Comparing the teaching efficacy of a procedure-in-a-box toolkit to a live instructional workshop.

BACKGROUND: Emergency procedures have been traditionally taught in live "hands on" workshops, which are expensive (tuition, travel, hotel, and leaving one's practice idle). This study was conducted to compare the teaching efficacy of a traditional live workshop to a procedure-in-a-box toolkit (PBT) method which contains audiovisual instructions and props to practice the procedures. METHODS: Four procedures, zipper release, intraosseous needle placement, fishhook removal, and splinting, were taught to 32 physician volunteers, using both teaching methods. Each participant was asked to evaluate the teaching method after each session. RESULTS: The mean educational quality of each method were not significantly different from each other, but if given a choice study subjects preferred the live workshop more often. CONCLUSION: The live workshop is the preferable method for teaching procedures but when considering expenses, most of the subjects felt that the PBT method is an adequate substitute method for the live workshop

左中大脳動脈分枝閉塞患者のiSchemaView RAPID

The number of patients who develop acute ischemic stroke （AIS） increases year after year. Accordingly, the number of patients with disability also goes on increasing. This situation affects increment of medical expense in Japan. Therefore, managing the stroke patients is the urgent need. Recently, antiplatelet therapy and mechanical thrombectomy have been advanced, rapidly. Dual antiplatelet therapy for minor stroke patients during acute phase was reported to be effective to reduce neurological deterioration and recurrence. Furthermore, the evidence of mechanical thrombectomy by stent retrievers and aspiration catheters for large vessel occlusion, indicating internal carotid artery and/or middle cerebral artery occlusion, was established several years ago. This advancement of medicine might be helpful to manage the AIS patients. However, we suppose that it is not only important to advance medicine, but also make better system to treat AIS patients. First, developmental education to the people is needed to prevent AIS development and call emergency services as soon as possible after onset. Second, to make efficient emergency transport system is thought to be important to shorten the duration between onset and beginning of treatment. To achieve this objective, we have used application, named JOIN, to contact emergency services directly. Lastly, we made protocol in hospital for shortening time from door to treatment. Because increment of the number of AIS patients has tendency to increase for some time in the future, continuing to try described above might be needed

<原著>肝右葉切除における短肝静脈, 右肝静脈処理のための前方アプローチ

A simple procedure of right hepatic lobectomy for bulky liver tumors is proposed. The procedure is named "Anterior approach", which is characterized by transection of hepatic parenchyma without mobilization and rotation of the right hepatic lobe. The transection directly reaches the ventral surface of the retrohepatic inferior vena cava first at the portion of caudate process. The hepatic parenchymal transection proceeds from ventral to dorsal and from caudal to cranial. Several dorsal short hepatic veins are severed on the ventral surface of the IVC and the right hepatic vein is finally severed from inside. This method enables the minimization of operative stress and is especially useful for cases with a huge tumor in the right hepatic lobe which invades the diaphragm or thoraco-abdominal wall.巨大肝腫瘍に対する合理的な肝右葉切除法としての前方アプローチを紹介する. 肝右葉切除の標準手技として, 右葉の授動と脱転がある. これは肝の右側から, 肝部下大静脈に注ぐ短肝静脈や右肝静脈の剥離と切離を行う方法であるが, 後区域や右葉全体を占める巨大肝腫瘍の場合には, それらの手技は困難なことが多く, また腫瘍の破裂をきたす恐れもあり危険を伴う. 前方アプローチは, 右葉の脱転を行わずに直接肝実質を切離して, 肝部下大静脈腹側面に到達し, 尾状葉突起から頭側に向かつて肝実質の離断を進める方法である. 肝部下大静脈腹側面に注ぐ短肝静脈を, 順次肝離断面側から剥離処理し, 最後に右肝静脈の離断も同様に行う. 横隔膜浸潤, 胸壁, 腹壁浸潤がある場合には, 肝切離が終了してから合併切除として最後に行う. また本法は, 脱転による残存肝の阻血, 門脈血液鬱滞を回避出来る利点があり, 肝ミトコンドリアの酸化還元状態を反映する動脈血中ケトン体比(AKBR)の術中低下も軽微であることが判明しており, 手術侵襲の点からみても有用である前方アプローチの良い適応は, 1)後区域, 又は右葉全体を占拠するような巨大肝腫瘍の場合, 2)腫蕩が右横隔膜, 胸壁, 腹壁に浸潤している場合, 3)右葉の腫瘍の下大静脈への浸潤が疑われ, 下大静脈合併切除の要否を判定する場合, 4)肝障害のために右葉切除を行うには機能的予備力の点で不安がある場合, などである

