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To evaluate the 72-month clinical results of trabectome surgery (TOM) in patients with primary open-angle glaucoma (POAG), secondary OAG and childhood glaucoma. A total of 305 eyes from 249 glaucoma patients were analyzed in the current retrospective single-center study. Kaplan-Meier analysis was performed using three criteria: criterion A (postoperative intraocular pressure [IOP] ≤ 21 mmHg and ≥ 20% reduction from baseline IOP); criterion B (postoperative IOP ≤ 18 mmHg and ≥ 20% reduction from baseline IOP); and criterion C (postoperative IOP ≤ 16 mmHg and ≥ 20% reduction from baseline IOP). The changes in IOP, medication score, success probability, results of the multivariate analysis for success and failure risk factors, and complications were analyzed. The baseline IOP in all glaucoma patients decreased from 29.2 ± 9.8 mmHg with a 5.3 ± 1.7 medication score to 16.4 ± 5.8 mmHg (− 43.8%) with a 4.2 ± 1.5 medication score at 72 months (p

To analyze the rate and time of occurrence of intraocular pressure (IOP) elevation early after trabectome surgery (TOM) and the characteristics of glaucoma patients recovering from IOP elevation. Four hundred sixty eyes of 460 glaucoma (191 primary and 269 secondary open-angle glaucoma) patients who underwent TOM were evaluated. IOP elevation early after TOM was diagnosed when IOP increased by more than 5 mmHg over baseline within 1 week to 3 months. If the IOP decreased with the administration of anti-glaucoma eye drops alone, patients were classified as recovered. If the IOP did not decrease despite additional anti-glaucoma eye drop use, patients were classified as non-recovered. The rate and time of occurrence of IOP elevation early after TOM were investigated. Demographic and ocular variables related to recovery and non-recovery were identified by multivariate logistic regression analysis. Of the 460 patients, IOP elevation early after TOM occurred in 102 (22.2%). IOP elevation occurred most frequently at postoperative week 1. Of the 102 patients with IOP elevation, 55 (53.9%) recovered and 47 (46.1%) did not. A large hyphema size the day after surgery was associated with increased likelihood of recovery from IOP elevation (odds ratio [OR], 6.6). A history of past selective laser trabeculoplasty (SLT; OR, 0.10) and high baseline IOP (OR, 0.86) were associated with reduced likelihood of recovery from IOP elevation. IOP elevation early after TOM occurred most frequently at postoperative week 1. Patients with a large hyphema size, no history of SLT, and a lower baseline IOP recovered from IOP elevation early after TOM. A large hyphema the day after surgery suggested an increased likelihood of recovery from IOP elevation.

In the absence of a widely accepted and common definition of social enterprise (SE), a large research project, the "International Comparative Social Enterprise Models" (ICSEM) Project, was carried out over a five-year period; it involved more than 200 researchers from 55 countries and relied on bottom-up approaches to capture the SE phenomenon. This strategy made it possible to take into account and give legitimacy to locally embedded approaches, thus resulting in an analysis encompassing a wide diversity of social enterprises, while simultaneously allowing for the identification of major SE models to delineate the field on common grounds at the international level. These SE models reveal or confirm an overall trend towards new ways of sharing the responsibility for the common good in today’s economies and societies. We tend to consider as good news the fact that social enterprises actually stem from all parts of the economy. Indeed, societies are facing many complex challenges at all levels, from the local to the global level. The diversity and internal variety of SE models are a sign of a broadly shared willingness to develop appropriate―although sometimes embryonic―responses to these challenges, on the basis of innovative economic/business models driven by a social mission. In spite of their weaknesses, social enterprises may be seen as advocates for and vehicles of the general interest across the whole economy. Of course, the debate about privatisation, deregulation and globalised market competition―all factors that may hinder efforts in the search for the common good–has to be addressed as well. The first of a series of four ICSEM books, Social Enterprise in Asia will serve as a key reference and resource for teachers, researchers, students, experts, policy makers, journalists and other categories of people who want to acquire a broad understanding of the phenomena of social enterprise and social entrepreneurship as they emerge and develop across the world.

To determine the differences in scleral shape between the superonasal and superotemporal quadrants, the sites of scleral flap creation in trabeculectomy, using anterior segment optical coherence tomography (OCT). Thirty-four right eyes of 34 enrolled subjects without ocular disease, with the exception of cataract or ametropia, were studied. Mean patient age was 63.2 ± 15.9 (standard deviation) years (range 28–84 years). The same examiner captured all images using anterior segment swept source OCT. The mean measurements were calculated from three images captured for each eye, 60° from the horizontal line passing through the pupillary center in the superonasal and superotemporal sclera. The radius of the scleral surface curvature and the area of the convex part of the sclera between the superonasal and the superotemporal quadrants were determined using image analysis software and the paired t test. The radius of the scleral curvature was significantly different in the superonasal quadrant and superotemporal quadrant (34.3 ± 12.6 vs. 18.3 ± 3.6 mm, respectively; P

To describe a modified glaucoma staging system (Modified GSS) based on the visual field index (VFI) and evaluate the performance of the Modified GSS compared with the Bascom Palmer GSS and Enhanced GSS.A total of 549 eyes of 549 patients were studied retrospectively. The Modified GSS was used to classify the glaucomatous visual field defects into stage 0 to 5 based on the VFI. The cutoff values for each stage were derived from VFI that were equivalent to mean deviations of -6, -12, -20, and -25 dB by receiver operating characteristic analysis. The staging performances, based on each of three GSSs, were compared with both the Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study (CIGTS) scores.The VFI cutoff values calculated for each stage were 81.5, 62.5, 42.5, and 22.5%, respectively. The correlation coefficient of Modified GSS was greater than that of Bascom Palmer GSS (p0.001), and correlation coefficients of Modified GSS and Enhanced GSS were equivalent. However, Enhanced GSS tended to classify moderate to severe AGIS and CIGTS scores into higher stages (p0.001).The Modified GSS is easy to use and accurate, and the staging performance is either equal or superior to existing GSSs.

