Western Herbs and Botanicals ; Fusion, NOS ; Medicine

We report on the state of postgraduate anesthesiology training (3 months) at Fukui Medical School. This report was based on a questionnaire sent to 144 doctors who had undergone this training. The response rate was 68%.
Participants entered anesthesiology training at a mean of 1.9 ± 1.2 years after graduation. Seventyone trainees (91%) were actively involved in clinical anesthesiology, among which 48 trainees (63%) had experienced between 31 to 60 cases over a 3 month period. Twenty-four trainees (31%) indicated that the training period (3 months) was too short. After such training, 50 doctors (66%) practiced anesthesia, among which 29 encountered difficulties with endotracheal intubation. Sixty-nine trainees (93%) thought the training would be useful for resuscitation. We conclude that anesthesia training is effective at the end of a 2-year postgraduate training course, and recognize the need for improvement in the teaching of anesthesiology.

In order to examine the personal space perception, measurements were conducted on both elbows in 14 men and 46 women. Each subject, with his (or her) eyes closed and with his upper arm fixed horizontally, was instructed to stop the vertical and horizontal swing motion of his lower arm at the point he considered to be the middle of the range of possible motion on the front and side of plane at his shoulder, and this was repeated ten times. In various conditions, similar measurements were also done to study factors affecting the personal space perception in 14 men.
Mean values of bisected angles in percentage against range of motion were deviated from the middle points in the direction of the elbow extension, although there were large differences between the individuals. The deviation was smallest in the vertical. side of plane, and was larger in the horizontal plane than that in the vertical plane. The deviation was not so much affected by the various conditions.
It was suggested that the gain of the personal space perception is higher in the elbow extension than in the elbow flexion and its difference is larger in the horizontal plane than in vertical plane of the human elbow joint.

Afferent loop syndrome is often difficult to resolve. Among patients with afferent loop syndrome whose data were extracted from databases, 5 patients in whom metal stent placement was attempted were included and evaluated in this study. The procedure was technically successful without any adverse events in all patients. Metal stent(s) was placed with an endoscope in the through-the-scope manner in 4 patients and via a percutaneous route in 1 patient. Obvious clinical efficacy was observed in all patients. Adverse events related to the procedure and stent occlusion during the follow-up period were not observed. Metal stent placement for malignant obstruction of the afferent loop was found to be safe and feasible.
Afferent Loop Syndrome ; Endoscopes ; Follow-Up Studies ; Humans ; Intestinal Obstruction ; Palliative Care ; Self Expandable Metallic Stents ; Stents* ; Treatment Outcome

Background/Aims: Patients with acute cholecystitis (AC) after metallic stent (MS) placement for malignant biliary obstruction (MBO) have a high surgical risk. We performed percutaneous transhepatic gallbladder aspiration (PTGBA) as the first treatment for AC. We aimed to identify the risk factors for AC after MS placement and the poor response factors of PTGBA. Methods: We enrolled 401 patients who underwent MS placement for MBO between April 2011 and March 2020. The incidence of AC was 10.7%. Of these 43 patients, 37 underwent PTGBA as the first treatment. The patients’ responses to PTGBA were divided into good and poor response groups. Results: There were 20 patients in good response group and 17 patients in poor response group. Risk factors for cholecystitis after MS placement included cystic duct obstruction (p<0.001) and covered MS (p<0.001). Cystic duct obstruction (p=0.003) and uncovered MS (p=0.011) demonstrated significantly poor responses to PTGBA. Cystic duct obstruction is a risk factor for cholecystitis and poor response factor for PTGBA, whereas covered MS is a risk factor for cholecystitis and an uncovered MS is a poor response factor of PTGBA for cholecystitis. Conclusions The onset and poor response factors of AC after MS placement were different between covered and uncovered MS. PTGBA can be a viable option for AC after MS placement, especially in patients with covered MS.

OBJECTIVETeeth can serve as records of environmental exposure to heavy metals during their formation. We applied a new technology - synchrotron radiation microbeams (SRXRF) - for analysis of heavy metals in human permanent teeth in modern and historical samples.

