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Background; Magnetic resonance urography (MRU) is a new technique using heavily weighted T2 images. The present study described the clinical usefulness of MRU.Patients and Methods; Twenty-seven patients with urinary tract obstruction and 2 patients without obstruction underwent MRU. The urogram was reconstracted by means of maximum intensity projection method and multiplanar reformation method. As imaging examinations, intravenous urography (IVU) and retrograde pyelography (RP) were conducted in 22 and 11 patients, respectively. The quality of the images was subjectively classified into4grades (grade 0 to 3).Results; In the comparison of IVU to MRU, 9 patients whose urinary tracts were not identifiable or slightly identifiable (grade 0 or 1) by IVU showed grade 2.5 in the average in MRU. The average grade obtained by MRU was 2.6 in the patients whose urinary tracts were not clearly shown by RP.Conclusions; MRU provides an alternative to conventional imagings of urinary tract, especially in the cases in which only poor images are obtained by IVU. Although MRU cannot completely replace RP, it is useful to identify the location of the urinary tract disease, which is unidentifiable by RP., 背景；Magnetic resonance urography（MRU）はT２強調MRUとも呼ばれる新しい画像診断技術であり，当科における本法の臨床的有用性について検討した。対象と方法；尿路閉塞を伴う２７症例，および尿路閉塞を伴わない２症例を対象とした。尿路はmaximum intensity projection法とmultiplanar reformation法で描出した。他の画像診断として静脈性尿路造影（intravenous urography : IVU）および逆行性腎盂造影（retrograde pyelography : RP）を各々２２例，１１例に施行した。得られた画像はgrade０から３の４段階評価を加えた。結果；IVUとMRUの比較では，IVUで尿路の描出がgrade０あるいは１の９症例において，MRUでは尿路描出能は平均grade２．５であった。またRPで尿路描出が不良であった症例のMRU尿路描出能は平均grade２．６であった。結論；MRUは特にIVUで尿路の描出が不良な症例において優れた尿路描出能が認められた。MRUは完全にRPの診断能を凌駕するものではないが，RPで診断できないような尿路閉塞病変の位置確認などに有用であった。

The risk of nerve injury for pediatric thoracic epidural block increases stress for anesthesiologists. The purpose of this study was to investigate the usefulness of longitudinal ultrasound imaging for thoracic epidural block (T5-T6 or T6-T7) in anesthetized children scheduled for the Nuss procedure.Neuraxial structure in the longitudinal paramedian section was observed using ultrasound imaging before epidural puncture (US group, n = 10). In the control group, usual epidural block without ultrasound was performed. Attempts were made to observe epidural catheterization in ultrasound imaging in three cases.Patient age ranged from 5 to 7 years. Time for epidural block in the US group [100 (77-116) s; median value (95% confidence interval)] was significantly shorter than that in the control group [165 (130-206) s; P = 0.001]. The difficulty score was significantly lower in the US group than in the control group (P 0.001). Epidural catheterization was observed in all three cases in which the catheter manipulated the dura mater ventrally. There was a high correlation (r = 0.98, P 0.001) between needle depth and ultrasound estimation of the skin-dura distance in the US group.We concluded that longitudinal paramedian ultrasound imaging could reduce performance time and the difficulty for anesthesiologists during epidural block.

Objectives. We investigated the clinical effects and accuracy of ultrasound-guided cervical nerve root block. Additionally, spinal level and spread of injected solution were confirmed by anatomic dissection of fresh cadavers. Design Setting, Patients, and Interventions. Twelve patients diagnosed with mono-radiculopathy between C5–7 underwent ultrasound-guided nerve root block. An insulated needle was advanced with an in-plane approach using nerve stimulation and 2 mL of 0.375% ropivacaine with 4 mg of dexamethasone was injected using nerve stimulation. Ultrasound-guided C5–7 nerve root block was also performed in ten fresh cadavers. Blue dye (2 mL) was injected onto each nerve root and anatomic dissection was performed to confirm the exact spinal level and spread pattern of the dye. Results. Pain score before the procedure (65 [46–80], median [interquartile range]) was decreased to 25 [3–31] at 24 hours (P = 0.003) and 40 [28–66] at 30 days (P = 0.02) after the root block. Obvious side effects were not seen. All target nerve roots in patients and cadavers were correctly identified by ultrasound imaging. The needle tip did not reach the pedicle of the vertebral arch in the anteroposterior view of fluoroscopy, and spread pattern of contrast medium was extraforaminal and extraneural. Conclusions. This study suggests that injected solution by ultrasound-guided cervical nerve root block mainly spreads to the extraforaminal direction compared with conventional fluoroscopic technique. Therefore, present clinical study involves possibility of safer selective nerve root block with sufficient analgesic effects by ultrasound guidance, despite the absence of intraforaminal epidural spread of solution.

