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Background: Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. Methods: A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia–Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. Results: Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. Conclusion: Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.

We have examined the nurses' thinking process in their professional judgment and action in the Partogram of 170 labors by 17 Midwifery students in 2 years.

Background. The prevalence of allergies is steadily increasing worldwide; however, the pathogenesis is still unclear. We hypothesized that Mycobacterium avium subsp. paratuberculosis (MAP) may contribute to allergy development. This organism can be present in dairy foods, it can elicit an immunomodulatory switch from a Th1 to a Th2 response, and it has been speculated that it is linked to several human autoimmune diseases. To determine the contribution, sera from 99 individuals with various atopic disorders and 45 healthy nonallergic controls were assessed for total IgE levels and successively for MAP-specific IgE by ELISA. Results. The mean total serum IgE level in allergic patients was 256±235 IU/mL, and in the healthy controls it was 62±44 IU/mL (AUC = 0.88; p<0.0001). Among the patient groups, 50 of the 99 subjects had increased IgE total level ≥ 150 IU/mL, while 49 subjects had IgE ≤ 150 IU/mL (mean level: 407±256 IU/mL versus 106±16 IU/mL; p<0.0001). Additionally, 6 out of 50 subjects (12%) with IgE ≥ 150 IU/mL and none (0%) with IgE ≤ 150 IU/mL were positive for specific MAP IgE (AUC = 0.63; p=0.03). Conclusion. The present study revealed that MAP has the ability to induce specific IgE and might contribute to the induction of allergic inflammation in genetically predisposed individuals.

We have developed a simple one-dimensional scintillating fiber detector (SFD) for momentum tagging high-energy (a few hundred MeV per u) and high-intensity ( ∼ 10 6 particles per second, pps) beams of light ( Z ≤ 10 ) ions in the momentum-dispersive focal plane of a fragment separator. This SFD consists of 60 rows of scintillating fibers that have 2 mm square cross-sections. The detection efficiency is constant for beam intensities between 103 and 106 pps and a position detection efficiency of 100% is achieved by injecting ions obliquely. The position resolution is less than 1 mm (rms). In addition, the SFD is demonstrated to be effective for identifying particles in cocktail beams. These results show that the application of scintillating fibers is found to be one of the most suitable methods to tag the light radioactive ion beams.

A formulation for the analysis of pullout test on highly extensible planar reinforcement is presented. The non-linear differential equation for pullout mechanism was expressed in non-dimensional form and solved numerically using the Gauss–Siedel technique. Parametric study was carried out for various ranges of relative stiffnesses, and relative bond resistances. Normalized load–displacement relations and the variations of pullout force and reinforcement displacements along the length of reinforcement are presented graphically. A method for the estimation of the interface interaction parameters from a pre-failure test is also given. The numerical predictions compare well with the available experimental pullout test results for various geotextiles, polymers and nylon geosynthetics. Copyright © 1999 John Wiley & Sons, Ltd.

Pull-out tests are extensively used to simulate the soil-reinforcement interaction mechanism along the interface. A simplified analysis for evaluation of the interaction mechanism in a general pull-out test is proposed for geo-reinforcement. Numerical studies were carried out for pull-out responses from small to large strains for inextensible to extensible reinforcements. The incorporated bi-linear relation permits estimation of pre and post yield deformations, shear stress and tensile force variations along the length of the reinforcement. A comparative study is also presented between the steel geostrap and polymer strip to verify the general applicability of the theory on both extensible and inextensible reinforcements. Predictions from the model compare satisfactorily with the available experimental and theoretical pull-out test results for various geotextiles, polymers, nylon geosynthetics and steel strip reinforcements.

This technical note describes the analysis of reinforcement pull-out tests using a shear model that incorporates a hyperbolic shear stress-displacement relation for the soil-reinforcement interface. Numerical studies of pull-out tests were performed for small to large strains in inextensible and extensible reinforcements. Predictions based upon a hyperbolic model of shear mobilisation are compared with a theoretical bilinear model presented by Madhav et al. in 1998. Comparative parametric studies using both models were carried out for ranges of relative stiffness and bond resistance values. Normalised load-displacement relations and the variations of pull-out force and displacements with distance, are presented for comparative evaluation. The finite difference equations of the hyperbolic model result in a faster convergence than the bilinear model. The incorporated hyperbolic model estimates the pre- and post-yield deformations, and shear stress and tensile force variations along the length of the reinforcement. Predictions of laboratory and field pull-out results from the available theoretical and experimental tests for inextensible steel straps, and extensible geotextiles, polymers, and nylon geosynthetics are also presented.

