External dose measurements to investigate the body-size dependence of personal dosemeter responses in areas affected by the Fukushima Daiichi nuclear accident.

To formulate necessary protective measures after a large-scale nuclear accident, it is crucial to understand the levels of radiation to which persons living in radionuclide-contaminated areas are exposed. Individual monitoring using personal dosemeters (PDs) plays a role in this, although PDs were not originally intended to be used by members of the public. The present study investigated PD responses in areas highly affected by the Fukushima Daiichi nuclear accident, as well as the dependence of those measurements on body size. Three types of commercially available electronic PDs, including D-shuttle, which has often been used in Fukushima, were placed on the front surfaces of three age-specific anthropometric phantoms imitating a 5-y-old, a 10-y-old and an adult male, and these phantoms were then exposed to radiation in an open field in the affected area. In the case of D-shuttle, the ratios of PD readings to the ambient dose rate for the 5-y-old phantom and the adult male phantom were 0.79 and 0.72, respectively. The ratios were somewhat higher for the other PDs; any PDs showed higher readings than the effective doses estimated by simulations based on the assumed ground deposition of 134Cs and/or 137Cs over the affected areas.

Does preoperative enhanced CT predict requirement of intestinal resection in the patients with incarcerated myopectineal hernias containing small bowel?

PURPOSE: Bowel wall enhancement on CT imaging is considered one of the useful features for the prediction of the presence of irreversible ischemic change in patients with small bowel obstruction. However, the applicability of CT imaging in patients with incarcerated hernias has not been investigated in detail. The aim of this retrospective study was to evaluate the feasibility of preoperative CT findings for the prediction of the presence of irreversible ischemic change in patients with incarcerated hernias containing small bowel. METHODS: Included in this study were 76 patients who underwent surgery for preoperatively diagnosed incarcerated hernias containing small bowel (27 inguinal hernias, 37 femoral hernias and 12 obturator hernias) at our hospital between January 2011 and June 2020. The preoperative clinicoradiological features were compared between the groups, and predictors for intestinal resection were evaluated. RESULTS: Nineteen patients required intestinal resection (Resection group), and the other 57 patients did not require intestinal resection (Nonresection group). Multivariate analyses revealed that age ≥ 80 years (p = 0.018, odds ratio = 6.604) and the absence of bowel wall enhancement (p = 0.032, odds ratio = 51.200) were independent predictors for intestinal resection. In resected specimens, all patients with an absence of bowel wall enhancement on preoperative enhanced CT had ischemic changes extending beyond the muscularis propria. CONCLUSIONS: Preoperative enhancement CT yields useful information for the prediction of the presence of irreversible ischemic change in patients with incarcerated hernias containing small bowel.

Quantitative evaluation of 218Po behaviour in air in an artificial environment.

Experiments were carried out in a small enclosed booth for the purpose of understanding and modelling (218)Po behaviour. The experiment was conducted under two kinds of conditions without and with injection of incense smoke. A working model of (218)Po behaviour was applied to analyse the measured data. Under the condition without incense smoke, temporal changes in aerosol-attached and unattached (218)Po concentrations were successfully reproduced by the model. The deposition rate of unattached fraction and the rate of attachment were determined by the working model. Under the condition with incense smoke, temporal changes in (218)Po concentration were poorly simulated by the model. This can be attributed to the significantly increased aerosol concentration in small size ranges which is not properly considered in the attachment rate calculation in the model.

Dose estimation of a soft X-ray exposure incident.

A dose reconstruction was carried out on a case in which a worker was exposed to soft x rays using time motion studies, an ionization chamber for low energy photon measurements, and CdZnTe (CZT) spectrometry. The worker estimated his dose to be over 600 mSv. However, the doses to the skin and testes were evaluated to be 14 and 0.44 mSv, respectively, with an effective dose of 0.099 mSv.

Variation of microvascular blood flow augmentation--supercharge in esophageal and pharyngeal reconstruction.

