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.

Purpose: We report a case in which oral sodium valproate through a percutaneous endoscopic gastrostomy (PEG) tube for palliative decompression drainage in inoperable ileus achieved an effective drug concentration and ameliorated delirium and extrapyramidal side effects. Case Report: The patient was a male in his seventies who suffered from bladder cancer. He underwent PEG because of paralytic ileus with cancerous peritonitis. He had been receiving continuous intravenous infusion of haloperidol for the management of delirium, but needed to discontinue treatment with this agent due to tremor, an extrapyramidal side effect of haloperidol. Oral sodium valproate was therefore administered through the PEG tube for palliative decompression drainage. Plasma valproate concentrations showed effective levels, and his irritability was relieved. A good combination of sodium valproate and quetiapine fumarate allowed successful reduction of and eventual withdrawal from haloperidol, and tremor then improved. Conclusion: We often encounter difficulty with symptom control for patients who cannot use oral medications. When medication by other routes is difficult, this case suggests that sodium valproate through a PEG tube for palliative decompression drainage may be useful as a last resort for improving delirium.

We experienced a surgically treated case of chronic contained rupture of a common iliac artery aneurysm. A large number of cases of chronic contained ruptures of the abdominal aorta have been reported; however, that of the common iliac artery is very rare. A 66-year-old man was injured in a bicycle accident. Three months later, the patient felt a dull abdominal pain and noticed a tumor in the left lower abdomen. On presenting computed tomography (CT) scan revealed an aneurysm of the left common iliac artery. After further examinations, a contained rupture of the left common iliac artery aneurysm was diagnosed. At operation, the main aneurysm, 7.5×6.5cm in size, was seen in the left common iliac artery, extending to the right common iliac artery and the infrarenal abdominal aorta. A 5.0×3.0cm tear, was found oil the posterior wall of the left common iliac aneurysm, surrounded by a huge hematoma. The aneurysm was resected and the abdominal aorta and the common iliac arteries were replaced with a Bard Albumin-coated DeBakey vascular bifurcated graft (16×8mm). The postoperative course was uneventful.

BACKGROUND: As dental implants, pure titanium and Ti-6Al-4V has achieved broad clinical applications, but they also contain toxic vanadium and aluminum element. Moreover, their elastic modulus is so high as to produce stress shield. OBJECTIVE: To examine the micro-hardness and elastic modulus of the self-made Ti-30Nb-8Zr-2Mo titanium alloy. DESIGN, TIME AND SETTING: An observational experiment was performed at the laboratory of College of Material Science and Engineering at Hebei University of Technology between March 2003 and February 2006. MATERIALS: Titanium alloy was prepared using titanium sponge (≥ 99% purify), niobium strip (≥ 99.9% purify), molybdenum powder (≥ 99% purify) and zirconium sponge (≥ 99.4% purify).METHODS: The micro-hardness of the specimens was determined after uniformly annealing, hot-forging and solution. Compression test was conducted on post-aging samples. MAIN OUTCOME MEASURES: Hardness and stress-strain curve.RESULTS: The maximal alloy strength was obtained after solution under 800 ℃ for 0.5 hours. Post-aging alloy's hardness was improved significantly although little change occurred on solution alloy. Compressive strength of alloy samples was 1 054 MPa, while elastic modulus reached 16.5 GPa. CONCLUSION: Both micro-hardness and elastic modulus of the self-made Ti-30Nb-8Zr-2Mo titanium alloy have satisfied performance requirements for dental implant materials.

