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The cardioprotective effects of glucocorticoids in the acute setting of ischemia/reperfusion have been experimentally demonstrated in animals1–7 and humans.8 Although the mechanisms underlying glucocorticoid cardioprotection are not known with certainty, glucocorticoids are reported to preserve cellular function in ischemia thereby prolonging the period of myocardial viability. In previous studies, glucocorticoids were reported to improve lactate imbalance and prevent the leakage of intracellular enzymes caused by myocardial ischemia.6,7 At the same time, deleterious effects of glucocorticoids on ischemia-induced neuronal damage have been shown in various animal models, despite the ability of glucocorticoids to alleviate cerebral edema caused by traumatic brain injury and hemorrhage.9–13 Further, steroids are not indicated for traumatic brain injury in humans, as they do not improve clinical outcomes.14 Because adenosine 5′-triphosphate (ATP) provides energy to maintain membrane functional integrity in both the heart and brain, and ATP depletion precedes loss of cellular viability, the different effects of the agents in ATP utilization in the heart and brain during ischemia could well explain differences in ischemia-induced organ injury. In the present study, therefore, we investigated the effect of dexamethasone, a glucocorticoid without mineralocorticoid activity, on ischemia-induced reduction of ATP in the mouse heart and brain. In addition, we examined the effect of metyrapone, a potent inhibitor of the synthesis of glucocorticoids, to assess the role of endogenous glucocorticoids. We hypothesized that ATP levels would be diminished in neuronal tissue subjected to dexamethasone and improved in cardiac tissue subjected to dexamethasone. In contrast, ATP levels would be improved in neuronal tissue subjected to metyrapone and diminished in cardiac tissue subjected to metyrapone.

Introduction There are patients with lumbar disc herniation (LDH) having contralateral sciatic symptoms although the mechanisms of this clinical feature are still not well understood. The purpose of this study was to investigate these mechanisms by microendoscopic findings. Methods Patients were performed microendoscopic surgery using over-the-top approach (ME-OTT), with laminoplasty, extirpation of herniation, and observation of the contralateral nerve root. The over-the-top approach was applied through the same incision from the herniation side. Clinical results were assessed according to the clinical scoring system established by the Japanese Orthopedic Association (JOA) score. Results This study consisted of five patients, with the average age of 55.6 years old. The mean preoperative JOA score was 13 points. Three cases were Grade II and two were Grade III degrees of disc herniation. Levels of herniation were one at L3-4 and four at L4-5. Remission of sciatic symptoms was obtained in all cases after surgery. The average and percent improvements (%IP) of JOA scores at 2 months after surgery were 27.8 points and 92%, respectively. By the approach from the herniation side using ME-OTT, image around the contralateral nerve root was obtained without radical intervention. By ME-OTT, redness of the nerve root and fibrosis around the symptomatic nerve root were identified, whereas inflammatory changes were not apparent on the ipsilateral nerve root. Conclusions Operative treatment of LDH with contralateral symptoms by ME-OTT was a useful procedure for decompression and observation of the affected nerve root. Asymptomatic disc herniation, "silent disc herniation," was considered at the herniation side since there were less inflammatory changes around the ipsilateral nerve root. In contrast, compression of dura toward the opposite side by disc herniation could have led to mechanical stress against the contralateral nerve root and triggered inflammation at lateral recess, resulting in radicular pain.

While it is necessary to use antifungal drugs for opportunistic deep mycosis in patients with immune system dysfunction,the inappropriate use of such drugs needs to be reduced to prevent occurrence of antifungal drug resistance as well as from the pharmacoeconomic viewpoint.In this study,we evaluated a notification system for the proper use of antifungal drugs that was introduced at Ehime University Hospital in January 2008.We investigated changes in antimicrobial use densities (AUD) of antifungal drugs,dosage period,number of patients receiving them and average dosage period of antifungal drugs in β-D glucan negative or unidentified patients from January 2007 to December 2008.After the introduction of the notification system,there was a significant decrease in the average monthly AUD of antifungal drugs (from 12.8±1.8 to 7.6± 1.8 ; p

Postoperative outcomes of segmental pedicle screw fixation were evaluated in posterior scoliosis surgery with the use of navigation system.We report the usefulness of a navigation system and a segmental pedicle screw fixation in surgery for scoliosis.Few reports on a segmental pedicle screw fixation method for scoliosis surgery using a navigation system have been published. This is the report on the usefulness of a navigation system in segmental pedicle screw fixation.We targeted 16 cases in which segmental pedicle screw fixation had been performed using a navigation system at our hospital. We inserted 264 pedicle screws in total, and we did not perform registration for each corpus vertebrate in order to shorten the duration of the surgery. We reviewed screw deviation among the items for review using Neo classification with postoperative CT images (1.25 mm). For screw deviation in this case, grade 2 or higher in the Neo classification system was designated as total deviation. Furthermore, we evaluated the registration period per corpus vertebrae, the complications, duration of surgery, blood loss, Cobb angle, and the correction rate.In terms of screw deviation, 11 (4.2%) of the 264 inserted screws were classified as total deviation. However, there were no neurovascular complications during or after surgery in any cases, and all cases maintained strong internal fixation. In the relationship between the use or nonuse of registration and the deviation, four screws (3.2%) in the corpus vertebrae for which registration was performed and seven screws (5.0%) in the adjacent corpus vertebrae for which registration was not performed had deviated. The duration of registration per corpus vertebrate averaged 4 min and 24 s (58-791 s), but registration also requires a learning curve, so the duration of registration per corpus vertebrae averaged 1 min and 14 s in more recent cases, thus marking a significant shortening.Segmental pedicle screw fixation are excellent in regard to their fixing and correction force and have been clinically applied even in surgery for scoliosis, but the potential risk of neurovascular complications is unavoidable. The adoption of a navigation system in surgery for scoliosis is useful to increase the safety and certainty of the insertion of pedicle screws.

