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Introduction: Uterine adenosarcoma (UA) is a rare malignant mesenchymal neoplasm characterized by benign epithelial and malignant stromal components. Comprehensive genomic profiling has identified a high frequency of murine double-minute type 2 (MDM2) and cyclin-dependent kinase 4 (CDK4) amplification in UA. However, the significance of these genetic alterations in tumor biology remains poorly understood. This report presents a case of UA with immunohistochemically positive MDM2 and CDK4 expression., Case Presentation: The patient was a 72-year-old woman with a history of genital bleeding. Magnetic resonance imaging revealed an 11 × 5 × 7 cm mass in the endometrial cavity, extending into the uterine cervix. Biopsy of the tumor showed no malignant findings. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Microscopically, the tumor consisted of benign glandular epithelial components and low-grade sarcoma. The diagnosis was UA stage IA, pT1aNxM0. No sarcomatous overgrowth and no myometrial or lymphovascular invasions were observed. Immunohistochemistry confirmed MDM2 and CDK4 expression in the mesenchymal tissue. No recurrence was observed 12 months post-surgery., Conclusion: The pathological diagnosis of UA was based on histomorphological features. This study demonstrates that immunohistochemistry for MDM2 and CDK4 can help elucidate the molecular genetic features of UA. Further studies are needed to correlate the expression of these genes with the biological behavior of UA., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Objective: The author conducted a survey on social mutual aid and the social stimulative effect of older adults living in a rural district, and compared young old and old-old persons to clarify the roles of public health nurses in promoting community development., Materials and Methods: A cross-sectional study based on Andersen's Behavioral Model of Health Care Utilization was conducted with 2,500 residents aged 65 years or older of City A in Akita Prefecture. The study was conducted from April 8 to May 15, 2017. Participants were administered a questionnaire containing items on "social mutual aid in the rural district". Responses were recorded on a Likert scale., Results: As a result of factor analysis, the following four factors were extracted; [Blessing of a rural district and mutual help and assistance unique to a rural district], [Closeness of healthcare welfare service and family doctors in conjunction with their own health], [Decline of culture and community unique to rural districts accompanied by depopulation] and [Closeness of the town where they live]. Differences were observed in the closeness of social mutual aid and local societal stimulative effects, even between generations of old and old-old persons. In young-old persons, a negative correlation was observed between [Closeness of the town where they live] and other factors. In old-old persons, a negative correlation was found between [Decline of culture and community unique to rural districts accompanied by depopulation] and other factors., Conclusion: Since not only individual health indices but also local social mutual aid, which relates to individuals' influence on the construction of a Community-based Integrated Care System in a rural district, the author posits that a data collection and analysis system on social mutual aid would be beneficial for community development for older adults living in rural districts., Competing Interests: The author declares no conflicts of interest., (©2024 The Japanese Association of Rural Medicine.)

Objective: To clarify the association between dementia knowledge and attitudes, lifestyle backgrounds, and practical training experiences of nursing students, and examine the basic nursing education for dementia., Participants and Methods: A total of 412 first-to-fourth-year students at Nursing College A participated in the study. A cross-sectional survey was conducted regarding knowledge (15 questions) and attitudes (15 questions) related to dementia., Results: Consent was obtained from 158 individuals (The response rate was 38.3%). Significant items regarding dementia attitudes and cohabitation experiences were identified. Additionally, significant items regarding attitude toward dementia and care providing experiences were identified., Conclusion: Associations among attitude toward dementia, cohabitation experiences, and care providing experiences were determined. Knowledge and attitudes regarding dementia improved with practical training experience., Competing Interests: None., (©2024 The Japanese Association of Rural Medicine.)