AIM To compare the corneal biomechanical properties difference by ocular response analyzer (ORA) in normal tension glaucoma (NTG) patients with different visual field (VF) progression speed. METHODS NTG patients with well-controlled Goldmann applanation tonometer (GAT) who routinely consulted Kitasato University Hospital Glaucoma Department between January 2010 and February 2014 were enrolled. GAT and ORA parameters including corneal compensated intraocular pressure (IOPcc), Goldmann estimated intraocular pressure (IOPg), corneal hysteresis (CH), corneal resistance factor (CRF) were recorded. VF was tested by Swedish interactive threshold algorithm (SITA)-standard 30-2 fields. All patients underwent VF measurement regularly and GAT did not exceed 15 mm Hg at any time during the 3y follow up. Patients were divided into four groups according to VF change over 3y, and ORA findings were compared between the upper 25(th) percentile group (slow progression group) and the lower 25(th) percentile group (rapid progression group). RESULTS Eighty-two eyes of 56 patients were studied. There were 21 eyes (21 patients) each in rapid and slow progression groups respectively. GAT, IOPcc, IOPg, CH, CRF were 12.1±1.4 mm Hg, 15.8±1.8 mm Hg, 12.8±2.0 mm Hg, 8.4±1.1 mm Hg, 7.9±1.3 mm Hg respectively in rapid progression group and 11.5±1.3 mm Hg, 13.5±2.1 mm Hg, 11.2±1.6 mm Hg, 9.3±1.1 mm Hg, 8.2±0.9 mm Hg respectively in slow progression group (P=0.214

Changing in the work environment in recent years, an occupational physician needs to make a countermeasure to mental health disorders. When the occupational physician works with employees who have, or are suspected of having, high-functioning developmental disorders, it is necessary to consider the following: Whether, in the course of addressing problems faced by employees, occupational health staff members are able to consider the possibility of developmental disorders. An additional issue is whether the occupational physician, when working with the treating psychiatrist, is able to appropriately provide precise information. Furthermore, when an employee is diagnosed with a developmental disorder, there are questions of whether a smooth internal company approach is possible in the context of appropriate workplace support, and whether it is possible to obtain the understanding of colleagues prior to implementing appropriate workplace assignments and accommodations. Additionally, it is necessary to consider the career paths of employees with high-functioning developmental disorders that are discovered subsequent to being hired. In this paper, introducing some cases, It was summarized the challenges of developmental disabilities in the workplace and discussed correspondence in the workplace.

To evaluate the short-term results of Trabectome surgery performed on Japanese patients.Retrospective observational study. Trabectome surgery was performed on 117 eyes from 101 patients at Kitasato University Hospital from December 2010 to June 2013, involving 48 eyes with primary open-angle glaucoma (POAG), 62 eyes with secondary open-angle glaucoma (SOAG), and 7 eyes with developmental glaucoma. Trabectome surgery alone was performed on 34 phakic eyes (the phakic group) and 35 pseudophakic eyes (the pseudophakic group), and Trabectome surgery combined with phacoemulsification (the combined surgery group) was performed on 48 eyes. The main outcomes assessed were intraocular pressure (IOP), number of IOP-lowering medications, and success probabilities using Kaplan-Meier life-table analyses. Failure risk factors were identified using the Cox proportional hazards ratio.In all cases, after a mean follow-up of 18.5 ± 13.5 months, IOP was reduced from 31.6 ± 9.9 (SD) mmHg using 5.0 ± 1.7 medications to 16.4 ± 5.4 mmHg using 3.8 ± 1.8 medications. One year after surgery, IOP was reduced from 29.4 ± 7.8 to 16.1 ± 3.8 mmHg in POAG, from 33.6 ± 11.1 to 14.7 ± 2.9 mmHg in SOAG, from 33.0 ± 10.2 to 15.7 ± 3.3 mmHg in the phakic group, from 32.6 ± 9.3 to 15.3 ± 3.0 mmHg in the pseudophakic group, and from 29.9 ± 10.0 to 15.2 ± 3.0 mmHg in the combined surgery group. There were no statistically significant differences in IOP at each measurement point, either between POAG and SOAG or among the three procedure subtypes. The POAG and SOAG success rates at 12 months using postoperative IOP ≤ 21 mmHg and ≥20 % reduction in baseline as criteria were 53.9 and 77.2 %, respectively (p = 0.024, log-rank test). Twenty-one eyes (17.9 %) needed additional trabeculectomy. None of the univariate and multivariate risk factors for failure were detected.Trabectome surgery is safe and effective for Japanese patients whose target IOP is 18 mmHg or above. However, it is necessary to carefully consider Trabectome surgery for advanced POAG cases.

Purpose: To investigate the process of repair in the epithelial cells and the reconstruction in lens fibers of a mouse lens that has developed opacity because of a large-scale perforating injury. Methods: Lenses of 4-week-old mice were perforated with a needle through the cornea to induce the development of traumatic cataracts. Over the period from the first day to the fifth month after injury, eyeballs were extracted progressively from the mice and changes in the epithelial cells of these lenses were observed morphologically as well as histochemically. Results: Following the injury, the epithelial cells of the lenses extended toward the center of the injury, while undergoing repeated proliferation and stratification. After a month, the epithelial cells completely covered the entire injury. Later, a basal lamina and collagen fibers developed among the epithelial cells that had proliferated, the intracellular space enlarged, but the number of cells decreased. Histochemically, a strong actin-positive finding was observed in the epithelial cells in the growth phase. On the other hand, an investigation by means of the TUNEL method revealed epithelial cell death and a decrease in cell number. Maximal cell death was observed in the second month. During this period, lens fibers regenerated, and the clear areas of the cortex increased. Conclusion: Although the lenses exhibited opacity over a large area, the epithelial cells eventually fully covered the injured area. Once the repair was completed, the number of epithelial cells decreased. At the same time, the lenses were found to have developed increased clarity, leading to reconstruction. The epithelial recovery and the residual posterior suture may be the key to the reconstruction of the lenses.

A hybrid photodetector (HPD) combined with a III-V photocathode is considered to be an ideal photodetector, because the quantum efficiency (QE) is high, the collection efficiency is 100%, and the excess noise factor is negligible. As the first step, an HPD combined with a GaAs photocathode or a blue-enhanced GaAs (BE-GaAs) photocathode has been developed. Presently, the QE is approximately 20% from 550 nm to 850 nm, which is much higher than that of a conventional multi-alkali (S-20) photocathode. The 100% collection efficiency calculated by the computer simulation is supported by the test result of the flat uniformity. Considering the application in high energy physics using a wavelength shifter, energy resolutions of both the BE-GaAs-HPD and the conventional S20-HPD were measured using 650 nm LED light pulse. The BE-GaAs-HPD shows a resolution of 17%, finer than 34% of the S20-HPD. The experimental results are consistent with the theoretical estimation. The QE of the HPD is especially important, because the electron multiplication process is noiseless.

