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Background Approximately 40% of patients with chronic low back pain have a neuropathic component. In this study, we assessed the effects of analgesics on tactile hypersensitivity and walking distance in the rat cauda equina compression (CEC) model of neuropathic low back pain. Methods The effects of analgesics on tactile hypersensitivity were examined using the von Frey test in CEC and partial sciatic nerve ligation (pSNL) models. Effects on walking distance were assessed using a treadmill test. Levels of α2δ1 subunit and ATF-3 mRNA in dorsal-root ganglion (DRG) neurons and those of α2δ1 subunit protein in the spinal cord were determined using quantitative RT-PCR and western blotting, respectively. Histological features were assessed using immunohistological methods. Results Histological changes indicating nerve damage (increase in ATF-3 mRNA, decrease in NF-200 and an increase in CD68 immunoreactivity) were observed in the CEC model. Duloxetine had analgesic effects in both models and improved walking distance in the CEC model. Pregabalin had analgesic effects in both models; however, the effect was weaker in the CEC model than in the pSNL model. α2δ1 subunit expression in DRG neurons and in the spinal cord was unchanged in the CEC model, but significantly increased in the pSNL model. Indomethacin had no analgesic effect in either model. Intrathecal yohimbine inhibited the effects of duloxetine with significant effects on depression. Conclusions These findings suggest that the analgesic effects of duloxetine are mainly mediated by the spinal monoamine system, independent of the antidepressant effects of this agent. Significance The findings of this study suggest that duloxetine may be an effective treatment of broad neuropathic pain states, including neuropathic low back pain. The analgesic effects of duloxetine might be mediated by alterations of the descending pain modulatory pathways in the spinal cord, independent of the antidepressant effects.

BackgroundIt has been suggested that screening interventions may be effective for suicide prevention. Few studies, however, have reported their effects on outcome measures, including death by suicide among middle-aged adults.MethodWe used a quasi-experimental parallel cluster design with matched community-based intervention and control municipalities (total eligible population: 90 000) in Japan. At-risk residents within the intervention area were invited for universal depression screening and subsequent care/support. We compared changes in suicide incidence of adults aged 40–64 years for the 4-year pre- and post-implementation periods in the intervention group with the control group and the whole country. Incidence rate ratios (IRRs) of the outcomes were adjusted for age group, gender and interaction terms, using mixed-effects negative binomial regression models. Suicide rates among intervention and control subgroups were compared.ResultsThe screening procedure was offered to 52% of the intervention group, and 61% of those contacted responded over the implementation period. Suicide rates decreased more in the intervention group [IRR 0.57, 95% (CI) 0.41–0.78; F1,36 = 12.52, p = 0.001] than the control group (IRR proportion 1.63, 95% CI 1.06–2.48; F1,82 = 5.20, p = 0.025) or the whole country (IRR proportion 1.64, 95% CI 1.16–2.34; F1,42 = 8.21, p = 0.006). Sensitivity analyses confirmed the results from the primary analysis. There were lower suicide rates among both respondents and non-respondents to the screening than in the control group during the implementation period.ConclusionsPrevention efforts involved in the depression screening intervention were probably successful in reducing suicide rates.

The aerodynamic loss accounted to the secondary flow, or secondary loss, is one of the most prominent cause of the internal losses in turbine cascades. Secondary losses are mostly due to the interaction of Horse-Shoe Vortex and endwall crossflow. Authors have developed a so called endwall fence to reduce the secondary loss in gas turbine cascade by mitigating this interaction. However, the improvements resulting by the application of this method to a steam turbine cascade proved to be not so remarkable as for the gas turbine cascade. By conducting total pressure measurements at the endwall, previous results showed that the stream wise evolution of the losses presents two peaks; Horse-Shoe Vortex peak and crossflow peak. The abovementioned endwall fence is blocks the Horse-Shoe Vortex, but its screening effect on the crossflow is not sufficient. So in this research the use of two kinds of fences is proposed to reduce the secondary loss: one is to block the pressure side leg of the Horse-Shoe Vortex, the second is to block and guide the crossflow, which starts from the middle of the blade passage, toward the outlet. Therefore, they are called respectively Horse-Shoe Vortex fence and crossflow fence. The tests are carried out using the wind tunnel cascade and the test fences are made by 3D printer. The total loss is estimated by means of an automatically moving pitot tube located downstream the cascade. Many kinds of fences are tested and the optimum fence shape and position to minimize the secondary loss is obtained.

