Background/Aims: The necessity for pharyngeal anesthesia during upper gastrointestinal endoscopy is controversial. This study aimed to compare the observation ability with and without pharyngeal anesthesia under midazolam sedation. Methods: This prospective, single-blinded, randomized study included 500 patients who underwent transoral upper gastrointestinal endoscopy under intravenous midazolam sedation. Patients were randomly allocated to pharyngeal anesthesia: PA+ or PA– groups (250 patients/group). The endoscopists obtained 10 images of the oropharynx and hypopharynx. The primary outcome was the non-inferiority of the PA– group in terms of the pharyngeal observation success rate. Results: The pharyngeal observation success rates in the pharyngeal anesthesia with and without (PA+ and PA–) groups were 84.0% and 72.0%, respectively. The PA– group was inferior (p=0.707, non-inferiority) to the PA+ group in terms of observable parts (8.33 vs. 8.86, p=0.006), time (67.2 vs. 58.2 seconds, p=0.001), and pain (1.21±2.37 vs. 0.68±1.78, p=0.004, 0–10 point visual analog scale). Suitable quality images of the posterior wall of the oropharynx, vocal fold, and pyriform sinus were inferior in the PA– group. Subgroup analysis showed a higher sedation level (Ramsay score ≥5) with almost no differences in the pharyngeal observation success rate between the groups. Conclusions Non-pharyngeal anesthesia showed no non-inferiority in pharyngeal observation ability. Pharyngeal anesthesia may improve pharyngeal observation ability in the hypopharynx and reduce pain. However, deeper anesthesia may reduce this difference.

Background: Problems associated with using inhalational anaesthesia are numerous in veterinary anaesthesia practice. Decreasing the amount of used inhalational anaesthetic agents and minimising of cardiorespiratory disorders are the standard goals of anaesthetists. Objective: This experimental study was carried out to investigate the sparing effect of intravenous tramadol, lidocaine, dexmedetomidine and their combinations on the minimum alveolar concentration (MAC) of sevoflurane in healthy Beagle dogs. Methods: This study was conducted on six beagle dogs. Sevoflurane MAC was determined by the tail clamp method on five separate occasions. The dogs received no treatment (control; CONT), tramadol (TRM: 1.5 mg kg -1 intravenously followed by 1.3 mg kg -1 h -1 ), lidocaine (LID: 2 mg kg -1 intravenously followed by 3 mg kg -1 h -1 ), dexmedetomidine (DEX: 2 μg kg -1 intravenously followed by 2 μg kg -1 h -1 ), and their combination (COMB), respectively.Cardiorespiratory variables were recorded every five minutes and immediately before the application of a noxious stimulus. Results: The COMB treatment had the greatest sevoflurane MAC-sparing effect (67.4 ± 13.9%) compared with the other treatments (5.1 ± 25.3, 12.7 ± 14.3, and 40.3 ± 15.1% for TRM, LID, and DEX treatment, respectively). The cardiopulmonary variables remained within the clinically acceptable range following COMB treatment, although the mean arterial pressure was higher and accompanied by bradycardia. Conclusions Tramadol-lidocaine-dexmedetomidine co-infusion produced a remarkable sevoflurane MAC-sparing effect in clinically healthy beagle dogs and could result in the alleviation of cardiorespiratory depression caused by sevoflurane. Cardiorespiratory variables should be monitored carefully to avoid undesirable side effects induced by dexmedetomidine.

The International Classification of Functioning, Disability and Health (ICF), adopted by WHO in 2001, is an evolution of the International Classification of Impairments, Disabilities and Handicaps (ICIDH). It is a model that integrates the levels of 1) body function and structures, 2) activity, and 3) participation, and uses a holistic approach by focusing on the health of the entire body with an emphasis on the positive aspects of being able to do things. In May 2019, the WHO General Assembly adopted ICD-11, revised after 30 years, and for the first time introduced the classification of diseases used in traditional medicine. A symposium organized by the Ministry of Health, Labour and Welfare of Japan (MHLW) was held online on February 20, 2021, and is reported here.