AIM OF THE STUDY: A gastric tube is commonly used in thoracic esophageal reconstruction. When a gastric tube is not available, pedicled jejunum transfer and colonic interposition are alternative methods. Oral end of the reconstructed esophagus occasionally has poor blood flow and may result in partial necrosis of the oral segment. We performed additional microvascular blood flow augmentation, the "supercharge" technique, to improve a blood flow circulation in the oral segment of the reconstructed esophagus. METHODS: A series of 86 esophageal reconstructions with microvascular blood flow augmentation using the "supercharge" technique were performed. Reconstructive methods included a gastric tube in five patients, a gastric tube combined with a free jejunual graft in one, an elongated gastric tube in eight, a pedicled colonic interposition in 22, and a pedicled jejunum in 50. Recipient vessels were used in neck or chest region. RESULTS: The color and blood flow of the transferred intestine appeared greatly improved after microvascular blood flow augmentation. Thrombosis was noticed in three patients during the surgery, and all thrombosies were salvaged by re-anastomosis. There were only three patients with partial graft necrosis of oral segment, two patients with anastomotic leakage, one anastomotic stricture. CONCLUSIONS: Augmentation of microvascular blood flow by this "supercharge" technique can be expected to reduce the risk of leakage and partial necrosis of the transferred intestine. This technique contributes to the successful reconstruction of esophageal defect.

[The last period of surgical site infection after pulmonary resection for lung cancer with hemodialysis; report of a case].

An 80-year-old man had been on maintenance hemodialysis for nondiabetic chronic renal failure from June 1996. He underwent investigation of an abnormal chest X-ray and was referred to our hospital with a diagnosis of squamous cell carcinoma in the upper lobe of the right lung. On February 20, 2003, right upper lobectomy was performed. The postoperative course was uneventful and he was discharged on postoperative day 13. Two weeks later he was readmitted with a wound infection. Although he received antibiotics, drainage, and wound lavage, his fever persisted and chest X-ray showed inflammatory changes in the right lower lung field. He was placed on mechanical ventilation for dyspnea. After this, his respiratory function became stable and he could be weaned from the ventilator within 2 weeks. The subsequent course was uneventful and he was discharged 1 month after re-admission. This patient needed ventilation due to weakness caused by wound infection. Such infection is uncommon but can be fatal for a compromised host, so we administered antibiotics for 3 days until the wound closed.

A new technique of microvascular suturing: the chopstick rest technique.

With the conventional techniques of tying knots during microvascular anastomosis or neural suturing, time may be lost due to various reasons. The loose end of the suture often falls down into the operative field and gets stuck to the surrounding tissues. In the process of retrieving the suture, the surrounding tissues can be picked up together with the suture. When the posterior wall technique [Br J Plast Surg 34 (1981) 47, Plast Reconstr Surg 69 (1982) 139, Microsurgery 8 (1987) 22, J Reconstr Microsurg 15 (1999) 321] is used, the loose end of the suture may be stuck to the backside of the vessel and may be hard to grab. In order to avoid those problems, a new way of tying a microsuture was developed. By avoiding contact of the loose end of the suture to the surrounding tissue at any point during tying, the microvascular anastomosis can be performed quicker and more efficiently.

Self-expandable metallic stents for palliation of malignant esophageal obstruction: special reference to quality of life and survival of patients.

SUMMARY. Self-expandable metallic stents (EMS) provide a common option for malignant esophageal stenosis because of the low complication rate and high dysphagia improvement rate. However, there are few studies on the functional duration of EMS and the extent of improvement of the quality of life. We retrospectively analyzed 18 patients who received EMSs in our division from 1996 to 2002. The median duration of possible food intake and the median survival period were 94.5 and 108 days. The median duration of domiciliary treatment was 56 days. Six of the 18 patients were not discharged from hospital after EMS insertion. The Karnofsky index was found to be a significant determinant of the feasibility of domiciliary treatment. One-third of the patients are incapable of obtaining the benefits of the palliative therapy. EMS deployment should be prudently selected for patients exhibiting low performance status.

Usefulness of daily +2Gz load as a countermeasure against physiological problems during weightlessness.

