Optimal design for wavelength conversion with a configuration of walk-off compensation in free space in the nanosecond pulsed regime.

On the basis of standard wavelength conversion by the use of angular phase matching of nonlinear optical crystals arranged in free space, applicable to a wide range of wavelengths and laser intensities, we both numerically and experimentally present an optimal design for achieving near-full energy conversion while maintaining good TEM00 mode property of fundamental laser radiation in the nanosecond regime.

Investigation for Factors Affecting Body Perception Disturbance in Patients with Low Back Pain by Mechanism-Based Classification of Pain: A Cross-Sectional Study.

Background: Central sensitization is a pathophysiological cause of chronic low back pain and is linked with psychosocial factors. The association between central sensitization (CS) and body perception disturbance is currently unclear, and no prior studies have investigated this relationship in patients with acute or subacute low back pain. The objective of this study was to investigate potential factors that influence body perception disturbance using a mechanistic classification of low back pain. Methods: This cross-sectional study was conducted at the time of initial physical therapy in patients with low back pain. During the study period, 169 patients were recruited. Pain intensity, disease duration, disability, CS, and body perception disturbance were evaluated. Patients were divided into three groups according to the pathology of low back pain, and multivariate analysis was used to examine factors affecting body perception disturbance. The dependent variable was Fremantle Back Awareness Questionnaire (FreBAQ); the independent variables were age, gender, BMI, VAS, disease duration, RDQ, and CS Inventory-9 (CSI-9). Results: A total of 117 patients were included in our analysis. According to the mechanistic classification of pain, 66 (56.4%), 36 (30.8%), and 15 (12.8%) patients were categorized as having nociceptive pain (NP), peripheral neuropathic pain (PNP), and CS pain (CSP), respectively. Patients with PNP or CSP were significantly older than those with NP (p < 0.01). FreBAQ and RDQ scores were significantly higher in patients with CSP than those with NP (p < 0.05). The results of multiple regression analyses indicated that CSI-9 scores were significantly associated with FreBAQ (p < 0.01). Conclusion: Patients with CS syndrome and low back pain tend to have higher CSI-9 scores and be older. Body perception disturbance is influenced by CS or CS syndrome, regardless of the stage of low back pain, suggesting that patients with chronic low back pain tend to have low body image.

Digital zoom is a useful, simple, and cost-effective method of reducing radiation exposure in percutaneous coronary intervention.

Reducing radiation exposure is a very important issue in interventional cardiology techniques such as percutaneous coronary intervention. Although novel techniques to reduce radiation exposure are valuable, we should also reconsider older techniques. Digital zoom has been available in Japan from 2005. Digital zoom enlarges an 8-inch field of view (FOV) by 1.2 times, allowing visualization of a 6.7-inch FOV without FOV switching. We identified 2101 suitable cases of percutaneous intervention (PCI) and divided them into two groups according to the use of digital zoom; 1195 patients were included in the digital zoom group and 906 patients in the conventional group. We collected data regarding the reference air kerma (RAK) and dose-area product (DAP). We calculated RAK and DAP per minute fluoroscope time (RAK/min, DAP/min, respectively). There were intergroup differences in RAK, DAP, RAK/min, and DAP/min (digital zoom group vs conventional group; RAK, 1590 mGy [990-2410] vs 1850 [1220-2720], p < 0.01, RAK/min; 54.7 mGy/min [38.5-73.2] vs 71.2 [51.5-93.0], p < 0.01; DAP, 16,000 cGy × cm2 [10,300-24,400] vs 20,700 [13,400-29,500], p < 0.001; DAP/min, 557 cGy × cm2/min [392-737] vs 782 [571-1010], p < 0.01, respectively). Because of baseline differences between the two groups, we performed propensity score matching. Even after score matching, there were intergroup differences in DAP, DAP/min, RAK, and RAK/min. Furthermore, the least squares method showed that digital zoom is a significant predictor of RAK (ß = 0.14, p < 0.01) and DAP (ß = 0.20, p < 0.01). Digital zoom is an older cost-effective technique that can significantly reduce radiation exposure in PCI.

[Application of brain diffusion-weighted imaging performed using readout segmentation of long variable echo trains].