This paper proposes a new visual modeling environment for embedded component systems that improves the productivity of application developers. This embedded component system decreases the complexity and the difficulty of software development for embedded systems. Furthermore, it is possible to estimate the memory consumption of an entire application, since the proposed system uses a static configuration. This environment builds the development components for the application. As well, the visual modeling environment can automatically generate a build description that is part of the component description language. Finally, this environment can be used to generate C-language interface code, either. h. or. c, from the component descriptions.

Cryogenic gas chromatography (GC) combined with isotope labeling was applied to discriminative determination of hydrogen gas formed through consecutive CO2 reforming of methane and water–gas shift reaction. First, hydrogen gas was obtained by using a tandem reaction system, where reforming and shift reaction occurred consecutively. Here, D2O instead of H2O was used for shift reaction to label hydrogen gas generated there. Then, the resulting hydrogen isotopes were analyzed by a cryogenic GC system, in which an oven temperature was maintained at −196 °C by immersing a separation column into liquid nitrogen. On the chromatograms, the peaks of H2 and D2 generated from reforming and shift reaction, respectively, were clearly observed as well-separated peaks. Based on their peak intensities, hydrogen gas formed through the tandem reaction system was precisely determined with differentiating its sources.

The formation and relaxation processes of hollow atoms and related excited states of ions produced with a Ni microcapillary thin foil have been studied employing various experimental techniques. The first stage of the charge transfer from the surface to the ions was studied by using visible light measurements. On the other hand, X-ray measurements revealed the core electronic configurations of ions at the last moment of the hollow atom evolution. The overall feature of the electron capture processes in the capillary was given by the charge state distribution measurements.

To study collision processes of slow and ultra-slow highly charged ions (HCI) with atoms, molecules, and surfaces, we have been constructing a slow highly charged ion facility at RIKEN. A 14.5 GHz Caprice type ECR ion source (ECRIS) is used as the primary ion source of the facility. At present, the energy of the ion beam from the ECRIS ranges from 10 eV/q to 20 keV/q, where q is the charge state of the ions. In order to further reduce the energy (< 1 eV/q), we are developing two different schemes, which is one of the most important feature of the facility. The two schemes are (1) a positron cooling of HCIs and (2) a multiple ionization of neutral atoms or singly-charged ions with a femtosecond (fs) Tera-Watt (TW) laser. This paper presents an overview of the present facility and the schemes to produce ultra-slow HCI beams, which are expected to open new research fields.

KL-6 has been reported to be a serum marker for interstitial pneumonitis (IP). The purpose of this study was to determine the predictive value of KL-6 on the deterioration of vital capacity (VC) in rheumatoid arthritis (RA) patients with IP. In 32 RA patients we evaluated both the serum KL-6 level and VC in a prospective design. The diagnosis of IP was determined by clinical symptoms, chest X-ray, high-resolution computed tomography (HRCT) scanning and/or pulmonary function tests. Findings such as reticulonodular and/or cystic shadows on HRCT scanning were accepted as IP signs. The IP signs with ground-glass opacity were set as active. The mean period of observation was 31.2 (5.6) months. The initial and/or final serum KL-6 levels were more than 520 U/ml in seven patients (H-KL group). In the other 25 patients, both the initial and final KL-6 levels were 520 U/ml or less (L-KL group). Among the H-KL group patients, their percent VC (%VC) was significantly reduced (P < 0.01) during the observation period. No significant changes of KL-6 and %VC levels were seen in the L-KL group. Thus, we conclude that in RA patients with IP, abnormal levels of serum KL-6 may predict the deterioration of VC.

To examine the destructive course of systemic mutilating rheumatoid arthritis (RA) associated with the opera glass hand syndrome and severe generalized resorptive arthropathy, 49 (1.4%) patients were radiographically selected out of 3400 RA patients registered in this center. Of them, a retrospective chronological study was possible in 37 patients. Mean durations from the onset of RA to the opera glass hand syndrome and severe systemic resorptive arthritis were 16.3±6.5 and 16.9±7.0 years, respectively, and the progression rate of mutilating changes, especially of systemic joints, was significantly more rapid when changes started early after the onset of RA (r=−0.654,P

