Search

ContextAbaloparatide reduced fracture risk in postmenopausal women with osteoporosis in the Abaloparatide Comparator Trial In Vertebral Endpoints (ACTIVE). Its effect in Japanese patients remains unexamined.ObjectiveThis work aimed to determine the efficacy and safety of abaloparatide in increasing bone mineral density (BMD) in Japanese patients with osteoporosis at high fracture risk.MethodsThis was a randomized, double-blind, placebo-controlled study conducted in Japan. Postmenopausal women and men with osteoporosis with high fracture risk were given daily subcutaneous 80 µg abaloparatide or placebo for 78 weeks (18 months). The primary end point was percentage change in lumbar spine (LS) BMD from baseline at the last visit. Secondary end points included time-course changes in LS, total hip (TH), and femoral neck (FN) BMDs and bone turnover markers, and cumulative number of fractures.ResultsAbaloparatide increased LS, TH, and FN BMDs (mean [95% CI]) by 12.5% (10.3%-14.8%; P ConclusionIn Japanese patients with postmenopausal and male osteoporosis with high fracture risk, abaloparatide for 78 weeks robustly increased LS, TH, and FN BMDs, suggesting a similar efficacy in Japanese patients vs the ACTIVE study population.

This paper discusses the relationship between the rotational sensation of the handle of a fishing reel and the transmission error (TE) using a vibration-generating machine. A vibration based on gear-pair engagement in a fishing reel occurs when the handle of the reel rotates. The vibration is transmitted to the tips of the fingers via the handle. When a large vibration is present, the angler feels discomfort. It is widely accepted that the rotational sensation in the handle depends on the amplitude of the TE at a particular speed in terms of the mesh frequency of the gear pair, and the TE includes the harmonics of the mesh frequency and different wave patterns. The TE waveform is subdivided into unit TEs with the time defined as the individual tooth-to-tooth mesh period. The TE units can be classified into several specific shapes. The variation in these unit TEs affects the sensation of the angler. In this study, a vibration-generating machine is introduced to simulate vibration in commercial products. The relationship between the TE of the classified patterns and the rotational sensation in the handle was investigated using the vibration-generating machine. The vibration patterns were classified into six types of fluctuation components, and the influence of each type was investigated. The results confirmed that the amplitude and waveform fluctuations significantly influenced the rotational sensation of the handle. Moreover, we discovered that the mesh frequency is the most significant influencing factor for the rotational sensation in the handle.

This report discusses how a transmission error curve is derived by a coordinate measuring machine, and the result by a coordinate measuring machine is compared with the result by a transmission error measuring machine. A vibration based on a gear pair engagement in fishing reel occurs when a handle of the reel rotates. When this vibration is large, an angler feels uncomfortable. In author’s previous reports, it is known that a rotational feeling depends on the transmission error curve. The result indicates that the rotational feeling can be improved if the accuracy of a tooth flank is improved. In order to reduce the transmission error, the error should be measured in high accuracy. In this research, a measurement method for evaluating the rotational feeling was reported using a face gear pair via a coordinate measuring machine and a transmission error measuring machine. As a result, it was confirmed that the result of measurement by the coordinate measuring machine agrees very well with the result of measurement by the transmission error measuring machine.

This report discusses the method of tooth flank modification of a face gear which improves the handle rotational feeling in a fishing reel. A vibration based on a gear pair engagement in fishing reel occurs when a handle of the reel rotates. When this vibration is large, an angler feels uncomfortable, and it is known that the rotational feeling strongly depends on the transmission error of a face gear which is mounted on the reel. In this report, a new method of tooth flank modification was proposed. Based on the new method, it is possible to increase the mesh frequency while keeping the module size and the outer diameter of the face gear unchanged. In this method, several grooves were added along the contact curve on the tooth flank of the face gear. The influence on vibration by these grooves was investigated using the vibration simulator which was introduced in the author’s previous reports. Moreover, sample face gears were manufactured and the rotational feeling was evaluated. As a result, it was confirmed that the rotational feeling was improved by applying a proper number of grooves and groove width.