Background context Because posterior decompression and fusion for vertebral collapse in an osteoporotic spine sometimes results in a pullout of the pedicle screw. Several authors reported that fixation of pedicle screws in severely osteoporotic bone could be improved by inserting polymethylmethacrylate (PMMA) into the hole before inserting the screw. However, pedicle screws were not designed to be used with PMMA. Purpose To report a patient with vertebral collapse who were treated using a novel-concept, pedicle nail using with PMMA. Study design Case report. Methods The patient was a 74-year-old female who experienced back pain after some heavy lifting 3 months before. She was laid up for 2 months because of the back pain and weakness of her lower legs. Radiographs and magnetic resonance imaging showed vertebral collapse and neural severe compression from the posterior wall of vertebra T12. The pedicle nail consists of an outer sheath with evenly spaced holes and an internal, removable, threaded component. The outer sheath and the internal component were connected before insertion. The pedicle nail attaches to and is bound by the PMMA through the holes of the outer sheath. We performed a T11–L1 posterior fusion and laminectomy using the pedicle nail, and we used a hydroxyapatite block to perform a transpedicular vertebroplasty of T12. Results Bone union was observed on a lateral radiograph without pedicle nail loosening. Conclusions The authors speculate that posterior spinal fusion and vertebroplasty using the pedicle nail will be a reasonable choice for delayed paraplegia after osteoporotic vertebral fracture.

近年の分子生物学などの飛躍的な発展の一因として，複雑な実験手技についての明確なプロトコルが確立されていることが挙げられる。しかし，テキスト形式のプロトコルでは伝達できる情報量が限られており，実験系の確立に手間や時間がかかることが多い。そこで注目を集めているのがオンラインビデオジャーナルのJoVE（Journal of Visualized Experiments）である。実験プロトコルや実験の結果についてのより多くの情報を，動画を用いて科学コミュニティー全体で共有するというJoVEの取り組みや今後の展開を紹介する。

Study Design. The midterm results of prostaglandin E 1 (PGE 1 ) treatment in patients with lumbar spinal canal stenosis, and discuss the factors influencing the improvement rate by using multivariable analysis. Objective. We report the clinical results of PGE 1 treatments in patients with lumbar spinal canal stenosis. of Background Data. Neurogenic intermittent claudication, a prominent symptom of lumbar spinal canal stenosis, poses a substantial impairment of quality of life in patients. A variety of approaches to treatment for lumbar spinal canal stenosis have been reported. However, general systemic complications make it difficult for many elderly people to undergo surgical treatment. Sometimes the only reasonable option is to receive conservative treatment. Methods. The subjects were 63 patients with lumbar spinal canal stenosis. After admission, patients were given an intravenous infusion of PGE 1 (60 μg/d) for approximately 2 weeks. To obtain the spinal canal stenosis rate, the area of the dural canal observed on magnetic resonance imaging and CT myelography was measured by using image analysis software (NIH image). The correlation of improvement rates to ages, JOA scores, claudication distances, and stenosis rate obtained through magnetic resonance imaging was evaluated using multivariable analysis. Results. Regardless of stenosis type, JOA scores significantly improved after PGE 1 administration (the mixed type: P < 0.0001, the nerve root type: P < 0.01, and the cauda equina type: P < 0.01), and claudication distance was significantly improved. Multivariable analysis showed that JOA scores before PGE 1 administration significantly contributed to the improvement rates. Conclusion. Our midterm results showed that PGE 1 was useful for treating intermittent claudication in patients with lumbar spinal canal stenosis. The effect of PGE 1 was not related to the degree of stenosis obtained with images, age, or claudication distance, but was correlated with baseline disease severity (JOA scores before administration).

STUDY DESIGN Morphometric analysis. OBJECTIVE For safe and solid fixation, it is necessary to measure the diameter of the vertebral arch to ascertain whether or not screws can be used and if so, the appropriate size of screws to be used. SUMMARY OF BACKGROUND DATA Cervical pedicle screws are the most biomechanically stable screws. However, their use carries a high risk of neurovascular complications during screw insertion. In 2004, a new method to avoid such vertebral artery injuries was reported by insertion of screws with crosswise to the lamina of C2. For safe and solid fixation, it is necessary to measure the diameter of the vertebral arch to ascertain whether or not screws can be used and if so, the appropriate size of screws to be used. There is no report of the diameter of the vertebral arch by a navigation system. METHODS Morphometric analysis was performed on 42 patients who had undergone a CT scan of the cervical spine for either surgery or diagnostic purposes. To examine the possibilities to insert laminar screws, the diameter of the vertebral arch was measured using a navigation system. RESULTS The diameter of the vertebral arch in C2 was the largest in the cervical spine, individual differences ranging between 0.8 and 8.4 mm. In C2, insertion of screws with a diameter of 3 mm was possible in 80% of males and 63% of females. As for screws with a diameter of 4 mm, insertion was possible in 50% of the males and 24% of the females in C2. In C2, gender had a significant effect, but left-right differences and height did not. CONCLUSION Laminar screws are useful as they can prevent vascular injuries, but a preoperative evaluation is necessary.