Polyglycerol fatty acid esters (PGFEs) are common food additives. PGFE-based formulations exhibit high structural stability, however, the stability mechanism of the micellar structures has not been yet elucidated. In this study, nanostructural analysis was performed using small-angle neutron and X-ray scattering (SANS and SAXS) measurements to reveal the mechanism of the structural stability of PGFE-coenzyme Q10 (CoQ10) mixtures as a CoQ10 formulation. Pure PGFE formed multilamellar vesicles, whereas PGFE-CoQ10 formed spherical micelles. Furthermore, when the amount of added water increased, the PGFE-CoQ10 micellar size and the amount of water in the micelles remained unchanged. A model-fitting analysis of the SANS results suggested that the CoQ10 molecules were introduced between the surfactants, forming a palisade-type structure. The high structural stability of the PGFE-CoQ10 micelles was attributed to two factors: proper spreading of the hydrophilic head chains and inhibition of the change of the amount of water inside the micelles by the PGFE heads and quinone ring of CoQ10. This indicates that PGFE-CoQ10 can function in water while maintaining the micellar structure formed in the storage solution. The findings of this study are important for the safety and nano-hazard aspects of PGFE-CoQ10 formulations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Purpose: It is necessary to perform gantry quality assurance (QA) in high precision radiotherapy. However, the O-ring type linear accelerator (Halcyon) does not have a light field and laser as a reference of isocenter point. The aim of this study is to investigate the usefulness of a three-dimensional diode array detector for gantry angle QA, and an O-ring type linear accelerator., Method: The gantry angle and rotational center were verified using the ArcCHECK 3D diode array on the general linear accelerator (TrueBeam) as a reference and Halcyon. The gantry angles were measured at 0, 90, 180, and 270°. The accuracy of the gantry rotational center was evaluated using rotational irradiation in the clockwise and counterclockwise directions between 181° and 179°., Results: The QA system with ArcCHECK was able to apply on the TrueBeam and Halcyon. As a result of the accuracy of the gantry angle, the maximum error of value calculated from ArcCHECK was 0.1° compared with the nominal gantry angle of Halcyon. As a result of the accuracy of the gantry rotation isocenter of Halcyon, the distance between the isocenter and the gantry rotation center was 0.45 mm and 0.41 mm in the clockwise and counterclockwise directions, respectively., Conclusion: The QA system with ArcCHECK was useful for the gantry angle and the rotation center accuracy on the Halcyon.

Objective: Medical science students, especially nursing students, are more likely to experience academic stress; therefore, resilience helps them focus on their lessons attentively. However, the results of a few existing studies regarding how resilience impacts the academic performance of medical science students are incongruent. This study aimed to investigate whether resilience impacts the academic performance of Japanese nursing students. Methods: We conducted a cross-sectional, self-administered questionnaire survey from September to November 2020. A total of 229 undergraduate nursing students participated in this study; here, resilience was measured using the Bidimensional Resilience Scale, which includes innate factors (optimism, control, sociability, and vitality) and acquired factors (problem-solving, self-understanding, and understanding others). Academic performance was measured using the functional grade point average (f-GPA). Covariates were demographics, pre-entry academic performance levels, medical history, time spent walking, psychological distress, subjective economic status, and part-time jobs. Multivariate regression analyses were performed. Results: Among the 229 participants, the f-GPA mean (standard deviation) was 2.93 (0.46). Only vitality was significantly associated with a higher f-GPA after multiple imputations (β = 0.06; 95% confidence interval = 0.03-0.09; P <0.01). The Poisson regression analysis of 212 participants with all data indicated that vitality was associated with the fourth quartile f-GPA (prevalence ratio, 1.05; 95% confidence interval, 1.03-1.08; P <0.01). Conclusion: There was a significant association between the vitality of resilience components and academic performance among Japanese nursing students. This study suggests that an approach that develops resilience is necessary for the academic success of nursing students., Competing Interests: The authors declare that they have no competing interests., (©2021 The Japanese Association of Rural Medicine.)

