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Masahisa Arahata,1,2 Hidesaku Asakura,3 Eriko Morishita,4 Shinji Minami,2 Yukihiro Shimizu2 1Department of General Medicine, Nanto Municipal Hospital, Nanto, Toyama, Japan; 2Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Toyama, Japan; 3Department of Hematology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan; 4Department of Clinical Laboratory Science, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, JapanCorrespondence: Masahisa Arahata, Department of Internal Medicine, Nanto Municipal Hospital, 938 Inami, Nanto, Toyama, 932-0211, Japan, Tel +81 763 82 1475, Fax +81 763 82 1853, Email rqxhf297@yahoo.co.jpPurpose: Prognostic uncertainty can be a barrier to providing palliative care. Accurate prognostic estimation for patients at the end of life is challenging. This study aimed to evaluate the accuracy of end-of-life diagnosis using our unique diagnostic method.Patients and Methods: A retrospective longitudinal observational study was conducted through collaboration among three medical facilities in a rural super-aged community in Japan. In 2007, we established a unique end-of-life diagnostic process comprising (1) physicians’ judgement, (2) disclosure to patients, and (3) discussion at an end-of-life case conference (EOL-CC), based on Japanese end-of-life-related guidelines. Research subjects were consecutive patients discussed in EOL-CC between January 1, 2010, and September 30, 2017. The primary outcome was mortality within 6 months after the initial EOL-CC decision. Sensitivity, specificity, and diagnostic odds ratio were calculated using EOL-CC diagnosis (end-of-life or non-end-of-life) as an index test and overall survival (< 6 months or ≥ 6 months) as a reference standard.Results: In total, 315 patients were eligible for survival analysis (median age 89, range 54– 107). The study population was limited to patients with severe conditions such as advanced cancer, organ failures, advanced dementia with severe deterioration in functioning. EOL-diagnosis by our methods was associated with much lower survival rate at 6 months after EOL-CC than non-EOL-diagnosis (6.9% vs 43.5%; P < 0.001). Of the patients, 297 were eligible for diagnostic accuracy analysis (median age 89, range 54– 107). The EOL-diagnosis showed high sensitivity (0.95; 95% confidence interval [CI] 0.92– 0.97) but low specificity (0.35; 95% CI 0.20– 0.53) against the outcomes. It also showed a high diagnostic odds ratio (10.32; 95% CI 4.08– 26.13).Conclusion: The diagnostic process using the Japanese end-of-life guidelines had tolerable accuracy in identification and prognostication of end of life.Keywords: diagnostic accuracy, end-of-life, prognostication, overall survival, diagnostic odds ratio

Aim The present study clarified the relationship between elderly individuals providing nursing or caring for others, including their spouses, and their own health maintenance over three years. Methods Study participants were those who had completed the "Survey of Needs in the Spheres of Daily Life" distributed to all elderly individuals ≥65 years old in Nanto, Toyama Prefecture, Japan, in both 2014 and 2017. We evaluated data from 6,088 individuals after excluding those with insufficient data. Detailed responses were analyzed in order to understand the situation of the people to whom the respondents were providing nursing or care (e.g. spouses or others), the presence or absence of providing this nursing or care, and the relationship between these factors and the providers' health maintenance over a period of three years using multiple logistic regression analyses. Results Even after adjusting for critical variables, including basic attributes, overall health, and functional capacity in elderly men, among the subjects who had partners to whom they provided nursing or care, including a spouse, the number of individuals whose own health was maintained 3 years later was higher than among those who did not provide such nursing or care (odds ratio [OR], 1.67; P = 0.004). Furthermore, compared to women who did not provide nursing or care, the OR for women who did provide care for people others than their spouses was 1.44 (P = 0.045). Conclusions Our results suggest that providing nursing or caring for others (including a spouse for elderly men; excluding a spouse for elderly women) has a positive impact on health maintenance among the elderly.

