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The increased numbers of older and frail patients with heart failure (HF) means there is an urgent need to establish regional collaborative systems for medical and nursing care. However, expectations related to collaborative HF care among medical and care staff remain unclear. We conducted a questionnaire survey with staff in hospitals, clinics, and nursing care facilities (NCFs) who had experienced collaboration through the common HF collaborative pathway in the western region of Tottori Prefecture, Japan, from July 2019 to July 2020. We received 150 responses from hospitals and 41 responses from clinics and NCFs. Following introduction of the collaborative pathway, 57% of respondents from hospitals, 35% from clinics, and 71% from NCFs rated collaboration as improved. Staff from hospitals and clinics were most satisfied with improved education interventions following implementation of the collaborative pathway, and NCF staff were most satisfied with improved information sharing. Staff from hospitals and NCFs placed the highest importance on improving information sharing through collaboration, and clinic staff placed the highest importance on improving efficiency. The needs for collaborative HF care differ between hospitals, clinics, and NCFs. A collaboration program should be designed to meet the different needs of diverse staff in the community.

Mass transfer rates, k(L), of single carbon-dioxide (CO2) bubbles rising through vertical pipes filled with alcohol-electrolyte mixed aqueous solutions were measured to investigate the combined effects of alcohol and electrolyte on k(L). 1-octanol and 1-heptanol, which are known to adsorb to the interface and behave like surfactant, were used. Sodium chloride (NaCl) was used for the electrolyte. The surface tension, σ, decreased with increasing the NaCl concentrations, C-N, while keeping the alcohol concentration, C-A, constant. Three combinations of C-A and C-N having the same values of σ were selected for the experimental conditions to avoid the effect of σ. The pipe diameters, D, were 12.5 and 18.2 mm. A wide range of bubble diameter covered various bubble shapes, i.e. ellipsoidal, cap, semi-Taylor and Taylor bubbles. The conclusions obtained are as follows: (1) the combination of C-A and C-N for the same σ does not affect the aspect ratios of ellipsoidal bubbles and the lengths, L, of Taylor bubbles, (2) the Sherwood numbers, Sh, of bubbles in alcohol-NaCl mixed aqueous solutions depend on the combination of C-A and C-N due to the change in the Schmidt number, Sc, even at the same σ for all the tested combinations of concentrations of impurities, and (3) the modified Sherwood number, Sh(D), of contaminated Taylor bubbles is well correlated in terms of the bubble Reynolds number, Sc, the dimensionless group for surfactant properties and L/d(T), where d(T) is the transition bubble diameter at the transition from the ellipsoidal-cap bubble regime to the transition regime.

IntroductionCurrently, there are no reports of diaphyseal femoral fracture equivalent to atypical femoral fractures (AFFs) in patients receiving long-term hemodialysis (HD).Case reportA 56-year-old Japanese man receiving long-term HD for 34 years was admitted to our hospital due to a delay in postoperative healing. The patient began maintenance hemodialysis at 22 years of age. The patient then underwent surgical parathyroidectomy (PTX) for secondary hyperparathyroidism at 43 years of age, which resulted in decreased levels of parathyroid hormone (PTH). Thereafter, this patient’s serum 1,25(OH)2D3level was very low because active vitamin D3derivative was not administered. At 54 years of age, a transverse fracture of the femoral shaft equivalent to AFF occurred. Surgery with open reduction and internal fixation using intramedullary nailing was performed; however, the delay of postoperative healing continued for 16 months. A left iliac crest bone biopsy was performed and showed osteoid-like lesion and an increase of woven bone. The patient received active vitamin D3derivative and recombinant human PTH (1–34) derivative. Twenty-nine months after the first surgery, a reoperation was performed. Simultaneously, a right iliac crest bone biopsy was performed. Bone morphometrical improvement was confirmed. Six months after resurgery, the bone union was achieved.SummarySevere vitamin D3deficiency and decreased levels of PTH may induce a higher osteoid state and an increase of woven bone, which may then attribute to the development of diaphyseal femoral fracture and impairment of postoperative bone healing. It is hypothesized that treatment with active vitamin D3and teriparatide acetate may be a therapeutic option via the accelerated formation of lamellar bone for refractory diaphyseal femoral fracture of long-term dialysis.

Although lymphangioleiomyomatosis is often observed with tuberous sclerosis, uterine lymphangioleiomyomatosis is rare. Our patient was 36 years old (gravida 0, para 0). She had a history of tuberous sclerosis, and many myometrial cystic lesions were identified during assisted reproductive therapy. Although we administered a gonadotropin-releasing hormone analog, myometrial cystic lesions increased in size. Therefore, simple hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node biopsy were performed. Postoperative histology showed lymphangioleiomyomatosis and myometrial abscess. For uterine lesions in young women with tuberous sclerosis, the possibility of uterine lymphangioleiomyomatosis should also be considered.

