Right-sided infective endocarditis (RSIE) localized to the right ventricular free wall is rare, and surgical excision of vegetations in such cases has seldom been reported. We describe a case of RSIE with the vegetations on the right ventricular free wall associated with ventricular septal defect (VSD) that was successfully treated with surgical intervention at an appropriate timing. The patient was a 30-year-old woman who had been diagnosed with a VSD shortly after birth. No surgical treatment had been performed and she had been followed conservatively. She was emergently transported to our hospital with disturbed consciousness caused by water intoxication due to psychogenic polydipsia. On admission, she presented with severe hyponatremia and elevated inflammatory markers. CT was performed, showing multiple bilateral pulmonary infiltrates, which were initially suspected to be pneumonia. After admission, blood cultures yielded Streptococcus mitis, and echocardiography showed two mobile vegetations on the right ventricular free wall, corresponding to a jet lesion caused by the VSD, leading to the diagnosis of RSIE. Subsequent contrast-enhanced CT showed filling defects in both pulmonary arteries, and septic pulmonary embolism (SPE) was diagnosed. Although antibiotic therapy improved inflammatory findings, the patient had a history of IE, which itself was an indication for VSD closure. In addition, we observed newly emerging, albeit minor, infiltrates in the lung fields. Therefore, we decided to proceed with elective surgery at that point. The vegetations on the right ventricular free wall was excised, the VSD was closed with an expanded polytetrafluoroethylene (ePTFE) patch, and the atrial septal defect incidentally found during surgery was also closed with direct sutures. Pathological examination of the excised specimen confirmed the infective vegetations. Including the period of postoperative oral antibiotic therapy, the total duration of antibiotic treatment was eight weeks. Her postoperative course was uneventful, and no recurrence was observed at 3 months after surgery.

Objective: Human papillomavirus subtypes are predictive indicators of cervical intraepithelial neoplasia (CIN) progression. While colposcopy is also an essential part of cervical cancer prevention, its accuracy and reproducibility are limited because of subjective evaluation. This study aimed to develop an artificial intelligence (AI) algorithm that can accurately detect the optimal lesion associated with prognosis using colposcopic images of CIN2 patients by utilizing objective AI diagnosis. Methods: We identified colposcopic findings associated with the prognosis of patients with CIN2. We developed a convolutional neural network that can automatically detect the rate of high-grade lesions in the uterovaginal area in 12 segments. We finally evaluated the detection accuracy of our AI algorithm compared with the scores by multiple gynecologic oncologists. Results: High-grade lesion occupancy in the uterovaginal area detected by senior colposcopists was significantly correlated with the prognosis of patients with CIN2. The detection rate for high-grade lesions in 12 segments of the uterovaginal area by the AI system was 62.1% for recall, and the overall correct response rate was 89.7%. Moreover, the percentage of high-grade lesions detected by the AI system was significantly correlated with the rate detected by multiple gynecologic senior oncologists (r=0.61). Conclusion Our novel AI algorithm can accurately determine high-grade lesions associated with prognosis on colposcopic images, and these results provide an insight into the additional utility of colposcopy for the management of patients with CIN2.

Continuous subcutaneous injections of medication are effective in controlling symptoms of the terminal stage of cancer. Chlorpromazine and levomepromazine occasionally cause skin irritation. We examined all patients who underwent continuous subcutaneous administration of psychotropic drugs (chlorpromazine, levomepromazine, midazolam) at the palliative care unit of our hospital from April 2010 to March 2013, the frequency of adverse skin reactions of Common Terminology Criteria for Adverse Events (CTCAE) v4.0 grade 3 or above. Of the 603 hospitalized patients, 389 (64.5%) underwent continuous subcutaneous administration of one of the three drugs. The frequency of grade 3 or above (ulceration or necrosis) adverse skin reactions was 4 out of 345 chlorpromazine cases (1.2%; 95% CI: 0.0-2.3%), 2 out of 90 levomepromazine cases (2.2%; 95% CI: −0.8-5.2%), and 0 out of 210 midazolam cases (0.0%; 95% CI: 0.0-0.0%). The frequency of serious adverse skin reactions caused by continuous subcutaneous administration of psychotropic drugs was low, suggesting that this treatment is relatively safe for the skin.

