Previous studies have been reported on the properties of moxa and the effect it has on the self defense mechanism of the body. To study the characteristics of acupoints, the study this time is from the point of whether there are any differences in biological responses if the same stimuli (5mg/body and 15mg/body of moxa) are applied to different acupoints. The acupoints chosen were KIMON, which is the therapeutic acupoint of liver, and DAIO, which is the spleen meridian acupoint located on the same vertical line and which has no effect on the liver. Male ddy mice (6 weeks old) were used as experimental animals. A comparison of the clinical biochemical values of serum 1, 3, 6 and 24 hours after application was conducted. The amount of invasion on body function from each moxibustion stimulus through the strength and progress of biological response was studied. Increases in serum Amylase, LDH, CK, GOT, and GPT in the DAIO group were obtained as compared to that of the KIMON group. There was also a decrease in serum CHE in the DAIO group as compared to that of the KIMON group. It was suggested that there were difference in biological responses between different application points, even with the application of the same stimuli.

We have used narrative approach to supplement the two usual methods of teaching biomedical ethics: the principlebased approach and the casuistic approach. Our experience suggested (1) although the learning of key principles is essential to medical ethics, the casuistic approach can be the more effective strategy than the principle-based approach for learning clinical moral reasoning and (2) that narrative approach can be the most effective learning strategy in humane medicine, especially in relativizing a student's moral views. By combining these three approaches, learning strategies in medical ethics can be refined.

We conducted a questionnaire survey on medical students' attitude on bioethics education. The survey was conducted at the beginning of bioethics courses for fifth-year students from 1997 through 1999. The results suggest that students who had relatively stronger interest in bioethics considered themselves to be “generalist-oriented doctors” rather than “specialist-oriented doctors” and were interested in nonmedical academic fields. Teaching of most bioethical issues was evaluated as not being sufficient for the students' level of interest. Many students thought that bioethics should be taught repeatedly throughout their medical education and that more time should be dedicated to case discussion.

The establishment of experimental peripheral neuropathy and effect of moxibustion on it have been studied using male S. D. rats. To determine the condition of experimental peripheral neuropathy, rats were fed on the solution of acrylamide in the concentration of 100, 200, 300, 400 and 500p.p.m. The body weight decreased dependently on its concentration and the behavior in rats was also detriorated. Especially, ataxia, hindlimb weakness and muscle wasting in rats were remarkably observed.
The effect of moxibustion has been studied on the rats which fed on the 400p.p.m. acrylamide solution. The method of moxibustion is followes; 25mg of moxa was divided into 10 cones and they were treated by each 5 cones on right and left B-18, B-25 and G-34, respectively. The treatment of moxibustion was 6 times in 3 ones a week for 13 days.
As a results, after 12-13 days, moxibustion treated rats showed to improve the deterioration of behavior and muscle wasting induced by acrylamide. Especially, B-25 treated rats showed the improvement of weight in anterior tibial, gastrocnemius and soleus muscle. On the other hand, steadiness on slope was decreased by acrylamide feeding and decrease of the steadiness was not improved by the treatment of moxibustion.
It is suggested that the sutable stimulation of moxibustion improved the deterioration of behavior and muscle waste on the acrylamide induced peripheral neuropathy in rats.

Morphological changes of sciatic and tivial nerves have been observed microscopically and cholinesterase activities of anterior tibial, gastrocnemius and soleus muscles have been examined by the biochemical determination and histochemical method. 25mg of moxa/body (3 times a week, x6) were treated on the acupuncture point, B-18, B-25 and G-34 in acrylamide neuropathy rats.
After 400p.p.m. acrylamide treatment, the degeneration of peripheral nerves with myelin ovoids and foldes, and shrunken myelinated axons were observed. These lesions were advanced in the tibial nerve than in the sciatic nerve. In B-25 and B-18 moxibustion rats, good results were obtained to decrease myelin degeneration in peripheral nerves, but the lesions were advanced in G-34 rats than in acrylamide ones.
In the acrylamide rats, no change of muscle cholinesterase activity was found except the increase in the enzyme activity in the homogenate of anterior tibial muscle. In the gastrocnemius muscle of moxibustion treated rats, the microsomal fraction which contained much more sarcoplasmic reticulum showed high cholinesterse activity. And the activity per muscle protein showed various changes.
It showed that the stimulation of moxibustion had a mild effect to recover the experimental peripheral neuropathy induced by 400p.p.m. acrylamide because of morphological changes of sciatic and tibial nerves and weight of skeletal muscles.