Soil-reinforcement pull-out tests are essential for evaluating the strength, integrity, and effectiveness of the soil-reinforcement system. In this paper, a new pull-out test model that calculates the soil-geosynthetic reinforcement interface shear stress for highly extensible geosynthetic reinforcement is proposed. Based on a new bilinear interface shear model, the geosynthetic pull-out test results are calculated with regard to the variation of the mobilised geosynthetic tension with distance, geosynthetic pre-yield and post-yield behaviour, and the effective and extended length of the geosynthetic reinforcement. The resulting nonlinear equation for the soil-geosynthetic interface shear stress pull-out mechanism is nondimensionalised, expressed in a finite difference form, and solved numerically using the Gauss-Siedel technique. A parametric study is carried out for a range of relative stiffness values and interface shear stresses. The normalised load-displacement relationship and the variation of the pull-out force and reinforcement displacements, with distance along the reinforcement, are presented. The values calculated using the proposed model are compared with experimental pull-out test results for a needle-punched, nonwoven geotextile, polyester fibres coated with polyethylene, and nylon reinforcements.

The angular distribution of proton-${}^{9}$C elastic scattering at 277--300 MeV/nucleon was measured with a newly designed recoil proton spectrometer. The angular distribution was analyzed using the relativistic impulse approximation. The root-mean-square matter radius of ${}^{9}$C was deduced to be $2.{43}_{\ensuremath{-}0.28}^{+0.55}$ fm with different two-parameter Fermi density distributions for protons and neutrons.

We show that the generating functions of Gromov--Witten invariants with ancestors are invariant under a simple flop, for all genera, after an analytic continuation in the extended Kahler moduli space. This is a sequel to [LLW].

The compression-mode isoscalar giant monopole resonance (ISGMR) has been studied in the Sn, Cd and Pb isotopes using inelastic scattering of 400 MeV {alpha}-particles at extreme forward angles, including 0 deg. We have obtained completely 'background-free' inelastic-scattering spectra for the Sn, Cd, and Pb isotopes for a wide angular and excitation-energy range. The various giant resonances excited with different transferred angular momenta were extracted by a multipole-decomposition analysis (MDA). It was found that the centroid energies of the ISGMR in Sn isotopes are significantly lower than the theoretical predictions. The K{sub {tau}} in the empirical expression for the nuclear incompressibility has been determined to be K{sub {tau}} = -550{+-}100 MeV for the Sn isotopes. The extracted value for the Cd isotopes is K{sub {tau}} = -480{+-}100 MeV. These numbers are consistent with values of K{sub {tau}} = -370{+-}120 MeV obtained from an analysis of the isotopic transport ratios in medium-energy heavy-ion reactions, K{sub {tau}} -500{sub -100}{sup +120} MeV obtained from constraints placed by neutron-skin data from anti-protonic atoms across the mass table, and K{sub {tau}} = -500{+-}50 MeV obtained from theoretical calculations using different Skyrme interactions and relativistic mean field (RMF) Lagrangians. Stringent constraints on interactions employed in nuclear structuremore » calculations are obtained on the basis of the experimentally determined values for K{sub {infinity}} and K{sub {tau}}. These parameters constrain as well the equation of state (EOS) of nuclear matter. However, a significant discrepancy still remains. The ISGMR positions in Sn and Cd isotopes are systematically lower than the predictions obtained on basis of determined from the ISGMR in {sup 208}Pb. This raises the question ''Why are Sn and Cd nuclei so soft?''. For a clue to solve the problem, we discuss the preliminary results on the exact positions of the ISGMR in {sup 204,206,208}Pb.« less

Cross sections and analyzing powers for polarized proton elastic scattering from $^{58}\mathrm{Ni}$, and $^{204,206,208}\mathrm{Pb}$ were measured at intermediate energy ${E}_{p}=295$ MeV. An effective relativistic Love-Franey interaction is tuned to reproduce $^{58}\mathrm{Ni}$ scattering data within the framework of the relativistic impulse approximation. The neutron densities of the lead isotopes are deduced using model-independent sum-of-Gaussians distributions. Their error envelopes are estimated by a new ${\ensuremath{\chi}}^{2}$ criterion including uncertainties associated with the reaction model. The systematic behaviors of extracted error envelopes of the neutron density distributions in $^{204,206,208}\mathrm{Pb}$ are presented. The extracted neutron and proton density distribution of $^{208}\mathrm{Pb}$ gives a neutron skin thickness of $\ensuremath{\Delta}{r}_{\mathit{np}}={0.211}_{\ensuremath{-}0.063}^{+0.054}$ fm.

We studied the effect of ciclosporin (Cs) on rats which underwent a 90% hepatectomy. Rats were divided into two groups: group 1 (without Cs pretreatment) and group 2 (with Cs pretreatment). Animals were given a 4-day treatment of Cs (10 mg/kg/day) prior to hepatectomy. The 1-week survival, serum biochemistry and parameters for hepatocyte proliferation (indices for mitosis and 5-bromo-2-deoxyuridine uptake) were serially investigated. Although Cs pretherapy significantly upregulated liver cell proliferation in group 2, there was no improvement in the survival rate of the immunosuppressed animals (group 2) compared to the controls (group 1). The implications of Cs pretherapy are discussed in the setting of extensive hepatectomy.