UNLABELLED: Adaptation to head-down-tilt bed rest as a simulated microgravity leads to an abnormality of reflex control of circulation, hypovolemia and reduction of exercise capacity. We hypothesized that this cardiovascular deconditioning and reduction of exercise capacity could be prevented by a daily 1 hr centrifugation at +2Gz. To test this hypothesis, twenty healthy male subjects underwent 4 day of 6 degrees head-down-tilt bed rest. Ten of them were exposed to a +2Gz load for up to 30 min twice per day (the Gz group). The remaining 10 were not exposed to a Gz load (the no-Gz group). We estimated autonomic cardiovascular control by power spectral analysis of blood pressure and R-R interval variability, and baroreflex regulation by the transfer function analysis and the sequence method, before and after bed rest. Further, we measured hematocrit as an index of changes in plasma volume and maximal oxygen consumption as an index of exercise capacity, before and after bed rest. RESULT: In the no-Gz group, heart rate increased after bed rest. The high frequency power of R-R interval variability as an index of cardiac parasympathetic nervous activity, baroreflex gains estimated by transfer function analysis and the sequence method as index of the integrated arterial-cardiac baroreflex function decreased significantly. Associated with these changes, the ratio of low to high frequency power of R-R as an indicator of cardiac sympathovagal balance tended to increase after bed rest in the no-Gz group. However, those showed no significant changes after bed rest in the Gz group. Hematocrit increased after bed rest in the no-Gz group. It also tended to increase in the Gz group, however it did not achieve statistical significance. Maximal oxygen consumption decreased significantly to similar extent in both the groups. CONCLUSION: This result suggested that 1) a daily 1hr +2Gz load produced by a centrifuge might eliminate the changes in autonomic cardiovascular control during simulated weightlessness; 2) furthermore, it might partly reverse hypovolemia induced by bed rest; 3) however, it could not prevent the decreases in exercise capacity.

Safe and effective treatment of refractory facial lesions in atopic dermatitis using topical tacrolimus following corticosteroid discontinuation.

BACKGROUND: Topical corticosteroids are commonly applied in atopic dermatitis (AD) treatment. However, their chronic use may be associated with significant side effects at the application site. Skin atrophy and other undesirable effects are frequently seen after long-term corticosteroid treatment. In addition, when application of corticosteroids is discontinued, a rebound phenomenon in the facial lesions can occur within several days. Topical tacrolimus, an immunosuppressant currently used to prevent rejection after solid-organ transplantation, presents a potential alternative therapeutic agent for AD. OBJECTIVE: The present study is the first trial designed to evaluate the efficacy and safety of topically applied tacrolimus ointment after corticosteroid discontinuation without a washout phase in severe, long-term facial AD. PATIENTS/METHODS: Forty-seven patients with facial refractory AD were recruited, of whom 38 had undergone topical corticosteroid treatment for at least 4 weeks before enrollment (group 1) and the other 9 had not received steroid treatment (group 2). All 47 patients received 0.1% tacrolimus ointment, and the severity index and pruritus score were assessed as an AD clinical activity index every week and compared with baseline data. RESULTS: Both the severity index and pruritus score improved significantly in group 1 after 1 and 2 weeks of application (p < 0.01, respectively). Group 2 showed the greatest improvement at 4 weeks (p < 0.05). In this trial, none of the patients experienced a rebound phenomenon associated with tacrolimus treatment. A transient sensation of burning at the application site was the only adverse event in 31 of the 47 (66%) enrolled patients, but this condition improved after several days. Spectrophotometric assessment of the facial lesion following treatment revealed significant improvement in group 1 (p < 0.05). CONCLUSION: The present results indicate that topical tacrolimus treatment following corticosteroid discontinuation is safe and effective in refractory facial AD.

A patient with diabetes mellitus and severe arterial embolism.

An 89-year-old man with diabetes mellitus was admitted to the hospital because of a low-grade fever and a disturbance in consciousness. He had been diagnosed as having diabetes mellitus at the age of 22 years and had been taking oral hypoglycemic drugs for 16 years at least. A few days before admission, a loss of appetite was noticed by his family; he developed a stupor on the day of admission. On physical examination, his lower extremities were pale and his skin temperature was low. Laboratory tests showed an increase in his white blood cell count and his blood culture was positive for Staphylococcus aureus. An MRI showed that the abdominal aorta was totally occluded beneath the renal arteries, and no significant collateral circulation was observed. He was given antibiotics and anticoagulants, but his general condition continued to worsen. Laboratory tests showed renal failure and liver dysfunction, indicating multi-organ failure. On the 24th day of admission, he died of respiratory and heart failure. An autopsy showed the aorta to be totally occluded beneath the renal arteries by an embolism; atherosclerotic changes were rather mild. Acute plaque change on the surface of the aorta may have induced the sudden development of emboli in the aorta.