Background: Prognostic uncertainty can be a barrier to providing palliative care. Accurate prognostic estimation in patients at the end of life is a challenging issue.Methods: A retrospective longitudinal observational study was conducted collaborated by three medical facilities in a rural super-aged community in Japan. We established a unique end-of-life diagnostic process consisting of (1) physicians’ judgement, (2) disclosure to patients, and (3) discussions at an end-of-life case conference (EOL-CC), which were based on Japanese end-of-life related guidelines. Participants were consecutive patients discussed at EOL-CC between January 1, 2010, and September 30, 2017. The primary study outcome was mortality within 6 months after the initial EOL-CC decision. The secondary outcome was diagnostic odds ratio using EOL-CC diagnosis (end-of-life or non-end-of-life) as an index test and overall survival (less than 6 months or 6 months and more) as a reference standard.Results: A total of 315 patients were eligible for survival analysis (189 women, median [range] age 89 [54–107] years). In the survival analysis, end-of-life diagnosis was associated with much lower survival rate at 6 months after EOL-CC than non-end-of-life diagnosis (6.9% vs 43.5%, respectively; P < 0.001). However, 10 of the end-of-life patients were alive more than 1 year later (maximum 6.3 years). Of participants, 297 were eligible for diagnostic accuracy analysis (165 women, age 89 [54–107] years). The EOL-CC diagnosis showed high sensitivity (0.95; 95% CI 0.92–0.97) but low specificity (0.35; 95% CI 0.20–0.53) against the outcomes. It also showed the highest negative predictive value (0.44; 95% CI 0.23–0.64), the lowest negative likelihood ratio (0.14; 95% CI 0.07–0.29), and the highest diagnostic odds ratio (10.32; 95% CI 4.08–26.13) compared with other prognostic prediction tools (Charlson Comorbidity Index, Palliative Performance Scale, and Advanced Dementia Prognostic Tool).Conclusions: The diagnostic process using the Japanese end-of-life guidelines enabled more accurate identification and prognostication of end of life than existing prognostic tools. However, the study population was limited to patients with severe conditions, thus further research is necessary to build full consensus.

Two captive cheetahs from a zoo in Japan died of a severe fever with thrombocytopenia syndrome-like illness. Severe fever with thrombocytopenia syndrome virus, an endemic tickborne phlebovirus, was detected systemically with secretion of infectious viruses into the saliva. These cases highlight the risk for exposure of captive animals to endemic arthropodborne pathogens.

A 64-year-old female with advanced liver cirrhosis who had never experienced severe infections presented in 2004 with general malaise. At the time, her serum showed low levels of immunoglobulin (Ig) M (11 mg/dl) with high levels of both IgG (2,942 mg/dl) and IgA (808 mg/dl). Because serum levels of IgG and IgA in previous cases of selective IgM deficiency were normal, this case could have a novel immunological mechanism. By 2006, serum IgM was undetectable (

There is a need of surgery workflow analysis to increase an efficiency of advanced medical care. Surgical Operations have been recorded by several sensors for such as postoperative analysis and incidents detection. In particular, surgical video recording is commonly used, so there are some audio-visual recorded data, and they are useful to obtain a better understandings and description of advanced surgical operations. However, the recorded videos are not usually annotated, so it is not simple to conduct computational analysis, and data annotation is necessary to handle by computer. We target videos of awake craniotomy which is a special neurosurgery in this work. The cortical mapping process is the most important for brain tumor resection in awake craniotomy. Therefore, we aim to annotate this process to analyze medical staff's knowledge. We assume that the factor that affects the surgical procedures is below: positions of direct electric stimulations, duration of the stimulus, current intensity, tasks presented for patients. In this paper, we constructed annotated data from clinical recorded awake craniotomy videos. Data collection is performed manually by graphical user interface because several terms of annotation are hard to annotate completely automatically. After that, we visualized the several of annotated data and discussed the effect.

Chondrosarcoma is the second most common primary malignant bone tumor [1]. It is often observed in the pelvis, femur, shoulder girdle and diaphysial portions of long bones [2]. Its incidence in the sacral lesion is very low, and it was reported that only 18 cases of chondrosarcoma were observed out of 900 tumor cases (0.2%) [3]. On the other hand, Ozdemir et al. [4] report that the frequent symptoms and signs of sacral malignant bone tumors including primary and metastatic malignant bone tumors are nonspecific low back pain, sensation of pelvic pressure or discomfort, and neurological symptoms when the tumor compresses the neural structures. Symptoms of deep vein thrombosis (DVT) due to a sacral tumor were not described in this series. Only two cases of a bone tumor initially presenting as DVT have been reported in the English literature. Tasci et al. [5] report a case of Ewing sarcoma of the fibula with venous thrombosis in the popliteal vein, and Hoekstra et al. [6] present a case of pelvic girdle chondrosarcoma with venous thrombosis in the iliac vein and inferior vena cava. However, to our knowledge, a case in which the initial symptom of sacral chondrosarcoma is DVT due to tumor embolism in the iliac vein has not been reported. In this report, we present a case of chondrosarcoma of the sacrum that initially presents as DVT, and discuss the mechanism of this phenomenon.