脳卒中と認知症の予防

It became an important issue how we can live long in good health. Because stroke and dementia bring physical disability and cognitive functional decline and often need care, the treatment and prevention of those diseases are important. The number of stroke patients is increasing, but treatments for acute stroke has remarkably progressed, especially those by the endovascular therapy. Managing hypertension, diabetes mellitus, dyslipidemia and atrial fibrillation is key of the prevention. Because dementia patients are increasing remarkably, the countermeasures become the important problem of the country. Of the causes of dementia, Alzheimer disease is the most frequent followed by vascular dementia. Vascular dementia occurs due to cerebrovascular diseases. Therefore, it is important to manage hypertension, diabetes mellitus, dyslipidemia and atrial fibrillation for preventing vascular dementia. The etiology of Alzheimer disease is still unknown. A recent study suggests the possibility that hypertension, diabetes mellitus and dyslipidemia are involved in an etiology of Alzheimer disease. It may be effective for the prevention of Alzheimer disease to manage hypertension, diabetes mellitus and dyslipidemia

On-Foot Content Tourism Support System in Urban Tourist Destinations of Japan

It has also become possible for people to easily acquire tourism information that matches their own particular tastes using the internet, so tourism has taken a more diverse range of forms. One of these is “content tourism” that became popular in recent Japan. Sgains such a backdrop, the present study aimed to design, develop, operate and evaluate a system that integrated three subsidiary systems including Web-geographic information systems (GIS), a tourism information system and social networking service (SNS) in order to support walking-based content tourism. This made it possible to create sightseeing routes and to submit, store, and view tourist attraction information. Additionally, the system was operated for one month in Chofu City, Tokyo Metropolis, and the total number of users was 42. During the operation period, 12 new sightseeing routes were created and 30 new tourist attractions were submitted. Based on the results of the web questionnaire survey, users highly evaluated the key functions of the system and the overall system. However, of those key functions, evaluations were somewhat low for the ease of operation of the creation function of sightseeing route, so the improvements must be made. From the results of the access log analysis of users’ log data, the total number of sessions in this system was 134, 64% used PCs, 36% used mobile devices, Therefore, the approach of designing the system such that the same functions could be used regardless of the type of device one is using was an effective design approach

AN ANGIOGRAPHICAL PREDICTOR FOR SUCCESSFUL RECANALIZATION

Background: Mechanical thrombectomy undoubtedly improves functional outcomes for patients with acute ischemic stroke. Although we have observed occlusion sites that protrude proximally into the vessel on angiography, termed the “claw sign,” we have been unable to state its clinical significance. In this study, we aimed to determine whether the presence of a claw sign was related to recanalization success after mechanical thrombectomy. Materials and Methods: We retrospectively included 73 consecutive patients treated for acute cerebral large vessel occlusion by mechanical thrombectomy between January 2014 and December 2017. The angiographic claw sign was defined as a thrombus that protruded proximally by more than half the diameter of the parent artery. Claw sign positivity, clinical and etiological features, and outcomes were compared between groups with and without recanalization. Results: The claw sign was observed in 29 of 73 (40%) patients and was positive significantly more frequently in those with recanalization (50.0%) than in those without recanalization (5.9%) (P < .01). By multivariate analysis, the claw sign was the only pretreatment parameter to predict successful recanalization (odds ratio, 12.50; 95% confidence interval, 1.50-103.00; P = .019). Conclusions: The presence of the claw sign might predict successful recanalization in patients undergoing mechanical thrombectomy for large vessel occlusion

Dystonia and Cerebellum : From Bench to Bedside

Dystonia pathogenesis remains unclear; however, findings from basic and clinical research suggest the importance of the interaction between the basal ganglia and cerebellum. After the discovery of disynaptic pathways between the two, much attention has been paid to the cerebellum. Basic research using various dystonia rodent models and clinical studies in dystonia patients continues to provide new pieces of knowledge regarding the role of the cerebellum in dystonia genesis. Herein, we review basic and clinical articles related to dystonia focusing on the cerebellum, and clarify the current understanding of the role of the cerebellum in dystonia pathogenesis. Given the recent evidence providing new hypotheses regarding dystonia pathogenesis, we discuss how the current evidence answers the unsolved clinical questions

The integrin-binding defective FGF2 mutants potently suppress FGF2 signalling and angiogenesis.

