There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases....There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases.This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly prone to these diseases.By contrast,Caucasians are less likely to develop keloids and hypertrophic scars,and if they do,the scars tend not to be severe.This ethnic disparity also means that countries vary in terms of their differential diagnostic algorithms.The lack of clear treatment guidelines also means that primary care physicians are currently applying a hotchpotch of treatments,with uneven outcomes.To overcome these issues,the Japan Scar Workshop(JSW)has created a tool that allows clinicians to objectively diagnose and distinguish between keloids,hypertrophic scars,and mature scars.This tool is called the JSW Scar Scale(JSS)and it involves scoring the risk factors of the individual patients and the affected areas.The tool is simple and easy to use.As a result,even physicians who are not accustomed to keloids and hypertrophic scars can easily diagnose them and judge their severity.The JSW has also established a committee that,in cooperation with outside experts in various fields,has prepared a Consensus Document on keloid and hypertrophic scar treatment guidelines.These guidelines are simple and will allow even inexperienced clinicians to choose the most appropriate treatment strategy.The Consensus Document is provided in this article.It describes(1)the diagnostic algorithm for pathological scars and how to differentiate them from clinically similar benign and malignant tumors,(2)the general treatment algorithms for keloids and hypertrophic scars at different medical facilities,(3)the rationale behind each treatment for keloids and hypertrophic scars,and(4)the body site-specific treatment protocols for these scars.We believe that this Consensus Document will be helpful for physi展开更多
Background Osteoarthritis （OA） is a chronic and incurable disease, lacking effective treatment. Gene therapy offers a radical different approach to the treatment of arthritis. Even though the etiology of OA remains ...Background Osteoarthritis （OA） is a chronic and incurable disease, lacking effective treatment. Gene therapy offers a radical different approach to the treatment of arthritis. Even though the etiology of OA remains unclear, there is now considerable evidence to suggest that interleukin-1 （IL-1） and tumor necrosis factor- α （TNF- α ） are the main mediators in the pathogenesis of OA. The goal of this study was to determine the efficacy of local expression of interleukin-1 receptor antagonist （IL-1Ra） and soluble tumor necrosis factor- α receptor type Ⅰ （sTNF-RI） by direct adenoviral-mediated intra-articular gene delivery in the rabbit model of osteoarthritis. Methods Adenoviral vectors containing IL-1Ra or sTNF-RI genes were constructed. OA was induced in both hind knees of 12 New Zealand white rabbits by the excision of the medial collateral ligament plus medial meniscectomy. Five days after surgery, approximately 1 × 10^8 plaque-forming units （pfu） of adenovirus were injected into the joint space of the knee through the patellar tendon. A total of 12 operated rabbits were divided into four groups. Three experimental rabbit groups received 1 × 10^8 pfu of adenovirus encoding either IL-1Ra （3 rabbits）, sTNF-RI （3 rabbits） or IL-1Ra and sTNF-RI in combination （3 rabbits）, into both knee joints respectively. An inflamed control group of 3 rabbits received approximately 1 × 10^8 pfu of Ad-GFP into both joints. Three days after injection of the adenovirus, both knees of each rabbit were lavaged with 1 ml of saline solution through the patellar tendon. At day 7, the rabbits were sacrificed, and the knees were lavaged, dissected and analyzed for effects of transgene expression. Levels of IL-1Ra and sTNF-RI expression in recovered lavage fluids were measured using a cytokine ELISA kit. Cartilage from the lesion areas of medial femoral condyle and synovium were fixed, embedded, sectioned and stained with hematoxylin and eosin （cartilage and synovium） and toluidine blue （car展开更多
AIM:To investigate mortality reduction from gastric cancer based on the results of endoscopic screening.METHODS:The study population consisted of participants of gastric cancer screening by endoscopy,regular radiograp...AIM:To investigate mortality reduction from gastric cancer based on the results of endoscopic screening.METHODS:The study population consisted of participants of gastric cancer screening by endoscopy,regular radiography,and photofluorography at Niigata city in 2005.The observed numbers of cumulative deaths from gastric cancers and other cancers were accumulated by linkage with the Niigata Prefectural Cancer Registry.The standardized mortality ratio(SMR)of gastric cancer and other cancer deaths in each screening group was calculated by applying the mortality rate of the reference population.RESULTS:Based on the results calculated from the mortality rate of the population of Niigata city,the SMRs of gastric cancer death were 0.43(95%CI:0.30-0.57)for the endoscopic screening group,0.68(95%CI:0.55-0.79)for the regular radiographic screening group,and 0.85(95%CI:0.71-0.94)for the photofluorography screening group.The mortality reduction from gastric cancer was higher in the endoscopic screening group than in the regular radiographic screening group despite the nearly equal mortality rates of all cancers except gastric cancer.CONCLUSION:The 57%mortality reduction from gastric cancer might indicate the effectiveness of endoscopic screening for gastric cancer.Further studies and prudent interpretation of results are needed.展开更多
To elucidate the role of proton pump inhibitors (PPIs) in collagenous disease, direct effect of PPI on colonocytes was examined.METHODSCollagenous colitis is a common cause of non-bloody, watery diarrhea. Recently, th...To elucidate the role of proton pump inhibitors (PPIs) in collagenous disease, direct effect of PPI on colonocytes was examined.METHODSCollagenous colitis is a common cause of non-bloody, watery diarrhea. Recently, there has been increasing focus on the use of proton PPIs as a risk factor for developing collagenous colitis. Mouse CT26 colonic cells were treated with PPI and/or PPI-induced alkaline media. Expression of fibrosis-associated genes was examined by RT-PCR. In human materials, collagen expression was examined by immunohistochemistry.RESULTSCT26 cells expressed a Na<sup>+</sup>-H<sup>+</sup> exchanger gene (solute carrier family 9, member A2). Treatment with PPI and/or PPI-induced alkaline media caused growth inhibition and oxidative stress in CT26 cells. The treatment increased expression of fibrosis inducing factors, transforming growth factor β and fibroblast growth factor 2. The treatment also decreased expression of a negative regulator of collagen production, replication factor C1, resulting in increased expression of collagen types III and IV in association with lipid peroxide. In biopsy specimens from patients with collagenous colitis, type III and IV collagen were increased. Increase of type III collagen was more pronounced in PPI-associated collagenous colitis than in non-PPI-associated disease.CONCLUSIONFrom these findings, the reaction of colonocytes to PPI might participate in pathogenesis of collagenous colitis.展开更多
