Rhabdomyolysis with Multiple Electrolyte Imbalances under Proton Pump Inhibitor Treatment after Total Thyroidectomy.

A 90-year-old man presented with muscle weakness, difficulty concentrating, and dysphagia. About eighteen months prior to presentation, lansoprazole had been initiated to prevent stress ulcers; he also had a history of total thyroidectomy due to papillary thyroid cancer ten years prior. Laboratory findings were as follows: K 2.4 mEq/L, Ca 3.7 mg/dL, Mg 1.3 mg/dL, CK 5386 U/L, and intact PTH (iPTH) 14 pg/mL. Rhabdomyolysis with multiple electrolyte imbalances under proton pump inhibitor (PPI) treatment was diagnosed. We initiated intravenous hydration and electrolyte supplementation with discontinuation of PPI. After discontinuing PPI, the patient's serum magnesium, potassium, and calcium levels normalised with oral vitamin D and calcium supplementation. PPIs can cause hypocalcaemia and hypokalaemia via hypomagnesemia; hypocalcaemia is also a common postoperative complication of thyroidectomy. Careful monitoring of electrolyte levels is required in patients with long-term PPI treatment, especially in post-thyroidectomy cases.

Perceptions of Residents among Rural Communities with Medical Group Practice in Japan.

Elucidating the perceptions of residents regarding medical group practice (GP) among rural communities (GP-R) in Japan will be useful for establishing this system in such communities. A survey by questionnaire, as made by experts in rural health, was conducted in 2017. The self-administered questionnaire inquired about the perceptions of residents for accepting the GP-R into the community's healthcare using seven major elements of GP-R. The questionnaire was randomly distributed to 400 adult residents who lived in rural communities with a recently launched GP and had access to clinics within the communities. Among the 321 respondents, comparisons were made between younger (≤sixties) and older (≥seventies) residents, and a stepwise multiple regression analysis was performed to extract the factors influencing acceptance of the GP-R system. The results showed that older residents had a greater disapprove of being treated by different physicians daily or weekly in clinics (p < 0.001) and the use of telemedicine (p < 0.001) compared with younger residents. Younger residents showed a greater disapproval of clinics closing on weekdays than older residents (p = 0.007). Among all respondents, regardless of age groups, over half of residents approved of the involvement of nurse practitioners in the GP-R. Living with family and children was also extracted as an independent factor influencing a positive perception of the GP-R. These data suggest that the promotion of GP-R should consider generation gaps in the approach to medical practice as well as the family structures of residents. The involvement of nurse practitioners can also encourage the acceptance of GP-R in Japan.

Enhancement of Thermosensitivity of Gel-Immobilized Tunable Colloidal Photonic Crystals with Anisotropic Contraction.

A thermosensitive poly(N-isopropylacrylamide) (PNIPAM) circular gel film containing single-crystalline colloidal crystals was prepared, and the circular edge was pinched with washers to restrain the in-plane shrinkage of the gel film. Upon heating, the film shrunk in the thickness direction selectively, resulting in a change in the crystal structure of colloids embedded in the anisotropic shrunken gel. This led to the manipulation of the optical stop-band wavelength of the colloidal photonic crystals with a higher thermosensitivity and over a wider range of wavelengths covering a wide margin on either side of the visible-light region. The present method for enhancement of the sensitivity is very simple, and the principle should also be applicable to the gel-immobilized colloidal crystals that respond to stimuli other than temperature changes. The present findings contribute to the progress of practical applications of gel-immobilized colloidal photonic crystals as tunable photonic crystals and biological and chemical sensors.

Expression and localization of epidermal growth factor, transforming growth factor-α and epidermal growth factor receptor in the canine testis.

Gene expression of epidermal growth factor (EGF), transforming growth factor-α (TGF-α) and EGF receptor (EGF-R) and the localization of the corresponding proteins in the canine testis were studied. Levels of mRNA expressions were determined by semiquantitative reverse transcription polymerase chain reaction in the testes of the peripubertal (4-6 months), young adult (3-4 years), advanced adult (7-8 years) and senescent (11-16 years) groups. The EGF-R mRNA level in the testes of the peripubertal group was significantly higher than those in the other groups, whereas there was no difference in EGF and TGF-α mRNA levels among groups. Immunohistochemical stainings for EGF, TGF-α and EGF-R in the testis revealed that immunoreactivity in the seminiferous epithelium and Sertoli cell was weak and nonspecific for the stage of spermatogenesis, and distinct staining was found in Leydig cells. These results suggest that the EGF family of growth factors may be involved in testicular maturation and function in the dog.

