Laparoscopic ovarian cystectomy is a relatively uncomplicated process, but extraction of the resected cyst can sometimes be difficult, especially with ovarian dermoid cysts. We report here our method of extraction for ovarian cysts measuring 7-10cm, where we trap the cyst laparoscopically and utilize the 12mm trocar of the umbilical port to extract the cyst externally.

This study aimed to assess the effect of short-interval intracortical inhibition (SICI) before a jump off a platform (pre-set) on drop jump (DJ); the purpose was to investigate the relationship between this activity and performance, and the different effects of SICI on agonist and antagonist muscles during pre-set for jump athletes. Jump athletes (Jumper group, n=13) and Other athletes (Other group, n=9) performed DJ from drop heights of 0.30, 0.45, and 0.60 m). DJ performance was evaluated with DJ-index which was calculated from contact time and jump height. SICI was calculated from motor evoked potentials (MEP) recorded using paired-pulse transcranial magnetic stimulation for the medial gastrocnemius (MG) and tibialis anterior (TA) muscles in 7 jump athletes. Significantly higher DJ performance was observed for the Jumper group at all drop heights, and the Jumper group exhibited greater performance for the highest drop height than the Other groups. Significant decreases in SICI for MG were observed for the Jumper groups, and this decrease in inhibition was more prominent for the highest drop height during pre-set. Furthermore, the correlation between SICI for MG and DJ-index was stronger for increased drop heights, and a significantly positive correlation between these variables was observed at a height of 0.60 m. However, the SICI during the pre-set for TA exhibited no significant change under any of the conditions. The results of the present study suggest the importance of selective disinhibition of brain areas associated with the agonistic muscles during pre-set for higher DJ performance.

Objective: It is important to prevent dispensing errors for the safety of patients.  For this purpose, it is necessary to improve the dispensing process on the basis of risk priority.  Quantitative evaluation of risk in each operation makes it possible to compare the risk relatively.  In this study, we analyzed data reported in the Pharmacy Risk Error Management System (PREM-S) to evaluate the risk priority in the medicine preparation step of the dispensing process.
Methods: Data of 1,202 cases concerning medicine preparation step were extracted from in 2,458 cases reported into PREM-S between May 2010 and April 2011.  We classified the medicine preparation step into 31 categories based on the operation.  We analyzed the levels in each category as adverse effects on patient’s health by the errors and also the relationship between adverse effect and detection time.  The level represents the degree of adverse effect for the patient.
Results: Information on levels of the 31 categories was obtained from the analysis.  Eight categories included reports of effects on the health of patients.  Three categories such as calculation of powder medicine included level 4 cases.  Detection time was significantly different between level 1 and levels 2 to 4, but there was no significant difference between levels 2 to 4.
Conclusion: The results suggest that analysis of data reported in PREM-S enables evaluation of the risk priority systematically and efficiently.  Evaluation of the risk priority will contribute to prevention of dispensing errors and health effects derived from them.

The aim of this study was to demonstrate a time-series relationship in drop jump (DJ) from a pre-set state with improved performance. Twelve male college athletes performed a DJ from a height of 0.60 m. DJ performance was assessed with a DJ-index (jump height/contact time). Short-interval intracortical inhibition (SICI) was assessed as intracortical inhibitory circuit excitability in a pre-set state, calculated by using paired-pulse transcranial magnetic stimulation for the medial gastrocnemius muscle (MG). The H-reflex of the left MG and the ankle joint torque were calculated in the early phase of take-off. A significant correlation was shown between ⊿SICI during the pre-set state and the DJ index. Thus, we examined the relationships between phases, focusing on time-series relationships throughout the jump period. The results showed a significant correlation between ⊿SICI during the pre-set state and %H-reflex during the early phase of take-off, and peak ankle joint torque during take-off was also significantly correlated with %H-reflex during the early phase of take-off. A significant correlation was also demonstrated between ankle joint torque during take-off and the DJ-index. In conclusion, we observed a time-series relationship between DJ from a pre-set state and improved performance. A decrease of intracortical inhibitory circuit excitability in the pre-set state affects stretch-reflex facilitation during the early phase of take-off; stretch-reflex facilitation results in the development of a large force in the ankle joint during take-off, and this force develops ankle joint torque. These findings may be used to improve jump performance.