In rheumatoid arthritis (RA), interstitial-pneumonitis is one of the major extraarticular complications that worsens a patient's prognosis. KL-6, a human MUC1 mucin, has been reported to be a sensitive serum marker for activity of interstitial pneumonitis. We investigated the clinical significance of serum KL-6 level in patients with RA. Serum levels of KL-6 and RA-associated inflammatory markers were evaluated in 177 RA patients. The diagnosis of active interstitial pneumonitis was made by clinical symptoms, pulmonary function tests, chest X-ray film, and high resolution CT. Serum KL-6 was increased in 8 of 9 (88.9%) RA patients with active interstitial pneumonitis but in only 1 of 168 (0.6%) RA patients without active interstitial pneumonitis. No significant correlation was found between KL-6 level and conventional clinical parameters. In RA, abnormal elevation of serum KL-6 strongly indicates the complication of active interstitial pneumonitis.

OBJECTIVE—To examine the clinical characteristics of intractable diarrhoea associated with secondary amyloidosis in rheumatoid arthritis (RA). METHODS—Of 179 RA patients with biopsy confirmed secondary amyloidosis, 24 cases (23 women and one man) with intractable diarrhoea lasting for more than one month were retrospectively evaluated. RESULTS—The mean (SD) duration of diarrhoea was 87 (64) days. Prodromal symptoms of gastrointestinal dysfunction (n = 21) and impaired peristalsis (n = 16) were observed. Laboratory data showed hypoproteinaemia (4.7 (0.85) g/dl) caused by malabsorption or protein loss and high values of C reactive protein (17.0 (9.3) mg/dl). Recurrence of intractable diarrhoea (n = 4) and transition from intractable diarrhoea to other gastrointestinal problems of amyloidosis (ischaemic colitis (n = 2) and intestinal pseudo-obstruction (n = 4)) were observed. In 19 patients (25 episodes) the duration of intravenous hyperalimentation at remission (18 episodes) was 68 (52) days. Corticosteroid pulse therapy was administered to 10 patients (11 times) and the time elapsed from the end of corticosteroid pulse therapy to the end of diarrhoea was 18 (14) days. One and five year survival rates after the onset of intractable diarrhoea were 73.4% and 38.9% . Seven of 13 patients (54%) had died as a result of infectious diseases. CONCLUSION—Intractable diarrhoea associated with secondary amyloidosis in RA is a serious clinical entity and the prognosis is poor. Although it is assumed that intravenous hyperalimentation treatment and corticosteroid pulse therapy are favourable regimens for intractable diarrhoea, the patients should be monitored for possible infectious complications.

A few monolayers of lead (Pb) were deposited on clean Si(110) surfaces at room temperature and the structure at the surfaces was investigated with reflection high-energy electron diffraction (RHEED). Interesting findings were obtained, such as the formation of one-dimensional atomic chains and the appearance of a 7 × 2 superstructure.

Obesity, underweight, sarcopenia and excess accumulation of abdominal fat are associated with a risk of death and adverse health outcomes. Our aim was to determine whether body mass index (BMI) and body composition, assessed with dual-energy X-ray absorptiometry (DXA), are associated with radiation exposure among atomic bomb (A-bomb) survivors. This was a cross-sectional study conducted in the Adult Health Study of the Radiation Effects Research Foundation. We examined 2686 subjects (834 men and 1852 women), aged 48–89 years (0–40 years at A-bomb exposure), for BMI analysis. Among them, 550 men and 1179 women underwent DXA in 1994–1996 and were eligible for a body composition study. After being adjusted for age and other potential confounding factors, A-bomb radiation dose was associated significantly and negatively with BMI in both sexes (P=0.01 in men, P=0.03 in women) and appendicular lean mass (P

In this work we measured the time dependence of the light intensity of the 1s22s 1S1/2–1s12p 1P3/2 resonance transition in Li-like Al ions after passing through a 10 µg/cm2 carbon foil. The measurements were done at beam energies of 0.8 MeV/u and 2.5 MeV/u. Also, the 1s5g–1s6h transition in He-like Al ions, after passing through the same thickness carbon foil, at 2.5 MeV/u was investigated. The results show very obvious decreases of the light intensity for the Li-like transition with beam exposure time of the foil at both beam energies, while a slow increase was observed for the He-like line intensity. In this work several different foil aging effects on line intensities are discussed and a new normalization scheme is proposed to improve the reliability of beam foil spectroscopy method in lifetime measurements.