We performed fixation using laminar screws in 2 patients in whom lateral mass screws, pedicle screws or transarticular screws could not be inserted. One was a 56-year-old woman who had anterior atlantoaxial subluxation (AAS). When a guide wire was inserted using an imaging guide, the hole bled massively. We thought the re-insertion of a guide wire or screw would thus increase the risk of vascular injury, so we used laminar screws. The other case was an 18-year-old man who had a hangman fracture. Preoperative magnetic resonance angiography showed occlusion of the left vertebral artery. A laminar screw was inserted into the patent side (i.e., the right side of C2). Cervical pedicle screws are the most biomechanically stable screws. However, their use carries a high risk of neurovascular complications during screw insertion, because the cervical pedicle is small and is adjacent laterally to the vertebral artery, medially to the spinal cord, and vertically to the nerve roots. Lateral mass screws are also reported to involve a risk of neurovascular injuries. The laminar screw method was thus thought to be useful, since arterial injuries could thus be avoided and it could also be used as a salvage modality for the previous misinsertion.

Objective: Ischemic preconditioning (IP) has been shown to attenuate intracellular Na þ accumulation and Ca 2þ overload during ischemia and reperfusion, both of which are closely related to the outcome of myocardial damage. We compared the effects of single- and four-cycle IP in Na þ ,K þ -activated adenosine 5 0 -triphosphatase (Na þ ,K þ -ATPase) and Ca 2þ -activated adenosine 5 0 -triphosphatase (Ca 2þ -ATPase) activities in in vivo rabbit hearts, correlating these differences to the quality of protection against subsequent ischemia. Methods: The morphological outcome was evaluated in in vivo rabbit hearts subjected to 30 min of coronary occlusion and reperfusion for 180 min by assessing the ratio of infarct volume to risk zone volume. The effects of single- and four-cycle preconditioning ischemia were then examined. Another set of in vivo rabbit hearts was subjected to the measurement of ATPase activities at the conclusion of final preconditioning ischemia and at 60 min after reperfusion following 30 min of ischemia. Results: The infarct volume was reduced by single-cycle IP to 38% of that in the control group. The four-cycle IP further reduced the infarct volume, which was 11% of that in the control group. Na þ ,K þ -ATPase activity at 60 min after reperfusion in the four-cycle group was increased to 172% of that in the control group (10.8 mmol ADP/h/mg protein), whereas no difference was found in the single-cycle group. On the other hand, Ca 2þ -ATPase activity at the conclusion of IP was increased by single-cycle IP, the value being 255% of that in the control group (4.9 mmol ADP/h/mg protein). The four-cycle IP further increased the activity, and the value was 158% of that in the single-cycle group. Conclusions: Since increases in Na þ ,K þ -ATPase and Ca 2þ -ATPase activities contribute to the decrease in intracellular Ca 2þ concentration, the enhancement of these activities by four-cycle IP may be involved in the additional protection. q 2004 Elsevier B.V. All rights reserved.

A 54-year-old woman with a 21-year history of systemic lupus erythematosus (SLE) was admitted to the Matsuyama Red Cross Hospital due to subcutaneous and gingival hemorrhaging. She was diagnosed with acquired factor VIII inhibitors based on a prolonged activated partial-thromboplastin time (APTT) and factor VIII inhibitors. Steroid pulse and factor VIII plasma concentrate were administered to her, not long after which she was transferred to Ehime University Hospital due to gallbladder hematoma. Although her APTT and factor VIII activity were improved after treatment with human factor VIII, she died of multiple organ failure. The autopsy demonstrated a ruptured gallbladder.

We present a 38-year-old premenopausal Japanese woman with invasive micropapillary carcinoma (IMC) of the left breast with minimal lymph node metastasis despite a huge size. The patient noticed a left breast mass and a bloody nipple discharge 2 years before admission. On admission, physical examination revealed a huge, elastic hard mass with skin ulcer 12 × 12 cm in diameter occupying the entire left breast. The patient underwent modified radical mastectomy with level III lymph node dissection, and the defect was reconstructed with a vertical rectus abdominis myocutaneous flap. Histopathologically, IMC comprised about 60% of the tumor, admixed with papillotubular and mucinous carcinoma. Only one of twenty-five lymph nodes had tumor metastasis. The patient remains well 8 months postoperatively without any signs of recurrence.

This paper presents an in-process inspection-oriented autonomously generative CMM (Coordinate Measuring Machine) part programming methodology with a simplified part programming process to decrease the time and skill for CMM part programming. The proposed method differs from the CAD-based CMM programming approach. Using this new method, machining features in a complex part can be efficiently inspected after any stage of machining operations or after machining these features. The concept of the proposed CMM part programming approach and its implementation are described in this paper. The results obtained from the feasibility study show the developed CMM part programming system can autonomously generate an inspection plan for a work-in-progress part model generated from NC programs to realize the in-process measurement.