Background Manual patient handling is a major cause of low back pain among healthcare staff. The sliding sheet is an assistive device designed to aid healthcare staff performing patient repositioning in bed. The use of sliding sheets in healthcare facilities is currently relatively rare because of the perceived additional time required compared with non-assisted handling. However, the details of the time difference between techniques and the barriers to the use of sliding sheets have not been examined in depth. Objectives We sought to evaluate differences in working time and subjective fatigue between the use of sliding sheets and non-assisted handling techniques for patient repositioning, in order to understand the factors preventing the use of sliding sheets among nurses. Design We conducted a comparative study with an experimental design. Settings The study was conducted in the nursing practice room at a university in Japan. Participants We recruited 30 pairs of nurses and care receivers. All nurses were under 60 years old, with experience in lateral turning and repositioning in the process of changing diapers in clinical settings. Those with a previous or current medical history of low back pain were excluded. Care receivers were older adults (65–80 years old). We excluded adults with bedsores, body mass index values >30, or restricted joint motion due to femoral trochanteric fracture or compression fracture. Thus, 27 pairs were included in the final analysis. Methods The care receivers were instructed to behave as if they were bedridden patients with no limb movement, and as if they had contracture and difficulty communicating. Nurses repositioned the patient using three techniques assigned as interventions in random order: repositioning by one person using a sliding sheet (Sheet), repositioning by two people without a sliding sheet (Double), and repositioning by one person without a sliding sheet (Single). Working time was the primary endpoint for comparative analysis among the three technique conditions. Results The results revealed that the Sheet technique required significantly more time than the non-assisted techniques. However, when total staff time was taken into consideration, the Sheet technique outperformed the Double technique. Moreover, the Sheet technique was associated with significantly lower levels of subjective fatigue, compared with the Double technique. Conclusions The use of a sliding sheet can substantially reduce caregiver burden when performing patient repositioning, and requires less staff time than manual techniques involving more than one caregiver.

Currently, the pathogenesis of nontraumatic heterotopic ossification (HO), e.g., bone-like tissue in calcific tendinopathy remains unclear. Here, we report a 75-year-old, right-handed Japanese woman who had been on hemodialysis for 3 years and was admitted to our hospital to evaluate pain and swelling of the right forearm. She worked as a cook, and her main job over the 3 most recent years had been the frequent and continuous shredding of cabbage. A radiograph showed the highly radiopaque material on the dorsal aspect of the right wrist and in the right shoulder. The biopsy of this radiopaque material revealed HO with marrow, as well as calcified material. Histomorphometric analysis of the HO identified a severe type of osteitis fibrosa with a fibrous tissue volume to total volume of 19.8% (>0.5% required for diagnosis) and an osteoid volume to bone volume of 20.0% (>15% required for diagnosis). We found more woven bone-like tissue than lamellar bone-like tissue. However, the intact parathyroid hormone level was 3-times the normal upper limit with 203 pg/mL, but histomorphometric analysis of the right iliac crest revealed normal bone structure. These findings indicate that the frequent and continuous shredding action with the right hand contributed to the nontraumatic HO localized on the dorsal aspect of the right wrist.

Background: Although urate impaired the endothelial function, its underlying mechanism remains unknown. We hypothesized that urate impaired nitric oxide (NO) production in human umbilical vein endothelial cells (HUVECs) via activation of uric acid transporters (UATs). Purpose and method: In the present study, we studied effects of urate on NO production and eNOS protein expression in HUVEC cells in the presence and absence of urate lowering agents using molecular biological and biochemical assays. Results: HUVECs expressed the 4 kinds of UATs, URATv1, ABCG2, MRP4 and MCT9. Exposure to urate at 7 mg/dl for 24 h significantly reduced production of NO. Pretreatment with benzbromarone, losartan or irbesartan normalized NO production. The same exposure resulted in dephosphorylation of endothelial NO synthase (eNOS) in HUVECs. Again pretreatment with benzbromarone, losartan or irbesartan abolished this effect. Conclusion: Urate reduced NO production by impaired phosphorylation of eNOS in HUVEC via activation of UATs, which could be normalized by urate lowering agents.

