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Koichi Ono1, Tomonobu Koizumi2, Rikimaru Nakagawa1, Sumiko Yoshikawa2, Tetsutarou Otagiri11Department of Anesthesiology and Resuscitation; 2First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, JapanPurpose: The present study was designed to examine effects of different mean airway pressure (MAP) settings during high-frequency oscillation (HFO) on oxygenation and inflammatory responses to acute lung injury (ALI) in rabbits.Methods: Anesthetized rabbits were mechanically ventilated with a conventional mechanical ventilation (CMV) mode (tidal volume 6 ml/kg, inspired oxygen fraction [FIo2] of 1.0, respiratory rate [RR] of 30/min, positive end-expiratory pressure [PEEP] of 5 cmH2O). ALI was induced by intravenous administration of oleic acid (0.08 ml/kg) and the animals were randomly allocated to the following three experimental groups; animals (n = 6) ventilated using the same mode of CMV, or animals ventilated with standard MAP (MAP 10 cmH2O, n = 7), and high MAP (15 cmH2O, n = 6) settings of HFO (Hz 15). The MAP settings were calculated by the inflation limb of the pressure-volume curve during CMV.Results: HFO with a high MAP setting significantly improved the deteriorated oxygenation during oleic acid-induced ALI and reduced wet/dry ratios, neutrophil counts and interleukin-8 concentration in bronchoalveolar lavage fluid, compared to those parameters in CMV and standard MAP-HFO.Conclusions: These findings suggest that only high MAP setting during HFO could contribute to decreased lung inflammation as well as improved oxygenation during the development of ALI.Keywords: lung protective ventilation, open lung ventilation, IL-8, neutrophil

We proposed a comparator circuit scheme using a current-subtraction-type offset-cancellation technique. Chopper amps are commonly used in CMOS comparators. However, the drawback of chopper amp is reduction of offset cancellation effect by the coupling capacitor in the signal path. To overcome this problem, a new offset-cancellation technique is developed. The effect of the offset-cancellation technique is verified by a prototype ADC fabricated in a 0.18um CMOS.

The plasma profiles in a 300 cm rectangular plasma source sustained with multiple low-inductance antenna (LIA) modules were investigated using a fluid-simulation code. The profiles of argon plasmas sustained with two LIA modules were investigated in order to evaluate the appropriate spacing between LIA modules for obtaining uniform plasmas in multiple antenna configurations. For designing meter-scale large-area plasma sources, the simulation in the rectangular chamber with multiple LIA modules was carried out. Argon ion (Ar+) and metastable radical neutral (Ar*) distributions with a nonuniformity of

High-frequency oscillatory ventilation (HFOV) is a possible mechanical method for open lung strategies. The aim of this study was to examine whether HFOV has a beneficial effect on oleic acid-induced lung injury, with emphasis on changes in extravascular lung water. Thirteen anesthetized sheep prepared with a lung lymph fistula and vascular catheters for monitoring were randomly allocated to two experimental groups. In experiment 1, sheep (n = 6) were ventilated using conventional mechanical ventilation [CMV; 10 ml/kg of tidal volume, 70% oxygen, and positive end-expiratory pressure (PEEP) of 6 cmH(2)O after oleic acid administration (0.08 ml/kg)]. In experiment 2, sheep (n=7) were ventilated using HFOV (frequency=15 Hz, stroke volume=120 ml, mean airway pressure=15 cmH(2)O) after administration of the same dose of oleic acid as in experiment 1. Observation was continued for 4 h after oleic acid administration, then bronchoalveolar lavage (BAL) was performed and the lung wet-to-dry weight ratio was determined. Compared with CMV, HFOV significantly improved the deteriorated oxygenation during the late phase (2-4 h) of oleic acid-induced lung injury without any deterioration effects on pulmonary or systemic hemodynamics. HFOV showed significantly reduced lung lymph protein clearance, which paralleled significant decreases in wet-to-dry ratios and neutrophil counts in BAL fluid in the HFOV group. These findings suggest that HFOV could contribute to decreased lung lymph filtration in pulmonary microcirculation and improved oxygenation following oleic acid-induced lung injury in sheep.