Ground-state properties of ferrimagnetic XXZ chains with alternating spins S A and S B with nearest-neighbor exchange interaction are discussed based upon the results for finite-size systems obtained mainly by the exact diagonalization method and partly by the density matrix renormalization group method. For -1 1, the ground state is doubly degenerate Neel long-range ordered state with a finite energy gap.

In order to be utilized in such application fields as high energy physics or medical imaging, where a huge number of photodetectors are assembled in designated small area, the world's smallest hybrid photodetector (HPD), the compact HPD, has been developed. The overall diameter and the length of the tube are 16 mm and 15 mm, respectively. The effective photocathode area is 8 mm in diameter. At applied voltage of -8 kV to the photocathode, the electron multiplication gain of a PD incorporated HPD (PD-HPD) is 1,600, and that of an APD (APD-HPD) is 65,000. In the pulse height distribution measurement, photoelectron peaks up to 6 photoelectrons are clearly distinguishable with the APD-HPD. Experiments established that there was no degradation of gain in magnetic fields up to 1.5 T, an important performance characteristic of the compact HPD for application in high energy physics.

Compound gear lapping is to increase a certain degree of accuracy by lapping a pair of metal gears in mesh, and at the same time to improve roughness of tooth surface by lapping the metal gears in mesh with plastic gears at the shaft angle. The metal gears are lapping during traverse feeding in the place where oil coolant mixed with fine abrasive grains is spouted. The lapping test shows that only irregular profiles of the metal gears are removed and meshing noise is reduced. The test also finds the following; widely uniform tooth contacts are obtained by means of the plastic gears made of Polyacetal and fine adjustment of the shaft angle. Meshing noise is reduced to approximately 86 dB by selecting proper lapping conditions. The best tooth profile and the smallest meshing noise are achieved at the lapping time of 20 seconds. The profile is deteriorated and meshing noise becomes higher at a lapping time over 20 seconds.

Ninety-five patients with papillary thyroid carcinoma (PTC) who received primary surgical treatment in 1983 at Kuma Hospital and were followed until 1992 were the subjects of this study. Initial therapy was tumor resection for 5 patients, lobectomy for 23 patients, total thyroidectomy with unilateral modified neck dissection for 60 patients, and total thyroidectomy with bilateral modified neck dissection for 7 patients. Clinical stage at diagnosis was as follows. Class I included 28 patients with intrathyroidal disease, class II included 60 patients with positive cervical lymph nodes, and class II included 7 patients with tumor invasion into tissue outside of the thyroid gland. Recurrence of the tumor was evaluated according to lymphocytic infiltration in the thyroid gland. Group A consisted of 36 patients with PTC associated with lymphocytic infiltration, 26 with infiltration surrounding the tumor, 3 with infiltration inside of the tumor, and 7 with both. Group B consisted of the remaining 59 patients with PTC with no lymphocytic infiltration. There were no differences in age, sex, initial tumor size, or initial treatment between groups A and B. Antithyroglobulin antibody and/or antimicrosomal antibody were positive in 16 patients from group A and 4 patients from group B (P < 0.001). Class I included 14 patients from each group, class II included 22 patients from group A and 38 patients from group B, and class III included 7 patients, all from group B. Recurrence of the tumor was found in only 1 group A patient (2.8%), but in 11 patients of group B (18.6%). The percentage of patients free from recurrence over the 10 yr of follow-up in group A was significantly higher than that in group B (by Cox-Mantel test, P < 0.01). The time between initial treatment and recurrence was 2-10 yr. In comparing the clinical stage at the time of initial treatment, recurrence was found in 1 class II patient from group A (4.5%) and in 1 class I (7.1%), 6 class II (15.8%), and 4 class III (57.1%) patients from group B. No patients died during the 10 yr of follow-up. In conclusion, 1) lymphocytic infiltration surrounding the tumor or inside the tumor in PTC might be of use as a means for predicting a favorable prognosis; and 2) class II or class III patients with no lymphocytic infiltration had a high rate of recurrence.

Summary OBJECTIVE We previously reported the clinical characteristics of Graves' disease with undetectable TSH binding inhibitor immunoglobulins (TBII) at first visit, but a study of the prognosis of untreated TBII negative patients with anti-thyroid drug medication has never been undertaken. The aim of this paper is to study the difference between negative and positive TBll Graves' disease in relation to the effect of anti-thyroid drug treatment. PATIENTS From January 1986 to April 1991,1545 patients with untreated Graves' disease were referred to Kuma Hospital, Kobe, Japan. Of these, 94 TRAb negative patients were identified. Another 83 TRAb positive patients were randomly selected from the other Graves' disease patients and served as a comparison group. Fifty-six of the 94 patients in the TBII negative group and 52 of the 83 patients in the TBII positive group completed treatment with methimazole only. MEASUREMENTS The trial was conducted as a retrospective study with a maximum treatment period of 36 months and a follow-up period of a further 12 months. From the original pool of patients, we classified 56 TBII negative patients into two groups according to the clinical course taken; Group A in whom TBII remained undetectable throughout methimazole treatment (9 men and 34 women, age 37.2 ± 2.2 years), and Group B who became TBII positive (4 men and 9 women, 31.2 ± 44 years). Fifty-two TBII positive patients served as the comparison Group C (8 men and 44 women, age 38.1 ± 2.0 years). RESULTS Serum free T4 and free T3 levels in groups A and B were significantly lower before treatment than those of Group C (P < 0.001). The thyroid volumes of Group A and B patients were significantly smaller than those of Group C (P < 0.01). The level of TBII in Groups A and B was significantly lower than that in Group C (8.3 ± 0.7 and 8.8·1.1 vs 57.0 ± 28%, respectively, P < 0.001). The level of thyroid stimulating antibody (TSAb) in Groups A and B was significantly lower than that in Group C (478 ± 71.0 and 761 ± 140.3 vs 2143 ± 280%, respectively, P < 0.01), and there were no significant differences in TSAb activities between Groups A and B. The remission rates in Groups A, B and C were 77.4, 36.4 and 36.5%, respectively. These data Indicate that Group A has a good prognosis, but Group B has the same prognosis as Group C. CONCLUSION We conclude that patients In whom TSH binding inhibitor Immunoglobulins remained negative have a much better prognosis than TSH binding inhibitor immunoglobulins positive patients or those who become TSH binding inhibitor immunoglobulins positive, having been initially negative.