We present three extremely rare cases of spontaneous spinal epidural hematoma occurring in pregnancy. The patients developed progressive paralysis of the upper and lower limbs and the diagnoses were confirmed by magnetic resonance imaging. Urgent decompression is required to prevent neurological sequelae. The pregnancy may either be continued or delivered depending on the gestational age and severity of the disorder. Pregnancy-induced structural changes of the vascular walls and hemodynamic changes may play a role in the pathogenesis of spontaneous spinal epidural hematoma.

Recently, as laparoscopic myomectomy (LM) has become increasingly common, reports of intraoperative or postoperative complications have arisen. We experienced a case of massive hemorrhage resulting from a ruptured uterine arteriovenous fistula after LM. A 24-year-old woman, nulligravid, presented with hypermenorrhea. She was diagnosed with an 8-cm intramyometrial leiomyoma of the posterior uterus with endometrial deformation. LM was performed. The myoma was soft, its boundaries were not clear, and there was extensive contact with endometrium. Operative time, blood loss, and enucleate weight were 181 minutes, 1,000 ml, and 298g. On a transvaginal ultrasound 25 days after the operation, a cystic lesion was noted in the area of the myomectomy. Color Doppler ultrasonography showed a fountain of blood streaming from a single artery into the cyst, while the size of the cyst was not changed. However, a massive hemorrhage erupted even as we were conferring with the patient in the medical examination room. She underwent emergency laparotomy on the same day. Pulsatile bleeding from a 1mm diameter artery in the wound of the myomectomy was observed. We examined the cyst in detail after ligating the artery. The wall of cyst was a structured fibrous myomatous capsule of a white color with a perforation of the intrauterine part. Blood infiltration and hematoma were not seen at all in the myometrium of the cyst. We have performed LM on 406 patients in our hospital. This case was the first of its kind, so we are reporting it as a warning for consideration in the LM of the future.

Ectopic ovary is a rare gynecologic entity. A variety of synonymous terms such as ectopic ovary, supernumerary ovary, accessory ovary, and autoamputation of the ovary have been used to describe this condition. The etiology for ectopic ovary has not been elucidated, but several mechanisms have been proposed. They are categorized as either congenital (embryologically derived) or acquired. This report presents two cases of ectopic ovary resulting from different causes and one case of potential ectopic ovary.

In recent years, improvements in diagnostic technology have enabled the early detection of ectopic pregnancy, and the opportunities for preserving the oviduct have increased, particularly as laparoscopic surgery has become the first-line choice for treatment of ectopic pregnancy in an increasing number of institutions. At our institution we use laparoscopic techniques to attempt oviduct preservation in patients with ectopic pregnancy who wish to become pregnant again. In this report, we examined the rates of persistent ectopic pregnancy and repeat ectopic pregnancy over a ten year period in patients who were treated laparoscopically with oviduct preservation. When compared with other treatments, we found a lower rate of persistent and recurrent ectopic pregnancy in women who were treated with oviduct-persevering laparoscopy. We conclude that laparoscopic surgery with oviduct preservation should be the therapy of choice for ectopic pregnancy when the patient still desires to get pregnant. However, a thoroughly informed consent detailing the risks of persistent and recurrent ectopic pregnancies must be a priority because of the high emotional toll of these complications.

We investigated the effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on the stability of Kv1.5 channel protein. The expression and function of Kv1.5 (Kv1.5-FLAG) in transfected African green monkey kidney fibroblast cells as well as rat atrium were estimated by immunoblotting, immunoprecipitation, immunofluorescence and patch-clamp techniques. Both EPA and DHA immediately blocked Kv1.5 channel current in a dose-dependent manner, accompanied by reduction of their phosphorylation. Chronic treatment (for 12 h) with EPA at lower concentrations (0.3-10 muM) increased the level of Kv1.5-FLAG protein as well as Kv1.5 channel current without changes in its gating kinetics, prolonging its half-life; in contrast, both EPA and DHA at higher concentrations (30-100 muM) decreased the expression of Kv1.5-FLAG. EPA at the higher concentrations also decreased mRNA of Kv1.5 and synapse-associated protein 97 expression. EPA at the lower concentrations increased Kv1.5 expression in the endoplasmic reticulum, Golgi apparatus and cell membrane. EPA-induced increase of Kv1.5 channel expression and current was abolished by pretreatment with the protein transport inhibitor brefeldin A or colchicines, and by the Kv1.5 channel blocker 4-aminopyridine. Oral administration of EPA (30 mg/kg) increased the level of endogenous Kv1.5 in rat atria. These results indicate that chronic treatment with EPA at lower concentrations stabilizes Kv1.5 channel protein in the endoplasmic reticulum and Golgi apparatus thereby enhancing the Kv1.5 channel current on the cell membrane.

