We report on the state of postgraduate anesthesiology training (3 months) at Fukui Medical School. This report was based on a questionnaire sent to 144 doctors who had undergone this training. The response rate was 68%.
Participants entered anesthesiology training at a mean of 1.9 ± 1.2 years after graduation. Seventyone trainees (91%) were actively involved in clinical anesthesiology, among which 48 trainees (63%) had experienced between 31 to 60 cases over a 3 month period. Twenty-four trainees (31%) indicated that the training period (3 months) was too short. After such training, 50 doctors (66%) practiced anesthesia, among which 29 encountered difficulties with endotracheal intubation. Sixty-nine trainees (93%) thought the training would be useful for resuscitation. We conclude that anesthesia training is effective at the end of a 2-year postgraduate training course, and recognize the need for improvement in the teaching of anesthesiology.

Direct coronary artery reimplantation to the aorta and mitral valve repair were successfully performed in a 29-year-old female with Bland-White-Garland syndrome (BWG syndrome). Under cardiopulmonary bypass, the main pulmonary artery was completely transected and the left coronary artery was excised with a cuff of pulmonary artery wall. Then the left coronary artery was directly anastomosed to the ascending aorta. Mitral regurgitation was repaired with valvulo-annuloplasty. The post operative course was excellent.

Investigation was made into knee joint problems among tea pickers through a questionnaire. Following this, physical examinations were given and radiography was taken.
Of the male respondents, 18.9% said that they have pains in the knee (s). The corresponding figure for the women was a high as 38.5%. The number of men and women who complained of knee pain increased with age. However, it was not clear whether the incidence of knee pain has any bearing on the number of years they had worked or working hours per day. Rather, it seems to depend on the configuration of the plantation.
Knee pain occurs more frequently in persons working on sloping and hilly lands than those working on flat land. The difference in Q-angle is wider in the hilly area than in the flat land.
X-ray examination of the knee joint of the persons who complained of sensations revealed degenerative changes in the form of the synovial cavity. Changes in the form of the patella were more evident in the persons working on the sloping land than on the flat land.
On the slope, tea pickers have to bend their knees, requring femoral quadriceps and crural triceps to maintain contraction for cours. Thus the level of stress on the kneecaps becomes high.
To prevent knee joint injuries, improvement of footings, mechanization of collecting work, decreases in the frequency of decending and ascending the slop, and having a rest at proper intervals are necessary.
Furthermore, it is necessary to strengthen femoral quadriceps by excercise and control weight.

In Oita prefecture, where ATL is relatively endemic, the authors carried out hematology analysis using an E-4000 hematology analyzer in a health examination. This analysis screened a group of 104 males and 181 females out of randomly collected 11, 568 persons in terms of a higher (exceeded 50%) W-SCR rate (i. e. lymphocyte rate in cell size distribution). The collected peripheral blood smears from this group were further subjected to the examination of lymphocyte morphology.
Abnormal lymphocytes exhibiting dyscaryosis, such as indentation or lobulation, were observed in 11 cases, and further examination of anti-ATLA antibody and earlobe blood smears revealed eight suspected cases of ATL-related condition.
Clinical symptoms characteristic of ATL were not observed in the above eight cases, though the anti-ATLA antibody titer measured by the ELISA method increased by more than 25. In one case, being diagnosed as chronic-type ATL, abnormal lymphocytes amounted to 70% and the leukocyte count was 28, 000/μl. In the other seven cases, abnormal lymphocytes amounted to only 1-11%, and the leukocyte counts ranged from 5, 300 to 11, 100/μl, which was almost within the normal limits.
The method in reported as an useful means for screening cases of nonsymptomatic chronic or smoldering type ATL through a health examination.

