376 research outputs found
Building primary care in Japan: Literature review.
Japan's health system is well known for achieving one of the world's highest life expectancy with universal health coverage. However, the country now faces challenges of a rapidly aging population and changes in patterns and burden of disease. Primary care is an important component of a well-functioning health system. In Japan, primary care services are provided in both the community and hospital settings. The distinction between primary and secondary care may not always be clear. This review is based on the framework from the 2015 WHO publication on primary care systems in Europe. Our aim is to describe the journey of primary care in Japan, with its past, present, and future as a valuable addition to the academic English literature. We also hope that this article would inspire readers outside of Japan who might face similar issues in their respective countries
Papillo-Choledochectomy in the Operative Management of Mucosal Neoplasms of the Periampullary Region
Two patients with mucosal cancer of the periampullary region were treated with papillocholedochectomy,
which entails removal of the papilla of Vater and the whole length of the common bile duct. The neoplasm is dissected out through the plane between the duodenal circular and longitudinal muscles, deep to the sphincter of Oddi and the fibromuscular layer of the bile duct. Pathological examination showed that cancer was confined to the mucosal layer without stromal invasion, and that the operation achieved radical cure. For mucosal cancer, papillo-choledochectomy is
an alternative to pancreatoduodenectomy, provided that repeated frozen-section studies confirm the
completeness of excision
Neonatal asphyxia as an inflammatory disease: Reactive oxygen species and cytokines
Neonatologists resuscitate asphyxiated neonates by every available means, including positive ventilation, oxygen therapy, and drugs. Asphyxiated neonates sometimes present symptoms that mimic those of inflammation, such as fever and edema. The main pathophysiology of the asphyxia is inflammation caused by hypoxic-ischemic reperfusion. At birth or in the perinatal period, neonates may suffer several, hypoxic insults, which can activate inflammatory cells and inflammatory mediator production leading to the release of larger quantities of reactive oxygen species (ROS). This in turn triggers the production of oxygen stress-induced high mobility group box-1 (HMGB-1), an endogenous damage-associated molecular patterns (DAMPs) protein bound to toll-like receptor (TLR) -4, which activates nuclear factor-kappa B (NF-κB), resulting in the production of excess inflammatory mediators. ROS and inflammatory mediators are produced not only in activated inflammatory cells but also in non-immune cells, such as endothelial cells. Hypothermia inhibits pro-inflammatory mediators. A combination therapy of hypothermia and medications, such as erythropoietin and melatonin, is attracting attention now. These medications have both anti-oxidant and anti-inflammatory effects. As the inflammatory response and oxidative stress play a critical role in the pathophysiology of neonatal asphyxia, these drugs may contribute to improving patient outcomes
Superconductivity from Flat Dispersion Designed in Doped Mott Insulators
Routes to enhance superconducting instability are explored for doped Mott
insulators. With the help of insights for criticalities of metal-insulator
transitions, geometrical design of lattice structure is proposed to control the
instability. A guideline is to explicitly make flat band dispersions near the
Fermi level without suppressing two-particle channels. In a one-dimensional
model, numerical studies show that our prescription with finite-ranged hoppings
realizes large enhancement of spin-gap and pairing dominant regions. We also
propose several multi-band systems, where the pairing is driven by intersite
Coulomb repulsion.Comment: 4 pages, to be published in Phys. Rev. Let
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