A 14-year-old boy who underwent aortic valve-sparing operation for annuloaortic ectasia at the age of 9 was referred to our service with a diagnosis of acute type A aortic dissection. Emergency total arch replacement with the elephant trunk technique was done successfully and the postoperative course was uneventful. However, computed tomography (CT) 2 weeks after the operation showed a new dissection and enlargement in left subclavian artery and folded elephant trunk. Dilatation in coronary buttons were also seen since the time of surgery. No residual dissection was found in the aorta. Careful follow up is necessary for this case due to multiple aneurysmal changes and a new dissection lesion in a short period. Loeys-Dietz syndrome (LDS) is characterized by vascular findings (aortic aneurysm and dissection) and skeletal manifestations. Due to aortic dissection occurring in smaller diameter aortas in LDS patients than in Marfan syndrome, early and aggressive surgery is recommended for patients with LDS.

Since November 1999 we have attempted to use a right heart bypass (RHB) system for beating heart coronary artery bypass grafting (CABG), which system produce better exposure of lateral and posterior wall of the heart and so enable us to facilitate bypass grafting to these branches. We report on our initial clinical experience with this system and the purpose of this study is to evaluate the efficacy of this system. To clarify the efficacy of the RHB system, we compared the intraoperative and postoperative clinical course, as well as outcome, between patients who underwent beating heart CABG with RHB and patients without RHB. Seventy-seven patients underwent beating heart CABG with RHB (RHB group) between November 1999 and December 2001. In the same period, 88 patients underwent beating heart CABG without RHB. Of these latter, 30 patients needed displacement of the beating heart in order to expose target coronary arteries (OPCAB group). Perioperative clinical parameters were compared between the groups. Patients in the RHB group received more grafts (2.4±0.6) than patients in the OPCAB group (2.0±0.2, p=0.002). There were no hospital deaths in either group. While displacing the beating heart, SvO₂ decreased and pulmonary artery pressure increased in both groups. Nevertheless, the value of SvO₂ was significantly higher in RHB group while displacing to expose the circumflex region (p=0.048) and the distal right coronary artery region (p<0.01). The effect of elevation of pulmonary artery pressure in the RHB group was lower than that in the OPCAB group, but it was not statistically different. Water balance during operation was 2, 898±1, 019ml in the RHB group and the 2, 237±807ml in OPCAB group (p=0.002). Body temperature following operation was 36.0±0.8°C in the RHB group and 36.5±0.8°C in the OPCAB group (p<0.01). However, no differences were found in postoperative blood loss, required transfusion, duration of mechanical ventilation, ICU stay and hospital stay. No patient had postoperative complications related to the RHB system. The introduction of the RHB enabled bypass grafting to posterior wall vessels with better exposure and under greater hemodynamic stability. Therefore we think it a very effective support system which enable multiple coronary revascularization on beating heart CABG.

To develop an osseointegration analyzing system for dental implants, a new analyzing system which can assess the level of osseointegration between an implant and trabecular bone was constructed using digital radiography with morphological filter and node-strut analysis. For assessment of this system, a grayscale test chart that simulates six levels of an osseointegration was created. In addition, digital implant images were made in which the trabecular pattern around the implant was varied over a total of five levels. Implant osseointegration was evaluated on the basis of seven parameters related to the number of nodes (Nd) and terminuses (Tm) of the skeleton bound to the implant (Im) and the skeletal length. The seven parameters were as follows: the number of struts connecting the Im with the Nd and Tm (N.ImNd, N.ImTm), the total number of N.ImNd and N.ImTm (N.Im), the strut length connecting the Im with the Nd and Tm (ImNd, ImTm), and the ratios of the struts connecting the Im with the Nd and Tm (ImNd/TSL, ImTm/TSL), where TSL is the total strut length.Strong correlations (R² = 0.971-1.0) between the theoretical values from the test charts and the measured values were demonstrated. N.ImNd showed the strongest correlation, R² = 0.948, from the digital implant images, followed by N.Im and ImNd, with correlations of R² = 0.86 and R² = 0.84, respectively. This new system for evaluating implant osseointegration by applying morphological processing and node-strut analysis could be useful for computer-assisted diagnosis of digital dental implant images.