In order to study human acute B-lymphoblastic leukemia (B-ALL) in vivo, a novel xenotransplant model was established by using neonatal NOD/SCID/IL2 receptor γ chain(null) mouse. The CD34(+)CD19(+) bone marrow (BM) cells were sorted from the CD3(-)CD4(-)CD8(-) fraction of B-ALL patients by fluorescence-activated cell sorting (FACS), and injected into 100 cGy irradiated neonatal NOD/SCID/IL2rγ(null) mice through facial vein. The engraftment and proliferation of human B-ALL cells were monitored by the presence of human CD45(+)CD19(+) cells in peripheral blood (PB). Human hematopoietic chimerism in PB, BM and spleen of the recipients was examined by multiparameter flow cytometry. Morphological analyses of FACS-sorted murine marrow cells were performed by using May-Grunwald-Giemsa staining. Furthermore, leukemia cell infiltration in the organs was evaluated by hematoxylin-eosin staining. The results indicated that the sorted CD34(+)CD19(+) cells were able to initiate human B-ALL in vivo. The percentages of human CD45(+)CD19(+) cells in PB, BM and spleen of the recipient mice were (83.36 ± 10.05)%, (93.88 ± 5.05)% and (88.31 ± 5.01)%, respectively. Furthermore, the phenotype and morphology of the engrafted human cells were resemble to the original B-ALL cells from the patients. Similar to the clinical features, transplanted leukemic cells infiltrated into the organs, such as liver, lung, kidney and brain in the recipients. It is concluded that neonatal NOD/SCID/IL2rγ(null) mice can support efficient engraftment of the sorted CD34(+)CD19(+) cells from human B-ALL for a long-term period. Human-mouse xenotransplant model using neonatal NOD/SCID/IL2rγ(null) mouse may provide an important system to study the biology of human B-ALL in vivo.
Animals ; Animals, Newborn ; Disease Models, Animal ; Humans ; Interleukin-2 Receptor alpha Subunit ; immunology ; Male ; Mice ; Mice, Inbred NOD ; Mice, SCID ; Neoplasm Transplantation ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; immunology

BACKGROUND/AIMS: Both fecal immunochemical test (FIT) and fecal calprotectin (Fcal) results are useful biomarkers for ulcerative colitis (UC). However, the situations in which each marker should be used are largely unknown. METHODS: A total of 110 colonoscopy intervals of UC patients were assessed, and correlations between changes in colonoscopic findings and changes in the two aforementioned fecal markers were examined. RESULTS: Among patients with mucosal healing (MH) and negative FIT or Fcal results at the initial colonoscopy, FIT and Fcal findings exhibited accuracies of 93% (38/41) and 79% (26/33), respectively, for predicting the results of the subsequent examination. Among the 24 patients who showed endoscopic activity at the precedent colonoscopy and MH at the subsequent examination, positive-to-negative conversion of FIT and Fcal findings at the subsequent examination was observed in 92% (12/13) and 62% (8/13) of patients, respectively. Among the 43 patients who showed endoscopic activity at both the precedent and subsequent examinations, Fcal findings reflected the change in endoscopic activity better than FIT results (r=0.59, p<0.0001 vs r=0.30, p=0.054). CONCLUSIONS: The FIT is useful for confirming MH and the occurrence of relapse. In contrast, Fcal is useful for monitoring the mucosal status of patients with active inflammation.
Biomarkers ; Colitis ; Colitis, Ulcerative* ; Colonoscopy ; Humans ; Inflammation ; Leukocyte L1 Antigen Complex* ; Recurrence ; Ulcer*

BACKGROUND/AIMS: Fecal calprotectin (Fcal) as well as the fecal immunochemical test (FIT) are useful biomarkers for detecting activity and mucosal healing in inflammatory bowel diseases. Here, we report the performance of simultaneous measurements of Fcal and FIT for ulcerative colitis (UC) patients using the newly-developed latex agglutination turbidimetric immunoassay (LATIA) system. METHODS: Fcal and hemoglobin were measured by the LATIA system in 152 UC patients who underwent colonoscopy. Fcal was also quantified with a conventional enzyme-linked immunosorbent assay (ELISA). Fecal markers were evaluated in conjunction with the mucosal status of UC, which was assessed via the Mayo endoscopic subscore (MES) classification. RESULTS: The LATIA system could quantify calprotectin and hemoglobin simultaneously with the same fecal samples within 10 minutes. The values of the Fcal-LATIA closely correlated with those of the Fcal-ELISA (Spearman rank correlation coefficient, r=0.84; P<0.0001). The values of Fcal for each assay and the FIT all significantly correlated with the MESs (Spearman rank correlation coefficient, Fcal-LATIA: r=0.58, Fcal-ELISA: r=0.55, and FIT: r=0.72). The mucosal healing predictability (determined by an MES of 0 alone) of the Fcal-LATIA, Fcal-ELISA, and FIT-LATIA with the cutoffs determined by receiver operating characteristic curve analysis was 0.79, 0.78, and 0.92 for sensitivity, respectively, and 0.78, 0.69, and 0.73 for specificity, respectively. CONCLUSIONS: The performance of the novel Fcal-LATIA was equivalent to that of the conventional Fcal assay. Simultaneous measurements with FITs would promote the clinical relevance of fecal biomarkers in UC.
Agglutination ; Biomarkers ; Classification ; Colitis, Ulcerative ; Colonoscopy ; Enzyme-Linked Immunosorbent Assay ; Feces ; Humans ; Immunoassay ; Inflammatory Bowel Diseases ; Latex ; Leukocyte L1 Antigen Complex ; ROC Curve ; Sensitivity and Specificity