This report discusses relationship between a handle rotational feeling in reel and a gear pair vibration. The vibration occurs when a handle of the reel rotates. When the vibration is large, an angler feels uncomfortable. In order to measure the gear pair vibration, an evaluation method using a bone conduction speaker was proposed. In this method, the bone conduction speaker is attached onto the handle knob of the reel, and the slight vibration is measured. The measured data was analyzed by spectrogram and FFT (Fast Fourier Transform) analysis, and characteristic data for the forecast of handle rotational feeling in reel were extracted from the result of the FFT analysis. A total of five sample reels were prepared for evaluation. The evaluation points were made into a ranking, and the handle rotational feeling in these sample reels was judged through human judgment. The best estimate for the forecast was defined to be the average of rankings. In the evaluation for the relationship between handle rotational feeling in reel and the measured data, the MT-system of robust engineering was used. In this analysis, a forecast value was calculated based on these characteristic values. As a result, although the vibration was quite small, it was confirmed that there is a strong relationship between the two. Thereby, it becomes possible to make quantitative judgment. During the judgment, an inspector can hear the vibration sound amplified from the speaker, similar to that of the rotational feeling conducted from the handle. Consequently, the judgment becomes easier, and the judgment accuracy improves dramatically.

What kind of image will you have in mind when you hear about a fishing reel? The fishing reel is a simple device that releases and winds up a fishing line. In a world of hobbies, the demand for designability and functionality is enhanced when it comes to luxury goods. A representative example of functionality is the feeling experienced during rotation of the reel (i.e., feel of a fishing reel). The feeling is a vibration, and it occurs owing to gear-pair engagement when the handle of the reel rotates. The best professional anglers have said that they can feel if it is water turbidity or the behavior of a fish from the change in the feel of the fishing reel. To satisfy their demand, we must control the accuracy of the gear to the sub-micrometer level. For this purpose, the shape of the tooth flank of the gear is precisely designed by three-dimensional computer-aided design (3D-CAD). However, anglers’ demands increase each year. To respond to these demands, in addition to improving the tooth flank accuracy, we need to research the feel of the fishing reel. Initially, we must think about what is the feel of a fishing reel. We contributed to the research of the relationship between the vibration and the tactile sensitivity of the human finger. As a result, we elucidated that tactile sensation has a high correlation with the vibration of mesh frequency that occurs owing to gear-pair engagement. Using this phenomenon, we succeeded in developing a new feature called “micro-module gear TM.” This function improves the feel of the fishing reel by adapting a small gear module. This is a technology born from an entirely new approach to the optimization of the mesh frequency. However, research on gear and sensitivity is underdeveloped. In this paper, we report some state-of-the-art studies in this underdeveloped field that improved the feel of fishing reel.

There are no reports about the effect of bradycardia on stroke volume variation (SVV), and we hypothesized that induced bradycardia alters the value of SVV. Landiolol, an ultra-short-acting adrenergic β1-receptor blocking agent, was reported to induce bradycardia without decreasing blood pressure. The initial aim of this prospective study was to investigate changes in SVV values by induced bradycardia in patients with good cardiac function.At 30 min after anesthesia induction, if heart rate (HR) was80 bpm, the patient was chosen as a subject. Ten ASA physical status I-II patients aged 38-75 years who were scheduled for elective abdominal surgery were included in this study. Baseline values were recorded, and then administration of landiolol was started at 125 μg/kg/min for 1 min and then continued at 40 μg/kg/min. SVV and other parameters were recorded at baseline and 3 min after continuous landiolol injection.Landiolol significantly decreased systolic arterial pressure, and diastolic arterial pressure, contrary to our expectations, and also HR, SVV, cardiac output, stroke volume index, and pressure of end-tidal CO(2), whereas systemic vascular resistance values increased significantly.SVV decreased after continuous administration of a β1-adrenergic blocker, probably because of a decrease in the difference of maximum stroke volume (SV) and minimum SV, or the downward shift of the Frank-Starling curve that occurred after landiolol administration. We believe that SVV values might be overestimated or misinterpreted when HR is decreased by landiolol and might not necessarily indicate that the patient is hypervolemic or normovolemic.