We report the preliminary use of the readout segmentation of long variable echo trains(RESOLVE)sequence, a novel magnetic resonance(MR)scanning technique based on a readout segmented echo planar imaging(EPI)strategy. RESOLVE enables high-resolution diffusion-weighted imaging(DWI)by minimizing susceptibility distortions and T2* blurring. The software for this sequence was provided by Siemens AG, Germany. Previously, we determined appropriate sequence parameters to obtain sufficiently high-resolution images through phantom studies. Then, we applied the sequence to some clinical cases with neurological disorders and analyzed the RESOLVE-DWI data with diffusion tensor imaging(DTI)techniques. In this article, we report clinical application of the RESOLVE sequence in two cases, one with cerebellar infarction and one with an intracranial epidermoid cyst. In both cases, RESOLVE-DWI clearly exposed structures that were obscured or severely distorted by artifacts on usual single-shot EPI-DWI. DTI analyses for RESOLVE-DWI data provided detailed information about fiber tracts and cranial nerves.

Interleukin-6-producing dermoid cyst associated with multicentric Castleman's disease.

Dysregulated overproduction of interleukin-6 (IL-6) from activated B cells in affected lymph nodes has been implicated in the pathogenesis of multicentric Castleman's disease (MCD), a rare lymphoproliferative disorder accompanied by systemic manifestations. We here report the case of a 32-year-old female presenting with MCD associated with a dermoid cyst in the pelvic cavity. The co-occurrence of MCD and dermoid cyst has not been reported before. Immunohistochemical analysis of the tissue sections showed IL-6 production in CD68-positive macrophage cells, which had infiltrated the dermoid cyst. Removal of the cyst resulted in partial improvement in systemic symptoms accompanied by a decrease in serum IL-6, while complete improvement was obtained by treatment with an anti-IL-6 receptor antibody following resection of the dermoid cyst. To the best of our knowledge, this is the first study to provide evidence of IL-6 production by CD68(+) cells in a dermoid cyst involved in MCD.

Core temperatures during major abdominal surgery in patients warmed with new circulating-water garment, forced-air warming, or carbon-fiber resistive-heating system.

PURPOSE: It has been reported that recently developed circulating-water garments transfer more heat than a forced-air warming system. The authors evaluated the hypothesis that circulating-water leg wraps combined with a water mattress better maintain intraoperative core temperature ≥36°C than either forced-air warming or carbon-fiber resistive heating during major abdominal surgery. METHODS: Thirty-six patients undergoing open abdominal surgery were randomly assigned to warming with: (1) circulating-water leg wraps combined with a full-length circulating-water mattress set at 42°C, (2) a lower-body forced-air cover set on high (≈43°C), and (3) a carbon-fiber resistive-heating cover set at 42°C. Patients were anesthetized with general anesthesia combined with continuous epidural analgesia. The primary outcome was intraoperative tympanic-membrane temperature ≥36°C. RESULTS: In the 2 h after anesthesia induction, core temperature decreased 1.0 ± 0.5°C in the forced-air group, 0.9 ± 0.2°C in the carbon-fiber group, and 0.4 ± 0.4°C in the circulating-water leg wraps and mattress group (P < 0.05 vs. forced-air and carbon-fiber heating). At the end of surgery, core temperature was 0.2 ± 0.7°C above preoperative values in the circulating-water group but remained 0.6 ± 0.9°C less in the forced-air and 0.6 ± 0.4°C less in the carbon-fiber groups (P < 0.05 vs. carbon fiber). CONCLUSIONS: The combination of circulating-water leg wraps and a mattress better maintain intraoperative core temperature than did forced-air and carbon-fiber warming systems.

[Construction of a system for proper TS-1 application].

TS-1 is an oral anti-tumor drug, which contains 5-chloro-2, 4-dihydroxypyridine (CDHP), a compound mainly excreted in urine. Since the CDHP concentration is increased among patients with impaired renal function, the frequency of side effects of TS-1 increases in such patients. Therefore, we constructed a computer-aided system that enables prompt monitoring of creatinine clearance (Ccr) calculated from the serum creatinine levels of patients prescribed TS-1 at the time pharmacists prepare the medicine. With this system, we found two cases who were prescribed TS-1, despite their decreased Ccr. One was a patient whose estimated Ccr was less than 30 mL/min/m2. With such renal malfunction, pharmacokinetics of the drug was considerably changed compared with normal control, and the dosage should be reduced. The other case presented with severe jaundice and had only a mild decrease of renal function (Ccr: 50 mL/min/m2). So we measured the concentration of uracil in the urine and performed a drug lymphocyte stimulation test for further investigation of concomitant affecting factors. Our system is useful because it can show pharmacists both the dosage TS-1 patients take and their renal function at a glance in real time. This system can be adapted for every medicine which might accumulate in patients with renal dysfunction.