Objectives: Uterine myomas are frequently occurring benign tumors that are characterized by symptoms such as anemia and dysmenorrhea, and may lead to infertility. In this study, we examined the efficacy of laparoscopic myomectomy, as well as pregnancy and obstetric outcome after the surgery in patients with uterine myomas who were infertile or wished to conceive.Methods: Of 300 patients who underwent laparoscopic myomectomy in our hospital, 78 who wished to conceive before or after surgery, and whose factors contributing to infertility were identified, were selected as subjects. The factors measured during/after the surgery included uterine weight, number of myomas, maximum diameter of myomas, blood loss, and operative time. The pregnancy rate and obstetric outcome after the surgery were also examined. Results: The pregnancy rate after the surgery was 53.8%; the pregnancy rate was as high as 73.0% in women who had no other factors contributing to infertility except uterine myomas. Spontaneous pregnancies occurred in 85.7% of the patients and 14.3% required assisted reproductive technology (ART). Forty-four pregnancies were confirmed in 42 patients after surgery. Of these 44 pregnancies, 20.4% resulted in spontaneous abortions and 79.5% culminated in a successful delivery. Nine gravidas (25.7%) were delivered vaginally and 26 gravidas (74.3%) had caesarean sections. The only complication noted was a case of serious bleeding after expulsion of the placenta during a caesarean section.Conclusion: In patients who wish to conceive and have no other obvious factors contributing to infertility except uterine myomas, laparoscopic myomectomy improves the pregnancy rate. It is necessary to establish strict indications for laparoscopic myomectomy, taking complications during pregnancy and delivery into consideration, and to improve the surgeon's skills.

The aim of this study was to elucidate the mechanisms for regulations of cardiac Kv1.5 channel expression. We particularly focused on the role of heat shock proteins (Hsps). We tested the effects of Hsps on the stability of Kv1.5 channels using biochemical and electrophysiological techniques: co-expression of Kv1.5 and Hsp family proteins in mammalian cell lines, followed by Western blotting, immunoprecipitation, pulse-chase analysis, immunofluorescence and whole-cell patch clamp. Hsp70 and heat shock factor 1 increased the expression of Kv1.5 protein in HeLa and COS7 cells, whereas either Hsp40, 27 or 90 did not. Hsp70 prolonged the half-life of Kv1.5 protein. Hsp70 was co-immunoprecipitated and co-localized with Kv1.5-FLAG. Hsp70 significantly increased the immunoreactivity of Kv1.5 in the endoplasmic reticulum, Golgi apparatus and on the cell membrane. Hsp70 enhanced Kv1.5 current of transfected cells, which was abolished by pretreatment with brefeldin A or colchicine. Thus, Hsp70, but not other Hsps, stabilizes functional Kv1.5 protein.

We report a novel action of intracellular adenosine monophosphate (AMP) to inhibit β-adrenergic signaling in isolated rat ventricular myocytes. Extracellular application of adenosine or AMP suppressed isoproterenol (Iso)-induced prolongation of action potential duration (APD). This effect was completely abolished by an A 1 -receptor antagonist, DPCPX. Intracellular application of AMP, but not adenosine, attenuated Iso-induced APD prolongation. Iso-induced increases in the L-type Ca 2+ current (I Ca,L ) were also inhibited by intracellular AMP. These inhibitory effects were not affected by either DPCPX or glibenclamide. In vitro, AMP directly inhibited PKA activity via binding to its regulatory subunit. These results suggest that intracellular AMP attenuates β-adrenergic signaling by directly inhibiting PKA activity, independently of A 1 -purinergic receptor.

Destructive spondyloarthropathy (DSA) is the most serious spinal complication of dialysis-related amyloidosis in patients on long-term hemodialysis (HD), but we could not find any information about DSA in patients on peritoneal dialysis (PD) for over 10 years. We retrospectively evaluated factors contributing to DSA in HD and PD patients. Sixty-seven patients on dialysis for 10 to 19 years were compared between a PD group (n = 23) or a HD group (n = 44). In the PD group, nine patients (39%) developed DSA. The mean age of DSA patients was significantly higher than that of non-DSA patients (66.2 ± 10.0 vs. 51.0 ± 12.8 years, P = 0.03). The frequency of cervical spine DSA did not show any difference between the PD and HD groups, but the frequency of lumbar spine DSA showed a significant difference (22% vs. 5%, P = 0.04). The serum beta-2 microglobulin (B2MG) level was significantly higher in PD patients than in HD patients (38.4 mg/L vs. 27.4 mg/L, P = 0.0025). Mechanical stress such as elevation of the intra-abdominal pressure due to infusion of PD fluid (1500 mL to 2000 mL) for over 10 years might contribute to lumbar DSA in patients on long-term PD.

