Many researchers have pointed out that CO₂ bathing directly effects expanding dermal vessels. To clarify the effect of CO₂ bathing on red blood cell (RBC), the change of RBC viscosity after single bathing(for 10 minutes at 40°C) with artificial CO₂ water made of sodium bicarbonate and citric acid dissolved in plain water was investigated. RBC viscosity was measured at both shear rates of 0.0439 (low) and 94.5 (high) sec^-1 using a viscosimeter (Low Shear 30 made by Contraves). The subjects of this study consisted of three male patients and three female patients with a history of cerebro-vascular disease and ranging from 53 to 80 years old.
The results are presented below.
1) On the twenty-first day of serial CO₂ bathings, a significant decrease in RBC viscosity was found in these patients as compared with that in controls who were subjected to bathing with plain water. However, it was not found on the first day. RBC viscosity of the blood sample that has an elevated PCO₂ due to the CO₂ gas bubbled into it was measured in relation with the PCO₂. RBC viscosity decreased gradually at both shear rates as the PCO₂ was elevated and the MCV increased.
2) MCV increased significantly after single bathing on the twenty-first day of serial CO₂ baths as compared to that of controls who were subjected to bathing with plain water.
3) ATP concentration in RBC decreased significantly after single bathing as compared to that before bathing.
From these results, we can conclude that serial CO₂ baths effectively decrease RBC viscosity due to the increase in MCV, which is attained by CO₂ through “chloride shift.”

Many researchers have pointed out that CO₂ bathing directly effects expanding dermal vessels. The authors have recently reported a decrease in red blood cell after CO₂ bathing. To clarify other effects of CO₂ bathing on RBC, the changes in the hemoglobinoxygen-dissociation curve (P50) were measured after single bathing (for 10 minutes at 40°C) with artificial CO₂ water made of sodium bicarbonate and citric acid dissolved in plain water. P50 was measured with an oxygen-dissociation analyzer (HEMO-O-SCAN^TM made by American Instrument Company) and 2, 3-diphosphoglycerate (2, 3-DPG) in RBC, with enzymatic analysis. The subjects of this study consisted of six male patients and four female patients, ranging from 53 to 80 years old.
The results are presented below.
1) Nine of ten patients showed an increase in P50 after 15 to 30 minutes of CO₂ bathing. The remainder showed a transient increase in P50.
2) No significant increase in 2, 3-DPG concentration in RBC was found in the group subjected to CO₂ bathing as compared to that of the controls who were subjected to plain water bathing. However, seven patients showed an increase in 2, 3-DPG after 15 to 30 minutes of CO₂ bathing, and three patients showed a decrease in 2, 3-DPG.
3) Partial pressures of oxygen (PO₂) and carbon dioxide (PCO₂) in the venous blood were measured. Elevation of PO₂, lowering of PCO₂, and increase in pH were observed in almost all patients after a single CO₂ bath.
From these results, we can conclude that a single CO₂ bath effectively decreases oxygen affinity of hemoglobin, presumably due to a rise in the blood temperature and partially due to an increase in 2, 3-DPG concentration in RBC.

From April 1983 through March 1993, 10, 767 women underwent health examinations at the Health Care Center in Obihiro Kosei Hospital. Cervical smears were taken from theuterine cervix for cervical cancer screening. One hundred and six women had abnormal results, greater than class III. Those patients who were diagnosed as having carcinoma numbered 10 (0.09%). Of the cervical carcinomas found, 1 was frankly invasive (adenocarcinoma Ib); 3, microinvasive (2; squamous cell carcinoma and 1; co-existence of adenocarcinoma and squamous cell carcinoma); and 6, carcinomas in situ (squamous cell carcinoma).

Objective: In this study, we evaluated the change in degree of recognition and understanding of palliative care as pharmacy students’ years advanced.
Methods: A questionnaire survey consisting of 11 items about recognition of narcotics and 27 items about understanding of palliative care was conducted with first- to fifth-year pharmacy students.  We divided the questions about the image of narcotics into groups and classified the questions about their knowledge of palliative care into the categories based on some reports.
Results: Among the three groups of questions about the image of narcotics, the degree of “right recognition of narcotics” increased, and those of “wrong recognition of narcotics” and “sense of resistance to narcotics” decreased as pharmacy students’ years advanced.  Additionally, questions about their knowledge of palliative care were categorized into three: “basic guidelines for cancer pain relief and methods of narcotic use,” “role of pharmacists in palliative care and support for patients,” and “pharmacologic characteristics of narcotics.”  Their degree of understanding of each category increased with an increase in years.  Both the recognition of narcotics and understanding of palliative care changed in the fourth- and fifth-grade year students compared to the first-, second-, and third-year ones.
Conclusion: These results suggest that the recognition and understanding of palliative care changed along the same trends as pharmacy students’ years advanced.  Therefore, it is important that pharmacy students acquire appropriate knowledge to play an active role in palliative care.

