The effect of bathing with artificial sodium sulfate on changes in the systolic blood pressure and the level of atrial natriuretic polypeptide (ANP) in plasma or atrium of normotensive male rats was studied. The following results were obtained:
1) As a result of bathing for 20 minutes at a temperature of 37°C, the systolic blood pressure lowered and the plasma ANP level decreased. The blood pressure lowered most clearly after artificial sodium sulfate bathing at a prescribed concentration (p<0.5), while the plasma ANP level decreased significantly after plain water bathing (p<0.01).
2) The atrial ANP level showed no significant change. Presumably the reason was that the quantity of atrial ANP was so large that it was not affected by fluctuations in the peripheral ANP level.
3) The temperature and duration of bathing, the concentration of bath salts, and other factors might also influence the plasma ANP level.
These results suggest that the artificial sodium sulfate bathing lowers the blood pressure by preventing heat radiation from the skin and by delicate regulatory mechanisms on ANP secretion.

The effects of bathing with artificial sodium sulfate on the systolic blood pressure and the level of atrial natriuretic peptide (ANP) in plasma and or in atrium of spontaneously hypertensive rats (SHR) were studied. The following results were obtained:
1) As a result of bathing for 20 minutes at a temperature of 37°C, the systolic blood pressure lowered and the plasma ANP level increased. The blood pressure lowered with increasing concentration of sodium sulfate (p<0.01).
2) The plasma ANP level in a standing position for 20 minutes decreased than in a normal position.
3) The plasma ANP level in SHR was higher and increased more clearly by bathing, compared to the previous results in normotensive rats (WKA). The blood pressure lowered far more in SHR than in WKA.
4) The atrial ANP level was not significantly influenced by bathing nor by changing the posture.
These results indicate that the artificial sodium sulfate bathing has more potent hypotensive effect than plain water bathing probably due to prevent heat radiation, and affects the blood pressure and the plasma ANP more significantly in SHR than in WKA. In addition, the effects of mild bathing to cardiovascular and neurohumoral systems may modulate directly or indirectly the ANP secretion.

Objective To observe the impact of zotepine on the excitatory synaptic response and long term potentiation (LTP) of dentate gyrus neurons.Methods Male rabbits ( n = 20) weighting about 2.5 ～ 3.5 kg were divided into four groups randomly ( n = 5 ): control, zotepine 1.0, zotepine 2.0 and zotepine 5.0.To each rabbit,there were 60 results during 120 min.Population spike(PS) amplitude and excitory postsynaptic potential (EPSP) slope were used to be the indexes of the excitatory synaptic response of dentate gyrus neurons.The sequence was base response ( at the beginning), intraperitoneal injection of 0.5ml dimethylsulfoxide or 0.5ml zotepine-dimethylsulfoxide solution ( 1.0,2.0,5.0 mg/kg of zotepine dosage) ( after 30 min) and titanic stimulation (after 90 min).Results To 4 groups,the PS amplitude and EPSP slope after single stimuli were not significantly different from those before single stimuli.In control group, the PS amplitude and EPSP slope after titanic stimulation[(0.68 ± 0.052)mV and(0.633 ± 0.024 )mV/ms] were significantly different from those before injection[(0.266 ±0.008) mV and(0.246 ±0.010) mV/ms] (P＜0.05 ～0.01 ) ,and LTP were induced.LTP were not induced after titanic stimulation in group zotepine 1.0,2.0 and 5.0.After titanic stimulation, the PS amplitude and EPSP slope in group zotepine 5.0[(0.277 ±0.008)mV and(0.296 ±0.007) mV/ms] were significantly different from those in group control(P＜ 0.05).Conclusion Zotepine had little effect on the excitatory synaptic response of dentate gyrus neurons after single stimuli in perforant path, while it blocked the induction of LTP in perforant path-dentate gyrus pathway.