Methods: This study included 229 patients (107 men and 122 women; mean age, 68.9 years) who received one or two levels of MISTLIF, and the patient’s age, gender, disease, paralysis, preoperative physical functions, duration of symptom(s), and surgery-associated factors (waiting for surgery, number of surgical levels, surgical time, and intraoperative blood loss) were studied. Radiographic characteristics and clinical outcomes such as Oswestry Disability Index (ODI) scores and Visual Analog Scale (VAS; 0–100) ODI scores for low back pain, leg pain, and numbness were studied. One year following surgery, patient satisfaction (defined as satisfaction for surgery and for present condition; 0–100) was assessed using VAS and its relationships with investigation factors were examined. Results: The mean VAS scores of satisfaction for surgery and for present condition were 88.6 and 84.2, respectively. The results of multiple regression analysis showed that preoperative adverse factors of satisfaction for surgery were being elderly (β =-0.17, p =0.023), high preoperative low back pain VAS scores (β =-0.15, p =0.020), and postoperative adverse factors were high postoperative ODI scores (β =-0.43, p <0.001). In addition, the preoperative adverse factor of satisfaction for present condition was high preoperative low back pain VAS scores (β =-0.21, p =0.002), and postoperative adverse factors were high postoperative ODI scores (β =-0.45, p <0.001) and high postoperative low back pain VAS scores (β =-0.26, p =0.001). Conclusions According to this study, significant preoperative low back pain and high postoperative ODI score after surgery are linked to patient unhappiness.

We have conducted a nationwide survey on faculty development for simulation-based medical education in Japan. The response rate was 90%. Forty-seven (68%) schools have implemented faculty development programs for simulation-based education. The most commonly implemented contents were standardized patient development, task trainer, high fidelity manikin operation, and student evaluation, which were related to objective structured clinical examination objective clinical skill assessment. Only 15 percent of medical schools implemented topics on reflective practice, and scientific writing. A constraint on faculty time was the most commonly perceived barrier to simulation use (mentioned by 62 schools; 90%).

No abstract available.
Matrix Metalloproteinases* ; Stomach Neoplasms ; Tissue Inhibitor of Metalloproteinase-1 ; Tissue Inhibitor of Metalloproteinase-2

The need for palliative care for heart failure patients has been attracting attention, but the system for providing such care is not yet fully established in Japan. Iizuka Hospital is a 1048-bed acute care hospital located in Fukuoka, Japan. The Heart Support Team (HST) was established to provide palliative care for heart failure at the hospital. After the HST was launched in May 2017, 168 referrals for palliative care intervention for heart failure patients by March 2022. Twenty-five (14.8%) met the intervention cases’ additional palliative care treatment criteria. The Integrated Palliative Outcome Scale was administered to 11 consecutive patients from April 1 to 30, 2021. In establishing and operating the HST, the challenge was recruiting, training, and creating a system to sustain the system. Creating the HST in collaboration with staff specializing in palliative care, psychiatric care, and cardiovascular specialists was the first step in establishing a method for palliative care to heart failure patients in an acute care hospital.

[Background] Presenteeism, defined as the practice of sick workers who come to work, and whose work performance effectiveness has been reduced due to various signs and symptoms, causes a significant financial loss to companies. However, comprehensive and effective occupational health countermeasures have not yet been presented. Therefore, we report here the results of an interim analysis to determine whether an allowance for acupuncture treatment is beneficial for workers' presenteeism. [Methods] A four-week randomized intergroup comparative study was conducted on office workers who were aware of their presenteeism. Participants were allocated to either the control group, in which regular recommended presenteeism countermeasures for each workplace were implemented arbitrarily, or to the intervention group in which an allowance of up to 8,000 was given for acupuncture treatment, in addition to the usual arbitrary measures. The primary endpoint was the WHO-HPQ relative presenteeism score: a score lower than 1 indicates lower work performance; and it was analyzed with the "full analysis set" population.[Results] A total of 52 patients were assigned to the intervention group (n = 30) and the control group (n = 22). On average, the intervention group received acupuncture treatments 1.4 times for stiff neck and shoulders (67%), lower back pain (26%), depression (5%), and allergies (2%), and paid a total of 7,219; and 6,556 was paid as an expense allowance. As a result, the relative presenteeism score was 0.95 in the intervention group, compared to 0.91 in the control group, with a between-group difference of 0.04 (ES (r) = 0.22, P = 0.12).[Conclusions] With a total of up to 8,000 offered to office workers who were aware of their presenteeism, an acupuncture treatment allowance for a four-week period was provided 1.4 times on average. The results suggested that the treatment allowance would increase workers' performance efficiency by about 4% (equivalent to 19,691 per person) compared to those without it.