Can daily centrifugation prevent the haematocrit increase elicited by 6-degree, head-down tilt?

A measure to counteract the effects of low or zero gravity is required for long-term space flight, such as the manned Mars mission scheduled by the National Aeronautics and Space administration (NASA) for 2014. We conducted a series of centrifugation experiments with humans, using a short-arm centrifuge (radius 1.8 m, made by First Medical Co., Tokyo, Japan). We employed 6-degree, head-down tilt (HDT) for 4 days to simulate space flight. Ten healthy male volunteers underwent 4-day HDT and a 2-G daily centrifuge load for 60 min in the +Gz direction and measurements, such as haematocrit, 24-h urine volume, body weight and electrocardiogram (ECG) were made. There was no significant increase in the haematocrit during the HDT period, although our previous studies had shown a significant increase during HDT. A 60-min daily load of +2 Gz appears to be effective in reversing the haematocrit increase due to 4-day HDT.

[Effects of 6-degree head-down bed rest on physical fitness].

We investigated changes in enduring physical fitness during a ground-based weightlessness simulation of 6-degree head-down bed rest (HDBR). Ten healthy volunteers participated in the 6 days of HDBR. In each, their physique, muscular strength, physical fitness, cardiovascular function, and hematocrit were measured before and after HDBR. The results are as follows: (1) Thigh extensor power: the cross-sectional areas of the thigh and leg muscles were significantly decreased after HDBR, but recovered immediately afterwards. (2) Hand grip power and instantaneous power: the body response time showed no significant change before and after HDBR. (3) High physical capacity was correlated with a greater decrease in physical capacity after HDBR. (4) Remarkable functional depression appeared in the cardiovascular system compared with the gas exchange system as measured by the enduring physical fitness test. (5) The functional depression in the cardiovascular system lasted for more than 3 days after HDBR. (6) Six days of HDBR had little influence on physical fitness attributable to the inactivity and seemed to effectively simulate weightlessness for the cardiovascular system.

[TRAM flap breast reconstruction using a fascia-sparing technique].

Although the TRAM flap has been accepted as one of the most common methods for breast reconstruction utilizing the autologous tissue, its disadvantage is that scarring of the abdominal sheath and muscle may result in postoperative abdominal bulge or hernia. To solve this problem, the authors developed the fascia-sparing technique in TRAM flap breast reconstruction. The technique, in which most of the anterior rectus sheath is preserved, has been applied in 3 patients after radical mastectomy and 7 patients after modified radical mastectomy. With an average follow-up period of 1 year and 2 months, no abdominal bulge or hernia was noted in any patient without the use of prosthetic mesh for the abdominal closure. This fascia sparing technique is particularly effective for TRAM flap reconstruction requiring bilateral rectus abdominis muscle portions and containing only a few minor perforators, for which a DIEP flap is not suitable.

Non-invasive assessment of human baroreflex during different body positions.

Two techniques for evaluating human baroreflex sensitivity (BRS), i.e. the sequence technique and the cross-spectral technique, were compared during the following four different body positions; 6 degrees head-down tilt (HDT), supine (Sup), 60 degrees head-up tilt (HUT) and upright (Upr). The sequence technique is based on the slope of linear regression between beat-to-beat RR intervals and systolic blood pressures. The cross-spectral technique is based on the cross-spectral analysis of RR interval and systolic blood pressure variabilities, and the estimates of BRS were computed separately for the low-frequency region (0.04-0.15 Hz) and the high-frequency region (0.15-0.5 Hz). The BRS obtained by the sequence technique had a significant correlation to that obtained by the cross-spectral technique for the low-frequency region in HDT, Sup and HUT, but not in Upr. There was a significant correlation between the BRS obtained by the sequence technique and that obtained by the cross-spectral technique for the high-frequency region in every body position. It became clear that the sequence technique is mutually related to the cross-spectral technique for the high-frequency region, but not necessarily identical to the cross-spectral technique for the low-frequency region. Moreover, a comparison was also made between the baroreceptor activating sequence and the deactivating sequence in the sequence technique during the four different body positions. Although the estimates of BRS of the activating sequence and the deactivating sequence were similar in every body position, the numbers of their sequences were progressively separated in the order of HDT, Sup, HUT and Upr. The numbers of the activating sequence and the deactivating sequence in the sequence technique were found to be separated in a sympathetically dominant condition.

