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INTRODUCTION Endobronchial ultrasonography-guided transbronchial biopsy (EBUS-TBB) with guide sheath (GS) is an effective procedure for diagnosing small peripheral pulmonary lesions (PPLs) (≤20 mm in the largest diameter). However, samples obtained using EBUS-TBB with GS are small, and the diagnostic yield of small PPLs biopsied using EBUS-TBB with GS is unsatisfactory. OBJECTIVES The aim of this study was to evaluate the diagnostic yield of small PPLs using EBUS-TBB without GS compared to that with GS. MATERIALS AND METHODS Between 1 April 2013 and 31 March 2015, 276 consecutive lesions were biopsied using EBUS-TBB with GS or without GS. We retrospectively compared EBUS-TBB with and without GS in terms of the diagnostic yield and complications related to small PPLs (≤20 mm). RESULTS Of the 276 lesions who underwent EBUS-TBB with or without GS, we identified 80 lesions with small PPLs (≤20 mm). Sixty-two lesions were successfully diagnosed by EBUS-TBB (77.5%, diagnostic yield). The diagnostic yield of PPLs using EBUS-TBB without GS was not significantly higher than that using EBUS-TBB with GS (34/41 = 82.9% and 28/39 = 71.7%, respectively; p = 0.233). However, according to size (≤15 mm or > 15 mm), location (upper, middle/lingular, or lower area), and structure (solid nodule or ground-glass opacity), the diagnostic yield of small PPLs (≤15 mm) using EBUS-TBB without GS was significantly higher than with GS (21/26 = 80.7% vs. 8/16 = 50.0%, p = 0.036). There were no complications among the two groups. CONCLUSIONS EBUS-TBB without GS is an effective and safe procedure for diagnosing small PPLs (≤15 mm) compared to that with GS.

To determine the characteristics of eyes with treatment-naive quiescent choroidal neovascularization (CNV) detected by optical coherence tomography angiography (OCTA). Thirty-eight eyes of 37 treatment-naive consecutive patients (30 men, 7 women, average 69.8 years) were studied. Quiescent CNVs were detected by OCTA (RTVue XR Avanti, Optovue, Fremont, CA) in all eyes. Swept-source OCT (SS-OCT; DRI-OCT, Topcon, Japan) confirmed the absence of exudation. The symptoms, visual acuity, CNV size, and status of the fellow eye were evaluated. Patients were followed longitudinally and the length of follow-up period and development of exudation were recorded for each patient. We also investigated patients’ medical records from their referral hospitals in search of prior exudation. All eyes with quiescent CNV were diagnosed at the initial visit with sub-retinal pigment epithelium CNVs, i.e., type 1 CNV, from the OCT and OCTA images. Prior exudation was confirmed in 15 eyes (39.5%) from their medical records of the referral hospitals. Symptoms were present in 18 eyes (47.3%). An exudative CNV was present in 12 of the fellow eyes. Exudation developed in 12 eyes (31.6%) during an average follow-up period of 25.1 months. One-half of the eyes had a prior exudation. The CNV at the baseline in eyes that developed exudation during the follow-up period was larger than eyes without exudation; however, the difference was not significant (0.59±0.47 vs 0.48±0.32 mm2, P = 0.50). Quiescent CNVs will develop exudation in approximately 30% of the eyes during a mean 2-year follow-up period. These findings must be remembered when investigating quiescent CNVs that could not be distinguished from eyes with former active CNV and naturally deactivate CNV.

