A Simulation of the Policy of Public Pension Finance in Japan

The purpose of this paper is to estimate the total sum of premium payments and benefit payments from 2005 to 2010 and make proposals for future policy. This study has made clear that there is a tendency of a total decrease in premium payments. Moreover, the sum of premiums will be less than the sum of benefit payments to be paid. Therefore, our proposal is benefit cutting, raising of the starting age of benefit payments and raising premium payments. Thus we will be able to save a total of 17.42 trillion yen in finance for the public pension system

An Observation of Worker Duty Recognition at Hospitals and Elder Care Facilities Separately

In this study, we examined measures that could be implemented in personnel affairs and management to insure longer stability in the workforce of hospitals and elder care facilities, by grasping the characteristics of the conditions at both institutions and comparing them. First, we made a factor analysis for 38 question items and set up a duties recognition standard according to hospitals and elder care facilities. As a result, five factors of similar content were obtained for both institutions. Next, we calculated the mean of the duties recognition standard according to each characteristic. The results showed that care workers at hospitals had a lower "sense of purpose." In contrast, in elder care facilities, the lower "sense of purpose" was among nurses. In addition, the over-20-years group of workers had the lowest "stress reactors" at hospitals, but the "work burden" was the highest. Furthermore, an analysis of the relationship between the "duties recognition standard" and "job satisfaction" showed the "continuation awareness" of nurses and care workers at hospitals was lower than other types of jobs. It also showed that the nurses at elder care facilities had a lower "sense of belonging." Finally, in the relevance analysis of the duties recognition standard with job satisfaction, we found that in both hospitals and elder care facilities, "continuation awareness," "sense of belonging" and "office environmental awareness" in common have the strongest equilateral correlation with "human relations in the office.

Three-dimensional live imaging of Atoh1 reveals the dynamics of hair cell induction and organization in the developing cochlea

During cochlear development, hair cells (HCs) and supporting cells differentiate in the prosensory domain to form the organ of Corti, but how one row of inner HCs (IHCs) and three rows of outer HCs (OHCs) are organized is not well understood. Here, we investigated the process of HC induction by monitoring Atoh1 expression in cochlear explants of Atoh1-EGFP knock-in mouse embryos and showed that only the cells that express Atoh1 over a certain threshold are selected for HC fate determination. HC induction initially occurs at the medial edge of the prosensory domain to form IHCs and subsequently at the lateral edge to form OHCs, while Hedgehog signaling maintains a space between IHCs and OHCs, leading to formation of the tunnel of Corti. These results reveal dynamic Atoh1 expression in HC fate control and suggest that multi-directional signals regulate OHC induction, thereby organizing the prototype of the organ of Corti

3.OT MRA で観察される外側線条体動脈の分枝形態

PURPOSE:We hypothesized that the pattern of branching of the lenticulostriate arteries (LSAs) is involved in the variation of the distribution of the infarction within the LSA region. Our purpose was to evaluate the visibility of LSAs in 3D time-of-flight (TOF) MR angiography (MRA) with a 3.0 T scanner and to investigate the branching patterns of LSAs.MATERIALS AND METHODS:We performed 3D TOF MRA at 3.0 T for 100 healthy subjects. We assessed the number of LSAs and the number of branches arising from each LSA by evaluating MRA source images.RESULTS:In 200 hemispheres, 330 LSAs were visualized (mean = 1.65/hemisphere). In 3.5% of all hemispheres, no LSA was depicted; one LSA was depicted in 39%, two in 46.5%, and three in 11%. The maximum number of depicted LSA branches was five in 2% of all subjects, four in 7%, three in 26%, and two in 49% (mean = 2.3/subject). A large LSA trunk with three or more branches was found in 35% of subjects.CONCLUSION: Visualization of LSAs was possible in 96.5% of subjects by use of 3.0 T MRA. LSA branching patterns were variable, and a large LSA trunk with three or more branches was common.博士（医学）・乙第1305号・平成24年11月27日© Springer International Publishing AG,2012Copyright © 2012 Japan Radiological Societ

Effects of excitation light intensity on parathyroid autofluorescence

The intraoperative identification and preservation of the parathyroid glands are vital techniques, which are largely dependent on a surgeon’s experience. Therefore, a simple and reproducible technique to identify the parathyroid glands during surgery is needed. Parathyroid tissue shows near-infrared (NIR) autofluorescence, which enables the intraoperative identification of the parathyroid gland. We herein present two cases that underwent surgery on the parathyroid glands, which were observed using the NIR fluorescence imaging system LIGHTVISION® (Shimazu, Kyoto, Japan). In a case of papillary thyroid carcinoma, the system was adopted to preserve normal parathyroid glands during left hemithyroidectomy. The left lower parathyroid gland was identified using the imaging system under white light; however, its autofluorescence was visualized more clearly with the excitation light of NIR. In a case of primary hyperparathyroidism due to MEN1, the system was adopted to identify and remove all of the parathyroid glands during total parathyroidectomy. The autofluorescence of diseased glands was weaker than that of normal glands, even with the excitation light of NIR. When the parathyroid glands were irradiated with a red laser pointer, the intensity of autofluorescence significantly increased. However, the largest gland, which was pathologically proven to contain strongly proliferating chief cells, did not show autofluorescence. These results suggest that normal or less diseased parathyroid glands, which are generally small and difficult to identify during surgery, showed relatively strong autofluorescence. A stronger excitation light increases the autofluorescence of parathyroid glands, which enhances sensitivity for detecting parathyroid glands during surgery. In conclusion, LIGHTVISION® is a useful device to identify parathyroid glands and an additional excitation light of a red laser pointer increases the detection sensitivity