AIM： To evaluate the usefulness of the microcatheter techniques in balloon-occluded retrograde transvenous obliteration （BRTO） of gastric varices.METHODS： Fifty-six patients with gastric varices underwent BRTOs us...AIM： To evaluate the usefulness of the microcatheter techniques in balloon-occluded retrograde transvenous obliteration （BRTO） of gastric varices.METHODS： Fifty-six patients with gastric varices underwent BRTOs using microcatheters. A balloon catheter was inserted into gastrorenal or gastrocaval shunts. A microcatheter was navigated close to the varices, and sclerosant was injected into the varices through the microcatheter during balloon occlusion. The next morning, thrombosis of the varices was evaluated by contrast enhanced computed tomography （CE-CT）. In patients with incomplete thrombosis of the varices, a second BRTO was performed the following day. Patients were followed up with CE-CT and endoscopy.RESULTS： In all 56 patients, sclerosant was selectively injected through the microcatheter close to the varices. In 9 patients, microcoil embolization of collateral veinswas performed using a microcatheter. In 12 patients with incomplete thrombosis of the varices, additional injection of sclerosant was performed through the microcatheter that remained inserted overnight. Complete thrombosis of the varices was achieved in 51 of 56 patients, and the remaining 5 patients showed incomplete thrombosis of the varices. No recurrence of the varices was found in the successful 51 patients after a median follow up time of 10.5 too. We experienced one case of liver necrosis, and the other complications were transient.CONCLUSION： The microcatheter techniques are very effective methods for achieving a higher success rate of BRTO procedures,展开更多
AIM: To investigate whether the pro- and anti-inflammatory cytokine gene polymorphisms, IL1B-511C/T, IL1B-31C/T, IL6-634C/G, TNF-1031T/C, TNF-857C/T, and IL10-1082A/G, interact with smoking and drinking habits to infl...AIM: To investigate whether the pro- and anti-inflammatory cytokine gene polymorphisms, IL1B-511C/T, IL1B-31C/T, IL6-634C/G, TNF-1031T/C, TNF-857C/T, and IL10-1082A/G, interact with smoking and drinking habits to influence infection with H pylori.METHODS: The subjects were 410 Japanese transit company employees. C-reactive protein and conventional cardiovascular risk factors were evaluated. Serum anti-H pylori antibodies were measured. The genotypes of IL1B-511C/T, IL1B-31C/T, IL6-634C/G, TNF-1031T/C, TNF-857C/T, and IL10-1082A/G polymorphisms were determined by allelic discrimination using fluorogenic probes and a 5′nuclease assay.RESULTS: In gender- and age-adjusted logistic analyses, the subjects with TNF-857T/T had a significantly lower odds ratio (OR) for H pylori seropositivity (reference -857C/C; OR = 0.15, 95% CI: 0.03-0.59, P = 0.007). After stratification according to smoking and drinking status, among never-smokers, the subjects with IL1B-511C/T had a significantly lower OR (reference -511C/C; OR = 0.30, 95% CI: 0.10-0.90, P = 0.032). Among drinkers in the 1-5 times/wk category, the subjects with IL1B-511T/T had a significantly lower OR (reference C/C; OR = 0.38, 95% CI: 0.16-0.95, P = 0.039), and the subjects with IL1B-31C/T and T/T had a significantly higher OR (reference C/C; C/T: OR = 2.59, 95% CI, P = 0.042: 1.04-6.47; C/C: OR = 3.17, 95% CI: 1.23-8.14, P = 0.017). Among current smokers, the subjects withIL6-634C/G had a significantly higher OR (reference C/C; OR = 2.28, 95% CI: 1.13-4.58, P = 0.021). However, the interactions terms between the aforementioned genotypes and lifestyles were not statistically significant.CONCLUSION: Contrary to previous findings, the results herein suggest that the TNF-857T/T genotype may be protective against chronic infection with H pylori. Drinking and smoking habits may influence the effect of cytokine gene polymorphisms. Further studies are required to clarify the effects of the pro- and anti-inflammatory cytokine polymorphisms and gene-environmental interacti展开更多
As a result of donor shortage and high postoperative morbidity and mortality after liver transplantation,hepatectomy is the most widely applicable and reliable option for curative treatment of hepatocellular carcinoma...As a result of donor shortage and high postoperative morbidity and mortality after liver transplantation,hepatectomy is the most widely applicable and reliable option for curative treatment of hepatocellular carcinoma(HCC).Because intrahepatic tumor recurrence is frequent after loco-regional therapy,repeated treatments are advocated provided background liver function is maintained.Among treatments including local ablation and transarterial chemoembolization,hepatectomy provides the best long-term outcomes,but studies comparing hepatectomy with other nonsurgical treatments require careful review for selection bias.In patients with initially unresectable HCC,transarterial chemo-or radio-embolization,and/or systemic chemotherapy can down-stage the tumor and conversion to resectable HCC is achieved in approximately 20%of patients.However,complete response is rare,and salvage hepatectomy is essential to help prolong patients’survival.To counter the short recurrence-free survival,excellent overall survival is obtained by combining and repeating different treatments.It is important to recognize hepatectomy as a complement,rather than a contraindication,to other nonsurgical treatments in a mul-tidisciplinary approach for patients with HCC,including recurrent or unresectable tumors.展开更多
A novel Radio On Fiber(ROF) access is proposed and demonstrated which enables the pico-cell Base Station (BS) for high-speed wireless communications to eliminate external electric power supply facilities. We demonstra...A novel Radio On Fiber(ROF) access is proposed and demonstrated which enables the pico-cell Base Station (BS) for high-speed wireless communications to eliminate external electric power supply facilities. We demonstrated 2.4-GHz band radio signal transmission through the BS without external electric power supply. The electrical power used for BS circuit is feeded by optical power over optical fiber from central station.展开更多
To investigate factors related to resumption of smoking by women after childbirth, the smoking habits of 241 postnatal women, who initially had stopped smoking after pregnancy, in a rural city in Aomori Prefecture, Ja...To investigate factors related to resumption of smoking by women after childbirth, the smoking habits of 241 postnatal women, who initially had stopped smoking after pregnancy, in a rural city in Aomori Prefecture, Japan, were studied at 5 - 6 days, 1 month, and 12 months after childbirth. At 1 month after childbirth, only nine women had resumed smoking, but a total of 40 women had resumed smoking after 12 months. Factors related to smoking resumption after childbirth included the switching from breast feeding to bottle feeding and the influence of smoking by their spouses. Spousal smoking is an important factor in the resumption of smoking by women after childbirth.展开更多