Objective: Although it is well known that smoking is a risk factor for subarachnoid hemorrhage, the association between smoking and unruptured intracranial aneurysms remains unclear. The aim of the present study was to investigate whether smoking status was associated with unruptured intracranial aneurysms among Japanese brain health check-up examinees. Materials and Methods: We conducted a cross-sectional study of 1,496 adults (aged 26-90 years) undergoing brain health check-ups at a single community medical support hospital in Akita, Japan between 2009 and 2013. In Japan, people can discretionarily undergo a brain health check-up for early detection of unruptured intracranial aneurysms or subarachnoid hemorrhages. Participants responded to a questionnaire on lifestyle, such as smoking status, and were classified into three groups: never, former, and current smoker. The evaluation of unruptured intracranial aneurysms detected by magnetic resonance angiography was performed by an expert physician. Multiple logistic regression models were used to estimate the odds ratio for unruptured intracranial aneurysms. We performed statistical analyses by age, sex, and family history of stroke. Results: The number of participants with unruptured intracranial aneurysms was 43 (2.9%). The mean age (standard deviation) and proportion of males was 55.8 (9.5) years and 53.3%, respectively. The adjusted odds ratios (95% confidence intervals) for unruptured intracranial aneurysms of 1.21 (0.48-3.08) among former smokers and 2.88 (1.10-7.50) among current smokers were compared to those of never smokers (p-trend = 0.041). After stratifying by age, sex, and family history of stroke, no interactions were found. Conclusion: This cross-sectional study conducted in Japan showed that smoking was positively associated with unruptured intracranial aneurysms among brain health check-up examinees., Competing Interests: The authors declare that there are no conflicts of interest., (©2020 The Japanese Association of Rural Medicine.)

Objective: This study aimed to clarify the association between social mutual aid and psychological stress among residents in a rural district. Materials and Methods: A cross-sectional study based on Andersen's Behavioral Model of Health Care Utilization was conducted on 2,500 residents of City A in Akita Prefecture who were aged 65 years or older. The study was conducted from April 8 to May 15, 2017. Participants were administered a questionnaire containing items on individual characteristics (predisposing, enabling, and need) and contextual characteristics (physical factors). Results: Responses were obtained from 1,236 participants, and data from 974 valid questionnaires were analyzed. Factors related to the high level of psychological stress were "maintenance of confidential relationships that could only be formed in the rural district (low)" and "social support (low)", which are forms of social mutual aid. Use of health services had no association with psychological stress, whereas when psychological stress was high (5 points or higher), the rate of "not participating in community groups (no)" was also high. Conclusion: The findings of this study indicate the need for the objective evaluation of the roles of self-help and mutual help among elderly adults living in a rural district and the mutual help and public help functions represented by health services. It is also important to develop districts that promote the enhancement of social mutual aid so that such help can be fully utilized., Competing Interests: The authors declare no conflicts of interest., (©2020 The Japanese Association of Rural Medicine.)

The structures of micelles and microemulsions consisting of polyglycerol polyricinoleate (PGPR) were investigated by small-angle X-ray scattering (SAXS) and rheological measurements. The SAXS results show that amphiphilic PGPR molecules form stable micelles in glycerol. When vitamin E is added to the PGPR micelles, it is encapsulated in the micelles and forms an emulsion. These micelles are stable towards mechanical shearing up to a shear rate of 1000 s -1 , with shear thinning occurring in the emulsion above 100 s -1 , indicating that the emulsion may undergo break up by shearing, but recovers the structure by releasing shear strain.

A flow-type microreactor containing glutaminase-mesoporous silica composites with 10.6 nm pore diameter (TMPS10.6) was developed for the continuous synthesis of theanine, a unique amino acid. High enzymatic activity was exhibited by the local control of the reaction temperature.

A novel catechin, pilosanol N (1), was isolated from Agrimonia pilosa Ledeb and its structure was determined by (1)H, (13)C NMR and HRESI-MS analyses. Compound 1 inhibited nitric oxide (NO) production in LPS/IFN-γ -induced RAW264.7 macrophages, and then the iNOS gene expression and its protein production with LPS/IFN-γ treatment cells were also suppressed in the presence of 1. In addition, compound 1 scavenged NO or nitrogen radicals generated from NOR3 (4-ethyl-2-hydroxyamino-5-nitro-3-hexenamide) as an NO donor. These results indicated that pilosanol N can decrease the level of NO through a mechanism that involved both a decrease in the NO production and NO scavenging., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