AIM Comprehensive management, including medical treatment, care and nursing, rehabilitation, and nutrition management is essential for elderly patients with aspiration pneumonia. We designed and attempted a unique comprehensive intervention method for aspiration pneumonia, and analyzed whether it could improve their prognosis. METHODS The subjects were patients aged 75 years or more, in whom aspiration pneumonia had been diagnosed between January 15(th) and April 15(th), 2008. Immediately after diagnosis, our project team analyzed the pathophysiology of each case based on the checklists and conference records, and planned an individualized strategy of comprehensive intervention. We analyzed their mortality due to pneumonia, duration of their hospitalization and recurrence-free survival 1 year after antibiotic therapy (1-year RFS), and compared them with those of patients who were managed without antibiotic intervention during the same period in the previous year. RESULTS There were 41 events in 34 patients (15 men, 19 women, age 87.5±5.7) which were eligible for analysis as an intervention group and 51 events in 46 patients (24 men, 22 women, age 87.5±6.4) were eligible as a control group (age 87.5±6.4). Our comprehensive intervention tended to reduce aspiration pneumonia mortality (4.9% vs. 17.6%, P=0.061). There was no significant difference in the duration of hospitalization between the 2 groups (47.2±35.0 days vs. 55.6±52.1 days, P=0.454). The 1-year RFS of the intervention group was significantly higher than that of the control group (48.5% vs. 24.3%, P=0.040). CONCLUSIONS Our comprehensive intervention for the management of elderly patients with aspiration pneumonia achieved a significant improvement in 1-year RFS.

The present study was carried out to measure fecal progestagen and estrone concentrations during pregnancy in a giraffe and examine the possibility of utilizing this assay system for pregnancy diagnosis. Fecal samples were collected from a giraffe during her third and fourth parities and mixed with methanol to prepare a fecal solution. Diluted fecal solution was used for direct enzyme immunoassay for progestagen and estrone. The newborn calf from the third parity was viable, although that from the fourth parity died 5 days after calving. In the third parity, the giraffe's progestagen and estrone concentrations increased transiently from days 30 to 120 of pregnancy. Then, they decreased and remained low until day 330. This was followed by a drastic rise in both concentrations as parturition approached. Parturition caused a reduction in the progestagen and estrone concentrations of the feces. In the fourth parity, the progestagen concentration increased gradually after mating until day 320. This was followed by a reduction in the concentration until parturition. However, the estrone concentration fluctuated, and the duration and extent of the prepartum rise in concentration were shorter and lower than those of the third parity. The hormone dynamics of the third parity suggest the possibility of early pregnancy diagnosis by measuring progestagen or estrone between days 30 and 120 after mating.

Estrogens are essential for normal reproductive activity in females and males and for ovarian differentiation during a critical developmental stage in many vertebrates. To understand the molecular mechanisms of estrogen action and to evaluate estrogen receptor ligand interactions in the Japanese giant salamander ( Andrias japonicus ), we isolated cDNA encoding the estrogen receptor (ER) from the liver. A full-length Japanese giant salamander ER cDNA (jgsER) was obtained using 5′ and 3′ rapid amplification cDNA ends (RACE). The deduced amino acid sequence of the jgsER showed high identity to the Xenopus ERα (ESR1) (77.7%). We have applied both the conventional ERE-luciferase reporter assay system and the GAL4-transactivation system to characterize this receptor. In two different transient transfection assay systems using mammalian cells, the jgsER protein displayed estrogen-dependent activation of transcription. The GAL4-transactivation system showed about 10-fold greater activity of the estrogen receptor by hormone when compared to the conventional ERE-luciferase reporter assay system. Tissue distribution of ERα mRNA was examined and kidney, ovary and liver exhibited expression. This is the first isolation of an estrogen receptor from a salamander and also is the first functional cDNA obtained from the Japanese giant salamander, an endangered species considered a special natural monument of Japan.