Introduction
 During the course of primary health care activities in Khammouane province of Lao PDR by non- profit organization, international support and partnership for health, an exceedingly high infant mortality rate was recognized in some villages. As thiamine deficiency was strongly suspected for the main cause of the high mortality, the household survey with an emphasis on nutritional aspect and the measurement of thiamine level in the blood of mothers as well as their breast-milk were carried out for the confirmation.
Methods
 The survey was conducted at Sibounhouane sub-district (Group 1) with the highest infant mortality and Hatkhamhieng sub-district (Group 2) with the lowest mortality. Fifty families of the two groups, each consisting of randomly selected 25 families with less than one year old infant(s) were interviewed by using prepared questionnaire. The body weight of both mother and infant was measured and blood and milk were taken from the mother.
Results
 The ethnic minorities of the group 1 consisted of Lao Lum (44%) and Lao Theung (56%), whereas only Lao Lum in the group 2. The economical indicators and the mother's educational level in the group 1 were inferior to those in the group 2. There was no significant difference in the methods of preparing staple glutinous rice, likely to flux thiamine and intake of thiaminases between the two groups. High infant mortality rate was documented in the group 1 whose clinical symptoms were mostly consistent with those of infantile beriberi. The concentration of thiamine in the blood and milk of mothers in both groups were considerably lower and significant reduction of thiamine level was observed in the group 1 than the group 2. Nevertheless, both groups of those infants tended to be inadequately fed with the foods except for breast-milk during their early infantile phase.
Conclusions
 The low concentration of thiamine in the blood and milk of mothers was strongly suggestive that infantile beriberi due to thiamine deficiency was the principal cause of the infant mortality in the study region. We hereby surmise that thiamine deficiency could be extensively prevalent in Lao PDR than the currently studied areas because of their traditional preparing methods of staple dietary rice, postpartum food taboos and intake of thiaminases. For the prevention of infant death due to severe thiamine deficiency, necessary measures including the exchange of information among the institutions concerned, adequate thiamine supplementation and nutritional counseling have to be urgently adopted.

In 1999, an insecticide-treated net (ITN) distribution project was started in several malaria-endemic villages in Lao P.D.R., namely Vientiane, Bolikhamxay and Khammouanne Provinces. After the completion of the project, it was found that the ITNs were effective for malaria control based on the analysis of the slide positivity rate for malaria parasites between 1999 and 2000 [6]. We conducted malariometric, entomological and KAP surveys in 2005-06 to confirm the status of malaria and to determine the effectiveness of ITNs in three different socioepidemiological areas (near city, rural and remote), represented by the Xebangfay and Boualapha districts, Khammouanne Province.
A marked decrease in the annual malaria incidence and slide positivity rate was noted from 1999 to 2006 in the two districts. The malaria prevalence was significantly reduced in near city areas (5.6%-10.7% in 1999 to 0% in 2005-06) and rural areas (21.4%-50.9% in 1999 to 0%-1% in 2005-06). Twelve positive cases were recorded in remote areas (3.4 - 7.7% in 2006).
The illiteracy rate was significantly higher among the respondents in the remote (83.9%) than among those in the near city (32.7%) and rural (54%) areas. In all areas, more than 50% of the villagers indicated that they were not aware of malaria. Similarly, about 60% of the respondents were found to have incorrect knowledge concerning malaria transmission. In remote, 40.9% of the respondents were aware of the methods to prevent malaria infection and 49.5% used mosquito nets throughout the year, rates significantly lower than the corresponding rates in near city and rural. The density of persons per net in remote (3.1-5.9) was considerably higher than that in near city (1.8-2.1) and rural (1.2-2.7). Malaria vector mosquitoes, such as An. minimus and An. nivipes were collected by human-baited adult collection, and cow-baited and CDC light traps. The results of the analysis suggested that the lower the number of persons per net the more effective the reduction of malaria morbidity in these areas. It is imperative that ITN distribution and health education regarding malaria be strengthened, especially in remote, but also in other areas.

In order to study respiratory transients during exercise, we examined breath-by-breath differences between gas exchange kinetics measured at the mouth and those estimated at the alveolar level. The gas exchange data at the mouth were obtained by measurement of expired gases only (expiratory flow method) . Correction for breath-by-breath changes in lung gas stores was applied to the total gas exchange, which was obtained by subtracting expired from inspired gas volume (alveolar gas exchange method) . Constant work loads (150, 200, 250 W) and a ramp work load (30 W/min) preceded and followed by a 50 W load were generated by a computerized cycle ergometer. Best-fit first- or second-order model values for gas exchange kinetic parameters were found by the non-linear least-squares method.
1. Regardless of work intensity and forcing function, the breath-by-breath variation in gas exchange measured at the mouth was larger than the gas exchange estimated at the alveolar level, in both a non-steady state and a steady state. The variation was caused by the invalidity of assuming zero N₂ exchange at the mouth, which was attributed to changes in lung volume.
2. Vo₂ kinetics at the alveolar level were faster than those at the mouth, while the converse held for Vco₂ at the onset of constant load work, due to the effects of fluctuations in lung gas stores on the kinetics of gas exchange at the mouth. During ramp load work, Vo₂ and Vco₂ kinetics at the alveolar level were faster than those at the mouth.
3. Steady state gas exchange values at the alveolar level and at the mouth were the same during constant load work, since the lung gas stores corrections added up to small fractions of the total gas exchange when summed over the long term.
4. Consideration of both the proper end-expiratory lung volume and ventilationperfusion inhomogeneity was required in order to estimate the true alveolar gas exchange.