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.

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.

In order to find an effective way to detect bacteria responsible for respiratory tract infections in children, we first examined as pharyngeal swabs, epi-pharyngeal swabs and nasal aspirates obtained from children hospitalized at our pediatric service during these five months from December 1997 to April 1998. In the rate of bacterial infection, it was found that nasal aspirates came out on top with 92.6%(25/27), followed by epipharyngeal swabs with 71.6%(53/74) and pharyngeal swabs with 26.2%(38/145). Single-species bacteria were found in 78.9%(30/38) of pharyngeal swabs, where as 45.3% of epi-pharyngeal swabs (24/53) and 52.0% of nasal aspirates (13/25) proved mixed infections with two-or three-defferent species. Thus it was suggested that nasal aspirates and epi-pharyngeal swabs would be far more adequate than pharyngeal swabs to detect bacteria with accuracy.
Next, based on the efficiency of bacterial detection, we compared culture media for the specimen obtained from in-patients and out-patients at our pediatric service. The rate of isolation of gram-negative rods was as low as 0.3%(1 of 314 strains) even when BTB agar plate, a selective medium for these bacteria, was employed. The sensitivety was not much different from those observed with nonselective blood agar plate. These results suggest that the conventional blood agar media can substitute for the more expensive type of BTB agar medium for the diagnosis of infections diseases of the airwaysin children.

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.

Re-do open cardiac surgery may sometimes require complete ablation around the pericardium for the 2 major reasons of attaining better myocardial protection and obtaining effective DC cardioversion. However, this ablation may increase postoperative hemorrhage which may require blood transfusion. Hypothermia is based on the concept of myocardial protection during open heart surgery by suppressing myocardial metabolism, but recently the approach has been changed to maintaining myocardial metabolism with aerobic or anaerobic energy production. We have already reported that histidine-buffered cardioplegia which promote anaerobic glycolysis, provided an excellent functional recovery of myocardium post-ischemia with lower inotropic requirements in a range from 10°C to 37°C of myocardial temperature. Based on our theoretical background and clinical data, we tested the efficacy of this type of cardioplegia in patients receiving multiple surgical procedures with minimum ablation after sternotomy. First case, who had undergone a Bentall procedure for annulo-aortic ectasia 14 years previously had a thrombotic valve and mitral regurgitation. Aortic valve plasty and mitral valve replacement (MVR) was performed. The second case who had undergone MVR 15 years previously had malfunction of the prosthetic valve and underwent re-MVR. The third and fourth cases had ventricular septal defect (VSD) which were closed using Teflon patches. The third case had patch closure during second operation for residual shunt. The fourth case received tricuspid valve replacement (TVR) for tricuspid regurgitation due to a pacemaker lead implanted into the right ventricle through the left subclavian vein. The fifth case received coronary artery bypass surgery in a second operation for restenosis of the graft and progressing atherosclerosis. All hearts started beating spontaneously without DC cardioversion after the aortic unclamp. Ventricular fibrillation occurred in the first case while the patient was weaned from cardiopulmonary bypass and treatment was performed by aortic cross clamp, infusion of the cardioplegia followed by aortic unclamp to start own beat again. Two of 3 patients who were able to donate their own blood preoperatively did not require homologous blood transfusion. Due to advantages such as excellent myocardial protection under hypothermic or normothermic condition, ease of use and relatively lower potassium concentration, histidine-buffered cardioplegia can be an excellent candidate for myocardial protection in re-do cases with less ablation technique.