Background: Problems associated with using inhalational anaesthesia are numerous in veterinary anaesthesia practice. Decreasing the amount of used inhalational anaesthetic agents and minimising of cardiorespiratory disorders are the standard goals of anaesthetists. Objective: This experimental study was carried out to investigate the sparing effect of intravenous tramadol, lidocaine, dexmedetomidine and their combinations on the minimum alveolar concentration (MAC) of sevoflurane in healthy Beagle dogs. Methods: This study was conducted on six beagle dogs. Sevoflurane MAC was determined by the tail clamp method on five separate occasions. The dogs received no treatment (control; CONT), tramadol (TRM: 1.5 mg kg -1 intravenously followed by 1.3 mg kg -1 h -1 ), lidocaine (LID: 2 mg kg -1 intravenously followed by 3 mg kg -1 h -1 ), dexmedetomidine (DEX: 2 μg kg -1 intravenously followed by 2 μg kg -1 h -1 ), and their combination (COMB), respectively.Cardiorespiratory variables were recorded every five minutes and immediately before the application of a noxious stimulus. Results: The COMB treatment had the greatest sevoflurane MAC-sparing effect (67.4 ± 13.9%) compared with the other treatments (5.1 ± 25.3, 12.7 ± 14.3, and 40.3 ± 15.1% for TRM, LID, and DEX treatment, respectively). The cardiopulmonary variables remained within the clinically acceptable range following COMB treatment, although the mean arterial pressure was higher and accompanied by bradycardia. Conclusions Tramadol-lidocaine-dexmedetomidine co-infusion produced a remarkable sevoflurane MAC-sparing effect in clinically healthy beagle dogs and could result in the alleviation of cardiorespiratory depression caused by sevoflurane. Cardiorespiratory variables should be monitored carefully to avoid undesirable side effects induced by dexmedetomidine.

BACKGROUND/AIMS: Transpapillary forceps biopsy is an effective diagnostic technique in patients with biliary stricture. This prospective study aimed to determine the usefulness of the wire-grasping method as a new technique for forceps biopsy. METHODS: Consecutive patients with biliary stricture or irregularities of the bile duct wall were randomly allocated to either the direct or wire-grasping method group. In the wire-grasping method, forceps in the duodenum grasps a guide-wire placed into the bile duct beforehand, and then, the forceps are pushed through the papilla without endoscopic sphincterotomy. In the direct method, forceps are directly pushed into the bile duct alongside a guide-wire. The primary endpoint was the success rate of obtaining specimens suitable for adequate pathological examination. RESULTS: In total, 32 patients were enrolled, and 28 (14 in each group) were eligible for analysis. The success rate was significantly higher using the wire-grasping method than the direct method (100% vs 50%, p=0.016). Sensitivity and accuracy for the diagnosis of cancer were comparable in patients with the successful procurement of biopsy specimens between the two methods (91% vs 83% and 93% vs 86%, respectively). CONCLUSIONS: The wire-grasping method is useful for diagnosing patients with biliary stricture or irregularities of the bile duct wall.
Bile Ducts ; Biliary Tract ; Biopsy* ; Constriction, Pathologic* ; Diagnosis ; Duodenum ; Hand Strength ; Humans ; Methods* ; Prospective Studies* ; Sphincterotomy, Endoscopic ; Surgical Instruments*

From January 1981 through December 1986, 27, 513 individuals consisting of 17, 918 males and 9, 595 females underwent health examinations at Health Care Center in Obihiro Kosei Hospital. 14.2% of healthy and asymptomatic men and 29.1% of healthy and asymptomatic women had microscopic hematuria (one or more RBCs per HPF).
To evaluate the clinical significance of microhematuria, about one third of patients with asymptomatic microhematuria who had undergone complete urological examination were reviewed.
Genitourinary neoplasms were found in 0.21%(8 bladder cancers, 2 prostatic cancers and 1 renal cell cancer). The incidence of cancers increases proportionate to increase in age, furthermore, lesions were found more commonly in men than in women. We could find no relationship between the degree of hematuria and the cause. The results suggest that patients with asymptomatic microhematuria should undergo urological examinations.