<strong>Background:</strong> Harsh parenting practices during childhood have long-term negative effects on children’s mental health. A focus of nursing care on women’s resilience should be implemented be...<strong>Background:</strong> Harsh parenting practices during childhood have long-term negative effects on children’s mental health. A focus of nursing care on women’s resilience should be implemented because mothers who have experienced violence tend to be harsh parents. <strong>Aim:</strong> This study investigated the association between mothers’ violent experiences and harsh parenting (HP) and examined the effects of a sense of coherence (SOC) on this association, assuming that SOC can be an indicator of resilience. <strong>Method:</strong> In this prospective cohort study of 487 mothers, data were collected on SOC and history of intimate partner violence (IPV) at 1 year after childbirth and HP of their child at 18 months after childbirth. <strong>Results: </strong>In the 277 responses analyzed by multiple logistic regression analysis, a strong SOC moderating the effect on HP was observed for current IPV and witnessing IPV in childhood, but not for experiencing childhood corporal punishment. <strong>Discussion: </strong>SOC is a useful indicator of resilience in female victims of violence and is effective in regulating stress spillover. However, its effects are weakened by the learned acquisition aspect of violence.<strong> Conclusion</strong>: In nursing, providing support to alleviate stress and relearn parenting based on an assessment of the mother’s history of violence and SOC as the resilience indicator is important in curbing HP.展开更多
In this study, the wing design problem for different planforms for supersonic transport (SST) under supersonic and transonic cruise conditions is discussed to obtain knowledge of the supersonic air-foil from the viewp...In this study, the wing design problem for different planforms for supersonic transport (SST) under supersonic and transonic cruise conditions is discussed to obtain knowledge of the supersonic air-foil from the viewpoint of wing planform dependency. Two types of planforms were considered—a cranked arrow wing with a high sweep-back angle and a tapered wing with a low sweep- back angle. The optimum airfoils of these planforms were designed by efficient global optimization, which combined the evolutionary algorithm with the Kriging surrogate model. To acquire design knowledge, the functional analysis of variance was applied to the solution space and the design space. The design results show that the optimum airfoil and the contribution ratios of design variables for the airfoils of the two planform are different.展开更多
AIM: To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration(BRTO) for ruptured gastric varices.METHODS: Emergency BRTO was performed in 17 patients with gastric vari...AIM: To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration(BRTO) for ruptured gastric varices.METHODS: Emergency BRTO was performed in 17 patients with gastric varices and gastrorenal or gastrocaval shunts within 24 h of hematemesis and/or tarry stool.The gastric varices were confirmed by endoscopy,and the gastrorenal or gastrocaval shunts were identified by contrast-enhanced computed tomography(CE-CT).A 6-Fr balloon catheter(Cobra type) was inserted into the gastrorenal shunt via the right internal jugular vein,or into the gastrocaval shunt via the right femoral vein,depending on the varices drainage route.The sclerosant,5% ethanolamine oleate iopamidol,was injected into the gastric varices through the catheter during balloon occlusion.In patients with incom plete thrombosis of the varices after the first BRTO,a second BRTO was performed the following day.Patients were followed up by endoscopy and CE-CT at 1 d,1 wk,and 1,3 and 6 mo after the procedure,and every 6 mo thereafter.RESULTS: Complete thrombosis of the gastric varices was not achieved with the first BRTO in 7/17 patients because of large gastric varices.These patients underwent a second BRTO on the next day,and additional sclerosant was injected through the catheter.Complete thrombosis which led to disappearance of the varices was achieved in 16/17 patients,while the remaining patient had incomplete thrombosis of the varices.None of the patients experienced rebleeding or recurrence of the gastric varices after a median follow-up of 1130 d(range 8-2739 d).No major complications occurred after the procedure.However,esophageal varices worsened in 5/17 patients after a mean follow-up of 8.6 mo.CONCLUSION: Emergency BRTO is an effective and safe treatment for ruptured gastric varices.展开更多
The influences of DC and AC electric fields,at frequencies up to 1.48 MHz and the maximum strength of about 6 kV/cm,on soot formation and flame structure were investigated using a counterflow type acetylene diffusion ...The influences of DC and AC electric fields,at frequencies up to 1.48 MHz and the maximum strength of about 6 kV/cm,on soot formation and flame structure were investigated using a counterflow type acetylene diffusion flame.The distributions of flame luminosity,soot volume fraction,flame temperature and OH concentration in flame were measured by non-invasive detection methods. Under the influence of electric fields,the changes in distribution of the soot volume fraction were confirmed. Electric fields of high frequency and high intensity reduced the soot volume fraction,whereas other electric fields increased it.The maximum values of flame temperature and OH concentration decreased. In the relationship between the maximum value of the soot volume fraction and the maximum temperature,the maximum soot volume fraction showed both increase and decrease with maximum temperatures depending on the frequencies and intensities of the electric fields,and both of them occurred at temperatures lower than 1900 K.The production of the incipient particles seemed to be the dominant process controlling the soot volume fraction due to the electric fields.The luminosity of a sooting diffusion flame was found to depend on the volume fraction and temperature of the soot particles in the flame.As for the behavior of the flame in the electric fields,the ionic wind effect was not found to be dominant in the present work,and the result of the previous simulation based on the ionic wind theory was not consistent with the present experimental results.展开更多