To measure the narrow beam used in stereotactic irradiation, installation of the ionization chamber parallel to the X-ray beam axis has been used instead of perpendicular installation. However, the definition of the effective point is a major problem in the parallel installation. In this study, we analyzed the effective point in parallel installation, and considered the prediction and evaluation of measurement point displacement. Relative dosimetry was carried out by installing the thimble ionization chamber in both perpendicular and parallel configurations. We then searched for the measurement point that coincided with the PDD of the perpendicular installation by using the displacement of the measurement point of the parallel installation. We found that the effective point of measurement for relative photon beam dosimetry depends on every detail of the chamber design, including the cavity length and the cavity radius. Moreover, the effective point of measurement also depends on the beam quality and the field size. The amount of effective point displacement for the parallel installation was quantified with the linear expression of TPR(20,10). Our results showed that the amount of effective point displacement can be estimated by the ionization volume of the dosimeter and the energy used.

Unlike commercial ferric pyrophosphate, micronized dispersible ferric pyrophosphate (MDFP: Sun-Active Fe) does not precipitate and is completely dispersible in liquid form. MDFP shows a sharp particle size distribution at a nanometer level, which is several times smaller than that of commercial ferric pyrophosphate. The bioavailability of MDFP was compared to ferric pyrophosphate, sodium ferrous citrate, and ferrous sulfate by three bioavailability tests in rats; namely the serum iron concentration curve, the hemoglobin regeneration efficiency, and Association of Official Analytical Chemists' hemoglobin repletion test. The high area under curve value, a lag in peak time, and continued high serum iron concentration by MDFP over the other iron compounds indicates a sustained release of iron in the serum iron concentration curve method. MDFP showed the highest hemoglobin regeneration efficiency among all the iron compounds tested. The relative biological value of MDFP per unit of ferrous sulfate in each bioavailability test showed a high value as compared to other iron compounds. The above results suggest that MDFP is an ideal compound with high bioavailability for iron fortification in various liquid applications.

Stercoral perforation of the colon or rectum is a rare cause of acute abdomen, with fewer than 70 cases documented in the literature. We report herein the case of a 60-year-old man who presented with anuria and epigastric pain with physical signs of peritonitis. An abdominal X-ray showed bilateral subphrenic free air accumulation, and an emergency laparotomy subsequently revealed perforation of the rectum, suggestive of a stercoral cause, which was treated by simple closure after debridement. Following an uneventful postoperative course, he was discharged from the hospital 3 weeks after his operation and is now doing well without having suffered any further gastrointestinal problems. The clinical features, diagnosis, and treatment of the disease are reviewed following the presentation of this case. Surgeons should be aware of the possibility of this fatal disease, despite its rare incidence. Furthermore, it is important to recognize the condition at an early stage because it has a significantly high mortality if not treated early. Conversely, the surgical outcome is satisfactory provided surgery is performed in due time.

Background and Objectives: The present study compared the effects of sequential methotrexate and fluorouracil followed by leucovorin rescue (MFL), as an adjuvant chemotherapy versus a combination of tegafur (UFT) and mitomycin C (MMC), on patient survival and recurrence after surgery for colorectal carcinoma., Methods: Between January 1990 and December 1995, a total of 46 patients with advanced colorectal cancer were treated postsurgically by adjuvant chemotherapy using MFL or UFT-MMC. Surgical treatment was performed according to standardized procedures for radical resection of colorectal cancer. The patients were stratified into two groups after surgery. The MFL regimen consisted of MTX (100 mg/m2) and 5-FU (600 mg/m2) at hour 24, followed by leucovorin rescue. The UFT-MMC regimen consisted of MMC (12 mg/m2) intraoperatively and MMC (6 mg/m2) ever other week after surgery for 2 months and oral UFT (375 mg/m2/day), a combination of tegafur and uracil in a molar ratio of 1:4, was continued for 3 years or longer depending on the patients tolerance., Results: The overall survival rates after surgery was significantly (P < 0.05) higher in the MFL than the UFT-MMC group. Recurrence rates were significantly lower in the MFL than the UFT-MMC Group, especially for liver recurrence. Disease-free survival was significantly (P < 0.05) higher in the MFL than the UFT-MMC group., Conclusions: The present results demonstrated the superiority of MFL therapy for improving postsurgical survival in patients with advanced colorectal cancer, in particular for those patients with a high risk of recurrence following potential curative resection.