INTRODUCTION Laparoscopic management for potentially malignant renal cysts can pose a therapeutic dilemma, because it is difficult to resect the cystic tumor without spillage of its content. We developed a new technique to minimize the risk of inadvertent intraoperative rupture of the cyst capsule by using a S.A.N.D. balloon catheter. MATERIALS AND METHODS A 45-year-old male presented with an indeterminate renal cyst, and was underwent laparoscopic partial nephrectomy. The cyst wall was sandwiched and sealed firmly between the 2 balloons, which are equipped at the tip of a S.A.N.D. balloon catheter. The cystic tumor was completely excised without renal pedicle clump. RESULTS The operation was successful without intraoperative morbidity and no intraperitoneal spillage of cyst content occurred. CONCLUSIONS We demonstrate how to avoid the intraoperative rupture of the cyst capsule by using a S.A.N.D. balloon catheter. This technique is safe and feasible, while maintaining the benefits of minimal invasiveness.

Background and objective Phosphodiesterase 3 (PDE3) inhibitors and sevoflurane are both known to have bronchodilator properties and the combination of these two agents may be synergistic. We tested this hypothesis in a model of airway hyperresponsiveness using ovalbumin-sensitised guinea pigs. Methods Animals were randomised into five groups: control, sevoflurane, sevoflurane/theophylline, sevoflurane/milrinone and sevoflurane/olprinone. Total lung resistance (RL) and dynamic lung compliance (CL) were recorded and the dose-response curves for acetylcholine (Ach) of RL and CL were used to evaluate the bronchodilator effect. Results The dose-response curve for Ach of RL was elevated that for and CL was depressed significantly in the ovalbumin-sensitised animals compared to normal control guinea pigs. Among the five sensitised groups, RL was higher in the order of control > sevoflurane > sevoflurane/theophylline > sevoflurane/milrinone > sevoflurane/olprinone with increasing Ach concentration. Sevoflurane/olprinone treatment attenuated the bronchoconstriction induced by the highest dose of Ach with RL being significantly lower (0.318 ± 0.056 cmH2O ml(-1) s(-1)) than those observed in the control group (0.437 ± 0.061 cmH2O ml(-1) s(-1)), sevoflurane group (0.378 ± 0.052 cmH2O ml(-1) s(-1)) and in the sevoflurane/theophylline group (0.374 ± 0.073 cmH2O ml(-1) s(-1)). Conclusion Combined use of PDE inhibitors with a volatile anaesthetic had a synergic bronchodilator effect in ovalbumin-sensitised guinea pigs. A greater bronchodilator effect can be obtained by using the selective PDE3 inhibitor olprinone with the volatile anaesthetic sevoflurane.

The dimorphic sperm of Hemilepidotus gilberti, i.e., haploid eusperm and diploid parasperm, have different morphologies corresponding to their own roles in fertilization. To estimate how these specific sperm morphologies were established, we focused on the nuclear morphologies and examined their changing processes in dimorphic spermiogenesis. Electron microscopic observation revealed that, in euspermatids, chromatin condensation first appeared as a mosaic pattern of moderate electrodense material in the peripheral region of the round nucleus. Those materials spread across the whole area to form a uniformly condensed nucleus. Chromatin condensation began similarly in paraspermatids to that in euspermatids. These became localized to one side of a nucleus and further condensed to form strong electrodense chromatin clusters, which are a specific feature of parasperm. From the remodeled nuclei of eusperm and parasperm, we found five and three kinds of sperm-specific basic proteins (SBPs), respectively, substituted to histones. The N-terminus amino acid sequences of the SBPs suggest that, in parasperm, one major SBP and two minor ones were distinct from each other. In eusperm nuclei, two kinds of specific SBPs were detected in addition to the homologs of parasperm SBPs. The specific SBPs had homologous amino acid sequences with huge arginine clusters, and one of them was most dominant among the five kinds of SBPs. The different combinations of SBPs in the eusperm and parasperm may cause a specific pattern of chromatin condensation in the dimorphic sperm nuclei of H. gilberti.

We provide an initial description of laparoscopic diagnosis and management of urachal mucinous borderline tumor associated with pseudomyxoma peritonei. Treatment for pseudomyxoma peritonei remains controversial, with continually evolving surgical procedures; however, we describe our experience and the potential benefits of a laparoscopic approach for pseudomyxoma peritonei.

Japanese traditional medicines, Kampo medicines (KMs), are usually herbal medicine based on traditional Chinese herbal medicine but developed into a unique form in Japan. At present, 148 kinds of KMs have been approved and are enlisted on the “National Health Insurance Drug Tariff.” About 72% of Japanese physicians prescribe some KMs to their patients. Based on patients' symptoms, KMs are given alone or in combination with contemporary western medicines. KMs can manage urological problems including erectile dysfunction, male infertility, lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia, overactive bladder (OAB), urolithiasis as well as late-onset hypogonadism (LOH) in Japan. In men's health clinic, a number of patients is eugonadal with suspicious LOH-related symptoms. Some are not eligible for androgen replacement therapy (ART) while others have no response to ART. To manage these patients, KMs can be used to improve indefinite complaints, or LOH-related symptoms. F...

