Attitude of Emergency Medical Technicians Toward Electrocardiogram　- Needs of Electrocardiogram Training Courses and Other Learning Opportunities.

BACKGROUND: Early intervention in prehospital settings is important for treating patients with acute coronary syndrome (ACS). Emergency medical technicians (EMTs) are the essential first responders who treat these patients, and their current attitudes towards electrocardiograms (ECGs) have not been identified. This study investigated the awareness of EMTs of ECGs to shorten hospital arrival time, improving patient prognosis.Methods and Results: An anonymous questionnaire survey, with 27 statements about ECG and ACS response, was administered to 395 EMTs. The statements were related to interest, motivation, learning status, confidence, and norms pertaining to ECGs, a sense of perceived behavioral control, and training courses. The primary outcome was the perception of EMTs that their interpretation of an ECG affected patient prognosis (Statement [S] 1). Participants assigned scores for each statement using a scale ranging from 1 (strongly disagree) to 10 (strongly agree). The mean score for S1 was 7.09. Mean scores for statements regarding confidence and learning status were 3.96 and 3.53, respectively. The participants had a positive impression of training courses (score >5.5). CONCLUSIONS: The EMTs experience was that their interpretation of an ECG could affect the prognosis of patients with ACS. Conversely, they lacked confidence reading ECGs, but were willing to attend ECG training courses. Therefore, efficient training programs need to be established to achieve a better prognosis for ACS patients.

Direct measurement of the evolution of magnetism and superconductivity toward the quantum critical point.

Nontrivial quantum states can be realized in the vicinity of the quantum critical point (QCP) in many strongly correlated electron systems. In particular, an emergence of unconventional superconductivity around the QCP strongly suggests that the quantum critical fluctuations play a central role in the superconducting pairing mechanism. However, a clear signature of the direct coupling between the superconducting pairing states and the quantum criticality has not yet been elucidated by the microscopic probes. Herein, we present muon spin rotation/relaxation and neutron diffraction measurements in the superconducting dome of CeCo(In1 - xZnx)5. It was found that a magnetically ordered state develops at x≥ 0.03, coexisting with the superconductivity. The magnitude of the ordered magnetic moment is continuously reduced with decreasing x, and it disappears below x∼ 0.03, indicating a second-order phase transition and the presence of the QCP at this critical Zn concentration. Furthermore, the magnetic penetration depth diverges toward the QCP. These facts provide evidence for the intimate coupling between quantum criticality and Cooper pairing.

[A Case of Locally Advanced Pancreatic Cancer Successfully Resected after S-1 Therapy in an Elderly Patient].

We report a case of locally advanced pancreatic body cancer, accomplishing R0 resection following preoperative chemotherapy. An 80-year-old female patient was admitted to our hospital because of high CA19-9 levels.Based on computed tomography images, she was diagnosed with locally advanced cancer of the pancreatic body.We started S-1 chemotherapy (100mg/day, 2 weeks administration 1 week rest)because the tumor was suspected to have invaded the celiac trunk and the common hepatic artery.The tumor decreased in size, and the encasement of the celiac trunk and the common hepatic artery were released, following 6 months of chemotherapy.Subsequently, distal pancreatectomy with D2 lymph node dissection was performed.The patient was healthy and showed no signs of recurrence 5 years and 9 months after surgery.

[Two Cases of Laparoscopic Resection of Colon Cancer Manifested by Liver Abscess].

We report 2 cases of laparoscopic surgery for patients who had liver abscess as the initial manifestation of underlying colon cancer. The first case was in an 80-year-old woman who presented to our hospital with a diagnosis ofliver abscess. Percutaneous transhepatic abscess drainage(PTAD)was performed as initial treatment. Subsequent colonoscopy revealed a type 1 tumor in the cecum, and biopsy results ofthe mass indicated adenocarcinoma. The patient underwent laparoscopic right hemicolectomy as curative treatment. The pathological findings were as follows: tub1, T2, N0, M0 and Stage I . Two years later, she remains disease free. The second case was in a 59-year-old man with liver abscess. Colonoscopy also revealed a type 2 tumor in the sigmoid colon. After treatment of the liver abscess with PTAD, laparoscopic sigmoidectomy was performed with a preoperative diagnosis of sigmoid colon cancer. The pathological findings were as follows: tub2, T3, N0, M0 and Stage II . Lung metastases appeared 10 months after surgery, and systemic chemotherapy was administered. In conclusion, liver abscess is occasionally caused by malignancy, and complete gastrointestinal evaluation should be conducted. Laparoscopic radical surgery can be safely performed in cases in which the liver abscesses are controlled.

[A Case of Infectious Pseudoaneurysm That Developed after Surgery for Local Recurrence of Rectal Cancer].

