Objective To investigate the accuracy of electrocardiogram(ECG)-gated CT angiography in the detection of bleb in unruptured aneurysm. Methods In 2004,15 unruptured aneurysm patients received ECGgated CT angiography examination. Results Ten of the patients had bleb and the bleb was detected as the pulsation site in ECG-gated CT angiogram.Surgically excised specimen were stained and histological investigation revealed that there were partial or complete absence of tunica media smooth muscle and the internal elastic lamina layer in the aneurysm wall in 15 cases.A sudden reduction of collagen layer was noted in 10 cases with bleb.(Conclusion)ECG-gated CT angiography can be used in the bleb detection of unruptured aneurysms,and its accuracy can be verified by histological examination.

Objective To evaluate the usefulness of Doppler micro-probe and rigid endoscope in aneurysm surgery. Methods From April 2005 to July 2006,Doppler micro-probe and rigid endoscope were applied to 96 patients with aneurysm.The number of aneurysm was 107.The diameter of the Doppler probe was 1.5 mm,with a frequency of 20 MHz.Endoscopes with 0,30 and 70 degree were used.Doppler and endoscope were employed before and/or after aneurysm clipping. Results In all the 107 aneurysms,there were 39 in which the endoscope provided information unavailable under the microscope.The clip was adjusted after endoscope and/or Doppler examination in 19 aneurysms,10 of which were due to incomplete clipping,while the other 9 compromise of small perforators. ConclusionDoppler and endoscope are useful in aneurysm surgery,and can be applied both before and/or after clipping.

To examine the relationship between sports activity and bone mass acquisition, we observed one-year changes in the bone mineral content and density (BMC and BMD) of weight-bearing and non-weight-bearing bone in 68 college women who had participated in various sports since the age of 18.5 years on average. Based on their sports experience, the subjects were divided into four groups: Group A: 18 students who have not had participated in any kind of sports activity since junior high school days ; Group B: 8 students who had participated in team sports at junior and senior high school, then stopped practicing after entering college ; Group C: 14 students who had participated in team sports since junior high school ; Group D: 28 rhythmic sports gymnasts. Whole-body and regional BMC in the head, trunk, arms and legs, and BMD of the lumbar spine and proximal femur were measured using an XR-26 DXA scanner. Height, weight and calcium intake were similar among the four groups, and during the experiment their values changed little. With regard to annual changes in BMC and BMD for weight-bearing regions: 1) In Group A, no signifi-cant increases were observed in any of the body regions; 2) In Groups B and C, only the lumbar spine showed a significant increase. Comparing the changes in BMD in these two groups, Group C showed a larger increase than Group B, although the value did not reach statistical significance ; 3) In Group D, significant increases in BMD for the lumbar spine and femoral neck and in BMC for the trunk and legs were found. The annual changes in BMD were significantly higher than Group A. As to annual changes in non-weight-bearing bones such as those in the head and arms, there were not significant differences among the groups. These data indicate that sports practice may affect changes in bone mass in weight-bearing regions in female college students. Furthermore, it is possible that the amount and quality of sports training may influence the peak bone mass and its timing.

Objective To evaluate the size,aspect ratio and configuration in ruptured aneurysms. Methods Three-dimensional CT angiogram of 61 confirmed ruptured saccular aneurysms were analyzed.The maximum diameter and aspect ratio were measured,and the configuration of the aneurysms were observed. Results The average maximum diameter was 8.54 mm,and 78.8% of the aneurysms were less than 10 mm in maximum diameter.The average aspect ratio was 2.15,and more than 65% of the aneurysms had an aspect ratio over 1.6.45.9% of the aneurysms harbored a bleb or were multi-lobular in shape. Conclusion Aneurysms less than 10 mm in maximum diameter are also easy to rupture.More than 60% of the ruptured aneurysms had an aspect ratio over 1.6.Bleb and multi-lobular change are common in ruptured aneurysms.