持続血液濾過透析(CHDF)中にメシル酸ナファモスタット(NM)による高カリウム血症を生じた慢性腎不全症例を経験した.症例は68歳の男性.肺水腫のため緊急入院し処置中に心停止を起こした.すぐに蘇生し人工呼吸下にNM30mg・hr-1を用いたCHDFを行った.入院時の血清K+は4.7mEq・l-1であったが,CHDF開始20時間後から急速に上昇し最高6.5mEq・l-1に達した.この高カリウム血症はNMをヘパリンに変更することで改善した.NMによる高カリウム血症の発生機序は尿へのカリウム排泄の抑制とされる.本症例は無尿の慢性腎不全のためこの機序による高カリウム血症ではない.NMが腎以外に作用して高カリウム血症を生じたと考えられた.

Rationale Coffin-Lowry syndrome (CLS) is a rare inherited disease with specific clinical features, such as mental retardation, facial dysmorphism, and cardiac abnormality. In particular, the characteristic facial features of CLS, including retrognathia and large tongue, are associated with difficult ventilation and/or intubation, which is a serious problem of anesthesia management. However, case reports on anesthesia management of CLS are very limited as there are only two published English reports till date. In this case report, we discuss anesthetic and postoperative considerations in patients with CLS, focusing on difficult airway management, and summarize past reports including some Japanese articles. Patient concerns A 25-year-old man with CLS was planning to undergo laminectomy because of progressive quadriplegia caused by calcification of the yellow ligament. We suspected difficulty in airway management because of several factors in his facial features, short thyromental and sternomental distances in computed tomography, severe obesity, and sleep apnea syndrome. Diagnoses Difficult airway was suspected. However, because of mental retardation, awake intubation was considered difficult. Interventions We selected bronchofiberscope-guided nasotracheal intubation, maintaining spontaneous breathing under moderate sedation with a propofol target-controlled infusion. Outcomes Airway management was safely performed during anesthesia induction. Lessons In many patients with CLS, difficult intubation was reported, and sedation or slow induction maintaining spontaneous breathing was mainly selected for anesthesia induction. Spontaneous breathing should be maintained during anesthesia induction in case of CLS patients.

症例は70歳の女性。マムシ咬傷後,マムシ毒の直接作用,およびDICとその合併症によって死亡した1例を報告した。初診34時聞後,咬傷側上肢全体の腫脹·乏尿·低体温にて当院救急救命センターを受診した。抗毒素血清療法,セファランチン療法,透析および血漿交換療法などの加療を施行するも,第8病日に死亡した。剖検の結果,死因はマムシ毒がDICを惹起し,腸管の穿孔,それによる腹膜炎からの敗血症を発症したことに加え,肺炎による呼吸不全となり,かつマムシ毒の直接作用による肝,心筋,腎尿細管などの出血,壊死などによる多臓器不全と考えた。

低血糖症状にて発症し, 死後の病理解剖にて急性壊死性膵炎と診断のついた症例を経験した. 症例は65歳, 男性. 橋本病と心房細動の既往歴があり慢性糸球体腎炎による腎不全のため1991年10月より維持血液透析中であった. 入院の前日まで著変なく経過していたが, 1996年5月意識障害をきたし当院へ搬送された. 入院時著明な低血糖発作 (13mg/dl) をきたしており, 血清アミラーゼ値は正常範囲内であった. 血糖値の改善とともに意識状態も改善がみられた. その後断続的な腹痛みられるものの血清アミラーゼ値の上昇は認めず, 低血糖の原因精査を行っていた. 第12病日早朝より強い上腹部痛が出現し再び低血糖発作と高度の乳酸アシドーシスを合併しショック状態となった. 腹部CT上Grade Vの急性膵炎の所見を認め加療を開始したが多臓器不全進行し死亡した. 死後の病理解剖にて急性壊死性膵炎の所見を認めた. 血液透析患者において急性壊死性膵炎を合併した場合本例のように非腎不全患者にみられる一般的な膵炎とは異なる臨床像を示すこともあるため注意が必要と思われる.

Methimazole (MMI) (>0.1 mmol kg(-1), p.o.) given in combination with DL-buthionine sulphoximine (BSO) (3 mmol kg(-1), i.p., 1 h before MMI administration), an inhibitor of glutathione (GSH) synthesis, caused liver injury in mice. The injury was characterized by centrilobular necrosis of hepatocytes and an increase in serum alanine transaminase (ALT) activity. Methionazole (2 mmol kg(-1)) alone resulted in only a marginal increase in serum ALT activity, but produced no histopathological changes in the liver. Pretreatment with hepatic cytochrome P-450 monooxygenase inhibitors--cobalt chloride, isosafrole, methoxsalen, metyrapone and piperonyl butoxide-prevented or tended to suppress the hepatotoxicity induced by MMI in combination with BSO. Treatment with N,N-dimethylaniline and ethyl methyl sulphide, competitive substrates of flavin-containing monooxygenases (FMO), also resulted in remarkable suppression of the hepatotoxicity caused by MMI in combination with BSO. These results suggest that MMI is activated by reactions mediated by both cytochrome P-450 monooxygenases and FMO, and that the inadequate rates of detoxification of the resulting metabolite are responsible for the hepatotoxicity in GSH-depleted mice.