A tutorial education system for medical students was introduced at Kinki University in 1998. To evaluate the efficacy and to identify problems of the system, questionnaires were given to both students and tutors. Many students (approximately 80%) enjoyed the system and felt that tutorial lectures were effective. Many students believed that their selflearning time had increased and that they had developed the ability to think scientifically. However, they also thought that the material for tutorials was insufficient and that some tutors lacked teaching ability. Tutors thought that students had developed motivation (52%), problem-solving ability (58%), and debating skills (77%). Tutors also pointed out several problems, e.g., that some students had not developed self-leaning ability. Also, some tutors were poorly motivated. These findings suggest that we need to improve tutorial materials and the quality of tutors as well as fostering the self-learning ability of students.

The physical work load of farmers and dust conditions in the harvesting process of chrysanthemums were investigated for two households (seven workers for A and three for B household, respectively) at mid March in 1984.
The total working hours a day of each household were 3225 min (460 min as average per a worker) for A and 1954 min (652 min) for B, being allotted more times to males than females. However, all of the house keeping hours were carried out only by females.
The intensity of each working load of farmers was not so heavy, as “light” and “moderately heavy” by Christesen's criteria and energy expenditure a day was calculated 2895-3604 kcal for males and 2155-2295 kcal for females.
In this working process farmers were enforced to keep careful handling with chrysanthemums and fixed body posture for 4 to 6 hours a day. Particulary, the working posture of sorting and bundling chrysanthemums may cause over strained load to the muscle and joint of the lower back and legs.
The dust concentrations of the sorting room were not so high. However, the farmers were exposed a large quantity of cilia of chrysanthemum leaves, calculated 37-259 pieces/cm² on the slide grass a day. The numbers of cilia varied with amounts of handling chrysathemums.
It was suggested that the cilia of chrysanthemums may be the most important allergen to the immediate type of allergy of the chrysanthemum growers.

Introduction  Asahikawa Medical University (AMU) has conducted a 7-week JICA training course “Health Systems Management for Regional and District Health Management Officers” since 2008 and trained a total of 132 participants from 22 countries. In order to assess how trainees applied their public health knowledge and skills obtained through the training course to their communities, we conducted interviews in Kenya, Malawi, and Liberia to explore their current public health problems and to identify what programs are required for our further training course to improve their health system.Methods  Among 29 trainees in three countries in total, 15 were face-to-face interviewed and 6 were phone-interviewed on February 2019. The rest was missing but we identified five of their current position.Results  The trainees made best use of knowledge and skills obtained from following lectures and/or field trips in their communities, such as “Project Cycle Management”, “Maternal and child health”, “Public health centers’ visit”, “Waste management including water supply and sewage treatment”, “School health”, “Tele-medicine”, and “5S-KAIZEN”. They also requested us to provide following lectures and field visits to tackle with their future health problems, such as “Japan’s experience to achieve the Universal Health Coverage”, “Health system strengthening”, “Disaster medicine and management”, “Non-communicable diseases”, and “Capacity development”.Discussion & Conclusions  By face-to-face or phone interviews in three countries, we grasped ideas of current health problems and verified an effectiveness of our training programs in each country. We also helped the trainees, their co-workers, community people (volunteers) to increase the motivation of their relevant works and activities through the field visit. Therefore, in order to provide a better training program, we further need to enhance international cooperation between us and African countries as well as to strengthen our training capacities including regular follow-up systems to ex-trainees.

Retroperitoneal hematoma (RH) due to radiologic intervention for an intracranial lesion is relatively rare, difficult to diagnose, and can be life-threatening. We report a case of RH that developed in a patient on anticoagulant therapy following endovascular coiling of a ruptured anterior communicating artery (AcoA) aneurysm. An 82-year-old man presented with a 12-day history of headache. Computed tomography (CT) on admission demonstrated slight subarachnoid hemorrhage, and left carotid angiography revealed an AcoA aneurysm. The next day, the aneurysm was occluded with coils via the femoral approach under general anesthesia. The patient received a bolus of 5,000 units of heparin immediately following the procedure, and an infusion rate of 10,000 units/day was initiated. The patient gradually became hypotensive 25 hours after coiling. Abdominal CT showed a huge, high-density soft-tissue mass filling the right side of the retroperitoneum space. The patient eventually died of multiple organ failure five days after coiling. RH after interventional radiology for neurological disease is relatively rare and can be difficult to diagnose if consciousness is disturbed. This case demonstrates the importance of performing routine physical examinations, sequentially measuring the hematocrit and closely monitoring systemic blood pressures following interventional radiologic procedures in patients with abnormal mental status.
Aged, 80 and over ; Anesthesia, General ; Aneurysm ; Angiography ; Arteries ; Consciousness ; Headache ; Hematocrit ; Hematoma ; Heparin ; Humans ; Intracranial Aneurysm ; Multiple Organ Failure ; Physical Examination ; Radiology, Interventional ; Subarachnoid Hemorrhage

