Objective Peritoneal lymphatic features are studied to provide necessary data for understanding transport capabilities of the endothelial and mesothelial cells. Methods Enzyme\|histochemical staining methods were employed to investigate organization of the lymphatic networks and their endothelial ultrastructures in the monkey peritoneum using light,scanning and transmission electron microscopy. Results 5' Nase positive initial lymphatics showed extensive network,obvious valve like structures and numerous blind ends.The calibre of lymphatics with extremely irregular lumen varied greatly from 40 to 120?m.Lymphatic endothelium was usually separated from mesothelium by a small quantity of loose connective tissue,or they directly contacted each other in some areas.No basal lamina occurred between the peritoneum and the lymphatics originating from milky spots in the omentum and mesovarium.Milky spots are oval or round visible bodies aggregated by macrophages and lymphocytes.Both the endothelium of lymphatic lacunae and the mesothelium that forms the peritoneal stomata,represent a strong 5' Nase activity.Abundant microfibrils attached the stomatal edge. Conclusion The distribution and structure of peritoneal initial lymphatics reveal significant regional variations,and lymphatic endothelium has a close morphological and functional relationship with the mesothelium. [

It is well known that patients with abdominal aortic aneurysms (AAA) have a high incidence of coronary artery disease (CAD), and that the major cause of death in patients undergoing aneurysmectomy is acute myocardial infarction. A total of 53 patients (mean age, 71 years) underwent elective repair of AAA between January 1991 and November 1999. In an attempt to reduce early and late mortality caused by myocardial infarction, coronary angiography (CAG) was performed in all cases. Significant CAD was found in 23 patients (43%), with triple vessel disease in 1 patient (2%), double vessel disease in 5 patients (9%), single vessel disease in 16 patients (30%) and left main in 1 patient (2%). Ten patients (19%) in whom CAD was detected by CAG had no history of CAD and displayed no ischemic findings on ECG. In 4 patients (8%), AAA repair was performed 2 (mean) months after coronary artery bypass grafting (CABG). Percutaneous transluminal coronary angioplasty (PTCA) was performed in 8 patients (23%) 19 days (mean) prior to AAA surgery. No patient had a perioperative myocardial infarction either following coronary revascularization (CABG and PTCA) or AAA resection. Moreover, there was only one operative death after abdominal aneurysmectomy (2%), in a patient who was 70 years old with chronic hemodialysis and who died due to multiple organ failure caused by uncontrollable adhesional ileus. The results of this study emphasize the importance of preoperative routine coronary angiography following coronary artery revascularization to enhance the operative outcome of AAA repair.

We report a case of successful surgical treatment for an aortic anastomotic false aneurysm associated with a graft-duodenal fistula after abdominal aortic aneurysm repair. A 63-year-old man was admitted with melena and an aortic anastomotic false aneurysm after prosthetic graft replacement 8 years previously. CT scan demonstrated an aneurysm with a maximum diameter of 70mm at the proximal anastomotis of the prosthetic graft. Gastroduodenoscopy revealed no bleeding site in the stomach or the first and second portions of the duodenum. Therefore, we performed an emergency operation under a diagnosis of an aortic anastomotic false aneurysm associated with a graft-duodenal fistula. The aneurysm was replaced with interposition of a new prosthetic graft via a thoracoabdominal approach. The fistula was repaired by covering the duodenum with the jejunum through a left pararectal laparotomy. The postoperative course was uneventful, and there was no evidence of graft infection at 14 months after the operation.

Background/Aims: The precise incidence of symptomatic uncomplicated diverticular disease (SUDD) and its effects on the quality of life (QOL) remain unclear, particularly in Asian patients with right-sided SUDD. We assess the prevalence of SUDD and its impact on QOL in a real-world population. Methods: Five institutional cohorts of patients who received outpatient treatment for unexplained abdominal symptoms from January 15, 2020 to March 31, 2022, were included. All patients underwent colonoscopy. SUDD was defined as the presence of recurrent abdominal symptoms, particularly pain in the lower right or left quadrant lasting > 24 hours in patients with diverticulosis at the site of pain. The 36-item short-form health survey was used to assess QOL. Results: Diverticula were identified in 108 of 361 patients. Among these 108 patients, 31% had SUDD, which was right-sided in 39% of cases.Of the 50 patients with right-sided diverticula, 36% had SUDD, as did 15 of 35 patients with left-sided diverticula (43%). Among the 33 patients with SUDD, diverticula were right-sided, left-sided, and bilateral in 39%, 45%, and 15% of patients, respectively. Diarrhea was more frequent in the SUDD group than in the non-SUDD group. Patients with SUDD had significantly lower physical, mental, and role/social component scores than those without SUDD. Conclusions It is important to recognize that patients with SUDD account for as high as 31% of outpatients with unexplained abdominal symptoms; these patients have diarrhea and a low QOL. The presence of right-sided SUDD was characteristic of Asian patients.

