Physiological changes induced by the localized bathing of hands, feet, and simultaneous hand-foot baths were studied and compared with each other in order to elucidate the physiological mechanism of hand and foot baths. Fifteen healthy adult males (32±10years old) took hand, foot, and simultaneous hand-foot carbonated (module mixture type artificial carbonated bath, at a CO₂, concentration of 1,100±100 ppm, pH 4.8) and freshwater baths (pH 7.4) at 38°C, and assumed a control sitting position following a randomized controlled design. They took 7 kinds of localized baths mentioned above at 1-week intervals. Each localized bathing session involved a 5-minute rest in a sitting position, the 30-minute bathing, followed by a 10-minute rest. Subjects’physiological parameters, such as the heart rate, blood pressure, near infrared spectroscopy of the forehead, laser Doppler flowmetric findings for immersed (foot) and non-immersed (shoulder muscle) body surface capillary fiow, as well as the body temperature of sublingual and tympanic membranes were monitored.
 While no physiological changes occurred during the proximal 5-10 minutes after starting simultaneous hand-foot baths, the body temperature, cerebral tissue circulation, cutaneous blood flow of the non-bathed skin, and heart rate increased and the diastolic pressure decreased in the distal half of 30-minute carbonated and freshwater baths. These physiological changes would probably be due to the thermal effect.
 However, the proximal 5-10 minutes after staning hand and foot carbonated baths showed opposite autonomic changes, which disappeared in the simultaneous hand-foot carbonated baths. Freshwater localized hand and foot baths did not lead to such differences. The cutaneous blood flow of bathed skin of the hands and feet was also significantly different only in the carbonated baths, while no differences were obtained in the freshwater hand and foot baths.
 Taken together, 38 °C and 1,100 ppm carbonated localized baths (hands and feet) showed opposing heart rate variability just after staning bathing, and they induced different cutaneous blood flow changes during bathing. These physiological differences in hand and foot bathing may be due to somato-autonomic and axonal refiexes induced by skin nociceptive ion channels with different sensitivities and reactions due to the varying pH of the bathing medium, and due to different hydrostatic pressures of the hand and foot baths.

　　Mature cystic teratoma with malignant transformation is a rare disease with an incidence of about 1% among ovarian tumors. Here, we describe how we were able to diagnose pathological tissue preoperatively using colonoscopy. The patient was a 68-year-old woman (gravida 4). She presented with abdominal pain. Her general condition was poor. On examination, we found perforation of an ovarian tumor into the sigmoid colon. Lower gastrointestinal endoscopy was performed and some tissue was retrieved. Pathological analysis of the tissue revealed a diagnosis of squamous cell carcinoma.

Introduction: The career support system was introduced in Okayama University Hospital in 2008, and the number of users has exceeded 150. Methods: To examine changes in perceptions of the system and its users, we conducted a questionnaire survey of supervisors and the colleagues of system users in FY2011 and FY2018. Results: Compared to 2011, the following items were significantly higher in FY2018: "I have experience working with users of the support system", "I think this system is useful for the medical office", and "This system makes the medical office more appealing". In the analysis of the colleagues of system users only, in addition to the aforementioned three items, the item "Users of the system are able to do their jobs to the degree expected" was significantly higher in FY2018. Conclusion: The effectiveness of the career support system is becoming more recognized, and the evaluation of the work content of the system's users has improved.

Introduction : As one of the strategies for the introduction of collaborative drug therapy management (CDTM) into a community healthcare system in Japan, we constructed a ‘positive list’ which was agreed by a family physician in advance, and subsequently validated the effects on healthcare insurance fees, the number of prescription question and the changes of utilization rate for generic drugs.
Methods : The items that replaced prescription questions with regard to ex post facto approval were defined as ‘Resolved Questions’ in our constructed positive list. By adopting the ‘Resolved Questions’, we then examined the effect on healthcare insurance fees, prescription questions and the changes of utilization rates for generic drugs.
Results : Among all prescription questions accepted from January through May 2012 inclusive, 178 (22.7%) were ‘Resolved Questions’, without there being change in the therapeutic strategies by the prescribing physicians. During this period, 17,455 healthcare insurance fees were reduced. In addition, the utilization rate for generic drugs were increased up to 46.6%.
Conclusion : The reduction of healthcare insurance fees, prescription questions and the increased utilization rates of generic drugs were facilitated by prudent pharmacist judgements based on ‘Resolved Questions’.

