We successfully performed one-stage definitive repair for 3 infants weighing 4.2, 6.1 and 5.2kg with complex coarctation without homologous blood transfusion. The priming volume of the bypass circuits was 195ml, and their lower hematocrit values during cardiopulmonary bypass were 15, 16 and 13%, respectively. In order to diminish the aortic cross clamp time, the aortic arch was repaired with the heart beating, using isolated cerebral and myocardial perfusion methods. The base excess in each patient decreased to -9.4, -8.0 and -4.9mEq/l during the rewarming phase, however, their postoperative hemodynamic and respiratory conditions were satisfactory. They have grown without any sequelae for at least 2 months.

We describe a young adolescent patient with spontaneous abdominal aortic rupture who was treated successfully. A 14-year-old boy was admitted to our hospital with severe abdominal pain and hypovolemic shock, without any episode of trauma. Computed tomography (CT) revealed massive hematoma in the retroperitoneal space and extravasation of copious amounts of contrast medium in front of the terminal aorta. Neither aortic aneurysm nor dissection was observed in this CT. An emergency operation was carried out. At first, left thoracotomy and clamping of the thoracic descending aorta were performed in order to reduce the aortic bleeding. Midline laparotomy revealed an aortic perforation of approximately 8mm at the bifurcation of the abdominal aorta. The aortic wall surrounding the perforation was nearly normal without any aortic aneurysm or dissection. A segment of the terminal aorta (length, 3cm) including the perforated lesion was excised and reconstruction was performed with a woven Dacron tube graft (10mm in diameter). On microscopic examination, the marginal tissue near the perforation showed diminished elastic fibers and minimal dissection of the medial layer of the aortic wall; however, no cystic medial necrosis or inflammation was seen.

  The Project for Improving Maternal and Newborn Care through Midwifery Capacity Development by Japan International Cooperation Agency (JICA) was initiated for capacity building through pre-and post-service midwifery training.
  Firstly, we have shared the concept of ideal midwifery care based on the definition of evidence-based medicine (EBM) with our counterparts, which involves the integration of the best research evidence with clinical expertise and patient values. In addition to evidence-based midwifery care, we tried to provide individualized woman-centered care.
  After sharing these concepts in our project sites, we tried to modify the lectures on the basic concepts of midwifery care in the Health Center Midwifery Training program, and care providers’ attitudes based on EBM in the Basic Emergency Obstetric and Neonatal Care Training program.
  Our trial is an essential first step towards the further reduction of maternal mortality in Cambodia.

  The purpose of this study was to accumulate fundamental data for use in the future project for preventing or delaying institutionalization of the aged by clarifying the relationship between the Kihon Checklist and bone density. All the subjects were residents of the southern part of Akita Prefecture in the 65-74 age band. The Kihon Checklist was used. The women who marked the items on the list related to “intraoral conditions” tended to be low in bone density. Those who checked off the items related to “oral functions” -- the standard of judgment in determining the level of care needed - were inactive and depressed.   Since bone density was an indicator of whether the elderly women were in need of nursing care, we thought it of paramount importance to encourage them to participate in the screening for osteoporosis on a regular basis and to take measures to maintain or improve bone density.

OBJECTIVE: We wanted to clarify the relationship between the visibility of air cysts on CT images, the CT slice thickness and the size of the air cysts, with contact radiographs as the gold standard, for the accurate evaluation of honeycomb cysts. MATERIALS AND METHODS: An inflated and fixed autopsied lung having idiopathic interstitial pneumonia was evaluated. The corresponding air cysts were identified on the contact radiographs of a 0.5 mm-thick-section specimen and also on the CT images of three different kinds of section thickness: 0.5, 1.0 and 2.5 mm. The maximal diameters of the air cysts were measured under a stereomicroscope. RESULTS: A total of 341 air cysts were identified on the contact radiograph, and they were then evaluated. Sixty-six percent of air cysts 1 to 2 mm in diameter were detected by 0.5 mm slice thickness CT, while only 34% and 8% were detected by 1.0 and 2.5 mm slice thickness CT, respectively. Only 28% and 22% of air cysts less than 1 mm in diameter were detected by 0.5 and 1.0 mm slice thickness CT, respectively. CT with a 2.5 mm slice thickness could not demonstrate air cysts less than 1 mm in diameter. CONCLUSION: The CT detection rate of honeycombing is significantly influenced both by the slice thickness and the size of the air cysts.
Aged ; Aged, 80 and over ; Cadaver ; Cysts/*radiography ; Female ; Humans ; Lung Diseases/pathology/*radiography ; Tissue Fixation/methods ; *Tomography, X-Ray Computed