The role of plasma levels of oxidized low density lipoprotein (OxLDL) in the development of coronary heart disease (CHD) has not been fully elucidated. We examined the relationship among plasma levels of OxLDL, measured by an enzyme immunoassay using an antibody against OxLDL (FOH1a/DLH3) and apolipoprotein B, CHD, and modalities at the onset of acute coronary syndrome (ACS). A total of 115 individuals who underwent coronary angiography were studied. Of these, 21 patients complicated with extracoronary cardiovascular diseases were excluded. Consequently, 94 patients (63 men) (ACS: 23, stable angina pectoris (SAP): 46, and normal coronary artery (NCA):25) were eligible for inclusion in the study. Elevated plasma levels of OxLDL were associated with CHD, especially with ACS. In patients with NCA, hypertension was associated with plasma OxLDL. Plasma levels of OxLDL were significantly higher in patients with new-onset type ACS than in those with worsening type ACS (2.98 versus 1.53 mg/dL, P = 0.002). In conclusion, plasma levels of OxLDL are associated with CHD and significantly higher in patients with new-onset ACS. The findings of the present study suggest that plasma OxLDL can be a marker of the development of CHD and modalities of ACS.

The present study was designed to evaluate pulmonary and systemic hemodynamics and blood gas changes on switching from conventional mechanical ventilation (CMV) to high-frequency oscillatory ventilation (HFOV) in a large animal model of acute lung injury.Eleven anesthetised sheep chronically instrumented with vascular monitoring were prepared. Animals received oleic acid (0.08 ml x kg(-1)) intravenously and were ventilated for 4 h h after the administration of oleic acid. The animals were then randomized into the two following different ventilation modes: CMV (tidal volume [V(T)], 6 ml x kg(-1); respiratory rate [RR], 25 x min(-1)) with positive end-expiratory pressure (PEEP) of 12 cmH(2)O; or CMV under the same settings without PEEP. HFOV was then switched. The setting of mean airway pressure with a fixed stroke volume was changed between 25, 18, and 12 cmH(2)O every 20 min. Mean pulmonary artery pressure, pulmonary artery occlusive pressure (Paop), left atrium pressure, systemic arterial pressure, cardiac output (CO), and blood gas composition under each setting were measured before and after HFOV.Switching to HFOV, from without PEEP, resulted in significant increases in Paop and PaO2 and a decrease in CO at higher (25, 18 cmH(2)O) mean airway pressure. However, when changed from low V(T) and PEEP, HFOV produced further improvements in oxygenation without any deterioration of cardiovascular depression. Thus, switching to HFOV from CMV with low V(T) and high PEEP may have little influence on pulmonary or systemic hemodynamics in acute lung injury.We conclude that hemodynamic responses are dependent on the predefined setting of PEEP during CMV, and on applied mean airway pressure during HFOV.

Atmospheric pressure nonthermal plasma has very high chemical reactivity and can decompose various toxic materials. The authors are engaged in decomposing the various kinds of VOCs (volatile organic compounds) by using the nonthermal plasma (typically barrier discharge reactor). To improve the energy efficiency, modification of the plasma reactor has been done. A new catalyst, manganese dioxide—supported alumina sphere of 3 mm in diameter was manufactured by ourselves for the combined process with the plasma. That can decompose the ozone very well, where the ozone is one of the typical byproducts produced by the strong barrier discharge in the air. At that ozone decomposition process, dilute TCE (trichloroethylene) is also oxidized very well. The ozone decomposition generates single atomic oxygen which oxidizes TCE very well. The total performance of that alumina assisted plasma process is investigated. The specific energy density (SED) is only 10 J/L when the TCE decomposition efficiency is more than 99 % which is the least record in our experiments. Moreover, the carbon balance from TCE to carbon oxide is also more than 90 % at the SED of 90 J/L.

von Recklinghausen病 (VRD) に小腸GISTおよび褐色細胞腫を合併した症例を経験した. 症例は30歳時にVRDと診断された33歳, 女性. 顔色不良および腹痛を訴え産婦人科受診. CT上, 骨盤内に石灰化を伴う13cm大の腫瘍, 左副腎に3cm大の腫瘍を認めた. 精査にて骨盤内腫瘍はGISTの疑い, 左副腎腫瘍は褐色細胞腫と診断され, 当科へ転科後手術が施行された. 骨盤内の腫瘍は空腸が起始部であり, 小腸部分切除, さらに左副腎摘出術を施行した. 小腸腫瘍は病理学的に悪性GISTの診断, また副腎の褐色細胞腫にも悪性を示唆する所見を認めた. 術後1年現在再発を認めていない. VRDに合併した複数の悪性腫瘍の報告が散見され, 予後に関与する可能性があるため, 早期発見のための全身検索が重要であると考える.

