Shortened cataract surgery by standardisation of the perioperative protocol according to the Joint Commission International accreditation: a retrospective observational study

OBJECTIVES: To investigate the impact of standardisation of the perioperative protocol based on the Joint Commission International (JCI) accreditation guidelines for operating time in cataract surgery. DESIGN: Retrospective observational study. SETTING: Single centre in Japan. PARTICIPANTS: Between March 2014 and June 2016, 3127 patients underwent cataract surgery under topical anaesthesia including 2581 and 546 patients before and after JCI accreditation, respectively. PRIMARY AND SECONDARY OUTCOMES: We compared three time periods, comprising the preprocedure/surgery time (pre-PT), PT and post-PT, and total PT (TPT) of cataract surgery between patients before and after JCI accreditation, by regression analysis adjusted for age, sex and cataract surgery-associated confounders. RESULTS: The main outcomes were pre-PT, PT, post-PT and TPT. Pre-PT (19.8+/-10.5 vs 13.9+/-8.5 min, p \u3c 0.001) and post-PT (3.5+/-4.6 vs 2.6+/-2.1 min, p \u3c 0.001) significantly decreased after JCI accreditation, while PT did not significantly change (16.8+/-6.7 vs 16.2+/-6.3 min, p=0.065). Consequently, TPT decreased on average by 7.3 min per person after JCI accreditation (40.1+/-13.4 vs 32.8+/-10.9 min, p \u3c 0.001). After adjusting for confounders, pre-PT (beta=-5.82 min, 95% CI -6.75 to -4.88), PT (beta=-0.76 min, 95% CI -1.34 to -1.71), post-PT (beta=-0.85 min, 95% CI -1.24 to -0.45) and TPT (beta=-7.43 min, 95% CI -8.61 to -6.24) were significantly shortened after JCI accreditation. CONCLUSION: Perioperative protocol standardisation, based on JCI accreditation, shortened TPT in cataract surgery under local anaesthesia

Radiofrequency Ablation with the Real-Time Virtual Sonography System for Treating Hepatocellular Carcinoma Difficult to Detect by Ultrasonography

Radiofrequency ablation has been applied to treat hepatocellular carcinoma, with favorable therapeutic outcomes. Nevertheless, practitioners have approached radiofrequency ablation with some reluctance due to the difficulty of identifying isoechoic tumors and recurrent tumors. The aim of the present study is to investigate the efficacy of Real-time Virtual Sonography to treat hepatocellular carcinoma difficult to detect by conventional ultrasonography. Real-time Virtual Sonography is a system generating multiplanar reconstruction images in real-time using the Hitachi medico EUB-8500 equipped with a probe. The system included following components: 1) digital imaging and communications in medicine (DICOM) data from dynamic CT, 2) a magnetic field generator to match the multiplanar reconstruction image on the monitor and the actual ultrasonography image, 3) the cross section with the tumor displayed as a multiplanar reconstruction image. Total twenty-five nodules of twenty-one patients underwent radiofrequency ablation monitored by Real-time Virtual Sonography. All nodules difficult to detect via conventional ultrasonography were clearly visualized in real-time. The average nodule diameter was 2.4 ± 1.6 cm, and punctures and coagulation were performed an average of 2.2 and 3 times per session. Dynamic CT after session confirmed effective coagulation of each nodule. In conclusion, this study demonstrates that the present system is capable of effectively and accurately treating tumors difficult to detect by conventional ultrasonography

Re-investigation of the spin crossover phenomenon in the ferrous complex [Fe(HB(pz)3)2]

The temperature dependence of the magnetic susceptibility, optical reflectivity and electrical conductivity of [Fe(HB(pz)3)2] (pz = pyrazolyl) revealed irreversible changes in the material during the low-spin to high-spin transition when the ‘‘as-prepared’’ sample was heated above B400 K for the first time. During this first heating sequence, the initially fine powder sample became coarse, and its crystal structure changed from tetragonal to monoclinic. Single-crystals of the monoclinic form suitable for X-ray analysis could be isolated after the first thermal cycle, and their structure was resolved in the P21/n (Z = 4) space group. Successive cooling and heating cycles did not lead to further modification of the crystal structure, and the temperature dependence of the physical properties remained invariable. Remarkably, the electrical conductivity of the sample measured at 293 K dropped from 6.1 108 to 2.1 1011 S m1 following the first thermal cycle—suggesting possible applications of this material in read-only memory devices (ROM)

Aesthetic pectoral muscle flap repair for refractory enterocutaneous fistula after salvage esophagectomy in a female patient