The strength distributions of the giant monopole resonance (GMR) have been measured in the even-A Sn isotopes (A = 112-124) with inelastic scattering of 400-MeV alpha particles in the angular range 0 degrees-8.5 degrees. We find that the experimentally observed GMR energies of the Sn isotopes are lower than the values predicted by theoretical calculations that reproduce the GMR energies in Pb-208 and Zr-90 very well. From the GMR data, a value of K-tau = -550 +/- 100 MeV is obtained for the asymmetry term in the nuclear incompressibility.

The strength distributions of the giant monopole resonance (GMR) have been measured in the even-A Sn isotopes (A=112--124) with inelastic scattering of 400-MeV $\alpha$ particles in the angular range $0^\circ$--$8.5^\circ$. We find that the experimentally-observed GMR energies of the Sn isotopes are lower than the values predicted by theoretical calculations that reproduce the GMR energies in $^{208}$Pb and $^{90}$Zr very well. From the GMR data, a value of $K_{\tau} = -550 \pm 100$ MeV is obtained for the asymmetry-term in the nuclear incompressibility., Comment: Submitted to Physical Review Letters. 10 pages; 4 figures

The isoscalar giant monopole resonance (GMR) has been investigated in a series of Sn isotopes (A=112--124) using inelstic scattering of 400-MeV alpha particles at extremely forward angles (including 0deg). The primary aim of the investigation has been to explore the role of the "symmetry-energy" term in the expression for nuclear incompressibility. It is found that the energies of the GMR in the Sn isotopes are significantly lower than those expected from the nuclear incompressibility previously extracted from the available data on the compressional-mode giant resonances., Invited talk at COMEX2:Second International Conference on Collective Motion in Nuclei under Extreme Conditions, St. Goar, Germany, June 20-23, 2006. To be published, eventually, in Nuclear Phys. A. 8 pages, 4 figures

The Samanalawewa reservoir, formed by a 100m high embankment dam, is one of the largest reservoirs in Sri Lanka built in the recent times. It is located 160km south east of the capitol, Colombo, and is the key element of the 120-million-watt Samanalawewa Hydroelectric Project. It is constructed on one of the main rivers in Sri Lanka, the Walawe River. Geologically the project is in an area of karst within the Highland series of the Sri Lankan Precambrian complex comprised of crystalline metamorphic rocks. The area has been subjected to extensive folding, faulting and hydrothermal reactions. Thus, the project area is geologically complex. On several occasions a number of agencies have studied the project site, conducting various detailed geological, hydrogeological and geophysical investigations. Signs of a possible leak through the right bank appeared when poor geologic conditions were encountered during construction of the dam. Immediately, more investigations were carried out. During the initial trial impoundment, a small spring appeared downstream of the partially filled reservoir, and impoundment was suspended. Additionally, up to a distance of 2.5 km on the right bank, a flat water table was observed responding to the river levels. As a remedial measure, a 100m-deep, 1300m-long grout curtain was constructed, using 13,640 tons of cement, and impoundment resumed. The leakage continued, increased and finally resulted in a land slide. Impoundment was again suspended, and more detailed investigations were called for. The next remediation effort consisted of installing a liner of clay over the suspected ingress zones. Even after using 50,000m 3 of clay, the leakage could not be stopped, although it did help to reduce groundwater pressure in the right bank. The reservoir is presently operating with a continuous leakage of 1800 litres per second. Recently, a number of sinkholes were found in an area far from the areas under consideration. Preliminary studies indicate a connection between these sinkholes and the main leakage. Detailed studies are underway to investigate the extent of the ingress areas as an aid in planning suitable remedial measures. Because of the complex geological conditions caused by karst in the area of the site, the exact mechanism of leakage cannot be established, preventing successful remediation.

Ablation of the stratum corneum (SC) by pulsed‐laser irradiation is one method of enhancing transdermal drug delivery (TD). For non‐invasive laser TD treatment, we have tried to enhance TD without ablation of the SC using an MIR‐FEL (6‐μm wavelength) (FEL : free electron laser). Lidocaine was used as the drug in this study. The enhancement of TD was measured by HPLC. It was found that the lidocaine TD of the sample irradiated by MIR‐FEL was enhanced 10 fold faster than the non‐irradiated sample with a flux at 0.5 μg/cm2/h, measured by HPLC. We have demonstrated the effectiveness of TD enhancement by an MIR‐FEL (6‐μm wavelength) irradiation.