症例は60歳, 男性. 平成6年に胃癌にて胃全摘, Roux-enY再建術を施行されている. 腹痛にて当院受診. 初診時所見が軽度であったため一時帰宅経過観察となったが, 症状が増悪し再受診. 精査の結果, 輸入脚の著明な拡張および, 胆管炎, 膵炎をきたしており, 輸入脚閉塞症と診断した. 上部消化管内視鏡検査にて内腔からの減圧は不可能と判断し, 緊急手術を施行した. 開腹すると輸入脚は吻合部の閉塞により著明な拡張をきたしていた. 狭窄した吻合部を含め輸入脚を約8cm切除し, 側々吻合にて輸入脚の再吻合を施行した. 術後は重症膵炎によるDIC, 急性循環不全, 急性呼吸不全を合併し, 人工呼吸器管理下に8日間の集中治療を要したが, 徐々に全身状態は改善し術後46日目に軽快退院となった.胃癌全摘後の輸入脚閉塞症は稀であるが, 発症後は早期に胆管炎, 膵炎を合併し, 治療の遅れは全身状態の重篤化につながる. 早期診断, 治療が必要な病態の1例としてここに報告する.

症例は61歳, 女性. 平成17年6月直腸癌に対し直腸高位前方切除を施行されている. 病理学的所見はRs, 3型, 43×50mm, 中分化型腺癌, SE, N2, H0, P0, M0, Stage IIIbであった. 術後7カ月目にCEA値が上昇したが, 腹部CTでは明らかな再発所見を認めなかった. 全身検索目的にFDG-PETを施行したところ右副腎に集積を認め, その後の腹部CTにて右副腎に約2.5cmの腫瘍を認めた. 血液生化学検査ではカテコラミン, 副腎皮質由来ホルモン活性値等は正常値を示し, 機能性副腎腫瘍は否定された. 以上より直腸癌孤立性副腎転移と診断し, 右副腎摘出術を施行した. 腫瘍は病理組織学的に直腸癌副腎転移と診断された. 術後CEA値は正常化した.大腸直腸癌孤立性副腎転移は稀であり, 特徴的臨床症状を呈さないことから, 早期に画像所見にて診断することは困難である. われわれはFDG-PETにて診断し, 外科的切除をしえた症例を経験したため報告する.

Purpose: An amino acid-containing elemental diet (ED) does not require digestion for nutritional absorption, making it a good option for patients with gastrointestinal malabsorption. We conducted a randomized trial to confirm that perioperative ED enhanced the recovery of patients undergoing laparoscopic colectomy. Methods: Patients in the intervention arm received commercially available ED from the day prior to surgery until postoperative day (POD) 3, whereas patients in the control group received a conventional perioperative diet program. To verify the endpoints, "estimated minimum length of stay in hospital after surgery" (emLOS) was defined as the number of days necessary to reach all the five criteria; namely, "sufficient oral intake", "sufficient pain control", "withdrawal of intravenous alimentation", "no abnormal findings in routine examinations", and "no rise in fever". Results: A total of 102 patients were randomized, 94 of whom were analyzed (ED 45, control 49). There was no morbidity or mortality. Shorter emLOS (POD 4 vs. POD 7; p = 0.018), earlier resumption of sufficient oral intake (POD 3 vs. POD 4; p = 0.034) and faster recovery to defecation (2.2 vs. 3.1 days; p = 0.005) were observed in the ED group vs. the control group. Conclusions: The perioperative ingestion of ED by patients undergoing laparoscopic colectomy is safe and can reduce the postoperative hospital stay by supporting the acceleration of oral intake.

Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) is a classical glycolytic enzyme that is involved in cellular energy production and has important housekeeping functions. We used the natural prooxidant and proatherogenic molecule oxidized low-density lipoprotein (OxLDL) to determine a potential link between OxLDL-promoted oxidative stress, GAPDH expression, and smooth muscle cell energy metabolism. OxLDL but not native LDL (nLDL) produced a 60% to 100% dose- and time-dependent reduction of GAPDH protein. OxLDL increased reactive oxygen species (ROS) formation, including rapid elevation of H 2 O 2 levels. OxLDL decreased intracellular catalase expression, likely contributing to the increase in H 2 O 2 . Antioxidants, anti-CD36 receptor antibody, NADPH oxidase, or lipoxygenase blockers decreased OxLDL-specific ROS and prevented GAPDH downregulation. 12/15-Lipoxygenase or p47phox deficiency resulted in attenuation of GAPDH downregulation, but 5-lipoxygenase suppression had no effect. OxLDL or exogenous H 2 O 2 oxidized GAPDH thiols, decreasing GAPDH protein half-life and increasing GAPDH sensitivity to proteasome-mediated protein degradation in vitro. OxLDL- or small interfering RNA–specific downregulation of GAPDH resulted in 65% reduction in glycolysis rate and 82% decrease in ATP levels. In conclusion, our data demonstrate that OxLDL downregulated GAPDH via a H 2 O 2 -dependent decrease in protein stability. GAPDH protein damage resulted in marked depletion of cellular ATP levels. Our data have important implications for understanding the metabolic effect of OxLDL on the vessel wall and mechanism of atherogenesis.

Thirty-five patients with extensive abdominal or pelvic cancer who suffered uncontrolled, diffuse, extensive, and incapacitating pain were treated with a combination of neurolytic celiac plexus block (CPB), inferior mesenteric plexus block (IMPB), and superior hypogastric plexus block (SHGPB). The combination of neurolytic CPB, IMPB, and SHGPB was performed with alcohol, mainly using a transintervetebral disc approach. The combination neurolysis produced effective immediate pain relief in all the patients (visual analog scale (VAS), reduced from 8.8 +/- 0.2 to 0). This pain relief persisted during the first 3 months (VAS, 2.3 +/- 0.5) or until death. Morphine consumption was significantly decreased for the first 1 month (from 96 +/- 29 mg to 31 +/- 10 mg per day) after the neurolysis and thereafter continued to be lower than before the surgery, though not significantly so. No serious complications were observed to have been caused by the neurolytic procedure on the three sympathetic plexuses. Our preliminary clinical results suggest that the combination of neurolytic CPB, IMPB, and SHGPB improves the quality of life of patients who have incapacitating cancer pain, by reducing both the intensity of the pain and their opioid consumption, without serious complications. This combination procedure may provide a new therapeutic option for pain relief in patients with advanced cancer.

A 37-year-old man with beta-thalassemia intermedia (betaTI), a rare disease caused by partial or complete deficiency of beta-globin chain synthesis, fell into a hemolytic crisis. Severe anemia persisted despite frequent transfusions. Therefore, he was scheduled for splenectomy to alleviate the anemia. The preoperative laboratory data showed marked anemia and liver dysfunction. Echocardiography revealed hyperkinetic left ventricular motion and increased cardiac index (CI), indicating a compensatory hyperdynamic circulation induced by persistent, severe anemia. Our strategy during general anesthesia was to keep the hyperkinetic cardiovascular system steady. Hence, the hemodynamic parameters including the CI were measured using a Swan-Ganz catheter, and other physiological parameters were monitored perioperatively. Anesthesia was maintained with balanced anesthesia: isoflurane at low concentrations and fentanyl to avoid cardiovascular depression. Throughout the operation, vital signs were kept stable and the lactate/pyruvate ratio was unchanged, indicating that anaerobic metabolism did not increase. We report successful anesthetic management with attention to hemodynamic changes in a patient with betaTI.

症例は64歳,男性.約30年前にvon Recklinghausen病と診断された.平成14年6月16日,左側胸部から背部にかけての激痛を訴え当院に搬送された.胸部X線で左肺に胸水および左第6～8肋間に病的骨変形を,胸部CTにて肋間動脈の出血像を認めたため,緊急手術を施行した.第7肋骨床を開胸すると,胸腔内に約3,200mlの出血を認めた.原因は第6肋間神経の神経鞘腫からの動脈性出血であった.その他,第7肋間にも多数の神経鞘腫を認めたが,腫瘍全体の摘出は困難であり,第6肋間の腫瘍を可及的に摘出し,肋間動静脈・肋間神経を結紮した. von Recklinghausen病は3,000人に1人と常染色体優性遺伝疾患としては最も多いものの一つであるが,血胸を合併した症例はわれわれの調べ得た限りでは本邦で10例報告されているのみである.そのうち5例は死の転帰をとっており,迅速な診断と手術が必要と考える.