To evaluate the reproducibility and interexaminer consistency in analyzing the optic disc parameters using a newly fundus stereoscopic camera, and their correlation with parameters of the Heidelberg Retina Tomograph II (HRT II) was also examined.This study examined 53 eyes of 53 healthy volunteers (mean age, 21.8 y). Fifty-five eyes of 55 glaucoma patients (mean age, 59.3 y) were also involved. A Nonmyd WX retinal camera was used for stereoscopic fundus imaging. The diagnostic parameters for the optic nerve head analyses were examined under the following conditions: (1) the intraexaminer reproducibility was determined by a certified orthoptist (CO) with 1 year's experience, with the appropriate coefficient of variation in 8 healthy eyes; and (2) the interexaminer consistency of the diagnostic parameters by both glaucoma specialist and CO was examined in 45 healthy eyes and 55 glaucomatous eyes. By subgroup analysis, the healthy eyes were classified into 2 groups based on the degree of myopia, the optic disc of glaucomatous eye was classified into 4 types: focal ischemic, generalized enlargement, myopic, and senile sclerotic, and also classified into 3 stages (early, moderate, and severe) by Hodapp-Anderson-Parrish scale. (3) The correlation of parameters common to Nonmyd WX and HRT II was examined in 18 eyes of randomly selected patients.The results were as follows: (1) Mean coefficient of variation of 2.6% to 17.6%, with volume parameters considerably lower than the other parameters. (2) In both groups, a high or moderate degree of consistency was obtained (r=0.40 to 0.99; P=0.032 to0.0001), except only the upper rim width in healthy subjects (r=0.28; P=0.137). In particular, good consistency was obtained in healthy eye with-3 D of myopia, in glaucoma patients with the generalized type of optic disc and severe glaucomatous stage. (3) A strong correlation with HRT II was obtained only in the cup area and the disc area by both specialist and CO (r=0.75 to 0.90; P=0.0003 to0.0001).Our studies indicated that most of the parameters were highly reproducible and consistent, and less difference was found between the results obtained by an experienced glaucoma specialist and a non-expert CO in patients with deep cupping and severe eye, but the examiner needs a clear understanding of the criteria for the rim and the cup.

Zoledronic acid(ZA)dosage should be adjusted according to the risk it poses for renal impairment. The recommended dosage for patients with creatinine clearance(Ccr)of less than 60mL/min was established on the basis of an area under the curve analysis, but is doubted because it was calculated without performing a clinical trial. Creatinine secretion from the renal tubule affects Ccr; therefore, using Ccr as the basis for dosage adjustment may be inappropriate since this can cause an overestimation of the glomerular filtration rate(GFR). The Japanese Society of Nephrology recommends using the estimated GFR(eGFR)for evaluating renal function. Therefore, this study investigated the relationship between renal function before and adverse events(AEs)after ZA administration. The dosage of only 3 of the 47 patients with Ccr less than 60mL/min could be adjusted on the basis of Ccr. During ZA therapy(3 courses), the blood urea nitrogen level and occurrence of hypokalemia were higher in the non-adjusted group than in the adjusted group, but the total number of AEs was equivalent for both groups. For all the patients, Ccr and eGFR were used as parameters for investigating AEs; the total number of AEs was equivalent for patients with differing levels of renal function. Therefore, we suggest that AEs observed during ZA therapy did not depend on the renal function level before ZA administration.

As a fundamental study of photodiodes (PDs) for electron bombardment, two types of PDs have been experimentally investigated to be applied in electron tubes. A PD bombarded from the front surface (FB-PD), where a pn junction of planar structure existed, was evaluated to measure the fast response characteristics such as a 2.1 ns rise time. However, more than an order of magnitude increase of dark current was also confirmed after a long term stability test of 1000 hours. On the other hand, a PD bombarded by electrons from the rear surface (RB-PD) showed no increase of dark current after the stability test and a fast rise time of 2.7 ns. However, it was clarified that the rise time of RB-PD depended on the applied voltage to the PD, and an applied voltage of 200 V was necessary to achieve such a fast response. Since it was a much higher voltage than expected, some modifications may be necessary to achieve a fast response with a lower applied voltage, considering the yield of the PDs. Comparisons of the two types of PDs for some other characteristics are discussed. Preliminary test results of an electron bombardment APD are also discussed. >

To determine the histological characteristics of hyperthyroid Graves' disease with undetectable TSH receptor antibodies (TRAb), we examined the thyroid histological findings of patients with hyperthyroidism who were referred for subtotal thyroidectomy and who lacked circulatory TRAb. Four patients had undetectable TRAb (6.4 +/- 4.2%) before treatment (group A). Their pathological and clinical findings were compared with those of four patients who had hyperthyroid Graves' disease with detectable TRAb (83.8 +/- 8.3%) before treatment (group B). The groups were matched for sex, age, duration of antithyroidal drug therapy, anti-Tg antibody, and antimicrosomal antibody levels. All patients were in a euthyroid state just before operation. Papillate hyperplastic epithelia in group A were significantly less severe than in group B. Enlarged colloids were not observed in two of the four patients in group A but were observed in all four patients in group B. Moderate or marked lymphocytic infiltrations were observed in all patients in group A but were virtually absent in group B. Based on these results, it is probable that hyperthyroid Graves' disease with undetectable TRAb titers represents an early stage or subtype of usual hyperthyroid Graves' disease in which there is marked or moderate lymphocytic infiltration.

The basic cancer pain management at our hospitalis based on WHO Cancer Pain Treatment Method-Opioid together with NSAIDs. We investigated 48 patients who were administered an opioid as management of cancer pain for three (3) months from May to July in 2008. Consequently, we found that 20 out of the 48 patients (41.7%) used an opioid together with NSAIDs. Meanwhile, we also investigated constipation and digestive impediment as side effects caused from opioid and NSAIDs, respectively. Of the 20 patients, 12 patients (60%) used laxative for constipation, and 18 patients (90%) used a digestive ulcer treatment drug for digestive impediment. Ten (20.8%) of the 48 patients used all 4 drugs-opioid, NSAIDs, laxative and digestive ulcer treatment drugs. As a result, we decided to further examine cancer pain management at our hospital.