Sperm motility-initiating substance (SMIS), a novel motility inducer from newt egg-jelly, is activated by the release from associated jelly substances at the beginning of internal fertilization and affects female-stored sperm. We examined motility initiation kinetics of newt sperm in response to SMIS by monitoring the changes of sperm intracellular calcium ([Ca²(+)](i)). In quiescent non-motile sperm loaded with the Ca²(+) indicator Fluo-4, intracellular free Ca²(+) was observed around mitochondria using confocal scanning laser microscopy. A slight increase in [Ca²(+)](i) occurred simultaneously and transiently at motility initiation in sperm treated with either heated jelly extract (hJE) containing activated SMIS, or a low osmotic solution, which naturally initiates motility in externally-fertilizing amphibians and can initiate motility in urodele sperm. When the increase of [Ca²(+)](i) at motility-initiation was monitored using spectrofluorometry, large increases in [Ca²(+)](i) occurred immediately in the low osmotic solution and within 1.5 min in the hJE. In the intact jelly extract (no heating), small increases of [Ca²(+)](i) irregularly occurred from around 1 min and for about 4 min, during which motility was differentially initiated among sperm. These results indicate that the SMIS induces differential initiation of sperm motility depending on the activational states of the SMIS and its overall activity. The motility initiation in the jelly extract was delayed in sperm whose intracellular Ca²(+) had been chelated with BAPTA-AM. The relative levels of [Ca²(+)](i) were variable with a mean of 414 ± 256 nmol/L among resting sperm, suggesting that the level of [Ca²(+)](i) in the resting sperm modulates the responsiveness to the SMIS.

High-mobility group box-1 (HMGB1) protein acts as a transcription factor in the nucleus and also as a pro-inflammatory cytokine when released into extracellular fluids. The presence of higher levels of HMGB1 is reported in the gingival crevicular fluid from periodontal patients. Since the proliferation of bacteria within the periodontal pocket is closely involved in the exacerbation of periodontal disease, it is hypothesized that the periodontal pocket causes the release of HMGB1. Immunohistochemical staining of inflamed gingiva revealed that HMGB1 is exclusively dislocated from the nucleus to the cytoplasm in the pocket epithelium, whereas it is mainly present in the nucleus in the gingival epithelium. Butyric acid, an extracellular metabolite from periodontopathic bacteria populating the periodontal pocket, induced the passive release of HMGB1 as a result of eliciting necrosis in the human gingival epithelial cell line. Thus, the periodontal epithelium may provide a unique pathological setting for HMGB1 release by bacterial insult. Abbreviations: HMGB1, high-mobility group box-1; TNF-α, tumor necrosis factor-α; CHX, cycloheximide; PI, propidium iodide; ROS, reactive oxygen species; HDAC, histone deacetylase.

Recent reports on laparoscopic surgery for urachal anomalies have not described any techniques to restore the natural appearance of the umbilicus. In this report, we present a simple technique that enables complete resection of urachal anomalies while preserving the natural appearance of the umbilicus.Laparoscopic excision of symptomatic urachal anomalies was performed for 4 men and 2 women. After dissecting the urachal lesion along the preperitoneal plane toward the umbilicus, the cephalic side of the lesion was ligated and the skin at the base of the umbilicus was divided while compressing the anterior abdominal wall to ensure complete removal of the lesion.The laparoscopic procedure was successfully completed with minimal blood loss, and the umbilicus could be restored to its natural appearance in all the cases.This is the first report to describe a procedure for restoring the natural appearance of the umbilicus. This simple, alternative approach yields better cosmetic results and, therefore, will be useful, especially in younger patients.

The Full Service School serves many kinds of services on learning and life to solve many schools and family problems. The health and counseling services are one of the most important services in life support for students at The Full Service School. This study aims to clarify how to use the health and counseling room and how to support the student at those rooms. The results are as follow.1) The service organization and school prepare the health and counseling room by repairing the vacant space at many case of existing school. 2) The site planning of these rooms consider the relativity with school based service center, class room and sport facilities etc. 3) The health staffs are nurse, reception staff and support staff of service organization. The counseling staffs are counselor and coordinator of service organization with counseling skill. 4) The health room has some function such as medical examination, rest and nurse office. The counseling room has few functions such as counseling space and counselor office. 5) Integration types share the few staffs and functions with reception and counseling etc.

Motility initiation is a key event during internal fertilization of female-stored sperm, although the underlying mechanisms remain unclear. In internally fertilizing urodeles, quiescent sperm initiate motility on the surface of the egg-jelly, a thick extracellular matrix that accumulates around the egg in oviduct. By immunizing mice with egg-jelly extracts, we successfully generated an alpha34 monoclonal antibody (mAb) which neutralized sperm motility-initiating activity in the egg-jelly of the newt, Cynops pyrrhogaster, in a dose-dependent manner. The alpha34 mAb recognized an unglycosylated 34 kDa protein in the outermost of the six layers that comprise egg-jelly. Under nonreducing conditions, immunoblotting with alpha34 mAb produced many bands in addition to the 34 kDa protein, suggesting that the 34 kDa protein associates not only with the jelly matrix itself, but also with additional substances present in the matrix. Our current results are compatible with the supposed features of sperm motility-initiating substance (SMIS), indicating that the 34 kDa protein itself, or a complex consisting of the 34 kDa protein and some other molecules, is the SMIS in C. pyrrhogaster. Immunofluorescence staining further indicated that SMIS was distributed in a dot-like pattern in the outermost jelly layer and was fully covered with acrosome reaction-inducing substance (ARIS). Immunocytochemical and scanning electron microscopic examinations of the outermost jelly layer strongly suggests that the 34 kDa protein localized in granules (2 microns) and that ARIS was distributed covering the granules and in the sheet-like structure above the granules. These data suggest that the initiation of sperm motility is mediated by the acrosome reaction.

