Atherosclerotic morbidity of the ascending aorta is associated with an increased risk of perioperative cerebral damage during cardiac surgery. To minimize the risk, we developed a refined method for occluding the diseased ascending aorta. From April 2005 to December 2007, 18 patients underwent cardiac surgery. Just before aortic cross-clamping, the aorta was opened during brief circulatory arrest in order to flush out any possible remaining atheromatous debris. The specially designed intra-aortic occluder was applied to an extremely calcified aorta. There were no hospital mortalities or cerebrovascular accidents. In conclusion, our technique can greatly contribute to the prevention of embolic complications in patients with a severely diseased ascending aorta.

A 56-year-old man was admitted to our hospital for the purpose of rehabilitation. Because this patient developed apallic syndrome 21 days after he recovered from his first coma, he was diagnosed with the interval form of carbon monoxide (CO) poisoning. On admission, he showed paralysis of all limbs, motor dysfunction due to joint contractures, pain, and higher brain dysfunction. These symptoms were consistent with magnetic resonance imaging (MRI) findings that the frontal white matter was mainly affected while the involvement in the basal ganglion was mild. Rehabilitation was continued, and his motor dysfunction was improved in a few months, although the higher brain dysfunction needed a longer term to improve. An interruption of his rehabilitation resulted in the exacerbation of the motor dysfunction. Subsequent complications of CO poisoning have been reported to be linked to the areas of the involvement revealed by MRI. Since CO poisoning can show various symptoms, a diversity of rehabilitation is required, according to the patients' symptoms. We think that rehabilitation is the most effective therapy for the subsequent complications of CO poisoning. Since the symptoms require a long time to improve, it is difficult to deal with them within the application of the existing health insurance and nursing care support regulations. We consider that rehabilitation for motor dysfunction and higher brain dysfunction are important, in addition to hyperbaric oxygen therapy in the acute stage of CO poisoning.

PREAVOID is pharmaceutical intervention that is utilized to illustrate pharmacists’ contributions to medical care.  Currently, there is a great need for pharmacists to provide good medical services to inpatients; as a result, many pharmacists conduct pharmaceutical management in hospital wards.  However, pharmacists who have limited experience in working in the ward do not know exactly what they should check with respect to pharmaceutical management.  To resolve this problem, we determined 16 pharmaceutical-management items based on PREAVOID that was conducted at Nagara Medical Center.  Moreover, we conducted a pre-questionnaire survey assessing whether pharmacists who had worked in the ward for fewer than 4 years attended to these 16 check items in their daily work prior to our introducing the list to them.  The results indicated that pharmacists who had fewer than 2 years of experience working in wards attended to the 16 check items less than those who had more than 2 years of experience, and approximately half of the pharmacists had not received adequate guidance before beginning work at the ward.  In addition, most pharmacists indicated that clear check points were useful for conducting pharmaceutical management and the 16 check items were useful for their daily work.  These results indicate that the 16 check items are a useful educational tool for enabling pharmacists to conduct high quality pharmaceutical management from the initial stage and that using the 16 check items is superior to pharmacists only gaining this ability via prolonged experience working in the ward.

Although numerous studies have shown that each neuropsychological test is effective for diagnosing mild cognitive impairment (MCI) or Alzheimer’s disease (AD), studies comparing diagnostic accuracies of various neuropsychological tests are relatively rare and practical cutoff values are not available. The present study aimed to investigate the validity of neuropsychological tests and develop cutoff values for each in differentiating healthy control (HC), MCI and AD groups. A total of 84 HC, 187 with MCI and 195 with AD were evaluated by the selected seven neuropsychological tests using receiver operating characteristic (ROC) curve analysis. Logical Memory (LM) delayed recall (cutoff, 7) and Rey Auditory Verbal Learning Test (RAVLT) delayed recall (cutoff, 6) were effective for differentiating HC from MCI. To distinguish MCI and AD, Rey Osterrieth Complex Figure Test (ROCFT) 3 mindelayed recall (cutoff, 6) and LM immediate recall (cutoff, 4) were excellent. Delayed recall of verbal materials, as indexed by LM and RAVLT was sensitive for discriminating MCI from HC. Handling visual memory traces, as indexed by ROCFT and immediate verbal information by LM were sensitive for differentiating MCI and AD.
Alzheimer Disease ; Dementia ; Neuropsychological Tests

The University of Tokyo Disability Services Office and the University of Tokyo Hospital have striven to advance the inclusion of individuals with disabilities and to encourage the co-production of research as well as mental health services with peer support workers. In convergence with these endeavors, the Center for Diversity in Medical Education and Research (CDMER) was founded in 2021. The Center aims to establish an environment and culture that facilitates the participation and success of medical professionals with disabilities. For this purpose, it is essential to integrate the perspective of the social model of disability into medical education and promote co-production in the medical field, which is among the most challenging areas that can realize co-production. The Center is involved in various educational and research activities, including managing educational programs for medical students and supporting student-led research.