Anchovy （Engraulis aponicus）, a small pelagic fish and food of other economic fishes, is a key species in the Yellow Sea ecosystem. Understanding the mechanisms of its recruitment and biomass variation is important ...Anchovy （Engraulis aponicus）, a small pelagic fish and food of other economic fishes, is a key species in the Yellow Sea ecosystem. Understanding the mechanisms of its recruitment and biomass variation is important for the prediction and management of fishery resources. Coupled with a hydrodynamic model （POM） and a lower trophic level ecosystem model （NEMURO）, an individual-based model of anchovy is developed to study the influence of physical environment on anchovy＇s biomass variation, Seasonal variations of circulation, water temperature and mix-layer depth from POM are used as external forcing for NEMURO and the anchovy model. Biomasses of large zooplankton and predatory zooplankton which anchovy feeds on are output from NEMURO and are controlled by the consumption of anchovy on them. Survival fitness theory related to temperature and food is used to determine the swimming action of anchovy in the model. The simulation results agree well with observations and elucidate the influence of temperature in over-wintering migration and food in feeding migration.展开更多
Background: Clozapine is the most efficacious among antipsychotics for patients with schizophrenia. Nevertheless, clozapine is not effective in more than about 50% of treatment refractory schizophrenia patients, and s...Background: Clozapine is the most efficacious among antipsychotics for patients with schizophrenia. Nevertheless, clozapine is not effective in more than about 50% of treatment refractory schizophrenia patients, and several pharmacological strategies are used to augment it. Several reviews including meta-analyses have been published, but the efficacy of augmentation therapy for clozapine-resistant patients is not adequately supported. Though there is a weak connection between the oral dose and plasma concentration of clozapine, there is no report of augmentation therapy considering the plasma concentration of clozapine. Blonanserin is reported to be effective in treatment of both positive and negative symptoms of schizophrenia and well tolerated. Methods: We obtained consent to evaluate clinical presentations and clozapine plasma concentrations at the Okayama Psychiatric Medical Center and had not identified the individual for ethical reasons. This is a case report. Results: This case fulfilled the diagnostic criteria of neuroleptic-induced dopamine supersensitivity psychosis. Monotherapy with blonanserin was not effective, but augmentation of blonanserin with clozapine was effective and well tolerated by a clozapine-resistant schizophrenia patient. Conclusion: Because clozapine may ameliorate dopamine supersensitivity psychosis, the addition of blonanserin to clozapine may be effective even if monotherapy with blonanserin was not.展开更多
More than 20 years have passed since the first report of laparoscopic colectomy in 1991. Thereafter, laparoscopic surgery for the management of colorectal diseases has been widely accepted as a prevailing option becau...More than 20 years have passed since the first report of laparoscopic colectomy in 1991. Thereafter, laparoscopic surgery for the management of colorectal diseases has been widely accepted as a prevailing option because of improved cosmetic outcomes, less postoperative pain, and shorter hospital stay in comparison with open surgery. To further the principle of minimally invasive surgery, two new approaches have been developed in this rapidly evolving field. The first is the totally laparoscopic approach. Currently most of standard techniques inevitably involve an abdominalincision for retrieval of the specimen and preparation for anastomosis, which might compromise the benefits of laparoscopic surgery. The totally laparoscopic approach dispenses with this incision by combining completely intraperitoneal anastomosis with retrieval of the specimen via a natural orifice, such as the anus or the vagina. Our new and reliable technique for intraperitoneal anastomosis is also described in detail in this article. The second is the single-incision approach. While three to six ports are needed in standard laparoscopic surgery, the single-incision approach uses the umbilicus as the sole access to the abdominal cavity. All of the laparoscopic procedures are performed entirely through the umbilicus, in which the surgical scar eventually becomes hidden, achieving virtually scarless surgery. This article reviews the current status of these two approaches and discusses the future of minimally invasive surgery for colorectal diseases.展开更多
The autofluorescence visualization method （AVM） uses blue excitation light to assist in the diagnosis of epithelial dysplasia. It detects epithelial dysplasia as a black area, which is known as fluorescence visualiz...The autofluorescence visualization method （AVM） uses blue excitation light to assist in the diagnosis of epithelial dysplasia. It detects epithelial dysplasia as a black area, which is known as fluorescence visualization loss （FVL）. In this study, we evaluated the detection accuracy for epithelial dysplasia of the tongue using the objective AVM and assessed its possible clinical utility. Seventy-nine tongue specimens clinically suspected to have leukoplakia or squamous cell carcinoma （SCC） were analyzed. First, the AVM was subjectively performed using the Visually Enhanced Lesion scope （VELscope）, and the iodine-staining method was then performed. After biopsy, the histopathological results and the luminance ratio between the lesion and healthy tissue were compared, and a receiver operating characteristic curve was created. The cutoff value for the objective AVM was determined; the lesion was considered FVL-positive or -negative when the luminance ratio was higher or lower than the cutoff value, respectively. The histopathological diagnoses among the 79 specimens were SCC （n = 30）, leukoplakia with dysplasia （n = 34）, and leukoplakia without dysplasia （n= 15）. The cutoff value of the luminance ratio was 1.62, resulting in 66 FVL-positive and 13 FVL-negative specimens. The luminance ratio was significantly higher in the epithelial dysplasia-positive than -negative group （P〈O.O00 1）. The objective AVM showed much higher consistency between histopathological results than did the two methods （kappa statistic = 0.656）. In conclusion, objective autofluorescence visualization has a potential as an auxiliary method for diagnosis of epithelial dysplasia.展开更多
To investigate the characteristic food intake during early pregnancy in women with gestational diabetes mellitus (GDM) in a rural city in Aomori Prefecture, Japan, one hundred and twenty-one women were recruited and q...To investigate the characteristic food intake during early pregnancy in women with gestational diabetes mellitus (GDM) in a rural city in Aomori Prefecture, Japan, one hundred and twenty-one women were recruited and queried about their habitual dietary intake. Food intake of patients was assessed using the model nutritional balance chart at 12 - 16, 24 - 28, and 34 - 36 weeks of gestation. Of the 121 pregnant women examined, 19 were obese. During early pregnancy, food intake ratios of the obese women were significantly lower than those of the non-obese women for the categories of milk (p < 0.001) and sugar (p < 0.05). GDM group was 7 women among 19 women in obesity group during mid-pregnancy. During early pregnancy, women with GDM had significantly higher sugar intake ratios than women without GDM (p < 0.05). These results suggested that obese pregnant women are able to prevent GDM by limiting their sugar intake during early pregnancy.展开更多
