STUDY DESIGN: A retrospective cohort study. PURPOSE: To investigate the risk factors for postoperative delirium after spine surgery, excluding older age, which has already been established as a strong risk factor. OVERVIEW OF LITERATURE: More than 30 risk factors have been reported for delirium after spine surgery, making it challenging to identify which factors should be prioritized. We hypothesized that risk factors could not be prioritized to date because the factor of older age is very strong and influenced other factors. To eliminate the influence of older age, we performed an age-matched group comparison analysis for the investigation of other risk factors. METHODS: This study involved 532 patients who underwent spine surgery. Two patients of the same age without delirium (delirium negative group) were matched to each patient with delirium (delirium positive group). Differences in suspected risk factors for post-operative delirium between the two groups identified from previous reports were analyzed using univariate analysis. Multivariate analysis was performed for factors that showed a significant difference between the two groups in the univariate analysis. RESULTS: Fifty-nine (11.1%) of 532 patients developed postoperative delirium after spine surgery. Large amounts of intraoperative bleeding, low preoperative concentration of serum Na, high postoperative (day after surgery) serum level of C-reactive protein, low hematocrit level, low concentration of albumin, and high body temperature were detected as significant risk factors in the univariate analysis. Large amounts of intraoperative bleeding remained a risk factor for postoperative delirium in the multivariate analysis. CONCLUSIONS: We should pay attention to and take precautions against the occurrence of postoperative delirium after spine surgery in patients of older age or those who experience severe intraoperative bleeding.
Body Temperature ; C-Reactive Protein ; Cohort Studies ; Delirium ; Hematocrit ; Hemorrhage ; Humans ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Spine

Objectives: Bathing in a bathtub made of hinoki cypress may promote relaxation. This study focuses on changes in autonomic nervous system function, and emotional assessments of individuals who bathed in a hinoki cypress bathtub.Methods: All 16 study participants bathed twice, as interventions in this study. The baths consisted of bathing in a hinoki cypress bathtub and in a modular bathtub as the control experiment. During the study, participants wore a holter monitor. Before and after bathing, saliva samples were collected for cortisol measurement, and participants underwent a subjective emotional assessment, the Mood Check List-Short Form.2 (MCL-S.2). After bathing, an additional subjective emotional assessment, the Visual Analog Scale (VAS), was performed.Results and Discussion: The emotional assessments in the MCL-S.2 indicated a significant increase in positive emotional scores (“pleasantness”) after bathing in a hinoki cypress bathtub. The VAS scores showed a significant decrease in the “feeling of fatigue” after bathing in a hinoki cypress bathtub, compared to bathing in a modular bathtub. These results suggest that study participants who bathed in a hinoki cypress bathtub experienced positive effects, and decreased feelings of fatigue. The salivary cortisol concentration decreased significantly after bathing in the hinoki cypress bathtub and in the modular bathtub. For both the hinoki cypress bathtub and the modular bathtub, the high frequency (√HF) values collected with the holter monitor after bathing, were higher than the √HF values collected prior to bathing. The results suggest that bathing in water temperatures of 38-39°C for 15 min enhances relaxation, and has a positive effect on the human body.

Objectives: Bathing in a bathtub made of hinoki cypress may promote relaxation. This study focuses on changes in autonomic nervous system function, and emotional assessments of individuals who bathed in a hinoki cypress bathtub.

Methods: All 16 study participants bathed twice, as interventions in this study. The baths consisted of bathing in a hinoki cypress bathtub and in a modular bathtub as the control experiment. During the study, participants wore a holter monitor. Before and after bathing, saliva samples were collected for cortisol measurement, and participants underwent a subjective emotional assessment, the Mood Check List-Short Form.2 (MCL-S.2). After bathing, an additional subjective emotional assessment, the Visual Analog Scale (VAS), was performed.

Results and Discussion: The emotional assessments in the MCL-S.2 indicated a significant increase in positive emotional scores (“pleasantness”) after bathing in a hinoki cypress bathtub. The VAS scores showed a significant decrease in the “feeling of fatigue” after bathing in a hinoki cypress bathtub, compared to bathing in a modular bathtub. These results suggest that study participants who bathed in a hinoki cypress bathtub experienced positive effects, and decreased feelings of fatigue. The salivary cortisol concentration decreased significantly after bathing in the hinoki cypress bathtub and in the modular bathtub. For both the hinoki cypress bathtub and the modular bathtub, the high frequency (√HF) values collected with the holter monitor after bathing, were higher than the √HF values collected prior to bathing. The results suggest that bathing in water temperatures of 38-39°C for 15 min enhances relaxation, and has a positive effect on the human body.

　The education program in all medical schools in Japan has been studied and analyzed every 2 years since 1974 by the curriculum committee of the Association of Japan Medical Colleges. Based on the most recent analysis in 2015, the marked innovation of medical education, such as an integrated curriculum, active learning, and clinical clerkship, was recognized.