Statistical data of mortality and morbidity related to anesthesia have not been reported in Japan since World War II. The need to comprehensively examine the events of cardiac arrest as well as mortality prompted the first national study in Japan.Confidential questionnaires were sent to all Japan Society of Anesthesiologists Certified Training Hospitals every year from 1994 through 1998. Collected data were analyzed for incidence of cardiac arrest and other critical events during anesthesia and surgery, and their outcomes within 7 postoperative days. The principal causes of the critical incidents were also analyzed.With an average response rate of 39.9%, a total of 2,363,038 cases were documented over 5 years. The average incidence per year of cardiac arrest during surgery due to all etiologies and that totally attributable to anesthesia was 7.12 [95%CI: 6.30,7.94] and 1.00 [0.88, 1.12]) per 10,000 cases, respectively. The average mortality per year in the operating room or within 7 postoperative days due to all etiologies and that totally attributable to anesthesia was 7.18 [6.22, 8.13] and 0.21 [0.15, 0.27] per 10,000 cases, respectively. The two principal causes of cardiac arrest during anesthesia and surgery due to all etiologies were massive hemorrhage (31.9%) and surgery (30.2%), and those totally attributable to anesthesia were drug overdose or selection error (15.3%) and serious arrhythmia (13.9%). Preventable human errors caused 53.2% of cardiac arrest and 22.2% of deaths in the operating room totally attributable to anesthesia.The rates in Japan of cardiac arrest and death during anesthesia and surgery due to all etiologies as well as those totally attributable to anesthesia are comparable to those of other developed countries.

Gastrointestinal involvement is often seen in patients with systemic lupus erythematosus (SLE). All parts of the gastrointestinal tract may be affected. However, rectal involvement at onset is rare. We describe here a case of SLE in which rectal ulcers due to vasculitis occurred as the initial manifestation of the disease without involvement of any other organ. The ulcers worsened, along with the appearance of lupus nephritis 5 years later When steroid therapy was initiated, there was rapid clinical and radiographic improvement. Our case suggests that rectal ulcer is a rare but important complication of SLE and can represent the initial and sole clinical manifestation of the disease.

Perioperative mortality and morbidity in Japan for the year 1999 were analyzed retrospectively with special reference to operative regions. The total number of analyzed cases was 701,940. The percentages for each operative region were as follows, craniotomy 4.5%, thoracotomy 3.3%, heart and great-vessels 3.9%, thoracotomy with laparotomy 0.8%, laparotomy except caeserian-section 31.7%, ceserian-section 3.2%, head-neck and otolarynx 14.5%, chest-abdomen-perineum 11.1%, spine 3.5%, extremity including peripheral-vessel 16.5%, and others 6.9%. The incidence of serious events, including cardiac arrest and severe hypotension and hypoxemia suggesting impending cardiac arrest was 34.58 per 10,000 cases in all operative regions. The events were observed more frequently in heart and great-vessels 247.26, thoracotomy with laparotomy 128.91 and thoracotomy 61.55, and less frequently in chest-abdomen-perineum 13.52 and extremity including peripheral-vessel 16.99. Regarding the prognosis of events, the cases with no sequela were 69.9% in all operative regions. While there were fewer cases with no sequela in craniotomy 50.4%, thoracotomy with laparotomy 54.3% and heart and great-vessels 58.6%, there were more cases in head-neck and oto-larynx 95.2% and chest-abdomen-perineum 90.5%. The incidence of serious events totally attributable to anesthetic management was 7.79 per 10,000 cases in all operative regions. The events were observed more frequently in thoracotomy 12.82, heart and great-vessels 12.29 and spine 11.06, and less frequently in extremity including peripheral-vessel 5.17 and chest-abdomen-perineum 6.05. Regarding the prognosis of events, the cases with no sequela were 93.1% in all operative regions. There were fewer cases with no sequela in thoracotomy with laparotomy 80.0% and craniotomy 81.8%. The main cause of events in thoracotomy and spine was the inadequate airway management, and in heart and great-vessels was the overdose or miss-selection of drugs. Although the incidence of serious events totally attributable to anesthetic management was one fourth of all events, most of them resulted from human factors. Thus, the more efforts are necessary to improve the outcomes. While the total deaths from 701,940 cases, including death on the operation day or within 7 days after it, were 528 cases (7.52 per 10,000 cases), the deaths totally attributable to anesthesia were 7 cases (0.10 per 10,000 cases).

This paper describes an innovative way of distinguishing landslide-prone regions by simple and direct measurement and statistical interpretation of a topographic map. For this purpose, the topographic maps are enlarged and the contour interval and cross-slope distances are measured. A frequency distribution histogram based on chi-square method is constructed from the measurements. Generally, two fundamental patterns emerge from the histogram: the landslide-prone area shows several peaks whereas the remaining area shows just a single peak. The technique was used to study the landslide-prone areas of the western Kyushu District of Japan. Six sub-regions were categorised depending upon the scale functions and probability parameters. The landslide-prone and safe areas were accurately discriminated under 0. 1 to 1% confidence level. The analysis independently discovered most of the hazardous areas that were later verified in the field.

