A vascular access catheter has been widely used for hemodialysis patients in an emergency when an arteriovenous shunt get clogged and cannot be reopened or when patients have no arterio-venous fistula. However, it often causes deterioration in activities of daily living (ADLs) and other troubles. Therefore, we place the catheter into the internal jugular vein in the neck to minimize the risk of complications and patients' inconvenience. Nevertheless, free spaces tend to be created between the dressing agent and skin because the articular excursion is wide in the neck. Although the CDC (Centerfor Disease Control and Prevention) guidelines recommended that the dressing tapes should be changed once every seven days, we change the tapes every two or four days to avoid peeling-off. In this study, we examine the difference in fixation ability between two types of tapes;standard size (10×12 cm) and 1/4 cut-size (5×6 cm). Our results showed that there were significant differences in peeling-off area between the two tapes. The smaller-sized tape had better adhesion to the skin so that you could not peel it off easily. Furthermore, the smaller one stuck fast to the catheter and needed less replacement. Consequently, the skins seemed to be more protected.
Catheter ; Blood vascular ; SIZES ; Access ; Fixation - action

  A vascular access catheter has been widely used for hemodialysis patients in an emergency when an arteriovenous shunt get clogged and cannot be reopened or when patients have no arterio-venous fistula. However, it often causes deterioration in activities of daily living (ADLs) and other troubles. Therefore, we place the catheter into the internal jugular vein in the neck to minimize the risk of complications and patients' inconvenience. Nevertheless, free spaces tend to be created between the dressing agent and skin because the articular excursion is wide in the neck. Although the CDC (Centerfor Disease Control and Prevention) guidelines recommended that the dressing tapes should be changed once every seven days, we change the tapes every two or four days to avoid peeling-off. In this study, we examine the difference in fixation ability between two types of tapes;standard size (10×12 cm) and 1/4 cut-size (5×6 cm). Our results showed that there were significant differences in peeling-off area between the two tapes. The smaller-sized tape had better adhesion to the skin so that you could not peel it off easily. Furthermore, the smaller one stuck fast to the catheter and needed less replacement. Consequently, the skins seemed to be more protected.

OBJECTIVESTo examine the long-term effects of lifestyle on the recovery from risk factors of cardiovascular disease and to discuss the difference in the effects of lifestyle modification in subjects with a single risk factor and those with multiple risk factors.

METHODSWe used checkup data compiled for 6477 male workers, aged 20-59 years in 1995, with risk factors of cardiovascular disease. The relation between the recovery from risk factors 9 years later and baseline lifestyles was examined by logistic regression according to the initial number of risk factors.

RESULTSNine years following the baseline measurements, 1907 subjects had recovered from at least one risk factor. When there was initially a single risk factor, a good overall lifestyle was effective in the recovery [odds ratio (OR) 1.27; 95% confidence interval (CI) 1.03, 1.57], with maintaining good dietary habits (OR 1.24; 95% CI 1.07, 1.45) and moderate stress levels (OR 1.19; 95% CI: 1.03, 1.38) both found to be especially effective in the recovery. When there were multiple risk factors, although the effect of a good overall lifestyle on the recovery was less than that when there was only a single risk factor, non-smoking (OR 1.27; 95% CI 1.07, 1.51) and limiting working hours (OR 1.25; 95% CI 1.05, 1.49) were found to be effective.

CONCLUSIONSOur results provide evidence that good lifestyles are effective in the recovery from multiple risk factors. Effects of lifestyle on recovery from multiple risk factors are different from effects on the recovery from a single risk factor, with the difference depending on the initial number of risk factors.

In March 2001, Research and Development Project Committee for Medical Educational Programs proposed a model core curriculum for undergraduate medical education. In this curriculum, implementation of the clinical clerkship is strongly recommended. Two similar curriculum models were later presented by other organizations, and some differences were observed among them. We, Undergraduate Medical Education Committee, have evaluated and compared themodel core curriculum 2001 with the Japanese newer proposals as well as those of USA and UK. Here is reported our proposals for a better rewriting of the learning objectives in the model core curriculum 2001, with some emphasis on the nurture of the competence of the case presentation and decision making process.

In order to implement, or enhance the quality of clinical clerkship, it is necessary to develop good educational environment which will be appropriate to allow medical students participate in medical team services. Important things to be considered will be, (1) Systematic management of the individual department's program by the faculty of medicine, (2) Developing educational competency within the medical care team function, and (3) Nurturing students' awareness forself-diected learning and cooperative team work, and teaching- and medical staffs' awareness of their educational responsibilities. In this paper, to develop better educational environment for clinical clerkship, we propose a desirable situation of the educational organization, dividedly describing on the roles of dean, faculties, board of education, department of medical education, clerkship director, teaching physicians, residents and medical students.

OBJECTIVEThe food consumption and serum nutritional status of people living in the Kathmandu valley, Nepal, were examined to obtain actual data for comparison with our previous findings.

METHODSA dietary survey of 45 males and 60 females was carried out in March 1997 by the 24-hr dietary recall method and nutrient intake was calculated from food tables of India and Japan. Fasting venous blood samples were obtained and serum biochemical parameters were measured using clinical kits.

