Progress in vascular surgery has been owing to the development of vascular prosthesis. However, clinical results of small-caliber synthetic vascular prostheses, which were applied to coronary surgery and infrainguinal arterial reconstruction, have been still inferior to those of autogenous vein graft. Since Maruyama succeeded in culturing vascular endothelial cells from human umbilical cord vein in 1963, tissue culture of vascular endothelium has played an important role of clarifying various aspects of thrombosis, fibrinolysis and atherosclerosis. In order to improve the patency rate of small-caliber vascular graft, the idea to connect tissue culture with synthetic material was occurred to mind. Since 1978 endothelial cell seeding has been investigated for the purpose to provide native antithrombogenicity to synthetic vascular prosthesis. There were many reports about the better patency, the earlier endothelialization and the less platelet adhesion on the luminal surface of the experimentally seeded graft. Recently “prelined graft”, which is made from in vitro seeding of cultured endothelial cells, has been paid attention to rather than the classical technique of endothelial seeding with preclotting method. In our bioresearch laboratory vascular endothelial cells were derived enzymatically from canine external jugular veins. They were cultured to confluency and seeded in vitro to small-caliber vascular prostheses by the rotation method. Experimental results of animal implantation in 8 weeks revealed that the endothelial seeded graft had superior patency to control graft. Seeded endothelial cells were observed histologically to form monolayer lining at the middle portion on the inner surface. Their function was confirmed by the peroxidase antiperoxidase reaction to identify Factor VIII related antigen in the cell body. Subendothelial structure was examined thinner in the intimal area of good endothelial coverage. There are several problems about hybrid vascular prosthesis, which is concomitantly composed of synthetic material and cultured vascular cells. First, experienced technique of tissue culture should be mastered for harvesting cells and maintenance of the experimental graft. Study of vascular smooth muscle cell and extracellular matrix should be also advanced in pararell with that of endothelial cells. Synthetic material should be searched in pursuit of biodegradable or bioresorbable graft which is expected to have cell affinity. Concerning the cell attachment, necessity of coating substance on the graft such as adhesive protein should be reconsidered. Seeded endothelial cells should be evaluated from the immunological point of view before clinical application, because cultured cells from human vascular wall may acquire various antigenicity in the course of tissue culture. Seeding of cultured endothelial cells in vitro will be an evolutionary trend for the development of small-caliber synthetic vascular prosthesis.

The purpose of this study was to assess an impact of water immersion recovery after short distance swimming on the recovery process in pulmonary functions in individuals with the past history of bronchial asthma (PHA). Eleven Japanese healthy males with PHA (23 years) volunteered to perform two bouts of a 25-m maximal front crawl session in an indoor pool. The two bouts were separated by either 10-min of recovery on the land (L-session) or the same condition with water immersion to the neck (W-session), using a counterbalanced crossover design. Water temperature was 30 °C. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV_1.0) (%predicted) were measured according to the following time course; at baseline (REST), water immersion to the neck (WIN) before the swimming session, after 5-min (REC-5) and 10-min (REC-10) recovery with the assessment of dyspnea sensation (ADS) at the same time point. %FVC and %FEV_1.0 at WIN, REC-5 and REC-10 in the W-session were significantly lower than those REST. A similar reduction was observed at WIN in the L-session, and %FEV_1.0 at REC-5 was significantly different from those REST. The subjects had higher ADS at REC-5 in both sessions compared with those REST. %FVC and %FEV_1.0 at REC-5 and REC-10 in W-session were significantly lower than those at REC-5 and REC-10 in L-session. These results indicates a negative impact of not only water immersion recovery but also recovery on the land after short distance swimming on pulmonary function in individuals with PHA.

Purpose: We evaluated the efficacy of continuous administration of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) in patients with end-stage non-small cell lung cancer. Method: Our study included 33 patients most recently treated with EGFR-TKI for non-small cell lung cancer that had once been responsive to EGFR-TKI but eventually showed worsening. We compared patients who discontinued EGFR-TKI within one month (n=16) after their disease progressed and those who continued the treatment (n=17). Results: The median survival time was significantly longer in patients who continued EGFR-TKI (191 days) than in those who discontinued the treatment (62 days) (p=0.0098). Adverse events experienced by patients who continued the treatment included Grade 1 eruption in six, Grade 2 eruption in one, Grade 1 diarrhea in one and Grade 1 AST/ALT elevation in four. All of these adverse events were manageable. Conclusion: In patients with non-small cell lung cancer initially responsive to EGFR-TKI but eventually showing worsening and becoming unfit for cytotoxic anticancer drugs, continuous administration of EGFR-TKI may extend their survival with acceptable toxicity. Further investigation of this strategy is warranted. Palliat Care Res 2011; 6(1): 119-125

　At Showa University, which consists of the Schools of Medicine, Dentistry, Pharmacy, and Nursing and Rehabilitation Sciences, systematic interprofessional education for the purpose of training staff who can contribute to the medical team has been introduced with the cooperation of all 4 schools and through all undergraduate years. In the lower years, students study the basics of medical team care through a 4-school joint curriculum of experiential learning （such as early exposure） and problem-based learning inside and outside of the university. In the upper years, to acquire practical skills, students study the practice of medical team care through a joint curriculum of participatory learning in hospitals and the community. Through this curriculum, I expect that the medical staff to promote patient-centered team medical care in a variety of medical fields will grow in the future.