Forequarter amputation is a rare procedure, performed mainly for patients with malignant bone and soft tissue tumors. The present case involved a 59-year-old man with left scapula chondrosarcoma. Rehabilitation began on the second day after amputation for a left shoulder chondrosarcoma. We performed early mobilization, wound management, mirror therapy for phantom pain, strength training for the remaining muscles, and activities of daily living (ADL)/instrumental ADL (IADL) training for only the remaining upper limb. In addition, we made a shoulder disarticulation prosthesis. Six months after the operation, the International Society of Limb Salvage-Musculoskeletal Tumor Society functional score was 36.7％ for 6 items and 73.3％ for 3 items, while the Disability of Arm, Shoulder and Hand score was 31.7. The patient-reported outcome had a low score because of the lack of an upper limb, including the scapula. However, when he was discharged from the hospital, he gained self-care independence with only the remaining upper limb and resumed fishing as a hobby. We suggest that rehabilitation after forequarter amputation requires careful intervention based on a deep evaluation of the patient's ADL/IADL, hobbies, and quality of life, in accordance with the patient's lifestyle.

Forequarter amputation is a rare procedure, performed mainly for patients with malignant bone and soft tissue tumors. The present case involved a 59-year-old man with left scapula chondrosarcoma. Rehabilitation began on the second day after amputation for a left shoulder chondrosarcoma. We performed early mobilization, wound management, mirror therapy for phantom pain, strength training for the remaining muscles, and activities of daily living (ADL)/instrumental ADL (IADL) training for only the remaining upper limb. In addition, we made a shoulder disarticulation prosthesis. Six months after the operation, the International Society of Limb Salvage-Musculoskeletal Tumor Society functional score was 36.7％ for 6 items and 73.3％ for 3 items, while the Disability of Arm, Shoulder and Hand score was 31.7. The patient-reported outcome had a low score because of the lack of an upper limb, including the scapula. However, when he was discharged from the hospital, he gained self-care independence with only the remaining upper limb and resumed fishing as a hobby. We suggest that rehabilitation after forequarter amputation requires careful intervention based on a deep evaluation of the patient's ADL/IADL, hobbies, and quality of life, in accordance with the patient's lifestyle.

Objectives: The authors considered the community-based on-site water sampling-surveys case-study in Angono, Rizal, in the Republic of the Philippines. The study was designed to determine whether individual citizens within the community could successfully collaborate in order to develop a method for quantification of E. coli levels in water (especially underground water) for domestic use.

Methods: We used techniques that had been validated in Japan for on-site evaluation of E. coli. These simple techniques enabled the on-site quantification of E. coli levels in multiple water sources, including underground water.

Results: The techniques used in Japan were successfully adopted in the Philippines, and we cooperated with regional medical technicians, scientists, and citizens, in order to develop a system where ultimately, the people in Angono can perform all the tasks related to on-site water quality evaluation. From societal and economic perspectives, we were able to reduce the traditionally high laboratory cost (including testing cost and samples transit cost) of coliform bacteria and E. coli evaluation to a lower, fixed cost level that is affordable for regional health centers and other sites.

Conclusion: The transfer of a simple inspection method technology, under the supervision of an experienced Japanese research team, allowed us to validate the E. coli on-site quantification strategy at a regional level as "co-creation of science and society". In addition, beyond technology transfer, our collaborative efforts with scientists, regional medical engineers, and citizens, led to the creation of an NGO (non-governmental organization) that serves citizens in the town of Angono with regard to water quality assessment and certification activities.