The present study proposes a novel experimental approach to examine the effect of previous schedule history on subsequent responses. College students used a three-button device to indicate their choice of response. We performed two experiments. Each experiment consisted of three phases. In experiment I, fixed-ratio 10 (FR 10) reinforcement schedule was employed in phases 1 and 3. Phase 2 employed “Rotary-FR 10” schedule: after obtaining a point produced by pressing one of three specified buttons in a triangular array 10 times, the effective button changed to another in a clockwise direction. Optimal response pattern for Rotary-FR 10 was analyzed. Two types of behavior, referred to as “consecutive” and “scatter” were observed in phase 1. The mean number of optimal responses in consecutive type was significantly higher than scatter type in phases 2 and 3. In experiment II, two schedules were used in phase 1, and the same protocol used in experiment I was followed. We found that the reinforcement schedule used in phase 1 affected acquisition of the optimal response in phase 2. These results suggest that the earlier behavioral tendencies play an important role in determining subsequent behavior and that such behavioral tendency can be modified by specifically designed protocols.

Preference between forced choice and free choice in concurrent-chain schedules of reinforcement was investigated in pigeons after exposure to particular combinations of terminal links. In Experiment 1, in which terminal links always ended with reinforcers, one of three pairs of terminal links was arranged as preexposure: (a) both terminal links had only one key (forced choice), (b) both terminal links had two keys (free choice), or (c) a combination of forced and free choice was arranged across sessions. In test sessions following the preexposure, pigeons' preferences rapidly shifted to the terminal links with which they had no recent experience. In Experiment 2, the same procedure was repeated except that each terminal link ended intermittently with reinforcers with a probability of .5 and there was no terminal-link arrangement with a combination of free and forced choice. Pigeons showed the same preference changes as in Experiment 1, but the preference changes did not appear immediately at the beginning of test sessions. These data suggest that recent previous experience was a more important determinant of preference than the difference between forced-choice and free-choice terminal links.

今回われわれは直腸・横行結腸癌術後に播種性血管内血液凝固症候群(以下DIC)を伴う播種性骨髄癌症を経験したので,文献的考察を加え報告する.症例は70歳の女性.進行直腸癌で低位前方切除術を施行した.その3カ月後,横行結腸癌に対し結腸右半切除術を施行した.術後縫合不全を認め, 21日目に回腸人工肛門を造設した後,全身状態が改善し経口摂取可能となったが, 41日目にDICを発症した.まず最初に,縫合不全に関連した腹腔内感染症によるDICと考え,重傷感染症とDICに対する治療を施行したが,効果は認められなかった.最終的に骨髄穿刺により播種性骨髄癌症と診断されたが,抗癌剤治療を施行できず病状が悪化し,術後58日目に死亡した.消化管原発の播種性骨髄癌症は稀な病態であり, DIC発症前に発見し治療することが重要であると考える.

症例は76歳男性で,嚥下困難と体重減少を主訴に前医受診,下部食道腫瘍の診断で当科を紹介された.入院時白血球数は18,300/mm3,その後27,900/mm3と上昇し38℃台の発熱出現,血中G-CSFは101pg/mlでIL-1, IL-6も高値を示した.腎機能障害あるため左開胸経横隔膜的食道切除をおこなったが,病理診断はいわゆる癌肉腫でpT1b (SM) pN0M0 Stage Iであった.術後発熱,白血球数ともに正常化しG-CSFは10pg/ml未満となり,抗G-CSF抗体による免疫組織染色陽性であったことからG-CSF産生腫瘍と診断した.

This study examines the relationship between quality of life (QOL) and the legal Japanese grade of visual impairment as defined by the Physically Disabled Persons Welfare Act. Participants of this cross-sectional study were 98 Japanese patients legally classified as visually impaired, from six ophthalmology departments. Vision-related QOL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). The short Japanese version of this questionnaire (VFQ-J11) score was calculated from the VFQ-25 results for each participant. Health utility was measured using the EuroQoL Index (EQ-5D). Data were collected for age, gender, vision-disability level, the corrected visual acuity of each eye, and disease type. The mean age was 66.8 years (SD = 17.8). Visual impairment grade was significantly associated with VFQ-J11 score and the composite score developed from the VFQ-25 (p

本論文では, 炭素繊維強化プラスチック材 (CFRP) の構造部材への適用性を検討することを目的とする. 角形断面を有するCFRP管部材の基本物性, 強度特性ならびに破壊性状を把握するために引張試験, 圧縮試験, 曲げ試験を実施した. 炭素繊維の配置方向および積層厚を変えて, 5種類の積層構造について検討した. 本載荷実験により, CFRP部材は, 引張応力下では十分な強度および剛性を有するものの, 圧縮応力下では材料本来の強度を発揮できない場合もあり, 薄肉鋼構造と同様に適切な補剛構造とする必要がある. 一方で, 構造体としての品質確保のため, 規格の整備ならびに標準試験法の確立を早急に進める必要がある.

