Although the patent ductus venosus is congenital, the symptoms due to hyperammonemia vary, possibly depending on the shunt ratio and individual tolerance to ammonia. We have experienced two adult patients with large caliber patent ductus venosus and compensated liver cirrhosis. In one case, the ductus venosus simply communicated to the portal vein, but in the other case there were multiple short communicating vessels between the ductus venosus and left portal vein. Both cases were successfully treated by the transvenous embolization with steel coils and ethanolamine oleate, which has an expansive nature.
Adult ; Cases ; Transvenous approach ; Two ; Open

The effect of changes in vascular transmural pressure upon differential digital plethysmogram (delta DPG) was studied in seven normal subjects. Changes in vascular transmural pressure were produced by the gravitational potential energy change (GPEC method) of an extremity from the heart level. Delta DPG which was characteristic of stability, discrimination and low speed record by modified devices was applied for the experiments including postural, static and dynamic exercises. Room temperature during experiments was kept constant. The Delta DPG-P wave amplitude in maximal elevation of upper and lower extremities (mean±S. D., n) increased to 162.3±33.5% (38) and 176.7±33.4% (12), respectively, and that in maximal lowering of upper and lower extremities decreased to 36.9±10.5% (35) and 37.5±12.6% (15), respectively. These data reveal that the GPEC method may be useful for the determination of arteriolar sensitivity in humans.

Before the introduction of high density barium for contrast studies of the upper gastrointestinal tract, we conducted a survey concerning the adverse reactions to a swallow of barium and barium concentration.
The incidence of side effects rose as the density of barium increased but the effects were transient. There were no cases requiring medical treatment.
Furthermore, the constipation group and the normal group were examined separately.
The ratio of adverse reactions was high in the constipation group even when the barium density was low. In this group stool hardening and delayed excertion were also noticed.
The constancy of barium stool excretion was basically normal, and the barium density had little effect.
The effects of a laxative on the excretion consistency were investigated. The administration of a laxative did not always have a positive affect on excretion. The timing of the administration of the laxative and the amount of water intake should be examined in the future.
We also investigated how the patients feel when they are swallowing barium. We found that whether feel uncomfortable or not depended on the properties of barium rather than its density.
From these results it appears that appropriate guidance is necessary about the use of high density barium, in order to supress the occurrence of side effects, especially in the constipation group.

  Background: Heat shock proteins (Hsps), expression of which are induced by thermal treatment, function in the protection of kidneys by suppressing apoptosis and maintaining renal tubular viability. Moreover, recently, it has been indicated that the expression of Hsps can be a therapeutic target for autosomal dominant polycystic kidney disease (ADPKD). We investigated the effect of dry sauna therapy on ADPKD model mice.  Methods and Results: The mice (male DBA/2FG-pcy mice) were categorized into three groups: controls, TS: pcy mice subjected to prolonged sauna with administered water containing 4% sucrose, SW: pcy mice administered water containing 4% sucrose. The TS group was subjected to sauna sessions twice a week for four weeks. The TS group attained and were maintained at rectal temperatures of approximately 39.0°C, until they were carefully removed from the far infrared-ray device. After 4 weeks of sauna treatment, creatinine and blood-urea-nitrogen (BUN) levels determined by an enzymatic method. The heat shock protein (HSP) or cell growth and size related proteins were analyzed by western blotting. The TS group exhibited marginally higher creatinine and BUN levels than did the control and SW groups, however, the differences were not significant. However, cyst enlargement in the TS group reduced significantly compared to that of the control group. HSP90 expression was slightly decreased in the TS and SW groups relative to the control group (p < 0.01 or p < 0.001, vs. control), as was Erk expression, which is linked to cyst development and proliferation (p < 0.05, TS vs. control). Hsp27 expression and phosphorylation level in the SW group were comparable with that of the control group. However, the TS group had increased levels of Hsp27 and phosphorylation (NS). The expression of pro-caspase-3 in the TS group was marginally lower than that in the control group. However, the activity of caspase-3 in all groups showed no differences.  Conclusion: The findings of this study indicated that 4 weeks of sauna treatment could cause transient dehydration and related renal dysfunction and led to the risk of stimulating cyst growth by increased Hsp27 expression. Moreover, we concluded that prevention of dehydration and cyst growth could be suppressed by taking an appropriate amount of water directly after sauna treatment.

  Background: Heat shock proteins (Hsps), expression of which are induced by thermal treatment, function in the protection of kidneys by suppressing apoptosis and maintaining renal tubular viability. Moreover, recently, it has been indicated that the expression of Hsps can be a therapeutic target for autosomal dominant polycystic kidney disease (ADPKD). We investigated the effect of dry sauna therapy on ADPKD model mice.  Methods and Results: The mice (male DBA/2FG-pcy mice) were categorized into three groups: controls, TS: pcy mice subjected to prolonged sauna with administered water containing 4% sucrose, SW: pcy mice administered water containing 4% sucrose. The TS group was subjected to sauna sessions twice a week for four weeks. The TS group attained and were maintained at rectal temperatures of approximately 39.0°C, until they were carefully removed from the far infrared-ray device. After 4 weeks of sauna treatment, creatinine and blood-urea-nitrogen (BUN) levels determined by an enzymatic method. The heat shock protein (HSP) or cell growth and size related proteins were analyzed by western blotting. The TS group exhibited marginally higher creatinine and BUN levels than did the control and SW groups, however, the differences were not significant. However, cyst enlargement in the TS group reduced significantly compared to that of the control group. HSP90 expression was slightly decreased in the TS and SW groups relative to the control group (p < 0.01 or p < 0.001, vs. control), as was Erk expression, which is linked to cyst development and proliferation (p < 0.05, TS vs. control). Hsp27 expression and phosphorylation level in the SW group were comparable with that of the control group. However, the TS group had increased levels of Hsp27 and phosphorylation (NS). The expression of pro-caspase-3 in the TS group was marginally lower than that in the control group. However, the activity of caspase-3 in all groups showed no differences.  Conclusion: The findings of this study indicated that 4 weeks of sauna treatment could cause transient dehydration and related renal dysfunction and led to the risk of stimulating cyst growth by increased Hsp27 expression. Moreover, we concluded that prevention of dehydration and cyst growth could be suppressed by taking an appropriate amount of water directly after sauna treatment.

