We report on a case of the altered mental status from hyperammonemia due to a urinary tract infection of urease-producing (urea-splitting) bacteria. A 98-year-old Japanese woman, who had no history of liver cirrhosis or portal hypertension, presented with altered mental status. The cause of the altered mental status was attributed to an elevation of ammonia in her blood. The urine culture grew Proteus vulgaris. Complete recovery occurred with the use of an antibiotic for the urinary tract infection. Among patients with urinary tract infections, but without liver cirrhosis or portal hypertension, production by urea-splitting bacteria and the subsequent tubular reabsorption of ammonia, may result in hyperammonemic encephalopathy.

The aim of this study was to investigate the relationship between changes in swimming velocity (SV), stroke rate (SR), stroke length (SL) and muscle activities during a 4×50m swimming test to simulate a 200m freestyle race. A total of 20 male collegiate swimmers participated in this study. The electromyography (EMG) signals of 11 muscles, 7 muscles in the upper half of the body and 4 muscles in the lower half, were recorded with surface electrodes. SV, SR and SL were analyzed for each 50m (S1, S2, S3 and S4) from side view recordings of swimmers taken with an underwater camera.SV and SR for S1 were significantly higher than for S2 and S3. SL for S1 was significantly longer than for S3. The averaged EMGs (aEMGs) for S1 were significantly higher than for S2 or for S3 in 5 muscles (flexor carpi ulnaris, biceps brachii, triceps brachii, deltoideus posterior and rectus femoris). There were no significant changes between S3 and S4 in SV, SR, SL and aEMG of all muscles except pectoralis major which showed the highest aEMG in S4. Significant correlations were observed between changes of (Δ) aEMG and ΔSV, especially in upper half muscles (r=0.485-0.939, p<0.05).These results suggested that decline in muscle activities of the five muscles mentioned earlier caused a decrease in SV from S1 to S3; and an increase in muscle activity of the pectoralis major led preventing a decline in SV by maintaining the SR in S4.

The purposes of this study were as follows: 1) to classify competitive swimmers on the basis of their stroke rate (SR) and stroke length (SL) by applying a factor analysis and a cluster analysis, 2) to derive discriminant functions by applying a multiple discriminant analysis of the stroke characteristics, and 3) to compare the race patterns of groups classified according to the results of the cluster analysis. 94 male swimmers who had participated in 100-m freestyle events held at the All Japan Swimming Championship from 2000 to 2004 were selected as subjects. The average value of their swimming velocity, SR, and SL in four swimming phases (15-25 m, 25-45 m, 57.5-75 m, and 75-95 m) were measured from videos captured. The subjects were classified according to their SR and SL by applying a factor analysis and a cluster analysis. Results showed that the competitive swimmers could be classified into Type1-4. Type1 showed high values of SR throughout the race, Type2 showed high values of SR in the first half and high values of SL in the second half, Type3 showed high values of SL in the first half and high values of SR in the second half, and Type4 showed high values of SL throughout the race. Although there was no difference in swimming records among the four groups, each group had different race patterns. These results suggest that the knowledge of race patterns might be useful to swimmers or coaches for planning race strategies.

Due to the widespread acceptance of gastric and esophageal endoscopic submucosal dissections (ESDs), the number of medical facilities that perform colorectal ESDs has grown and the effectiveness of colorectal ESD has been increasingly reported in recent years. The clinical indications for colorectal ESD at the National Cancer Center Hospital, Tokyo, Japan include laterally spreading tumor (LST) nongranular type lesions >20 mm and LST granular type lesions >30 mm. In addition, 0-IIc lesions >20 mm, intramucosal tumors with nonlifting signs and large sessile lesions, all of which are difficult to resect en bloc by conventional endoscopic mucosal resection (EMR), represent potential candidates for colorectal ESD. Rectal carcinoid tumors less than 1 cm in diameter can be treated simply, safely, and effectively by endoscopic submucosal resection using a ligation device and are therefore not indications for ESD. The en bloc resection rate was 90%, and the curative resection rate was 87% for 806 ESDs. The median procedure time was 60 minutes, and the mean size for resected specimens was 40 mm (range, 15 to 150 mm). Perforations occurred in 23 (2.8%) cases, and postoperative bleeding occurred in 15 (1.9%) cases, but only two perforation cases required emergency surgery (0.25%). ESD was an effective procedure for treating colorectal tumors that are difficult to resect en bloc by conventional EMR. ESD resulted in a higher en bloc resection rate as well as decreased invasiveness in comparison to surgery. Based on the excellent clinical results of colorectal ESDs in Japan, the Japanese healthcare insurance system has approved colorectal ESD for coverage.
Asian Continental Ancestry Group ; Carcinoid Tumor ; Colorectal Neoplasms ; Delivery of Health Care ; Emergencies ; Hemorrhage ; Humans ; Insurance ; Japan ; Ligation ; Tokyo