Preoperative ingestion of only clear fluids until 2 hours before induction of anesthesia is a common preoperative fasting regimen. Gastric emptying times, however, vary among clear fluids. We therefore investigated the gastric emptying of 2 clear glucose-electrolyte drinks.A 2-way crossover study was performed in 10 healthy volunteers. After fasting, the volunteers drank 500 mL of either OS-1(®), an oral rehydration solution, or Pocari Sweat(®), a popular sports drink, over 3 minutes in a standing position. Magnetic resonance imaging was performed before, immediately after, and 30 minutes after the drinking of each test fluid. The difference in gastric emptying between OS-1(®) and Pocari Sweat(®) was evaluated by comparing gastric fluid volume, flow rate, and residual ratio. We also compared the flow rates of sodium, potassium, carbohydrates, and osmotically active particles in the 2 test fluids.Gastric fluid volume 30 minutes after drinking was significantly smaller for OS-1(®) (76.0 ± 57.0 mL) than for Pocari Sweat(®) (158.1 ± 73.5 mL, p0.01), although the volumes did not differ before or immediately after drinking. The flow rate was significantly faster for OS-1(®) (10.66 ± 3.34 mL) than for Pocari Sweat(®) (8.68 ± 3.02 mL/min, p0.05), and the residual ratio was significantly smaller for OS-1(®) (21 ± 14% than for Pocari Sweat(®) (41 ± 19%, p0.01). The flow rates of sodium, potassium, and glucose differed significantly between OS-1(®) and Pocari Sweat(®), whereas the flow rate of osmotically active particles did not.Gastric emptying is significantly faster for OS-1(®) than for Pocari Sweat(®).

Study Objective To investigate changes in stroke volume variation (SVV) by both induced hypertension (pressor test) and hypotension (depressor test), and also by induced hypotensive anesthesia in patients with good cardiac function. Design Prospective, controlled clinical study. Setting University hospital. Patients 31 ASA physical status 1 and 2 patients, aged 39-62 years, who were scheduled for elective surgery. Interventions We conducted three studies: a pressor test study, a depressor test study, and an induced hypotensive anesthesia study. In the pressor test, patients received a bolus of phenylephrine 0.001 mg/kg to increase systolic arterial pressure (SAP) by 30% to 40% compared with baseline. In the depressor test, patients received a bolus of nitroglycerine 0.005 mg/kg to decrease SAP by 30% to 40% compared with baseline. In the induced hypotensive anesthesia test, patients received intravenous (IV) nitroglycerine continuously until mean arterial pressure (MAP) was reduced to 60-70 mmHg. Measurements When arterial pressure reached the target pressure for each study type, SVV and other parameters were recorded. Main Results Induced hypertension (pressor test) decreased SVV, while induced hypotension (depressor test) and induced hypotensive anesthesia increased SVV. Conclusions SVV does not misinterpret preload dependency assessment of patients receiving medications to increase or to lower blood pressure.

This research report discusses how to derive a path of contact on a face gear. A sample was manufactured, in which tooth modification is taken into account, and the sample was investigated as to whether it is robust against alignment errors. It has been verified that the assembly operation can be improved in mass production line.

比較的短時間の耳鼻咽喉科手術のレミフェンタニル併用全身麻酔直後に，きわめて激しいせん妄を示した成人の症例を3例経験した．3例とも激しいせん妄状態が30分以上持続した．スタッフおよび患者自身に危険が及び，多くのマンパワーを必要とした．鎮痛不十分とレミフェンタニルの使用が関与していると考えられた．比較的短時間かつ少量のレミフェンタニル投与を全身麻酔に併用した場合には，術後せん妄が発生しやすくなる可能性について検討する必要がある．

Stroke volume variation (SVV) during controlled mechanical ventilation is a useful predictor in response to volume expansion, and pleth variability index (PVI), a novel algorithm allowing for automated and continuous calculation of the respiratory variations in the pulse oximeter waveform amplitude, can also predict fluid responsiveness non-invasively in mechanically ventilated patients. The aim of this study was (1) to determine whether acute fluid infusion affects SVV and PVI, and (2) to compare the two values in the case of acute fluid infusion after a preoperative fast following general anesthesia induction.After tracheal intubation, the patients' lungs were mechanically ventilated. Subjects were anesthetized using sevoflurane and were given a rapid, constant-rate infusion of crystalloid (500 ml in 15 min). Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), cardiac output (CO), cardiac index (CI), SVV, and PVI were measured at baseline and after 250 and 500 ml had been infused, and these values were compared.SAP, DAP, CO, and CI were unchanged after the infusion. HR and SVV decreased significantly after the infusion. SVI increased significantly after the infusion. There was a significant difference in PVI only between the post 250 ml and post 500 ml infusions.A rapid infusion of 250-500 ml of a crystalloid in nearly healthy subjects who had fasted overnight returned their SVV to within the normal range. In such cases, SVV is a more sensitive predictor of fluid responsiveness than is PVI, and the infusion gradually increased SVI.