Positive correlation between patency and mRNA levels for cyclooxygenase-2 and prostaglandin E synthase in the uterine cervix of bitches with pyometra.

Factors involved in patency of uterine cervices in the bitch with pyometra remain to be clarified. This study examined relationship between patency and mRNA levels for inducible nitric oxide synthase (iNOS), cyclooxygenase (COX)-1, COX-2 and prostaglandin E synthase (PGES) in the uterine cervix of bitches with pyometra. Cervical patency was measured by inserting the stainless steel rods with different diameter into cervical canals. Levels of mRNA expression were determined by semi-quantitative reverse transcription-polymerase chain reaction. The cervical patency was positively correlated with mRNA levels for COX-2 and PGES, but not those for iNOS and COX-1. The results suggest that gene expression of COX-2 and PGES may be involved in the regulation of patency in the uterine cervix of bitches with pyometra.

Crystallization of Brownian particles in thin systems constrained by walls.

Keeping formation of a colloidal crystal by a centrifugal force in mind, we carry out Brownian dynamics simulations in thin systems and study ordering of particles induced by an external force. During solidification, the two-dimensional ordering along walls initially occurs. Then, the ordered particles on the walls act as substrates, and crystallization proceeds into bulk. When the external force is weak, the close-packed face of the crystal structure is parallel to the bottom wall. The direction of the close-packed face depends on the strength of the external force: The close-packed face becomes parallel to the side walls with a strong external force.

Factors associated with patency of the uterine cervix in bitches with pyometra.

This study examined factors involved in the patency of uterine cervices in the bitch with pyometra. The uterine cervices were obtained from the bitches with pyometra at the time of ovariohysterectomy. Cervical patency was measured by inserting the stainless steel rods with different diameter into cervical canals. Collagen concentration and collagenase activity (for type I collagen) in the tissue were determined and the number of neutrophils, which contain the enzymes related to collagen metabolism, and morphological changes in collagenous fibers were studied by histological examination. Levels of mRNA expressions for hormonal factors, estrogen receptor-α (ER-α), progesterone receptor (PR), relaxin (Rlx) and an attractant of neutrophils, interleukin-8 (IL-8), were determined by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). In the statistical analysis, the cervical patency positively correlated with the collagenase activity, and negative correlation was found between the cervical patency and collagen concentration. Histological examination indicated distinct positive correlation between the cervical patency and the number of neutrophils in the cervical stroma and that the collagenous fiber in the uterine cervix became thinner and degraded with increase of the cervical patency. Although there was no relationship between the cervical patency and the level of mRNA for ER-α, PR or Rlx, IL-8 mRNA level has significant positive correlation with the cervical patency and the number of neutrophils in the cervical stroma. These results suggest that the increased number of neutrophils in the uterine cervix, which could be related to the local expression of IL-8, may be involved in collagen degradation and connective tissue remodeling to increase cervical patency in the bitch with pyometra.

Widely tunable lasing in a colloidal crystal gel film permanently stabilized by an ionic liquid.

Widely tunable laser action by low threshold optical excitation can be realized by a colloidal crystal gel (CC-G) film permanently stabilized by a non-volatile ionic liquid. The CC-G film consists of a non-close-packed structure of microparticles immobilized in a polymer gel. Optical excitation with green light gives rise to a single and very narrow laser emission with red color. The single laser emission peak can be tuned in a wide wavelength range by applying mechanical stress.

Inverse opal photonic crystal of chalcogenide glass by solution processing.

Chalcogenide opal and inverse opal photonic crystals were successfully fabricated by low-cost and low-temperature solution-based process, which is well developed in polymer films processing. Highly ordered silica colloidal crystal films were successfully infilled with nano-colloidal solution of the high refractive index As(30)S(70) chalcogenide glass by using spin-coating method. The silica/As-S opal film was etched in HF acid to dissolve the silica opal template and fabricate the inverse opal As-S photonic crystal. Both, the infilled silica/As-S opal film (Δn ~ 0.84 near λ=770 nm) and the inverse opal As-S photonic structure (Δn ~ 1.26 near λ=660 nm) had significantly enhanced reflectivity values and wider photonic bandgaps in comparison with the silica opal film template (Δn ~ 0.434 near λ=600 nm). The key aspects of opal film preparation by spin-coating of nano-colloidal chalcogenide glass solution are discussed. The solution fabricated "inorganic polymer" opal and the inverse opal structures exceed photonic properties of silica or any organic polymer opal film. The fabricated photonic structures are proposed for designing novel flexible colloidal crystal laser devices, photonic waveguides and chemical sensors.

