Renal damage caused by hemolysis during cardiopulmonary bypass (CPB) was investigated, and the preventive effects of haptoglobin in regard to this condition was also evaluated. Nineteen patients who underwent open heart surgery were divided into two groups: a control group (n=11) and a haptoglobin group (n=8). In the control group, the level of plasma-free hemoglobin increased significantly after CPB (p<0.01), and this level was strongly correlated with renal tubular leaking enzymes: NAG (r=0.76) and γ-GTP (r=0.81), in the Intensive Care Unit or on the first day after surgery. On the contrary, in the haptoglobin group, in which 4, 000 units of haptoglobin was added in the priming solution of CPB, no increased level of plasma free hemoglobin was observed. Furthermore, leak age of renal tubular enzymes were statistically less (p<0.05). It was concluded that free hemoglobin was a cause of renal damage during CPB and the damage was preventable by the administration of haptoglobin.

Objective: The hospital is changing its formulary reference from paper-based to intranet.  There was concern that both paper-based and intranet versions of the formulary would be necessary.  Revising the paper-based hospital formulary each time package inserts are revised is difficult.  For your review we report on the creation of the iPhone® electronic formulary which enables rapid off-line formulary retrieval and easy updates while at the same time providing low cost service in a light device.
Methods: The CSV (Comma Separated Value) of the hospital formulary dictionary was made using a standard personal computer.  The CSV data file was converted using JAMES2DIC into a HTML file format.  Next, the converted HTML file is transformed into the EPWING (Electronic Publishing WING) format using EBStudio.  Finally, we forward the EPWING dictionary file from the personal computer to the iPhone®.  The retrieval becomes possible by using EBPocket for iOS of EPWING/electronic book viewer software for the iPhone®.  The number of items was assumed to be 29 items thought for a lot of inquiries to exist.
Results: We compared the paper-based formulary with the iPhone® electronic formulary.  As a result, the iPhone4® electronic formulary shortened the retrieval time, was smaller, lighter, and excellent at a lower price.
Conclusion: The iPhone4® electronic formulary enables the user to perform complex full-text searches and retrieve information at a much higher speed than is possible with paper based formularies.  It has the additional advantage of seamless integration and deployment of formulary additions or reference material revisions.  We believe we have successfully created a practical electronic formulary.

Objective: When dopamine is administered using a syringe pump, the reduction in drug infusion volume due to syringe replacement can cause hemodynamic instability. To address this, several changeover methods have been developed. This study aimed to investigate the optimal syringe changeover method by comparing the time required for syringe replacement and the drug infusion volume during replacement across different methods. 　Methods: Experiment I. The time required for syringe replacement using the standard syringe changeover method and the flushing method was compared using the Mann-Whitney U test, and the volume of dopamine solution not infused during syringe replacement was estimated. Experiment II. At dopamine infusion rates of 3.6 ml/h (general initial rate) and 6.0 ml/h (standard rate), the dopamine infusion volume over 60 min after syringe replacement was compared between the on-off method or double pumping method and standard syringe changeover method. 　Results and Discussion: There was no significant difference in syringe replacement time between the standard syringe changeover method and the flushing method. The volume of uninfused dopamine solution during the syringe replacement period was less than 0.1 ml for both flow rates. At a flow rate of 3.6 ml/h, the volume of dopamine infused 10 min after the start of infusion was significantly larger with both the double pumping method and the on-off method compared with the standard method. At 30 min and between 50 to 60 min, only the on-off method showed a significantly larger infusion volume compared with the standard method. At a flow rate of 6.0 ml/h, no significant differences were observed at any time point. These findings suggest that higher flow rates may reduce the impact of frictional resistance.

Pulmonary venous obstruction (PVO) after repair of total anomalous pulmonary venous connection remains a significant problem. Once it occurs, it not infrequently recurs. A 14-month-old boy with recurrent pulmonary venous obstruction after repair of mixed type total anomalous pulmonary venous connection was successfully treated by the method of sutureless in situ pericardial repair and anastomosis of the left pulmonary vein to the left atrial appendage. His postoperative course was uneventful. Cardiac catheterization at 2 years and 9 months after the re-redo operation showed successful relief of PVO with marked reduction of pulmonary hypertension. In addition, multidetector computed tomography (MDCT) performed 3 years and 1 month after the operation showed no pulmonary vein obstruction.

Correction of fetal malpresentation such as knee-chest positioning and external cephalic version, has long been performed in cases of breech presentation. The reliability and safety of such treatment, however, remains unclear. We performed moxibustion on three acupoints, namely, Saninko, Shiin, and Yusen to correct the condition.
We studied a total of 28 women, 22 of whom were observed until delivery, and six who had not reached full term by the end of the study. Cephalic presentation was achieved in 25 (89.3%), All but one of the fetuses that were corrected to cephalic presentation had full term vaginal delivery. The remaining one underwent premature delivery due to premature rupture of the membrane at 35 weeks 6 days. None of the babies showed any abnormalities. Correction could not be achieved in three women by the time of delivery. One of these three had dicornate uterus and underwent caesarian section due to premature rupture of the membrane. The other two had full term vaginal delivery of live babies. These results indicate that the correction of breech presentation by moxibustion is a safe method which cause no adverse effects on the mother or baby.