　　Case 1: A woman in her 70s was carried into emergency department of our hospital. Apparently she had dyspnea. Acute pulmonary heart was suspected. Electrocardiography S I Q III T III-pattern. The patient was diagnosed with popliteal vein vascular aneurysm by ultrasonography. Case 2: A man in his 60s, was referred to our hospital for treatment of lower extremity swelling and pain. Like Case 1, the male patient was suspected of having deep vein thrombosis and femoral artery aneurysms by ultrasound inspection and also diagnosed with pulmonary thromboembolism based on CT findings. We were able to rescue these two patients by rapid medical cooperation. Ultrasonography was particularly useful for diagnosis and morphological evaluation of blood vessels.

Objective: We investigated the incidence of side effects related to contrast medium employed in our hospital based on monitoring materials to improve the safety of contrast-enhanced examinations.  Furthermore, we compared the incidence of side effects between the original product and generic drugs to confirm the safety of each preparation.
Methods: The survey period was from April 2007 until March 2011.  Based on the number of patients who underwent contrast-enhanced examinations and that of patients with side effects, we calculated the incidence of side effects in our hospital, and confirmed its annual changes.  Subsequently, we again collected the incidence of side effects per each manufacturer’s preparation employed, and confirmed the state of side effects of individual preparations.  Furthermore, we evaluated the symptoms as side effects, interval until appearance, and treatment for side effects during the data collection period, as well as the subsequent state, symptoms as side effects, and interval until appearance.  The chi square independence test was employed to compare the results among groups.  p<0.05 was regarded as significant (paired test).
Results: There were no changes in the annual incidence of side effects.  There were also no significant differences in the annual incidence of side effects among the preparations.  Furthermore, there were no marked differences in the symptoms, interval until appearance, treatment for side effects, or subsequent state among the preparations.
Conclusion: We investigated the appearance of side effects regarding contrast-enhanced examinations for 4 years.  We confirmed that there were no differences in the incidence of side effects among the preparations.

[Objective]To clarify the effects of electroacupuncture (EA) on the menstrual cycle at puberty, we investigated whether or not EA influences the menstrual cycle, the number of ovulations, and the duration of the high-temperature phase. Also we investigated the improvement of menstrual disorder and changes in body mass index (BMI) by EA treatment.
[Methods]Twenty-five female students participated in this study.
Non-treatment periods from three to four months were evaluated before EA treatment. During treatment, EA was performed once a week. We compared the menstrual cycle, the number of ovulations, and the duration of the high temperature phase for non-treatment and EA treatment periods. To evaluate the relation between BMI and improvement of menstrual disorder by EA, female students were divided into two groups, improvement or not-improvement group.
[Results]Twenty female students were analyzed in this study. In those with extended periods of amenorrhea, the menstrual cycle became significantly shorter during EA (P< 0.001). In those with polymenorrhea, the menstrual cycle became significantly longer during EA (P< 0.05), reaching a normal cycle length. Improvement of the menstrual cycle was found in 30.0%of the subjects. However, an increase in the number of ovulations and extended duration of the high temperature phase were found in 20.0%and 25.0%of the subjects, respectively. Although BMI did not vary significantly between the improvement and the not-improvement groups, the percentage of those with normal weight tended to be higher in the improvement group than in the not-improvement group.
[Conclusion]These findings suggest that EA influences follicular growth. However, it had been thought that EA could not influence ovulation or affect luteal function. Additionally, when BMI is nearly normal, it appears more likely that acupuncture is effective for menstrual disorder at puberty.

The most common form of malignant transformation developing from a mature cystic teratoma is squamous cell carcinoma, representing 80% of malignant transformations, while adenocarcinoma accounts for approximately 5%. Because of this rarity, few reports exist of preoperative diagnosis of this tumor by magnetic resonance imaging, in particular with fat suppression techniques. Here, we report magnetic resonance imaging findings and clinical features of a 79-year-old woman with mucinous adenocarcinoma arising from a mature cystic teratoma (measuring 5x6 cm), classified as surgical stage IA. Because of the poor prognosis of malignant transformation, when mature cystic teratomas are detected (even smaller than 5 cm tumor size) in postmenopausal women, serum tumor marker carcinoembryonic antigen levels and fat-suppressed magnetic resonance imaging may be potential indicators of malignant transformation.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Aged ; Carcinoembryonic Antigen ; Carcinoma, Squamous Cell ; Early Diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Teratoma

[Objective]To aleviate incidents and prevent medical accidents in acupuncture and moxibustion therapy, we constructed an incident report (IR) system at the Center of Acupuncture Science, Meiji University of Integrative Medicine.
[Methods]The IR system was operated with the center staff as reporters. The staff reported incidents when encountered or found. The cases of incidents were added up per item, and the contents of incidents fed back per month to staff and students. The feedback was given orally at a morning assembly, and a feedback poster was put up.
[Results]There were 146 cases from July 2004 to September 2005. The contents of incidents were 96 cases concerning the environment of treatment, 0for incidents before treatment and 50 during or after treatment. The largest number of incidents in the environment of treatment was 66 cases for inappropriate disposal of instruments. The largest number of incidents during or after treatment was 12 cases in nearly forgetting to remove acupuncture needles from the body.
[Discussion]Ten mean cases per month occurred as incidents. However, it was clear that the incidents in most cases could have been prevented if the acupuncturist had been noticed and took measures to deal with the situation. To prevent medical accidents, we consider a need to continuously feed back the contents of incidents to instructors and students and call them to their attention.