RESULTSThe mean body mass index values was at about the same level in both sexes, although the mean percentage body fat of females was higher than that of males, and vice versa for packed red cell volume. The main foods consumed by both sexes, were rice, potatoes, meats, milk & dairy products and vegetables, with a difference in the amounts consumed. Females did not drink alcoholic beverages. The mean daily intakes of energy, protein, lipids, iron and vitamin B group for the males were higher than those for the females, while those of vitamins A and C for the males were lower than those for the females. The mean values of serum biochemical parameters for both sexes were generally at the normal levels, but those of ALT and TG were at the higher end of the normal range. Differences of correlation between food groups and between serum parameters were observed depending on the sex, however, no clear relationship between food and nutrient intake and serum biochemical parameters were observed.

CONCLUSIONSThe present food intake study revealed that the amounts of food consumption for both sexes, especially for the females, were mostly insufficient although the serum parameters were at the normal levels. The energy intake of both sexes was lower than that of estimated requirements and those in Terai region. The relatively high serum TG level of the subjects may be due to the consumption of large amounts of cereals containing much carbohydrate. Our findings suggested a marked influence on food consumption by food price and income in spite of the easier food availability in the city, and also lack of knowledge about nutrients and health, thus there is need for improvement of the nutritional status of this group of people.

Recent studies have developed simple techniques for monitoring and assessing sleep. However, several issues remain to be solved for example high-cost sensor and algorithm as a home-use device. In this study, we aimed to develop an inexpensive and simple sleep monitoring system using a camera and video processing. Polysomnography (PSG) recordings were performed in six subjects for four consecutive nights. Subjects' body movements were simultaneously recorded by the web camera. Body movement was extracted by video processing from the video data and fi ve parameters were calculated for machine learning. Four sleep stages (WAKE, LIGHT, DEEP and REM) were estimated by applying these fi ve parameters to a support vector machine. The overall estimation accuracy was 70.3 ± 11.3% with the highest accuracy for DEEP (82.8 ± 4.7%) and the lowest for LIGHT (53.0 ± 4.0%) compared with correct sleep stages manually scored on PSG data by a sleep technician. Estimation accuracy for REM sleep was 68.0 ± 6.8%. The kappa was 0.19 ± 0.04 for all subjects. The present non-contact sleep monitoring system showed suffi cient accuracy in sleep stage estimation with REM sleep detection being accomplished. Low-cost computing power of this system can be advantageous for mobile application and modularization into home-device.
Machine Learning ; Methods ; Mobile Applications ; Polysomnography ; Sleep Stages ; Sleep, REM ; Support Vector Machine

Objective: The purposes of this trial were to demonstrate the feasibility and effectiveness of the hybrid of intracavitary and interstitial brachytherapy (HBT) for locally advanced cervical cancer patients in the phase I/II prospective clinical trial. Methods: Patients with FIGO stage IB2-IVA uterine cervical cancer pretreatment width of which was ≥5 cm measured by magnetic resonance imaging were eligible for this clinical trial. The protocol therapy included 30–30.6 Gy in 15–17 fractions of whole pelvic radiotherapy concurrent with weekly CDDP, followed by 24 Gy in 4 fractions of HBT and pelvic radiotherapy with a central shield up to 50–50.4 Gy in 25–28 fractions. The primary endpoint of phase II part was 2-year pelvic progression-free survival (PPFS) rate higher than historical control of 64%. Results: Between October 2015 and October 2019, 73 patients were enrolled in the initial registration and 52 patients proceeded to the secondary registration. With the median follow-up period of 37.3 months (range, 13.9–52.9 months), the 2- PPFS was 80.7% (90% confidence interval [CI]=69.7%–88%). Because the lower range of 90% CI of 2-year PPFS was 69.7%, which was higher than the historical control ICBT data of 64%, therefore, the primary endpoint of this study was met. Conclusion The effectiveness of HBT were demonstrated by a prospective clinical study. Because the dose goal determined in the protocol was lower than 85 Gy, there is room in improvement for local control. A higher dose might have been needed for tumors with poor responses.

BACKGROUND: Although fat accumulation in human organs is associated with a variety of diseases, there is little evidence about the effect of a fatty pancreas on the development of subclinical chronic pancreatitis over the clinical course. METHODS: We conducted a prospective cohort study from 2008 to 2014 of patients who underwent a medical checkup consultation for fat accumulated in the pancreas. Patients included in the analysis were divided into a non-fatty pancreas group (n = 9710) and fatty pancreas group (n = 223). The primary end point was the odds ratio (OR) for chronic pancreatitis associated with fatty pancreas, which was diagnosed using ultrasonography. We used a multiple logistic regression model to estimate the OR and the corresponding 95% confidence interval (CI). RESULTS: Ninety-two people were diagnosed with chronic pancreatitis, including both presumptive and definitive diagnoses. Twelve people were diagnosed with chronic pancreatitis by ultrasonography among the 223 patients with fatty pancreas, and 80 patients among 9710 were diagnosed with non-fatty pancreas. The crude OR was 6.85 (95% CI 3.68, 12.75), and the multiple adjusted OR was 3.96 (95% CI 2.04, 7.66). CONCLUSIONS Fat accumulation in the pancreas could be a risk factor for developing subclinical chronic pancreatitis.
Adipose Tissue ; diagnostic imaging ; pathology ; Adult ; Alcohol Drinking ; epidemiology ; Female ; Humans ; Japan ; epidemiology ; Life Style ; Logistic Models ; Male ; Middle Aged ; Pancreas ; diagnostic imaging ; pathology ; Pancreatitis, Chronic ; diagnosis ; epidemiology ; etiology ; Physical Examination ; Prospective Studies ; Risk Factors ; Smoking ; epidemiology