Open-angle glaucoma associated with severe atopic dermatitis (atopic glaucoma) tends to be severe and difficult to treat because of ocular surface/eye lid inflammation. To determine the validity of regarding atopic glaucoma as a clinical entity, we carried out retrospective analysis and pathologic investigations.Forty-five cases (62 eyes) of atopic glaucoma were reviewed retrospectively. During surgical treatment, aqueous humor and trabeculectomy specimens were obtained. The aqueous humor samples were analyzed by multiplex cytokine assay. The surgical specimens were analyzed histologically.Atopic glaucoma was often associated with atopic cataracts (43 eyes) and retinal detachments (19 eyes). A history of glucocorticoid medications was absent in 12 cases. A total of 50 eyes required surgical interventions because of advanced visual field defects and/or high intraocular pressures. Bleb-associated postsurgical infections were observed in 7 eyes. Elevated levels of inflammatory cytokines (IL-8 and CCL2) were observed in the aqueous humor samples obtained from atopic glaucoma patients compared with those from senile cataract patients. Ultrastructural analysis of trabecular meshwork tissues obtained from atopic glaucoma patients showed abnormal accumulation of 10 to 30 nm fibers in the corneoscleral meshwork.We would like to propose atopic glaucoma as a new clinical entity, ranging from pure atopic glaucoma to a mixed type of atopic/steroid-induced glaucoma that should be considered as one of the clinical features of atopic ocular complications.

An 88-year-old Japanese woman was admitted to our hospital for abdominal pain with a raised inflammatory reaction. Esophagogastroduodenoscopy (EGD) and computed tomography (CT) showed a duodenal ulcer punching a liver cyst. Since neither ascites nor free air were detected on CT and her family did not wish for aggressive medical treatment, the patient received clinical observation and conservative management. Antibiotic and proton-pump inhibitor therapy was effective, and she exhibited an uneventful recovery. A reexamination of EGD and CT confirmed that the fistulous tract between the liver cyst and duodenum was blockaded.

Properties of pigeons’ pecks on a two-by-two array of four keys were brought under the control of three stimulus dimensions. Stimulus form (circle or plus) determined key column (left or right), stimulus number (one or two) determined key row (top or bottom), and stimulus color (green or red) determined rate (fast or slow). Appropriate control of responding by all eight possible combinations of stimulus properties sometimes emerged even when performance was established with incomplete contingencies. For example, if high-rate contingencies never operated during presentations of one circle on green and low-rate contingencies never operated during presentations of two plusses on red, appropriate high and low rates nevertheless emerged in the presence of all combinations of green and red with the other stimulus properties. In tests of the emergence of combined stimulus control over different response properties, procedures that maintain reinforcement contingencies for some response dimensions while relaxing c...

Background: We have performed total pharyngolaryngoesophagectomy in case of double cancer, head–neck and thoracic esophageal cancer, or cervical esophageal cancer that extended down to the level of aortic arch. The procedure is very challenging. Methods: From April 1984 to May 1998, 14 patients underwent the procedures for double cancer of head–neck and thoracic esophagus (n=10), hypopharyngeal or cervical esophageal cancer (n=3), and synchronous esophageal cancer (n=1). The grafts used were whole stomach (n=6), elongated stomach roll (n=5), and stomach roll with free jejunum (n=3). The routes of reconstruction were posterior mediastinum (n=10), antesternal (n=3), and retrosternal (n=1). Results: Elongated stomach roll with microvascular anastomoses was long enough for reconstruction and the blood supply of the graft was sufficient. There was no fatal complication in this procedure. Oral feeding was achieved in 13 (93%) patients. Conclusions: The elongated stomach roll with microvascular anastomosis is efficient and the placement of the conduit in the posterior mediastinum is recommended to allow a better alimentary comfort in total pharyngolaryngoesophagectomy.