We report on the direct relationship between output power and the current carrying capability of a squirrel-cage HTS induction/synchronous motor based on experiment. The secondary windings are fabricated by use of so-called DI-BSCCO tapes, and the conventional (normal conducting) stator, three-phase and four-pole, is utilized. The tests are carried out in liquid nitrogen for two kinds of HTS windings, in which the number of HTS rotor bars is varied. It is directly shown that the output power is proportional to the rotor bars' critical current at 77 K. In other words, the torque can be enlarged by increasing the critical current of the HTS rotor bars.

We investigate both theoretically and experimentally the momentum distribution of multiply charged ions ionized by an intense multicycle laser field with a maximum intensity of $\ensuremath{\sim}(50--70)\phantom{\rule{0.3em}{0ex}}\mathrm{PW}∕{\mathrm{cm}}^{2}$. Ions with different charge states are produced during a single laser shot due to a spatial variation of the laser intensity within the beam focus. The measurements show approximately a simple linear relation between the width of the momentum distributions and the ionization potential of the ions. Such a power law scaling appears to be universal for various rare gas atoms used (He, Ne, Ar). We analyze this ionization dynamics using a quasiclassical tunneling theory for a single active electron model assuming that the interaction between electrons is negligible in such a strong field limit. We show that for the relatively long pulses used in the present work ($\ensuremath{\sim}200\phantom{\rule{0.3em}{0ex}}\mathrm{fs}$ or $\ensuremath{\sim}80\phantom{\rule{0.3em}{0ex}}\text{cycles}$) the effect of the laser envelope plays an important role in the ionization process.

The position- and energy-sensitive primary particle detectors of a nanodosimetry system are described. They consist of a telescope of silicon strip detectors, which allow the determination of the particle's position from the hit strip address and its energy from the specific energy loss. In our implementation, the energy loss is measured through the time-over-threshold.

Adenomatoid tumors are uncommon neoplasms of the paratesticular tissues. We report a case of an adenomatoid tumor of the testicular tunica albuginea. A 54-year-old man presented with a painless right intrascrotal mass. Serum levels of HCG-beta and AFP were within normal limits. Scrotal ultrasonography showed an oval-shaped low echoic lesion located on the surface of the testis. The patient underwent right partial orchiectomy. Histological examination revealed adenomatoid tumor of the tunica alubuginea testis. Adenomatoid tumors of the testicular tunica alubuginea are rare. Examination of tumor markers, ultrasound studies and diagnoses of frozen sections can prevent needless orchiectomy.

A goal of this work is proposal and construction of simulation methods of haptic reproduction and interactive visualization of a beating heart in cardiovascular surgical training and education. The data for the beating heart model was obtained from ECG-gated 3D MRI of a normal volunteer. The elastic information was assumed as a uniform value with clinically experienced elasticity. Using a real-time 3D graphics and a haptic device, a simulation environment of the beating heart was designed and implemented. After the construction, some cardiovascular surgeons evaluated the implemented system. Its visualization and haptic expression were scored excellent, but some details in haptic interface were remained to be improved. Finally, for more realistic cardiovascular surgical simulation, future development of the method is discussed.

A case of cardiac myxoma with multiple brain hemorrhage is reported. A 57-year-old male had complained of lower abdominal pain, diarrhea and fever for 3 days. On admission, he was in a condition of disseminated intravascular coagulation and sepsis. An abdominal CT scan showed infarction in the right kidney and spleen and an echocardiogram also showed myxoma in the left atrium. Although he presented no neurological symptoms, the brain CT showed multiple brain hemorrhage in the bilateral brain hemispheres. Total resection of the tumor was carried out for the improvement of the patient's general condition. Vimentin, S-100 protein and neuron specific enolase was positive in immunological staining and the pathological diagnosis was myxoma. Postoperative recovery of consciousness was poor and left hemiparesis developed. CT showed the increase of hematoma but angiography showed no cerebral aneurysm. The symptoms improved with conservative therapy. However the enhanced lesion remained in the right parietal lobe and an operation was performed 5 months later. The myxoma cell could not be found in the pathological examination, so tumor embolism, cerebral infarction, hemorrhagic infarction due to DIC, hematoma enlargement caused by heparinization during operation were suspected to have occurred in this order without tumor growth.