Deep venous thrombosis (DVT) and pulmonary embolism (PE) after spinal or lower extremity surgery are well recognized as common complications. Since 1995 we have investigated the incidence of PE after orthopedic surgery using ventilation-perfusion (V/Q) lung scans, and the prevalence of PE was about 10%. With a view to detecting early-stage PE by simple examinations, we evaluated the use of both the blood gas analysis and the D-dimer measurement after spinal or lower extremity surgery.Altogether, 85 patients who underwent spinal or lower extremity surgery were eligible for the study. Pneumatic sequential leg compression devices (PSLCDs) were utilized continuously both intra- and postoperatively. Arterial blood gas analysis and D-dimer measurement were performed pre- and postoperatively on days 3 and 7. We set lung scan criteria as follows: postoperative decrease in Pa(O2) (deltaPa(O2) byor = 10 torr (group G), postoperative D-dimer ofor = 1 microg/ml (group D), or both. Patients with the criteria went on to undergo lung scans, and PE was diagnosed by the existence of any mismatch between ventilation-perfusion (V/Q) lung scans.A total of 44 (51.8%) patients met the lung scan criteria and underwent perfusion lung scans, 10 (11.7%) of whom were diagnosed as PE. In groups G and D, about 30% showed PE. Moreover, six (85.7%) of the seven patients with both criteria showed a significant increase (83.7%) in the prevalence of PE.Patients with the above criteria showed a high prevalence of PE. Moreover, 10 (11.7%) of the 85 patients were diagnosed as having PE, which corresponded to the prevalence in our former studies where lung scans were performed in all patients. The blood gas analysis and the D-dimer measurement may be utilized as the first screening examinations.

東京水産大学海洋システム工学講座

Objective To analyse the results of laparoscopic ovarian biopsy and the laparoscopically observed morphological features of the ovary in premature ovarian failure (POF), in relation to clinical outcome, and to construct an appropriate guideline for clinical management utilizing laparoscopy. Design A retrospective study of patient records. Setting Fujita Health University Hospital. Subjects 19 women with POF, treated between 1991 and 2000. Main outcome measures The ovaries from 12 patients who underwent laparoscopy were classified, according to morphological features, as sclerotic, atrophic or hypoplastic. The detection rate for a primordial follicle was assessed for each ovarian type, and the correlation between morphological features and patient clinical outcome was investigated. Results Induction of ovulation was successful in eight of 19 patients (42.1%). Among the 12 patients who underwent laparoscopy, ovulation induction was successful in four, but not in the remaining eight. The rate of detection of a primordial follicle was 50.0% for the four women with successful ovulation induction and 14.2% in the eight other women. With regard to ovarian type, primordial follicles were detected only in sclerotic ovaries. It was shown that cyclic therapy with estrogen and progesterone (CTEP) had appreciably favourable effects, and then the combined therapy with CTEP-primed gonadotrophin-releasing hormone (GnRH) agonist and human menopausal gonadotrophin–human chorionic gonadotrophin (hMG–hCG) was a reasonable therapeutic method. Conclusions There was a clear relation between the rate of detection of primordial follicles and the morphological features of the ovaries. Therefore, laparoscopy should be done an early stage to determine the type of ovary. Furthermore, in establishing whether or not there is a primordial follicle in the ovary, laparoscopy seems to have an important role in the planning of treatment.

Marked tumor regression in advanced vaginal cancer was induced by adjuvant therapy with the biological response modifier sizofiran (SPG) in a 94-year-old woman. SPG was repeatedly injected into the tumor. To examine the relationship between tumor cell expression of human leukocyte antigens (HLA) and lymphocytic infiltrates in tumor tissues, we performed immunohistochemical examinations using monoclonal antibodies to HLA-ABC, HLADR, Leu2a, Leu3a, and Leu4. HLA-DR expression, which was not seen before the administration of SPG, was positive with the repeated SPG injections. The subsets of Leu4(CD3) -positive cells and. cells increased markedly as the infiltration advanced. These findings suggest that repeated intratumoral injection of SPG may enhance cell-mediated immune response via an increase in the expression of HLA-DR antigens.