AIM: To investigate whether a subcutaneous penrose drain would decrease the superficial surgical site infection (s-SSI) rate in elective colorectal surgery. METHODS: This is a comparative study of the historical contr...AIM: To investigate whether a subcutaneous penrose drain would decrease the superficial surgical site infection (s-SSI) rate in elective colorectal surgery. METHODS: This is a comparative study of the historical control type. Intervention consisted of the use of penrose drain in elective open colorectal surgical wounds. The outcome was an incidence of s-SSI. The patients were risk stratified according to the depth of subcutaneous tissue.RESULTS: There were 131 patients (40 patients with high s-SSI risk) in the prior period (from July 2008 to June 2009, when no penrose drains were inserted) and 151 patients (75 patients with high s-SSI risk) in the latter period (from June 2010 to November 2011, when penrose drains were inserted). The overall s-SSI rate was 6.1% and 5.3% during the two periods (P = 0.770), and the s-SSI rate in the high s-SSI risk group was 15.0% and 8.0% (P = 0.242).CONCLUSION: Although penrose drain was not observed to significantly reduce s-SSI, there tended to be a reduced risk of s-SSI in the high s-SSI risk group.展开更多
文摘There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases.This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly prone to these diseases.By contrast,Caucasians are less likely to develop keloids and hypertrophic scars,and if they do,the scars tend not to be severe.This ethnic disparity also means that countries vary in terms of their differential diagnostic algorithms.The lack of clear treatment guidelines also means that primary care physicians are currently applying a hotchpotch of treatments,with uneven outcomes.To overcome these issues,the Japan Scar Workshop(JSW)has created a tool that allows clinicians to objectively diagnose and distinguish between keloids,hypertrophic scars,and mature scars.This tool is called the JSW Scar Scale(JSS)and it involves scoring the risk factors of the individual patients and the affected areas.The tool is simple and easy to use.As a result,even physicians who are not accustomed to keloids and hypertrophic scars can easily diagnose them and judge their severity.The JSW has also established a committee that,in cooperation with outside experts in various fields,has prepared a Consensus Document on keloid and hypertrophic scar treatment guidelines.These guidelines are simple and will allow even inexperienced clinicians to choose the most appropriate treatment strategy.The Consensus Document is provided in this article.It describes(1)the diagnostic algorithm for pathological scars and how to differentiate them from clinically similar benign and malignant tumors,(2)the general treatment algorithms for keloids and hypertrophic scars at different medical facilities,(3)the rationale behind each treatment for keloids and hypertrophic scars,and(4)the body site-specific treatment protocols for these scars.We believe that this Consensus Document will be helpful for physi
文摘Background Osteoarthritis （OA） is a chronic and incurable disease, lacking effective treatment. Gene therapy offers a radical different approach to the treatment of arthritis. Even though the etiology of OA remains unclear, there is now considerable evidence to suggest that interleukin-1 （IL-1） and tumor necrosis factor- α （TNF- α ） are the main mediators in the pathogenesis of OA. The goal of this study was to determine the efficacy of local expression of interleukin-1 receptor antagonist （IL-1Ra） and soluble tumor necrosis factor- α receptor type Ⅰ （sTNF-RI） by direct adenoviral-mediated intra-articular gene delivery in the rabbit model of osteoarthritis. Methods Adenoviral vectors containing IL-1Ra or sTNF-RI genes were constructed. OA was induced in both hind knees of 12 New Zealand white rabbits by the excision of the medial collateral ligament plus medial meniscectomy. Five days after surgery, approximately 1 × 10^8 plaque-forming units （pfu） of adenovirus were injected into the joint space of the knee through the patellar tendon. A total of 12 operated rabbits were divided into four groups. Three experimental rabbit groups received 1 × 10^8 pfu of adenovirus encoding either IL-1Ra （3 rabbits）, sTNF-RI （3 rabbits） or IL-1Ra and sTNF-RI in combination （3 rabbits）, into both knee joints respectively. An inflamed control group of 3 rabbits received approximately 1 × 10^8 pfu of Ad-GFP into both joints. Three days after injection of the adenovirus, both knees of each rabbit were lavaged with 1 ml of saline solution through the patellar tendon. At day 7, the rabbits were sacrificed, and the knees were lavaged, dissected and analyzed for effects of transgene expression. Levels of IL-1Ra and sTNF-RI expression in recovered lavage fluids were measured using a cytokine ELISA kit. Cartilage from the lesion areas of medial femoral condyle and synovium were fixed, embedded, sectioned and stained with hematoxylin and eosin （cartilage and synovium） and toluidine blue （car
基金Supported by Grant-in-Aid for H22-Third Term Comprehensive Control Research for Cancer 022 from the Japanese Ministry of Health,Labour and Welfare
文摘AIM:To investigate mortality reduction from gastric cancer based on the results of endoscopic screening.METHODS:The study population consisted of participants of gastric cancer screening by endoscopy,regular radiography,and photofluorography at Niigata city in 2005.The observed numbers of cumulative deaths from gastric cancers and other cancers were accumulated by linkage with the Niigata Prefectural Cancer Registry.The standardized mortality ratio(SMR)of gastric cancer and other cancer deaths in each screening group was calculated by applying the mortality rate of the reference population.RESULTS:Based on the results calculated from the mortality rate of the population of Niigata city,the SMRs of gastric cancer death were 0.43(95%CI:0.30-0.57)for the endoscopic screening group,0.68(95%CI:0.55-0.79)for the regular radiographic screening group,and 0.85(95%CI:0.71-0.94)for the photofluorography screening group.The mortality reduction from gastric cancer was higher in the endoscopic screening group than in the regular radiographic screening group despite the nearly equal mortality rates of all cancers except gastric cancer.CONCLUSION:The 57%mortality reduction from gastric cancer might indicate the effectiveness of endoscopic screening for gastric cancer.Further studies and prudent interpretation of results are needed.