The clinical outcome of malignant biliary obstruction caused by metastatic gastric cancer remains unclear. This study was designed to evaluate the clinical outcome and predictive factors of survival in patients who underwent percutaneous transhepatic biliary drainage (PTBD) for malignant biliary obstruction caused by metastatic gastric cancer. Between April 1997 and March 2006, 38 consecutive patients with malignant biliary obstruction caused by metastatic gastric cancer were retrospectively analyzed. All patients underwent PTBD. After PTBD, serum bilirubin levels significantly decreased in 29 (76%) of 38 patients. Pruritus, fever, jaundice, anorexia, abdominal pain, and general fatigue improved significantly in 100%, 100%, 78%, 64%, 53%, and 48% of patients, respectively. Early complications related to the intervention occurred in ten patients. Seven patients developed symptoms of recurrent jaundice or cholangitis. Overall median survival was 79 days, and 6-month and 1-year survival rates after PTBD were 39.5% and 13.2%, respectively. Serum bilirubin level after PTBD (P

Seasonal change in spermatogenesis was examined in the restricted spermatogonium-type testes of a teleost, Oryzias latipes. Histological observation revealed that the number of each stage of germ cells during most of the non-reproductive season, from October to January (O–J period) was nearly half of that during the reproductive season, from May to July (M–J period), except for type B spermatogonia (B-gonia), which was actually equal. As a result, the ratio of primary spermatocytes (P-cytes) to B-gonia was remarkably small in the O–J period. Despite the differences between both time periods, the proliferative activity of type A spermatogonia (A-gonia), B-gonia, or P-cytes was at a similar level in both periods. Moreover, in cultured testes treated with bromodeoxyuridine as a cell-lineage tracer, P-cytes differentiated to spermatids in 11–15 days in both M–J and O–J periods. These indicate that spermatogenesis is active in each period at a different state. In the spermatogenic testis, A-gonial proliferation was maintained by human follicle stimulating hormone/luteinizing hormone in culture. Whereas cell death of B-gonia and/or P-cytes gradually increased in the M–J period in spite of those cells being constant in population sizes. In transition to the O–J period, A-gonia and P-cytes first decreased, which was accompanied by a decrease in proliferative activity of A-gonia and relative increase of dead cells from B-gonia and/or P-cytes against live P-cytes. These suggest that A-gonial proliferation and cell death of B-gonia and/or P-cytes that is induced coordinately with B-gonial differentiation are critical for the spermatogenic control.

Our previous studies have shown that the acrosome reaction (AR) occurs in egg-jelly of the Japanese newt, Cynops pyrrhogaster. This is analogous to the substances of echinoderms but distinct from those of many other vertebrates derived from the egg envelope or its derivative, the zona pellucida. To identify the AR-inducing substances in newt egg jelly, a monoclonal antibody (mAb) was generated against the jelly by screening the culture supernatants to find the one that best neutralized the AR-inducing activity of the jelly substance. The mAb specifically reacted to protein bands in the jelly. These proteins, with apparent molecular weights of 122 and 90 kDa, exhibited AR-inducing activity, indicating that they are definitely AR-inducing substances. Western blotting using the mAb indicated that the 122 and 90 kDa proteins are present only in the egg jelly's outermost layer, where AR-inducing activity is known to occur. Both proteins were recognized with wheat germ agglutinin (WGA), a lectin that inhibits AR-induction in egg jelly extract. Taken together, these findings indicate that the 122 and 90 kDa proteins are the AR-inducing substances in the egg jelly of C. pyrrhogaster. The WGA recognition of the proteins was lost by N-glycosidase digestion, suggesting that N-linked carbohydrate moieties in these proteins may be responsible for the AR-inducing activity.

We previously developed artificial promoters that were activated in response to X-ray irradiation. Sonication with 1.0 MHz ultrasound that causes intracellular oxidative stress was found to activate some of these promoters though to lesser degrees. The most sensitive one among these promoters showed intensity- and duration-dependent activations by sonication. In addition, its activation by sonication was attenuated when N-acetyl cysteine was present, suggesting the involvement of intracellular oxidative stress in the activation mechanism. Improved promoters for sensitivity to X-ray irradiation were also found more sensitive to sonication. The most improved one showed 6.0 fold enhancement after sonication with 1.0 MHz ultrasound at 1.0 W/cm2 for 60 s. This enhancement was also attenuated with the presence of N-acetyl cysteine. When stably transfected HeLa cells with the most sensitive promoter were transplanted on to mice and sonicated, luciferase activity by the promoter increased to 1.35 fold in average though it was not statistically significant compared to control. Although gene regulation in vivo by sonication was not clear, this is the first report on artificially constructed promoters responsive to ultrasound.