Significance of urinary glucaric acid measurement and its application to paclitaxel therapy.

Individual variations in P-450 activity affect the in vivo pharmacokinetics as well as the efficacy and side effect of drugs. It is proposed that urinary glucaric acid (GA) level may indirectly represent P-450 activity and may therefore be an indicator of P- 450 activity in the clinical setting. However, no standard method has been developed so far. Metabolism of paclitaxel (PTX), an anticancer drug, is mediated by P-450. If P-450 activity could be predicted by measuring urinary GA level during PTX administration and individual blood PTX concentration could be inferred, urinary GA level would be a potent tool to predict the efficacy and side effects of the drug. We therefore measured the urinary GA levels of patients on antiepileptics that are suggested to induce P-450 and those of control subjects, to determine whether urinary GA level could be an indicator of P-450 activity. Then, we examined the relationship between urinary GA level and blood PTX concentration and looked into the possibility of predicting pharmacokinetics based on the relationship between urinary GA level and area under the blood concentration-time curve (AUC). The means+/-S. D. of urinary [(GA level)/(Cr level) x 10] levels of 16 patients on antiepileptic medication and 24 control subjects were 0. 98 mg/mL+/-0. 91 and 0. 19 mg/mL+/-0. 07, respectively. The urinary GA levels of patients on antiepileptic medication were significantly higher than those of control subjects. On the other hand, the relationship between AUC and urinary GA levels in eight patients on PTX showed that AUC tended to become large when urinary GA levels were low. The above results reveal that measuring urinary GA level by the easy and noninvasive way of urine collection would enable us to predict P-450 activity and infer blood PTX concentration.

Individual differences in rate-limiting reactions during metabolism of irinotecan hydrochloride.

UNLABELLED: Irinotecan hydrochloride (CPT-11) is converted to SN-38 by carboxylesterase, SN-38 is conjugated by UDP-glucuronosyl- transferase (UGT) to SN-38G. Individual differences in enzyme activity influence the efficacy of this anticancer agent and the adverse reactions it induces. In this study, individual differences in the metabolism of this drug were determined by calculating its c 1 on version (CPT-11 to SN-38) and conjugation ratios (SN-38 to SN-38G) from blood concentrations of CPT-11, SN-38, and SN-38G at immediately and 60 min after a 90-min intravenous infusion of CPT-11. Changes in conversion and conjugation during long-term infusion of CPT-11 were also investigated. The median conversion and conjugation ratios were 0.0155 and 2.812, respectively (n=48). Based on these values, the patients were classified into four types: low-low type (10.4%), low-high type (31.2%), high-low type (31.2%), and high high type (27.1%). Prolongation of infusion time resulted in an increase in the conversion ratio in the low-high type and an increase in the conjugation ratio in the high-low type. These changes, however, were very slight in the high-high type. Thus, a longer infusion time made it possible to increase the number of doses in the low-high type and minimize adverse reactions in the high-low type. CONCLUSION: In patients found to have a low SN-38 conversion ratio or SN-38G conjugation ratio based on simple assessment of data obtained by 2-point blood sampling, modification of infusion time may allow pharmacokinetic changes that confer a clinical benefit.

[Significance of urinary uracil measurement following administration of DPD inhibitory fluoropyrimidine(DIF)products].

Individual differences in 5-FU metabolism are mainly attributed to individual differences in the activity of DPD, an enzyme that can metabolize more than 85% of 5-FU. Because urinary uracil is a reflection of DPD activity, it is measured to predict and prevent the occurrence of side effects caused by pyrimidine-type chemotherapeutic agents. From urinary uracil values measured in 84 gastrointestinal cancer patients, 0-60 mmol/g.creatinine was set as a standard. In patients whose urinary uracil values exceeded the standard, 5-FU tended to be accumulated when S-1, a DIF product, was administered and side effects, such as anorexia, vomiting and diarrhea occurred immediately after the start of S-1 administration. If an appropriate DIF product is selected and its dosage set based on the patient's urinary uracil value, the occurrence of side effects would be reduced. Subsequently, a continuation of medication would be possible.