基金Supportedby MEXT KAKENHI,No.14478268 and No.16675788
文摘To elucidate the role of proton pump inhibitors (PPIs) in collagenous disease, direct effect of PPI on colonocytes was examined.METHODSCollagenous colitis is a common cause of non-bloody, watery diarrhea. Recently, there has been increasing focus on the use of proton PPIs as a risk factor for developing collagenous colitis. Mouse CT26 colonic cells were treated with PPI and/or PPI-induced alkaline media. Expression of fibrosis-associated genes was examined by RT-PCR. In human materials, collagen expression was examined by immunohistochemistry.RESULTSCT26 cells expressed a Na<sup>+</sup>-H<sup>+</sup> exchanger gene (solute carrier family 9, member A2). Treatment with PPI and/or PPI-induced alkaline media caused growth inhibition and oxidative stress in CT26 cells. The treatment increased expression of fibrosis inducing factors, transforming growth factor β and fibroblast growth factor 2. The treatment also decreased expression of a negative regulator of collagen production, replication factor C1, resulting in increased expression of collagen types III and IV in association with lipid peroxide. In biopsy specimens from patients with collagenous colitis, type III and IV collagen were increased. Increase of type III collagen was more pronounced in PPI-associated collagenous colitis than in non-PPI-associated disease.CONCLUSIONFrom these findings, the reaction of colonocytes to PPI might participate in pathogenesis of collagenous colitis.
文摘AIM： To evaluate the usefulness of the microcatheter techniques in balloon-occluded retrograde transvenous obliteration （BRTO） of gastric varices.METHODS： Fifty-six patients with gastric varices underwent BRTOs using microcatheters. A balloon catheter was inserted into gastrorenal or gastrocaval shunts. A microcatheter was navigated close to the varices, and sclerosant was injected into the varices through the microcatheter during balloon occlusion. The next morning, thrombosis of the varices was evaluated by contrast enhanced computed tomography （CE-CT）. In patients with incomplete thrombosis of the varices, a second BRTO was performed the following day. Patients were followed up with CE-CT and endoscopy.RESULTS： In all 56 patients, sclerosant was selectively injected through the microcatheter close to the varices. In 9 patients, microcoil embolization of collateral veinswas performed using a microcatheter. In 12 patients with incomplete thrombosis of the varices, additional injection of sclerosant was performed through the microcatheter that remained inserted overnight. Complete thrombosis of the varices was achieved in 51 of 56 patients, and the remaining 5 patients showed incomplete thrombosis of the varices. No recurrence of the varices was found in the successful 51 patients after a median follow up time of 10.5 too. We experienced one case of liver necrosis, and the other complications were transient.CONCLUSION： The microcatheter techniques are very effective methods for achieving a higher success rate of BRTO procedures,
基金a Grant-in-Aid for Young Scientists from the Ministry of Education,Culture,Sports,Science and Technology of Japana Grant-in-Aid for Scientific Research from the Ministry of Health,Labour and Welfare of Japan
文摘AIM: To investigate whether the pro- and anti-inflammatory cytokine gene polymorphisms, IL1B-511C/T, IL1B-31C/T, IL6-634C/G, TNF-1031T/C, TNF-857C/T, and IL10-1082A/G, interact with smoking and drinking habits to influence infection with H pylori.METHODS: The subjects were 410 Japanese transit company employees. C-reactive protein and conventional cardiovascular risk factors were evaluated. Serum anti-H pylori antibodies were measured. The genotypes of IL1B-511C/T, IL1B-31C/T, IL6-634C/G, TNF-1031T/C, TNF-857C/T, and IL10-1082A/G polymorphisms were determined by allelic discrimination using fluorogenic probes and a 5′nuclease assay.RESULTS: In gender- and age-adjusted logistic analyses, the subjects with TNF-857T/T had a significantly lower odds ratio (OR) for H pylori seropositivity (reference -857C/C; OR = 0.15, 95% CI: 0.03-0.59, P = 0.007). After stratification according to smoking and drinking status, among never-smokers, the subjects with IL1B-511C/T had a significantly lower OR (reference -511C/C; OR = 0.30, 95% CI: 0.10-0.90, P = 0.032). Among drinkers in the 1-5 times/wk category, the subjects with IL1B-511T/T had a significantly lower OR (reference C/C; OR = 0.38, 95% CI: 0.16-0.95, P = 0.039), and the subjects with IL1B-31C/T and T/T had a significantly higher OR (reference C/C; C/T: OR = 2.59, 95% CI, P = 0.042: 1.04-6.47; C/C: OR = 3.17, 95% CI: 1.23-8.14, P = 0.017). Among current smokers, the subjects withIL6-634C/G had a significantly higher OR (reference C/C; OR = 2.28, 95% CI: 1.13-4.58, P = 0.021). However, the interactions terms between the aforementioned genotypes and lifestyles were not statistically significant.CONCLUSION: Contrary to previous findings, the results herein suggest that the TNF-857T/T genotype may be protective against chronic infection with H pylori. Drinking and smoking habits may influence the effect of cytokine gene polymorphisms. Further studies are required to clarify the effects of the pro- and anti-inflammatory cytokine polymorphisms and gene-environmental interacti
基金Supported by Grant-in-aid from the 106~(th) Annual Congress of the JSS Memorial Surgical Research Fund,Tokyo,Japan
文摘As a result of donor shortage and high postoperative morbidity and mortality after liver transplantation,hepatectomy is the most widely applicable and reliable option for curative treatment of hepatocellular carcinoma(HCC).Because intrahepatic tumor recurrence is frequent after loco-regional therapy,repeated treatments are advocated provided background liver function is maintained.Among treatments including local ablation and transarterial chemoembolization,hepatectomy provides the best long-term outcomes,but studies comparing hepatectomy with other nonsurgical treatments require careful review for selection bias.In patients with initially unresectable HCC,transarterial chemo-or radio-embolization,and/or systemic chemotherapy can down-stage the tumor and conversion to resectable HCC is achieved in approximately 20%of patients.However,complete response is rare,and salvage hepatectomy is essential to help prolong patients’survival.To counter the short recurrence-free survival,excellent overall survival is obtained by combining and repeating different treatments.It is important to recognize hepatectomy as a complement,rather than a contraindication,to other nonsurgical treatments in a mul-tidisciplinary approach for patients with HCC,including recurrent or unresectable tumors.