The Committee on Operating Room Safety of Japanese Society of Anesthesiologists (JSA) sends annually confidential questionnaires of perioperative mortality and morbidity to Certificated Training Hospitals of JSA. This report is on perioperative mortality and morbidity in 1999 with a special reference to anesthetic methods. Four hundred and sixty-seven hospitals reported the number of cases referred to anesthetic methods and total numbers of cases were 727,723. The incidences of cardiac arrest per 10,000 cases due to all etiology are estimated to be 6.77 cases in average, 5.33 cases in inhalation anesthesia, 34.26 cases in total intravenous anesthesia (TIVA), 5.26 cases in inhalation anesthesia plus epidural or spinal or conduction block, 5.29 cases in TIVA plus epidural or spinal or conduction block, 0.73 cases in spinal with continuous epidural block (CSEA), 2.85 cases in epidural anesthesia, 1.63 cases in spinal anesthesia, 2.53 cases in conduction block and 46.51 cases in other methods. However, the incidences of cardiac arrest per 10,000 cases totally attributable to anesthesia are estimated to be 0.78 case in average, 0.51 case in inhalation anesthesia, 1.35 cases in TIVA, 0.97 case in inhalation anesthesia plus epidural or spinal or conduction block, 1.51 cases in TIVA plus epidural or spinal or conduction block, 0.73 case in CSEA, 1.71 cases in epidural anesthesia, 0.54 case in spinal anesthesia, 2.52 cases in conduction block and 1.08 cases in other methods. The incidences of severe hypotension per 10,000 cases due to all etiology are estimated to be 16.64 cases in average, 13.61 cases in inhalation anesthesia, 100.36 cases in TIVA, 13.32 cases in inhalation anesthesia plus epidural or spinal or conduction block, 9.07 cases in TIVA plus epidural or spinal or conduction block, 3.65 cases in CSEA, 6.26 cases in epidural anesthesia, 7.31 cases in spinal anesthesia, 2.52 cases in conduction block and 28.12 cases in other methods. On the other hand, the incidences of cardiac arrest per 10,000 cases totally attributable to anesthesia are estimated to be 2.40 cases in average, 1.65 cases in inhalation anesthesia, 0.81 cases in TIVA, 3.92 cases in inhalation anesthesia plus epidural or spinal or conduction block, 2.77 cases in TIVA plus epidural or spinal or conduction block, 2.56 cases in CSEA, 3.42 cases in epidural anesthesia, 2.71 cases in spinal anesthesia, zero case in conduction block and zero case in other methods. The incidences of severe hypoxia per 10,000 cases due to all etiology are estimated to be 5.32 cases in average, 6.7 cases in inhalation anesthesia, 9.17 cases in TIVA, 5.16 cases in inhalation anesthesia plus epidural or spinal or conduction block, 4.53 cases in TIVA plus epidural or spinal or conduction block, 2.56 cases in CSEA, zero case in epidural anesthesia, 1.08 cases in spinal anesthesia, zero case in conduction block and 1.08 cases in other methods. On the other hand, the incidences of severe hypoxia per 10,000 cases totally attributable to anesthesia are estimated to be 2.39 cases in average, 3.22 cases in inhalation anesthesia, 2.43 cases in TIVA, 2.26 cases in inhalation anesthesia plus epidural or spinal or conduction block, 2.77 cases in TIVA plus epidural or spinal or conduction block, zero case in CSEA, zero case in epidural anesthesia, 0.54 cases in spinal anesthesia, zero case in conduction block and 1.08 cases in other methods. The mortality rates of cardiac arrest per 10,000 cases due to all etiology are estimated to be 3.56 cases in average, 2.82 cases in inhalation anesthesia, 24.55 cases in TIVA, 1.4 cases in inhalation anesthesia plus epidural or spinal or conduction block, 1.51 cases in TIVA plus epidural or spinal or conduction block, zero cases in CSEA, 0.57 cases in epidural anesthesia, 0.27 cases in spinal anesthesia, zero case in conduction block and 42.18 cases in other methods. On the other hand, the mortality rates of cardiac arrest per 10,000 cases totally attributable to anesthesia are estimated to be 0.08 case in average, 0.09 case in inhalation anesthesia, 0.27 case in TIVA, 0.05 case in inhalation anesthesia plus epidural or spinal or conduction block, zero case in TIVA plus epidural or spinal or conduction block, zero case in CSEA, 0.57 case in epidural anesthesia, zero case in spinal anesthesia, conduction block and other methods. The outcomes of cardiac arrest totally attributable to anesthesia are 70.2% of full recovery without any sequelae, 10.5% of death within 7 days, 1.8% of vegetative state and 17.5% of unknown results while the outcome of critical events including severe hypotension and severe hypoxia totally attributable to anesthesia is 94.9% of full recovery without any sequelae, 0.4% of death within 7 days, 0.2% of vegetative state and 4.5% of unknown results. These results indicate that there are no differences in mortality and morbidity totally attributable to anesthesia among anesthetic methods in 1999 at Certificated Training Hospitals of Japan Society of Anesthesiologists.