[Study of a relationship between a change in the urinary uracil value after a S-1 long-term administration and the recurrence of stomach cancer].

S-1 has been reported good results in the treatment of stomach cancer. However, a DPD activity change has also been reported as one of the causes for a recurrence though some recurrence cases observing a state of tumor being unchanged continuously for more than 1 year. Therefore the urinary uracil value, which could simply be predicted in the DPD activity at the time of a recurrence after having administered S-1 for a long-term, was measured. And the urinary uracil value was examined whether it could become an index of recurrence compared with a healthy 5-person example as reference. In the result, a monthly difference in change of the urinary uracil values of the reference was small. However, the urinary uracil values in patients who were administered S-1 more than 6 months but recurred, were significantly lower comparing with the healthy 5-person example. We concluded from this study that the change in DPD activity due to an induction of DPD by 5-FU and metastasis of cancer caused the recurrence and lower a urinary value. The urinary uracil value reflecting DPD activity of the whole body could be used as an index of recurrence at the time of long-term dosage of S-1. Furthermore, a measurement of the urinary uracil value seems to be promising for estimation and evaluation of the cure.

[Determining S-1 dosage at hospitals prioritizing cancer chemotherapy].

Although it is recommended that the standard S-1 dosage should be based on how large the body surface area is, an on-site setting of the appropriate dosage is often lower than the standard one, depending on the individual's condition and considering possible side effects and so, on. Here, we investigated usage conditions for S-1 as a part of field training for expert pharmacists at our hospital that performs total clinical treatments. Decreases in dosage per day for elderly patients were although the standard dosage is generally determined according to the amount of a patient's body surface. We conducted a retrospective survey with a total 90 patients by creating a tree-diagram to identify a reduction standard. It was found that the S-1 dosage was decreased when there were side effects, aggravation in performance status, decrease in kidney function, old age, combined injection chemotherapy, and a decrease in radiation therapy performance. The dosage decreases without such medical reasons were seen in only 4 of the 90 patients. The individual target dosage on the basis of daily medical examination.

[Equalization of spread of breast cancer chemotherapy regimen at general hospitals--with EC and FEC regimens].

We investigated the differences in safety and management of adverse events of chemotherapy among three hospitals, Sakai Municipal Hospital, Takarazuka Municipal Hospital and National Hospital Organization Osaka-minami Medical Center. The main purpose of this study was to equalize the spread of breast cancer chemotherapy regimen. The following three regimens were evaluated; epirubicin (75 mg/m(2)) /cyclophosphamide (500 mg/m(2)) (EC75), epirubicin (75 mg/m(2)) /cyclophosphamide (500 mg/m(2)) /5-fluorouracil (500 mg/m(2)) (FEC75) and epirubicin (100 mg/m(2)) / cyclophosphamide (500 mg/m(2)) /5-fluorouracil (500 mg/m(2)) (FEC100). Sixty-three patients were evaluated. We studied the level of myelosuppression after each regimen. As a result, there was no significant difference in neutrocyte counts at nadir after chemotherapy among hospitals and regimens. However, the values tended to be ranked EC75>FEC75>FEC100. In addition, we examined the risk of febrile neutropenia (FN) according to the multi- national association for supportive care in cancer (MASCC) scoring system. Almost all patients (61/63) were in the low risk group of FN, and only two patients had developed FN. At one hospital, patients receiving chemotherapy were prescribed ciprofloxacin tablets prophylactically for prexia over 38 deg C, and the patients learned from it. Thus, no marked difference in the safety (side effects such as myelosuppression) was recognized. However, management of side effects was different among these hospitals. In conclusion, it is very important to provide patients with adequate information on side effects.

[Improvement of urinary d-glucaric acid assay and its application].