Self-assembled nanogels of cholesterol-bearing mannan (CHM) containing phosphodiester bonds in its structure were used as templates for calcium phosphate mineralization to prepare novel organic—inorganic hybrid nanocarriers for drug-delivery systems. These hybrid materials were synthesized from a solution of calcium phosphate in the presence of CHM nanogels. The size and crystallinity of the nanomaterials were controlled by changing the calcium ion concentration. Spherical amorphous calcium phosphate (ACP) nanoparticles of ~20 nm in size and needle-shaped hydroxyapatite (HAp) crystals ~80 nm in length were formed from solutions of [Ca2+] = 0.8 and 2.0 mM, respectively. These hybrid nanomaterials showed excellent colloidal stability in solution, which was supported by the polymer chains of CHM on the outer surface of the hybrid nanomaterials. It was also found that an amorphous-to-crystalline transformation occurred during the formation of CHM nanogel-HAp hybrid nanomaterials.

Crohn病は全消化管に生じる難治性の炎症性腸疾患である．特に瘻孔を合併した症例では難治性で，QOLを著しく損なうものである．今回，われわれは約10年間にわたる腸管膀胱皮膚瘻に対して手術を施行し，良好な経過をたどった症例を経験したので報告する．患者は32歳，男性．1995年12月下腹部痛を主訴に発症し，手術が施行されCrohn病と診断された．1997年4月には腸管膀胱瘻の再発を認め，手術を勧めるも拒否された．2004年8月にレミケード（TNF-α抗体）を投与したが改善せず，在宅中心静脈栄養療法や麻薬による疼痛管理が必要となった．2006年5月に同意が得られ再手術を施行し，回腸・S状結腸・上部直腸・膀胱の一部を瘻孔とともに摘出し尿管皮膚瘻を造設した．現在，食事療法，内服加療，レミケード治療により良好な経過をたどっている．

患者は26歳，男性．1995年頃に他院でCrohn病と診断されるも，自己判断にて治療を受けていなかった．2006年12月初旬から下痢，腹痛，発熱を認め，腹痛が増強したために紹介受診となった．腹部は板状硬で筋性防御を認め，腹部CT検査で腹水の貯留と回腸末端部に著明な壁肥厚と強い造影効果を認めたため，Crohn病による汎発性腹膜炎と診断し緊急手術を施行した．腹腔内に膿性腹水を認め，小腸穿孔による汎発性腹膜炎であり，小腸部分切除術を施行した．切除標本は，肉眼所見で120cmにわたる縦走潰瘍と狭窄を，病理所見で類上皮細胞性肉芽腫と全層性の炎症性細胞浸潤を認めた．術後1年9カ月現在，食事療法，内服加療，抗TNF-α抗体の維持療法を行い，現在Crohn病の再発，増悪は認めていない．Crohn病に対する定期診察と適切な治療の必要性を再認識させられた症例であり，若干の文献的考察を加えて報告する．

This paper will consider the 1887 Japanese translation of Apuleius'Golden Assfrom the angle of classical reception. Although this was the first translation of Greco-Roman literature to appear in modern Japanese, it has, at least in print, never been examined by a classicist before. With the rising interest in the study of classical receptions, including those taking place outside the West, the time may be ripe for a serious look at this early Meiji translation by Morita Shiken—its content, source, intellectual climate surrounding its production, and its own subsequent reception in Japan.The ancient novel, as Whitmarsh observes, is a genre uniquely suited for reception studies, especially of the more usual kind that is concerned with the modern period. Although a late and ignoble genre within antiquity, despite its often considerable linguistic and literary artistry, it came to enjoy relatively wide cultural recognition and circulation in the early modern period, before being outshone by the modern Western novel and sinking back into relative obscurity again both in the public and in academia—and its literary character is still very much controversial, to the extent that it is debated whether the ancient genre may justifiably be called ‘novel’. The history of the reception of the novel therefore may show more intriguing twists and contradictions than that of such established and uncontroversially ‘great’ genres as epic or tragedy.

はじめに:胃癌骨転移の頻度は少ないが，quality of lifeを著しく悪化させるため，その特徴を知ることは重要である．対象と方法:1991年から2007年までに当科で経験した初発胃癌で，手術あるいは化学療法を施行した1,084例のうち骨転移を呈した16例を対象とした．16例の臨床像と予後因子，骨転移単独症例の臨床像，本邦報告例について検討した．結果:骨転移症例は比較的若年の女性，U領域，4型，未分化型，脈管侵襲やリンパ節転移の高度な進行癌が多かった．骨転移発症までの期間は中央値266日（23～1,579日）であった．骨転移発症からの生存期間は中央値102日（8～310日），6カ月生存率は42％と不良であったが，1980年代の報告と比較すると良好であった．骨転移発症後の予後因子として単変量解析で女性，66歳以上の高齢，PS不良例，化学療法非施行例が挙げられた．多変量解析では年齢，PS，化学療法の有無が独立した予後因子となった．骨転移単独症例は4例で原発巣の悪性度が低いにもかかわらず，リンパ節転移の高度な症例が多かった．骨転移後の治療法では9例に化学療法が施行され，TS-1を中心として多剤を投与できた症例の生存期間は比較的良好であった．結語:骨転移症例の特徴を十分に理解し，早期発見から化学療法を施行することにより，予後が改善する可能性が示唆された．

We compared the enhancement effects of three different echo contrast agents (ECAs); Levovist, YM454, and MRX-815H as artificial microbubbles on ultrasound mediated gene transfection (USMGT) with 1 MHz ultrasound at 0.2 MPa using a luciferase expression vector in PC3 cells and elucidated the mechanisms of differences of USMGT facilitation by these ECAs. At a concentration of each ECA that induced iso-survival, ECAs with lipid shell (YM454 and MRX-815H) facilitated USMGT higher than those without shell (Levovist), and the order of the ECAs facilitating free radical formation by sonication was; YM454 > MRX-815H > Levovist. These results suggested that the lipid shell type ECAs facilitated gene transfer higher than that by the non-shell type ECA.