Detection of relaxin mRNA in the corpus luteum, uterus, and uterine cervix in the bitch.

In the pregnant bitch, the placenta is a major source of circulating relaxin, but its local expression in the reproductive organs is not clear. This study demonstrated expression of relaxin mRNA in the corpus luteum, uterus, uterine cervix as well as placenta in the pregnant and nonpregnant bitch by reverse transcriptase-polymerase chain reaction (RT-PCR).

New route to produce dry colloidal crystals without cracks.

We report a new route for fabricating opal films in which the particles are bounded by polymer gel. A loosely packed colloidal crystal immobilized in a hydrogel is homogeneously shrunk and dried and converted into a crack-free opal film. The obtained film shows a uniform diffraction color and excellent transmission spectral properties inherited from the starting state. The optical stop band wavelength is adjustable by varying the amount of gel-polymer.

Doubly enhanced spontaneous emission due to increased photon density of states at photonic band edge frequencies.

Double enhancement of spontaneous emission due to increased photon density of states at the emission frequency and the small group velocity of light at the excitation frequency was clearly demonstrated by angle-resolved photoluminescence experiments for dielectric multilayers composed of Ta2O5 and SiO2 with oxygen vacancies as light emitters. Theoretical emission profiles given by the weak modulation approximation agreed well with the experimental observations.

Gel immobilization of centimeter-sized and uniform colloidal crystals formed under temperature gradient.

We report the fabrication of large and high-quality charged colloidal crystals that are incorporated in a polymer hydrogel matrix. The colloidal crystals are prepared by the thermally induced unidirectional crystallization of colloidal silica in coexistence with pyridine, whose dissociation degree increases with temperature. Their crystal structures are immobilized in the polymer hydrogel matrix by photoinduced polymerizations. The crystals are large sized (maximum dimensions: 1 x 10 x approximately 30 mm), and their lattice planes are well oriented and parallel to the gel surface. Furthermore, they have excellent spatial uniformity in the Bragg wavelengths (<0.7% in standard deviation). The present gelled colloidal crystals, which are unique in that they have large sizes as well as good optical uniformity, will be useful as photonic materials.

Unidirectional crystallization of charged colloidal silica due to the diffusion of a base.

Dilute aqueous dispersions of charged colloidal silica (particle volume fraction = approximately 0.03-0.04, particle diameter = 110 nm) exhibit unidirectional crystal growth due to the diffusion of a weak base, pyridine (Py). Similar diffusion-crystallization is enabled by a salt of a weak acid and a strong base, sodium hydrogen carbonate (NaHCO3). The resulting crystals consist of columnar (or cubic) crystal grains with a maximum height of a few centimeters and a maximum width of 1 cm. The crystal growth process is attributed to a combination of (i) the diffusion of Py or NaHCO3 accompanied by a charging reaction of the silica particles and (ii) the charge-induced crystallization of the silica colloids. Theoretical growth curves based on the reaction-diffusion model for the case of Py were in good agreement with the observed curves. We also report the immobilization of the resulting large crystals by using a polymer hydrogel matrix.

Evaluation of a medical school for rural doctors.

CONTEXT: Jichi Medical School (JMS) is the first and only medical school in Japan that was founded exclusively to graduate/prepare rural doctors. PURPOSE: To evaluate the long-term effect of JMS on the nationwide distribution of doctors. METHODS: Data from the Japanese population census of 1995 and from the Japanese physician census of 1994 were combined for use in this study. We extracted the JMS graduates from the physician census and compared the distribution of JMS graduates to that of non-JMS graduates. JMS graduates have an obligation to work in rural areas for 9 years after graduation. Therefore, we divided them into those doctors who were either "under rural duty" or "after rural duty." FINDINGS: JMS graduates were more likely than non-JMS physicians to practice in rural municipalities. The percentage of JMS graduates practicing under rural duty in communities meeting at least 1 of 4 possible criteria for being considered rural was 2.7 times greater than the percentage of non-JMS graduates in such communities. The percentage of JMS graduates practicing after rural duty in communities meeting at least 1 rural criterion was 2 times that of non-JMS graduates. The JMS graduates accounted for only 0.7% of all the physicians in Japan. However, they accounted for 4.2%, 1.5%, 1.8%, and 3.0% of the physicians in small population, remote, mountain, and medically underserved municipalities, respectively. CONCLUSIONS: The goal of JMS to produce rural doctors in Japan has made an impact on doctor distribution nationwide.