Long-term effects of a low-dose hydrochlorothiazide (HCTZ) with losartan (LOS) on uric acid (UA) metabolism as well as glucose metabolism have been studied in hypertensive patients in comparison with those of a low-dose HCTZ with telmisartan (TEL).Fifty-nine hypertensive patients were allocated to a combination therapy with either losartan (50 mg/day)/HCTZ (12.5 mg/day) (LOS + HCTZ group: n = 37) or telmisartan (40 mg/day)/HCTZ (12.5 mg/day) (TEL + HCTZ group: n = 22), respectively. Before and 1 year after the treatment, blood pressure and biochemical parameters of blood and urine were evaluated.Both systolic and diastolic blood pressures significantly decreased in two groups, without any statistical differences among them. LOS + HCTZ caused no changes in the serum UA level or the ratio of UA clearance to creatinine clearance (CUA/Ccr), whereas TEL + HCTZ significantly increased the serum UA level and reduced CUA/Ccr. LOS + HCTZ did not influence CUA/Ccr in patients with their serum UA below 5.4 mg/dl, while LOS + HCTZ significantly increased CUA/Ccr in patients with their serum UA above 5.5 mg/dl. TEL + HCTZ significantly reduced CUA/Ccr in patients with their serum UA below and above 5.4 mg/dl to increase serum UA level significantly. Neither combination therapies caused any changes in fasting plasma glucose, HbA1c and HOMA-R. In patients with their serum UA level above 5.4 mg/dl, TEL + HCTZ increased HOMA-R, whereas LOS + HCTZ did not.LOS + HCTZ did not influence UA metabolism as well as glucose metabolism, likely because of inhibitory action of losartan on URAT1, although TEL + HCTZ were accompanied with impairment of the UA metabolism and glucose metabolism.

We present three extremely rare cases of spontaneous spinal epidural hematoma occurring in pregnancy. The patients developed progressive paralysis of the upper and lower limbs and the diagnoses were confirmed by magnetic resonance imaging. Urgent decompression is required to prevent neurological sequelae. The pregnancy may either be continued or delivered depending on the gestational age and severity of the disorder. Pregnancy-induced structural changes of the vascular walls and hemodynamic changes may play a role in the pathogenesis of spontaneous spinal epidural hematoma.

Many athletes complain of exercise-induced pain in the lower leg that can be caused by inflammatory diseases, peripheral nervous system disease, fatigue fracture, shin splint, and chronic compartment syndrome (CCS). CCS is the most typical exercise-induced condition and it often requires surgical decompression of the several compartments. There are already many techniques reported in the literature. Recently, an endoscopic technique for CCS was reported with which excellent results were achieved. We have modified it and developed a new technique for treating CCS of the lower leg. We report a case of CCS of the lower leg treated with 1-portal endoscopic fasciotomy. The technique helps to decrease damage to soft tissue and patients will immediately return to normal activities of daily living. Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 8 (October), 2001: E33

A 25-year-old infertile woman underwent laparoscopy because of a dermoid cyst of the left ovary and was found to have an ectopic ovary, to which an abnormal right fimbria was connected, with an isolated right ovary in the normal position and the bilateral segmental absence of the middle portion of the fallopian tubes. The complex of these anomalies is rare. A fundamental error might have existed in the mesenchyme of the gonadal ridges of the early embryo, rather than the epithelial origin of the mullerian and wolffian ducts.

The present study was undertaken to assess the effects of lipoxygenase products on ovulation, oocyte maturation, and steroid production in the perfused rabbit ovary preparation. Ovulatory efficiency was significantly reduced when rabbit ovaries were perfused with human CG (hCG) plus nordihydroguaiaretic acid (NDGA) at 10(-5) or 10(-6) M, as compared to contralateral hCG-treated controls. The addition of NDGA to the perfusate inhibited hCG-induced ovulation in a dose-related manner. The percentage of ovulated ova and follicular oocytes achieving germinal vesicle breakdown did not differ significantly between NDGA-treated ovaries and contralateral controls. Leukotriene B4 (LTB4) production by the perfused rabbit ovaries reached its maximum 6 h after exposure to hCG and then declined. The addition of NDGA at 10(-5) M significantly inhibited hCG-stimulated LTB4 production by rabbit ovaries throughout the entire perfusion periods. The ovulatory efficiency in ovaries treated with hCG alone or with hCG plus NDGA correlated significantly with LTB4 production by perfused rabbit ovaries 6 h after exposure to hCG (alpha = 0.8893, P less than 0.01). Furthermore, the addition of LTB4 at 100 ng/ml to the perfusate reversed the inhibitory effects of NDGA on hCG-induced ovulation. However, exposure to NDGA affected neither progesterone nor estradiol production elicited by hCG administration. These results suggest that NDGA may block hCG-induced ovulation in vitro, probably via the inhibition of LTB4 production by rabbit ovaries.