A 51-year-old woman with an unresectable pancreatic tumor that was histologically diagnosed as an adenosquamous carcinoma underwent chemoradiotherapy with 5-fluourouracil (FU) and low-dose cisplatin (low-dose FP). Because we recognized a partial response to the chemoradiotherapy, we subsequently administered combined chemotherapy with S-1 and cisplatin. After one course of this combined chemotherapy, the tumor was further reduced in size and became difficult to discern on abdominal computed tomography (CT). We have continued to administer the S-1 and cisplatin combined chemotherapy, and the patient is still alive. After 20 months of treatment, the tumor has not recurred (as assessed by abdominal CT). Additionally, we have not seen elevation of tumor markers. This report presents the successful use of chemoradiotherapy with low-dose FP and additional combined chemotherapy with S-1 and cisplatin for unresectable pancreatic adenosquamous carcinoma.

75歳の女性．平成18年8月下旬ヘビに右第1・2趾を咬まれ当院外来受診し経過観察入院となった．腫脹の進行に伴い横紋筋融解症による急性腎不全，高度炎症所見上昇，呼吸状態の悪化を認め，当救命救急センター紹介となった．症状の経過からマムシ咬傷を疑い，受傷後1日半経過していたが抗マムシ毒素血清とセファランチン®を投与した．CPKは112,200IU/lまで上昇していたが抗マムシ毒素血清投与後速やかに正常化した．急性腎不全・呼吸不全と肝機能の悪化を認め，持続血液濾過透析と人工呼吸管理を行った．尿量は受傷後3週目より徐々に回復し，4週目に透析から離脱した．マムシ咬傷による死亡原因は急性腎不全によるものが最多で，その原因は横紋筋融解によるミオグロビン血症やマムシ毒自体の腎毒性等による．急性期に透析・人工呼吸管理等の集中加療を行い救命しえた1例を経験したので報告する．

Poly(N-isopropylacrylamide) (PNIPAM) with a narrow molecular weight distribution was prepared by reversible addition-fragmentation chain transfer (RAFT) radical polymerization. A dithioester group at the chain end of PNIPAM thus prepared was cleaved by treating with 2-ethanolamine to provide thiol-terminated PNIPAM with which gold nanoparticles were coated via reactions of the terminal thiol with gold. The thermoresponsive nature of the maximum wavelength of the surface plasmon band and hydrodynamic radius (Rh) for the PNIPAM-coated gold nanoparticles were found to be sensitively affected by added salt. In pure water, Rh for the PNIPAM-coated gold nanoparticles at 40 degrees C (lower critical solution temperature (LCST)) was smaller than that at 25 degrees C (LCST) due to the shrinkage of the PNIPAM chains on the gold surface. The maximum wavelength of the plasmon band in pure water was almost independent of the temperature, the color of the solution remaining pink regardless of temperature. On the other hand, in the presence of 50 mM NaCl, the plasmon band at 40 degrees C was red shifted compared with that at 25 degrees C because of interparticle associations, the pink color at 25 degrees C changing to blue-purple at 40 degrees C. Furthermore, Rh for the PNIPAM-coated gold nanoparticles at 40 degrees C was significantly larger than that at 25 degrees C. Heat-induced association and dissociation for the PNIPAM-coated gold nanoparticles were completely reversible in 50 mM NaCl aqueous solutions, which is responsible for the reversible thermoresponsive color change.

Hydrogen-assisted reduction reactions at oxidized Ni(1 1 0) surfaces have been studied by metastable-induced electron spectroscopy (MIES). We prepared an O/Ni(1 1 0) surface with the high oxygen-coverage (3 × 1) surface phase, “HC-(3 × 1)”. This surface has been known to show no reactions to molecular hydrogen gas at RT, which differs from other surface phases, low-coverage (3 × 1) and (2 × 1), that undergo prompt reduction reactions at RT. We exposed the HC-(3 × 1) surface to molecular hydrogen while elevating the substrate temperature. In the temperature range from 450 to 550 °C, MIES showed a decrease in the emission intensity of the O2p-induced peak in parallel with a recovery of the Ni3d-induced peak intensity. Evidence of reactions of the HC-(3 × 1) surface to the incident molecular hydrogen was obtained on the MIES spectrum only at temperatures above 500 °C, where a H1s-induced peak appeared at the same energy as the case of initial H adsorption on the clean Ni(1 1 0) surface. This result means that molecular hydrogen takes effect on the HC-(3 × 1) O/Ni(1 1 0) surface but at reduced oxygen-coverages. A surface-structure dependency of the hydrogen-assisted reduction reactions at the O/Ni(1 1 0) surface is discussed.