The purpose of this study was to identify what motivates employers to promote good occupational health and safety practices in small-scale enterprises. Previous studies have shown that small-scale enterprises generally pay insufficient attention to issues of occupational health and safety. These findings were mainly derived from questionnaire based surveys. Nevertheless, some small-scale enterprises in which employers exercise good leadership do take a progressive approach to occupational health and safety. Although good practices can be identified in small-scale enterprises, it remains unclear what motivates employers in small-scale enterprises to actively implement occupational health and safety practices. We speculated that identifying employer motivations in promoting occupational health would help to spread good practices among small-scale enterprises. Using a qualitative approach based on the KJ methods, we interviewed ten employers who actively promote occupational health and safety in the workplace. The employers were asked to discuss their views of occupational health and safety in their own words. A semi-structured interview format was used, and transcripts were made of the interviews. Each transcript was independently coded by two or more researchers. These transcripts and codes were integrated and then the research group members discussed the heading titles and structural relationships between them according to the KJ method. Qualitative analysis revealed that all the employers expressed a strong interest in a "good company" and "good management". They emphasized four elements of "good management", namely "securing human resources", "trust of business partners", "social responsibility" and "employer's health condition itself", and considered that addressing occupational health and safety was essential to the achievement of these four elements. Consistent with previous findings, the results showed that implementation of occupational health and safety activities depended on "cost", "human resources", "time to perform", and "advisory organization". These results suggest that employer awareness of the relationship between good management and occupational health is essential to the implementation of occupational health and safety practices in small-scale enterprises.

To assess the effect of corneal astigmatism on intraocular pressure (IOP) measurements using an Ocular Response Analyzer (ORA) and a Goldmann applanation tonometer (GAT).We prospectively examined 59 normal eyes of 59 healthy volunteers (18 men, 41 women; age, mean +/- standard deviation, 40.5 +/- 14.2 years; age range, 19-68 years). We quantitatively assessed the values of corneal-compensated intraocular pressure (IOPcc) and Goldmann-correlated intraocular pressure (IOP(G)) using an ORA (Reichert Ophthalmic Instruments). We also measured the IOP using a GAT (GAT-IOP). The amount of corneal astigmatism was assessed with an autokeratometer. We carried out these measurements three times, and the mean value obtained was used for statistical analysis.The mean IOPcc, IOP(G), and GAT-IOP were 14.7 +/- 2.6, 14.0 +/- 2.8, and 14.2 +/- 1.7 mmHg respectively. The mean corneal astigmatism was 0.94 +/- 0.55 D. We found no significant correlation between IOPcc and corneal astigmatism (Pearson's correlation coefficient r = -0.04, p = 0.79), or between IOP(G) and corneal astigmatism (r = 0.09, p = 0.52). However, we found a weak, but significant, correlation between GAT-IOP and corneal astigmatism (Pearson's correlation coefficient r = 0.34, p = 0.009).Both IOPcc and IOP(G) measured with ORA were less affected by the amount of corneal astigmatism, and the GAT-IOP readings were significantly higher in eyes with greater corneal astigmatism, suggesting that IOPcc as well as IOP(G) may be helpful for accurate IOP measurements in eyes with some corneal astigmatism.

To investigate intraocular pressure (IOP) measurement values in normal tension glaucoma (NTG) eyes using two different types of tonometer that are supposed to be little affected by corneal biochemical properties.This study included 30 normal eyes of 16 healthy subjects and 30 eyes of 16 patients with NTG. IOP was measured with a Goldmann applanation tonometer (GAT), a Pascal dynamic contour tonometer (DCT), and a Reichert ocular response analyzer (ORA) three times each for normal and NTG eyes. The main measures were GAT-IOP, DCT-IOP, corneal-compensated IOP (IOPcc), Goldmann-correlated IOP (IOPg), and central corneal thickness (CCT).In normal eyes, GAT-IOP was 13.2 +/- 1.4 mmHg; DCT-IOP, 13.0 +/- 1.6 mmHg; IOPcc, 13.6 +/- 2.0 mmHg; and IOPg, 12.4 +/- 2.0 mmHg. Multivariate analysis revealed no significant differences between the four measurements (p = 0.08). CCT was 524.6 +/- 27.3 microns. In NTG eyes, GAT-IOP was 13.1 +/- 1.3 mmHg; DCT-IOP, 13.7 +/- 1.3 mmHg; IOPcc, 15.2 +/- 2.0 mmHg; and IOPg, 12.7 +/- 2.0 mmHg. Multivariate analysis showed significant differences between the four measurements (p0.01). Sheffé's test showed that IOPcc was significantly higher than GAT-IOP, DCT-IOP, and IOPg (GAT-IOP vs IOPcc: p0.0001; DCT-IOP vs IOPcc: p = 0.01; IOPcc vs IOPg: p0.0001). CCT was 515.4 +/- 32.9 microns, with no significant difference between normal and NTG eyes (p = 0.15).We investigated the values of IOP in NTG eyes as measured by the DCT and ORA. IOPcc was significantly greater than GAT-IOP, DCT-IOP and IOPg in NTG eyes, suggesting the possibility that IOP values may be underestimated.

The etiology of subacute (de Quervain's) thyroiditis (SAT) is uncertain, although it probably represents a nonspecific inflammatory response by the thyroid to a variety of viruses. It has been suggested that nonimmune processes are involved in SAT patients who have negative autoantibody titers. The disease has a variable course; although it is self-limited in most cases, some patients develop transient hypothyroidism, and others do not during the recovery period. The present study was performed to evaluate the occurrence of TSH receptor antibody (TRAb), measured by RRA (TSH binding inhibitor), TRAb measured by stimulation assay (thyroid-stimulating antibody), and TRAb measured by blocking assay [TSH-blocking antibody (TSH-BAb)] activity in 68 patients with SAT who had negative autoantibody titers. The patients were divided into 2 groups: group I, 31 patients who developed hypothyroidism during the recovery period; and group II, 37 patients who remained euthyroid during recovery. Positive immunoglobulin activity occurred in about 20% of group I patients during follow-up, but in only 3% of group II patients. About 20% of group I patients developed positive TSH-BAb activity and were hypothyroid, requiring exogenous hormone therapy for 1.2-3.5 yr, whereas hypothyroidism was relatively transient in group I patients who had negative TSH-BAb activity (2-6 months). Although increased TSH-BAb activity may account for hypothyroidism in some patients with SAT, the precise mechanism for the development of transient hypothyroidism in SAT remains enigmatic.