Up until the present, the primary treatment for threatened premature labor has been bed rest, with drug therapy as a supplement. However, with drug therapy the problems of side effects and dosage limitations have made it difficult to achieve therapeutic effectiveness. In this paper, the authors report the favorable results obtained in such cases when moxibustion and a microwave emitter were used for stimulation therapy based on Oriental medical theory. Moxibustion was carried out on Shim, Yusen and Saninko (acupuncture points) in cases of threatened premature labor beyond the 24th week. Despite the short duration of treatment, uterine tension was relieved, fetal movement increased, and resistance in the umbilical artery and uterine artery reduced. Similar results were achieved with multiple microwave stimulation treatments; the effects lasted for long periods and were not accompanied by side effects. Thus, the results showed that through the use of moxibustion therapy in conjunction with drug therapy, the dosage could be reduced, and the frequency of side-effect appearance lowered. These results suggest that moxibustion therapy has potential as an effective and safe new treatment for threatened premature labor.

OBJECTIVE: Although radiation therapy (RT) and concurrent chemoradiotherapy (CCRT) are the global standards for adjuvant therapy treatment in cervical cancer, many Japanese institutions choose chemotherapy (CT) because of the low frequency of irreversible adverse events. In this study, we aimed to clarify the trends of adjuvant therapy for intermediate/high-risk cervical cancer after radical surgery in Japan. METHODS: A questionnaire survey was conducted by the Japanese Gynecologic Oncology Group to 186 authorized institutions active in the treatment of gynecologic cancer. RESULTS: Responses were obtained from 129 facilities. Adjuvant RT/CCRT and intensity-modulated RT were performed in 98 (76%) and 23 (18%) institutions, respectively. On the other hand, CT was chosen as an alternative in 93 institutions (72%). The most common regimen of CT, which was used in 66 institutions (51%), was a combination of cisplatin/carboplatin with paclitaxel. CT was considered an appropriate alternative option to RT/CCRT in patients with risk factors such as bulky tumors, lymph node metastasis, lymphovascular invasion, parametrial invasion, and stromal invasion. The risk of severe adverse events was considered to be lower for CT than for RT/CCRT in 109 institutions (84%). CONCLUSION: This survey revealed a variety of policies regarding adjuvant therapy among institutions. A clinical study to assess the efficacy or non-inferiority of adjuvant CT is warranted.
Chemoradiotherapy, Adjuvant ; Combined Modality Therapy ; Female ; Humans ; Japan/epidemiology ; Middle Aged ; Neoplasm Recurrence, Local/prevention & control ; *Practice Patterns, Physicians'/statistics & numerical data ; Risk Assessment ; Risk Factors ; Surveys and Questionnaires ; Uterine Cervical Neoplasms/radiotherapy/*therapy

PURPOSE: Atopic dermatitis (AD) is a chronic, relapsing eczematous inflammatory skin disease. Mutations in the filaggrin gene (FLG) are major predisposing factors for AD. Ethnic differences exist between Asian and European populations in the frequency and spectrum of FLG mutations. Moreover, a distinct set of FLG mutations has been reported in Asian populations. The aim of this study was to examine the spectrum of FLG mutations in Koreans with AD. We also investigated the association of FLG mutations and clinical features of AD and compared the Korean FLG landscape with that of other East Asian countries. MATERIALS AND METHODS: Seventy Korean patients with AD were enrolled in this study. Fourteen FLG mutations previously detected in Korean, Japanese, and Chinese patients were screened by genotyping. RESULTS: Four FLG null mutations (3321delA, K4022X, S3296X, and S2889X) were identified in eleven patients (15.7%). The most commonly detected mutations in Korean patients with AD were 3321delA (n=6, 9.1%) and K4022X (n=3, 4.5%). FLG mutations were significantly associated with elevated IgE (≥200 KIU/L and/or MAST-CLA >3+, p=0.005), palmar hyperlinearity (p<0.001), and a family history of allergic disease (p=0.021). CONCLUSION: This study expanded our understanding of the landscape of FLG mutations in Koreans and revealed an association between FLG mutations and AD phenotype.
Asian Continental Ancestry Group ; Causality ; Dermatitis, Atopic* ; Humans ; Immunoglobulin E ; Phenotype ; Skin Diseases

Background: The management of medical student examinations has been affected by the COVID-19 pandemic, necessitating measures to prevent overcrowding at the entry/exit flow line of the examination room. Specifically, one method to mitigate congestion at the examination room exit is to allow students to leave early after completing their exams.Methods: This study utilized the regular final examination in emergency medicine for fourth-year medical students at Hirosaki University. Students were permitted to leave the room early, up until 20 minutes before the 60-minute examination period concluded. We included 130 participants in the study and conducted a multiple logistic regression analysis with the test score (higher (1) or lower (0) than the average score) as the dependent variable and the presence or absence of early withdrawal, gender, bachelor transfer status, and regional quota student status as independent variables.Results: Of the 130 fourth-year medical students included in the study, 14 (10.8%) left the exam room early. The multiple logistic regression analysis indicated that bachelor transfer students (odds ratio (OR) = 4.20, 95% confidence interval (95% CI) 1.24-14.18) and female students (OR = 2.56, 95%CI 1.24-5.25) tended to achieve statistically significantly higher scores. However, early leavers (OR = 1.78, 95%CI 0.53-5.95) and regional quota students (OR = 1.72, 95%CI 0.78-3.78) did not exhibit a significant association with the highest scores.Discussion: We found that there is no significant association between early exit of medical students and exam scores in our emergency medicine examinations. Therefore, implementing early dismissal can be justified as a measure to ensure a smooth flow of students when leaving the room.