The present study examined stereotyped behaviors developed during human performances that were generated by response-dependent intermittent schedules of reinforcement. Thirty university students were assigned to either fixed-interval 30-s or fixed-ratio 30-s schedules in which points or monetary reinforcers were produced only by presses on the number keys of a 41-key computer keyboard. Behavior patterns developed by all subjects were classified into four categories: optimal, random, unique, and general stereotypes. The general stereotypes category was further subdivided into five idiosyncratic types: connection, order, shift, repeat, and restriction. Analysis of the data demonstrated the role of contiguity: Whatever behavior happened to precede reinforcers was repeated even though reinforcers did not depend on that behavior. These findings support the argument that much of idiosyncratic and stereotyped human behavior is produced and maintained by contingencies of reinforcement, rather than schedule-induced or adjunctive behavior.

This report summarizes the responses to a questionnaire, distributed to ITA member countries, on health and safety in shotcreting. The report deals with the following aspects of this topic: use of shotcrete; influence of dust on the human body; regulation and guidelines regarding dust concentration; efforts to reduce dust production; efforts to reduce dust emission and improve personal protection; and demands for Research and Development of shotcrete. An appendix presents the various countries' specific responses to the questionnaire.

The total number of patients with onchocerciasis on the African continent was estimated in 2008 at 25720000. The control strategy for onchocerciasis has dramatically changed during the last 30 years, resulting in a decrease of patients. Vector control was mainly used until around 1990. Since then, the strategy has been transferred to "Mass Drug Administration using Ivermectin". An "Integrated Approach" for several endemic diseases has become a popular control strategy since 2005. Several tasks remain for eliminating onchocerciais: improvement of the population coverage of drug distribution, construction of monitoring systems to inspect the emergence of drug resistance, invention of anti-macrofilarial drugs to replace anti-microfilarial drugs, and reinforcement of the health authorities in African countries. The possible elimination of onchocerciasis also depends on the continued political commitment to the program by the Ministry of Health. If the ongoing control program keeps producing results at the current pace, the elimination of onchocerciasis could be achieved in the near future.

We developed a novel single-step capillary electrophoresis (SSCE) scheme for miniaturized and easy to use system by using a microchannel chip, which was made from the hydrophilic material polymethyl methacrylate (PMMA), equipped with a capillary stop valve. Taking the surface tension property of liquids into consideration, the capillary effect was used to introduce liquids and control capillary stop valves in a partial barrier structure in the wall of the microchannel. Through the combined action of stop valves and air vents, both sample plug formation for electrophoresis and sample injection into a separation channel were successfully performed in a single step. To optimize SSCE, different stop valve structures were evaluated using actual microchannel chips and the finite element method with the level set method. A partial barrier structure at the bottom of the channel functioned efficiently as a stop valve. The stability of stop valve was confirmed by a shock test, which was performed by dropping the microchannel chip to a floor. Sample plug deformation could be reduced by minimizing the size of the side partial barrier. By dissolving hydroxyl ethyl cellulose and using it as the sample solution, the EOF and adsorption of the sample into the PMMA microchannel were successfully reduced. Using this method, a 100-bp DNA ladder was concentrated; good separation was observed within 1 min. At a separation length of 5 mm, the signal was approximately 20-fold higher than a signal of original sample solution by field-amplified sample stacking effect. All operations, including liquid introduction and sample separation, can be completed within 2 min by using the SSCE scheme.

