健常成人の対側，同側および両側耳への音刺激によるAEPの差異

Differences among AEPs evoked by left or right monaural, and binaural acoustic stimuli were studied with 40 healthy male subjects (21-33 y.o.). AEPs were evoked by click stimuli and derived from the five derivations and recorded averaging 100 responses, with 1024 msec of analysis time. The following results were obtained. 1) In all of five derivations, the contours of the group mean AEPs were roughly similar in both ipsilateral left and contralateral right monaural stimuli. These findings demonstrated that response characteristics in the cortex which contains receptive field of the two ears were well coincided with each other. 2) The latency of the N1 component was significantly shorter and the peak to peak amplitudes were significantly larger in both contralateral right monaural and binaural AEPs than in ipsilateral left monaural AEPs. These findings reconfirmed reports on both the hemispheric dominance of the contralateral ear and the stronger response of binaural stimuli than monaural stimuli. 3) The latency of the P2 component in contralateral right monaural AEPs was significantly longer than that in ipsilateral left monocular AEPs, and N 1-P 2, P 2-N 2 amplitudes were significantly larger. These findings supported the report that the sourse of P2 is the primary auditory area, and confirmed the hemispheric dominance of the contralateral ear. 4) The latencies of the long latency components in contralateral right monaural and binaural AEPs were significantly longer than those in ipsilateral left monaural AEPs, and their amplitudes were significantly larger. These findings suggested the existence of the complicated auditory imformation processing in the association cortex and long-recovery cycle system in the cortex

健常成人の対側,同側および両側眼への閃光刺激によるVEPの差異

Differences among VEPs evoked by left and right monocular, and binocular flash stimuli were studied with 40 healthy male subjects (21-33 y.o.). VEPs were evoked by LED flash stimuli and derived from the six derivations and recorded with 1024 msec of analysis time. The following results were obtained. 1) In all of six derivations, the contours of the group mean VEPs were roughly similar in both ipsilateral left monocular and contralateral right monocular stimuli. These findings demonstrate that response characteristics and receptive field properties of the two eyes are well coincided with each other. 2) In details, the latencies of the short and middle latency components of the third (O 1→T 5) and the forth derivation (O 1→Cz) in contralateral right monocular VEPs were significantly shorter than those in ipsilateral left monocular VEPs. In all derivations, the peak to peak amplitudes in contralateral right monocular VEPs were significantly larger than those in ipsilateral left monocular VEPs. These findings verified the hemispheric dominant laterality of the contralateral eye, even with latencies, besides with amplitudes. 3) As compared with left monocular VEPs, the latencies of the short and middle latency components in binocular VEPs were significantly short and the peak to peak amplitudes in binocular VEPs were significantly large. These findings might suggest the existence of "binocular depth cells" of the monkey, which respond when the two eyes stimulated simultaneously, even in man. 4) In details, the latencies of the long latency components in binocular and contralateral right monocular VEPs were significantly longer than those in ipsilateral left monocular VEPs. This finding suggests the delay of the alpha regeneration as a photic after discharge following VEPs, because binocular and contralateral right monocular stimuli are stronger than ipsilateral left monocular stimuli

The effects of insulin-induced hypoglycemia on the human SEP (Somatosensory Evoked Potential) and EEG

The effects of insulin-induced hypoglycemia on the central nervous system were studied by somatosensory evoked potential (SEP), with 8 schizophrenic patients (31~47 y. o.), during the 'kleine Insulinbehandlung'. In each of three experimental session on different days, human regular insulin was injected subcutaneously to the patients, whose consciousness level was lowered to the stage of somnolence, and recovered by intake of a glucose solution (100 g). EEG containig SEPs evoked by electric simuli was derived from the two derivations (1 st ch: C3'→A1+2, 4 th ch: C3'→F3'). In the experimental session, EEG containing SEPs was recorded before and 20, 40, 60, 80, 100 and 120 min after the injection of insulin, and 20 min after intake of glucose. Consecutive changes of group mean SEP were studied. Individual SEPs were subjected to the component analysis, and to the statistical assessment together with EEG power%. As a result, the middle and long latency components of SEP significantly prolonged in latency and significantly decreased in amplitude 60 min after the injection of insulin. On the other hand, the short latency components of SEP significantly prolonged in latency 100~120 min after the injection of insulin. These results suggested that the activity of cerebral cortex was inhibited, but subcortex was not affected to hypoglycemia in the early stage. In the results of the present study with SEP, the noradrenergic activities in the early stage of hypoglycemia, observed with AEP previously reported, were not confirmed

血漿ADAMTSは肝硬変患者の予後をChild-PughスコアやMELDスコアと同様に生存率を予測できる可能性がある

Aim:  Decreased plasma ADAMTS13 activity (ADAMTS13:AC) results in accumulation of unusually large von Willebrand factor multimers and platelet thrombi formation. Our aim was to evaluate whether ADAMTS13:AC is a prognostic marker in patients with liver cirrhosis. Methods:  Plasma ADAMTS13:AC and its related parameters were examined in 108 cirrhotic patients. Results:  ADAMTS13:AC decreased as the severity of liver disease increased (means: controls 100%, Child A-cirrhotics 79%, Child B-cirrhotics 63%, and Child C-cirrhotics 31%). ADAMTS13:AC markedly decreased in the cirrhotics with hepatorenal syndrome, refractory ascites and hepatic encephalopathy. The cumulative survival time was the shortest (median: 4.5 months) in the cirrhotics with severe to moderate ADAMTS13:AC deficiency (50%). In contrast, based on the Child-Turcotte-Pugh (CTP) score, Child C-cirrhotics had the worst survival, but the survival probabilities did not differ between Child A and B cirrhotics. Based on the Model for End-Stage Liver Disease (MELD) score, the survival was the worst for the cirrhotics in the fourth quartile, but it was not different among cirrhotics in the first three quartiles. Cox proportional-hazards regression analysis showed that ADAMTS13:AC and serum albumin were independent factors affecting the survival. Conclusions:  ADAMTS13:AC concomitantly decreases as the functional liver capacity decreases. This activity may be a useful prognostic marker that is equal or superior to the CTP score and the MELD score to predict not only the short-term prognosis but also the long-term survival of the cirrhotic patients.博士（医学）・甲613号・平成26年3月17