Considerable long-standing controversy and confusion surround the phylogenetic affinities of pinnipeds, the largely marine group of "fin-footed" members of the placental mammalian order Carnivora. Until most recently, the two major competing hypotheses were that the pinnipeds have a single (monophyletic) origin from a bear-like ancestor, or that they have a dual (diphyletic) origin, with sea lions (Otariidae) derived from a bear-like ancestor, and seals (Phocidae) derived from an otter-, mustelid-, or musteloid-like ancestor. We examined phylogenetic relationships among 29 species of arctoid carnivorans using a concatenated sequence of 3228 bp from three nuclear loci (apolipoprotein B, APOB; interphotoreceptor retinoid-binding protein, IRBP; recombination-activating gene 1, RAG1). The species represented Pinnipedia (Otariidae: Callorhinus, Eumetopias; Phocidae: Phoca), bears (Ursidae: Ursus, Melursus), and Musteloidea (Mustelidae: Mustela, Enhydra, Melogale, Martes, Gulo, Meles; Procyonidae: Procyon; Ailuridae: Ailurus; Mephitidae: Mephitis). Maximum parsimony, maximum likelihood, and Bayesian inference phylogenetic analyses of separate and combined datasets produced trees with largely congruent topologies. The analyses of the combined dataset resulted in well-resolved and well-supported phylogeny reconstructions. Evidence from nuclear DNA evolution presented here contradicts the two major hypotheses of pinniped relationships and strongly suggests a single origin of the pinnipeds from an arctoid ancestor shared with Musteloidea to the exclusion of Ursidae.

Tranexamic acid has been therapeutically used in various clinical conditions with bleeding. However, this drug might carry a risk of thrombosis as an adverse effect. We report a patient who developed left popliteal artery thrombosis after the administration of tranexamic acid for the treatment of upper gastrointestinal bleeding. A 96-years-old woman with gastric cancer was admitted to our hospital because of an ischemic stroke. She had severe anemia, and received a blood transfusion. To control the bleeding, a single dosage of tranexamic acid (1, 000mg/day) was administered. Twelve hours after the administration of the drug, she suffered an acute obstruction of the left popliteal artery. Tranexamic acid is frequently used to control gastrointestinal bleeding. However, no definite evidence exists confirming that tranexamic acid is useful for gastrointestinal bleeding. The inhibition of fibrinolysis by tranexamic acid is not considered to be safe in patients with a hypercoagulable state, and the use of tranexamic acid should be carefully determined on an individual basis.

Three-dimensional transvaginal ultrasound was used to determine the location of early gestational sacs (E-GSs) and, as a result, the physiological implantation sites of human blastocysts. We examined 138 patients who were found by three-dimensional transvaginal ultrasound to have a GS with an inner diameter of 3 to 6 mm (E-GS). The uterine cavity was divided into three parts: upper, middle, and lower regions. The upper region was subdivided into the right, middle, and left areas, and the middle region was subdivided into the right and left areas. Thus, overall 6 areas were designed and the frequency of the E-GS detection in each area was evaluated. Of the 138 patients, 123 (89.1%) had E-GSs detected in the upper region, which was found to be the most frequent region. When the frequency of E-GS detection among the upper three areas was compared, the right and left upper areas had a higher frequency than the middle upper area. As to the miscarriage rate, patients with E-GSs detected in the upper region had a significantly lower rate than those in the middle and lower regions (p

Atorvastatin is a powerful new synthetic 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor currently in clinical use. Its effects on plasma levels of factor VII were examined in 30 hyperlipidemic patients. After 12 weeks of atorvastatin treatment, factor VII activity (FVIIc) and factor VII antigen (FVIIag) levels had decreased by 13% (p < 0.0001) and 12% (p < 0.0001), respectively. The decreased concentrations of serum triglycerides correlated with decreases in FVIIc levels (r = 0.54, p = 0.0023) and FVIIag levels (r = 0.59, p = 0.0006) at 12 weeks of treatment with atorvastatin. No significant changes were seen in activated factor VII (FVIIa) levels. Plasma concentrations of fibrinogen were slightly, but not significantly, increased at 12 weeks. No significant changes were seen in plasminogen activator inhibitor-1 levels. The effects of atorvastatin on FVII may contribute to a decreased thrombotic potential, resulting in fewer thromboembolic events, including a reduction in coronary heart disease.