In free choice, two or more responses eligible for reinforcement are concurrently available, as when a pigeon’s pecks on either of two keys can produce fixed-interval (FI) reinforcers. In forced choice, only one eligible response is available, as when pecks on one key can produce FI reinforcers but extinction (EXT) is arranged for pecks on a second key. Free choice is typically preferred when pitted against forced choice in terminal links of concurrent-chain or multiple concurrent-chain schedules. When multiple concurrent-chain schedules arrange conditions A and B respectively for left and right terminal links during one initial-link stimulus but their reversal during a second initiallink stimulus, preferences can be determined within sessions as differences between relative initial-link rates. The experimental question was whether free-choice preference is demonstrable even with one free-choice alternative rarely or never chosen. A history of multiple concurrent-chains with equal single-FI terminal links was followed by training,independent of initial links, of FI 20-s (green key), FI 40-s (yellow key), and EXT (red key). Multiple concurrentchain schedules then pitted free-choice terminal links with green (FI 20-s) and yellow (FI 40-s) keys against forcedchoice terminal links with green (FI 20-s) and red (EXT) keys. These terminal links maintained responding almost exclusively on the green key whether the other key was yellow or red, and all reinforcers were produced by green-keyresponding. Even with reinforcers equal and with the yellow alternative rarely or never chosen, the green-yellow erminal link (free choice) was preferred to the green-red (forced choice) terminal link.Key words: free choice, forced choice, preference, concurrent-chain schedules, initial links, terminal links, iscriminated operants, Em uma situação de liberdade de escolha (escolha livre), duas ou mais respostas elegíveis para reforço estão concorrentemente disponíveis, como quando as bicadas de um pombo em qualquer um de dois discos pode produzir reforços em intervalo-fixo (FI). Em escolha forçada, uma única resposta é elegível para reforço, como quando as bicadas em um disco podem produzir reforços em FI, mas as bicadas em um segundo disco são colocadas em extinção (EXT).A liberdade de escolha tem sido tipicamente preferida à escolha forçada, quando ambas constituem os elos terminais de esquemas encadeados concorrentes ou de esquemas múltiplos encadeados concorrentes. Quando esquemas múltiplos encadeados concorrentes programam as condições A e B para os elos terminais à esquerda e à direita, respectivamente, na presença de um dos estímulos do elo inicial, mas programam as posições inversas para A e B nos elos terminais na presença do outro estímulo do elo inicial, as preferências podem ser determinadas, ao longo das sessões, como diferenças nas taxas relativas nos elos iniciais. A questão neste experimento era se a preferência por escolha livre é demonstrável mesmo quando uma das alternativas quase nunca é escolhida ou é escolhida raramente. Uma história experimental sob esquemas múltiplos cujos componentes eram cadeias concorrentes, nas quais os elos terminais eram um mesmo esquema de FI, foi seguida pelo treino, independente dos elos iniciais, de FI 20-s (disco verde), FI 40-s (disco amarelo), e EXT (disco vermelho) nos elos terminais. Então, os esquemas múltiplos de cadeias concorrentes programaram os elos terminais de escolha livre com dois discos, verde (FI 20-s) e amarelo (FI 40-s), concorrentemente com elos terminais de scolha forçada, também com dois discos, um verde (FI 20-s) e outro vermelho (EXT). Esses elos terminais mantiveram o responder quase que exclusivamente no disco verde, quer o outro fosse amarelo ou vermelho, e todos os reforços foram produzidos por respostas no disco verde. Embora os reforços fossem iguais e a alternativa com o disco amarelo nunca ou quase nunca tivesse sido escolhida, o elo terminal com os discos verde e amarelo (escolha livre) foi preferido ao elo terminal com os discos verde e vermelho (escolha forçada).Palavras-chave: escolha livre, escolha forçada, preferência, esquemas encadeados concorrentes, elos iniciais, elosterminais, operantes discriminados

Color flicker occurs when component signal processing with a field memory is used for a broad-band VCR to output a composite signal with a freeze image This flicker is caused by a residual chrominance signal in the processed luminance signal which interferes with the processed chrominance signal. Two methods are examined to suppress color flicker. One method is to alternately extend or reduce the field period at intervals of two fields when reading out signals from the field memory The other method is to input the luminance signal into a field-noise reducer, and stop writing it into the field memory in a field with an even number of lines. These two methods are employed in a VCR, thereby confirming color-flicker suppression The latter method is applied to an editing function in which the memory-freeze signal and another signal from an external input are mixed, since it can output a standard TV signal.

Recent experience with 4 cases of adult intussusception is described with a review of the literature. Case 1: A 79-year-old man was admitted to the hospital because of a right under abdominal pain and diarrhea. Barium enema, abdominal ultrasonography and CT indicated an intussusception at the ileocecal region. On laparotomy, intussusception extending to the ascending colon was noticed, and right hemicolectomy was carried out. The leading point was the ileum, which was 14cm oral side from the terminal ileum. There was no tumor in this area. Case 2: A 33-year-old woman had an ileocecal intussusce-ption due to a cecal malignant lymphoma, and underwent right hemicolectomy. Case 3: A 52-year-old man had a colonic intussusception due to a cancer of the ascending colon, and underwent right hemicolectomy. Case 4: A 63-year-old man had a colonic intussusception due to a rectal cancer, and underwent low anterior resection.