Bone mineral density (BMD) of total body, spine, and proximal femur and the percentage of body fat in 151 U.S.-born Japanese-American women and 137 Japan-born immigrant Japanese-American women living in San Diego, California were measured using dual-energy x-ray absorptiometry. These data were compared with unpublished data from Japanese women obtained in previous studies in Hamamatsu, Japan. The age-adjusted BMD for the spinal level, femoral neck, Ward's triangle, trochanter, and total body, respectively, of U.S.-born Japanese-American women were 10.2, 9.8, 9.9, 9.2, and 2.7% higher than those of native Japanese women. The U.S.-born Japanese-American women had significantly higher body fat than immigrant Japanese-American women. Furthermore, the immigrant women had higher BMD and higher body fat than their native Japanese counterparts; however, no significant total-body BMD differences were found among the three groups after age, height, and weight were adjusted. The U.S.-born Japanese-American women had BMD values equivalent to those of white normals at the spine and femur. Significant life-style differences between U.S.-born and immigrant Japanese-American women were noted. Weight, exercise, early menarche, and years of lifetime estrogen exposure correlated positively with BMD. The significant negative correlates of BMD were age, smoking, and percentage of body fat. Our study presents data suggesting that immigration to the United States has produced a higher BMD in Japanese-American women that is attributable to changes in life-style and diet.

This cross-sectional study investigated the effect of long-term activity as a caddie on ultrasonic properties of the os calcis. We measured 74 healthy women, age 20-59 years, who worked at a golf course as caddies. An age-matched control group of 433 healthy women, who were office workers or housewives, also were recruited for comparison. The ultrasound measurements were performed with an Achilles ultrasound densitometer. The quadriceps muscle strength and the hand grip strength were measured in a perimenopausal subgroup (45-59 years) of the caddies and a subgroup of controls matched for age, height, weight, and body mass index. Urinary pyridinoline and deoxypyridinoline were also measured in these perimenopausal subgroups. Caddies had significantly higher ultrasound values than controls in the 40-49 (stiffness index, 101.6 +/- 12.9% versus 87.9 +/- 11.9%; p < 0.0001) and 50-59 (stiffness index, 90.5 +/- 11.6% versus 77.2 +/- 11.6%; p < 0.0001) age-stratified groups. Quadriceps strength and grip strength were significantly higher in caddies than those in controls. In postmenopausal caddies, all ultrasound values were significantly higher than for controls. In caddies there were not significant decreases of any ultrasound values with postmenopausal age. Even for the subgroup within 3 years of menopause there were significant differences between caddies and controls (p < 0.01). There were no significant increases of pyridinoline and deoxypyridinoline after menopause in the caddies. We demonstrated that the caddies had higher ultrasound properties of the os calcis and lower bone resorption after menopause compared with controls.

An open-label study with blinded evaluation was performed to compare the preventive effect of a calcium supplement alone (monotherapy) or calcium supplement plus menatetrenone (combined therapy) on fracture in osteoporotic postmenopausal women aged 50 years or older. Patients were randomized to receive monotherapy (n = 2,193) or combined therapy (n = 2,185). Before randomization, the subjects were stratified into a subgroup without vertebral fractures (n = 2,986; no-fracture subgroup) and a subgroup with at least one vertebral fracture (n = 1,392; fracture subgroup). The incidence rate of new vertebral fractures during 36 months of treatment (primary endpoint) did not differ significantly between either subgroup of the two treatment groups. Although the cumulative 48-month incidence rate of new clinical fractures (secondary endpoint) was lower in the combined therapy group, the difference was not significant. There was a lower risk of new vertebral fractures in patients with at least five baseline fractures who received combined therapy. Also, the loss of height was less with combined therapy than with monotherapy among patients 75 years of age or older at enrollment, those whose last menstrual period occurred 30 years or more before enrollment, and those with at least five vertebral fractures at enrollment. Adverse events and adverse reactions were more frequent in the combined therapy group. In conclusion, menatetrenone therapy was not effective for preventing vertebral fractures in the full analysis set of this study, but the results suggested that it may prevent vertebral fractures in patients with more advanced osteoporosis.