The memory disturbance caused by medial temporal lesion is reported concerning 6 cases of cerebral hemorrhage, infarction, brain tumor, and contusion. The memory disturbance was significant compared with the patient's intact orientation and normal intelligence. In the category of memory, recent memory was more markedly disturbed than the immediate or remote memory. From the viewpoint of the lesion, the memory disturbance was more severe when, in addition to the hippocampus, the entorhinal gyrus or amygdala was damaged. The visual memory disturbance was mild and no difference was observed in the verbal or visual memory according to whether the lesion was right or left. The memory disturbance was usually transient and marked improvement was observed in some cases.

The crystal structure of a pepstatin-insensitive carboxyl proteinase from Pseudomonas sp. 101 (PSCP) has been solved by single-wavelength anomalous diffraction using the absorption peak of bromide anions. Structures of the uninhibited enzyme and of complexes with an inhibitor that was either covalently or noncovalently bound were refined at 1.0-1.4 A resolution. The structure of PSCP comprises a single compact domain with a diameter of approximately 55 A, consisting of a seven-stranded parallel beta-sheet flanked on both sides by a number of helices. The fold of PSCP is a superset of the subtilisin fold, and the covalently bound inhibitor is linked to the enzyme through a serine residue. Thus, the structure of PSCP defines a novel family of serine-carboxyl proteinases (defined as MEROPS S53) with a unique catalytic triad consisting of Glu 80, Asp 84 and Ser 287.

L-Glutamine and L-glutamate, which are important flavor components in soy sauce, are converted to L-pyroglutamate during brewing. Therefore, it is necessary that the L-glutamate and L-pyroglutamate contents can be measured accurately. We developed a simultaneous assay method for L-glutamate and L-pyroglutamate by using 5-oxoprolinase (without ATP hydrolyzing activity) and glutamate oxidase. By this method, the L-pyroglutamate could be measured accurately in a range of 0.05 to 1.0 mM in the presence of 1.0 mM L-glutamate. This system is effective for process and quality controls.

A case of arteriovenous malformation associated with venous malformation is reported. A 35-year-old male patient suffered intracerebral hemorrhage in the left occipital with acute subdural hematoma. Angiography showed an arteriovenous malformation fed by the left middle cerebral artery. The hematoma and nidus was operatively removed. He also had a venous malformation in the left temporal lobe. This rare case is reported with some discussion.

Kexstatin I is a potent proteinaceous inhibitor of Kex2 proteinase (EC 3.4.21.61). In the present study we show the molecular cloning, primary structure determination and expression of the gene encoding kexstatin I. We also demonstrate its enhanced activity and specificity for Kex2 proteinase inhibition by rational mutagenesis. The cloned kexstatin I gene encoded a protein of 145 amino acid residues, including the 35-residue signal sequence for secretion. The amino acid sequence showed 52% identity with those of the Streptomyces subtilisin inhibitors (SSIs). Thus kexstatin I is the first SSI-family member that can inhibit Kex2 proteinase. The reactive site of the inhibitor was determined to be -Thr(69)-Lys(70) downward arrowGlu(71)-, where downward arrow indicates the reactive site. Because Kex2 proteinase generally shows the highest affinity for substrates with basic amino acid residues at the P(1) and P(2) sites, conversion of the Thr(69)-Lys(70) segment of the inhibitor into dibasic motifs was expected to result in enhanced inhibitory activities. Thus we constructed kexstatin I mutants, in which the Thr(69)-Lys(70) sequence was replaced by the Thr(69)-Arg(70), Lys(69)-Lys(70) and Lys(69)-Arg(70) sequences using PCR-based mutagenesis, and analysed them kinetically. Among these mutants, the Lys(69)-Arg(70) mutant was the most potent inhibitor. The K(i) for Kex2 proteinase was 3.2x10(-10) M, which was 140-fold lower than that of the inhibitor with the Thr(69)-Lys(70) sequence. Although kexstatin I could also inhibit subtilisin, the enhancement of inhibitory activity upon such mutations was specific for Kex2 proteinase inhibition.

A case of central nervous system anomalies(agenesis of corpus callosum, colpocephaly, hydrocephalus, congenital dermal sinus) associated with congenital heart disease(double-outlet right ventricle, complete endocardial cushion defect, atrial septal defect, pulmonary arterial stenosis, patent ductus arteriosus) is reported. Female patient had been already diagnosed as hydrocephalus during pregnancy and ventricular drainage was performed soon after the delivery. Prostaglandin E 1 was also applied for heart disease, but saturation of O2 decreased to 80% on arterial blood gas analysis. Blalock-Taussig operation and ligation of ductus arteriosus was done 41 days after the delivery and ventricle-peritoneal shunt was also made for the progressive hydrocephalus on the same day. Chromosome analysis showed no abnormality. The genesis of this complicated brain and heart anomaly is discussed from the viewpoint of neural crest cell abnormality.

