Objective To compare perioperative parameters, as well as the oncological and func-tional results, for laparoscopic radical prostatectomy (LRP) performed via the posterior bladder and anterior bladder approaches. Methods The recorded pre-, peri-, and postoperative parameters and complications, and evaluated the oncological and functional results were collected and compared be-tween the posterior bladder approach (n=25) and the anterior bladder approach (n=34). Results There were no significant differences regarding the preoperative characteristics of the two groups. The mean blood loss, complications, positive surgical margins, and continence showed no significant differences between the 2 groups at 3 and 6 months postoperatively. The mean operation time was sig-nificantly shorter in anterior bladder approach group (174.2±58. 0 min) than in posterior bladder ap-proach group (224. 8±66.7 rain), (P<0. 01). Also, the postoperative recovery time until discharge was 5.9 d in anterior bladder approach group, which was significantly shorter than in posterior bladder approach group (7.5 d) (P<0.05). Conclusion The anterior bladder approach yields shorter oper-ation time and postoperative recovery period than posterior bladder approach for LRP.

Safety and effectiveness of powered food made from Agaricus blazei Murill was evaluated by a randomized human study. 45 healthy subjects were divided into 3 groups in sequence: control, 1 pack and 3 packs/day-administered groups. Each group had 15 persons. They had each packs for 28 days, and followed, in every two weeks, by the evaluation with CTCAE v3.0, QOL (SF36-v2), and biochemical examinations including liver/lung/kidney function, insulin resistance and NK activity and high-sensitivity CRP. None of them had adverse events nor biochemical/lung abnormal examinations. 1 and 3 packs-administered groups improved their QOL, high-sensitivity CRP and NK activity in a dose-dependent manner. These results ascertained safety, and effectiveness of the powdered food made from Agaricus blazei Murill against presymptomatic disorders including metabolic syndrome.

60 cancer patients between the ages of 20 and 80 who had completed a main treatment were randomly administered Tabebuia Avellanedae (Taheebo) extract 2.0 g/day (usual dosage), 4.0 g/day (2 times dosage), or 6.0 g/day (3 times dosage) for 6 months. A blood biochemical exam, urinalysis, adverse effects, several immunological parameters, urine 8-OHdG and QOLsurvey were evaluated. Five patients dropped out, but there was no direct cause and effect between the extract and dropout. Although several items of the blood biochemical exam revealed slight variation within the normal limits, distinct abnormities were not detected. Furthermore, side effects like allergic symptoms were not found. Immune parameters and urine 8-OHdG did not change significantly. CRP, which is a sensitive marker of inflammation, was significantly improved, and this may suggest the possibility of this extract helping to prevent hardening of blood vessels due to arteriosclerosis. In Japan, long-term food safety tests have rarely been done, therefore we recommend that more of these exams be carried out.

Objective: Gagome kombu (Kjellmaniella crassifolia), an edible brown seaweed grown around the southern area of Hokkaido, is known to abundantly contain fucoidan. Previous studies show that on animals, fucoidan from Gagome kombu (GKF) exhibits immune-enhancing, anti-cancer and anti-influenza virus capabilities. In this study, we focused on the elderly and evaluated the safety and immune-efficacy of GKF.
Methods: Eighteen (18) Japanese elderly subjects were chosen to ingest the test samples (3 tablets/day containing 50 mg GKF and lactic acid bacteria) for 8 weeks. Before ingestion and every 4 weeks thereafter (4^th and 8^th week), blood chemistry analysis, hematological analysis, urinalysis and immune analysis were conducted.
Result: Test results showed no adverse clinical changes in blood and urinary analysis. In addition, no serious symptoms were observed. Moreover, GKF markedly decreased serum IgE levels.
Conclusion: These results indicate that in the case of elderly, GKF is a safe functional food ingredient.

Objective: Fucoidan, a sulfated polysaccharide in Gagome kombu (GKF) is known to exhibit immune-enhancing and anti-cancer activities. Recently, cancer patients use various dietary supplements containing fucoidan and mushroom extracts. However, there have been few reports on the safety and efficacy of fucoidan-containing supplements. In this study, we examined the safety of long-term ingestion of GKF in cancer patients.
Methods: Twenty six (26) Japanese cancer patients—16 of whom (male 6, female 10, age 62.8 ± 10.7) have completed cancer treatment and 10 (male 4, female 6, 67.0 ± 10.6) still under treatment and regularly taking anti-cancer drugs and hormone pills—were chosen to ingest GKF-containing supplements (200–300 mg/day) for 8 weeks. Before ingestion and every 4 weeks thereafter (4^th and 8^th week), blood chemistry analysis, hematological analysis, urinalysis and immune analysis were conducted.
Result: There were no adverse clinical changes in blood and urinary analysis. In addition, no serious adverse effects were observed.
Conclusion: These results indicate long-term ingestion of GKF is indeed, safe for cancer patients.