STUDY DESIGN A retrospective study. OBJECTIVE To predict intraoperative vertebral rotation in patients with scoliosis using posterior elements as anatomic landmarks. SUMMARY OF BACKGROUND DATA In patients with scoliosis, accurate intraoperative vertebral rotation measurements are needed to avoid spinal cord injury caused by pedicle screw misplacement. Generally, we predict vertebral rotation by anatomic landmarks, that is, posterior elements that can be seen during surgery, such as spinous processes, transverse processes, or laminae. However, correlation between vertebral rotation and these anatomic landmarks is unclear. METHODS Seventy-six vertebrae (T4-T12) of 17 patients with thoracic scoliosis were measured. Patients who had severe scoliosis (>90 degrees Cobb angle) were excluded from this study. We assessed apex and adjacent vertebrae using axial computed tomography scans taken with patients in a supine position. We measured the angle between the vertebral reference line (Ve), defined as the midline of the vertebral body, and various lines based on the following anatomic landmarks of posterior elements of the vertebrae: (a) The Spinous q process line (Sp), defined as the midline of the spinous process; (b) A bisector (Bi) of the bilateral lines that pass the depressions in the laminae to the medial apex of the transverse processes; (c) a line (Tr) perpendicular to a line which passes the bilateral transverse processes; and (d) a line (La) perpendicular to the line which passes the bilateral depressions in the laminae. RESULTS The average Cobb angle in A-P radiographs was 68 degrees. The average angles between Sp, Bi, Tr, and La and the vertebral reference line were 13.6 degrees (range 0 degrees -29.2 degrees), 3.0 degrees (range 0 degrees -9.0 degrees), 2.5 degrees (range 0 degrees -8.1 degrees), and 4.4 degrees (range 0 degrees -11.9 degrees), respectively. CONCLUSION The line Tr, (runs perpendicular to the line which passes the bilateral transverse processes) had the greatest correlation to the rotation of a vertebra. On the other hand, the line Sp (defined as the midline of the spinous process) was not sufficient for predicting rotation of a vertebra and can be disregarded during the intraoperative analysis and screw placement.

We present three patients with urinary retention caused by spinal cord infarction of the deep white matter bilaterally within the ventral and lateral columns. This region corresponds to the watershed of the anterior spinal artery. We consider therefore that the descending pathway to the bladder lies in this area.

The paper deals with the autonomous programming technology for the high speed coordinate measuring machine (CMM). In order to provide the breakthrough technology to enhance the operability of CMMs to be used for in-line measurement of mechanical parts, a new autonomous programming method which automatically generates a CMM program from the CNC program used for machining of the part is proposed. The developed technology can provide new functionality such as efficient work-in-progress measurement capability without using the CAD product model based approach.

A 60-year-old man was transferred to our hospital in shock about 12 hours after onset of abdominal pain, vomiting, and diarrhea following a party he attended the previous night. There were no significant problems in his medical history. On admission he showed signs of hypotension, high fever, cyanosis, ecchymoses, and anuria. Laboratory examination revealed a marked decrease in white blood cells and platelets, liver and renal dysfunction, hypoglycemia, and metabolic acidosis. An abdominal computed tomographic scan demonstrated a small spleen. Sepsis with disseminated intravascular coagulation (DIC) and acute renal failure was suspected. He was treated with heparin, dopamine, epinephrine, methylprednisolone, and piperacillin and underwent continuous hemofiltration with endotoxin absorption. Despite these treatments his condition deteriorated rapidly and he died 18 hours after onset of symptoms. An autopsy showed a hypoplastic spleen, weighing only 44g, extensive hemorrhage in the bilateral adrenal cortexes, and no septic focus. A blood culture yielded Streptococcus pneumoniae. Immunochemical analysis revealed a marked decrease in the IgG2 level. These findings suggested that the patient had developed fulminant pneumococcal sepsis with DIC and Waterhouse-Friderichsen syndrome due to immunosuppression following a hypoplastic spleen. We should examine the immunological functions including hyposplenism when a healthy person suddenly develops septic shock without any readily identifiable cause.

The effect of argon ion etching pretreatment to observe the inner structure of coated paper by SEM was reported previously (The 61 st Pulp and Paper Research Conference of Japan Tappi, 1994). The application of this technique to commercialcoated papers is reported in this paper.The coated layer structure, especially pigment distribution and arrangement, was observed clearly by this technique. Based on the SEM observation for 21 kinds of commercial coated papers, this paper discusses the relationship between those structure and properties, e.g. Print gloss, Dry pick strength and Blistering resistance.

A 49-year-old man ingested about 200ml of Fenvalerate (synthetic pyrethroid)-Dimethoate (organophosphate) mixture with suicidal intent. He was in deep coma (GCS 3) on admission, 1 hour after ingestion, with a pupil size of 6mm on both sides. He had tachycardia, hypotension, hyperemic bulbar conjunctiva, blushed skin, and decreased activity of serum cholinesterase (Δph 0.45). These signs were compatible with pyrethroid poisoning. He was intubated and received gastric lavage. Six hours after ingestion, he developed systemic muscular fasciculation and clonic convulsion. Diazepam, midazolam, and vecuronium were given intravenously, but both conditions gradually worsened. Twelve hours after ingestion, he showed signs of organophosphate poisoning, such as miosis, increased salivation, and low serum cholinesterase (ΔpH 0.01). Atropine was given intravenously and he underwent direct hemoperfusion (DHP) on the 2nd and 3rd hospital days. Strong muscular fasciculation and convulsion markedly decreased after the 1st DHP. The patient was discharged on the 20th hospital day without any neurological sequelae.This case suggests that the signs of pyrethroid poisoning may develop very early and DHP that is effective for frcating muscular fasciculation and convulsion due to poisoning pyrefhroid.