The purpose of this study was to assess the clinical features and characteristics of the blood flow in uterine vascular abnormalities using ultrasound and magnetic resonance imaging (MRI). A total of 17 women were diagnosed with uterine vascular abnormalities by ultrasound. The clinical characteristics of the patients and the distribution and waveform of the intrauterine vessels were examined using transvaginal gray-scale and Doppler ultrasonography, spin-echo MRI, and MR angiography. The average age of the 17 subjects was 44.3 years, and 5 were postmenopausal women. The number of pregnancies and deliveries was 2.0 and 1.7, respectively. Of the 17 subjects, 7 had a moderate or severe grade of dysmenorrhea and 7 had a history of vascular disease. In all subjects, vaginal ultrasound demonstrated tubular or numerous tortuous anechoic areas in the uterine wall, and Doppler ultrasound showed that the tubular or numerous dilated tortuous vessels had an atypical wave flow, unlike that of an artery or a vein. The distribution of displayed flow varied, and the waveforms of the Doppler ultrasound displayed three patterns. The averages of the pulse Doppler flow indices showed low impedance in the abnormal uterine vessel and the uterine artery, especially in cases of true arteriovenous malformations. MR angiography demonstrated distinct, tortuous, and coiled vascular channels in the pelvis during and just after the arterial phase. Characterization of the clinical features of uterine vascular abnormalities is considered to be valuable for obstetricians and gynecologists.

A semantic sensor network describes the physical world using the metadata obtained from a sensor network. In this paper, we present our design and implementation of MeT, a real world oriented metadata management system for semantic sensor networks. MeT generates metadata either statically based on the application semantics, or dynamically using inference rules. It then constructs relationships between physical objects through these metadata. The sensor devices in MeT include RFID tags, position sensors and Motes. The users can query MeT about physical objects through either a Graphic User Interace, or Robovie, a communication robot. We give several concrete examples of querying physical objects in MeT to demonstrate the functionality of our system.

To evaluate the postoperative adhesion formation caused by instruments used in gynecologic laparoscopic surgery and to determine the optimal instruments to use to reduce adhesions.Seventeen juvenile pigs underwent laparoscopic bilateral resection of the uterine horns under general anesthesia and pneumoperitoneum. The laparoscopic procedures were carried out using monopolar electrocautery (ME) (n = 8), an electrothermal bipolar vessel sealer (EBVS) (n = 6), an ultrasonically activated scalpel (UAS) (n = 6), a loop-type ligature (LTL) with a steel scalpel for severing the tissues (n = 6), and an automatic stapling device (ASD) (n = 8). Second- look laparotomy was performed 14 days postoperatively, and the degree of postoperative adhesions was scored from 0 to 6.The mean and range of adhesion scores were 0.00 with EBVS, 0.13 (range, 0-1) with ASD, 0.33 (range, 0-2) with LTL, 1.17 (range, 0-3) with UAS, and 3.13 (range, 2-6) with ME. We found a statistically significant difference in the extent of postoperative adhesion formation associated with these 5 instruments (P0.001, Kruskal-Wallis test).Adhesion formation increased in the order EBVSASDLTLUASME. Our study strongly suggests that surgical instruments can be selected to reduce postoperative adhesion formation, a particular concern in women of reproductive age.

This study develops a dialog system named SAR for communication robots. SAR employs robot's sensor information to accept oral commands from users. There is a difficulty for the robots to deal with the oral commands because humans frequently use an anaphoric expression or an abstract expression. SAR succeeds in interpreting these expressions based on the obtained sensor information. For example, SAR could interpret Japanese anaphoric expressions such as "KOTTI MUITE (look at me)". Moreover, SAR could interpret an abstract expression such as "MOUSUKOSHI SUSUME (move further)".

We report three cases of the development of ossification of the posterior longitudinal ligament (OPLL) after atlanto-axial fusion. This fusion should be recognized as a causative factor in the development of OPLL. The pathological mechanism is suggested to be increased mechanical stress.

