Reactive oxygen species (ROS) produced by neutrophils are crucial for defense against infectious diseases, and the adequate measurement of ROS levels is an important way to evaluate the possibility of infections. The fluorescent probe dihydrorhodamine 123 has been applied exclusively to the measurement of ROS thus far. We developed a novel method for detecting ROS, which utilizes the chemiluminescent probes Luminol and Diogenes. The new method quantitatively detects ROS produced by as few as 10 to 10⁴ neutrophils. Furthermore, this method can detect ROS levels in one microliter of whole blood or ROS produced by Epstein-Barr immortalized B lymphocytes. This method will be valuable for prompt diagnosis of neonatal chronic granulomatous diseases in which neutrophils aberrantly produce superoxide.

This study was performed to clarify whether local anesthesia or sympathetic ganglion block abolishes the effects of electrical acupuncture (EA) on the autonomic nervous system or not.
Twelve healthy adult volunteers and 24 patients are divided into the following three experimental groups of each 12. EA was performed to the traditional acupuncture points on the meridians (H7; SHENMEN and CX4; HSIMEN). (1) In control group, only EA was performed. (2) In stellate ganglion block (SGB) group, EA was performed after unilateral SGB. (3) In local anesthesia (LA) group, EA was performed after local anesthesia on the same acupuncture points. The measured parameters on the autonomic nervous system functions were heart rates, R-R intervals in ECG, blood pressure and deep tissue temperature.
Results are as follows; Means of heart rate decreased significantly by EA in both control and SGB groups. Systolic blood pressure, diastolic blood pressure and RR-CV showed no significant changes by EA in all groups. Deep tissue temperature of the anterior forearm ipsilateral to the stimulation side decreased significantly by EA in SGB group. Deep tissure temperature of the anterior forearm contralateral to the stimuli decreased significantly by EA in both control and SGB groups. In LA group, however, all parameters were not changed by EA.
In summary, the effects of electrical acupuncture on the autonomic nervous system were not much different between control and SGB groups. It seems that one side of stellate ganglion block dose not interfere with the effects of acupuncture. On the other hand, any changes on the autonomic nervous system by electrical acupuncture were not observed in LA group. The fact showed that local anesthesia abolishes the effects of acupuncture on site. Local anesthesia blocks peripheral nerves and nerve endings. Therefore, we conclude that the effects of acupuncture on the autonomic nervous system are transmitted through the peripheral nerves, especially through the sensory nerves.

The purpose of this study was to explore the burden of introducing LCP-J in two wards（medical oncology and respiratory medicine）in Tohoku University Hospital. We administered audit evaluations about dying cancer patients and interviewed 2 doctors and 8 nurses regarding LCP-J intervention. LCP-J was used for 22 patients（38％）, and no significant difference in infusion, potent opioid analgesic and sedative medication within last 48 hours were seen between users and nonusers. Responses were categorized into［confirm directions about dying care among health care professionals］, and［training in dying care in a structured way］as usefulness facets of the LCP-J, and［difficulty in assessment of dying］,［burden of health care professionals］, and［difficulty using LCP-J without knowledge and training in dying care］as burdens of the LCP-J. We explored the burden of LCP-J in general wards, and found that use of the LCP-J could need education in dying care and backup of the palliative care team.

STUDY DESIGN: Retrospective study. PURPOSE: The purpose of this study was to investigate the influence of sagittal alignment of the strut graft on graft subsidence and clinical outcomes after anterior cervical corpectomy and fusion (ACCF). OVERVIEW OF LITERATURE: ACCF is a common technique for the treatment of various cervical pathologies. Although graft subsidence sometimes occurs after ACCF, it is one cause for poor clinical results. Malalignment of the strut graft is probably one of the factors associated with graft subsidence. However, to the best of our knowledge, no prior reports have demonstrated correlations between the alignment of the strut graft and clinical outcomes. METHODS: We evaluated 56 patients (33 men and 23 women; mean age, 59 years; range, 33–84 years; 45 with cervical spondylotic myelopathy and 11 with ossification of the posterior longitudinal ligament) who underwent one- or two-level ACCF with an autogenous fibular strut graft and anterior plating. The Japanese Orthopaedic Association (JOA) score recovery ratio for cervical spondylotic myelopathy was used to evaluate clinical outcomes. The JOA score and lateral radiograms were evaluated 1 week and 1 year postoperatively. Patients were divided into two groups (a straight group [group I] and an oblique group [group Z]) based on radiographic assessment of the sagittal alignment of the strut graft. RESULTS: Group I showed a significantly greater JOA score recovery ratio (p<0.05) and a significantly lower graft subsidence than group Z (p<0.01). CONCLUSIONS: Our findings suggest that a straight alignment of the strut graft provides better clinical outcomes and lower incidence of graft subsidence after ACCF. In contrast, an oblique strut graft can lead to significantly increased strut graft subsidence and poor clinical results.
Asian Continental Ancestry Group ; Bone Transplantation ; Cervical Vertebrae ; Clinical Study ; Female ; Humans ; Incidence ; Male ; Pathology ; Retrospective Studies ; Spinal Cord Compression ; Spinal Cord Diseases ; Spinal Fusion ; Transplants*