A cDNA clone encoding a tissue-type transglutaminase (TGase) was isolated from a cDNA library prepared from the liver of red sea bream (Pagrus major). The cDNA sequence had an open reading frame coding for a protein of 695 amino acids and showed 43% identity to the sequence of guinea pig liver TGase, revealing a relatively low overall similarity. However, the 25-amino-acid sequence containing the putative active site (Cys272) of the enzyme was completely conserved between the two species, and was also identical to the corresponding regions of human and bovine endothelial cell TGases. In addition, the critical residues (His332 and Asp355) thought to form the catalytic-center triad together with Cys272, were found in the highly conserved region. The red sea bream TGase had an extension of 11 amino acids in the C-terminal region and some differences in the N-terminal region when compared with guinea pig TGase. From the cloned cDNA, a semi-synthetic TGase gene suitable for overexpression in Escherichia coli was constructed (pTTG2-22). At a reduced temperature (28 degrees C), E. coli cells transformed with pTTG2-22 could produce soluble TGase which exhibited catalytic activity in the presence of calcium. E. coli extracts containing the recombinant red sea bream TGase induced gelation of actomyosin solutions, accompanied by a significant increase of epsilon-(gamma-glutamyl)lysine bonds, which are predominantly derived from the cross-linking of myosin heavy chains. These results indicate that this fish TGase should be useful for further analysis of TGase structure/function relationships and that it could also be employed to enhance the viscoelastic properties of proteinaceous materials.

Candidiasis of the esophagus progressing to stricture formation in a 74-year-old male is reported. Esophageal candidiasis develops in the presence of various predisposing conditions such as long-standing administration of antibiotics or corticosteroids, and malignancy. The first endoscopic examination of this patient revealed unusual multiple black plaques in the esophagus. Despite intensive exploration, no predisposing factors were found. The stricture was progressive, despite the administration of adequate antifungal therapy, and its presence necessitated several attempts at dilatation. Case reports of esophageal candidiasis without underlying disease are very rare.

It has been proved that genuine microgrooves on the rubbed polymer surfaces for liquid crystal alignment have very regular and narrow intervals. The minimum mean interval, 0.03 μm, is observed by field-emission scanning electron microscope (FE-SEM) after staining the polyimide alignment layer with ruthenium tetroxide (RuO4) at room temperature. Its coefficient of variance is 14.7%. Results on Atomic Force Microscope (AFM) measurements essentially coincide with that of FE-SEM. On the other hand, microgrooves of the poly(amic acid) which has poor ability to let the liquid crystals align, have less regular and wider intervals than polyimide. Five other polymers were also observed in the same manner. Non-destructive staining at room temperature and the existence of heavy metal compound on and just beneath the surface may make possible observation of the real topography of the rubbed polyimide surface. It is also emphasized from dichroic ratio measurements that observation without any distortion of the samples is very important.

The relationships between the speed of deterioration in severe asthma attack and clinical characteristics as measured by arterial blood gas values, duration of mechanical ventilation needed, and course of peak inspiratory pressure (PIP) during mechanical ventilation were studied. Twenty-six patients with severe bronchial asthma who underwent mechanical ventilation were classified into 3 groups according to the time interval from the first symptoms of asthma attack to endotracheal intubation: rapid onset group-(ROG: n=9

Endothelium-dependent relaxations mediated by Gi protein are prominently impaired in atherosclerotic coronary arteries. However, it remains to be determined whether the expression of endothelial Gi protein per se is reduced in coronary atherosclerosis. Thus, in the present study the expression of endothelial Gi protein was examined by immunohistochemical staining using a specific antibody against human Gi protein (alpha-subunits of Gi-1 and Gi-2 proteins) in the proximal segment of the left anterior descending coronary arteries (segment 6) from 40 consecutive autopsy cases. The immunoreactive level of the Gi protein was semi-quantitated in four grades (none, 0; slight, +; moderate, +2; high, +3) and the mean value of the ratings of all endothelial cells was used as an index of the endothelial Gi protein expression of the artery. The immunoreactive level of the Gi protein in human coronary arteries was significantly reduced with ageing and extent of coronary atherosclerosis (both P0.05), and was lower in patients with than in those without hypertension (P0.01) or hyperlipidaemia (P0.05). In addition, the level was significantly lower in the eccentric portions than in the concentric ones in each atherosclerotic coronary artery (P0.0001). These alterations in the immunoreactive level of endothelial Gi protein in human coronary arteries may explain, in part, why Gi protein-mediated, endothelium-dependent relaxations are prominently impaired in atherosclerosis.

It is suspected that there is a surface layer which structure is different from the inner part of the coated layer. And it might be easily considered that the structure of real cross section is broken when microtomed. The broken layer might cover the real cross section. The observation of the structure of the coated layer by a scanning electron microscope must be considered very carefully.Herein, we introduce a new technique to remove the above-mentioned layers in order to observe the inner or real structures.The technique includes argon ion etching procedure of the coated layer stained with osmium tetroxide. This etching is assumed to remove the layers resulting in clear observation of the structure.Using this technique, we can observe the coated layer structure more precisely. Application of this to two types of coated paper made in different drying temperature and to two kinds of coated paper of different air permeability shows effectiveness clearly and gives resonable results.

We experienced an incident of the stricture caused by the degradation of an O-ring in the oxygen outlet of the central piping. The event was identified by the intermittent decrease of the central piping oxygen supply pressure into the anesthesia machine. In this case, pressure was judged normal by periodical checking. But the malfunction became clear when the parts of outlet were replaced, because similar incidents frequently had occurred. The cyclical rhythm of the declining oxygen supply pressure means that oxygen supplies decreases with the increase of oxygen consumption, and it may be a sign of serious malfunction. Therefore, it is necessary to check the pressure deviations under use of high-flow oxygen.

