Suzaku Detection of Extended/Diffuse Hard X-Ray Emission from the Galactic Center

Five on-plane regions within +/- 0.8deg of the Galactic center were observed with the Hard X-ray Detector (HXD) and the X-ray Imaging Spectrometer (XIS) onboard Suzaku. From all regions, significant hard X-ray emission was detected with HXD-PIN up to 40 keV, in addition to the extended plasma emission which is dominant in the XIS band. The hard X-ray signals are inferred to come primarily from a spatially extended source, rather than from a small number of bright discrete objects. Contributions to the HXD data from catalogued X-ray sources, typically brighter than 1 mCrab, were estimated and removed using information from Suzaku and other satellites. Even after this removal, the hard X-ray signals remained significant, exhibiting a typical 12--40 keV surface brightness of 4E-10 erg cm-2 s-1 deg-2 and power-law-like spectra with a photon index of 1.8. Combined fittings to the XIS and HXD-PIN spectra confirm that a separate hard tail component is superposed onto the hot thermal emission, confirming a previous report based on the XIS data. Over the 5--40 keV band, the hard tail is spectrally approximated by a power law of photon index ~2, but better by those with somewhat convex shapes. Possible origins of the extended hard X-ray emission are discussed.Comment: 13 pages, 18 figure

Advance Requests of In-patients and Their Families regarding Medical Intervention Practices at the End of Life

Much emphasis is being placed nowadays on Advance Care Planning（ACP）. Under this circumstance, we report on the “advance-request form” prepared by our hospital, along with some relevant considerations. ［Intended Persons and Method］A total of ５３９ newly admitted patients and their families were asked to sign and submit the “advance-request form,” indicating their preferences on the following three kinds of end-of-life interventional practices:（ １）cardiac massage,（２）endotracheal intubation and mechanical ventilation, and（３）use of vasopressors. ［Results］Completed questionnaires were returned by ２１５ male and ３２４ female patients（average age :８２．３ years）. Of the responders, ７２（１４％）indicated their desire for all the three of the aforementioned interventions（［１］,［２］, and［３］）,６５（１２％）indicated their desire for only（１）, ４５（８%）indicated their desire for only（１）and（３）, １４（３%）indicated their desire for only（３）, while the remaining３４１（６３%）requested that none of these to be implemented. Of all the patients, ８７（１６％）patients were able to make their own decisions. ［Conclusion］About ３０％ or more patients and their families indicated their desire for some kind of life-sustaining treatment at the end of life. We believe that ACP only prioritizes a patient’s right to self-determination and that the practice of ACP should not lead to withholding of life-sustaining treatment

コロンブス ノ タマゴ テキ ハッソウ ニ モトズイタ タイイ ヘンカンヨウ マット ノ シサク

We report on a new mat experimentally developed by us for changing the position of the body (named i-mat), based on an idea of a floating body. [Method] At first,4, approximately 70cm long, belts were attached to both the right and left side of the pad for tying to the beds. For a lateral position with a 30-degree tilt to the right side, the belt attached on the left side is fixed to the right bed fence and the length of the belt is adjusted so that the patient’s position becomes lateral with a 30-degree tilt. The body pressure levels (mmHg) at sites of bone were measured after position changes by using a simple body pressure-measuring device (PREDIA®) in 10 patients with an independence degree of daily living rating of C2 (group i) in whom the i-mat was used, and compared with the levels measured after position changes in patients where a mat made of urethane (Nasentpat®) was used (group N). [Results] The pressure levels in the sacral region and occipital region could be significantly lowered in group i as compared with that in group N. We also measured and compared the pressures at the major trochanter, acrominon, and iliac regions, because the high-pressure loaded region shifted to these regions on the side facing the bed in the lateral position. No significant differences in the pressure levels at the major trochanter and acrominon were found between the i and N groups. The pressure level in the iliac region in the i group was significantly higher than that that in the N group. [Conclusion] Use of this experimentally produced i-mat can significantly lower the pressure load at the sacral and occipital regions when the patient is placed in the lateral position of either side with a 30-degree tilt, as compared to that of Nasentpat®. But it appears that caution should be exercised to prevent the occurrence of bedsores in the iliac region