Thermostability reinforcement through a combination of thermostability-related mutations of N-carbamyl-D-amino acid amidohydrolase.

For the improvement of N-carbamyl-D-amino acid amidohydrolase (DCase), which can be used for the industrial production of D-amino acids, the stability of DCase from Agrobacterium sp. KNK712 was improved through various combinations of thermostability-related mutations. The thermostable temperature (defined as the temperature on heat treatment for 10 min that caused a decrease in the DCase activity of 50%) of the enzyme which had three amino acids, H57Y, P203E, and V236A, replaced was increased by about 19 degrees C. The mutant DCase, designated as 455M, was purified and its enzymatic properties were studied. The enzyme had highly increased stability against not only temperature but also pH, the optimal temperature of the enzyme being about 75 degrees C. The substrate specificity of the enzyme for various N-carbamyl-D-amino acids was changed little in comparison with that of the native enzyme. Enzymochemical parameters were also measured.

Inhibition of endothelium-dependent hyperpolarization by endothelial prostanoids in guinea-pig coronary artery.

1. In smooth muscle of the circumflex coronary artery of guinea-pig, acetylcholine (ACh, 10(-6) M) produced an endothelium-dependent hyperpolarization consisting of two components. An initial component that occurs in the presence of ACh and a slow component that developed after ACh had been withdrawn. Each component of the hyperpolarization was accompanied by an increase in membrane conductance. 2. Indomethacin (5 x 10(-6) M) or diclofenac (10(-6) M), both inhibitors of cyclooxygenase, abolished only the slow hyperpolarization. The initial hyperpolarization was not inhibited by diclofenac nor by nitroarginine, an inhibitor of nitric oxide synthase. 3. Both components of the ACh-induced hyperpolarization were abolished in the presence of atropine (10(-6) M) or high-K solution ([K+]0 = 29.4 mM). 4. The interval between ACh-stimulation required to generate an initial hyperpolarization of reproducible amplitude was 20 min or greater, but it was reduced to less than 5 min after inhibiting cyclooxygenase activity. Conditioning stimulation of the artery with substance P (10(-7) M) also caused a long duration (about 20 min) inhibition of the ACh-response. 5. The amplitude of the hyperpolarization generated by Y-26763, a K+-channel opener, was reproducible within 10 min after withdrawal of ACh. 6. Exogenously applied prostacyclin (PGI2) hyperpolarized the membrane and reduced membrane resistance in concentrations over 2.8 x 10(-9)M. 7. At concentrations below threshold for hyperpolarization and when no alteration of membrane resistance occurred, PGI2 inhibited the initial component of the ACh-induced hyperpolarization. 8. It is concluded that endothelial prostanoids, possibly PGI2, have an inhibitory action on the release of endothelium-derived hyperpolarizing factor.

Sensitivity analyses of heart rate variability variables by an incremental, passive head-up tilt.

We analyzed the sensitivity of heart rate variability (HRV) variables as an index of autonomic nervous activity by an incremental, passive head-up tilt (HUT). Twelve healthy male volunteers, mean age 20.5 years +/- 2.1 SD, were subjected, after a horizontal (0 degrees) supine posture period, to an incremental, passive HUT of 14.5, 30, 48.6, 61 and 90 degrees. The tested HRV variables were: heart rate (HR), standard deviation of the RR interval (SD(RR)), coefficient of variance of the RR interval (CV(RR)), low-frequency band [0.04-0.15 Hz] power spectrum (P(LF)), high-frequency band [0.15-0.4 Hz] power spectrum (P(HF)), the ratio of P(LF) to P(HF) (P(LF)/P(HF)), coefficients of low-frequency and high-frequency component variance (C-CV(LF), C-CV(HF)), percentages of P(LF) and P(HF) in total power spectrum (%LF, %HF), and normalized units of low frequency and high frequency band power spectra (NU(LF), NU(HF)). The SD(RR), CV(RR), P(LF) and C-CV(LF) were not sensitive to the sine of the tilt angles, i.e., the body-axis component of gravity (+Gz), in the incremental HUT. Therefore, these variables may be less suitable as indices of autonomic nervous activity. The P(LF)/P(HF), NU(LF), and NU(HF) appear to be useful as indices of sympathovagal balance. Both the NU(LF) and NU(HF) (both are equivalent and inversely related) are suitable for the comparison of sympathovagal balance between subjects of different ages and levels of physical fitness because they are not significantly influenced by age and physical fitness. The HR and HRV variables represent quite different characteristics of autonomic nervous activity, according to the Rosenblueth Simeone model. Therefore, the HR appears to be effective for combined assessment of sympathovagal balance. These results provide information useful in the selection of HRV variables while estimating autonomic nervous activity from short-term HRV.

