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ST-segment elevation myocardial infarction (STEMI) can be caused by coronary artery vasospasm (VSA) due to endothelial dysfunction. However, the clinical role of endothelial function tests in VSA-induced STEMI is not fully understood. We present the case of a 43-year-old woman with atypical chest pain and no coronary risk factors. STEMI caused by VSA was diagnosed. Flow-mediated vasodilatation (FMD) and EndPAT tests were performed; the FMD and reactive hyperaemia index were 3.8% and 1.23, respectively. Endothelial dysfunction is the putative cause of STEMI. FMD and EndPAT tests might be useful for predicting adverse outcomes in young premenopausal women with VSA.

Background and Aim: Surgical site infection (SSI) remains an important concern in Japan. The Japanese Soci‐ ety for Infection and Prevention Control disclosed that the incidence of SSIs has been lowered only by a fraction over the past 10 years. The importance of taking steps to reduce the occurrence of SSIs is recognized by many hospitals, but to date, no truly effective countermeasures have been reported. We executed a plan to better un‐ derstand the spec fic surveillance needs at St. Marianna University School of Medicine Hospital and then de‐ velop and institute procedures that would reduce the incidence of SSIs. Methods and Results: In 2005, we began development of an enhanced SSI surveillance system. With our basic CDC-based surveillance system in place, we assembled a team of doctors and nurses to oversee surveillance. We practiced strict record keeping and data analysis, gleaned information from staff, and enlisted the coopera‐ tion of other departments. New procedures were established accordingly and implemented in three phases. Be‐ tween 2005 and 2013, we witnessed informative fluctuat ons in the incidence of SSIs. Key components of our new system were standardized postoperative wound cleansing, use of buried absorbable sutures to close surgical wounds, consistent provision of 6 antibacterial agents, each one active against a common organ spec fic patho‐ gen, and establishment of a prophylactic protocol. New methods of information sharing were also instituted. We lowered the incidence of SSIs from 8% in 2006 to approximately 6.9% in 2012. We continue to monitor the number of SSIs occurring and are encouraged by a steady decline. Conclusion: Establishment of the SSI team at our hospital has proven to be a useful multidisciplinary approach to nosocomial infection awareness and control. Gradual introduction of the system to the various departments and step-by-step implementation have decreased the occurrence of SSIs and the nosocomial spread of infectious agents.

Smooth muscle tumor of uncertain malignant potential (STUMP) is a tumor that cannot be histologically diagnosed as unequivocally benign or malignant [1]. Uterine STUMP is histologically characterized by the existence of standard smooth muscle differentiation, low mitotic index and diffuse atypia. We describe a case of cutaneous skull metastasis from uterine STUMP. To our knowledge, this is the first case report in English of cutaneous metastasis of STUMP.A 68-year-old woman was referred to our department [...]

Many neuropsychological studies demonstrate impairment of working memory in patients with major depressive disorder (MDD). However, there are not enough functional neuroimaging studies of MDD patients seeking for the underlying brain activity relevant to working memory function. The objective of this study is to evaluate prefrontal hemodynamic response related to working memory function in patients with MDD. Twenty-four subjects with MDD and 26 age- and gender-matched healthy subjects were recruited for the present study. We measured hemoglobin concentration changes in the prefrontal and superior temporal cortical surface areas during the execution of working memory task (WM; 2-back, letter version) using 52-channel near-infrared spectroscopy (NIRS), which enables real-time monitoring of task-related changes in cerebral blood volumes in the cortical surface areas. MDD patients showed a smaller increase in lateral prefrontal and superior temporal cortex activation during the 2-back task and associated poorer task performance than healthy controls. The results coincided with previous findings in terms of working memory deficits and prefrontal cortex dysfunction in MDD patients, but contradicted with some previous fMRI studies that suggested increased cortical activity during the working memory task in patients with depression. The contradiction may, in part, be explained by a relatively low level of cognitive demand imposed on the subjects in the present study.

Parkinson's disease is derived from a degeneration of the dopaminergic neurons in the substantia nigra pars compacta, which leads to a marked loss of striatal dopamine concentration. Among the treatment for Parkinson's disease, the number of patients taking dopamine D2 receptor agonist is on the rise. Ropinirole, a selective dopamine D2 receptor agonist, shows a strong inhibitory effect on the pathogenesis of Parkinson's disease. 1 Although several adverse events of ropinirole are well-known, such as sleep disturbance, a drug eruption due to ropinirole has not been reported in English so far. Herein, we describe here an unusual case of a patient with Parkinson's disease who developed multiple fixed drug eruption after ropinirole treatment. We also reviewed the past literature on drug eruption caused by other dopamine D2 receptor agonists further. A 60-year-old female with Parkinson's disease was referred to our department for evaluation of an eruption of 2 days' duration. An erythematous eruption on the extremities had developed three hours after 7th daily administration of ropinirole for her Parkinson's disease. The erythematous lesions gradually became pigmented. On physical examination, well-defined pigmentations

A zinc phthalocyanine (ZnPc) analog containing one 1,8-naphthalene unit has been synthesized and characterized by electronic absorption, magnetic circular dichroism, and fluorescence emission spectroscopy, together with voltammetric measurements. It shows two small bands in the near-infrared region, but normal ZnPc type spectra in shape are also observed in the 300−700 nm region. These spectra are explained by a five-orbital model, as suggested by molecular orbital calculations in the framework of the PPP approximation.