This study was conducted to clarify the relationship between the number of pollen grains per anther and spikelet fertility under low temperature conditions in the rice cultivars and lines including lines with quantitative trait loci (QTL) for cold tolerance, adapted to the Tohoku region of northern Japan. Cold-water treatment decreased anther length, the number of pollen grains per anther, and spikelet fertility in all cultivars and lines. The number of pollen grains was proportional to anther length in all cultivars and lines and under all temperatures. Spikelet fertility decreased with decreasing the number of pollen grains in cold-water treatments at 18.5 and 19.3 °C. ‘Ouu 415’, with the qLTB3 QTL for cold tolerance, had 28% more pollen grains and 9% higher spikelet fertility than the recurrent parent, ‘Hitomebore’, in the 18.5 °C cold-water treatment, suggesting that qLTB3 increased both parameters. Lines with the qCTB8 QTL for cold tolerance had significantly more pollen grains in two of the three years and significantly higher spikelet fertility in all three years in the 19.3 °C cold-water treatment, suggesting that qCTB8 reinforced cold tolerance. Ctb1, a proposed cold-tolerance QTL, had no effect on the number of pollen grains or spikelet fertility. In conclusion, the cultivars and lines with more pollen grains had a higher cold tolerance. Some of QTLs were inferred to increase the number of pollen grains and reinforce cold tolerance.

Case Coronal shear fractures of the hamate are relatively rare injuries. Surgical intervention is recommended for displaced fractures. However, there is no established surgical procedure for the displaced coronal shear fractures of the hamate. Therefore, we present 2 cases of the displaced coronal hamate fracture with metacarpal dislocations, which were successfully managed with open reduction and internal fixation, using the headless compression screw by the 2-directional approach. Conclusion Our procedure ensured that the screw's distal end captured the hamate hook, and the displaced bone fragments were reduced considerably in both cases.

Cell tissue construction is one of the important issues for tissue engineering, which is a key-technology in regenerative medicine. Recently, several studies have reported, the in vitro fabrication of simple cell tissues. However, organs are made of some kinds of cells and they are complex tissues. Therefore, a technology to reproduce the complex structure and biological function of the organ is needed. In this paper, we propose an automated system for the construction of a cell tissue in vitro, based on hydrogel fiber. We fabricate the cell tissues with some kinds of gel fibers, and the tissues with fine arbitrary shape structures. To evaluate the proposed system, a fine lattice structure was constructed as an example of cell tissue form. Furthermore, we designed a gel fiber discharge nozzle using laminar flow, and fabricated the lattice structure using laminar flow fiber. Through the experiments of the lattice shape structure construction, we observed the cell growth in the constructed lattice form, which proves the functionality of the structure. Moreover, we fabricated 3-laminar flow fibers, and we will fabricate more functional cell tissues.

Cell tissue construction is one of the important issues for tissue engineering, which is a key-technology in regenerative medicine. Recently, several studies have reported, the in vitro fabrication of simple cell tissues. However, organs are made of some kinds of cells and they are complex tissues. Therefore, a technology to reproduce the complex structure and biological function of the organ is needed. In this paper, we propose an automated system for the construction of a cell tissue in vitro, based on hydrogel fiber.

The dependence of the fusion excitation function on the orientation angles of the symmetry axis of deformed projectile- and target-nucleus relative to the beam direction is studied. The averaged over all orientations values of the fusion–fission cross sections obtained for 16 O + 238 U and 60 Ni + 154 Sm reactions are compared with the experimental data. The capture and fusion cross sections for the 16 O + 238 U reaction are nearly the same while those are different for the 60 Ni + 154 Sm reaction due to sufficient contribution of the quasifission events. The large values of the fusion cross section are obtained in the range 60 ° α i 90 ° of the orientation angles of the projectile- and target-nucleus. This phenomenon is explained by the dependence of the intrinsic fusion and quasifission barriers on the orientation angles of reactants.

We report a 76 -year-old woman with rheumatoid arthritis for 20 years, who gradually experienced dull pain in her leg thigh and general fatigue. She was gaven medicine at a near by hospital. But due to worsening conditions, she was introduced to our hospital. On the same day she visited our hospital, she reguired relaxation and debridement. Bacteriological examination showed the existence of group A Streptococci in the lesion, and we diagnosed this case as toxic shock like syndrome.Treatment with high-dose penicillin, clindamycin, and globulin were effective. After one month, she underwent skin graft from another thigh. After three months, she was able to walk for herself and was discharged. We considered it is important to diagnose her illness as Group A Streptococcus Infection.