A 65-year-old man was referred to our hospital in April 2003 with a pancreas tumor detected by a thorough medical checkup. Computed tomography (CT) showed swelling of the pancreatic body and tail, and magnetic resonance cholangiopancreatography (MRCP) showed only the main pancreatic duct in the head of the pancreas. Diagnosing autoimmune pancreatitis, we observed the patient without medication. However, one year later CT showed stenosis of the splenic artery and portal vein accompanied by development of collateral circulation around the pancreas. He had no symptoms, and CT showed no changes in the pancreatic swelling.;;He was admitted to our hospital on January 6, 2005, presenting with a history of jaundice which first appeared on January 1, 2005, and increased collateral circulation around the pancreas with pancreatic swelling were seen on CT. We started prednisolone therapy at 40 mg/day for exacerbation of autoimmune pancreatitis. Serum bilirubin levels improved from 11.9 mg/dl to 2.5 mg/dl, and pancreatic swelling also improved four weeks after starting therapy.;;We present a rare case of autoimmune pancreatitis that developed marked collateral circulations.
X-Ray Computed Tomography ; Pancreatitis ; Collateral Circulation ; Pancreatic polypeptide, avian ; Swelling

BACKGROUND/AIMS: Infliximab (IFX), an antibody to tumor necrosis factor, (TNF)-alpha has efficacy in treating Crohn's disease (CD). However, knowledge of the potential effects of IFX on patients' immune profiles is lacking. The purpose of this study was to reveal the immunological effects of IFX. METHODS: Twenty-two patients with a CD activity index (CDAI) of 194.2+/-92.9 and an average duration of disease of 3.26 months and 21 healthy controls were included. Patients were to have their first IFX remission induction therapy with 3 infusions (5 mg/kg) at weeks 0, 2, and 6. Oral 5-aminosalicylic acid was the only ongoing medication in the patient population. Blood samples at baseline, 12 hours after the first infusion and at week 14 were labeled with anti-CD4/CD25 antibodies for immunohistochemical measurement of regulatory T-cells (Treg). Serum cytokines and chemokines were measured by suspension array and ELISA. RESULTS: CDAI significantly decreased prior to the second IFX infusion (p<0.001). Clinical remission rates were 77.3% and 91% by the second and third infusions, respectively. At baseline, interleukin (IL)-6 (p<0.03), IL-8 (p<0.03), IL-10 (p=0.050), IL-13 (p<0.01), transforming growth factor-beta1 (p<0.01), and 'regulated on activation, normal T cell expressed and secreted' (RANTES) (p<0.01) were elevated in patients. After the initial IFX infusion, TNF-alpha (p<0.04), IL-6 (p<0.03), interferon (IFN)-gamma (p<0.04), IFN-gamma-inducible protein-10 (p<0.01), monocyte chemoattractant protein-1 (p<0.01), macrophage inflammatory protein-1beta (p<0.01), and RANTES (p<0.01) were decreased. IFX infusion was associated with an increase in Treg (p<0.01) and a decrease in the Th1 (IFN-gamma)/Th2 (IL-4) ratio (p<0.03). CONCLUSIONS: IFX use was associated with restoration of the Th1/Th2 balance after a single infusion and seemed to promote induction of naive Th0 lymphocytes to Treg. This knowledge should have clinical relevance.
Antibodies ; Antibodies, Monoclonal ; Chemokine CCL2 ; Chemokine CCL5 ; Chemokines ; Crohn Disease ; Cytokines ; Humans ; Immune System ; Interferons ; Interleukin-10 ; Interleukin-13 ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Lymphocytes ; Macrophages ; Mesalamine ; Remission Induction ; T-Lymphocytes, Regulatory ; Tumor Necrosis Factor-alpha ; Infliximab