The bedside wellness system (BSW) is effective for decreasing stress and improving mental well-being and should help relieve the side effects and mental disorders of patients during cancer chemotherapy.The study was a randomized clinical trial. After giving informed consent, patients were randomly assigned to the BSW intervention or control groups. The patients were given the Hospital Anxiety and Depression Scale (HADS) test before the trial to evaluate their emotional baseline. The Cancer Fatigue Scale, which was developed at our institute, and face visual analog scale were used to measure the emotional state and subjective feelings before and after the trial. The degree of emesis was measured using a visual analogue scale after the experience. We set up the system in a room in the outpatient clinic of the National Cancer Center New Hospital Building.The decreases in the fatigue score and emesis score 3-5 days after chemotherapy were statistically significant (both p0.05) and carry-over effects were detected.BSW intervention therapy is an effective way to treat fatigue and emesis. This virtual reality system is a new therapeutic method that can be used in palliative medicine.

We present the system design and the methods of video-based guidance to assist with brain tumor biopsy procedures. The system comprises of a three-dimensional (3-D) position sensor, a CCD camera, a liquid crystal display (LCD) and a graphics computer equipped with a video capture board. The markers for positional measurement are attached to the CCD camera, a surgical tool, and the patient head. In order to be integrated into the camera-viewing capacity, 3-D images of the head and guidance indicators are visualized to form a life like video image. For reliable guidance, we also use the surgical plan, called the "safety map", which is a sphere surface highlighting the covering area of anatomically significant tissues and obstacles around the target for the indication of the biopsy needle's insertion starting-point. The safety map can be visualized in exactly the same way as it would be in a real life situation. The preliminary experiments were performed at the National Cancer Center. A high degree of flexibility in terms of views was created by using general apparatuses which are a CCD camera and a LCD. The display of the safety map enabled a successful completion of both craniotomy and biopsy needle insertion procedures.

A 41-year-old woman was admitted with gross hematuria and pain on urination. Cystoscopy showed a huge and lobulated submucosal non-papillary bladder tumor. Pelvic computed tomography demonstrated a heterogeneous and enhanced lobulated mass, 8 cm in diameter, with extravesical invasion but there appeared to be no metastatic lesions. Transurethral biopsy revealed leiomyosarcoma pathologically. Total cystectomy and construction of an ileal conduit were performed. The tumor was histologically diagnosed as leiomyosarcoma. Immunohistochemical studies revealed the tumor to be positive for epithelial membrane antigen (EMA) and muscle actin but negative for desmin, and S-100. We reviewed 102 cases of vesical leiomyosarcoma reported in Japan. Among these 102 cases, there were no EMA-positive cases. Immunohistochemical and electromicroscopic evaluation should be performed to evaluate this disease.

Ultrasonograms of the carotid artery were compared with the intraoperative finding of atheroma plaque in terms of stenosis, fragility, ulceration and calcification. Soft type, intermediate type and these mixed type plaques were fragile plaques in almost all cases. All hard type plaques were tough plaques. The detection of stenosis and calcification was satisfactory, however that of ulceration was not sufficient. The stenotic lesions frequently existed in bilateral carotid arteries and the intima was easy to become thick even after the endoarterectomy. The ultrasonogram was thought to be the essential study for the carotid artery lesions.

Benign polyp of the renal pelvis is extremely rare. We report a case of fibroepithelial polyp in the renal pelvis complicated with medullary sponge kidney successfully treated by percutaneous resection. The patient had recurrent bilateral renal stones because of medullary sponge kidney. Percutaneous resection of renal pelvic polyps was carried out through a 26 Fr Amplatz sheath using a 24 Fr resectoscope. Pathological diagnosis was a fibroepithelial polyp. The etiology of this polyp was suggested to be chronic irritation of renal stone.