External fixator is essential for unstable fracture of the distal radius. From January 1997 to December 2000, we treated 12 distal radius fractures with the Poanfix external fixtor. They included 1 male and 11 females aged 64 years on average. We classified them by Frykman's classification. To assess maintenance of reduction, ulnar variance (UV), palmar tilt, radial tilt, and carpal height ratio were measured before reduction and after removal of the external fixator. Clinical results by Saito's point system were excellent in 7 cases, good in 4, poor or fair in none, indicating results were satisfactory. X-p showed that palmar tilt and radial tilt did not differ significantly between before and after removal of the fixator. But 5 cases had UV greater than 2 mm. Two groups with more or less 2mm UV had different mean age and duration of external fixtor. The reason is suspected to be bone defect of distal radius due to osteoporosis. Consequently, we recommend a supplyment ary operation with external fixator for patients with radial fracture developing osteoporosis.

In this study we analyzed 70 patients with lumbar disc herniation treated by blocks since 1996. Fifty-one patients were treated by selective nerve root blocks and 19 were treated by continuous lumbar epidural blocks. The purpose of this paper is to compare the efficacy of the selective nerve root block and continuous epidural block. The functional results were evaluated on the basis of the Japanese Orthopaedic Association (JOA) score, subjective symptoms: 9 points. We assessed the block effectiveness when the JOA score improved by more than 2 points after the blocks. It was effective in 31 patients (60.8%) for selective nerve root blocks and 8 patients (42.1%) for continuous epidural blocks. Selective nerve root block is considered to be superior to continuous epidural block. Selective nerve root block showed better results especially for patients with negative SLR test. The herniated mass was protrusion type and space-occupying ratio was less than 30%.

【目的】大腿骨近位部骨折症例の手術からリハビリまでを担う当院において，自宅退院が困難となった症例を検討した．【対象と方法】H15～17年の間，当科で手術を行った大腿骨近位部骨折230例中，受傷前自宅生活であった174例（男性29例，女性145例，平均年齢83.0歳）を対象とした．転院あるいは施設入所となった症例群（施設入所群）の背景を調査し，また施設入所群と自宅退院群との比較により，自宅退院が困難になる影響因子を検討した．【結果】施設入所群は35例（20.1％）であった．自宅退院が困難になる影響因子は男性，独居，受傷前独歩不能および歩行能力低下であった．【考察】大腿骨近位部骨折の退院後治療において，施設介護は重要な役割を果たしている．一方で慢性的な施設数の不足は在院日数長期化の原因であり，入院早期からの多施設間での連携が円滑な退院後治療への移行に重要と思われた．

We have experienced 3 cases of dumb-bell tumor of the cervical spine. According to Eden's classification, there was 1 case of type 2, 1 type 3, and 1 type 4. Type 2 and type 4 cases were operated by the posterior approach. The type 3 case was operated on by both the posterior and lateral approach. Pathological diagnoses indicated pseudotumor in type 2, Schwannoma in type 3, and fibrous tissue tumor in type 4. There were no postoperative complications in all cases, but the type 3 case showed postoperative instability of the cervical spine.

We performed rotational acetabular ostetomy (RAO) on 14 patients. All subjects were women, their ages at surgery ranged from 25 to 52 years, and the follow-up period averaged 4 years. We compared the CE angle and AC angle before and after surgery.All patients showed improvement of both the CE angle and AC angle. The mean CE angle improved from 4.4 degrees to 24.6 degrees (p

The purpose of this study was to evaluate outcome of bilateral total knee arthroplasties (TKA's) in two groups of patients: Group A had simultaneous arthroplasty of both knees, and Group B had staged bilateral arthroplasty.Bilateral (TKA's) were performed in fifteen patients with severe rheumatoid arthritis (4 cases) and osteoarthritis (11 cases). Group A (8 patients) had both knees replaced simultaneously in one operation. Group B (7 patients) had two operation in a staged procedure. The postoperative mobility was analyzed in the two groups of patients who were similar with respect to age, type of arthritis, preoperative range of motion, and postoperative management.In this small series of cases there was a significantly shorter hospitalization period, and cheaper costs in Group A.

