in 1 day, whereas CV and LAAA did in 7 days. ERP was highly positively correlated with LAAV ( r =0.78, p r =0.73, p r =−0.58, p Conclusions : Pacing-induced electrical and mechanical remodeling of the atrium exhibits divergent patterns of progression and regression such that changes of ERP and contractile function take place more rapidly than those of CV and atrial size.

Patients with OSAS (obstructive sleep apnoea syndrome) demonstrate renal signs such as proteinuria, glomerular hypertrophy and focal glomerular sclerosis. We performed a clinical study to investigate the glomerular function in OSAS patients and the short-term effect of CPAP (continuous positive airway pressure) on it. OSAS patients underwent a sodium thiosulphate and p-aminohippurate double clearance test, polysomnography and ambulatory blood pressure monitoring before and a week after the induction of CPAP. Twenty-seven consecutive patients (24 males) with moderate-to-severe OSAS admitted to our hospital for the induction of CPAP, and 32 healthy donors for renal transplantation as controls participated in the study. Before treatment, the glomerular filtration rate, estimated by the sodium thiosulphate clearance test, was within normal range, and the renal plasma flow was significantly lower than normal in the OSAS patients, thus the FF (filtration fraction) value was much higher than normal. FF before CPAP was not significantly correlated with age, body mass index or blood pressure; however, indices of increased hypoxaemia correlated with increased FF values. Polysomnographic variables after CPAP showed significant improvements in all patients, and only the nocturnal blood pressures were slightly lower than before CPAP. In 21 patients who underwent the clearance test after CPAP, FF significantly decreased from 0.26±0.04 to 0.23±0.03 (P

To investigate the association between periprosthetic signal intensity at low-field-strength magnetic resonance (MR) imaging after failed hip arthroplasty and radiographic, surgical, and pathologic findings.The study group comprised 22 consecutive women who underwent hip arthroplasty (mean age, 62 years; age range, 35-74 years). All patients underwent MR imaging prior to revision surgery. Coronal fast short inversion time inversion-recovery (STIR) images and spin-echo T1-weighted images were obtained with a 0.5-T MR imaging unit before and after administration of contrast material. The periprosthetic region was divided into the seven femoral Gruen zones. Two observers retrospectively analyzed signal intensity patterns. Association of signal intensity patterns with radiographic, surgical, and pathologic findings was determined with chi2 analysis and generalized estimating equations.Diagnostic-quality images were obtained for 150 zones. Periprosthetic signal intensity was greater than that of bone marrow in the distal femur on the fast STIR images, and no contrast enhancement was seen on the T1-weighted images (type I signal intensity pattern) in 11 zones. Signal intensity was greater than that of bone marrow on the fast STIR images, and contrast enhancement was seen on the T1-weighted images (type II signal intensity pattern) in 45 zones. Signal intensity was less than or equal to that of bone marrow on the fast STIR images, and no contrast enhancement was seen on the T1-weighted images (type III signal intensity pattern) in 94 zones. Type I and II patterns were associated with focal or nonfocal lucency, an unstable stem, and fibrosis or granuloma. A type III pattern was associated with a normal radiographic appearance, a stable stem, and normal bone tissue. Significant association was demonstrated between periprosthetic signal intensity and radiographic (P.001, chi2 test and generalized estimating equations), surgical (P.05, Mantel-Haenszel chi2 test and generalized estimating equations), and pathologic findings (P.05, chi2 test).Low-field-strength MR imaging depicted periprosthetic tissue signal intensity that was significantly associated with radiographic, surgical, and pathologic findings.

Purpose The indications and the safety of non-ischemic partial nephrectomy using a microwave tissue coagulator were studied. Materials and methods Non-ischemic partial nephrectomy was performed on 17 kidneys of 16 patients using a microwave tissue coagulator. The diagnosis was renal tumor and renal stones in eleven and five patients, respectively. Renal tumors were less than 4 centimeters in diameter, while the stones were associated with a caliceal diverticulum or secondary cortical atrophy. Excision of the tumors was done via the retroperitoneal approach through an oblique lumbar incision. The needle of the microwave tissue coagulator was inserted around the tumor (stone) 10 to 20 times, and the coagulator was activated. Then the tumor (stone) was excised with a sharp knife or scissors. Patients were encouraged to walk on the first postoperative day. Results Vascular clamping was necessary in one patient to reduce bleeding. Nephrectomy was done after partial nephrectomy in one patient because it was difficult to close the urinary collecting system after it was widely exposed. Although urine leakage was seen postoperatively in two patients, it ceased spontaneously at 14 and 23 days after surgery. Postoperative complications developed in one of seven patients (14%) with protruding renal tumor, in three of five patients (60%) with non-protruding renal tumor and in two patients with renal stone. Allogenic or autologous blood transfusion was not necessary, nor was any bleeding noticed post-operatively. In one patient, atrophy of the renal parenchyma occurred gradually after surgery and function was eventually lost. However, renal function was well preserved and recurrence of the problem was not observed in the other 15 patients, excluding one who died of esophageal cancer. Conclusions The microwave tissue coagulator is a useful surgical instrument for non-ischemic partial nephrectomy, not only in patients with renal tumors but also in patients with complicated kidney stones. However, non-protruding renal tumor in a patient with solitary kidney should be avoided for this surgery. Thermal injury to the renal parenchyma or large vessels should be avoided and urine leakage from the collecting system should be meticulously treated during the operation.