Perioperative mortality and morbidity in Japan from Jan. 1 to Dec. 31, were studied retrospectively. Committee on Operating Room Safety of Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 774 Certified Training Hospitals of JSA and received answers from 60.2% of the hospitals. We analyzed their answers with a special reference to the age group. The total number of anesthetics available for this analysis was 732,788. All cases were divided in to 7 groups; group A(1 months), group B(12 months), group C(5 years), group D(18 years), group E (65 years), group F(85 years), and group G(85 years). The incidences of all critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 168.14, 47.86, 24.63, 14.65, 28.43, 50.4, and 43.68 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The overall mortality rate (death during anesthesia and within 7th postoperative day) were 74.10, 6.63, 3.30, 3.07, 4.82, 13.74, and 11.84 per 10,000 anesthetics in patients with group A, B, C, D, E, F, and G, respectively. The incidences of cardiac arrest were 54.15, 8.84, 5.08, 2.56, 4.84, 11.02, and 6.66 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The mortality rates after cardiac arrest were 42.75, 2.95, 2.54, 1.70, 2.00, 6.56, and 5.18 in patients with group A, B, C, D, E, F, and G, respectively. The incidences of all critical events, the incidence of cardiac arrest, and the overall mortality rate were much higher in group A than other groups and lower in group D. Mortality and morbidity due to all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and operation were as follows. The incidence of all critical events attributable to co-existing disease were the highest in these four groups, and 94.04, 15.46, 7.87, 6.13, 7.26, 17.38, and 16.29 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The incidences of all critical events attributable to anesthetic management were 31.35, 16.94, 4.60, 6.09, 10.77, and 14.07 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The incidence of cardiac arrest in group A was much more attributable to co-existing disease and operation than other causes. The incidences of cardiac arrest attributable to anesthetic management were 0.00, 1.47, 0.25, 0.34, 0.83, 0.92, and 0.22 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The mortality rates in these groups were 0.00, 0.00, 0.00, 0.17, 0.07, 0.05, and 1.48, and no death was found in cases under 5 years of age. The two cases of death in G group were due to too high anesthesia levels in spinal anesthesia. Other causes including overdose of anesthetics, toxic effect of local anesthetic, improper management of airway, and incompatible blood transfusion were preventable with the anesthesiologists' effort in protocol development and skilled assistance.

Perioperative mortality and morbidity in Japan for the year 1999 were studied retrospectively. Committee on Operating Room Safety of the Japan Society of Anesthesiologists (JSA) sent confidential questionnaires to 774 Certified Training Hospitals of JSA and received answers from 60.2% of the hospitals. We analyzed their answers with special reference to ASA physical status (ASA-PS). The total number of anesthetics analyzed was 655, 644. Mortality and morbidity due to all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and operation were as follows. The incidence of cardiac arrest (per 10,000 anesthetics) was 0.68, 3.76, 14.37, 67.03, 0.36, 4.68, 27.96, 206.30 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 8.93, 26.99, 71.30, 188.52, 8.68, 31.27, 136.16, and 790.92 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates (death during anesthesia and within 7th postoperative day) after cardiac arrest were 0.16, 0.94, 5.71, 33.51, 0.00, 1.46, 16.41 and 167.76 per 10,000 anesthetics in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates were 0.24, 1.66, 12.16, 67.03, 0.00, 3.51, 34.65 and 417.14 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. Overall mortality and morbidity were higher in emergency anesthetics than in elective anesthetics. ASA-PS correlated well with overall mortality and with morbidity, regardless of etiology. The incidences of cardiac arrest totally attributable to anesthesia were 0.24, 0.45, 1.47, 8.38, 0.36, 1.75, 2.43 and 11.34 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of all critical events totally attributable to anesthesia were 4.92, 8.81, 14.74, 20.95, 4.34, 11.40, 15.80 and 22.67 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates after cardiac arrest totally attributable to anesthesia were 0.00, 0.00, 0.61 and 4.53 in patients with ASA-PS of I-IV, I E-II E, III E, and IV E, respectively. The overall mortality rates totally attributable to anesthesia were 0.00, 0.04, 0.18, 0.00, 0.00, 0.61 and 4.53 in patients classified to ASA-PS of I, II, III, IV, I E-II E, III E, and IV E, respectively. Only one death, due to overdose of anesthetics, was reported among patients with good physical status (ASA-PS of I, II, II E and II E). Anesthetic management was mainly responsible for critical events in patients with good physical status, while co-existing diseases were in those with poor physical status. The major co-existing diseases or conditions leading to critical events were heart diseases in elective anesthetics, and hemorrhagic shock in emergency anesthetics. We reconfirmed that ASA-PS is beneficial to predict perioperative mortality and morbidity. It also seems likely that we should make much more efforts to reduce anesthetic morbidity in patients with good physical status, and to improve preanesthetic assessment and preparation of cardiovascular conditions in those with poor physical status.