This study proposed a rapid method to quantify the colonization rate of arbuscular mycorrhizal fungi (AMF) in plant roots. The method involved the use of an image analysis software (WinRHIZO Pro). The colonization rate is defined as the ratio of the fungal body to the plant root area in a micrograph. Three seedlings of Chengiopanax sciadophylloides, a woody species that accumulates radiocesium, were collected from a secondary forest in the Yamakiya district of Kawamata, Fukushima Prefecture during May–September 2014. The colonization of AMF structures was examined under a light microscope, and the percentage of colonization was determined using the WinRHIZO method. The superiority of the new method was verified by comparing with a modified grid-line intersect method. The colonization of AMF was confirmed in all the seedlings, and a significant coefficient of determination (R² = 0.94) was found with both the methods. The results suggested that the WinRHIZO method is reliable for estimating the colonization of AMF in C. sciadophylloides.
Colon* ; Forests ; Fungi* ; Methods* ; Microscopy ; Plant Roots ; Seedlings

In Korea, mass mortality of Quercus mongolica trees has become obvious since 2004. Raffaelea quercus-mongolicae is believed to be a causal fungus contributing the mortality. To evaluate the pathogenicity of the fungus to the trees, the fungus was multiple- and single-inoculated to the seedlings and twigs of the mature trees, respectively. In both the inoculations, the fungus was reisolated from more than 50% of inoculated twigs and seedlings. In the single inoculations, proportions of the transverse area of non-conductive sapwood at inoculation points and vertical lengths of discoloration expanded from the points were significantly different between the inoculation treatment and the control. In the multiple inoculations, no mortality was confirmed among the seedlings examined. These results showed that R. quercus-mongolicae can colonize sapwood, contribute to sapwood discoloration and disrupt sap flows around inoculation sites of Q. mongolica, although the pathogenicity of the fungus was not proven.
Colon ; Fungi ; Korea ; Mortality ; Quercus* ; Seedlings ; Trees ; Virulence

Introduction : Prevention of embolic stroke is the key issue to perform aortic arch replacement in patients with a shaggy aorta. The aim of this study is to report the utility of the isolation technique for total arch replacement in patients with a shaggy aorta. Methods : Clinical results of seven patients (71.7 years old, all men) with a shaggy aorta who underwent total arch replacement between January 2017 and November 2018 were retrospectively reviewed. The operative indications were a distal arch or proximal descending aortic aneurysm in 6 patients and a thrombus inside brachiocephalic artery in one. A cerebral perfusion was established by inserting a cannula directly into all supra-aortic branches before starting systemic perfusion. Result : Utilizing the isolation technique with clamping of all branches in 4 patients and the functional isolation technique with clamping of two branches in 3, total arch replacement was performed in all patients (operation time : 513 min, selective cerebral perfusion time : 162 min). No operative death was observed and no newly developed stroke was encountered. Conclusion : The isolation technique is a useful method to prevent stroke during total arch replacement in patients with a shaggy aorta.

We present a 62-year-old woman who was diagnosed with primary pulmonary arterial sarcoma with pulmonary hypertension. CT showed a large defect inside both main pulmonary arteries in accordance with the accumulation of FDG-PET. To relieve the symptom and to prevent sudden death, removal of a massive pulmonary tumor and postoperative chemotherapy were planned. Utilizing the intermittent systemic circulatory arrest under deep hypothermia (18°C), the pulmonary artery trunk and both main pulmonary arteries were opened. The tumor stacking inside the pulmonary artery was removed and its origin at the commissure of the pulmonary artery valve was resected. The defect was repaired with a pulmonary valve replacement. Histopathological examination revealed high grade sarcoma. Her postoperative course was uneventful ; however, she died of cerebral hemorrhage during chemotherapy six months after surgery.

Purpose: The purpose of this study was to clarify the current status of Do-Not-Resuscitate discussions (DNRd) with terminally ill cancer patients in Japan and the psychological burden on bereaved families depending on whether or not a DNRd is performed. Method: A multicenter prospective observational study of advanced cancer patients admitted to 23 palliative care units (PCUs) in Japan was conducted, and a questionnaire survey of bereaved families was also conducted after patients died. Result: 1,605 patients were included in the analysis, and 71.4% of patients had a DNRd with doctors before PCU admission, 10.8% at admission, and 11.4% during admission. In contrast, 93.3% of family members had a DNRd with doctors before PCU admission, 48.4% at admission, and 52.1% during admission. Conclusion: Although DNRd was performed between patients and physicians in 72.3% of cases at any point throughout the course of time from before PCU admission to death, there was no evidence of psychological burden such as depression or complicated grief in the bereaved families due to patient participation in DNRd.