We report two cases of spastic cerebral palsy classified as diplegia-type complicated cervical spondylotic myelopathy. Under the Gross Motor Function Classification System (GMFCS), both were classified as Level IV, defined as standing with support, but with difficultly, after the diagnosis of cervical spondylotic myelopathy. Paralysis in both the upper and lower limbs deteriorated and became a form of quadriplegia. In one case, there was no appeal from the patient even after the manifestation of symptoms；diagnosis and surgery were both time consuming, with no improvements in post-operative symptoms including urinary incontinence. In the other case, early diagnosis was possible and operation was scheduled early. The post-operative response was positive, and the patient was able to recover to pre-cervical spondylotic myelopathy conditions. Complications of cervical spondylotic myelopathy is well-known in the athetosis type；however, reports on the spastic type are limited. Here, we report complications of cervical spondylotic myelopathy in spastic cerebral palsy and show that early detection and surgery are important factors in mitigating long-term recovery.

We report two cases of spastic cerebral palsy classified as diplegia-type complicated cervical spondylotic myelopathy. Under the Gross Motor Function Classification System (GMFCS), both were classified as Level IV, defined as standing with support, but with difficultly, after the diagnosis of cervical spondylotic myelopathy. Paralysis in both the upper and lower limbs deteriorated and became a form of quadriplegia. In one case, there was no appeal from the patient even after the manifestation of symptoms；diagnosis and surgery were both time consuming, with no improvements in post-operative symptoms including urinary incontinence. In the other case, early diagnosis was possible and operation was scheduled early. The post-operative response was positive, and the patient was able to recover to pre-cervical spondylotic myelopathy conditions. Complications of cervical spondylotic myelopathy is well-known in the athetosis type；however, reports on the spastic type are limited. Here, we report complications of cervical spondylotic myelopathy in spastic cerebral palsy and show that early detection and surgery are important factors in mitigating long-term recovery.

BACKGROUND/AIMS: Although mucosal healing (MH) has been considered a treatment goal for patients with ulcerative colitis (UC), the risk factors predictive of relapse in patients who achieve MH are unknown. Because the platelet count has been shown to be a marker of inflammation in inflammatory bowel diseases, this study aimed to assess whether the platelet count could predict relapse in UC patients with MH. METHODS: A prospective observational study was performed. UC patients with MH were consecutively enrolled in the study and monitored for at least 2 years or until relapse. The correlation between the incidence of relapse and the platelet count at the time of study enrollment was examined. RESULTS: In total, 43 patients were enrolled, and 14 patients (33%) relapsed. The median platelet count at the time of enrollment in the patients who relapsed significantly differed from that in the patients who did not relapse (27.2×104/μL vs 23.8×104/μL, respectively; p=0.016). A platelet count >25.0×104/μL was a significant risk factor for relapse based on a multivariate analysis (hazard ratio, 4.85; 95% confidence interval, 1.07 to 25.28), and according to the Kaplan-Meier analysis, this cutoff could identify patients susceptible to relapse (p=0.041, log-rank test). CONCLUSIONS: The platelet count could be used as a predictor of relapse in UC patients with MH.
Blood Platelets* ; Colitis ; Colitis, Ulcerative* ; Humans ; Incidence ; Inflammation ; Inflammatory Bowel Diseases ; Kaplan-Meier Estimate ; Multivariate Analysis ; Observational Study ; Platelet Count* ; Prospective Studies ; Recurrence* ; Risk Factors ; Ulcer*