The background and course of Kampo treatment in 39 patients with uncontrollable otolaryngeal symptoms treated between April 2013 and March 2016, in the Department of Kampo Medicine at Tohoku University Hospital, were analyzed retrospectively. An improvement in overall symptoms was noted with Kampo treatment in 28 of 39 cases (71%). The commonly reported subjective symptoms included glossodynia (7 cases), postnasal drip (4 cases), oral discomfort (4 cases), dizziness (3 cases), and taste disorder (3 cases). Analysis using the classification of qi, blood, and fluid revealed that cases with qi stagnation pattern (15 of 18 cases) were effectively treated with Kampo treatment. Prior reports support our finding that smoothing qi with Kampo medicine is effective in alleviating some chronic symptoms. The symptoms improved within 6 weeks after the treatment was initiated. Therefore, a 6-week period can be considered sufficient to determine the effectiveness of Kampo medicine. Many of the patients for whom Kampo treatment was not effective had depression and domestic stress. In conclusion, Kampo treatment may be effectively used to treat uncontrollable, chronic otolaryngeal symptoms in selected cases that are unresponsive to Western medicine.

Background: Given the shortage of medical professionals in the Philippines, Barangay Health Workers (BHWs) may play a role in providing postpartum healthcare services. However, as there are no reports regarding BHW activities in postpartum healthcare, we conducted this study to understand postpartum healthcare services and to explore the challenges and motivations of maternal health service providers. Methods: Focus group interview (FGI) of 13 participants was conducted as qualitative research methodology at Muntinlupa City. The results were analyzed according to the interview guide. The proceedings of the FGI were transcribed verbatim, and researchers read and coded the transcripts. The codes were then used to construct categories. Results: Four important activities were highlighted among 11 analysis codes. These activities were “Assessment of postpartum women’s conditions,” “Recommendation to visit a health facility,” “Measurement of blood-pressure and vitamin intake,” and “Providing postpartum health information.” Among five analysis codes, we identified three challenges that BHWs face, which were “No current information regarding postpartum care,” “Some postpartum women do not want to receive healthcare services from BHW,” and “Too many assigned postpartum women.” Among five analysis codes, we identified two reasons for continuing BHW activities, which were “Hospitality to help postpartum women and their family in the community” and “Performance of mission in providing BHW services.” Conclusion: This study is the first to evaluate BHW activities in postpartum healthcare services. Our results indicate that BHWs play a potentially important role in evaluating postpartum women’s physical and mental conditions through home-visiting services. However, several difficulties adversely affected their activities, and these must be addressed to maximize the contributions of BHWs to the postpartum healthcare system.

Background: Given the shortage of medical professionals in the Philippines, Barangay HealthWorkers (BHWs) may play a role in providing postpartum healthcare services.However, as there are no reports regarding BHW activities in postpartumhealthcare, we conducted this study to understandpostpartum healthcare services and exploring the challenges and motivations ofmaternal health service providers. Methods: Focus group interview (FGI) of 13participants was conducted as Qualitative Research Methodology at Muntinlupa City. The results were analyzed according tothe interview guide. The proceedingsof the FGI were transcribed verbatim, and researchers read and coded thetranscripts. The codes were then used to construct a categories. Results: Four important activities were highlighted among 11 analysiscodes. These activities were “Assessment of postpartum women’s conditions,”“Recommendation to visit a health facility,” “Measurement of blood-pressure andvitamin intake,” and “Providing postpartum health information.” Among fiveanalysis codes, we identified three challenges that BHWs face, which were “Nocurrent information regarding postpartum care,” “Some postpartum women do notwant to receive healthcare services from BHW,” and “Too many assigned postpartumwomen.” Among five analysis codes, we identified two reasons for continuing BHWactivities, which were “Hospitality to help postpartum women and their familyin the community” and “Performance of mission in providing BHW services.” Conclusion: This study is the first to evaluate BHW activities in postpartumhealthcare services. Our results indicate that BHWs may play an important rolein evaluating postpartum women’s physical and mental conditions throughhome-visiting services. However, several difficulties adversely affected theiractivities, and these must be addressed to maximize the contributions of BHWsto the postpartum healthcare system.