OBJECTIVE: We conducted a pooled analysis of published studies to compare the performance of human papillomavirus (HPV) testing and cytology in detecting residual or recurrent diseases after treatment for cervical intraepithelial neoplasia grade 2 or 3 (CIN 2/3). METHODS: Source articles presenting data on posttreatment HPV testing were identified from the National Library of Medicine (PubMed) database. We included 5,319 cases from 33 articles published between 1996 and 2013. RESULTS: The pooled sensitivity of high-risk HPV testing (0.92; 95% confidence interval [CI], 0.90 to 0.94) for detecting posttreatment CIN 2 or worse (CIN 2+) was much higher than that of cytology (0.76; 95% CI, 0.71 to 0.80). Co-testing of HPV testing and cytology maximized the sensitivity (0.93; 95% CI, 0.87 to 0.96), while HPV genotyping (detection of the same genotype between pre- and posttreatments) did not improve the sensitivity (0.89; 95% CI, 0.82 to 0.94) compared with high-risk HPV testing alone. The specificity of high-risk HPV testing (0.83; 95% CI, 0.82 to 0.84) was similar to that of cytology (0.85; 95% CI, 0.84 to 0.87) and HPV genotyping (0.83; 95% CI, 0.81 to 0.85), while co-testing had reduced specificity (0.76; 95% CI, 0.75 to 0.78). For women with positive surgical margins, high-risk HPV testing provided remarkable risk discrimination between test-positives and test-negatives (absolute risk of residual CIN 2+ 74.4% [95% CI, 64.0 to 82.6] vs. 0.8% [95% CI, 0.15 to 4.6]; p<0.001). CONCLUSION: Our findings recommend the addition of high-risk HPV testing, either alone or in conjunction with cytology, to posttreatment surveillance strategies. HPV testing can identify populations at greatest risk of posttreatment CIN 2+ lesions, especially among women with positive section margins.
Cervical Intraepithelial Neoplasia/pathology/surgery/*virology ; Female ; Humans ; Neoplasm Recurrence, Local/*virology ; Neoplasm, Residual ; Papillomaviridae/*isolation & purification ; Papillomavirus Infections/complications/*diagnosis ; Predictive Value of Tests ; Risk Assessment/methods ; Sensitivity and Specificity ; Uterine Cervical Neoplasms/pathology/surgery/*virology

BACKGROUNDSeveral studies have suggested that the exposure to cadmium (Cd) increased mortalities from renal diseases, cardiovascular diseases and malignant neoplasm, including lung cancer and prostate cancer among inhabitants living in Cd-polluted areas and factory workers. This study aimed to assess the influence of environmental exposure to Cd on long term outcome of inhabitants living in an area polluted by Cd.

METHODSA 22-year follow-up study was conducted with 3119 inhabitants (1403 men and 1716 women) living in the Cd polluted Kakehashi River basin in Japan. The subjects were divided into 4 groups according to the amount of urinary Cd level (< 3.0 µg/g creatinine (Cr), 3.0 - 4.9 µg/g Cr, 5.0 - 9.9 µg/g Cr, and ≥ 10.0 µg/g Cr). Mortality was calculated by the person-years method. Hazards ratios (HR) and 95% confidence intervals (CI) were assessed by the Cox's proportional hazard model.

RESULTSCompared with urinary Cd < 3.0 µg/g Cr group, the HR of 5.0 - 9.9 µg/g Cr and ≥ 10.0 µg/g Cr groups were significantly increased after adjustment for age in both sexes: 1.24 (95%CI 1.01 - 1.51) and 1.48 (95%CI 1.17 - 1.90) for men; 1.64 (95%CI 1.17 - 2.28) and 1.78 (95%CI 1.27 - 2.50) for women. The most frequent cause of death was malignant neoplasm in men and cardiovascular diseases in women. The significant increase in mortality risk for cardiovascular diseases was observed in the subjects with ≥ 10 µg/g Cr in both sexes: 1.79 for men (95%CI 1.02 - 3.12) and 2.38 for women (95%CI 1.11 - 5.07). When the subjects were divided into 2 categories (< 20 µg/g Cr and ≥ 20 µg/g Cr), the HR of the urinary Cd ≥ 20 µg/g Cr group for nephritis and nephrosis were 4.82 (95%CI 1.07 - 21.61) in men and 7.92 (95%CI 1.77 - 35.33) in women, respectively. The significant increase was not observed for malignant neoplasm.

CONCLUSIONThese results suggest a dose-response relationship between Cd body burden and mortality for cardiovascular diseases, cerebrovascular diseases and nephritis and nephrosis.

Aged ; Aged, 80 and over ; Cadmium ; toxicity ; Cardiovascular Diseases ; mortality ; Cerebrovascular Disorders ; mortality ; Environmental Exposure ; adverse effects ; Female ; Follow-Up Studies ; Hazardous Substances ; Humans ; Japan ; Male ; Middle Aged ; Nephritis ; mortality ; Nephrosis ; mortality ; Proportional Hazards Models ; Risk Factors