Effects of Irrigation Methods on the Growth of Petunia Grown in Heat Fusion Polyester Fiber Hardened Medium without Polythylene Pot

Recenty, polyethylene pots(PP) present a significant environmental issue for waste disposal. To develop bedding plant production system without PP, properties of compacted medium hardened by heat fusion polyester fiber were investigated. Effects of irrigation methods on the growth of vegetative propagated petunia grown in medium without PP were investigated. The effect of medium type was not as significant as the difference in water loss per pot. Water loss per pot of medium without PP was about two times greater than medium held in PP. No compacted medium disintegrated easily without root-ball formation, and in 20 days after cutting about half of non-compacted medium had disintegrated. Compacted medium did not disintegrate before rooting. Medium type did not significantly affect rooting rates, plant heights, leaf numbers and fresh weights when transplanted to medium. Also, cell or pot medium type did not significantly affect plant heights, flower numbers, leaf numbers and fresh weights. Non-compacted medium without PP easily disintegrated with overhead irrigation. Subirrigation and much overhead irrigation had similar effect on growth when planted in containers.However, less overhead irrigation had significantly lower growth. Moreover, in less overhead irrigation, non-compacted medium without PP had remarkably lower growth than compacted medium without PP. In, conclusions, compacted medium without PP did not affect the growth of bedding plants whenever water and nutrient regime was well regulated. Compacted pot medium was easy to transplant since it did not disintegrate. Therefore, it was considered practical and feasible to use compacted medium without PP for bedding plant production

Vascular Patterns of Villous Tumors of the Colorectum

In order to more fully understand the morphological characteristics of villous tumors of the colorectum, the vascular patterns of six colorectal resection specimens were microangiographically studied. Grossly, villous adenomas were of two main types: pedunculated polyps and carpet-like lesions. Pedunculated villous adenomas had many large stalk vessels in a broad short pedicle, representing a large blood supply to the tumor. The carpet-like lesions were composed of continuous clusters of polyps with stalk vessels and the flat elevated lesions among polyps and at the periphery showed similar vascular patterns to the mucosa of normal colon. In lesions with cancer invasive to the proper muscle layer, scattered ulcerations due to the destruction of polyps were also observed, corresponding to at least a Dukes B lesion. The above findings could represent very important additional information for endoscopic treatment or local excision for the prevention of hemorrhagic complicatios or incomplete removal of tumor

Clinical Aspect of Peripheral Cholangiocarcinoma: A Study of 7 Hepatectomy Cases

To clarify the features and problems presented by a peripheral cholangiocarcinoma (CCC), seven patients with hepatectomy from the First Department of Surgery, Nagasaki University School of Medicine (6 patients), and from Department of Surgery, National Ureshino Hospital (one patient) were reviewed. Men predominate with ratio of 5:2, and an average age was 65.4 years. Tumor location was left lateral segment in 4 patients, right lobe, middle lobe and posterior segment in one, respectively. Three patients were associated with hepatolithiasis. Underlying liver disease was found in 4 patients (57%); cirrhosis in 3 patients, and chronic hepatitis in one. Initial symptoms were abdominal pain, fever and palpable abdominal mass. In imaging modalities available, the detection rates of tumor were 100% in CT and 67% in US and angiography, respectively. Combination of MRI and CT clearly showed tumor characteristics. The serum CEA was slightly elevated in 5 patients (83%), but serum CA19-9 rose strikingly in 3 patients. Most tumors showed an infiltrating growth along intrahepatic bile duct, with a portal vein thrombus and/or satellite tumors frequently. In 3 patients, early recurrence with intrahepatic metastasis occured within the first 6 months. The patient of poorly differentiated adenocarcinoma containing a squamous or signet ring cell carinoma showed an extremely poor prognosis. This study suggests that early detection of small CCC and an extended resection are the most important factors for the survival of patient

Preferences of young physicians at community hospitals regarding academic research training through graduate school: a cross-sectional research.

[Background] Desire to attend graduate school for academic research training following the mandatory two-year clinical internship is unknown among young Japanese physicians who work at community hospitals after their internship. The aim of this study is to determine opinions and factors regarding pursuing higher education through graduate school among young physicians who work at community hospitals after their two-year internship. [Methods] This cross-sectional survey was conducted among young physicians working at community hospitals after their two-year internship. We examined the percentage of young physicians considering higher education through graduate school, the planned timing and field of enrollment among those wanting to enroll, and reasons for not continuing their education among those with no such plans. The association between desire to enroll in graduate school and background characteristics was examined using modified least-squares regression to estimate proportion difference. [Results] Among 127 (73.2 % internal medicine specialists, median age 30 years) physicians in 33 hospitals, 71 (55.9 %) stated that they wished to enroll in graduate school. The most frequently reported timing was 7–8 years after graduation from medical school. Those who stated no desire to attend graduate school cited concerns about the quality of training or not having enough knowledge to choose an appropriate laboratory or field, among other reasons. Increased number of years since graduating medical school [adjusted proportion difference (PD) −6.0 %, 95 % confidence interval (95 % CI) −9.8 to −2.3 %], being a woman with children [adjusted PD −53.4 %, 95 % CI −87.3 to −19.5 % (vs. a man not having children)], and completing their two-year internship at both university and community hospitals [adjusted PD −40.3 %, 95 % CI −72.5 to −8.0 % (vs. internship only at community hospitals)] were associated with a reduction in desire to enroll in graduate school. [Conclusions] We identified a growing trend in desire among young physicians to attend graduate school. Attracting those young physicians who express no desire to attend graduate school, however, will require establishment of more flexible graduate school programs which address their concerns