Correctly folded recombinant wild-type human serum albumin and the single-residue mutants K199A, W214A, R218H and H242Q were produced with the use of a yeast expression system. The changes in R218H resulted in a pronounced decrease in intrinsic fluorescence. Thermodynamic parameters for thermal denaturation of the present mutants and of five additional mutants have been determined, showing small increases in stability for two mutants (R218H and H242Q) and a larger decrease in stability for one (W214A). In the last of these, denaturation was a heterogeneous process starting at physiological temperature. The high-affinity binding constant for warfarin at pH 7.4 was determined by fluorescence spectroscopy: there was a significant increase in affinity for binding of warfarin to H242Q and K199A and a smaller decrease in affinity for W214A and R218H. The findings show that Trp-214 is not as essential for the high-affinity binding of warfarin as has previously been thought.

The efficacy and safety of mesalamine enema were examined in 20 patients with steroid-resistant or dependent, distal ulcerative colitis. Rectal bleeding disappeared in 3 (18%). 8 (50%) of 16 patients within 2 weeks and 4 weeks after the start of mesalamine enema treatment, respectively. Mean clinical activity index (CAI) score after the treatment was significantly reduced (8.1--3.6, p0.001). Furthermore, Mean doses of oral corticosteroid after the treatment (7.3 mg) were also significantly lower than those before the treatment (12.8 mg) (p0.01). Four patients dropped out. Three patients could not retain the enemas because of abdominal discomfort and one patient had fever and rash. There were no significant differences in age, gender, disease duration, disease type, and mean doses of oral corticosteroid before the treatment between the response group (n = 8) and the non-response group (n = 8). However, clinical and endoscopic activities before mesalamine enema treatment in the non-response group (CAI 9.8, Matts score 8.0) were higher than those in the response group (CAI 6.4, Matts score 5.5). These results suggest that mesalamine enema is useful for mildly to moderately active distal ulcerative colitis by improving clinical symptoms and reducing corticosteroid.

The Saga Plain of Kyushu, Japan, is surrounded by mountains and the inland Ariake Sea. It consists of lowland soft deposits of Quaternary age around the big inland Ariake Sea. The Ariake Clay shows great variation in material thickness, sensitivity, and softness. The top clayey soil is generally 10 to 20 m thick. Clay minerals are represented by montmorillonite, illite, hydro halloysite and metahalloysite with a lot of diatom remains. Natural disasters such as landslides, subsidence, liquefaction, and flooding are frequent due to its inherent weak engineering properties. These characteristics are linked with many engineering problems for further infrastructure development. In the paper, quantitative correlations from a vast soil test database are briefly presented for each geographical location.

The flash flood and debris flow after a heavy rainfall wiped out a village of southern Japan on the tragic midnight of 10 July 1997, and a great loss of property and lives took place in this ill-fated incident. After the heavy rainfall, the debris flow induced by a sudden flash flood took 21 lives in Southern Kyushu. Detailed field investigation, in situ survey, electrical survey, and hydrogeological analyses were conducted to find out the triggering factors of the disaster. The main factors of this disaster were a hidden fault and the perched groundwater. Moving soil mass downhill into the agricultural pond had triggered the flash flood. The details of sequential disaster events as perceived from the observation and analyses are presented in this paper.

Database is a systematic collection and storage of certain base information related in space and time. Any such database that is a systematic collection and storage of certain base information needs further intelligent analysis for the engineering application. Also, the organised listings, sorting, analyses, and instant retrieval of this ground information are highly useful in management. We developed the new information system named Global Earth Information System (GEIS) as a powerful assistant for researchers to query, analyse, and map data in support of the decision-making process. The real world information can be collected of thematic layers that can be analysed and linked together by geography. Secondary data are induced from original data as a representative of area or time.

To identify the integrated impact of psychological, social, and clinical factors onto the quality of life (QOL) in the patients with Crohn's disease.Two hundred twenty two out-patients participated in a cross-sectional questionnaire survey in which health-related QOL (SF36), disease-specific symptoms, psychological adaptation and social support were measured. Multi-variable regression models were used to test the impact of clinical, psychological, and social factors on the patient's QOL and symptom reports.The patient's symptoms and health-related QOL were significantly associated not only with disease activities, but also with the patient's psychological adaptation and the quality of social support.The results strongly suggest that a psychoeducational intervention may be useful in combination with a clinical intervention to improve the patient's QOL.

Even when the causative factors are known, cancer may still occur in some circumstances. Many mutagenic substances occur in food. The carcinogenic potential of food compounds in humans is not yet clear. If they do play a role in the occurrence of cancer, it would be exceedingly difficult to remove them from the environment. Dietary fiber is generally believed to protect against colorectal cancer. Burkitt first proposed the fiber hypothesis based on his observation of low colon cancer rates in regions of Africa where fiber intake is high. Some case control studies of colorectal cancer have pointed the beneficial effect of total dietary fiber. Dietary fiber consists of plant cell wall polysaccharides and liginin, which are not hydrolyzable by human digestive enzymes, and includes pectin, cellulose, and hemicellulose. Several plausible physical and biochemical mechanisms for the beneficial effect of dietary fiber have been proposed. The risk of colorectal cancer decreases with high intake of total fiber and increased with diets high in animal fat.