We have already proposed a fuzzy document retrieval system using a keyword connection matrix to represent similarities between keywords. By using the keyword connection matrix, documents are graded according to their relevance to a user query. We have also proposed a learning method to modify the relationship values so as to reduce the difference between relationship values initially assigned using statistical information, and the user's evaluation. There were, however, two problems with our previous method: First, we restricted compound queries to logical or ; second, our method could not accept ambiguous user judgments in the learning process. We have extended our method to solve these two problems. In the new method, compound queries composed of keywords with and, or and/or not are processed, and the learning method has been modified to allow fuzzy judgements as well as compound queries. The new method has been implemented on a Unix workstation. Measurement of the recall and precision ratios has shown the effectiveness of our method. The averages for these ratios in several retrievals were 56% and 40% respectively, compared to 41% and 43% using the conventional crisp method. The effect of learning was also measured. The average of the recall and precision ratios were increased to 75% and 50% after 30 learning iterations.

For visual analysis of the density reorganization and distortion, the one-dimensional cut Δϱ(x, y 0,z 0) and the two-dimensional cut Δϱ(x, y, z 0) of the three-dimensional electron density difference function Δϱ(x, y, z) are frequently employed. However, these cut functions do not satisfy any sum rules in contrast to the original difference function Δϱ(x, y, z). To avoid this difficulty, the use of the marginal electron density functions ϱ x (x) and ϱ xy (x, y) and their difference functions Δϱ x (x) and Δϱ xy (x, y) is proposed. The marginal densities are condensation of the three-dimensional density onto a particular plane or line of our interest, and they satisfy the sum rule (i.e., the conservation of the number of electrons) exactly. Some basic properties of the marginal electron density are clarified for typical diatomic molecular orbitals. An illustrative application is given for the bonding and antibonding processes in the H2 system.

It has been shown that hypothyroidism of some patients may be associated with increased activity of thyroid stimulating-blocking antibodies (TSBAb). The present study was undertaken to follow the course of thyroid blocking, stimulating immunoglobulins and TSH-binding inhibitor immunoglobulins (TBII) in six hypothyroid patients who had elevated TSBAb and were treated with T4. Four of the six had Graves' disease previously treated with antithyroidal drugs, one had Graves' disease treated with 131I and one had subacute thyroiditis and subsequently became hypothyroid. The patients were followed for 1-5 years. Blocking activity and TBII normalized in four of the six during T4 therapy, so T4 was discontinued and they remained euthyroid. These data indicate that it is important to monitor carefully thyroid function in hypothyroid patients treated with a fixed amount of T4 to avoid subclinical hyperthyroidism and its consequence, e.g. osteoporosis.

Background Small-scale enterprises (SSEs) usually share poorer resources for promoting occupational health. Aim To investigate inequality of health status among SSEs in Japan. Method A cross-sectional, multiple-centred study was carried out using the periodical health check-up data for the fiscal year 2000 to compare the age-adjusted proportions of workers with hypertension (HT), hyperlipidaemia, impaired glucose tolerance (IGT) and obesity and of current smokers by size of enterprise, i.e. ≤29, 30-49, 50-99, 100-299, 300-999 and 2:1000 employees in Japan. Results From five leading occupational health organizations, data were collected for 9833 enterprises with a total of 436 729 subjects, 302 383 males and 134 346 females. The proportions of workers in SSEs with ≤49 employees with HT, IGT and obesity were 8.5, 5.0 and 3.5%, respectively, higher than those in enterprises with ≥50 male employees. The prevalence of smokers in SSEs with ≤49 employees was 61%, 2-6% higher than in enterprises with≥50 male employees. These proportions showed a significantly increasing tendency with decreasing size of male workforce. Conclusion Despite the cross-sectional design and only adjusting age as a potential confounder, higher proportions of HT, IGT, obesity and smoking in male workers were found in SSEs compared to larger organizations.

As a fiindamental study of photodiodes (PDs) for electron bombardment, two types of PDs have been experimentally investigated to be applied in electron tubes. A PD bombarded from the fiont surface (FB-PD), where pn junction of planer structure existed, was evaluated to perform fast response characteristics such as 2. Ins in rise time, however, more than an order of increase of dark current was also confirmed after a long term stability test of 1000 hours. On the other hand. a PD bombarded by electrons from the rear surface (RB-PD) was measured to show no increase of dark current after the stability test and fast rise time of 2.7ns. However, it was clarified that the rise time of RB-PD depended on applied voltage to the PD, and applied voltage of 200V was necessary to achieve such fast response. Since it was much higher voltage than it was expected, some modifications may be necessary to achieve fast response with lower applied voltage, considering a yield of the PDs. Comparison of two types of PDs on some other characteristics are discussed. Preliminary test result of electron bombardment APD is also discussed.

A prospective study was conducted to evaluate the intraocular pressure (IOP) lowering effect of brinzolamide 1.0% ophthalmic suspension as an adjunctive therapy with latanoprost 0.005% ophthalmic solution in patients with open angle glaucoma or ocular hypertension.Fourteen patients with open angle glaucoma (OAG) or ocular hypertension (OH) who had been using latanoprost 0.005% for more than 6 months were initiated on adjunctive brinzolamide therapy. The IOP values at 1 month, 2 months, and 3 months were compared with those measured immediately before adding brinzolamide to the regimen (baseline). The incidence of adverse events such as conjunctival hyperemia and corneal epithelial defect were also examined.The baseline IOP was 21.1 +/- 4.8 mmHg (mean +/- standard deviation). After 1 month, 2 months, and 3 months of therapy IOP was 16.9 +/- 4.5 mmHg, 16.6 +/- 4.0 mmHg, and 15.9 +/- 3.1 mmHg, respectively, showing significant reductions in IOP at all the measuring time-points during the study compared with the baseline value (p0.01). Conjunctival hyperemia developed in one patient after 1 month and in another after 2 months; however, both were mild, and therapy was continued. Corneal epithelium defect was observed in 3 patients. One of them had mild defect before brinzolamide was added to the regimen. Increase of eye discharge was seen in one patient. No serious side effects were otherwise observed.The addition of brinzolamide to a latanoprost 0.005% regimen may further lower intraocular pressure in patients with open angle glaucoma or ocular hypertension.