"Seishu Hanaoka and his surgery" by Shuzo Kure is one of the most important books for the study of Seishu Hanaoka. However, several incorrect descriptions have been pointed out in the book. Therefore, we checked the content about Seicho Kamata, a distinguished disciple of Seishu Hanaoka (p.154-163) in the book, and found three incorrect descriptions. The figure being described as that of Seicho Kamata is his father's. His graveyard being described as "Nyohoji" is truly "Daizenji". Seicho Kamata is also described as the second distinguished disciple of Seishu Hanaoka ; however, authors think that he was the first distinguished disciple from his career. Further investigation into the content of the book is necessary.

A modified mean field theory is applied to the axial next nearest-neighbor Ising (ANNNI) model, where the model is treated exactly along the direction of competing axial interactions while the mean field approximation is made within the ferromagnetic layer. Particular attention is paid to the partially disordered states and the asymmetric states, which are predicted to be stabilized by the mean field theory if the intralayer interaction is weak. Both numerical and analytical calculations are made to find that neither the partially disordered states nor the asymmetric states are stabilized but only the conventional ordered states are stable.

The coating color which is applied on the base paper forms the coated layer structure. In this process, latexes migrate and form coated layer as binder.We directly observed the latex film continuously surrounding clays which were removed by hydrofluoric acid before observation.We also examined the latex film forming process using the method of freeze-drying. “Tg” (glass transition temperature) of the latex particles plays an important role on the formation of the coated layer and its structure. The lower the Tg is, the bulkier the coated layer structure is. This coincides with the result of the mercury porosimetry.

アクリル酸カリウムやアクリルアミド (AAm) などの固体モノマーをグロー放電プラズマにさらすと, 重合反応が固相で起こってポリマーが生成した. ここではこの重合をプラズマ固相重合と呼ぶ. このような重合は鎖状のポリアクリル酸カリウム及びゲル状のポリAAmを生成した. AAmとメタクリルアミドあるいはマレイミドとの二成分固体の共重合を検討した結果, これらの系が混合物を形成する場合はゲル状ポリマーを生成するが, 固溶体あるいは化合物を形成する場合は鎖状ポリマーを生成することがわかった. これらの結果から, プラズマはモノマーの固体表面を攻撃して重合を開始すると推定され, また, AAmの場合は, プラズマ電極に供給した電力によって絶縁破壊が起こり, モノマー結晶が局部的に溶融するため, 固相重合の成長反応が進むと考えられる.

BackgroundNeuronal nitric oxide synthase (nNOS) is involved in the regulation of a diverse population of intracellular messenger systems in the brain. In humans, abnormal NOS/nitric oxide metabolism is suggested to contribute to the pathogenesis and pathophysiology of some neuropsychiatric disorders, such as schizophrenia and bipolar disorder. Mice with targeted disruption of the nNOS gene exhibit abnormal behaviors. Here, we subjected nNOS knockout (KO) mice to a battery of behavioral tests to further investigate the role of nNOS in neuropsychiatric functions. We also examined the role of nNOS in dopamine/DARPP-32 signaling in striatal slices from nNOS KO mice and the effects of the administration of a dopamine D1 receptor agonist on behavior in nNOS KO mice.ResultsnNOS KO mice showed hyperlocomotor activity in a novel environment, increased social interaction in their home cage, decreased depression-related behavior, and impaired spatial memory retention. In striatal slices from nNOS KO mice, the effects of a dopamine D1 receptor agonist, SKF81297, on the phosphorylation of DARPP-32 and AMPA receptor subunit GluR1 at protein kinase A sites were enhanced. Consistent with the biochemical results, intraperitoneal injection of a low dose of SKF81297 significantly decreased prepulse inhibition in nNOS KO mice, but not in wild-type mice.ConclusionThese findings indicate that nNOS KO upregulates dopamine D1 receptor signaling, and induces abnormal social behavior, hyperactivity and impaired remote spatial memory. nNOS KO mice may serve as a unique animal model of psychiatric disorders.

A 36-year-old woman was scheduled for the right lower lobe resection under the left one-lung ventilation with a double-lumen tube (DLT). Difficult intubation due to limited (1.5 cm) mouth opening was recognized following the induction of anesthesia. Fiberoptic oral intubation by the DLT was successfully performed under the ventilation via the nostrils using a small-size, child mask covering only the nose (nasal mask). Ventilation was well maintained using the nasal mask, and the gas leakage was coped with tightening the lips with the tube and using a high flow of oxygen. This nasal mask ventilation method is useful and safe in cases of difficult intubation by DLT in which no other proper methods are available.

In this study, the stomal portion of the gastric remnant mucosa following a gastrectomy for gastric cancer was examined endoscopically and histopathologically. The ODC activity was assayed from biopsies from the stomal portion of the gastric remnant and from the greater curvature. The results obtained can be summarized as follows: 1. Endoscopic changes in the stomal mucosa (redness) were found significantly more often in patients following a B-II than in patients who had had a B-I. Histopathological changes consisting of glandular dilatation and an irregular glandular structure were detected in many of the stomal mucosal specimens. 2. The ODC activity was significantly higher in the stomal portion of the remnant stomach tlian in the greater curvature. As for the stomal portion, ODC activity was significantly higher following a B-II titan following a B-I. In summary, the present findings suggest that active cell proliferation occurs in the gastric remnant mucosa, particularly in the region of anastomosis, and that an enhancement of cell proliferation kinetics plays a role in the pathogenesis of primary cancer in the stomal portion of the remnant stomach.