Objectives: The first objective of this study was to classify men aged 40-74 yrs with metabolic syndrome (MetS) according to daily rice intake, and the second was to investigate physical measurements, physiological examinations, blood biochemical assays, intake of food other than rice and lifestyle and environmental factors in the study group.
Methods: We analyzed data from 6095 men aged 40-74 yrs who had undergone full medical examinations. The men were classified into 3 age groups: (1) 40-49 yrs, (2) 50-59 yrs, and (3) 60-74 yrs. The men were classified further into 3 groups according to daily rice intake: group 1 (≤300 g), group 2 (300-450 g), and group 3 (≥450 g). The relationship between daily rice intake and the following factors was analyzed in the three age brackets: (1) physical measurements including waist circumference, (2) physiological measurements, (3) serum biochemical indices, (4) whether or not the person was taking medication for hypertension, diabetes mellitus or serum lipid abnormalities, (5) lifestyle, and (6) consumption of foods other than rice.
Results: Daily rice intake was related strongly to the occurrence of MetS in all three age brackets. Multiple logistic regression analysis showed (1) a significant increase in the odds ratio for MetS (1.461 times) for group 3 compared with group 1 in men aged 40-49 yrs and (2) a significant increase in the odds ratio for MetS (1.501 times) for group 3 compared with group 1 in men aged 50-59 yrs. However, there was no significant difference in the odds ratio for MetS among rice intake groups in the 60-74 age bracket.
Conclusion: In men aged 40-59 yrs, daily rice intake strongly influenced the incidence of MetS, whereas in men aged 60-74 yrs, there was no relationship between daily rice intake and MetS.

　　Yuri Kumiai General Hospital is a community-based core hospital that treated approximately 14,000 patients in the emergency outpatient clinic in 2014, with approximately 7,800 walk-in patients on Saturdays, Sundays, and holidays. In April 2014, we incorporated an inhospital triage system for walk-in patients on weekends and holidays to quickly diagnose the conditions of patients in a crowded waiting room and promptly treat those requiring urgent care. Furthermore, in April 2015, we introduced the Japanese Triage and Acuity Scale (JTAS) to standardize the quality of triage care. Evaluation and analysis of 7,454 triage forms to identify future challenges revealed that the triage rate was 88% immediately after the incorporation of the JTAS, with 93 incomplete triage forms, 13 undertriage cases, and 18 overtriage cases. This showed that the severity of emergency was determined based only on subjective symptoms and complaints, with no application of objective physical assessment. We presented a list of analysis results to triage staff, further assessed undertriage cases, and provided feedback in monthly workshops. At 1 year after introduction, the rate of triage increased to 95%, with 12 incomplete forms, 9 undertriage cases, and 21 overtriage cases, and the number of cases increased where the severity of emergency was determined accurately from the entire clinical picture including vital signs and the cause of injury. These findings suggest that use of the JTAS enabled a standardized triage system to be established and that the assessment of undertriage cases and organization of continuous workshops improved the quality of triage and the skill of triage nurses.

There have been concerns that neuraminidase inhibitors (oseltamivir, zanamivir, laninamivir, and peramivir) cause neuropsychiatric adverse events (NPAEs).  We evaluated the number of relevant reports, reporting ratio, and reporting odds ratio (ROR) by using spontaneous reporting database, such as the Japanese Adverse Drug Event Report (JADER) (April 2004 to July 2014).  The RORs of oseltamivir, zanamivir, laninamivir, and peramivir were 11.8 (95% confidence interval (CI), 10.8-13.0), 47.0 (95% CI, 40.0-55.3), 9.5 (95% CI, 6.8-13.2), and 3.3 (95% CI, 2.1-5.1), respectively.  The lower limit of the ROR 95% CI of NPAEs of all neuraminidase inhibitors was ≥1.  We analyzed the association of age and gender with NPAEs in patients treated with oseltamivir using a logistic regression model.  The adjusted ROR of NPAEs was 66.9 (95% CI, 50.3-88.9) in male patients treated with osletamivir aged 10-19 years.  The adjusted RORs of NPAEs were increased in male and female patients under the age of 20 years.  Neuraminidase inhibitors including oseltamivir treatment could be associated with NPAEs.  Therefore, these drugs should be used carefully in clinical practice.