中～高分化型腺癌切除例のうち, 術前細胞診の陽性であった26例について, 腫瘍最大割面のHE染色標本の観察にて下里の細胞亜型分類を行い, 術前細胞診における組織型判定を細胞亜型ごとに検討した. 対象症例26例は気管支表面上皮細胞型7例, クララ細胞型13例, 混合型6例に分類された. クララ細胞型は全例腺癌と判定されていたが, 気管支表面上皮細胞型は3例が腺癌, 4例が扁平上皮癌と判定されていた. 混合型は5例が腺癌, 1例が大細胞癌と判定されていた, 組織型誤認例は全例擦過細胞診による判定であった.気管支表面上皮細胞型の擦過細胞像として,(1) 変性壊死細胞が多数認められる.(2) 紡錘形の細胞が層状に配列する.(3) 結合性はあるが平面的な配列.(4) 核偏在が明らかでなく, 核小体不明瞭.の4つの細胞所見が認められ, 誤判定の原因と考えられた. 擦過細胞診における組織型判定に際しては, 細胞亜型を念頭においた細胞所見の検討が必要と思われた.

A phase I study of N4-palmitoyl-1-beta-D-arabinofuranosylcytosine (PLAC) was conducted in 88 patients; 36 with solid tumors and 52 with hematological malignancies, using 2 different schedules. Schedule 1 employed a single oral administration and Schedule 2, 5-day consecutive daily oral administration. In Schedule 1, the daily dose was initiated with 1 mg kg-1 which was escalated up to 24 mg kg-1 according to the modified Fibonacci's method. Side effects included nausea, vomiting and skin rashes, but myelosuppression was not seen within this dose range. In Schedule 2, the daily dose was started with 1 mg kg-1 which was escalated up to 24 mg kg-1. Major side effects were nausea, vomiting and anorexia, and mild myelosuppression was noted at 12 mg kg-1 or more. The dose-limiting toxicity was gastrointestinal toxicity, which appeared at 3.3 mg kg-1 or more and became frequent at 7 mg kg-1 or more. Pharmacokinetic study revealed that the plasma concentrations of PLAC and ara-C, obtained by the oral intake of 3.3 mg kg-1 or more of PLAC, were sufficient for these compounds to exert cytotoxic effects on various human leukemia cells in vitro. Based on these observations and plausible mechanism of action of PLAC, further clinical study should be carried out in a treatment schedule of considerably prolonged administration period with 3.3-6 mg kg-1 day-1 of PLAC.

A highly sensitive and specific solid-phase enzyme immunoassay system for terminal deoxynucleotidyl transferase (TdT, EC 2.7.7.31) has been developed by the use of monospecific antibody against calf thymus TdT and β- d -galactosidase from Escherichia coli as label. The immunoassay system was composed of solid phase (polystyrene beads) with immobilized F(ab′)2 antibody fragments and the antibody Fab′ fragments labeled with β- d -galactosidase. The minimum detectable concentration of calf TdT was 0.1 ng/ml (0.01 ng/assay), making it more sensitive than the radioimmunoassay or enzyme immunoassay methods that use alkaline phosphatase as label, as reported previously. The assay system cross-reacted with human TdT, and TdT in neoplastic cells or sera from leukemic patients was successfully detected by the present immunoassay method.

The TDXR system based upon fluorescence polarization immunoassay was used for therapeutic drug monitoring of methotrexate in serum. This system was evaluated for utility as well as precision and a test-dose method for individual dosage regimen adjustments in high-dose methotrexate therapy.A comparison of the TDX system to enzyme immunoassay (EMITR sytem), which has been used for methotrexate assay, was made on 93 specimens; as a result, excellent correlation, r=0.998. The day-to-day precision was established by 8 replicated analyses during 2 weeks, where coefficient of variation was 0.72 to 2.56% of the within-day precision, CVs was 0.61 to 2.69%.A study was made to determine if test-dose bolus injection could be used to predict infusion plateau methotrexate concentration. Small nontoxic dose of methotrexate (50mg/ m2) was given to patients who were followed for 24 hr. and the pharmacokinetic data were used to dose modification of high-dose methotrexate infusion.We used 2 methods of assuming linear kinetics, the pharmacokinetic parameter and total body methotrexate clearance derived from the test-dose data, which can be used to predict infusion plateau methotrexate concentration. We have good prediction from pharmacokinetic parameter of 2 compartment models. It is concluded that test-dose method can be a useful guide to allow appropriate dose modification of high-dose methotrexate therapy.

近年成人における全身性巨細胞封入体症の報告は増加の傾向にある.そして,その殆どは免疫機構に異常を来たす疾患とか免疫抑制剤使用例に合併した報告である.本症例は38才の男性で,発熱,リンパ節腫脹,黄疸,肝腫大,腹水,末梢血中ならびに腹水中への異型リンパ球出現などを主な所見とし,発病より約6ヵ月で死亡した.剖検により,肺,肝,脾,副腎に巨細胞封入体を認めたので,とくに基礎疾患のない全身性巨細胞封入体症の本邦における既報の症例を含めて,文献的考察を加えた.