The relationship between the bilateral occurrence and coagulation time was analyzed in 137 cases of chronic subdural hematoma. Bilateral chronic subdural hematomas more frequently happened in the patient with coagulation time elongation beyond the normal control. This tendency was significant in the non-traumatic group and bilateral subdural hematomas were found in: 45% in prothrombin time (PT)-elongated group vs 10.3% in non-elongated group and 38.9% in activated partial thromboplastin time (aPTT)-elongated group vs 14.6% in non-elongated group. The ratio of PT and aPTT coagulation time against the normal control was significantly larger in the bilateral group than in the unilateral group. The ratio was as follows: PT ratio was 1.056 in bilateral group and 0.995 in unilateral group. aPTT ratio was 1.051 in bilateral group and 0.954 in unilateral group. Furthermore the bilateral hematomas tended to happen in hemodialysis cases, and in patients on warfarin or anti-platelet drugs. Bilateral hematomas were found in 41.7%, 37.5% and 33.3% respectively. The ratio of PT and aPTT coagulation time was as follows: PT ratio was 1.040 in hemodialysis cases and 1.082 in warfarin-applicated cases. aPTT ratio was 1.022 in hemodialysis cases and 1.055 in warfarin-applicated cases. These results suggest that the suppressed coagulation ability and platelet function are involved in the genesis of bilateral chronic subdural hematomas.

The technology of virtual reality (VR) offers several advantages in the field of medicine because it enables us to practice medical procedures repeatedly, and can provide a variety of experiences by using virtual organs in different patients. It also aids in learning about a clinical procedure and facilitates objective evaluation by a supervisor. In the field of clinical oncology, a virtual environment can be useful for simulating surgery, diagnosing cancer invasion, obtaining informed consent or enhancing patient education, and for clinical communication using network-based VR. This technology can also be used to improve a patient's living conditions and to treat the psychological problems and/or stress of cancer patients. In the present chapter advanced VR research for palliative medicine at the National Cancer Center Hospital Japan is described and discussed.

The possibility of applying Virtual Reality (VR) techniques to the mental care of patients is discussed in this chapter. VR technology holds much promise for providing supportive activities and promoting cooperation among caregivers. Interactivity with media may give the feeling of control to patients and thus provide a greater joy than passively watching television. Immersion in VR is expected to reduce pain and relieve anxieties for a while. Some kinds of VR content would make patients relaxed or encourage them in their fight against disease. Moreover, networked VR could offer a virtual space where patients meet, communicate, organize activities, and share experiences with other people--other patients, friends, family members, medical doctors, social workers, and so on. A basic study and trials to evaluate our developed VR system, called the 'Bedside Wellness System,' provide evidence for the effectiveness of this approach. Future research tasks are also discussed.

Experience in three pontine hemorrhage cases which were treated by open surgery is recorded here. They were operated on by trans-fourth ventricular, subtemporal transtentorial on retromastoid suboccipital approaches. The neurological symptom improved noticeably in one case who was operated on through the retromastoid suboccipital approach seven days after the onset. The pontine hemorrhage can even be cured with open surgery which is performed in the early stage and through the operative approach.

This is a report of successful management for a far advanced, chemorefractory testicular cancer patient. A 29-year-old male was referred to our hospital for the treatment of progressive lung metastases with elevated hCG level, which had recurred after complete remission following 3 courses of BEP chemotherapy and progressed after transient partial regression following 2 courses of intensified EP chemotherapy. In addition, a 3 cm in diameter, solitary brain metastasis was detected on CT. First, we performed wedge resection of bilateral pulmonary lower lobe for chemorefractory pulmonary metastases. Histological examination revealed viable embryonal carcinoma identical to the primary one. Thereafter, whole brain irradiation in combination with VIP chemotherapy (etoposide 100 mg/m2, cisplatin 20 mg/m2 and ifosfamide 1200 mg/m2 daily for 5 consecutive days) was carried out to treat brain metastasis. By 2 cycles of VIP therapy and irradiation (36 Gy), partial tumor regression and normalization of hCG level were achieved, leading to salvage surgery of the brain metastasis which histologically proved to be necrosis. Following an additional cycle of VIP therapy, the patient has been free of recurrence 24 months after completion of the treatment.

Carbon was deposited on the surface of a stainless steel tube by ECR (Electron Cyclotron Resonance) plasma with a CH4/H2 gas mixture in order to reduce outgassing from the steel surface. The magnetic field for the ECR resonance was obtained by permanent magnets. The outgassing rates before and after the deposition were measured. The outgassing rate of water vapor from the coated surface after an exposure of 104 L water vapor is reduced to 1 70 after 5 min pumping and to 1 5 after 60 min pumping, reaching an outgassing rate of 7.6 × 10−8 Pa m3 s−1 m−2. Depth profiling and the ratio of hydrogen atom to carbon atom in the carbon film were obtained. Comparison of activation energies of desorption (Ed) measured by TDS (Thermal Desorption Spectroscopy) between the two different surfaces supports the reason of the improvement of the outgassing property by the carbon coating.