A gene fragment encoding a putative pyrroloquinoline quinone glucose dehydrogenase (PQQ GDH) was cloned from a bacterial cellulose (BC)-forming acetic acid bacterium, Gluconacetobacter xylinus (=Acetobacter xylinum) strain BPR 2001, which was isolated as a high BC producer when using fructose as the carbon source. A GDH-deficient mutant of strain BPR 2001, namely GD-I, was then generated via gene disruption using the cloned gene fragment. Strain GD-I produced no gluconic acid but produced 4.1 g.l(-1) of BC aerobically in medium containing glucose as the carbon source. The ability of strain GD-I to convert glucose to BC was approximately 1.7-fold higher than that of the wild type. Strain GD-I was also able to produce 5.0 g.l(-1) of BC from a saccharified solution, which was derived from sweet potato pulp by enzymatic saccharification. Supplementation of ethanol during aerobic cultivation further increased the concentration of BC produced by strain GD-I to 7.0 g.l(-1). The rate of conversion from glucose to BC under these cultivation conditions was equivalent to that of strain BPR 2001 cultivated with fructose as the carbon source.

Purpose: To clarify the morphological changes in the rat lens after irradiation with continuous low doses of x-ray at different intervals. Methods: Male Wistar rats at the age of 8 weeks were irradiated with three doses of 2 Gy at intervals of either 1 week or 1 day. Over the period from the first week to the eighth week after irradiation, the eyeballs of the rats were enucleated progressively and changes in the lenses were examined morphologically. A comparison was made with specimens from control rats at each time of enucleation. Results: (1) Three doses of weekly irradiation: 1 week later, the lens epithelium and fibers at the equator showed mild swelling. Bow configuration was slightly disturbed. Eight weeks later, swelling and uneven height of epithelial cells in the equatorial area, irregular bow configuration, swelling of cortical fibers and epithelial loss and deformed nuclei at the central epithelium were observed. (2) Three doses of daily irradiation: 1 week later, mild changes in the lens such as uneven height of epithelial cells, irregular bow structures, and swelling of cortical fibers were observed. Eight weeks later, irregular bow configuration, posterior dislocation of nuclei, severe epithelial loss and marked swelling of cortical fibers were observed at the equatorial area. Epithelial loss and deformed nuclei of the epithelium were observed in the central area. Conclusion: The lens was damaged by continuous irradiation even though the dose was low. The damage to the lens caused by daily irradiation was more severe than that by weekly irradiation. The main symptoms were degeneration and loss of epithelial cells and swelling of cortical fibers.

Purpose: To clarify the mechanism underlying the development of cataract in the rat lens after intraperitoneal administration of iodoacetic acid (IAA). Methods: (1) The 2% IAA dissolved in saline solution was injected at a dose of 40 mg/kg body weight into the rat peritoneal cavity. The retina and lens were intermittently extirpated and were examined by light and electron microscopy. (2) Two kinds of tracer, Evans blue (EB) and horseradish peroxidase (HRP), were injected into the tail veins and anterior chamber, and were observed with dissecting and electron microscopes. Results: (1) Four weeks after administration, a part of the lens epithelium at the lateral side of the lens was degenerated, and the lens nucleus developed faint turbidity after 8 weeks. After 16 weeks, the nuclear turbidity could not be observed because mild cortical opacity was developing. The epithelial degeneration recovered from around 12 weeks, and instead of spherical nuclei, elliptical nuclei appeared. (2) The EB dye injected into the tail vein significantly stained the ciliary body, where the anterior and posterior ciliary arteries anastomosed. EB injected from the lateral side of the lens was seen to move towards the lens nucleus. Electron microscopically, the epithelial degeneration of the ciliary body was observed. The incorporated HRP substance was found in the cytoplasm of the nonpigmented cells of the ciliary epithelium at an early stage after IAA administration. Conclusion: IAA injected intravenously first developed epithelial degeneration at the lateral side of the lens. This change induced swelling of the lens fibers in the lens nucleus. Recovered epithelial cells had a transformed nucleus, and in turn the cortical cataract was induced by a differentiation disorder of the lens fibers. These results indicate that the breakdown of the blood-aqueous barrier in the nonpigmented epithelium of the ciliary body is a trigger to cause the cataract. The IAA-induced cataract may be useful as an animal model of human age-related cataract.

Purpose: To clarify the causative factor underlying rupture of the posterior capsule of the RLC mouse lens as a recessive trait around the 50th postnatal day. Methods: The lenses of the RLC mouse were removed in the period from birth to 50th postnatal day. Some specimens were observed by light microscopy and transmission and scanning electron microscopy. Others were examined as flat preparations of the lens epithelium. Results: There was an abnormal arrangement of lens fibers at the newborn stage, and lens fibers of the perinuclear zone ended almost vertical in relation to the posterior capsule. Consequently, the posterior suture was not formed in this mouse lens. On the 10th postnatal day, the ends of the lens fibers that terminated in the posterior capsule became swollen, and the posterior capsule at the posterior polar region became thin. On the 20th day, the area of swollen fibers was so large at the center of the posterior capsule that a vacuolated area was observed under the dissecting microscope. On the 30th day, the posterior cortical fibers in this area showed marked swelling, and the posterior capsule became extremely thin. On the 40th day, the anterior cortex became unusually thick, and the lens nucleus was dislocated towards the posterior capsule. On the 50th day, the posterior capsule ruptured. At this time the lens fibers from the perinuclear zone constituted the central area of rupture, and the cortical fibers from the equator formed the protruded area outside the lens. Conclusion: The findings revealed that the RLC mouse lens has an abnormal lens fiber arrangement from the early period of lens development, that the lens fibers from the perinuclear zone cause swelling without forming the posterior suture, and that the thin capsule is ruptured by pushing out of the nucleus by thickening of the anterior cortex.