INTRODUCTIONAn observational study was carried out to estimate the strength of the relationships among balance, mobility and falls in hemiplegic stroke inpatients. The objective was to examine factors that may aid in the prediction of the likelihood of falls in stroke patients.

METHODSA total of 53 stroke patients (30 male, 23 female) aged 67.0 ± 11.1 years were interviewed regarding their fall history. Physical performance was assessed using the Berg Balance Scale (BBS) and the Functional Independence Measure (FIM) scale. Variables that differed between fallers and non-fallers were identified, and a discriminant function analysis was carried out to determine the combination of variables that effectively predicted fall status.

RESULTSOf the 53 stroke patients, 19 were fallers. Compared with the non-fallers, the fallers scored low on the FIM, and differed with respect to age, time from stroke onset, length of hospital stay, Brunnstrom recovery stage and admission BBS score. Discriminant analysis for predicting falls in stroke patients showed that admission BBS score was significantly related to the likelihood of falls. Moreover, discriminant analysis showed that the use of a significant BBS score to classify fallers and non-fallers had an accuracy of 81.1%. The discriminating criterion between the two groups was a score of 31 points on the BBS.

CONCLUSIONThe results of this study suggest that BBS score is a strong predictor of falls in stroke patients. As balance is closely related to the risk of falls in hospitalised stroke patients, BBS might be useful in the prediction of falls.

Accidental Falls ; prevention & control ; Aged ; Discriminant Analysis ; Female ; Hemiplegia ; complications ; Humans ; Male ; Middle Aged ; Postural Balance ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Stroke ; complications ; Stroke Rehabilitation

Introduction: Recently, community-based medical education has become widespread in Japanese medical schools, but the current status is not clear on a national level. A second survey of community-based medical education at all Japanese medical schools was conducted. The first survey was done in 2011. Methods: Members of the Council made and distributed a questionnaire to medical schools in order to assess the situation of community-based medical education as of April 2014. Results: A total of eighty schools responded. The number of schools which had community medicine programs was seventy-eight. In the first survey, the number was seventy-three. Seventy-seven schools gave community-based clinical clerkships. Discussion: The number of medical schools that had curriculum about community medicine was more than indicated in the first survey. Further research about the contents or implementation system of community-based clerkships is needed.

OBJECTIVE: This study estimated the effects of weekend and off-hour childbirth and the size of perinatal medical care center on the incidence of cerebral palsy. METHODS: The cases were all children with severe cerebral palsy born in Japan from 2009 to 2012 whose data were stored at the Japan Obstetric Compensation System for Cerebral Palsy database, a nationally representative database. The inclusion criteria were the following: neonates born between January 2009 and December 2012 who had a birth weight of at least 2000 g and gestational age of at least 33 weeks and who had severe disability resulting from cerebral palsy independent of congenital causes or factors during the neonatal period or thereafter. Study participants were restricted to singletons and controls without report of death, scheduled cesarean section, or ambulance transportation. The controls were newborns, randomly selected by year and type of delivery (normal spontaneous delivery without cesarean section and emergency cesarean section) using a 1:10 case to control ratio sampled from the nationwide Japan Society of Obstetrics and Gynecology database. RESULTS: A total of 90 cerebral palsy cases and 900 controls having normal spontaneous delivery without cesarean section were selected, as were 92 cerebral palsy cases and 920 controls with emergent cesarean section. A significantly higher risk for cerebral palsy was found among cases that underwent emergent cesarean section on weekends (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.06-2.81) and during the night shift (OR 2.29, 95% CI 1.30-4.02). No significant risk was found among normal spontaneous deliveries on weekends (OR 1.63, 95% CI 0.97-2.73) or during the quasi-night shift (OR 1.26, 95% CI 0.70-2.27). Regional perinatal care centers showed significantly higher risk for cerebral palsy in both emergent cesarean section (OR 2.35, 95% CI 1.47-3.77) and normal spontaneous delivery (OR 2.92, 95% CI 1.76-4.84). CONCLUSION Labor on weekends, during the night shift, and at regional perinatal medical care centers was associated with significantly elevated risk for cerebral palsy in emergency cesarean section.
Case-Control Studies ; Cerebral Palsy ; epidemiology ; etiology ; Delivery, Obstetric ; statistics & numerical data ; Health Facilities ; statistics & numerical data ; Humans ; Incidence ; Infant, Newborn ; Japan ; epidemiology ; Parturition ; Perinatal Care ; statistics & numerical data ; Retrospective Studies ; Time Factors