Introduction: Optimization of after-hours visits to medical institutions is one of the major problems in medical systems. The purpose of this study was to clarify the effects of the distribution of booklets about after-hours common symptom management to all residents on the number of after-hour consultations.Method: The Tadami town government distributed booklets to all town residents in July 2011. We analyzed the number of after-hours consultations per month at Tadami National Health Insurance Asahi Clinic, which is the only medical institution in the town, from January 2010 to December 2012. We employed an interrupted time series analysis.Result: The number of included after-hours consultations during the study period was 2,399. The baseline trend was 0.0071 (95% confidence interval −0.011, 0.025), and the slope change from the baseline trend was −0.0061 (−0.034, 0.022).Conclusion: On comparison of before and after the distribution of a booklet about after-hours common symptom management to all residents in the town, the number of after-hours consultations did not change significantly.

Coronary artery disease (CAD) was evaluated by noninvasive examination in abdominal aortic aneurysm (AAA) patients. A simultaneous operation or a 2-staged operation was performed depending on the seriousness of the condition when both diseases were combined. A total of 36 patients underwent elective repair of AAA between 1996 and 2001. Coronary angiography (CAG) was performed only in patients with suspected CAD by dipyridamole myocardial scintigraphy. Significant CAD was found in 8 patients. Simultaneous operation was performed in 4 patients, and off-pump coronary artery bypass grafting (OPCAB) was performed in all cases of simultaneous operation. In 4 patients receiving 2-staged operations, 1 standard coronary artery bypass grafting (CABG), 1 OPCAB and 2 percutaneous transluminal coronary angioplasties (PTCA) were performed prior to AAA surgery. Twenty-eight patients underwent only AAA operation. Though there were no incidents of perioperative myocardial infarction or cardiac related deaths in this group, 2 patients died due to other causes (hemorrhage and duodenal perforation). In the 8 patients associated with CAD, 1 patient died of MNMS after simultaneous operation. The other 7 patients revived their social function soon of the discharge. Dipyridamole cardiac scintigraphy was considered to be an effective examination for evaluation of CAD in AAA patients. There was no need to perform CAG in all AAA patients. The policy of choosing simultaneous operation or 2-staged operation according to the seriousness of the 2 diseases seemed to be appropriate.

In dialysis cases complicated with ischemic heart disease, there are many problems, such as poor preoperative general condition, calcified aorta, water-electrolyte control, and the necessity for other simultaneous operations. Off-pump coronary artery bypass grafting (OPCAB) was considered very useful in coping with these problems. OPCAB, employed in five cases, was compared with conventional coronary artery bypass grafting with extracorporeal circulation (ECC group, 9 cases). Regarding preoperative coexisting diseases, collagen diseases, porcelain aorta, cerebral infarction, and others were recognized in the OPCAB group in 3 of 5 cases. Emergency operations were performed in 5 of 9 cases in the ECC group, and in 2 of 5 cases in the OPCAB group. The bypass number (3.2 vs. 2.0) and complete revascularization rate (7 of 9 vs. 2 of 5), tended to be higher in the ECC group. The OPCAP group was significantly superior in blood transfusion (6.7 vs. 3.0u), postoperative CK-MB (63 vs. 33u), and the postoperative usual hemodialysis commencing time (4.2 vs. 1.0 day). Concerning use of postoperative IABP (3 of 9 vs. 0 of 5), and postoperative ventilator weaning time (2.7 vs. 1.0 day), a good tendency was shown in the OPCAB group. Although a high mortality rate (2 of 5) was recognized in OPCAB group compared with ECC group (1 of 9), those were urgent cases who had a very poor preoperative condition, and both cases suffered non-cardiac deaths. Excluding special cases, such as an unstable hemodynamic state requiring assisted circulation, and poor coronary run off, OPCAB seems useful for the treatment of coronary artery disease in dialysis patients.

Aging-related oxidative stress and free radical theory has become accepted increasingly as explaination, at least in part of the aging process. In murine models of aging, a genetic deficiency of the p66(Shc) (66-kilodalton isoform of Shc gene products) gene, which encodes a phosphotyrosine signal adapter protein, extends life span by 30%, and confers resistance to oxidative stress. Upon oxidative stress, p66(Shc) is phosphorylated at Ser36, contributing to inactivation of the forkhead-type transcription factors (FKHR/ FoxO1), which regulates the gene expression of cellular antioxidants. The p66(Shc) has a direct connection with the life span related signaling, which is conserved evolutionarily. Shc is basically not expressed in mature neurons of the adult brain and spinal cord. Instead, two Shc homologues, Sck/ShcB and N-Shc/ ShcC, which have been proved to be effective on oxidative stress and aging, are expressed in neural system. The expression of Shc-related genes is affected in the aging process, which may be relevant to cellular dysfunction, stress response and/or cognitive decline during aging.
Aging ; physiology ; Animals ; Brain ; metabolism ; Forkhead Box Protein O1 ; Forkhead Transcription Factors ; metabolism ; Gene Deletion ; Humans ; Mice ; Neurons ; metabolism ; Oxidative Stress ; physiology ; Phosphorylation ; Shc Signaling Adaptor Proteins ; deficiency ; genetics ; metabolism ; physiology ; Signal Transduction ; physiology ; Spinal Cord ; metabolism ; Src Homology 2 Domain-Containing, Transforming Protein 1 ; Src Homology 2 Domain-Containing, Transforming Protein 2 ; Src Homology 2 Domain-Containing, Transforming Protein 3