In February 2011, a male patient in his 60's underwent a low anterior resection and lateral lymph node dissection for lower rectal cancer. Due to large intestinal obstruction from local recurrence, an abdominoperineal resection was performed 5 years 8 months after his first surgery. Inflammation of the pelvic dead space persisted, requiring drainage after the surgery. Although bloody discharge was observed on the 12th and 30th postoperative day, the source of bleeding was not identified on contrast-enhanced CT. On the 35th postoperative day, the patient suddenly lost 700 mL of blood via the abdominal drain and perineal wound. Urgent angiography revealed an aneurysm on the branch of the left iliac artery. Therefore, transcatheter arterial embolization was performed for hemostasis. Infectious complications associated with surgery for locally recurrent rectal cancer frequently occur due to impaired tissue blood flow. This case highlights the importance of paying close attention to the possibility of infectious pseudoaneurysm.

Enhancement of ferromagnetism by oxygen isotope substitution in strontium ruthenate SrRuO3.

The oxygen isotope effect of the ferromagnetic transition in itinerant ferromagnet strontium ruthenate SrRuO3 with a Curie temperature Tc of 160 K is studied. We observed for the first time a shift of ∆Tc ~ 1 K by oxygen isotope substitution of 16O → 18O in SrRuO3 by precise measurements of DC and AC magnetizations. The results surprisingly lead to the noteworthy inverse isotope effect with negative coefficient α = -∂ lnTc/∂ lnM. The Raman spectra indicate that the main vibration frequency of 16O at 363 cm-1 shifts to 341 cm-1 following oxygen isotope substitution 18O. This shift is remarkably consistent with the Debye frequency being proportional to ∝ 1√M where M is the mass of an oxygen atom. The positive isotope shift of ∆Tc can be understood by taking account of the electron-phonon interaction.

A novel approach to monitor coating amount by short-wavelength near-infrared spectroscopy using a tracer with a long-chain hydrocarbyl group.

Investigation into the use of near-infrared (NIR) as a Process Analytical Technology has been conducted for in-process monitoring of coating amounts for oral pharmaceutical products. However, the low specificity of NIR spectra has made it time consuming and costly to establish quantitative calibration models for commercial production. Here we revealed that long-chain hydrocarbyl group compounds containing saturated hydrocarbon chains, such as cetyl and stearyl, exhibit specific and strong absorption in the short wavelength (SW)-NIR region (800-1,100 nm) with limited interference from peaks corresponding to other components. To simplify the quantitative model, we used cetanol as a model tracer of coating amount to enhance detection sensitivity and analytical precision. The coating amount on crystalline cellulose granules was determined only from the intensity of NIR absorption at a single wavelength, which was attributed to the tracer. The results showed close agreement with quantitative analyses from gas chromatography and measurement of weight gain. In conclusion, we determined coating amount with considerable accuracy from NIR absorption at a single wavelength in the SW-NIR region using the long-chain hydrocarbyl containing compound as a tracer, thereby eliminating the need for complicated statistics.

[A case of advanced gastric cancer with liver metastases successively treated with S-1/CDDP combination therapy followed by curative resection].

The patient was a 67-year-old male with type-3 gastric cancer from the upper body of the stomach to the cardia. An abdominal computed tomography scan revealed liver metastases(S8)(T2N0M0H1, Stage IV). The patient received neoadjuvant combined chemotherapy with S-1 and CDDP. S-1(120mg/body/day)was orally administered for 3 weeks followed by 2 drug-free weeks as a course, and CDDP(60mg/m2)was administered by intravenous infusion on day 8. After the second course, significant tumor reduction and disappearance of liver metastases resulted. Total gastrectomy, splenectomy, cholecystectomy, and D2 nodal dissection were performed. The histological diagnosis revealed no metastases in all lymph nodes: Stage I B. The combined neoadjuvant chemotherapy with S-1 and CDDP can be considered an effective treatment for advanced gastric cancer.

A novel rapid quantitative analysis of drug migration on tablets using laser induced breakdown spectroscopy.

There have been few reports wherein drug migration from the interior to the surface of a tablet has been analyzed quantitatively until now. In this paper, we propose a novel, rapid, quantitative analysis of drug migration in tablets using laser induced breakdown spectroscopy (LIBS). To evaluate drug migration, model tablets containing nicardipine hydrochloride as active pharmaceutical ingredient (API) were prepared by a conventional wet granulation method. Since the color of this API is pale yellow and all excipients are white, we can observe the degree of drug migration by visual inspection in these model tablets. In order to prepare tablets with different degrees of drug migration, the temperature of the drying process after tableting was varied between 50 to 80 °C. Using these manifold tablets, visual inspection, Fourier transform (FT)-IR mapping and LIBS analysis were carried out to evaluate the drug migration in the tablets. While drug migration could be observed using all methods, only LIBS analysis could provide quantitative analysis wherein the average LIBS intensity was correlated with the degree of drug migration obtained from the drying temperature. Moreover, in this work, we compared the sample preparation, data analysis process and measurement time for visual inspection, FT-IR mapping and LIBS analysis. The results of the comparison between these methods demonstrated that LIBS analysis is the simplest and the fastest method for migration monitoring. From the results obtained, we conclude that LIBS analysis is one of most useful process analytical technology (PAT) tools to solve the universal migration problem.