Wetlands have a number of functions. They are a habitat for animals and plants as well as a source of food. In addition, they contribute to flood control, stabilization of the coastline, and land reclamation. They also help to preserve the supply of groundwater and contribute to the sedimentation of silt with abundant nutrients; they also filter pollutants and store organic matter (Matthews 1995). Due to the public’s inability to recognize the value of wetlands; however, they have been decreasing globally. This is due to the common misconception that wetlands are barren land that should be converted for other uses through such means as land reclamation. A review of the past 100 years reveals that about 50,000 km2 of wetlands have disappeared in China (Record China 2009). Approximately 2,110.62 km2 of wetlands existed throughout Japan about 100 years ago during the Meiji and Taisho Eras, but they had decreased to 820.99 km2 by 1999, which means that approximately 1,300 km2 (or 61.1 %) of those wetlands have disappeared (Geospatial Information Authority of Japan 2000). On the other hand, there was over 25,000 km2 of land being used as rice paddies in 2011 (Statistics Bureau 2011). However, much of these rice paddies are believed to have been developed via the natural clearing and filling of wetlands.

A male chimpanzee (Pan troglodytes) suddenly died of acute hemorrhagic enteritis at the age of 18 years. Within 24 hours after its death, a large quantity of spermatozoa of excellent quality was recovered from the distal cauda epididymides and was subsequently cryopreserved. After storage for 67 days, the frozen spermatozoa were thawed and inseminated in an adult, normal cycling, nulliparous female. The optimal day for insemination was estimated by monitoring the swelling of the female’s sex skin and urinary luteinizing hormone concentrations. Pregnancy was confirmed by a urinary chorionic gonadotropin test, and a normal female infant was born after 214 days of gestation. This birth demonstrates that distal cauda epididymal spermatozoa recovered from a dead male can be cryopreserved and successfully inseminated in a female chimpanzee. Zoo Biol 20:135–143, 2001. © 2001 Wiley-Liss, Inc.

A p53-inducible gene, the growth arrest and DNA damage-inducible gene 45 (gadd45), is associated with cell growth inhibition, DNA damage response and DNA repair. Here we report that Delta12-prostaglandin J2 (Delta12-PGJ2), an in vivo metabolite of arachidonic acid, which inhibits cell proliferation, induces gadd45 mRNA in HeLa cells. Because the p53 protein in HeLa cells is inactivated by papilloma virus E6, this type of gadd45 induction appears to be p53-independent. The induction was dose-dependent, and the maximum induction was observed at a concentration of 7.5 microgram/ml. In a time course study, gadd45 mRNA was induced 3 h after the addition of 7.5 microgram/ml Delta12-PGJ2. To investigate the transcriptional mechanism of gadd45 mRNA induction, we cloned a human genomic DNA fragment containing the gadd45 promoter region, and investigated the effect of Delta12-PGJ2 on the gadd45 promoter activity. In HeLa cells, 7.5 microgram/ml Delta12-PGJ2 markedly stimulated the gadd45 gene promoter about 20-fold or more. On the other hand, Delta12-PGJ2 did not stimulate the promoter activity of a reporter plasmid containing only p53 binding sites in HeLa cells, indicating that the gadd45 promoter activation by Delta12-PGJ2 was not mediated by p53. These results suggest that one of the mechanisms of cell growth arrest by Delta12-PGJ2 is mediated through a p53-independent induction of gadd45.

p27Kip1 is an inhibitor of multiple cyclin-dependent kinases (cdk), and can arrest the cell-cycle progression by inhibiting the phosphorylation of the retinoblastoma gene family products. Tumor formation in p27Kip1 knockout mice clearly shows that p27Kip1 plays an important role in inhibiting tumor formation and progression. To investigate the mechanism of transcriptional p27Kip1 gene expression, we isolated the genomic DNA fragment of the 5′ flanking region of the human p27Kip1 gene and characterized its promoter region. The human p27Kip1 promoter is TATA-less, and the sequence is highly homologous to the murine p27Kip1 promoter sequence. In the promoter assay, deletion from −774 to −435 relative to the initiating codon resulted in a 15–20-fold reduction of the p27Kip1 promoter activity, suggesting that the elements for basal promoter activity exist in this highly conserved 340 bp region, where putative CTF and ATF sites are conserved.