An abdominal advancement flap (AAF) is a flap that pulls the elevated abdominal skin up and creates the shape of the inferior portion of the breast by making a neo-inframammary fold. Seven patients underwent remodeling using an AAF or a method combining an AAF with other volume displacement techniques after partial mastectomy. The excision volume ranged from 15% to 35%. AAF with only mobilization of the gland flaps was performed in two cases, with lateral mammoplasty in one case, with the round block technique (RBT) in one case, with a modified RBT in one case, and with medial mammoplasty in two cases. Although one patient treated with a RBT had a partial blood-flow insufficiency of the nipple-areola complex, it improved with conservative treatment. The cosmetic results were found to be excellent in three cases, good in three, and fair in one case.
Breast ; Cosmetics ; Displacement (Psychology) ; Female ; Humans ; Mammaplasty ; Mastectomy, Segmental ; Skin ; Surgical Procedures, Operative

PURPOSE: Although various strategies have been reported, there are no defined criteria for cosmetic evaluation methods after breast-conserving surgery (BCS). Since Asians tend to have smaller breasts, indistinct inframammary folds, and conspicuous scars, differences in the cosmetic results are expected. So we examined two subjective methods and one objective method to determine the differences, and elements necessary for a cosmetic evaluation after BCS. METHODS: Frontal photographs of 190 Japanese were evaluated using the Harris scale (Harris) and the evaluation method proposed by the Japanese Breast Cancer Society Sawai group (Sawai group) as the subjective methods, and the Breast Cancer Conservation Treatment cosmetic results (BCCT.core) as the objective method, respectively. In order to examine the necessary elements for developing a new ideal method, 100 out of 190 were selected and assessed separately by six raters using both the Harris and modified Sawai group methods in the observer assessment. The correlation between the two methods was examined using the Spearman rank-correlation coefficient. RESULTS: The results of the BCCT.core and the other two methods were clearly different. In the observer assessment, the consensuses of the six raters were evaluated as follows: 27, 27, 26, and 20 cases were evaluated as "excellent," "good," "fair," and "poor," respectively. For the Spearman rank-correlation coefficient, values higher than 0.7 indicated a strong correlation, as seen by the values of 0.909 for the breast shape and 0.345 for the scar. The breast shape accounted for the most significant part of the evaluation, and the scar had very little correlation. CONCLUSION: In this study, we recognized a clear difference between the subjective and objective evaluation methods, and identified the necessary elements for cosmetic evaluation. We would like to continue developing an ideal cosmetic evaluation that is similar to subjective one and is independent from raters.
Asian Continental Ancestry Group* ; Breast ; Breast Neoplasms ; Cicatrix ; Consensus ; Esthetics ; Humans ; Mastectomy, Segmental*

We introduce a method combining two oncoplastic techniques for breast-conserving reconstruction. The procedure is as follows: first, an extended glandular flap is made by undermining the breast from both the skin and the pectoralis fascia to the upper edge of the breast at the subclavicular area. After modeling the breast mound with the extended glandular flap, an inframammary adipofascial flap is made. The flap is reflected back to the breast area remodeled using the extended glandular flap. After reshaping the breast, the inframammary line is then re-shaped. This method is indicated for patients with breast cancer in the outer portion of the breast, who have small dense breasts, and have undergone a large excision of about 40% of their breast volume. We treated four patients, all of whom had either excellent or good cosmetic results with no fat necrosis.
Breast ; Breast Neoplasms ; Cosmetics ; Fascia ; Fat Necrosis ; Female ; Humans ; Mammaplasty ; Mastectomy, Segmental ; Skin

Background/Aims: No screening test for esophageal motility disorder (EMD) has been established, the objective of this study is to examine the potential usefulness of our newly developed “Onigiri esophagography” combined with an obstruction level (OL) classification system in screening for EMD. Methods: A total of 102 patients with suspected EMDs who underwent both high-resolution manometry (HRM) and Onigiri esophagography between April 2017 and January 2019 were examined. The EMD diagnosis was performed based on the Chicago classification version 3.0 by HRM. Onigiri esophagography was performed using a liquid medium (barium sulfate) followed by a solid medium, which consisted of an Onigiri (a Japanese rice ball) with barium powder. The extent of medium obstruction was assessed by the OL classification, which was defined in a stepwise fashion from OL0 (no obstruction) to OL4 (severe obstruction). Results: The patients with OL0 (32.3%), OL1 (50.0%), OL2 (88.0%), OL3 (100.0%), and OL4 (100.0%) were diagnosed EMDs by HRM. The area under the curve, as determined by a receiver operating characteristic analysis, for the OL classification was 0.86. Using the cutoff value of OL1, the sensitivity and specificity were 87.3% and 61.3%, respectively, while using a cutoff value of OL2, the sensitivity and specificity were 73.2% and 90.3%, respectively. Conclusion In conclusion, Onigiri esophagography combined with the OL classification system can be used as a screening test for EMDs with a cutoff value of OL1.

The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.