In cases of stent-grafting for ruptured aneurysm, endoleak is a serious problem. We report 2 cases of ruptured aneurysms that were treated with endovascular stent-graft placement. Case 1: A 79-year-old woman had a ruptured thoracic aortic aneurysm that was treated with endovascular stent-grafting from the distal arch to the descending aorta. Although her infra-operative course was uneventful, she died suddenly the day after operation. Autopsy revealed re-rupture of the aneurysm due to endoleak from the proximal site. Case 2: An 84-year-old woman was treated with endovascular stent-grafting for ruptured abdominal aortic aneurysm. The stent-graft was inserted from the infra-renal abdominal aorta to the right common iliac artery with femoro-femoral crossover bypass placement. There was evidence of type II endoleak that occurred via the left internal iliac artery (IIA) and inferior mesenteric artery (IMA) 16 days after surgery. A CT scan performed 6 months after surgery revealed an increase in aneurysm size and persistent type II endoleak. Both embolization of the aneurysmal sac through the IMA and surgical ligation of the IMA failed, and endoleak from the IMA persisted. Re-rupture of the aneurysm occurred 10 months after initial surgery and emergency open surgery was performed. In stent-grafting for ruptured aneurysms, only the thrombus outside the graft resists the pressure caused by the endoleak. We conclude that endoleak after stent-grafting for ruptured aneurysm should be treated completely as soon as possible because of the risk of re-rupture.

To assess the effectiveness of a problem-based learning tutorial system introduced at Gifu University School of Medicine in 1995, we conducted a questionnaire survey of medical knowledge, attitudes about learning, communication ability, and social behavior in sixth-year medical students. The questionnaire was given to instructors and attending physicians at community hospitals who were involved in clinical education. Many of the evaluators felt that students who trained with the tutorial system showed improved understanding, a more active attitude toward learning, and a better attitude toward patients than did students who received traditional, lecture-based education.

We investigated both the acute effects of maximal exercise and the chronic effects of training on nonspecific immunity in 15 winter-sports athletes during different periods of training : (a) before the athletic season, in summer, when the athletes were undertaking extensive endurance training to enhance aerobic capacity, (b) during the winter sports season, in early winter, when endurance and athletic training were being undertaken, and (c) after the winter sports season, in spring, when the athletes were resting (detraining for a month) . The mean value of the maximal oxygen uptake in each training period was (a) 65.4 (SD 4.6) mL·kg^-1·min^-1, (b) 63.1 (SD 5.5) mL· kg^-1·min^-1, and (c) 58.3 (SD 5.8) mL·kg^-1·min^-1, respectively. Following maximal exercise, acute peripheral leukocytosis due to lymphocytosis and neutrophila was observed in every period. The capacity of isolated neutrophils to produce reactive oxygen species upon stimulation with opsonized zymosan measure by luminol-dependent chemiluminescence (LDCL) was significantly enhanced after maximal exercise before and during the athletic season. However, the degree of enhancement was smaller during after-season detraining, suggesting that the conditioning state affected the exercise-induced changes in neutophil functional status. Serum opsonic activity also showed a similar pattern. As for the chronic effects of training, the resting values of the neutrophil count, especially the segmented neutrophil count, the neutrophil LDCL response and the serum IgG level, declined significantly in the pre-season training period. Since the subjects were engaged in exhaustive endurance training under heat exposure at that time, the nonspecific immune status might have been partially compromised due to chronic overload.

The efficacy of Landiolol hydrochloride (Onoact^®) for the treatment of arrhythmia was studied in 10 adult patients who underwent cardiovascular surgery. Onoact was continuously infused at a mean rate of 0.018 mg/kg/min initially and followed by 0.01 mg/kg/min. After the initiation of Onoact infusion, supra-ventricular tachycardia was eliminated in 5 out of 6 patients, and ventricular tachycardia disappeared in all 4 patients. The decrease in systemic blood pressure was not significant. Low-dose continuous infusion of Onoact was safe and effective even in patients just after cardiovascular surgery.

[Objective]Mie University Hospital Department of Anesthesiology established an integrated acupuncture care clinic in April 2010. A total of 8 incidents and accidents occurred during a period of eight months from commencement in April through November of 2010.
Re-examination of the issues from the incident and accident reports, led to the creation of a clinical manual for the acupuncture clinic as a means to improve the safety of the acupuncture clinic.
[Methods]Based on the contents of the reported incidents, which were collected from electronic medical records up to November 1st 2010, a safety manual was created for the prevention of recurring incidents and accidents. Following a request for approval to the Safety Division of Mie University Hospital, the safety manual underwent screening and inspection and was eventually approved.
After the introduction of the manual, the occurrence of incidents and accidents, was tracked using electronic medical records for a period of four months from December 2010 to March 2011.
[Results]The incidents and accidents that occurred before the creation of the manual were all related to acupuncture (dropped acupuncture needles: 5, needles taken home: 1, and leaving needles inserted: 2). Incidents and accidents have not been reported since the introduction of the manual, that is, for a period of four months from December 2010 to March 2011.
[Conclusion]Clinical practice based on the manual suggests the possibility of preventing incidents and accidents, as none have been reported since the introduction of the manual. The safety manual is still incomplete, as it emphasizes mainly the management of acupuncture and not its entire context. If any further negative incidents or accidents occur, a review and improvement of the present manual will be required. In order to deal with any new negative incidents or accidents, organizing a team will be indispensable.
Since Mie University Hospital has an established Safety Division, soliciting the cooperation of the infectious disease control and medical safety experts to ensure safe clinical practices in the acupuncture core clinic should also be arranged.
The results suggest that the creation of a safety manual can be a means of preventing the occurrence of incidents and accidents.