Our recent IR study demonstrated that hydrogen-bond structure in cellulose Ibeta drastically changes around 220 degrees C (Watanabe et al. Biomacromolecules 2006, 7, 3164). In the present study, temperature-dependent IR spectra of cellulose Ialpha from 30 to 260 degrees C were analyzed by use of perturbation-correlation moving-window two-dimensional correlation spectroscopy. It was observed that as in the case of cellulose Ibeta abrupt changes in the hydrogen-bond structure occur around 220 degrees C in cellulose Ialpha. It was also revealed that although weakly hydrogen-bonded OH groups in Ibeta are stable below 230 degrees C thermal oxidation of those in Ialpha is accelerated around 220 degrees C. In this way, the present study has clarified a difference between the thermal behavior of Ialpha and that of Ibeta at the functional group level. Our result suggests that the drastic change in the hydrogen-bond structure around 220 degrees C makes cellulose Ialpha much more unstable than Ibeta.

判例研究(Case Study)

術中内視鏡検査で出血部位の同定が可能であった小腸angiodysplasiaの2例を経験したので報告する. 症例1 : 76歳, 男性. 2004年3月17日出血源不明の消化管出血のため当院を紹介された. 腹部血管造影でも出血源を認めず, 緊急開腹術を行った. 術中内視鏡検査で, 空腸に拍動性出血を認め, 同部位を含む約10cmの空腸部分切除を行った. 病理組織学的検査でangiodysplasiaと診断した. 現在まで再出血を認めていない. 症例2 : 28歳, 男性. 2005年9月7日黒色便を主訴に当院内科を受診した. 上部内視鏡検査, 大腸内視鏡検査, 腹部血管造影で出血源を同定できず, 緊急開腹手術を行った. 術中内視鏡検査で, 空腸に出血を伴う隆起性病変を認め, 病変を含む約10cmの空腸部分切除を行った. 病理組織学的検査でangiodysplasiaと診断した. 現在まで再出血を認めていない.

The acrosome reaction of newt sperm is induced at the surface of egg jelly and the acrosome-reacted sperm acquire the ability to bind to the vitelline envelope. However, because the substance that induces the acrosome reaction has not been identified, the mechanism by which the acrosome-reacted sperm bind to the vitelline envelope remains unclear. We found here that a Dolichos biforus agglutinin (DBA) specifically mimicked the acrosome reaction immediately upon its addition in the presence of milimolar level Ca2+. Fluorescein isothiocyanate-labeled DBA bound specifically to the acrosomal cap of the intact sperm in the presence of a Ca2+-chelating agent, EDTA, suggesting that binding of DBA to the native receptor for the egg jelly substance on the acrosomal region took the place of the egg jelly substance-induced acrosome reaction. In contrast, the sperm that had been acrosome reacted by DBA treatment did not bind to the vitelline envelope of the egg whose jelly layers were removed. Subsequent addition of jelly extract caused the sperm binding to vitelline envelope, indicating that the egg jelly of the newt contains substances that are involved in not only inducing the acrosome reaction but also binding to the vitelline envelope. This is the first demonstration of the involvement of egg jelly substance in the binding of acrosome-reacted sperm to the vitelline envelope. J. Exp. Zool. 307A:301–311, 2007. © 2007 Wiley-Liss, Inc.

症例は50歳代の男性. 上腹部痛を主訴に近医を受診し下部消化管内視鏡検査にて横行結腸肝彎曲に腫瘤を指摘された. 精査加療目的に平成17年4月当科に入院した. 腹部CTにて傍大動脈リンパ節の腫大を認め, 傍大動脈周囲リンパ節転移を伴う横行結腸癌の診断にて横行結腸切除術, リンパ節郭清を施行した. 腫瘍は境界不明瞭で潰瘍形成を伴わない5型を呈していた. 病理組織診断では腺扁平上皮癌であり, 郭清したすべてのリンパ節に転移を認めstageIV (SE, H0, P0, M1) であった. 術後は早期より一日20行以上の下痢を認め, 縫合不全から消化管皮膚瘻を形成したが保存的に軽快し, 術後75日目に退院した. 現在は外来にて化学療法を施行中である. 腺扁平上皮癌は結腸での発生は稀であり, 悪性度が高く予後不良であるとされる. 若干の文献的考察を加えて報告する.

症例は70歳代, 男性. 前立腺癌に対し内分泌療法を受けている. 2006年12月, 下腹部痛のため当科を受診した. 下腹部に著明な圧痛と反跳痛を認め, 血液検査で炎症所見を認めた. 腹部造影CT検査で骨盤腔内に腹水の貯留と大網に帯状の肥厚像を認めた. 保存的加療を行うも改善せず, 急性腹膜炎の原因精査のため, 全身麻酔下に腹腔鏡検査を施行した. 肥厚した大網が広汎に腹壁に癒着し, 壁側腹膜は発赤し, 骨盤内に淡血性腹水を認めた. 大網を剥離した後, 小切開を加え大網を部分切除した. 切除した大網に4cm大の腫瘤を4個認め, 病理組織検査で腺癌の転移と診断された. 術後の上部消化管内視鏡検査でBorrmann4型胃癌を認め, 胃癌の大網転移と診断した.