Salvage living donor liver transplantation after percutaneous transluminal angioplasty for recurrent Budd-Chiari syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Budd-Chiari syndrome is a very rare pathological entity that ultimately leads to liver failure. Several therapeutic modalities, including percutaneous transluminal angioplasty, have been attempted to save the life of patients with Budd-Chiari syndrome. Few reports have described a salvage living donor liver transplantation performed after percutaneous transluminal angioplasty in a patient with acute Budd-Chiari syndrome.</p> <p>Case presentation</p> <p>A 26-year-old Japanese man developed severe progressive manifestations, such as massive ascites and hematemesis due to rupture of esophageal varices. After making several investigations, we diagnosed the case as Budd-Chiari syndrome. We first performed percutaneous transluminal angioplasty to dilate a short-segment stenosis of his inferior vena cava. The first percutaneous transluminal angioplasty greatly improved the clinical manifestations. However, after a year, re-stenosis was detected, and a second percutaneous transluminal angioplasty failed to open the severe stricture of his inferior vena cava. Since our patient had manifestations of acute liver failure, we decided to perform salvage living donor liver transplantation from his brother. The transplantation was successfully performed and all clinical manifestations were remarkably alleviated.</p> <p>Conclusion</p> <p>In cases of recurrent Budd-Chiari syndrome, the blocked hepatic venous outflow is not always relieved, even with invasive therapies. We have to take into account the possibility of adopting alternative salvage therapies if the first therapeutic modalities fail. When invasive therapy such as percutaneous transluminal angioplasty fails, liver transplantation should be considered as an alternative option.</p

コウガンヤク ニ ヨル バクロ ノ ジッタイ ト タイサク ノ ケントウ ガイライ カガク リョウホウ カンレン シセツ ノ カンキョウ チョウサ ヨリ

近年、抗がん薬の曝露対策の重要性が周知され、職業性曝露対策ガイドラインに基づく対策が、各施設で実施されている。CSTD 使用、PPE 装着、患者への曝露対策のオリエンテーションを実施している外来化学療法関連施設で、曝露対策効果の評価を目的とし、揮発性薬剤のシクロホスファミド・在宅で投薬をするフルオロウラシル・使用頻度の高いゲムシタビン・パクリタキセル（アルブミン懸濁型も含む）の4種類の薬剤を指標として、調製から投薬、患者の排泄までの一連の流れでの環境曝露を調査した。薬剤調製エリア、点滴準備エリアにおいては薬剤の検出があったが、治療環境では検出されず、ガイドラインに基づく薬剤師と看護師の曝露対策の効果として評価できた。患者の在宅物品である在宅ポンプ表面・廃棄袋の汚染、および患者用トイレからの薬剤検出があり、今後の曝露対策の強化の必要性が示唆された。資料Information

A study of Relationships with Childcare Teachers' Resilience and Their Mental Health : Investigation of childcare teachers' years of experience

There have been remarkable changes in circumstances for childcare teachers and their mental health has become a great issue. In this study, we focused on resilience: the resistive power to stress, and discussed the changes in resilience of childcare teachers, in relation to the experience. The relationship between childcare teachers' resilience and their mental health was also examined. The results revealed that resilience of childcare teachers rised as their experience increased. In particular, it was identified that their selfefficacy, one of component of resilience, rised as their experience increased. In addition, a positive correlation was confirmed between resilience and mental health. These results suggest that an approach to improve childcare teachers' self-efficacy might be effective as a strategy to maintain their mental health

Research on stress in child care of caregivers : Examination from relation between years of experience and social support

Recently, the situation in which the child care in Japan was surrounded changed greatly. As a result, the caregivers of child care center becomes very busy, and the mind and body's load has increased. Then, it is necessary to think about some help to the caregivers. In some researches, caregivers' stressor is clarified. However, caregivers' stress situation was clarified by using the index to understand caregivers' stress overall in this research. Therefore, the factor to reduce caregivers' stress situation and stress was examined in this research. In addition, the factor to reduce the stress was examined in this research. The result of this research is shown below. The first point is about caregivers' stress. The caregivers don't think that they grow up in working. The second point is about the reduction factor of the caregivers' stress. The social support of the caregivers' in the same center is effective for the caregivers' stress reduction. Years of experience were not effective for the caregivers' stress reduction. There is a very important meaning for these results to think about support to the caregivers. It will be necessary to investigate the inside fact of caregivers' stress in the future. Therefore, it is necessary to do a qualitative investigation. It thinks about the caregivers' support based on the result of them and this researches

Research on the child care givers' mutual support : Examination from technical side and emotional side

Recently, in Japan, the situation of child care center in society changed greatly. Therefore, the child care givers' tiredness has increased. In this situation, the child care giver of 804000r more have received support from the same child care center's care giver. Then, this research examines the child care givers' mutual support in same child care center. The following were clarified from interview of three child care givers'. Technical support to the child care giver has been done by the senior care giver. And, emotional support to the child care giver has been done by the colleague. Moreover, the child care giver with a young experience recognizes support by receiving technical support from the senior care giver. It was confirmed that the mentoring relationship was constructed between the senior child care giver and the junior care giver. To enable the mutual support between the child care givers, it was suggested that these are necessary