We propose an improved method to measure urinary D-glucaric acid (GA), which might be of value as an indirect index of the activity of cytochrome P450 (CYP). This method was about 20 times more sensitive than existing methods. Beer's law was obeyed in the concentration range 5.5-66 ng ml(-1) for GA, with the effective molar absorptivity at 533 nm and the relative standard deviation being 9.1 x 10(5) dm(3) mol(-1) cm(-1) and 0.69% (n = 6), respectively. In addition, we introduced the correction value {GA/Cr ratio x10} of urinary GA by measuring urinary creatinine (Cr) at the same time. Based on the proposed method, the GA and Cr values in spot urines of healthy persons and cancer patients were subsequently measured and the correction values of both groups subjected to comparison. As a result, a statistically significant difference was recognized between the two groups.

Caenorhabditis elegans opens up new insights into circadian clock mechanisms.

The roundworm, Caenorhabditis elegans, is known to carry homologues of clock genes such as per (=period) and tim (=timeless), which constitute the core of the circadian clock in Drosophila and mammals: lin-42 and tim-1. Analyses using WormBase (C. elegans gene database) have identified with relatively high identity analogous of the clock genes recognized in Drosophila and mammals, with the notable exception of cry (=cryptochrome), which is lacking in C. elegans. All of these C. elegans cognates of the clock genes appear to belong to members of the PAS-superfamily and to participate in development or responsiveness to the environment but apparently are not involved in the C. elegans circadian clock. Nevertheless, C. elegans exhibits convincing circadian rhythms in locomotor behavior in the adult stage and in resistance to hyperosmotic stress in starved larvae (L1) after hatching, indicating that it has a circadian clock with a core design entirely different from that of Drosophila and mammals. Here two possibilities are considered. First, the core of the C. elegans circadian clock includes transcriptional/translational feedback loops between genes and their protein products that are entirely different from those of Drosophila and mammals. Second, a more basic principle such as homeostasis governs the circadian cellular physiology, and was established primarily to minimize the accumulation of DNA damage in response to an environment cycling at 24 h intervals.

[The efficacy of carbon-fiber resistive-heating in prevention of core hypothermia during major abdominal surgery].

BACKGROUND: Perioperative hypothermia causes numerous severe complications, such as coagulopathy, surgical wound infections, and morbid myocardial outcomes. For prevention of intraoperative hypothermia, an inexpensive, non-disposable carbon fiber resistive warming system has been developed. METHODS: We evaluated the efficacy of resistive-heating, comparing to circulating-water mattress and forced-air warming system. Twenty four patients undergoing elective abdominal surgery were randomly assigned to warming with: 1) a circulating water mattress, 2) a lower-body forced-air system, or 3) a carbon-fiber, resistive-heating blanket. RESULTS: Tympanic membrane temperature in the first two hours of surgery decreased by 1.9 +/- 0.5 degrees C in the water mattress group, 1.0 +/- 0.6 degree C in the forced-air group, 0.8 +/- 0.2 degree C in the resistive-heating group. The decreases in core temperature by the end of surgery were 2.0 +/- 0.8 degrees C in the water mattress group, 0.6 +/- 1.1 degrees C in the forced-air group, and 0.5 +/- 0.4 degree C in the resistive blanket group, respectively. There was no significant difference in the changes of core temperature between the forced-air group and the resistive-heating group. No side effects related to resistive-heating blanket were observed. CONCLUSIONS: Even during major abdominal surgery, carbon-fiber resistive-heating maintains core temperature as effectively as forced air.

Resistive-heating and forced-air warming are comparably effective.

UNLABELLED: Serious adverse outcomes from perioperative hypothermia are well documented. Consequently, intraoperative warming has become routine. We thus evaluated the efficacy of a novel, nondisposable carbon-fiber resistive-heating system. Twenty-four patients undergoing open abdominal surgery lasting approximately 4 h were randomly assigned to warming with 1) a full-length circulating water mattress set at 42 degrees C, 2) a lower-body forced-air cover with the blower set on high, or 3) a three-extremity carbon-fiber resistive-heating blanket set to 42 degrees C. Patients were anesthetized with a combination of continuous epidural and general anesthesia. All fluids were warmed to 37 degrees C, and ambient temperature was kept near 22 degrees C. Core (tympanic membrane) temperature changes among the groups were compared by using factorial analysis of variance and Scheffé F tests; results are presented as means +/- SD. Potential confounding factors did not differ significantly among the groups. In the first 2 h of surgery, core temperature decreased by 1.9 degrees C +/- 0.5 degrees C in the circulating-water group, 1.0 degrees C +/- 0.6 degrees C in the forced-air group, and 0.8 degrees C +/- 0.2 degrees C in the resistive-heating group. At the end of surgery, the decreases were 2.0 degrees C +/- 0.8 degrees C in the circulating-water group, 0.6 degrees C +/- 1.0 degrees C in the forced-air group, and 0.5 degrees C +/- 0.4 degrees C in the resistive-heating group. Core temperature decreases were significantly greater in the circulating-water group at all times after 150 elapsed minutes; however, temperature changes in the forced-air and resistive-heating groups never differed significantly. Even during major abdominal surgery, resistive heating maintains core temperature as effectively as forced air. IMPLICATIONS: Efficacy was similar for forced-air and resistive heating, and both maintained intraoperative core temperature far better than circulating-water mattresses. We thus conclude that even during major abdominal surgery, resistive heating maintains core temperature as effectively as forced air.