脳血栓症急性患者14名を2群 (各7例) に分け, トロンボキサン (TX) A2合成酵素阻害薬CV-4151を100mg/日 (C群) あるいはオザグレルナトリウム160mg/日 (O群) を14日間投与し, プロスタノイド代謝に及ぼす影響, 臨床効果及び安全性を比較検討し, かつC群では薬物動態も調査し, 以下の結果を得た.(1) 血清TXB2生成抑制は, C群, 0群とも認められたものの, C群の効果は著明かつ持続的であった.投薬24時間後の時点で, C群はなお有意に抑制していたが, O群ではTXB2値は投与前値の約3倍の値を示した.また, 血清6-keto-PGF1α生成促進作用が両群ともにみられた. (2) 早朝尿および24時間蓄尿において, C群, O群共に11-dehydro-TXB2の排泄を抑制, 2, 3-dinor-PGF1αについては増加傾向を示した. (3) CV-4151および代謝物の血中濃度推移からみた薬物動態について投与1日目と連日投与した14日目とを比較した結果, 特に蓄積性は認められなかった. (4) 臨床効果や安全性についてはCV-4151とオザグレルナトリウムはほぼ同程度であった.以上の臨床薬理学的検討からCV-4151は脳血栓症急性期患者に対して有用な薬剤になる可能性が示唆された.

TIAまたは脳血栓発症後の二次予防を目的としてチクロピジン : 200mg/日または300mg/日投与した68例 (平均年齢70.2±9.3歳) を対象に, 血小板凝集能が薬効の指標となりうるかを検討した.平均観察期間は30.2カ月で, この間15例にTIAまたは脳血栓が発症した.投与後の血小板最大凝集率 (凝集惹起物質 : ADP終濃度8μmol/l) により15%以上の群と15%未満の群に分類しその累積再発率を比較すると, 後者が有意に (p

Lipoma arborescens arising in the extra-articular bursa of the knee joint is extremely rare. We describe an 11-year-old boy who complained of a gradual swelling mass of the lateral knee joint. Magnetic resonance imaging (MRI) showed a high signal intensity tumor on T1- and T2-weighted images with a thickened septa and nodular lesion that showed low signal intensity. The radiologist suggested the possible differential diagnosis of well-differentiated liposarcoma. At operation, the tumor was found under the iliotibial tract and was not in contact with the knee joint. Histopathologically, this lesion was diagnosed as lipoma arborescens arising in the extra-articular bursa of the knee joint. On MRI, the appearance of lipoma arborescens arising in the extra-articular bursa of the knee joint differed from that of conventional intra-articular lipoma arborescens. In this report, we describe a case of extra-articular lipoma arborescens of the knee joint bursa and discuss the diagnosis and etiology.

Leptin is a protein that is synthesized and secreted from adipose tissue. We examined the changes in serum leptin level during the menstrual cycle in 5 normal and 5 obese Japanese women, and compared the data with those of serum estradiol (E2) and progesterone (P4) concentrations. Serum leptin levels were highly correlated with body mass index (BMI) and percent body fat, being higher in the obese group than in the normal group. In the obese group, serum leptin level increased in the luteal phase in parallel with the rise in the serum E2 level. In the normal group, however, there was no significant change in serum level during the menstrual cycle. These results suggested that the serum leptin levels were influenced by the phase of menstrual cycle, probably through the action of E2, in different ways for obese and non-obese women.

Objective Our study was undertaken to determine the location of the tortuous intercostal artery in elderly patients by using 3D-CT angiography in order to prevent laceration during thoracentesis. Methods We evaluated the data of 3D-CT angiography of the intercostal artery in consecutive patients who had undergone contrast chest CT scan in our hospital from December 2007 to April 2008. We considered the "percent safe space" (the shortest lower rib-to-intercostal artery distance/the upper rib-to-lower rib distance) to be an index of safety that can be used to prevent laceration of the intercostal artery during thoracentesis. We measured this index at 3 points: the total site (5-10 cm lateral to the spine), the lateral site (9-10 cm lateral to the spine), and the medial site (5-6 cm lateral to the spine). Results We evaluated 33 cases (25 males and 8 females; mean age, 74.2 years). The mean percent safe space at the total site was 58.6%. The percent safe space at the total site tended to decrease with advancing age, but the correlation was low (p=0.0378, r=-0.3631). The percent safe space at the lateral site (mean, 79.8%) was significantly higher than that at the medial site (61.2%, p