Purpose: Nursing is traditionally considered a female profession, and male nursing students face gender stereotype barriers. Most studies of male nursing students in Japan focus on their learning experiences in maternal nursing, and little is known about the experiences of male nursing students in their usual learning environment. Therefore, the purpose of this study is to explore the barriers and coping strategies of Japanese male nursing students in nursing education, including classroom and practical training. Methods: A qualitative descriptive design was used to study 20 male nursing students from eight Japanese universities. Purposive sampling using the snowball method was used to recruit participants. Semistructured interviews were used to gather data about the participants’ thoughts and experiences in nursing education. All interview data were analyzed using thematic analysis. Results: Four themes emerged from the data: (1) nursing choices of own volition; (2) loneliness due to the female-dominated environment and marginalization; (3) dealing with barriers and seeking support; and (4) positive experiences in nursing education. Male nursing students face barriers such as loneliness and feelings of alienation. Family support, mutual support among male nursing students, and the presence of role models were factors that addressed these barriers and positively influenced career choice. Conclusions This research suggests that nursing educators need to understand the barriers faced by male nursing students and provide a gender-neutral learning environment for all students.

Women with BRCA1/2 mutations have a high risk of breast cancer and may opt for risk-reducing mastectomy (RRM). We report a 38-year-old Japanese woman who was diagnosed as a BRCA2 mutation carrier. She underwent prophylactic bilateral skin-sparing mastectomy (SSM) with excision of the nipple and preservation of the areola skin. It is unclear whether a bilateral RRM leads to better survival compared with intensive surveillance. The oncological risk associated with the presence of remnant breast glandular tissue after SSM or nipple-sparing mastectomy has been obscure. We report the first case of RRM for a Japanese BRCA mutation carrier and provide a literature review on risk management for BRCA mutation carriers with a focus on the concepts and procedures of RRM.
Adult ; Asian Continental Ancestry Group ; Breast ; Breast Neoplasms ; Female ; Humans ; Mastectomy* ; Mastectomy, Subcutaneous ; Nipples ; Prophylactic Surgical Procedures ; Risk Management ; Skin

Man in his 70s, who had suffered from idiopathic thrombocytopenic purpura (ITP), was admitted to our hospital with chest pain at rest. Coronary angiography revealed obstruction of the right coronary artery and triple vessel disease. Because a bleeding tendency was expected during coronary artery bypass grafting, we performed percutaneous coronary intervention to the culprit lesion first, and then intravenous immunoglobulin and high dose dexamethasone were tried. His platelet count rose from 49,000 to 103,000/mm3, so we performed coronary artery bypass grafting. The patient had no postoperative hemorrhagic complications. We believe that high dose dexamethasone therapy is useful for patients with ITP who need surgery immediately.

We present a case of a 76-year-old woman who was diagnosed with sarcoidosis due to enlarged hilar lymph nodes 6 year earlier. Computed tomography (CT) revealed asymptomatic Stanford type A dissection at that time. A chest radiograph taken a year ago showed obvious cardiac enlargement; therefore, echocardiography was performed for further investigation, which revealed severe aortic regurgitation. The patient was referred to our department for surgery after the contrast-enhanced CT revealed the same intra-aortic intimal flap as before. Transthoracic echocardiography showed cardiac enlargement with a left ventricular end-diastolic diameter of 61 mm and aortic regurgitation of 3/4 degree. Contrast-enhanced CT showed an approximately 3-mm-wide band-like structure (linear shadow) that appeared to be the intima of the ascending aorta; however, no entry or false lumen was apparent. The structure in the ascending aorta had an appearance distinct from that of a typical aortic dissection, but was deemed possible in chronic aortic dissection. Nevertheless, intraoperative findings revealed that the linear shadow shown on CT was not due to dissection. The band-like structure was actually the intima, and it was excised. The aortic valve was replaced with a biological valve and the ascending aorta was replaced with a prosthetic graft. She was discharged home on the 11th postoperative day after a favorable recovery. Pathological findings of the band-like structure revealed the intima of the blood vessel and no evidence of inflammatory cell infiltration. There was no evidence of aortic dissection. We encountered a rare case of intra-aortic intimal band that was misdiagnosed and treated as an aortic pseudodissection. It is difficult to rule out aortic dissection prior to surgery; therefore, it is preferable to prepare the operation as a dissection.