We recently found that integrin αvβ3 binds to fibroblast growth factor (FGF)-αvβ31 (FGF1), and that the integrin-binding defective FGF1 mutant (Arg-50 to glutamic acid, R50E) is defective in signalling and antagonistic to FGF1 signalling. R50E suppressed angiogenesis and tumour growth, suggesting that R50E has potential as a therapeutic. However, FGF1 is unstable, and we had to express R50E in cancer cells for xenograft study, since injected R50E may rapidly disappear from circulation. We studied if we can develop antagonist of more stable FGF2. FGF2 is widely involved in important biological processes such as stem cell proliferation and angiogenesis. Previous studies found that FGF2 bound to αvβ3 and antagonists to αvβ3 suppressed FGF2-induced angiogenesis. However, it is unclear how FGF2 interacts with integrins. Here, we describe that substituting Lys-119/Arg-120 and Lys-125 residues in the predicted integrin-binding interface of FGF2 to glutamic acid (the K119E/R120E and K125E mutations) effectively reduced integrin binding to FGF2. These FGF2 mutants were defective in signalling functions (ERK1/2 activation and DNA synthesis) in NIH3T3 cells. Notably they suppressed, FGF2 signalling induced by WT FGF2 in endothelial cells, suggesting that the FGF2 mutants are antagonists. The FGF2 mutants effectively suppressed tube formation in vitro, sprouting in aorta ring assays ex vivo and angiogenesis in vivo The positions of amino acids critical for integrin binding are different between FGF1 and FGF2, suggesting that they do not interact with integrins in the same manner. The newly developed FGF2 mutants have potential as anti-angiogenic agents and useful tools for studying the role of integrins in FGF2 signalling

カツダンソウ チョクジョウ ノ トチ リヨウ キセイ ノ カノウセイ ト ゲンカイ カツダンソウガタ ジシン タイサク ニ カンスル ホウセイド ノ ニチベイ ヒカク

本稿は、活断層直上の土地利用規制について、アメリカ合衆国カリフォルニア州法と徳島県条例の比較をもとに、その可能性と限界を検討したものである。活断層の直上は、断層破断による地震発生時に断層が地表に表出することによって直上の建築物に対して破局的な被災をもたらしうる。カリフォルニア州法と徳島県条例は、このような被災を避けることを目的とし、活断層直上の土地利用を一定程度規制している。このような取り組みは破局的な被災を避けるための有用な手段の一つと考えられるが、断層自体の評価、私人の自由との関係性、財産権との関係性から法的に土地利用を規制することを直ちに正当化できるとは言えない。そこで、本稿では、文献とヒアリング調査によるカリフォルニア州法と徳島県条例の分析を基礎に、これらの論点について考察した。筆者の結論は、活断層直上の破局的な被災を軽減するために、他の施策と合わせて、一定の建築物を対象とした土地利用規制を実施する必要があるというものである。In this article, the author examined possibilities and limits on legal zoning above active fault by comparing legal institutions of Japan and the U.S. If an earthquake is occurred by active fault, the active fault might be exposed to the land surface, and it might occur catastrophic damage to architectural structures. To avoid such damage, California State code and Tokushima prefecture code regulate certain using land located on active fault. It seems that this regulation is useful to avoid catastrophic damage. However, concerning evaluation about fault, liberty, and property right, this zoning is not necessarily justified. Then the author analyzed codes of California and Tokushima and considered these points. In consequence, the author insisted that zoning above active fault targeted specific buildings are needed with other measures to avoid catastrophic damage by active fault

Claw sign predicts first-pass effect in MT

Background: Mechanical thrombectomy (MT) is an effective treatment for acute cerebral large vessel occlusion (LVO). Complete recanalization of vessels in a single procedure is defined as the first-pass effect (FPE) and is associated with good prognosis. In this study, angiographic clot protruding sign termed the “claw sign,” was examined as candidate preoperative imaging factor for predicting the FPE. Methods: We retrospectively analyzed data from 91 consecutive patients treated for acute LVO in the anterior circulation by MT between January 2014 and December 2019. The claw sign was defined as a thrombus that protruded proximally by more than half of the diameter of the parent artery. Radiological findings such as claw sign, clinical and etiological features, and outcomes were compared between groups with and without successful FPE. Multivariate analysis was conducted to evaluate perioperative factors associated with FPE. Results: FPE was achieved in 26 of 91 (28.6%) patients and the claw sign was observed in 34 of 91 (37.4%) patients. The claw sign was significantly more frequent in the successful FPE group than in the failed FPE group (53.8% vs. 30.8%; P = 0.040). After the multivariate analysis, the claw sign was the only pretreatment parameter that could predict FPE (odds ratio, 2.67; 95% confidence interval, 1.01–7.06; P = 0.047). Conclusion: The claw sign is an angiographic imaging factor that might predict FPE after MT for anterior circulation acute ischemic stroke