Few species have been of more disputed affinities than the red or lesser panda (Ailurus fulgens), an endangered endemic Southeast Asian vegetarian member of the placental mammalian order Carnivora. This peculiar carnivoran has mostly been classified with raccoons (Procyonidae) or bears (Ursidae), grouped with the giant panda (Ailuropoda melanoleuca) in their own family, or considered a separate lineage of equivocal ancestry. Recent molecular studies have indicated a close affinity of the red panda to a clade of procyonids and mustelids (weasels, otters, martens, badgers, and allies), but have failed to unambiguously resolve the position of this species relative to mephitids (skunks and stink badgers). We examined the relationship of the red panda to other extant species of the carnivoran suborder Caniformia using a set of concatenated approximately 5.5-kb sequences from protein-coding exons of five nuclear genes. Bayesian, maximum likelihood, and parsimony phylogenetic analyses strongly supported the red panda as the closest living relative of a clade containing Procyonidae and Mustelidae to the exclusion of Mephitidae. These three families together with the red panda (which is classified here as a single extant species of a distinct family, Ailuridae) compose the superfamily Musteloidea, a clade strongly supported by all our phylogenetic analyses as sister to the monophyletic Pinnipedia (seals, sea lions, walruses). The approximately unbiased, Kishino-Hasegawa, and Templeton topology tests rejected (P

Chronic disseminated intravascular coagulation (DIC) is a well-known complication of aortic aneurysm. A 63-year-old man with bleeding tendency and a large palpable abdominal aortic aneurysm (AAA) was diagnosed as having fibrinolysis dominant DIC by the excessive activation of both coagulation and fibrinolysis (plasmin -alpha2 plasmin inhibitor complex concentration is usually >4 microg/ml). Although several treatments were tried, DIC could not be controlled until the patient was given combined therapy of danaparoid (1,250 U/12 h, bolus IV) and tranexamic acid (0.5 g x 3/day, oral administration). This therapy may be beneficial when control for bleeding is required without restricting the ambulatory movement of patients by continuous drip.

A 35-year-old man with Guillain-Barre syndrome and ethylene diamine tetraacetic acid (EDTA)-dependent pseudothrombocytopenia associated with serologically-confirmed mumps is presented. A polyneuropathy developed 18 days after the onset of mumps, that improved with plasmapheresis. A decreased platelet count was observed 25 days after the onset of mumps attributed to platelet agglutination in blood anticoagulated with EDTA, and the agglutination was prevented by other anticoagulants. Guillain-Barre syndrome associated with mumps is rare and EDTA-dependent pseudothrombocytopenia following mumps has never been documented. This represents the first report of Guillain-Barre syndrome and EDTA-dependent pseudothrombocytopenia following mumps. Furthermore, our findings suggest activation of the humoral immune response as a potential pathogenesis.

We fabricated single-walled carbon nanotubes (SWNTs) covered with a thickness-controlled ZnO layer (ZnO–SWNTs) by pulsed laser deposition (PLD) and investigated their UV photoresponse, induced by the photodesorption of oxygen molecules from the ZnO surface. The magnitude of the negative photocurrent and the recovery time were strongly dependent on the thickness and morphology of the ZnO layer, and were highest when the ZnO layer was 3–4 nm thick. The observed recovery curves of the negative photocurrent were fitted with double-exponential-function curves, which indicate the coexistence of two types of adsorption sites for oxygen molecules on the ZnO surface. The light intensity dependence of the negative photocurrent was also measured.

Abnormally low levels of the cyclin-dependent kinase inhibitor p27Kip1 are found frequently in human carcinomas, and these levels correlate directly with both histological aggressiveness and patient mortality. p27Kip1 is haplo-insufficient for tumor suppression. Thus, p27Kip1 may be a useful molecule for the development of cancer therapies. To know the possible mechanisms underlying transcriptional control, we previously cloned the promoter region of human p27Kip1 gene. We report here the characterization of the 5′-regulatory region of the human p27Kip1 gene. Promoter analysis using 5′-deletion mutants revealed that a 39-bp region between −549 and −511 was required for maximal promoter activity. Point mutation analysis revealed that a CCAAT box within this region was essential for promoter activity. Gel shift assays and cotransfection experiments using a dominant negative form of the NF-Y transcription factor showed that NF-Y directly regulates p27Kip1 transcription through this CCAAT box. This finding might provide a clue to approach the mechanism of tumorigenesis.