BACKGROUND/AIMS: Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been used to diagnose gastrointestinal submucosal tumors (SMTs). Although rapid on-site evaluation (ROSE) has been reported to improve the diagnostic accuracy of EUS-FNA for pancreatic lesions, on-site cytopathologists are not routinely available. Given this background, the usefulness of ROSE by endosonographers themselves for pancreatic tumors has also been reported. However, ROSE by endosonographers for diagnosis of SMT has not been reported. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers for SMT, focusing on diagnosis of gastrointestinal stromal tumor (GIST), compared with that of EUS-FNA alone. METHODS: Twenty-two consecutive patients who underwent EUS-FNA with ROSE by endosonographers for SMT followed by surgical resection were identified. Ten historical control subjects who underwent EUS-FNA without ROSE were used for comparison. RESULTS: The overall diagnostic accuracy for SMT was significantly higher in cases with than without ROSE (100% vs. 80%, p=0.03). The number of needle passes by FNA with ROSE by endosonographers tended to be fewer, although accuracy was increased (3.3±1.3 vs. 5.9±3.8, p=0.06). CONCLUSIONS: ROSE by endosonographers during EUS-FNA for SMT is useful for definitive diagnosis, particularly for GIST.
Biopsy, Fine-Needle* ; Diagnosis* ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Gastrointestinal Stromal Tumors* ; Humans ; Needles

In recent years, the system for providing home medical care and palliative care has been improved, and the number of cancer patients who are treated at home until the end is increasing. The aim of this study was to investigate the circumstances of cancer patients who died at home and the presence of doctors and nurses at the moment of death. We conducted a prospective survey of end-oflife cancer patients receiving home visits from home care and palliative care clinics in Japan from 1st July to 31st December 2017. During the study period, we analyzed the mortality status of 676 patients who died in their homes, serviced by 45 clinics. Of these patients, 91% were living with families, 49% died on holidays or at night, and the doctor and nurse was present at the time of death in only 5.6% and 9.9% of cases, respectively. Most of the patients who died at home lived with their families, with few doctors and nurses present at the time of their patients’ death.

BACKGROUND: Studies reported adverse behavioral development including internalizing and externalizing problems in association with prenatal exposure to bisphenol A (BPA) and phthalates; however, findings were not sufficient due to using different assessment tools and child ages among studies. This study aimed to examine associations between maternal serum levels of BPA and phthalate metabolites and behavioral problems at preschool age. METHODS: The Strengths and Difficulties Questionnaire (SDQ) was used to assess behavioral problems at 5 years of age. BPA and phthalate metabolite levels in the first trimester maternal serum was determined by LC-MS/MS for 458 children. Variables used for adjustment were parental ages, maternal cotinine levels, family income during pregnancy, child sex, birth order, and age at SDQ completed. RESULTS: The median concentrations of BPA, MnBP, MiBP, MEHP, and MECPP, primary and secondary metabolites of phthalates, were 0.062, 26.0, 7.0, 1.40, and 0.20 ng/ml, respectively. MECPP level was associated with increase conduct problem risk (OR = 2.78, 95% CI 1.36-5.68) overall and the association remained after child sex stratification, and odds ratios were increased with wider confidence interval (OR = 2.85, 95% CI 1.07-7.57 for boys, OR = 4.04, 95% CI 1.31-12.5 for girls, respectively). BPA, ∑DBP (MnBP + MiBP), and ∑DEHP (MEHP+MECPP) levels were not associated with any of the child behavioral problems. CONCLUSIONS Our analyses found no significant association between BPA or summation of phthalate metabolite levels and any of the behavioral problems at 5 years of age but suggested possible association between MECPP levels and increased risk of conduct problems.
Adult ; Age Factors ; Benzhydryl Compounds ; blood ; Child, Preschool ; Environmental Exposure ; analysis ; Female ; Humans ; Male ; Phenols ; blood ; Phthalic Acids ; blood ; Pregnancy ; Prenatal Exposure Delayed Effects ; epidemiology ; Problem Behavior ; Smoking ; epidemiology ; Socioeconomic Factors