Added value of inflammatory markers to vital signs to predict mortality in patients suspected of severe infection

Objective: To evaluate the added value of inflammatory markers to vital signs to predict mortality in patients suspected of severe infection. Methods: This study was conducted at an acute care hospital (471-bed capacity). Consecutive adult patients suspected of severe infection who presented to either ambulatory care or the emergency department from April 2015 to March 2017 were retrospectively evaluated. A prognostic model for predicting 30-day in-hospital mortality based on previously established vital signs (systolic blood pressure, respiratory rate, and mental status) was compared with an extended model that also included four inflammatory markers (C-reactive protein, neutrophil-lymphocyte ratio, mean platelet volume, and red cell distribution width). Measures of interest were model fit, discrimination, and the net percentage of correctly reclassified individuals at the pre-specified threshold of 10% risk. Results: Of the 1015 patients included, 66 (6.5%) died. The extended model including inflammatory markers performed significantly better than the vital sign model (likelihood ratio test: p < 0.001), and the c-index increased from 0.69 (range 0.67–0.70) to 0.76 (range 0.75–0.77) (p = 0.01). All included markers except C-reactive protein showed significant contribution to the model improvement. Among those who died, 9.1% (95% CI −2.8–21.8) were correctly reclassified by the extended model at the 10% threshold. Conclusions: The inflammatory markers except C-reactive protein showed added predictive value to vital signs. Future studies should focus on developing and validating prediction models for use in individualized predictions including both vital signs and the significant markers

Association between social networks and discussions regarding advance care planning among Japanese older adults.

BACKGROUND:Older adults' discussions with family, or with physicians, or with both, about advance care planning (ACP) are increasingly regarded as important for the management of end-of-life care, and yet the factors that induce older adults to engage in ACP discussions are poorly understood. For example, in older adults, is stronger connectedness with family and friends (stronger "networks") associated with ACP discussions? By facilitating, or by impeding ACP discussions? We sought to evaluate the associations between ACP discussions and social networks in Japanese older adults. METHODS:In July 2016 we conducted a cross-sectional survey on 355 community-dwelling patients aged ≥65 years visiting community hospital clinics in Fukushima, Japan. We used the Lubben Social Network Scale (LSNS-6, the shortest available LSNS scale) to assess social networks and recorded two components of social network structure, marital status (dichotomized as "married" vs. "single / other") and living status ("living with others" vs. "living alone"). One item asked if patients had had ACP discussions. We analyzed the LSNS-6 social network and marital and living status data in relation to the occurrence of ACP discussions using multiple logistic regression models with adjustments for possible confounding factors. RESULTS:Respondents' social network was "limited" in 16% of cases; 61% had had ACP discussions. Respondents with a limited social network had a significantly lower tendency to have had ACP discussions than respondents with an "adequate" social network (adjusted odds ratio [AOR]: 0.35; 95% confidence interval [CI]: 0.18-0.66; P < 0.001). Marital status and living status were not significantly associated with ACP discussion. CONCLUSIONS:Among Japanese older adults, weaker social networks may be associated with a lower tendency to discuss ACP. Our findings may help practitioners to quickly screen populations at risk for inadequate ACP discussion by using the LSNS-6

Colorectal Cancer in Patients Older than 75 Years of Age

Five hundred and nine patients who underwent surgery for colorectal cancer during 1970-1988 at the First Department of Surgery, Nagasaki University School of Medicine, were studied retrospectively to compare the clinicopathological features in 65 cases older than 75 years of age and 409 ranged from 40 to 75 years of age. Older patients revealed a high frequency of right-sided tumors including the transverse colon (32.3%). The older patient group presented with a fewer Dukes stage D in 3.1% of cases compared with 16.4% of the middle age group with low incidences of hepatic metastasis (p <0.05), but there were no significant differences in lymph node involvement and peritoneal dissemination. A few vascular invasion was found on histologic examination in the older group, but no significant differences in the frequency of gross appearance, cell differentiaion, lymphatic invasion were observed among two groups. DNA ploidy pattern in the older group was also similar to that in the middle age group. The overall perioperative mortality rate was 1.4% (older : 1.5% ; control : 1.5% ; not significantly). Curative resection rates were 84.6% in older and 76.0% in middle age patients. Overall 5-year survival rate were 65.4% in older and 54.1% in control group. However, 14.5% of the older patients died from non-cancer related causes. The 5-year survival rate by exclusion of these cases was 72.4% with similar rate of control group. This study suggests that age should no longer be considered a major risk factor for surgical outcome in colorectal cancer, and that the preoperative indication and careful preoperative assessment including operative risks may improve the patient\u27s survival