Introduction
Compared to Japanese nationals, foreigners residing in Japan have a poor rate of maternal and child mortality and utilization of maternal and child health services. In this study, we examine the maternal and child health services provided by public health nurses to foreigners residing in Japan.
Methods
Questionnaires were administered to public health nurses working at local health centers in Aichi prefecture.
Results
Among the respondents, 4.5% were satisfied with the support system offered to foreigners residing in Japan, and 41.5% had offered their services to foreigners residing in Japan with various ideas. The following factors significantly affected satisfaction in public health nurses: acceptance by foreigners residing in Japan of the home of a newborn and maternal and child health check-ups (P=0.037, P=0.001, respectively), utilization of translators (P=0.002), and adopting a positive attitude towards providing health care services to foreigners residing in Japan (P=0.028).
Conclusions
Public health nurses in Japan are not satisfied with the health care services they offer foreigners residing in Japan. The results of this study suggest that it is important to provide them with multilingual materials and help them develop a positive attitude towards offering health care services to foreigners residing in Japan.

Glycosphingolipids (GSLs) are present in all mammalian cell plasma membranes and intracellular membrane structures. They are especially concentrated in plasma membrane lipid domains that are specialized for cell signaling. Plasma membranes have typical structures called rafts and caveola domain structures, with large amounts of sphingolipids, cholesterol, and sphingomyelin. GSLs are usually observed in many organs ubiquitously. However, GSLs, including over 400 derivatives, participate in diverse cellular functions. Several studies indicate that GSLs might have an effect on signal transduction related to insulin receptors and epidermal growth factor receptors. GSLs may modulate immune responses by transmitting signals from the exterior to the interior of the cell. Guillain-Barre syndrome is one of the autoimmune disorders characterized by symmetrical weakness in the muscles of the legs. The targets of the immune response are thought to be gangliosides, which are one group of GSLs. Other GSLs may serve as second messengers in several signaling pathways that are important to cell survival or programmed cell death. In the search for clear evidence that GSLs may play critical roles in various biological functions, many researchers have made genetically engineered mice. Before the era of gene manipulation, spontaneous animal models or chemical-induced disease models were used.
Animals ; Caveolae ; Cell Death ; Cell Membrane ; Cell Survival ; Cholesterol ; Diabetes Mellitus ; Gangliosides ; Glycosphingolipids ; Guillain-Barre Syndrome ; Intracellular Membranes ; Leg ; Mice ; Models, Animal ; Muscles ; Receptor, Epidermal Growth Factor ; Receptor, Insulin ; Second Messenger Systems ; Signal Transduction ; Sphingolipids

Urgent surgical repairs were successfully performed in four patients with blunt traumatic ruptures of the thoracic aorta. All 4 patients were involved in traffic accidents and had ruptures immediately distal to the aortic isthmus. The diagnoses were achieved by IV-DSA in case 1, by IV-DSA and enhanced CT in case 2 and by enhanced helical CT in cases 3 and 4. Intraoperative transesophageal echocardiography was performed in case 4. Operations were accomplished with the aid of temporary shunt in case 1, pulmonary-femoral artery bypass in case 2 and partial left heart bypass in cases 3 and 4. Prosthetic graft interposition was performed in cases 1, 3 and 4 and end-to-end aortic anastomosis was performed in case 2. There was no postoperative paraplegia in any patient. Early diagnosis and urgent surgical repair are important in treating blunt traumatic rupture of the thoracic aorta. Enhanced helical CT and transesophageal echocardiography are useful for the diagnosis of this type of injury.

A 58-year-old man was admitted for pneumonia after several business trips to Thailand, Vietnam, and Malaysia. Despite resolution of pneumonia on chest X-ray, high fever persisted. CT scan revealed a juxtarenal, atypical-shaped abdominal aortic aneurysm of 4.5cm in size, and this was thought to be the cause of persisting fever. After prolonged antibiotic treatment, surgical resection and prosthetic tube replacement of the aneurysm was performed. The aneurysm was a pseudoaneurysm, and histological examination showed chronic inflammation with no atherosclerotic change. It was thought to be of mycotic origin. On the 12th day after operation, he became febrile, and an arterial blood culture yielded Burkholderia pseudomallei. Antibiotics chosen according to sensitivity tests, were given. He was finally discharged with no exidence of persisting infection, on the 55th day after operation.