びまん性血管損傷 磁化率強調画像を用いた重症頭部外傷での収束性出血

INTRODUCTION:Susceptibility-weighted image (SWI) is one of the most sensitive methods for detect microbleeding and useful for evaluation of traumatic brain damage. The purpose of this study is to delineate the characteristics and importance of supratentorial deep white matter hemorrhages detected by SWI in cases of traumatic brain damage. METHODS:Twenty-one consecutive cases with severe traumatic head injury were included in the current study. MRI examinations were made within 1 month after injury. We evaluated the degree and distribution of the supratentorial hemorrhages on SWI retrospectively. We classified the degree of bleeding into four grades: "small hemorrhage," "single bead-like hemorrhage," "convergent-type hemorrhage," and "massive hemorrhage." We then correlated the degree and distribution of the hemorrhage to clinical outcomes. We also evaluated the apparent diffusion coefficient (ADC) image of lobes with "convergent-type hemorrhage." RESULTS:Existence of "massive hemorrhage" correlated with a poor outcome, that is, worse than "severely disabled" on the Glasgow Outcome Scale. The number of lobes affected by "convergent-type hemorrhage" also correlated with poor outcome. There were 45 lobes with "convergent-type hemorrhage" and 27 of them showed increased diffusivity on ADC images. CONCLUSION:Supratentorial massive hemorrhages and supratentorial convergent-type multiple hemorrhages were associated with poor prognosis after traumatic brain injury. The increased diffusivity in lobes with convergent-type hemorrhages may indicate that congestion of the proximal medullary vein may play some role for these hemorrhages.博士（医学）・甲第594号・平成25年3月15日© Springer International Publishing AG,201

Elevated Levels of VE-Cadherin-Positive Endothelial Microparticles in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease

ObjectivesThe purpose of this study was to examine whether CD144-EMP (endothelium-derived microparticles) is useful as a specific marker of endothelial cell (EC) dysfunction and to determine whether plasma levels of circulating CD144-EMP predicted coronary artery disease (CAD) in patients with type 2 diabetes mellitus (DM).BackgroundEndothelial cell dysfunction is involved in atherogenesis; however, the quantitative assessment of EC dysfunction has yet to be established clinically. Endothelium-derived microparticles are small, membrane-shed vesicles that are generated from the EC surface in response to cellular dysfunction and/or injury. Diabetes mellitus is known to be associated with EC dysfunction and accelerated atherosclerosis.MethodsWe characterized EMP using anti-CD144 (VE-Cadherin) antibody in various atherosclerosis-related cells and investigated the association between the levels of CD144-positive microparticles and hydrogen-peroxide-induced EC injury and acetylcholine-induced coronary vasomotion. Furthermore, we evaluated plasma CD144-EMP levels in patients with and without DM.ResultsWe demonstrated that CD144-positive microparticles were derived selectively from human EC. The levels of CD144-EMP reflected the degree of in vitro hydrogen-peroxide-induced EC injury and impairment of in vivo endothelium-dependent coronary vasodilation (p < 0.01). Plasma CD144-EMP levels were increased significantly in DM patients compared with patients without DM (p < 0.001). In DM patients, the elevated levels of CD144-EMP were the most significant risk factor for CAD relative to all other traditional risk factors (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8 to 6.9, p < 0.001). Notably, plasma CD144-EMP identified a subpopulation of established CAD patients in DM subjects without typical anginal symptoms (OR 10.6, 95% CI 3.9 to 29.5, p < 0.001).ConclusionsThe CD144-positive EMP exist in human plasma, and plasma CD144-EMP levels can be a clinically specific and quantitative marker of EC dysfunction and/or injury. Measurement of CD144-EMP, by providing a quantitative assessment of EC dysfunction, may be useful for identifying DM patients with increased risk of CAD

Application of susceptibility weighted imaging (SWI) for evaluation of draining veins of arteriovenous malformation: utility of magnitude images.

INTRODUCTION: The current study evaluated the signal characteristics of susceptibility weighted imaging (SWI) of arteriovenous malformation (AVM), especially for draining veins. For this purpose, we identified the draining veins of the AVM on angiography and evaluated the signal on magnitude image for SWI (SWI-mag) and minimum intensity projection image (SWI-minIP). METHODS: Subjects were 14 cases with angiographically proven AVM. SWI-mag, SWI-minIP, and time-of-flight (TOF) magnetic resonance angiography were acquired. For the draining veins of the AVM identified on angiography, we analyzed signal intensity on the images listed above, and classified it into hyperintensity (hyper), mixed intensity (mixed), hypointensity (hypo), and no visualization. RESULTS: On the analysis of 27 angiographically proven draining veins, 19 draining veins were classified as hyper, 3 as mixed, 0 as hypo, and 6 as no visualization on SWI-mag. On TOF images, 21 draining veins were classified as hyper, 2 as mixed, 0 as hypo, and 4 as no visualization, while 6 draining veins did not show hyperintensity on TOF, and SWI-mag visualized 3 of these 6 veins as hyper. CONCLUSION: SWI-mag depicted most draining veins of AVM as hyperintensity. We speculate that this is mainly due to the higher concentration of oxygenated hemoglobin (oxy-Hb) and inflow effect of the draining vein. SWI-mag seems to be useful in the analysis and follow-up for AVM as the signal on the image may reflect physiological status.博士（医学）・乙第1316号・平成25年7月22