Key Words: water quality, water management, community, local people, participatory approach, underground water, Escherichia coli, coliform bacteria, Philippines

Introduction: We analyzed the concentrations of the trace elements [chromium (Cr), arsenic (As), cadmium (Cd), cesium (Cs), lead (Pb), thorium (Th), and uranium (U)] in commercial bottled water consumed in the town of Angono, Rizal province, Luzon island, Philippines to evaluate the health risks of the trace elements in drinking water. There are some arguments that water resources available in the Philippines are heavily polluted by various materials, inparticular heavy metal elements. Method: The concentrations of seven trace elements in commercial bottled water produced and consumed in the Philippines were analyzed using a solution nebulization inductively coupled plasma mass spectrometry (SN−ICP−MS). Result: The concentrations of the trace elements except for Cs, which does not yet have a WHO guideline value, in the locally produced bottled water were below the WHO guideline values. The Cs concentrations (<0.6 μg/L) of the bottled water of the Philippines were generally similar to those of the bottled water produced and consumed in other countries such as Japan, China, and Indonesia. Conclusion The concentrations of trace elements in bottled water consumed in Angono, Philippines can be regarded as being at safe levels, as well as those of daily life water (i.e. tap, well, and spring water) consumed in the said town.
Drinking Water ; Trace Elements ; Philippines

Objective: The present study aims to determine the concentrations of seven trace elements [chromium (Cr), arsenic (As), cadmium (Cd), cesium (Cs), lead (Pb), thorium (Th), and uranium (U)] in tap, well, spring, river, and lake waters in the town of Angono, Rizal in the Philippines, consumed for drinking, cooking, bathing, and washing. In the town of Angono, both of the tap and purified tap waters produced in the refilling station are consumed as the water for drinking. Methods: Water samples from six unpurified tap, six purified taps, 10 wells, two springs, two rivers, and one lake water were obtained in October 2015. Samples were analyzed using solution nebulization inductively coupled plasma mass spectrometry. Results were evaluated for health risks of the trace elements in the water samples using WHO guideline values. The provisional WHO guideline values are as follows: Cr: 50 μg/L, As: 10 μg/L, Cd: 3 μg/L, Pb: 10 μg/L, and U: 30 μg/L. That of Cs has not been proposed yet. The WHO guideline value for the naturally occurring radioactive isotope 232Th in drinking water is 1 Bq/L, which is equivalent to 250 μg/L. Results: The concentrations of the trace elements in the tap water samples were <0.5% of the WHO guideline values, except Cs and Cd, with those of Cd being ~9% of the WHO guideline value. Purified tap waters contained the seven trace elements in lower concentrations, with the exception of Pb, which may have been added in small amounts from equipment used for water purification. The concentrations of the trace elements in water samples from the wells and springs in Angono were more variable than those of the tap waters, and these were also below the WHO guideline values. The concentrations of Cs in all water samples were <0.3 μg/L. The trace-element concentrations of the waters from Angono River and Laguna Lake were almost the same as those of the well and spring waters. Conclusion At present, the concentrations of trace elements in daily life water consumed in Angono are at safe levels.
Trace Elements

Objective: Several evidence-based practice guidelines have been developed to better treat bipolar disorder. However, the articles cited in these guidelines were based on clinical or basic studies with specific conditional settings and were not sufficiently based on real-world clinical practice. In particular, there was little information on the doses of mood stabilizers. Methods: The MUlticenter treatment SUrvey on BIpolar disorder in Japanese psychiatric clinics (MUSUBI) is a study conducted to accumulate evidence on the real-world practical treatment of bipolar disorder. The questionnaire included patient characteristics such as comorbidities, mental status, treatment period, Global Assessment of Functioning (GAF) score, and details of pharmacological treatment. Results: Most patients received mood stabilizers such as lithium (n = 1,317), valproic acid (n = 808), carbamazepine (n = 136), and lamotrigine (n = 665). The dose of lithium was correlated with age, body weight, number of episodes, depression and GAF. The dose of valproic acid was correlated with body weight, number of episodes, presence of a rapid cycle and GAF. The dose of carbamazepine was correlated with age, mania, and the presence of a rapid cycle. The dose of lamotrigine was correlated with the number of episodes, depression, mania, psychotic features, and the presence of a rapid cycle. Doses of coadministered mood stabilizers were significantly correlated, except for the combination of valproic acid and lamotrigine. Conclusion The dose of mood stabilizers was selectively administered based on several factors, such as age, body composition, current mood status and functioning. Further prospective studies are required to confirm these findings.