Effects of daily 2-Gz load on human cardiovascular function during weightlessness simulation using 4-day head-down bed rest.

An onboard short arm human centrifuge has been proposed as a countermeasure against physiological problems during long exposure to weightlessness in space and during extra planetary exploration. However, there are few studies on the effects of intermittent application of a Gz load via centrifuge during weightlessness. The present study evaluated the effects of a daily 2-Gz load on cardiovascular function during simulated weightlessness using a 4-day head-down bed rest (HDBR) period. Twelve young male subjects were exposed a HDBR period. Eight of them were exposed to a Gz load for up to 30 min twice per day (the Gz group). The remaining 4 were not exposed to a Gz load; they served as controls (the no-Gz group). Compared with the pre-HDBR period, the no-Gz group showed percent changes in the RR interval, the standard deviation (SD) of the RR interval, parasympathetic nervous activity, and baroreflex sensitivity (BRS) that progressively decreased and reached significance at the end of the HDBR period (-5.96 +/- 2.60%, -33.82 +/- 9.60%, -46.3 +/- 12.7% and -30.9 +/- 7.2%, respectively). In the Gz group, however, the percent changes in the RR interval, the SD of the RR interval, parasympathetic nervous activity, and BRS showed no significant changes throughout the HDBR period. At the end of the HDBR period, these indexes were 2.22 +/- 2.21%, -2.31 +/- 12.28%, 5.08 +/- 14.82% and 10.6 +/- 12.5%, respectively, and significantly greater than those of the no-Gz group. Sympathovagal balance indicators showed no significant change in the Gz and no-Gz groups (5.17 +/- 12.85% and 18.5 +/- 10.7%, respectively). These results indicate that a daily load of 2-Gz eliminates reduction of the RR interval, the SD of the RR interval, parasympathetic nervous activity, and BRS, and that it can maintain autonomic cardiovascular function in short-term weightlessness.

Production of thermotolerant N-carbamyl-D-amino acid amidohydrolase by recombinant Escherichia coli.

A plasmid, pNT4553, was constructed for high level production of N-carbamyl-d-amino acid amidohydrolase (DCase), the thermostability of which has been improved by amino acid substitution. The DCase activity and the stability of the plasmid in the host cells were dependent on the Escherichia coli strains used. E. coli HB101 was the most suitable host strain among the 13 types of E. coli tested. E. coli HB101 exhibited the highest activity, i.e. 6.36 units/ml of culture broth in 2YT medium (1.6% tryptone, 1.0% yeast extract, and 0.5% NaCl, pH 7.0), and the plasmid was stably maintained by cultivation in 5 types of E. coli including HB101. Casamino acids, NZ-amine, peptone, and protein extract (a mixture of hydrolyzates of corn gluten, wheat gluten and soybean), were found to be suitable as natural nitrogen sources for both enzyme activity and growth. When cultivation was carried out in the presence of high concentrations of glycerol (6.5%) as the carbon source, and protein extract (3.0%) as the nitrogen source, in a small volume of the medium (20 ml of medium in a 500-ml shaking flask), in which the aeration level was estimated to be high, growth and activity reached OD550=63.8 (17.1 mg of dry cell weight/ml of culture broth) and 22.9 units/ml of culture broth, respectively. The economical hyperproduction of DCase using only inexpensive constituents for the medium was achieved.