In this paper, the vapour transport of PbBr2 under vacuum during vacuum distillation refining and its condensation on the wall of the vessel were described. The macro- and micro morphologies of PbBr2 crystals grown in the vessel (glass tube) were studied. The crystal shape changed dramatically depending on the positions of condensation in the vessel, i.e., the crystal shape varied from an isometric polyhedron to columnar crystals with facets, and to a massive crystal without facets with a rise in the wall temperature. These results were interpreted in terms of the concentration gradient of the molecules in the vessel, surface roughening and/or surface melting of the crystals. (© 2007 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

Nanocrystallites formed with a magnetic field in gel have been examined by transmission electron microscopy. Micro-twin and multiply twinned nanoparticles of PbBr2 were selectively grown induced by the reaction under the influence of the magnetic field during the gel growth between Pb(NO3)2 and KBr solutions. The pentagonal growth in a magnetic field was discussed as a result of the attenuation of the ionic component in PbBr2 crystals.

Background. Lung resistance increases after induction of anaesthesia. We hypothesized that prophylactic bronchodilation with i.v. carperitide before tracheal intubation would decrease airway resistance and increase lung compliance after placement of the tracheal tube in both smokers and nonsmokers. Methods. Ninety-seven adults aged between 24 and 59 yr were randomized to receive i.v. normal saline (0.9% saline) (control) or carperitide, 0.2 m gk g � 1 min � 1 throughout the study. The 97 patients included smokers and nonsmokers. Thus the patients were allocated to one of the four groups: smokers who received normal saline (n=21), nonsmokers who received normal saline (n=27), smokers who received carperitide (n=19) or nonsmokers who received carperitide (n=30). Thirty minutes after starting normal saline or carperitide infusion, we administered thiamylal 5 mg kg � 1 and fentanyl 5 m gk g � 1 to induce general anaesthesia and vecuronium 0.3 mg kg � 1 for muscle relaxation. Continuous infusion of thiamylal 15 mg kg � 1 h � 1 followed anaesthetic induction. Mean airway resistance (Rawm), expiratory airway resistance (Rawe) and dynamic lung compliance (Cdyn) were determined 4, 8, 12 and 16 min after tracheal intubation and compared between the four groups. Results. At 4 min after intubation, Rawm and Rawe were higher and Cdyn lower in smokers than in nonsmokers in the control group. Rawm and Rawe were lower and Cdyn higher in smokers in the carperitide group than in smokers in the control group. Rawm and Rawe were lower in nonsmokers in the carperitide group than in nonsmokers in the control group. Conclusions. Marked bronchoconstriction occurred in the control groups (smokers and nonsmokers) 4 min after tracheal intubation. Prophylactic treatment with carperitide before induction of anaesthesia and tracheal intubation was advantageous, particularly in smokers. Br J Anaesth 2006; 96: 660–9

エスモロールは短時間作用型 β1遮断薬であり, 適応として ｢手術時の上室性頻脈性不整脈に対する緊急処置｣ があげられる. しかし, 本邦ではその著効例の報告がほとんどない. 今回, 脳動脈瘤クリッピング術前の頭部三点固定時に生じた連発する上室性期外収縮に対しエスモロールを使用し, 良好な結果が得られたので報告する.

The objective of this study was to systematically determine the diagnostic accuracy of bedside tests for predicting difficult intubation in patients with no airway pathology. Thirty-five studies (50,760 patients) were selected from electronic databases. The overall incidence of difficult intubation was 5.8% (95% confidence interval, 4.5-7.5%). Screening tests included the Mallampati oropharyngeal classification, thyromental distance, sternomental distance, mouth opening, and Wilson risk score. Each test yielded poor to moderate sensitivity (20-62%) and moderate to fair specificity (82-97%). The most useful bedside test for prediction was found to be a combination of the Mallampati classification and thyromental distance (positive likelihood ratio, 9.9; 95% confidence interval, 3.1-31.9). Currently available screening tests for difficult intubation have only poor to moderate discriminative power when used alone. Combinations of tests add some incremental diagnostic value in comparison to the value of each test alone. The clinical value of bedside screening tests for predicting difficult intubation remains limited.