METHODSEach tooth was cut in half. A longitudinal section 200 mum in thickness was subjected to the determination of the heavy metal content by SRXRF or conventional analytical methods (ICP-MS analysis or reduction-aeration atomic absorption spectrometry). The relative concentrations of Pb, Hg, Cu and Zn measured by SRXRF were translated in concentrations (in g of heavy metal/g of enamel) using calibration curves by the two analytical methods.

RESULTSConcentrations in teeth in the modern females (n = 5) were 1.2 +/- 0.5 mug/g (n = 5) for Pb; 1.7 +/- 0.2 ng/g for Hg; 0.9 +/- 1.1 mug/g for Cu; 150 +/- 24.6 mug/g for Zn. The levels of Pb were highest in the teeth samples obtained from the humans of the Edo era (1603-1868 AD: ) (0.5-4.0 mug/g, n = 4). No trend was observed in this study in the Hg content in teeth during 3,000 years. The concentrations of Cu were highest in teeth of two medieval craftsmen (57.0 and 220 mug/g). The levels of Zn were higher in modern subjects (P < 0.05) than those in the Jomon (~1000 BC: ) to Edo periods [113.2 +/- 27.4 (mug/g, n = 11)]. Reconstruction of developmental exposure history to lead in a famous court painter of the Edo period (18th century) revealed high levels of Pb (7.1-22.0 mug/g) in his childhood.

CONCLUSIONSSRXRF is useful a method for reconstructing human exposures in very long trends.

Background/Aims: The aim of this study was to evaluate the safety of sedation with propofol as an alternative to benzodiazepine drugs in outpatient endoscopy. Methods: In this prospective study, examinees who underwent outpatient endoscopy under propofol sedation and submitted a nextday questionnaire with providing informed consent were evaluated. Periprocedural acute responses, late adverse events within 24 hours, and examinee satisfaction were evaluated. Results: Among the 4,122 patients who received propofol in the 17,978 outpatient-based endoscopic examinations performed between November 2016 and March 2018, 2,305 eligible examinees (esophagogastroduodenoscopy for 1,340, endoscopic ultrasonography for 945, and total colonoscopy for 20) were enrolled, and their responses to a questionnaire were analyzed. The mean propofol dose was 69.6±24.4 mg (range, 20–200 mg). Diazepam, midazolam, and/or pentazocine in combination with propofol was administered to 146 examinees. Mild oxygen desaturation was observed in 59 examinees (2.6%); and mild bradycardia, in 2 (0.09%). Other severe reactions or late events did not occur. After eliminating 181 invalid responses, 97.7% (2,065/2,124) of the patients desired propofol sedation in future examinations. Conclusions Propofol sedation was found to be safe—without severe adverse events or accidents—for outpatient endoscopy on the basis of the patients’ next-day self-evaluation. Given the high satisfaction level, propofol sedation might be an ideal tool for painless endoscopic screening.

Background/Aims: The aim of this study was to evaluate the safety of sedation with propofol as an alternative to benzodiazepine drugs in outpatient endoscopy. Methods: In this prospective study, examinees who underwent outpatient endoscopy under propofol sedation and submitted a nextday questionnaire with providing informed consent were evaluated. Periprocedural acute responses, late adverse events within 24 hours, and examinee satisfaction were evaluated. Results: Among the 4,122 patients who received propofol in the 17,978 outpatient-based endoscopic examinations performed between November 2016 and March 2018, 2,305 eligible examinees (esophagogastroduodenoscopy for 1,340, endoscopic ultrasonography for 945, and total colonoscopy for 20) were enrolled, and their responses to a questionnaire were analyzed. The mean propofol dose was 69.6±24.4 mg (range, 20–200 mg). Diazepam, midazolam, and/or pentazocine in combination with propofol was administered to 146 examinees. Mild oxygen desaturation was observed in 59 examinees (2.6%); and mild bradycardia, in 2 (0.09%). Other severe reactions or late events did not occur. After eliminating 181 invalid responses, 97.7% (2,065/2,124) of the patients desired propofol sedation in future examinations. Conclusions Propofol sedation was found to be safe—without severe adverse events or accidents—for outpatient endoscopy on the basis of the patients’ next-day self-evaluation. Given the high satisfaction level, propofol sedation might be an ideal tool for painless endoscopic screening.