A 58-year-old man was admitted with pulsatile abdominal mass with fever and dull pain. Abdominal aortic aneurysm with left hydronephrosis due to obstruction of the left ureter was diagnosed by CT scanning. Aortic valve replacement was performed ten years previously for aortic regurgitation and recently his cardiac function deteriorated. On the 5th day after admission he suddenly suffered from hemorrhagic shock with massive melena. Emergency laparotomy was performed and ruptured abdominal aortic aneurysm was observed penetrating to the sigmoid colon with perianeurysmal abscess. The abdominal aorta was excluded and closed using two-layer sutures just below the renal artery, and bilateral common iliac arteries were also closed. The aneurysmal sac and the sigmoid colon were removed as a whole, and colostomy was made according to Hartmann's procedure. Permanent right axillo-bifemoral bypass graftiny was made to avoid infectious complications of the vascular graft. A successful vascular reconstruction was done without any complication of graft infection, however he died of cardiac failure due to dilated cardiomyopathy after 4 months postoperatively. We reported a successfully treated abdominal aortic aneurysm extending to the sigmoid colon with hemorrhagic schok.

Clostridium difficile is a major causative agent of antibiotic-associated diarrhea and has become the most common pathogen of healthcare-associated infection worldwide. The pathogenesis of C. difficile infection (CDI) is mediated by many factors such as colonization involving attachment to host intestinal epithelial cells, sporulation, germination, and toxin production. Bacterial cell surface components are crucial for the interaction between the bacterium and host cells. C. difficile has two distinct surface layer proteins (SLPs): a conserved high-molecular-weight SLP and a highly variable low-molecular-weight SLP. Recent studies have shown that C. difficile SLPs play roles not only in growth and survival, but also in adhesion to host epithelial cells and induction of cytokine production. Sequence typing of the variable region of the slpA gene, which encodes SLPs, is one of the methods currently used for typing C. difficile. SLPs have received much attention in recent years as vaccine candidates and new therapeutic agents in the treatment of C. difficile-associated diseases. Gaining mechanistic insights into the molecular functions of C. difficile SLPs will help advance our understanding of CDI pathogenesis and the development of vaccines and new therapeutic approaches. In this review, we summarize the characteristics and immunological roles of SLPs in C. difficile.
Clostridium difficile* ; Clostridium* ; Colon ; Diarrhea ; Epithelial Cells ; Germination ; Immunity, Innate ; Vaccines

Nasu-Hakola disease (NHD) is a rare autosomal recessive neuropsychiatric disorder characterized by bone cysts, fractures, and cognitive impairment. Two genes are responsible for the development of NHD; TYROBP and TREM2. Although it presents with typical signs and symptoms, diagnosing this disease remains difficult. This case report describes a male with NHD with no family or past history of bone fractures who was diagnosed using exome sequencing. His frontal lobe psychiatric symptoms recovered partially following treatment with sodium valproate, but not with an antipsychotic.
Bone Cysts ; Consanguinity* ; Exome* ; Fractures, Bone ; Frontal Lobe ; Humans ; Male ; Sodium* ; Valproic Acid*

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

Objective: To evaluate gender differences in mentee’s preference for mentoring styles and topics in academic medicine in Japan.
Methods: We conducted a cross-sectional questionnaire survey of mentees at 6 graduate schools of medicine in Japan from December 2011 through January 2012. The study participants were 1700 Japanese-speaking graduate students and postdoctoral fellows. The primary outcome was the percentage of respondents who desired to be mentored with a particular style or topic.
Results: A total of 676 （227 women） mentees responded to the survey. Women were less likely than men to prefer a hierarchical mentoring relationship （men, 82%; women, 71%; p＝0.001） but were more likely to desire a mentor for career consultation （men, 51%; women, 64%; p＝0.001）. Women were more likely than men to want guidance in developing a research portfolio （men, 85%; women, 90%; p＝0.04）, in computer skills／statistical skills （men, 68%; women, 81%; p＝0.001）, and in long-term career planning （men, 38%; women, 50%; p＝0.003）.
Conclusion: Women mentees in Japan express different preferences for mentoring styles and topics from men. Mentors in Japan must take these differences into consideration.

The purpose of this study was to introduce our patient-specific bioactive porous titanium implant manufactured using selective laser melting (SLM) and to establish the efficacy and safety of the implant for stand-alone anterior cervical discectomy and fusion (ACDF) based on a prospective clinical trial. We designed a customized ACDF implant using patient-specific data and manufactured the implant using SLM. We produced a bioactive surface through a specific chemical and thermal treatment. Using this implant, we surgically treated four patients with cervical degenerative disc disease and evaluated the clinical and radiological results. We achieved successful bony union in all but one patient without autologous bone grafting within 1 year. We observed no implant subsidence during the follow-up period, and all clinical parameters improved significantly after surgery, with no reported implant-related adverse effects. Our customized bioactive porous titanium implant is a safe and promising implant for stand-alone ACDF.