PbBr2 single crystals were grown by a vertical Bridgman method. The objective of this work is to examine the following two: (i) how the crystal quality is influenced by purification, (ii) how the crystal quality is influenced by growth rate. The following results were obtained. (1) The crystals grown from the materials of 99.99% and 99.999% purity were not transparent if they were not purified. On the other hand, a transparent crystal was obtained even from the material of 99.99% purity when it was refined by directional freezing as well as vacuum distillation. (2) It was found that very slow growth rate was needed to grow transparent crystals.

We report the epitaxial growth of the copper-phthalocyanine (CuPc) nano-crystallite on KCl {0 0 1} substrate by a thermal treatment method. When the crystallite is nucleated from a thick CuPc film, the crystallites grow with a random orientation. However, when CuPc is grown by the crystallization cycle of the vapor deposition and the thermal treatment, the crystallites grow keeping the epitaxial relationship.

Study objectives To examine whether prophylactic, atomized lidocaine blunts hyperdynamic responses and catecholamine release after an abrupt increase in volatile anesthetic administration. Design Prospective, randomized, double-blind, placebo-controlled study. Setting University-affiliated hospital. Patients 22 ASA physical status I adult patients scheduled for elective surgery. Interventions Patients were randomly assigned to the saline or lidocaine group, and abruptly inhaled 5% isoflurane (4.3 MAC) after inhalation of ultrasonically nebulized lidocaine or saline via endoscopy mask. An esophageal Doppler probe was inserted via the mask to assess global hemodynamic performance. Measurements and main results Immediately after abrupt inhalation of isoflurane, heart rate (HR) in the saline group increased significantly and mean arterial pressure (MAP) remained unchanged, whereas HR in the lidocaine group remained unchanged, and MAP decreased significantly. No significant differences were noted between the saline and lidocaine groups in aortic blood flow, stroke volume in the aorta, total systemic vascular resistance in the aortic circuit, or aortic diameter. The plasma norepinephrine concentration increased in both groups after isoflurane inhalation, significantly so in the saline group but not in the lidocaine group. Conclusion Prophylactic ultrasonically nebulized lidocaine (2 mg/kg) obtunds the hyperdynamic responses to abrupt inhalation of 5% isoflurane but does not completely block catecholamine release.

Cubic zinc sulfide crystals were grown by a flux method using PbCl 2 as a flux. The crystals were grown in the shape of platy or bulky crystals. The surface microtopographs of the crystals were observed by a differential interference microscope. One surface (top surface) of the platy crystals showed layer growth pattern that suggested the spiral growth mechanism, whereas another surface (back surface) showed the dendritic pattern. The luminescence property of the crystals was studied by means of cathode luminescence spectroscopy. Three peaks of spectra were observed at the wavelength of about 560, 470 and 336 nm depending on the purity, growth shapes, and top or back faces of platy crystals. The intensity of these spectra was varied depending on the growth conditions.

We describe a case of pyogenic spondylitis/spondylodiscitis (PS) after stellate ganglion block (SGB). The clinical pictures of 24 cases of post-SGB PS reported in the literature are reviewed. The most serious sequelae were spinal compression symptoms due to epidural spread of inflammation or crush of a vertebral body, meningitis, and dyspnea due to retropharyngeal abscess.

Purpose: Tizanidine is a clonidine derivative and has the same effects such as sedation anxiolysis and analgesic response. We evaluated the effect of tizanidine on infiltration pain during epidural catheterization. Methods: Forty patients scheduled to undergo epidural anesthesia in elective surgery were randomly allocated into two groups. The control group received placebo 60 minutes before arrival in the operating room and the tizanidine group received 3 mg of oral tizanidine as premedication 60 minutes before arrival in the operating room. Every patient was measured heart rate and blood pressure before receiving placebo or premedication and after arrival in the operating room. After an epidural catheter was indwelled the patients were questioned about the infiltrating pain of local anesthetic and the degree was assessed by means of visual analog scale score（VAS score 0～100 mm） . Results: Blood pressure in the operating room was significantly attenuated in the tizanidine group compared to the control group（148±21 mmHg vs 130±15 mmHg） . Heart rate was not significantly different between the two groups. Rate‑pressure product was significantly lower in the tizanidine group（11282±2960 vs 9592±2632） .V AS score in the tizanidine group was significantly lower than that in the control group（P ＜0.001） . Conclusion: It was possible to reduce the infiltration pain of local anesthetic during epidural catheterization by oral administration of 3 mg of tizanidine as premedication. Blood pressure and rate‑pressure product in the operating room were also attenuated by receiving tizanidine. Therefore we recommend premedication with tizanidine for patients undergoing epidural catheterization. （J Nippon Med Sch 2004; 71: 105―110）