We studied eighteen patients who had surgical treatment for tibial condylar fractures with a mean follow-up of 40.3 months (5-77).We evaluated the clinical results according to Hohl and Luck's criteria. There was no agreement between joint function and good anatomical grade. By using multiple regression analysis, we examined factors which affect the functional results. Our study results suggests that anatomical reduction and early active motion were the most important factors for obtaining optimal result for this fracture.

For the treatment of calcaneal fractures, evaluation of the posterior articular facet is very important. Intra-articular fracture of the calcaneus can be divided into three groups based on Crosby's classification using CAT. We treated type II and III fractures by open reduction through the lateral approach, and we evaluated clinical results and post-operative congruity of the posterior articular facet of the calcaneus using CAT.There were 11 type II fractures operated on, and no type III fractures. Five patients achieved an excellent result and 6 patients a very good result with minor complaints. The posterior articular facet was reduced anatomically in 9 patients. Two fractures retained their pre-operative congruity.Crosby reported that patients with type II or type III fractures were not satisfied with the results by conservative treatment. We recommend that displacement of the posterior articular facet of the calcaneus be evaluated using CAT and type II fractures be treated surgically, rather than conservatively.

During a seven-year period, 63 total hip replacements were performed in osteoarthritis patients; Seven dislocations occurred. Three hips had one dislocation, while the remaining 4 dislocated more than once. Six dislocations were posterior and one, anterior. Open reduction was done in one, revision was required in 4.The angle and the height of the acetabular component of the roentgenograms were not significant between the control group and the dislocated group. The leg length (mean) in the surgery of the dislocated group was 9.5mm longer than that of the control group (p

The standard in vivo micronucleus (MN) test detects clastogenicity in hematopoietic cells and is not suitable for detecting chemicals that target the skin. Previously, we have developed an in vivo rodent skin MN test that is simple to perform and can be applied to several laboratory animals, including the hairless mouse-a species whose use simplifies the procedure of skin testing. In this paper, we report new data that confirms the predictive ability of the test. Following the application of 10 polycyclic aromatic hydrocarbons (7,12-dimethylbenz[a]anthracene; 3-methylcholanthrene; benzo[a]pyrene; dibenz[a,h]anthracene; benz[a]anthracene; dibenz[a,c]anthracene; chrysene; benzo[e]pyrene; pyrene; anthracene) with various degrees of genotoxicity to the dorsal skin of hairless mice, we found that these compounds caused MN production that in general correlated with their reported carcinogenicity. We believe that this test will be useful in detecting skin clastogens that test negative when analyzed using the standard micronucleus test.

Historical changes in forensic psychiatric evaluation on criminal responsibility and proceedings in psychopathological findings of amphetamine psychosis are reviewed at first. The classification of amphetamine related mental disorders are proposed in 6 types. Among them, the clinical characteristics and psychopathological features of "Anxiety-situational reaction type" (Fukushima) are described. According to some reasonable grounds, offenders diagnosed as anxiety-situational reaction type should be evaluated as diminished responsibility in place of irresponsibility. Finally, two cases of murder committed under the influence of amphetamine, are reported in detail.

We performed anterior radial keratotomy on the right eyes of nine rhesus monkeys, making eight incisions of various depths from 0.36 to 0.5 mm with a No. 76-A Beaver blade. After three months, corneal buttons were obtained from the operated on eyes of seven monkeys by penetrating keratoplasty and two monkeys were killed, and both operated and unoperated on eyes were enucleated. We examined the specimens by scanning and transmission electron microscopy. We saw linear protrusions on the posterior cornea beneath and parallel to the radial keratotomy incisions in all cases. There were swollen endothelial cells at the central cornea in three eyes. In eight corneas, we saw damaged endothelial cells with invading inflammatory cells. The control eyes showed no abnormal histologic findings. These findings suggested that deeper incisions cause more endothelial damage, possibly in relation to structural weakness produced in the cornea. We think that cuts in Bowman's membrane and in the stromal tissue may cause corneal stretching, resulting in a continuing process of injury to the endothelial cell layer. There may be long-term, continuing damage to the corneal endothelium after anterior radial keratotomy.