文摘A novel Radio On Fiber(ROF) access is proposed and demonstrated which enables the pico-cell Base Station (BS) for high-speed wireless communications to eliminate external electric power supply facilities. We demonstrated 2.4-GHz band radio signal transmission through the BS without external electric power supply. The electrical power used for BS circuit is feeded by optical power over optical fiber from central station.
文摘To investigate factors related to resumption of smoking by women after childbirth, the smoking habits of 241 postnatal women, who initially had stopped smoking after pregnancy, in a rural city in Aomori Prefecture, Japan, were studied at 5 - 6 days, 1 month, and 12 months after childbirth. At 1 month after childbirth, only nine women had resumed smoking, but a total of 40 women had resumed smoking after 12 months. Factors related to smoking resumption after childbirth included the switching from breast feeding to bottle feeding and the influence of smoking by their spouses. Spousal smoking is an important factor in the resumption of smoking by women after childbirth.
文摘<strong>Background:</strong> Harsh parenting practices during childhood have long-term negative effects on children’s mental health. A focus of nursing care on women’s resilience should be implemented because mothers who have experienced violence tend to be harsh parents. <strong>Aim:</strong> This study investigated the association between mothers’ violent experiences and harsh parenting (HP) and examined the effects of a sense of coherence (SOC) on this association, assuming that SOC can be an indicator of resilience. <strong>Method:</strong> In this prospective cohort study of 487 mothers, data were collected on SOC and history of intimate partner violence (IPV) at 1 year after childbirth and HP of their child at 18 months after childbirth. <strong>Results: </strong>In the 277 responses analyzed by multiple logistic regression analysis, a strong SOC moderating the effect on HP was observed for current IPV and witnessing IPV in childhood, but not for experiencing childhood corporal punishment. <strong>Discussion: </strong>SOC is a useful indicator of resilience in female victims of violence and is effective in regulating stress spillover. However, its effects are weakened by the learned acquisition aspect of violence.<strong> Conclusion</strong>: In nursing, providing support to alleviate stress and relearn parenting based on an assessment of the mother’s history of violence and SOC as the resilience indicator is important in curbing HP.
文摘In this study, the wing design problem for different planforms for supersonic transport (SST) under supersonic and transonic cruise conditions is discussed to obtain knowledge of the supersonic air-foil from the viewpoint of wing planform dependency. Two types of planforms were considered—a cranked arrow wing with a high sweep-back angle and a tapered wing with a low sweep- back angle. The optimum airfoils of these planforms were designed by efficient global optimization, which combined the evolutionary algorithm with the Kriging surrogate model. To acquire design knowledge, the functional analysis of variance was applied to the solution space and the design space. The design results show that the optimum airfoil and the contribution ratios of design variables for the airfoils of the two planform are different.
文摘AIM: To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration(BRTO) for ruptured gastric varices.METHODS: Emergency BRTO was performed in 17 patients with gastric varices and gastrorenal or gastrocaval shunts within 24 h of hematemesis and/or tarry stool.The gastric varices were confirmed by endoscopy,and the gastrorenal or gastrocaval shunts were identified by contrast-enhanced computed tomography(CE-CT).A 6-Fr balloon catheter(Cobra type) was inserted into the gastrorenal shunt via the right internal jugular vein,or into the gastrocaval shunt via the right femoral vein,depending on the varices drainage route.The sclerosant,5% ethanolamine oleate iopamidol,was injected into the gastric varices through the catheter during balloon occlusion.In patients with incom plete thrombosis of the varices after the first BRTO,a second BRTO was performed the following day.Patients were followed up by endoscopy and CE-CT at 1 d,1 wk,and 1,3 and 6 mo after the procedure,and every 6 mo thereafter.RESULTS: Complete thrombosis of the gastric varices was not achieved with the first BRTO in 7/17 patients because of large gastric varices.These patients underwent a second BRTO on the next day,and additional sclerosant was injected through the catheter.Complete thrombosis which led to disappearance of the varices was achieved in 16/17 patients,while the remaining patient had incomplete thrombosis of the varices.None of the patients experienced rebleeding or recurrence of the gastric varices after a median follow-up of 1130 d(range 8-2739 d).No major complications occurred after the procedure.However,esophageal varices worsened in 5/17 patients after a mean follow-up of 8.6 mo.CONCLUSION: Emergency BRTO is an effective and safe treatment for ruptured gastric varices.
基金supported by Grant-in-Aid for Scientific Research on Priority Area“Exploration of Combustion Mechanism”
文摘The influences of DC and AC electric fields,at frequencies up to 1.48 MHz and the maximum strength of about 6 kV/cm,on soot formation and flame structure were investigated using a counterflow type acetylene diffusion flame.The distributions of flame luminosity,soot volume fraction,flame temperature and OH concentration in flame were measured by non-invasive detection methods. Under the influence of electric fields,the changes in distribution of the soot volume fraction were confirmed. Electric fields of high frequency and high intensity reduced the soot volume fraction,whereas other electric fields increased it.The maximum values of flame temperature and OH concentration decreased. In the relationship between the maximum value of the soot volume fraction and the maximum temperature,the maximum soot volume fraction showed both increase and decrease with maximum temperatures depending on the frequencies and intensities of the electric fields,and both of them occurred at temperatures lower than 1900 K.The production of the incipient particles seemed to be the dominant process controlling the soot volume fraction due to the electric fields.The luminosity of a sooting diffusion flame was found to depend on the volume fraction and temperature of the soot particles in the flame.As for the behavior of the flame in the electric fields,the ionic wind effect was not found to be dominant in the present work,and the result of the previous simulation based on the ionic wind theory was not consistent with the present experimental results.
基金supported by the National Natural Science Foundation of China (Grant No. 40830854)the National Basic Research Program of China (Grant No.2011CB403606)
文摘Anchovy （Engraulis aponicus）, a small pelagic fish and food of other economic fishes, is a key species in the Yellow Sea ecosystem. Understanding the mechanisms of its recruitment and biomass variation is important for the prediction and management of fishery resources. Coupled with a hydrodynamic model （POM） and a lower trophic level ecosystem model （NEMURO）, an individual-based model of anchovy is developed to study the influence of physical environment on anchovy＇s biomass variation, Seasonal variations of circulation, water temperature and mix-layer depth from POM are used as external forcing for NEMURO and the anchovy model. Biomasses of large zooplankton and predatory zooplankton which anchovy feeds on are output from NEMURO and are controlled by the consumption of anchovy on them. Survival fitness theory related to temperature and food is used to determine the swimming action of anchovy in the model. The simulation results agree well with observations and elucidate the influence of temperature in over-wintering migration and food in feeding migration.