The disturbance of immune regulatory T cells is related to the pathogenesis of ulcerative colitis. Here we demonstrated and characterized the serum factor from ulcerative colitis patients that induced proliferation of intrathymic T cells. The factor isolated from the patient sera by a combination of gel filtration and anion-exchange chromatography induced proliferation of CD4+CD8- intrathymic T cells in the organ-cultured embryonic mouse thymus. Purification and amino acid sequence analysis of the serum factor demonstrated that the N-terminal 12 sequence was homologous to that of interleukin-7. SDS-PAGE and Western blot confirmed that purified serum factor was interleukin-7. Enzyme immunoassay demonstrated that the serum interleukin-7 concentration was significantly increased in the patients. PCR and Southern blot hybridization demonstrated that interleukin-7 mRNA expression was increased in the thymus tissues from patients but decreased in the colonic mucosa. Since interleukin-7 is a crucial cytokine for proliferation and differentiation of T cells in the thymus, the present study indicates that interleukin-7 may contribute to the disturbance of immune regulatory T cells in ulcerative colitis.

Pulse dye-densitometry (PDD) is a newly developed method for monitoring the indocyanine green (ICG) concentration in an artery with which cardiac output (CO) and circulating blood volume (CBV) can be determined. We evaluated its accuracy for clinical use.In 7 patients under general anesthesia, ICG-sensitive optical probes (805 and 890 nm) were attached to a finger. Following injection of ICG, the arterial concentration of dye was recorded optically by the non-invasive test instrument and sampled arterial blood ICG concentration was also measured photometrically for comparison. In order to validate the PDD analysis, CO was also measured by both the dye dilution cuvette method and by thermodilution in 8 patients scheduled for coronary artery bypass grafting. In 30 other patients, CBV assessed by PDD was compared with its value estimated from body size.The blood dye concentration correlated well with the values obtained by PDD (r = 0.953, p0.01). Mean bias for the test PDD CO was +0.15 +/- 0.72 min l-1 (not significant (n.s.)) compared with the cuvette method while the mean bias of the thermodilution method vs the cuvette method was +0.79 +/- 0.84 min l-1 (p0.0001.). The average value of CBV obtained by PDD was 3.81 +/- 1.39 L compared with that estimated value, 3.72 +/- 0.77 L (n.s.).CO determined by PDD agrees well with cuvette densitometry, and somewhat less well with CO by thermodilution. The new method, by not requiring a pulmonary arterial catheter, is less invasive than either older method, and yields in addition a value of CBV.

We have established anti-colon antibodies producing B cell clones from the patient with ulcerative colitis, and analyzed the immunoglobulin heavy chain variable region (VH) gene segments of these clones using RT-PCR with VH family specific primers. VH3 family was used by all ten clones from ulcerative colitis that produced anti-colon antibodies, while various VH gene families were used by eight clones from normal controls. By nucleotide sequence analysis, two LPL clones were thought to be derived from a germ line gene segment, VH26. However, other three PBL clones were derived from 22-2B, 9-1 and 1.9-III, respectively. These results suggest the heterogeneity of the colonic antigens that autoantibodies in ulcerative colitis recognize.

To analyze the nature of intestinal mucosal lymphocytes in Crohn's disease, we established T cell lines of patients' intraepithelial lymphocytes. T cell lines from the affected terminal ileum of the patients showed an increased proportion of CD4+V beta 5.2/5.3+ T cells. These cells were increased in number after stimulation with staphylococcal enterotoxins C1 and D, showed an increase in cytolytic activity, and produced a large amount of interferon-gamma. To clarify the role of CD4+ mucosal lymphocytes in the intestinal inflammation, we then developed a novel colitis model by immunizing a rat with trinitrobenzenesulfonic acid (TNB) emulsion with adjuvant. Deep ulceration and granuloma formation in this colitis model resembled the histopathological findings of human Crohn's disease. Immunohistochemical and flow cytometric analysis demonstrated that the number of CD45RC(high)CD4+ mucosal lymphocytes was increased. Interestingly, the administration of anti-CD4 Abs prevented severe inflammation in the model. After treatment with anti-CD4 Abs, the anti-TNB Ab titer, the number of CD45RC(high)CD4+ cells, and interferon-gamma mRNA expression were significantly decreased in the mucosa of the model. These results suggest that some subsets of CD4+ mucosal lymphocytes play an important role in the triggering and progression of inflammation in Crohn's disease.

Benign tumors of the lung occur in low frequency, but its differential diagnosis from malignant tumors such as lung cancer is important. This paper presents as analysis of clinical features of 26 cases operated on for benign tumor of the lung. Histologically there were 15 hamartomas, 8 sclerosing hemangiomas, 2 inflammatory pseudotumors and one clear cell tumor. The roentgenographic appearances were well defined circumscribed solitary nodules in 17 cases (65%), and lobulation and spiculation in 9. Histological diagnosis of benign tumors was not obtained in all cases preoperatively. Minimal resection procedures were performed in 22 cases (85%). No postoperative complications developed.