To elucidate the current status of hip fracture incidence and treatment in Japan, a tally of hip fractures in patients from 1998 to 2000 was conducted in Japanese Orthopaedic Association-related hospitals. Response rates were from 40.5% to 55.6% in each observation year. The survey found a total of 110,747 new hip fractures aged 35 years old and over during the survey years. Age- and gender-specific number of patients increased with age and peaked at the age of 80-84 years, then leveled off after 85 years of age. The number of patients with femoral neck fractures exceeded that with trochanteric fractures before 75 years of age, and these figures became inverted thereafter. More left hips were fractured than right in all survey years; however, the difference was not significant. The most common cause of hip fractures was a simple fall; 68.8% sustained fractures indoors, and there was a significant monthly variation. Ninety-three percent of the patients with femoral neck fractures and 94% of the patients with trochanteric fractures were treated surgically, and about three fourths were treated with hemiarthroplasty among patients with femoral neck fractures. The mean hospitalization period was 56.4 days during the observation period.

Electroconvulsive therapy is an effective treatment for severe and medication-resistant depression. There have been no reports describing how a volatile anaesthetic affects haemodynamic responses, seizure duration, and recovery characteristics during electroconvulsive therapy. We carried out a repeated-measure crossover study to compare the effects on haemodynamic responses, seizure duration, and recovery characteristics of the following types of anaesthesia in electroconvulsive therapy: propofol alone, sevoflurane alone, and propofol combined with sevoflurane. We recruited 50 patients requiring electroconvulsive therapy for depression. For anaesthesia induction, 1.5 mg/kg propofol (condition P), 5% sevoflurane in oxygen following a vital capacity rapid inhalation induction (condition S), or 1.5 mg/kg propofol followed by 5% sevoflurane in oxygen (condition PS) was administered. Succinylcholine 1.5 mg/kg was then given. Electrical stimulation was administered after fasciculation. Measurements were obtained before anaesthesia induction (baseline), prior to succinylcholine administration, prior to electroconvulsive therapy, and at the peak after electroconvulsive therapy. After electroconvulsive therapy, peak heart rate and peak mean arterial pressure were highest in condition S. Whereas recovery time was longest in condition PS, motor seizure duration was significantly shorter than in either condition P or S. Electroencephalographic seizure duration was significantly shorter in condition PS than in condition P and significantly shorter in condition S than in condition P. Sevoflurane anaesthesia alone is most disadvantageous in terms of haemodynamics. Propofol-sevoflurane anaesthesia is advantageous in terms of haemodynamics, but disadvantageous in terms of seizure duration and recovery time. Propofol alone is most advantageous in terms of seizure duration.

Nitrous oxide (N(2)O) is a frequently used adjunct to propofol anesthesia. Although N(2)O reduces the requirement of propofol for induction and maintenance, the effects of both drugs on overall hemodynamics remain controversial. We tested the hypothesis that the addition of N(2)O to therapeutic doses of propofol alters hemodynamics and Doppler-derived variables evaluated with the esophageal Doppler monitor in a randomized, double-blinded, placebo-controlled design.Thirty ASA I-II patients (aged 30-66 yr) were randomly assigned to receive propofol with oxygen-enriched air (FIO(2) = 0.3; air group) or propofol with 70% N(2)O (N(2)O group). Following intubation, a computerized target-controlled infusion technique was used to administer propofol from 0 micro g x mL(-1) (baseline) to 5 micro g x mL(-1) in 1 micro g x mL(-1) increments.Mean arterial pressure (MAP) decreased more in the N(2)O group than in the air group only at 5 micro g x mL(-1). Aortic blood flow (ABF) showed a similar dose-dependent decrease in both groups. Peak aortic flow acceleration, as a myocardial contractility index, decreased significantly and similarly in both groups in a dose-dependent manner whereas peak velocity of ABF, as another measure of myocardial contractility, remained unchanged. Heart rate-corrected left ventricular ejection time, as a measure of preload, remained constant in both groups at any target plasma concentration.Propofol causes dose-dependent decreases in ABF and MAP; however, 70% N(2)O produces minimal hemodynamic and Doppler-derived variable changes under target-controlled propofol infusion at therapeutic concentrations.