In patients with myocardial infarction (MI), anginal attacks, reinfarctions or sudden deaths occur occasionally during or after bathing. Therefore it is important to know well about influence of bathing on cardiac function. In this study we examined hemodynamic indices by means of Swan-Ganz catheter and blood flow pattern with Doppler echocardiographic method in comparison with cardiac events (CE) during and after admission.
Forty-nine patients with MI (mean age 58.9 years) were examined, including 14 patients with extensive anterior MI, 12 with anterior, 17 with inferior and 6 with anterior and inferior MI. Bathing was carried out at supine position in a tap water at 42°C during 5 minutes in the Hubbard tank. The patients was classified into two groups, one with CE (Group A), and the other without CE (Group B). Hemodynamic indices by means of Swan-Ganz catheter, peak velocities of blood flow (PV) at left ventricular outflow tract (LVOT) and blood flow pattern at left ventricular inflow tract (LVIT) with Doppler echocardiographic method were studied in comparisons.
Seven of 49 patients had CE (2 cases with sudden death, 2 cases with reattack of MI and 3 cases with heart failure), and 2 of theses 7 cases had CE during bathing (one with sudden death and the other with reattack of MI). Pulmonary capillary wedge pressure (PCWP) increased from 4.0±2.7mmHg to 12.5±4.6mmHg in Group B, while in Group A marked increases in PCWP on bathing were noted from 3.9±1.2mmHg to 18.1±4.8mmHg (p<0.001) and significant high level was maintained during bathing. Mean pulmonary arterial pressure (mPAP) in Group A also increased during bathing significantly compared with Group B. Six of 13 patients (46.2%) with decreased PV at LVOT and 3 of 8 patients (37.5%) with markedly increased A/R at LVIT on bathing had CE, which was noted at the higher rate compared with those with increased PV and without markedly increased A/R (each, p<0.001, p<0.05). In Group A, severe heart failure on admission into coronary care unit was significantly noted much (p<0.001), physical work capacity was lower in exercise tolerance test by bycyle ergometer and left ventricular ejection fraction was lower (26.9±6.1% vs 56.1±16.6%, p<0.001) with significance in cardiac catheterization, suggesting cardiac dysfunction.
In conclusion, bathing should be carried out carefully in patients with markedly increased PCWP or mPAP, with decreased PV at LVOT and with markedly increased A/R at LVIT.

The first step of cancer medical treatment is to eliminate anxiety about opioids. It is recommended to use printed matter in the "Guideline for Cancer Pain Management" edited by Japanese Society of Palliative Medicine,but few medical professionals actually use it. We developed the Opioids' pamphlet designed by Aichi Prefectural Society of Hospital Pharmacists; abbreviated OPA. This pamphlet is little burdened for readers; focusing on eliminating anxiety about opioids. Evaluation of the utility of the OPA and the actual conditions of patient education about the use of opioids by medical professionals were investigated, since there have been no reports on these issues. A questionnaire survey was conducted in hospitals with more than 150 beds in Aichi Prefecture. It targeted doctors, pharmacists and nurses who were practicing palliative care using opioids. There were many pharmacists and nurses who had been consulted about opioids, and most of the consultations were about addiction. 60% of pharmacists and 30% of nurses voluntarily performed patient education. Awareness of the guideline for of cancer pain management was low. OPA, which was reviewed based on the guideline, was applicable to 99% of the cases where the nurses were consulted. Its size and contents were highly acclaimed. Therefore, OPA is extremely valuable in clinical practice. Palliat Care Res 2009; 4(1): 214-227