Objective: This study aimed to elucidate the electro-clinical characteristics of epilepsy and immunological markers in patients with epilepsy after infl uenza-associated encephalopathy/encephalitis (IAE). Methods: Eighteen patients with epilepsy after IAE (8 males, 10 females; mean age of onset 6.4±6.4 years) were studied. Antibodies to glutamate receptor (GluR) ε2 (NR2B) were examined by immunoblot and ELISA. Cytokines were measured by BioPlex. Results: Mean interval between IAE and epilepsy onset was 63.2 ± 95.0 days (mean ± SD). In 16 of 18 patients, complex partial seizures were observed. Most complex partial seizures were of short durations and showed few lateralizing signs. Interictal discharges were seen in the frontal area in 7 of 14 patients. Ictal EEG showed rapid propagation to bilateral hemispheres. Patients with higher cerebrospinal fl uid levels of anti-GluRε2 antibodies, higher cerebrospinal fl uid levels of IL-1β, soluble tumor necrosis factor receptor 1 and IFN-γ during chronic stage, had higher frequency of epileptic seizures. Conclusion: This study indicates that the frontal lobes are susceptible to rapid epileptogenesis after IAE, and that epileptic partial seizures after IAE had characteristics resembling generalized seizures. Presence of anti-GluRε2 antibodies and elevated IL-1β, TNFα, and IFN-γ in cerebrospinal fl uid may be associated with intractability of epileptic seizures.

Several studies have reported that molecular hydrogen (H₂) acts as a therapeutic medical gas owing to scavenging reactive oxygen species (ROS). However, little is known about effects of H₂ on exercise-induced oxidative stress. The purpose of this study was to investigate the effects of weekly hydrogen bathing on exercise-induced oxidative stress and delayed-onset muscle soreness (DOMS). Nine healthy and active young men participated in this study, and each subject performed hydrogen bathing trial and placebo bathing trial in a crossover design. The subjects performed downhill running (8 % decline) at 75 % peak oxygen uptake (VO₂peak) for 30 min, and each subjects conducted hydrogen or placebo bathing for 20 min, respectively, 1-6 days after downhill running. Before and after exercise, we measured visual analogue scale (VAS) and collected blood samples (Pre- and 5 min, 60 min after the end of bathing, 1day, 2days, 3days, 7days after downhill running). Blood sample analyses include creatine kinase (CK), myoglobin (Mb), malondialdehyde (MDA), reactive oxygen metabolites (d-ROMs), biological antioxidant potential (BAP), myeloperoxidase (MPO), interleukin-6 (IL-6), interleukin-17a (IL-17a) and lactate concentrations. Weekly hydrogen bathing had no effects of exercise-induced oxidative stress and muscle damage. On the other hand, hydrogen bathing significantly reduced DOMS (VAS) 1 and 2days after downhill running (p=0.033). These findings suggest that hydrogen bath after downhill exercise can be effective for reduction of DOMS.

  A look at the reports of accidents or near accidents in our hospital revealed that the incidence of falls or stumbles in children was at the top of the list in frequency. In the past five years, our pediatric ward has experienced an average of about 10 such cases annually. Regarding the risk of falling, advice is given by nurses to parents during the orientation session when their babies and little children are hospitalized. However,the advice was entirely subjective - not going by any rule or guidelines. Recently, an assessment score sheet for the risk factors for falling and a preventive measure against falls was drafted and trial used, with the result that changes were observed in the way the nurses in their 20s watch and take care of the little patients. Moreover, they became able to look after the infants according to their age, developmental stage and disposition. The use of the common pamphlet helped the young nurses gain selfconfidence even though they are inexperienced in child-rearing and nursing.  From these results, we concluded that the uniform guideline and order of priority led to the improvement of the quality of nursing in the nurses in their 20s.

To promote habitual participation in physical activity, a 3-month program for lifestyle physical activity intervention (L group) and structured exercise intervention (E group) was carried out in a community in Okayama Prefecture. One year later, we compared the two intervention groups in terms of cost-effectiveness and behavioral change in habitual physical activity. A total of 250 subjects voluntarily participated in the lifestyle physical activity intervention ; and a total of 42 subjects participated in the structured exercise intervention. The number of participants decreased to 115 (46%) and 21 (50%), respectively, one year later. However, the proportion of subjects who practice endurance exercise increased significantly in both L and E groups ; and an additional 35 subjects (30%) started to practice endurance exercise in L group and 5 (24%) in E group after the interventions. The cost-effectiveness for a person newly starting the endurance exercise practice in the L group intervention was 29,206 yen ; and the E group intervention was 124,731 yen, a ratio of 1/4.3. The study suggests that the cost-effectiveness for the lifestyle physical activity intervention was 4 times better than the structured exercise intervention.