We report an 88-year-old man suffering from repetitive non-occlusive mesenteric ischemia (NOMI) accompanied with bradycardia and portal venous gas. He was admitted to hospital with acute onset epigastralgia and vomiting. Consciousness was clear, but he was pale and had a cold sweat. Vital signs were normal except for sinus bradycardia (HR 42). Abdominal CT revealed portal venous gas. Over 14 months, he had three recurrences of symptoms. We administered a muscarinic antagonist that improved the symptoms at the first and the second recurrence; however, at the third recurrence, the antagonist was ineffective, and the patient had increased portal venous gas, intestinal intramural gas, and hyperlacticacidemia. We performed emergent operation because of the possibility of bowel necrosis. Intraoperative laparoscopy revealed no obvious necrosis, and indocyanine green fluorography revealed no vascular insufficiency. These findings suggested the involvement of NOMI in acute mesenteric ischemia. After surgery, isosorbide dinitrate transdermal patch was administered to prevent NOMI by inhibiting mesenteric artery spasm. A 4-year follow-up revealed no recurrence of NOMI. We report the first case of repetitive NOMI accompanied with bradycardia and portal venous gas and its successful treatment.

This study was performed to clarify the analgesic effect of ketamine injected into the first intercoccygeal (Co1-Co2) epidural space in standing cattle. Five adult cows were randomly received 3 treatments at least 1 week interval: 5, 10 and 20 mL of 5% ketamine. Sedation, analgesia, ataxia and other effects on cardiopulmonary and rumen functions were assessed before ketamine administration and until 120 min. The analgesia without sedation was shown at tail and perineum about 5 min after all three treatments. The duration of analgesia was significantly increased according to the volume of ketamine (p < 0.01). There was a similar tendency of ataxia with individual variation. There were minimal effects on cardiopulmonary and rumen functions. The present study showed that caudal epidural ketamine administration induced analgesia without sedation in cows, and the duration of analgesia was dose dependent with ataxia. However, the duration of analgesia after 5 and 10 mL ketamine administration is short for common surgical procedures and pain relief of perineum. Further studies are needed to prolong the duration of analgesia without side effects.
Analgesia, Epidural/*veterinary ; Analgesics/*administration & dosage ; Animals ; Blood Pressure/drug effects ; Body Temperature/drug effects ; Cattle/*physiology ; Female ; Heart Rate/drug effects ; Ketamine/*administration & dosage ; Respiration/drug effects ; Rumen/metabolism

Methods: Cases of 50 patients with ASD who underwent long spinal fusion (>9 levels) with S2AI screws were retrospectively reviewed. Loosening of S2AI screws and S1 pedicle screws and bone fusion at the level of L5–S1 at 2 years after surgery were investigated using computed tomography. In addition, risk factors for loosening of S2AI screws were determined in patients with ASD. Results: At 2 years after surgery, 33 cases (66%) of S2AI screw loosening and six cases (12%) of S1 pedicle screw loosening were observed. In 40 of 47 cases (85%), bone fusion at L5–S1 was found. Pseudarthrosis at L5–S1 was not significantly associated with S2AI screw loosening (19.3% vs. 6.3%, p=0.23), but significantly higher in patients with S1 screw loosening (83.3% vs. 4.9%, p<0.001). On multivariate logistic regression analyses, high upper instrumented vertebra (UIV) level (T5 or above) (odds ratio [OR], 4.4; 95% confidence interval [CI], 1.0–18.6; p=0.045) and obesity (OR, 11.4; 95% CI, 1.2–107.2; p=0.033) were independent risk factors for S2AI screw loosening. Conclusions High UIV level (T5 or above) and obesity were independent risk factors for S2AI screw loosening in patients with lumbosacral fixation in surgery for ASD. The incidence of lumbosacral fusion is associated with S1 screw loosening, but not S2AI screw loosening.

Gastric adenocarcinoma of the fundic gland mucosa type (GA-FGM) was proposed as a new variant of gastric adenocarcinoma of the fundic gland type (GA-FG). However, at present, the influence of Helicobacter pylori and the speed of progression and degree of malignancy in GA-FGM remain unclear. Herein, we report the first case of intramucosal GA-FGM that was endoscopically observed before and after H. pylori eradication over 15 years. The lesion showed the same tumor size with no submucosal invasion and a low MIB-1 labeling index 15 years after its detection using endoscopy. The endoscopic morphology changed from 0-IIa before H. pylori eradication to 0-IIa+IIc and then 0-I after H. pylori eradication. These findings suggest that the unaltered tumor size reflects low-grade malignancy and slow growth, and that the endoscopic morphology is influenced by H. pylori eradication.

BACKGROUND: Ibaraki's Amabie-chan is a COVID-19 infection control system unique to Ibaraki prefecture, Japan. It requires residents to register each time they visit events, commercial facilities, and restaurants. The number of registrations has been limited, and its function alerting about people positive for COVID-19 infection seems not to be working. Nevertheless, registration with the system might have some impact on the user's behavior. In the current preliminary survey, the possible impact of Ibaraki's Amabie-chan on infection prevention behavior and fear of COVID-19 was investigated. METHODS: A cross-sectional, web-based, anonymous, and self-administered survey was conducted at two workplaces in Tsukuba Science City, Ibaraki, Japan. The first survey was conducted at one of the workplaces in November 2020, and the second survey, at the other workplace in February 2021. Variables of interest were sex, age group, marital status, employment status, Ibaraki's Amabie-chan use, COVID-19 Contact-Confirming Application use, ten items of infection prevention behaviors, and fear of COVID-19. Hierarchical linear regression analysis was performed. RESULTS: In both surveys, use of Ibaraki's Amabie-chan was significantly associated with COCOA use and with "physical condition management such as body temperature measurement." No association was found with other infection prevention behaviors or with fear of COVID-19. CONCLUSIONS Our findings did not provide sufficient evidence for the effectiveness of Ibaraki's Amabie-chan in regard to users' infection control behavior. Further detailed study is needed to investigate the effectiveness in terms of infection prevention and the cost-effectiveness of Ibaraki's Amabie-chan.
COVID-19/prevention & control* ; Cohort Studies ; Cross-Sectional Studies ; Fear ; Humans ; SARS-CoV-2