— We determined intracellular free Ca2+ concentration by fluorescence spectroscopy and the time-resolved measurements of 2-[(2-amino-5-methylphenoxy) methyl]-6-methoxy-8-aminoquinoline-N, N, N′, N′-tetraacetic acid, tetrapotassium salt (Quin2) incorporated in suspended mouse leukemia L1210 cells. The paper reports the following two points. (1) Various fluorescence spectrum patterns in cell suspensions dissolved with Quin2 acetoxy methylester were compared with those of the complex in buffer solution containing esterase. (2) The fluorescence lifetime of Quin2 bound to Ca2+ was approx. 4.5–11 times longer (10 ± 1 ns) than that (1.5 ± 0.5 ns) of Quin2. The fraction of the long lifetime component was plotted against the concentration of CaCl2 in buffer solution. From the results obtained, it was found that approx. 35 nM Ca2+ was contained in each L1210 cell.

The superconducting field winding of the 70-MW classhigh-response excitation superconducting generator requires a maximum operation current of 4.5 kA at the field of 6 T and needs to allow the field change of 10 T/s. In addition, superconductors have to meet the requirements of saddle-shape winding in the rotor slot and require the mechanical strength withstanding the centrifugal force as well as electromagnetic force. The developed conductor has the configuration of double stranded cable, consisting of NbTi, Cu and CuNi. An optimization was made, taking into account the requirement of low ac loss and high current density. The critical current of 13.6 kA was achieved at the field of 6 T and the ac loss was 6.9 kW/m3. The developed low-loss high-current density superconductor will be able to be applied to the field winding of the 70-MW class high-response excitation superconducting generator.

The cell proliferative activity and capability of cytodifferentiation of cancerous and non-cancerous thyroid tissues were studied using 3H-thymidine (3H-TdR) autoradiography and immunohistochemistry for thyroglobulin. Cancerous lesions were induced by diisopropanolnitrosamine (DIPN) followed by methylthiouracil (MTU). Regenerative thyroid tissues were obtained through wounding. All the rats treated successively with DIPN and MTU were found to have carcinomas that invaded the surrounding tissue or blood vessels. By cumulative labeling with 3H-TdR, the maximal cell cycle times (Tc) of invasive and non-invasive parts of carcinomas were estimated to be 120hr and 180hr, respectively, whereas the Tc of regenerative and hyperplastic thyroid tissues were estimated as 113hr and 519hr, respectively. However, the duration of S phase (Ts) was greater in cancers (15-35hr) than in non-cancerous tissues (3-4hr), and the cancerous tissues showed lower expression of thyroglobulin than the non-cancerous thyroid tissues. These may reflect some injury in the DNA of cancer cells.

Background Schizophrenia is a complex genetic disorder caused by multiple genetic and environmental factors. The dystrobrevin-binding protein 1 (DTNBP1: dysbindin-1) gene is a major susceptibility gene for schizophrenia. Genetic variations in DTNBP1 are associated with cognitive functions, general cognitive ability and memory function, and clinical features of patients with schizophrenia including negative symptoms and cognitive decline. Since reduced expression of dysbindin-1 has been observed in postmortem brains of patients with schizophrenia, the sandy (sdy) mouse, which has a deletion in the Dtnbp1 gene and expresses no dysbindin-1 protein, could be an animal model of schizophrenia. To address this issue, we have carried out a comprehensive behavioral analysis of the sdy mouse in this study. Results In a rotarod test, sdy mice did not exhibit motor learning whilst the wild type mice did. In a Barnes circular maze test both sdy mice and wild type mice learned to selectively locate the escape hole during the course of the training period and in the probe trial conducted 24 hours after last training. However, sdy mice did not locate the correct hole in the retention probe tests 7 days after the last training trial, whereas wild type mice did, indicating impaired long-term memory retention. A T-maze forced alternation task, a task of working memory, revealed no effect of training in sdy mice despite the obvious effect of training in wild type mice, suggesting a working memory deficit. Conclusion Sdy mouse showed impaired long-term memory retention and working memory. Since genetic variation in DTNBP1 is associated with both schizophrenia and memory function, and memory function is compromised in patients with schizophrenia, the sdy mouse may represent a useful animal model to investigate the mechanisms of memory dysfunction in the disorder.

The concept of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome has been well clarified, after Chamot et al. suggested this peculiar disorder in 1987. The most commonly affected site in SAPHO syndrome is the anterior chest, followed by the spine. However, the clinical course and taxonomic concept of SAPHO spinal lesions are poorly understood. This study was performed to analyze: (1) the detailed clinical course of spinal lesions in SAPHO syndrome, and (2) the relationship between SAPHO syndrome with spinal lesions and seronegative spondyloarthropathy. Thirteen patients with spondylitis in SAPHO syndrome were analyzed. The features of spinal lesions were a chronic onset with a slight inflammatory reaction, and slowly progressing non-marginal syndesmophytes at multi spinal levels, besides the coexistence of specific skin lesions. SAPHO syndrome, especially spinal lesions related to palmoplantar pustulosis, can be recognized as a subtype of seronegative spondyloarthropathy.