Background: Pericardial effusion is a common finding with a wide spectrum of etiologies. Surgical management is recommended for a patient with intractable pericardial effusion which is resistant to medical treatment and causes cardiac tamponade. Various surgical approaches for pericardial effusion have been reported, for example thoracotomy, open abdominal surgery, video-assisted thoracic surgery, laparoscopic surgery, and subxiphoid approach. Objectives: We report the results of pericardial-peritoneal window using a subxiphoid approach under local anesthesia for refractory pericardial effusions. Methods: Five patients who underwent pericardial-peritoneal window surgery for refractory pericardial effusion between April 2011 to June 2022 were included in this study. The age of the patients was 61±14 years, and one (20%) was male. The comorbidities were four cases of autoimmune disease (two cases of scleroderma, one case of systemic lupus erythematosus, and one case of IgG4-related disease) (80%) and two cases of follicular lymphoma (40%). For comorbidities, steroids were administered in 2 patients (40%) and immunosuppressive drugs in 4 patients (80%). Colchicine was administered in 3 patients (60%) to treat pericardial effusions. Pericardiocentesis had been performed in 4 patients (80%) prior to surgery. Under local anesthesia in the supine position, a small incision was made at lower end of the sternum and the xiphoid process was resected. A pericardial-peritoneal window of more than 40 mm in diameter was created. In the past, only the diaphragmatic window was opened, but recently the diaphragmatic window and the anterior aspect of the pericardial sac membrane have been resected continuously to open the pericardial sac widely. Results: The operative time was 36±15 min. One complication was postoperative hemorrhage. There were no operative deaths or hospital deaths. Preoperative colchicine was discontinued in all patients after surgery. The mean postoperative follow-up was 2.7 years (0.5-5.9）, and no reaccumulation of pericardial effusion was observed in any of the patients. Conclusions: The pericardial-peritoneal window with a subxiphoid approach can be safely performed under local anesthesia, and if the window is created large enough, it could be a minimally invasive and effective treatment for refractory pericardial effusions.

OBJECTIVEPrevious studies on the association between physical activity (PA) and neighborhood environments (NE) focused on either objectively measuring the NE or the residents' perception of NE. Here, we investigate which actual or perceived NE is associated with residents' PA in Japan.

METHODSTwo regions with an objectively assessed high and low residential density, land use mix-diversity, and street connectivity, respectively, were identified in one city. The subjects were selected using a stratified random sampling method by sex and age in each region. The NE of the subjects was objectively measured using the Geographic Information System (GIS), and the subjects' perception of the NE was assessed using a questionnaire. The daily total number of walking steps was measured with an accelerometer, and walking and cycling time were assessed by a questionnaire.

RESULTSFor the female subjects, the mean cycling time, subjectively assessed as a means of transport, was significantly longer in the group with a high GIS score for the number of land use types, while the score for total number of walking steps was significantly higher among those who were aware of places to walk to, and cycling time for transport was longer for those who perceived an accessibility to post offices, banks/credit unions, gymnasiums/fitness facilities, and amusement facilities in their neighborhood. For the male subjects, the score for walking time for leisure was longer for those who perceived aesthetics and an accessibility to parks, and the score for total walking steps was significantly higher for those who perceived an accessibility to bookstores or rental video stores in their neighborhood.

CONCLUSIONSThe results to this study demonstrate that daily PA was high among female subjects living in a NE with land use mix-diversity, and who had an awareness of places to walk to and the accessibility to facilities for daily necessities in their neighborhood. For male subjects, daily PA was high among those who perceived the aesthetics of and accessibility to facilities for pleasure in their neighborhood. Further research is needed to determine the association between PA and NE on the basis of sex differences.