The change of cerebral blood flow (CBF) with aging was analyzed in 9 cases of moyamoya disease whose age ranged from 16 years old to 58 years old. CBF decreased more prominently in the various lobes with aging than control subjects and the decrement was more rapid in the affected side than in the non-affected side. CBF was thought to decrease with the hemorrhagic attack and the accompanying neurological deterioration. However the gradually-deteriorating brain damages caused by the chronic hypoperfusion also might be engaged in this CBF decrement.

This study was conducted to elucidate the influence of glucose in drinking water on whole blood viscosity and plasma osmolality of broilers during high temperature exposure. Two groups of birds, which had ad libitum access to either a 4% glucose-water solution (Group G) or tap water (Group W), were exposed simultaneously to 30 C from 0300 h for 12 h each day for 3 d. During the experimental period, Group G birds had greater metabolic energy intake and body weight gain than Group W. Hematocrit and whole blood viscosity decreased significantly at 30 C compared to controls at 20 C in Group W, whereas, in Group G, no changes were found for these two variables. Plasma osmolality also decreased at 30 C compared to 20 C in Group W, whereas no change was noted in this variable in Group G. However, at 20 C, plasma osmolality was significantly higher in Group W than in Group G, but no difference was observed between the two groups at 30 C. Plasma protein concentration decreased during exposure to 30 C in both groups, but the decrease tended to be greater in Group W than in Group G. These results suggest that glucose intake may alleviate the influence of heat stress on whole blood viscosity and plasma osmolality.

The cognitive functions were examined in the pre- and post-operative stages about the 16 cases of the chronic subdural hematoma. The evaluation was performed with MMS (mini-mental state) test. Although the average of the total score was 16.6 in the preoperative stage, it increased to 22.7 in the postoperative stage. Orientation of time and place, recall and the ability of writing a sentence, which were impaired prominently in the preoperative stage, improved significantly in the postoperative stage. The improvement was poorer in the patients with gait instability and in those older than 80 years. Trepanation surgery seems to be efficient for the improvement of cognition.

Two cases of subarachnoid hemorrhage associated with neurofibromatosis type I (von Recklinghausen's disease) are reported. A 30-year-old male patient (case 1) had been diagnosed as having neurofibromatosis type I due to neurofibroma and café-au-lait spot. He suffered from subarachnoid hemorrhage and angiography showed multiple aneurysms in the right and left middle cerebral arteries and left internal carotid artery. He also had arteriovenous malformation in the left temporal lobe. Case 2 was that of a 62-year-old female patient with neurofibroma and café-au-lait spot. She suffered from subarachnoid hemorrhage and angiography showed an aneurysm in the anterior communicating artery. Both patients were discharged with no deficits after neck clipping, however they both suffered from large-sized hematoma in the punctured site of the femoral artery after angiography. The cerebral aneurysms associated with neurofibromatosis type I are often multiple and may coexist with arteriovenous malformation.

A 45-year-old house-wife, who had undergone surgical treatment for lung adenocarcinoma 2 years previously, presented with a left renal mass detected by follow-up CT. During 7 months of observation, it rapidly enlarged from 1 cm to 3 cm in maximum diameter. Although the short doubling time (40 days) suggested that the tumor was metastatic, abdominal urtrasonography, angiography and CT scan did not exclude primary renal cell carcinoma. Left nephrectomy was performed. Histologically, the tumor proved to be metastasis from the previous lung adenocarcinoma. She has been alive with pulmonary recurrence 13 months after nephrectomy. The doubling time of the tumor may be one of the key factors in differentiating a metastatic renal tumor from a primary carcinoma.

The present study aims at the development of a new concept system that will contribute toward improving the quality of life for bedridden patients and the elderly. The results of a basic study showed the possibility of a virtual reality system reducing stress and pain, provided VR sickness does not occur. A Bedside Wellness System which lets a person experience a virtual forest walk and provides a facility of rehabilitation was proposed based on the basic study and developed. An experiment to assess the developed system using healthy subjects was executed. The data suggested the positive effects of the system; however, some points to be improved were also extracted. After a few improvements, the system will be available for clinical use.