A number of investigators have been concerned with the anthropometric as well as physical characteristics of sumo wrestlers during the past several decades. However, none have attempted to determine body density and percent body fat by the most accurate technique of hydrostatic or underwater weighings. Thus, a precise quantification of body density and percent body fat for the wrestlers has not yet been obtained. Ogawa et al. (1972) have predicted the body composition of sumo wrestlers from a formula which added the triceps and subscapular skinfold thicknesses. As the regression equation used in this instance was based on samples of normal young men, it may not have great predictive accuracy when used on the exceptional population of very stout athletes.
The purposes of this study were : (1) to assess the validity of percent body fat estimation by skinfold thickness measurement when compared to the hydrostatic weighing criterion method ; (2) to determine the interrelationships between anthropometric variables for use in the clear assessment of the physical characteristics of ‘Shindeshi’ sumo wrestlers ; and (3) to thereby develop a formula that would reliably predict percent body fat using skinfold thicknesses and/or anthropometric measurements in this exceptional population. The interrelationships between anthropometric and body composition variables were investigated using 35 Shindeshi sumo wrestlers, aged 15-20 years (X=16.5±1.5) .
The results of the present study can be summarized as follows.
1. The Shindeshi in the present study possessed physiques more developed than those tested in the past, as evidenced by Rohrer's and Ponderal Indices which were approximately 180 and 26.2, respectively. The development of body weight was particularly notable (i.e., over 100kg) .
2. Percent body fat for the Shindeshi was remarkably higher than that of a normal population of the same age, with approximately seventy percent of the Shindeshi possessing more than 20% body fat and less than 1.05000 body density.
3. Body density and height correlated negatively and insignificantly with almost all the variables. In contrast, correlations of body weight, circumferences, and all other variables were, in most cases, high and positive, with body weight correlating least with height. The skinfold measurement correlating best with % body fat was that taken at the thigh site (r=0.898) . The circumference measurements correlating best with % body fat were obtained at the thigh (r=0.888 and 0.831) and the abdomen (r=0 885) parts.
4. Of the six formulae for estimating % body fat, Sloan's correlated best with % body fat as determined by densitometry, and best approximated the mean value of 24.5%. However, all of the equations underestimated the measured % body fat of the Shindeshi.
5. When an exceptional population is being investigated, estimation of % body fat should be done with a population specific equation to ensure predictive accuracy. The following multiple regression equation (r=0.963) should, therefore, be utilized for estimation of % body fat in sumo wrestlers.
Y=0.2488x₁+0.6172x₂-14.3962 where x₁ and x₂ are abdomen circumference and skinfold thickness at thigh, respectively.

The Japanese Ministry of Health, Labor, and Welfare lists interstitial lung disease as an serious adverse drug event.  The Food and Drug Administration Adverse Event Reporting System (FAERS) and the Japanese Adverse Drug Event Report (JADER) databases are available to detect adverse events signals.  We analyzed reports of interstitial lung disease in FAERS and JADER and calculated the reporting fraction and reporting odds ratio (ROR) of drugs potentially associated with interstitial lung disease.  We applied Weibull shape parameter to time-to-event data in JADER.  We found FAERS to contain 3,522,995 reports from January 2004 to March 2013 and JADER to contain 292,720 reports from April 2004 to November 2013.  In FAERS, the reporting fractions of interstitial lung disease for Gefitinib, Bleomycin, and Amiodarone were 7.4% (285/3,856 reports), 3.2% (86/2,663 reports), and 1.9% (357/18,366 reports), and RORs (95% confidence interval [CI]) were 29.26 (25.89-33.07), 11.99 (9.66-14.88), and 7.29 (6.55-8.11), respectively.  In JADER, the reporting fractions of interstitial lung disease for Gefitinib, Bleomycin, and Amiodarone were 45.6% (1,070/2,348 reports), 22.1% (77/348 reports), and 27.9% (468/1,678 reports), and RORs (95% CI) were 18.46 (16.99-20.06), 5.83 (4.52-7.51), and 8.14 (7.31-9.07), respectively.  Adverse event signals of interstitial lung disease were observed in most drugs, which are warned as a suspected drug in the literature.  With the time-to-event analysis using Weibull shape parameter, time-dependency of adverse events in each drug was different.  Therefore, these drugs should be used carefully in clinical practice.

The diagnosis of pituitary carcinoma cannot be made easily histologically, and most cases of pituitary carcinoma are diagnosed only after the clinical detection of metastasis. Distant metastasis of pituitary tumor occurs in 0.1% to 0.2% of cases and has been reported in the liver, bone and central nervous system, with only one case of metastasis to the cauda equine reported. This study describes a rare case of the drop metastasis of adrenocorticotropic hormone-producing pituitary adenocarcinoma to the cauda equina, causing cauda equina syndrome.
Adenocarcinoma ; Adrenocorticotropic Hormone ; Cauda Equina* ; Central Nervous System ; Diagnosis ; Liver ; Neoplasm Metastasis* ; Pituitary Neoplasms* ; Polyradiculopathy