Ovsynch plus CIDR protocol for timed embryo transfer in suckled postpartum Japanese Black beef cows.

We compared synchronization and pregnancy rates, and the increase in blood progesterone concentrations during luteal development, between (1) Ovsynch plus an intravaginal controlled internal drug release (CIDR) device protocol followed by timed embryo transfer (timed ET), and (2) a conventional estrus synchronization method using PGF(2 alpha) and ET in suckled postpartum Japanese Black beef cows. Cows in the PGF group (n=18) received a PGF(2 alpha) analogue when a CL was first palpated per rectum at 10-d intervals after 1 to 2 month postpartum. Cows (n=11), which showed estrus (Day 0) within 5 d of the PGF(2 alpha), and had a CL on Day 7, received ET. Cows in the Ovsynch+CIDR group (n=19) underwent the Ovsynch protocol plus a CIDR for 7 d (GnRH analogue and CIDR on Day-9, PGF(2alpha) analogue with CIDR removal on Day-2, and GnRH analogue on Day 0), with ET on Day 7. The ovulation synchronization (100%) and embryo transfer (100%) rates in the Ovsynch+CIDR group were greater (P<0.01) than the estrus synchronization (66.7%) and the embryo transfer (61.1%) rates in the PGF group. The postpartum interval at ET in the Ovsynch+CIDR group (62.5 +/- 2.5 d) was shorter (P<0.01) than in the PGF group (74.9 +/- 3.9 d). The pregnancy rate in the Ovsynch+CIDR group (57.9%) did not differ significantly from that in the PGF group (50.0%). Plasma progesterone concentrations were not significantly different in the two groups on Days 0, 1, 2, 5, 7, 14 and 21. In summary, higher synchronization and transfer rates, and shorter postpartum interval to ET, can be achieved with timed ET following the Ovsynch plus CIDR protocol than after estrus with the single PGF(2 alpha) treatment followed by ET in suckled postpartum recipient beef cows. Pregnancy rates were similar. Also, the increase in blood progesterone concentrations during luteal development following ovulation synchronized by the Ovsynch plus CIDR protocol was similar to that after estrus induced by the PGF(2 alpha) treatment.

Tuning the effective width of the optical stop band in colloidal photonic crystals.

The optical stop band in colloidal crystals is characterized by the central frequency and bandwidth. Although the former is known to be highly tunable by changing the lattice constant, the latter is basically determined by the refractive index contrast between the particles and the background medium that is intrinsic to the materials. In this study, we show that the effective bandwidth in gelled colloidal crystals can also be tuned by controlling the fabrication conditions. Single-domain gelled colloidal crystals were prepared by photopolymerization under various photoirradiation conditions. It was observed that the width of the stop band in the transmission or reflectance spectrum could be expanded by simply adjusting the irradiation time.

Three-dimensional centimeter-sized colloidal silica crystals formed by addition of base.

Three-dimensional (3D) centimeter-sized colloidal crystals can be spontaneously formed simply by dropping a NaOH solution (10 mM, approximately 10 microL) into an aqueous dispersion of dilute charged colloidal silica (particle diameter 110 nm, particle volume fraction phi = 0.023, 3-4 mL). The charge number of the silica particle increases with pH. Upon adding the NaOH solution, first, sub-millimeter-sized polycrystals are formed in the upper part of the sample due to charge-induced crystallization. The local phi value in the crystal region becomes nonuniform. The crystals with a high phi value accumulate at the bottom of the cell and then grow upward as columnar crystals. The crystal widths increase discontinuously with the growth, and in some cases, 3D centimeter-sized crystals are formed. The centimeter-sized crystals are also obtainable by the controlled diffusion of the base from its dilute reservoir. The present findings may prove valuable in the fabrication of large 3D single-crystalline photonic materials.