Recently, in addition to standard surgical operations, reduction therapy (endoscopic mucosal resection and endoscopic gastrectomy) is indicated for early gastric cancer. However, the indication should be limited to the casesof early gastric cancer without lymph node metastases.
During the past 25 years, we have surgically treated 2, 246 cases of early gastric cancer. The percentage of lymph node metastasis in 1, 242 mucosal cancer cases was 1.8% and that in 1, 004 submucosal cancer cases was 16.9%. In the mucosal cancer cases, lymph node metastasis did not occur in the depressedtumors with a diameter of less than 10mm and the elevated tumors with a diameted of less than 20mm. In the submucosal cancer cases, lymph node metastasis did not occur in the elevated tumors less than 10mm in diameter. So, the cases of gastric cancerof these types require the reduction therapy.
However, in the mucosal cancers that have been diagnosed during the last 5 years, the percentage of preoperative correct diagnosis as for thedepth of invasion was 69.4%. In the submucosal cancers, the rate was 60.1%. Many of the cases diagnosed incorrectly had ulcers in the lesion. As for the infiltration type, INFβ and γ were noticeable in these cases. As for the histological type, most of the cases wereof the undifferentiated type.
Moreover, if should be noted, the percentage that the histological type of preoperative ensoscopic biopsy specimens agrees with that of postoperative ones is 50-60% except for tubl of mucosal cancers.

The promotion of clinical research in Japan requires the establishment of a formal and systematic education and training program for clinicians to ensure they become effective clinician investigators. The first of its kind in Japan, a formal 1-year masters-degree-level training program (MCR course) was started at Kyoto University School of Medicine and Public Health. The first 28 students graduated in 2008, with most returning to their original clinical institutions.
1) As follow-up, we conducted a self-administered questionnaire survey of all 28 graduates (response rate, 86%) concerning the current status of clinical research and problems encountered at their institutions.
2) Almost 40% of respondents (n=24) reported "no time" or "no research collaborators" for clinical research.
3) Twenty respondents (83%) have attempted to promote clinical research at their hospital or workplace, but only 1 has received institutional support.
4) Over half of the respondents (54%) would like to be working in both clinical research and clinical practice at their hospital in the future (10-year timescale). Forty-two percent of respondents had a concrete image of the clinical researcher's career path.
5) Although open to improvement, the MCR program presents a concrete model for the education of clinical researchers. These findings suggest that promoting the conduct of clinical research requires the implementation of a support system and adjustment of personal and physical infrastructure.

No abstract available.
Burkitt Lymphoma ; Fungemia ; Humans ; Trichosporon

We began providing comprehensive cardiac rehabilitation for congestive heart failure (CHF) in 2014 at our institution, using an original pamphlet and heart failure notebook to provide life guidance for CHF. However, the life guidance rate was lower in 2017 (61%) than it was in 2014 (77%). The objective of this study was to investigate the awareness of life guidance among nurses. We administered a questionnaire survey regarding life guidance to 28 nurses in December 2018. Among the 27 respondents, 26 nurses (96%) had high motivation and 21 (80%) felt a sense of accomplishment. Responses to the “most important point in life guidance” were “understanding living condition” by 14 nurses, “heart failure notebook” by 9 nurses, and “guidance using the pamphlet” by 6 nurses. Fifteen nurses (58%) felt that the guidance had become routine in nature, and 5 nurses (19%) were worried about their instruction. The nurses were motivated to provide life guidance, but they also felt that the guidance had become routine because they had been providing the same guidance for many years. We consider that the factors related to the lower life guidance rate are the routine/repetitive nature of the guidance and concerns about instruction. Going forward, we need to review the content of the guidance and the teaching approach.

An aortoesophageal fistula is a critical condition with high operative mortality. A case of aortoesophageal fistula following thoracic endovascular aneurysm repair is reported. The patient was a 72-year-old man complaining of dysphagia who underwent stent grafting for a saccular aneurysm of the descending aorta that was compressing the esophagus four months earlier. Endoscopic examination showed perforation of the aneurysm into the esophagus with severe stenosis. The aneurysmal sac was filled with thrombus. Aortography demonstrated a type I endoleak from the lesser curvature of the aortic arch, draining into the aneurysmal sac. The patient was afebrile with moderate elevation of C-reactive protein, and the white blood cell count was normal. The patient underwent closure of the aneurysmal entry with healthy aortic wall and replacement of the descending aortic aneurysm with a prosthetic graft. The graft was isolated from the fistula by an omental flap. The patient's postoperative course was uneventful. Computed tomography performed 4 years after the surgery showed shrinkage of the aneurysmal sac. The patient has had a healthy life for 9 years since the operation.