Anastomotic leakage is a severe complication of esophagectomy. Development of an enterocutaneous fistula after anastomotic leakage often occurs after subcutaneous-route reconstruction at esophagectomy. Pectoralis myocutaneous flap (PMCF) repair has recently been performed when an enterocutaneous fistula was refractory to conservative treatment. However, this procedure requires a conspicuous incision and results in deformity of the breast especially in female patient. We performed pectoralis muscle flap (PMF) repair for a 50-year-old woman with a refractory enterocutaneous fistula after salvage esophagectomy. We made an oblique incision along the inframammary crease in order to avoid a conspicuous scar and moved the PMF under the mammary gland to the site of anastomosis. This method was effective for repairing a refractory enterocutaneous fistula, with especially good aesthetic results in a female patient

ジェンダーと法 : フェミニズム法学の課題にかんする予備的研究

科学研究費補助金基盤研究（Ｃ)(２)「ジェンダー理論の法学教育への統合的モデル構築にむけた現状と課題の実践的研究」の2002年度研究経過報告である本稿は、米国フェミニズム法学のケースブックに基づき、以下の分野を扱う。第１章は、マイノリティの観点である批判的人種フェミニズムからの法学およびフェミニズム法学への批判と貢献を検討し、第２章はアファーマティヴ・アクション導入以来の批判派対擁護派の論争を整理し、平等概念、能力主義基準自体の歴史性を指摘する。第３章は、ポルノグラフィにかんして自由論者と規制論者の論点と、ポルノ規制条例にかんする判決を取り上げる。第４章は、なぜ法と女性とのかかわりにおいて「親密な関係」を統制する法が重視されるのか、婚姻関係内部の権力関係と婚姻可能性の権力性を検討し、第５章は、他者のケアを引き受ける者が置かれがちな経済的依存状態について、平等の観点から、ありうべき社会保障モデルを検討する。As a first year report of the research project "Toward A Model of Gender Perspectives into Legal Professional Education: A Study on Current Legal Education and Its Agenda for Gender Equal Society," this article addresses the following themes referring to "Feminist Jurisprudence: Taking Women Seriously" 2nd. First, critical race feminists' critique and contribution to jurisprudence and feminist jurisprudence; second, controversy over affirmative action and historicity of the key concepts of equality and merit; third, feminists' controversy over pornography, MacKinnon's ordinace and its constitutionality; fourth, law's intervention into intimate relationships and its justification of inequality inside and between the relationships; last, the state and care-takers' inevitable economic dependency, and rethinking of equality in social security policy

Two-dimensional Lattice Gross-Neveu Model with Wilson Fermion Action at Finite Temperature and Chemical Potential

We investigate the phase structure of the two-dimensional lattice Gross-Neveu model formulated with the Wilson fermion action to leading order of 1/N expansion. Structural change of the parity-broken phase under the influence of finite temperature and chemical potential is studied. The connection between the lattice phase structure and the chiral phase transition of the continuum theory is clarified.Comment: 42 pages, 20 EPS figures, using REVTe

Effects of ketamine on nicorandil induced ATP-sensitive potassium channel activity in cell line derived from rat aortic smooth muscle

Purpose : Nicorandil opens adenosine triphosphate-sensitive potassium (KATP) channels in the cardiovascular system and is being increasingly used for the treatment of angina pectoris. In the present study, we tested whether intravenous anesthetic agent ketamine affected nicorandil-induced native vascular KATP channel activation. Methods : We used excised inside-out patch clamp configurations to investigate the direct effects of ketamine racemate and S-(+)-ketamine on the activities of KATP channels in cultured rat aortic smooth muscle cells. Furthermore, we also investigated whether intracellular MgADP could modulate ketamine inhibition. Results : Nicorandil significantly activated KATP channel activity, whereas this channel activity was completely blocked by glibenclamide, a specific KATP channel blocker. Ketamine racemate inhibited the nicorandil induced KATP channel activity (IC50=34 1M, n=14), but S-(+)-ketamine was less potent than ketamine racemate in blocking nicorandil induced KATP channel activities (IC50=226 7M, n=10). Application of MgADP to the intracellular side of the channel was able to decrease the inhibitory potency of ketamine racemate on nicorandil induced KATP channel activities. Conclusions : Our results indicate that ketamine inhibits nicorandil induced KATP channel activities in a dose dependent and stereoselective manner. Furthermore, increase of intracellularMgADP attenuates the inhibitory potency of ketamine racemate