文摘Background: Clozapine is the most efficacious among antipsychotics for patients with schizophrenia. Nevertheless, clozapine is not effective in more than about 50% of treatment refractory schizophrenia patients, and several pharmacological strategies are used to augment it. Several reviews including meta-analyses have been published, but the efficacy of augmentation therapy for clozapine-resistant patients is not adequately supported. Though there is a weak connection between the oral dose and plasma concentration of clozapine, there is no report of augmentation therapy considering the plasma concentration of clozapine. Blonanserin is reported to be effective in treatment of both positive and negative symptoms of schizophrenia and well tolerated. Methods: We obtained consent to evaluate clinical presentations and clozapine plasma concentrations at the Okayama Psychiatric Medical Center and had not identified the individual for ethical reasons. This is a case report. Results: This case fulfilled the diagnostic criteria of neuroleptic-induced dopamine supersensitivity psychosis. Monotherapy with blonanserin was not effective, but augmentation of blonanserin with clozapine was effective and well tolerated by a clozapine-resistant schizophrenia patient. Conclusion: Because clozapine may ameliorate dopamine supersensitivity psychosis, the addition of blonanserin to clozapine may be effective even if monotherapy with blonanserin was not.
文摘More than 20 years have passed since the first report of laparoscopic colectomy in 1991. Thereafter, laparoscopic surgery for the management of colorectal diseases has been widely accepted as a prevailing option because of improved cosmetic outcomes, less postoperative pain, and shorter hospital stay in comparison with open surgery. To further the principle of minimally invasive surgery, two new approaches have been developed in this rapidly evolving field. The first is the totally laparoscopic approach. Currently most of standard techniques inevitably involve an abdominalincision for retrieval of the specimen and preparation for anastomosis, which might compromise the benefits of laparoscopic surgery. The totally laparoscopic approach dispenses with this incision by combining completely intraperitoneal anastomosis with retrieval of the specimen via a natural orifice, such as the anus or the vagina. Our new and reliable technique for intraperitoneal anastomosis is also described in detail in this article. The second is the single-incision approach. While three to six ports are needed in standard laparoscopic surgery, the single-incision approach uses the umbilicus as the sole access to the abdominal cavity. All of the laparoscopic procedures are performed entirely through the umbilicus, in which the surgical scar eventually becomes hidden, achieving virtually scarless surgery. This article reviews the current status of these two approaches and discusses the future of minimally invasive surgery for colorectal diseases.
文摘The autofluorescence visualization method （AVM） uses blue excitation light to assist in the diagnosis of epithelial dysplasia. It detects epithelial dysplasia as a black area, which is known as fluorescence visualization loss （FVL）. In this study, we evaluated the detection accuracy for epithelial dysplasia of the tongue using the objective AVM and assessed its possible clinical utility. Seventy-nine tongue specimens clinically suspected to have leukoplakia or squamous cell carcinoma （SCC） were analyzed. First, the AVM was subjectively performed using the Visually Enhanced Lesion scope （VELscope）, and the iodine-staining method was then performed. After biopsy, the histopathological results and the luminance ratio between the lesion and healthy tissue were compared, and a receiver operating characteristic curve was created. The cutoff value for the objective AVM was determined; the lesion was considered FVL-positive or -negative when the luminance ratio was higher or lower than the cutoff value, respectively. The histopathological diagnoses among the 79 specimens were SCC （n = 30）, leukoplakia with dysplasia （n = 34）, and leukoplakia without dysplasia （n= 15）. The cutoff value of the luminance ratio was 1.62, resulting in 66 FVL-positive and 13 FVL-negative specimens. The luminance ratio was significantly higher in the epithelial dysplasia-positive than -negative group （P〈O.O00 1）. The objective AVM showed much higher consistency between histopathological results than did the two methods （kappa statistic = 0.656）. In conclusion, objective autofluorescence visualization has a potential as an auxiliary method for diagnosis of epithelial dysplasia.
文摘To investigate the characteristic food intake during early pregnancy in women with gestational diabetes mellitus (GDM) in a rural city in Aomori Prefecture, Japan, one hundred and twenty-one women were recruited and queried about their habitual dietary intake. Food intake of patients was assessed using the model nutritional balance chart at 12 - 16, 24 - 28, and 34 - 36 weeks of gestation. Of the 121 pregnant women examined, 19 were obese. During early pregnancy, food intake ratios of the obese women were significantly lower than those of the non-obese women for the categories of milk (p < 0.001) and sugar (p < 0.05). GDM group was 7 women among 19 women in obesity group during mid-pregnancy. During early pregnancy, women with GDM had significantly higher sugar intake ratios than women without GDM (p < 0.05). These results suggested that obese pregnant women are able to prevent GDM by limiting their sugar intake during early pregnancy.
基金Supported by Osaka Medical Center for Cancer and Cardiovascular Diseases
文摘AIM: To investigate whether a subcutaneous penrose drain would decrease the superficial surgical site infection (s-SSI) rate in elective colorectal surgery. METHODS: This is a comparative study of the historical control type. Intervention consisted of the use of penrose drain in elective open colorectal surgical wounds. The outcome was an incidence of s-SSI. The patients were risk stratified according to the depth of subcutaneous tissue.RESULTS: There were 131 patients (40 patients with high s-SSI risk) in the prior period (from July 2008 to June 2009, when no penrose drains were inserted) and 151 patients (75 patients with high s-SSI risk) in the latter period (from June 2010 to November 2011, when penrose drains were inserted). The overall s-SSI rate was 6.1% and 5.3% during the two periods (P = 0.770), and the s-SSI rate in the high s-SSI risk group was 15.0% and 8.0% (P = 0.242).CONCLUSION: Although penrose drain was not observed to significantly reduce s-SSI, there tended to be a reduced risk of s-SSI in the high s-SSI risk group.