Reaction between deposited Ca layers and the Si(111) substrate has been studied by metastable-induced electron spectroscopy (MIES) and low-energy electron diffraction (LEED). When a Ca-deposited (about 1ML) Si(111) surface was annealed at temperatures in the range 470-570 K, the MIES spectrum showed a peak, named Ps, at a binding energy of about 7 eV which is assigned to be an isolated Si3s state. By referring electronic structure calculations for the bulk Ca-silicides, we confirmed that a solid-phase reaction at the Ca/Si interface to induce Ca2Si-like phases takes place at rather low annealing temperatures around 570 K. When Ca-covered (about 0.6 ML) Si(111) surfaces were annealed at temperatures in the range 770-870 K, the LEED showed 2× 1, 5× 1 and quasi-3× 2 reconstructions, depending on the temperature. We obtained MIES spectra from these surfaces involving spectral features which reflect local atomic structures of those Ca+Si surface phases. Correlations between the local atomic structure and the electronic structure probed by the MIES are discussed. [DOI: 10.1380/ejssnt.2007.89]

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To evaluate the efficacy of technical modifications of total hepatic vascular exclusion (THVE) for hepatectomy involving inferior vena cava (IVC).Of 301 patients who underwent hepatectomy during the immediate previous 5-year period, 8 (2.7%) required THVE or modified methods of IVC cross-clamping for resection of liver tumors with massive involvement of the IVC. Seven of the patients had diagnosis of colorectal liver metastases and 1 had diagnosis of hepatocellular carcinoma. All tumors involved the IVC, and THVE was unavoidable for combined resection of the IVC in all 8 of the patients. Technical modifications of THVE were applied to minimize the extent and duration of vascular occlusion, thereby reducing the risk of damage.Broad dissection of the space behind the IVC coupled with lifting up of the liver from the retrocaval space was effective for controlling bleeding around the IVC before and during THVE. The procedures facilitate modification of the positioning of the cranial IVC cross-clamp. Switching the cranial IVC cross-clamp from supra- to retrohepatic IVC or to the confluence of hepatic vein decreased duration of the THVE while restoring hepatic blood flow or systemic circulation via the IVC. Oblique cranial IVC cross-clamping avoided ischemia of the remnant hemi-liver. With these technical modifications, the mean duration of THVE was 13.4 ± 8.4 min, which was extremely shorter than that previously reported in the literature. Recovery of liver function was smooth and uneventful for all 8 patients. There was no case of mortality, re-operation, or severe complication (i.e., Clavien-Dindo grade of III or more).The retrocaval liver lifting maneuver and modifications of cranial cross-clamping were useful for minimizing duration of THVE.

The monitoring and operation (MO) system for the general control system (GCS) of the Materials and Life Science Experimental Facility (MLF) was upgraded. The MLF-GCS comprises programmable logic controllers (PLCs), operator interfaces (OPIs) for integral control and interlock systems, and shared servers. The system controls various components of the pulsed spallation neutron source such as a mercury target and hydrogen moderators. The MO system is used for monitoring, alarm notification and remote control from the MLF control room. The upgraded MO system operates with the EPICS framework, the OPI of Control System Studio (CSS), and the server software of PostgreSQL. The upgraded system has been operating since January 2014 without serious trouble. This paper describes an overview of the work experience upgraded MO system.

A 54-year-old woman exhibited pancreatic calcification on abdominal ultrasonography. Diagnostic imaging revealed a 20-mm mass with a 12-mm calcification in the tail of the pancreas. The mass was weakly enhanced in the early phase of contrast-enhanced CT. We performed pancreatectomy and splenectomy. Histopathological diagnosis was a nonfunctioning pancreatic neuroendocrine tumor (PNET), grade 2. This is a rare case of PNET with extensive calcification.

Molecular interactions between microcrystalline cellulose (MCC) and water were investigated by attenuated total reflection infrared (ATR/IR) spectroscopy. Moisture-content-dependent IR spectra during a drying process of wet MCC were measured. In order to distinguish overlapping O–H stretching bands arising from both cellulose and water, principal component analysis (PCA) and, generalized two-dimensional correlation spectroscopy (2DCOS) and second derivative analysis were applied to the obtained spectra. Four typical drying stages were clearly separated by PCA, and spectral variations in each stage were analyzed by 2DCOS. In the drying time range of 0–41 min, a decrease in the broad band around 3390 cm−1 was observed, indicating that bulk water was evaporated. In the drying time range of 49–195 min, decreases in the bands at 3412, 3344 and 3286 cm−1 assigned to the O6H6cdots, three dots, centeredO3′ interchain hydrogen bonds (H-bonds), the O3H3cdots, three dots, centeredO5 intrachain H-bonds and the H-bonds in Iβ phase in MCC, respectively, were observed. The result of the second derivative analysis suggests that water molecules mainly interact with the O6H6cdots, three dots, centeredO3′ interchain H-bonds. Thus, the H-bonding network in MCC is stabilized by H-bonds between OH groups constructing O6H6cdots, three dots, centeredO3′ interchain H-bonds and water, and the removal of the water molecules induces changes in the H-bonding network in MCC.