BACKGROUND: Venous thromboembolism (VTE) and the subsequent development of pulmonary embolism (PE) is a major cause of post-operative mortality in total knee arthroplasty (TKA). We evaluated whether the addition of an ultrasound-guided femoral nerve block with general anesthesia affected the incidence in the development of VTE following TKA. METHODS: This was a retrospective non-randomized comparative study with patients assigned to groups based on the surgery date (pre-femoral nerve block versus post-femoral nerve block periods). All anesthesia and medical records of the patients who had undergone computer-navigated TKA in our facility between January 2009 and March 2010 were retrospectively reviewed. RESULTS: Forty patients were identified; 15 patients underwent computer-navigated TKA under general anesthesia alone (Group G) and 25 patients underwent surgery under general anesthesia combined with ultrasound-guided femoral nerve block (Group F). The incidence of development of VTE post-operatively was significantly lower in Group F (P = 0.037). Logistic regression analysis identified the use of a femoral nerve block as the most significant variable correlating with the incidence of post-operative development of VTE, and the odds ratio for VTE development in Group G was 3.12 (95% CI, 0.57-20.56). CONCLUSIONS: We suggest the possibility that the addition of a femoral nerve block on general anesthesia may reduce the incidence of the development of VTE following TKA.
Anesthesia ; Anesthesia, General ; Arthroplasty ; Femoral Nerve ; Humans ; Incidence ; Knee ; Logistic Models ; Medical Records ; Nerve Block ; Odds Ratio ; Pulmonary Embolism ; Retrospective Studies ; Venous Thromboembolism

OBJECTIVEPrevious studies on the association between physical activity (PA) and neighborhood environments (NE) focused on either objectively measuring the NE or the residents' perception of NE. Here, we investigate which actual or perceived NE is associated with residents' PA in Japan.

METHODSTwo regions with an objectively assessed high and low residential density, land use mix-diversity, and street connectivity, respectively, were identified in one city. The subjects were selected using a stratified random sampling method by sex and age in each region. The NE of the subjects was objectively measured using the Geographic Information System (GIS), and the subjects' perception of the NE was assessed using a questionnaire. The daily total number of walking steps was measured with an accelerometer, and walking and cycling time were assessed by a questionnaire.

RESULTSFor the female subjects, the mean cycling time, subjectively assessed as a means of transport, was significantly longer in the group with a high GIS score for the number of land use types, while the score for total number of walking steps was significantly higher among those who were aware of places to walk to, and cycling time for transport was longer for those who perceived an accessibility to post offices, banks/credit unions, gymnasiums/fitness facilities, and amusement facilities in their neighborhood. For the male subjects, the score for walking time for leisure was longer for those who perceived aesthetics and an accessibility to parks, and the score for total walking steps was significantly higher for those who perceived an accessibility to bookstores or rental video stores in their neighborhood.

CONCLUSIONSThe results to this study demonstrate that daily PA was high among female subjects living in a NE with land use mix-diversity, and who had an awareness of places to walk to and the accessibility to facilities for daily necessities in their neighborhood. For male subjects, daily PA was high among those who perceived the aesthetics of and accessibility to facilities for pleasure in their neighborhood. Further research is needed to determine the association between PA and NE on the basis of sex differences.

Objective: To evaluate the efficacy of fan therapy for the relief of dyspnea in patients with chronic progressive disease. Methods: A systematic electronic database search of all available articles published before October 23, 2019 was conducted using Ichushi-Web of the Japan Medical Abstract Society databases, CENTRAL, EMBASE, and MEDLINE. In addition, a hand-search for updates was performed using PubMed on June 30, 2020 and December 7, 2021. The inclusion criteria were: 1) any RCTs comparing the effect of fan therapy with any other intervention, and 2) patients aged ≥18 years. Exclusion criteria were: 1) duplicate references, and 2) conference presentations. Results: We identified 110 studies, of which 10 met our criteria for inclusion. Finally, five studies were used in the meta-analysis. Fan therapy significantly improved dyspnea in patients with chronic progressive disease compared to control groups with a standardized mean difference of −1.43 (95% confidence interval: −2.70 to −0.17, I2=94%, p<0.0001). Conclusion: Fan therapy was found to be effective in reducing dyspnea in chronic progressive disease.

Objective: To evaluate the efficacy of high-flow nasal cannula oxygen (HFNC) for dyspnea in patients with advanced disease. Methods: A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Ichu-shi Web. Inclusion criteria were: 1) randomized controlled trials evaluating the effect of HFNC on dyspnea; 2) aged 18 years or older with advanced disease with hypoxemia; 3) control group was conventional oxygen therapy or noninvasive positive pressure ventilation. Exclusion criteria were: 1) patients in intensive care unit, 2) weaning from ventilator. Results: Six studies (4 from database searches, and 2 from hand searches) were included. In the 2 studies evaluating short-term intervention, one showed HFNC was more efficacious, and the other conventional oxygen was more efficacious. In the 2 studies evaluating long-term interventions: one showed HFNC was more efficacious, and the other showed no significant difference. In the 2 studies evaluating the intervention during exercise, one showed HFNC was more efficacious, and the other showed no significant difference. Conclusion: HFNC may be effective for dyspnea in patients with advanced disease associated with hypoxemia.

Pericardial effusion due to malignancy often needs drainage, however, it is difficult to repeat to puncture, especially in the case of little effusion space. Here we report a case of non-small cell lung cancer, 71 years old male, who was diagnosed in 2012 and had malignant pericardial effusion as a post-operative recurrence in June 2018. After several chemotherapy regimens, he suffered from dyspnea on effort due to increasing pericardial effusion. We performed pericardial drainage, but 2 months later pericardial effusion had increased again. The need of repeating of pericardial drainage was estimated, so we placed subcutaneously placed port system into his pericardial space. Thereafter, we drained pericardial effusion through it on demand for his dyspnea. Gradually his circulatory status had been exacerbated and he died on 36th day after the procedure. In the case of malignant pericardial effusion, the subcutaneously placed port system may be useful because repeated aspiration can be done by single procedure of pericardial puncture. It may keep quality of life of patients and more cases should be experienced and assessed.