The effects of short-term low intensity aerobic training on the physiological indexes and the Quality of Life were examined in 43 middle-aged White Collar Workers. Training was carried out for 205 +/- 117 minutes/week, at least 2-3 times/week for 2 months on a cycle ergometer or walking with intensity level set at the 50% VO2max. Following this training protocol, thirty-six men (exercise group) completed the 2-month training program and 7 men dropped out (the dropout group). In the exercise group, both the VO2max (l/min) and VO2max/wt increased significantly (VO2max (l/min): P < 0.05. VO2max/wt: P < 0.01), whereas the weight, body mass index, %fat, fat (kg) and the waist hip ratio (WHR) decreased significantly (WHR: P < 0.05, others: P < 0.01) after 2 months. In addition, the DBP and serum TC, LDL-c/HDL-c decreased significantly (LDL-c/HDL-c: P < 0.01, others: P < 0.05) whereas the HDL-c increased significantly (P < 0.05). A modified Croog questionnaire was used to assess the subject's Quality of Life. The questionnaire consisted of 59 questions and the overall assessment was based on eight components. Regarding the Quality of Life, physical symptoms, work performance and satisfaction, total Quality of Life all improved significantly (physical symptoms, P < 0.05; others: P < 0.01) and social participation also tended to improve (P < 0.08). There was a significantly negative correlation between the initial Quality of Life and the changes in the Quality of Life (6 of the 8 components). In the all subjects, there was a significantly positive correlation between the changes in physical symptoms and the changes in VO2max/wt (r = 0.36, P < 0.05). In the dropout group, the FBS increased significantly (P < 0.05) but no other variables regarding the Quality of Life significantly changed after 2 months. In conclusion the above results suggest that short-term low intensity aerobic training in the present study can help improve the physiological indexes, VO2max and Quality of Life in middle-aged White Collar Workers and the observed improvement in the Quality of Life was also found to be greater in the subjects with a low Quality of Life than in those with a high Quality of Life.

OBJECTIVE TSH-binding inhibitory immunoglobulin (TBII) is undetectable in about 10% of untreated Graves' disease patients, but the clinical characteristics and immunological significance of this finding are unknown. In this study we evaluated the clinical characteristics of TBII negative Graves' disease. PATIENTS We examined TBII in 1048 untreated patients at Kuma hospital from 1986 to 1990 and found 69 TBII undetectable patients (12 men and 57 women, mean age +/- SEM 35 +/- 2 years, group A). MEASUREMENTS We compared the clinical characteristics and immunological findings of group A with 57 untreated TBII detectable Graves' patients who were selected randomly (11 men and 46 women, mean age +/- SEM 40 +/- 2 years, group B). T4, TSH, FT4, FT3, 123I thyroid uptake, TBII, thyroid stimulating antibodies (TSAb) and the volume of the thyroid using ultrasonography were measured at the first visit. RESULTS Serum T4, FT4 and FT3 levels in group A were significantly lower than those in group B (P < 0.001). The values of TSAb in group A were significantly lower than those in group B (593 +/- 67 (mean +/- SE) vs 2143 +/- 280%, respectively, P < 0.001). The 123I thyroid uptake in group A was significantly lower than that in group B (53.1 +/- 1.1 vs 61.4 +/- 1.4%, respectively, P < 0.01). The thyroid volume in group A was significantly smaller than that in group B (39.1 +/- 3.0 vs 51.3 +/- 3.3 ml, respectively, P < 0.01). TSAb was undetectable in about 10% (6) of the TBII negative untreated Graves' patients at their first visit. CONCLUSION In the present study, untreated TBII negative patients with Graves' disease were characterized by mild elevation of thyroid hormones, mildly elevated 123I uptake, weak TSAb activities and small goitres. The finding of both TBII and TSAb negative titres in untreated Graves' disease patients was also confirmed.

Eighty-five patients with Graves' disease in clinical remission after treatment for over 1 year by methimazole therapy (36 patients, group A) or subtotal thyroidectomy (49 patients, group B) who became undetectable for serum thyrotropin levels (TSH less than 0.05 mU/l), were further followed for 1 year or more. Eight patients in group A (22%) and 7 patients in group B (14%) relapsed. Eleven patients in group A (30%) and 5 patients in group B (10%) had fluctuating patterns of free T4 in the upper normal to slightly supranormal range indicative of subclinical hyperthyroidism. The remaining patients continued to have undetectable TSH levels or restored normal TSH levels and normal thyroid hormone concentrations in sera. The results of the present study indicate that the occurrence of undetectable serum TSH concentrations in Graves' disease patients previously treated with methimazole or surgery are not necessarily predictive of clinical relapse because the eventual outcome is variable.

SUMMARY Hashimoto's thyroiditis (HT) and lymphoma arc sometimes difficult to distinguish between. Moreover, lymphoma sometimes develops in a thyroid gland from pre-existing HT. Open- or large-needle biopsy usually distinguishes between them; the specimen may be examined histologically and subjected to immunohistochemistry. Another possible method of examination is fine-needle aspiration biopsy (FNAB). The cells obtained may be evaluated cytologically, and subjected to flow cytometry, using various antibodies. In this study, anti-kappa and anti-lambda antibodies are especially important, as a gross predominance of kappa or lambda B lymphocytes infiltrating the thyroid is evidence for a B cell monoclone. In this study, 15 patients were selected because of their rapidly growing goitres. They all underwent FNAB. Five had cytology typical of HT, and no evidence of monoclonality on flow cytometry. They were diagnosed as HT without further histopathology. The remaining 10 patients had cytology suspected of lymphoma, or evidence of monoclonality on flow cytometry, or both. These patients underwent open- or large-needle biopsy. Only three of them were diagnosed histopathologically as lymphoma; the other seven were diagnosed histopathologically as HT, making 12 cases of HT in all. Five of these 12 cases, and one of the three cases of lymphoma showed flow cytometrical evidence of monoclonality; thus evidence of monoclonality from FNAB, while interesting, does not necessarily serve to differentiate between HT and lymphoma. Furthermore, the immunohistochemical assessment of monoclonalily did not correlate with the flow cytometrical assessment. Follow-up evidence will be required to discover whether those patients with a B cell monoclone in their HT are the ones who develop a lymphoma.