Effects of Lentinus edodes mycelia on dietary-induced atherosclerotic involvement in rabbit aorta.

Lentinus edodes mycelia lowers cholesterol levels and acts as an immunomodulator and tumor-inhibitor in animal models. Lentinus edodes mycelia contains eritadenine (C(9)H(11)O(4)N(5)) and glucans among other biological compounds. However, whether or not Lentinus edodes mycelia is anti-atherogenic remains unknown. We examined the effect of Lentinus edodes mycelia (L.E.M) on atherosclerosis in a rabbit model. Thirty-two Japanese white male rabbits were fed with 1.0% cholesterol for 8 weeks, then divided into groups and given 1) 1.0% cholesterol for over 8 weeks (control), 2) 1.0% cholesterol and 1.0% L.E.M for over 8 weeks, 3) 1.0% cholesterol and 2.0% L.E.M for over 8 weeks, and 4) 1.0% cholesterol and 4.0% L.E.M for over 8 weeks (n=8 each group). Total cholesterol (TC) was measured periodically throughout the experiment. After the experimental periods, the aortas were removed and atherosclerotic lesions were examined histologically, immunohistochemically and morphometrically to determine surface involvement (SI) and an atherosclerotic index (AI). Body weight and TC did not significantly differ among the four groups. Decreases in SI were significant in the 1% L.E.M (26.2+/-10.8%) and 2% L.E.M (29.3+/-15.7%) groups compared with the control (48.7+/-15.3%; p < 0.05). The AI was significantly decreased in the 1% L.E.M (6.62+/-4.31) and 2% L.E.M (7.49+/-3.49) groups compared with the control (16.96+/-9.21; p < 0.05). Foam cells aggregated in thickened intima of dietary-induced atherosclerotic lesions in the rabbit aorta. In contrast, the numbers of foam cells in the intima decreased in the experimental group. No-cholesterol-lowering action or dose-dependant effects of L.E.M were determined in this study, but atherosclerotic development was significantly inhibited, indicating that L.E.M had anti-atherogenic properties. L.E.M may inhibit atherosclerotic development in rabbit aorta and be beneficial as a nutritional supplement.

Changing site distribution of colorectal cancer in Japan.

PURPOSE: In North America and other high-risk areas, there has been a proximal shift in the subsite distribution of colorectal cancer. We wanted to determine whether any similar change has occurred in Japan, and where the incidence of this disease has increased sharply. METHODS: Data from the Reports of the Japanese Society for Cancer of the Colon and Rectum were used to analyze the time trend of colorectal cancer in Japan between 1974 and 1994 according to the patients' age at diagnosis and sex, and the site of the tumor within the colon or rectum. RESULTS: The percentage of patients over the age of 70, especially females, increased. The increase in the percentage of right-sided colon cancer in colorectal cancer cases was accompanied by a continuous decline in the percentage of rectal cancer in both sexes at all ages. In general, the percentage of right-sided colon cancer in colon cancer cases was stable in men, but increased in women. The rate among patients older than 70 years increased in men, but predominated and remained stable in women. No proximal shift in colon cancer was found in either sex under the age of 69. CONCLUSION: These findings indicated that a proximal shift in the subsite distribution of colorectal cancer has occurred in Japan. This rightward shift of colorectal cancer is due to the decreasing proportion of rectal cancer. Furthermore, the increasing proportion of older patients, especially females, may be another major determinant of the changing colon cancer subsite distribution.