ホウシャセン チリョウ ガ コウカテキ デ アッタ チョクチョウナイ ブンピツ サイボウ ガン ノ 1 レイ

A 54-year-old woman was seen at the hospital because of anal bleeding. Colonoscopy examination showed a type 2 tumor in the lower rectum and the histological diagnosis from the biopsy specimen was undifferenciated adenocarcinoma. Abdomino-perineal amputation of the rectum were performed. The resected specimen was positive for synaptophysin stain immunohistochemically and we diagnosed it as an endocrine cell carcinoma. We underwent adjuvant chemotherapy by bolus CPT-11, and the post operative course was uneventful. Intra-pelvic recurrence was observed 15 months after operation, and further 4 months later, metastasis developed around the pancreas. And we noticed the tumor in supraclavicular region 21 months after operation. The tumor was sensitive to chemotherapy, but continued to progress. So we underwent radiotherapy for each lesion. The lesion treated with radiotherapy were controlled until she died of cancer, 31 months after the operation. As a result of autopsy, an exellent effect of radiotherapy was confirmed

The effects of the herbal medicine Daikenchuto (TJ-100) after esophageal cancer resection, open-label, randomized controlled trial

Background Daikenchuto (TJ-100), a traditional Japanese herbal medicine, is widely used in Japan. Its effects on gastrointestinal motility and microcirculation and its anti-inflammatory effect are known. The purpose of this prospective randomized controlled trial was to investigate the effect of TJ-100 after esophagectomy in esophageal cancer patients. Methods Forty patients for whom subtotal esophageal resection for esophageal cancer was planned at our institute from March 2011 to August 2013 were enrolled and divided into two groups at the point of determination of the operation schedule after informed consent was obtained: a TJ-100 (15 g/day)-treated group (n = 20) and a control group (n = 20). The primary efficacy end-points were maintenance of the nutrition condition and the recovery of gastrointestinal function. The secondary efficacy end-points were the serum C-reactive protein (CRP) level and adrenomedullin level during the postoperative course, the incidence of postoperative complications, and the length of hospital stay after surgery. Results We examined 39 patients because one patient in the TJ-100 group was judged as having unresectable cancer after surgery. The mean age of the TJ-100 group patients was significantly older than that of the control group patients.The rate of body weight decrease at postoperative day 21 was significantly suppressed in the TJ-100 group (3.6% vs. the control group: 7.0%, p = 0.014), but the serum albumin level was not significantly different between the groups. The recovery of gastrointestinal function regarding flatus, defecation, and oral intake showed no significant between-group differences, but postoperative bowel symptoms tended to be rare in the TJ-100 group. There was no significant between-group difference in the length of hospital stay after surgery. The serum CRP level at postoperative day 3 was 4.9 mg/dl in the TJ-100 group and 6.9 mg/dl in the control group, showing a tendency of a suppressed serum CRP level in the TJ-100 group (p = 0.126). The rate of increase in adrenomedullin tended to be high postoperatively, but there was no significant difference between the two groups. Conclusions TJ-100 treatment after esophageal cancer resection has the effects of prompting the recovery of gastrointestinal motility and minimizing body weight loss, and it might suppress the excess inflammatory reaction related to surgery

Suzaku monitoring of hard X-ray emission from η carinae over a single binary orbital cycle

The Suzaku X-ray observatory monitored the supermassive binary system η Carinae 10 times during the whole 5.5 yr orbital cycle between 2005 and 2011. This series of observations presents the first long-term monitoring of this enigmatic system in the extremely hard X-ray band between 15 and 40 keV. During most of the orbit, the 15-25 keV emission varied similarly to the 2-10 keV emission, indicating an origin in the hard energy tail of the kT ∼ 4 keV wind-wind collision (WWC) plasma. However, the 15-25 keV emission declined only by a factor of three around periastron when the 2-10 keV emission dropped by two orders of magnitude due probably to an eclipse of the WWC plasma. The observed minimum in the 15-25 keV emission occurred after the 2-10 keV flux had already recovered by a factor of ∼3. This may mean that the WWC activity was strong, but hidden behind the thick primary stellar wind during the eclipse. The 25-40 keV flux was rather constant through the orbital cycle, at the level measured with INTEGRAL in 2004. This result may suggest a connection of this flux component to the γ-ray source detected in this field. The helium-like Fe Kα line complex at ∼6.7 keV became strongly distorted toward periastron as seen in the previous cycle. The 5-9 keV spectra can be reproduced well with a two-component spectral model, which includes plasma in collision equilibrium and a plasma in non-equilibrium ionization (NEI) with τ ∼ 1011 cm-3 s-1. The NEI plasma increases in importance toward periastron