Occurrence of choroidal neovascularization following laser photocoagulation treatment for central serous retinopathy (CSR) has been reported. We reviewed all the cases of photocoagulation treatment for CSR in our clinic during the past 25 years (1968-1993). Among 1,824 CSR-affected eyes which were treated, choroidal neovascularization occurred in 19 at the site of photocoagulation. In a careful reevaluation of pretreatment fluorescein angiograms, small choroidal neovascularizations were detected in 5 eyes, in which cases the diagnosis of CSR was incorrect. In 3 eyes, choroidal neovascularization was suspected and might have been masked. In the remaining 11 eyes, choroidal neovascularization was not seen. Our survey indicates that, in central serous retinopathy, when the age of the patient is over 50 years, and leakage is weak and parafoveal, choroidal neovascularization may be masked. Laser photocoagulation for these eyes should be conservative with careful, long-term observation.

We report a case of leiomyosarcoma whose origin was near the root of ileocecal mesentery and extended into the retroperitoneum. Preoperative imaging examination, including CT, MRI and angiography clearly displayed its origin and retroperitoneal extension. These results contributed to treatment planning.

The intravenous preparation of CS-1170 was administered in 9 cases of pediatric disease and was excellent or good in 5 cases (55.6%). It was poor in 3 of 4 cases of Mycoplasma pneumonia. We think that the dose of 50 mg/kg/day can exert an effect regardless of the intensity of symptoms. Through our present experiences with the excellent or good cases, an intravenous drip or intratracheal injection for 3 approximately 5 days is effective. Although there was no abnormality in the biochemistry or electrolyte findings before or after administration, eruption developed in one of the cases in which the drug was administered for 6 days.

I. Pharmacokinetics (1) CXM 24.4 and 31.9 mg/kg were administered by intravenous drip infusion for 4 hours. The plateau levels were obtained at 1 approximately 2 hours, the blood levels at which time were 25.6 and 33.8 micrograms/ml respectively with dose response observed. (2) The respective half-lives were as short as 49.4 and 36.2 minutes. (3) The total clearances were 74.6 and 127.2 ml/min respectively; when calculated on plateau level and infusion rate, these were 81.6 and 111.0 ml/min. These differently determined values were near each other. (4) The respective renal clearances were 157.8 and 101.9 ml/min. II. Clinical results CXM for intravenous use was administered to 21 pediatric patients, and the clinical results were good and excellent in 19 (90.5%). Excluding 2 cases with elevation of cold hemagglutination values, the efficacy rate of 94.7% (18/19 cases) was achieved. The doses administered ranged 44 approximately 100 mg/kg body weight, and this dosage level was considered enough to achieve clinical effect. With the current clinical trial we considered that although the effectiveness of this drug was proved in 3 approximately 7 day intravenous drip infusion and intravenous injection, the continued treatment with other oral antibiotic following CXM treatment would be necessary from the patients' general conditions and laboratory examination findings. No noteworthy side effects were observed in any of the patients. No abnormality was seen in biochemistry and electrolyte findings, either.

(1) When 20.8 approximately 34.7 mg/kg body weight of CS-1170 were instilled intravenously for 30 minutes to one hour, peak levels were obtained on completion of the intravenous drip in the range 85.7 approximately 1,117.3 microgram/ml. (2) The half life was 22 approximately 49 minutes which is very rapid. (3) The kidney clearance was 6.8 approximately 104.8 ml/min. (4) The total clearance was 5.9 approximately 111.5 ml/min, showing correlation with the kidney clearance. (5) The apparent distributional capacity was 0.3 approximately 4.3 liters, showing a strong correlation with body weight.

The case presented here may be the first identified report of Down syndrome with 21 trisomy in one child of triplets. One triplet died at 1 month of age; his facial appearance was not typical of Down syndrome. Detailed testing of blood groups suggested identical origin in the remaining two children. However, the fluorescent banding technique of chromosome, one-way mixed lymphocyte culture test, and HLA typing were suggestive of dizygotic orgin. Skin transplant studies supported this contention.