Jejunal interposition reconstruction with a stomach preserving esophagectomy improves postoperative weight loss and reflux symptoms for esophageal cancer patients

Background: Conventional reconstruction after an esophagectomy uses a gastric tube, which commonly causes several postoperative complaints such as gastric acid reflux in long-term survival cases. Intestinal interposition between the remnant esophagus and the stomach is an option to reduce complaints, and in this study, the advantages of jejunal interposition reconstruction with a stomach preserving esophagectomy (SPE) were assessed. Materials and methods: Eleven cases of jejunal interposition with an SPE and 16 cases with gastric tube reconstruction as a control were subject to a comparison of operation time, amount of bleeding, postoperative quality of life, and endoscopic findings. Results: The SPE group had a longer operation time (SPE: 560 +/- 121 min, control 414 +/- 83 min, P = 0.038), whereas there was no significant difference in blood loss. Postoperative weight loss was significantly recovered in the SPE group (SPE versus control = 94.0 +/- 5.4% versus 87.5 +/- 4.7% at 3 mo, P = 0.017; 97.2 +/- 7.5% versus 85.0 +/- 5.2% at 6 mo, P = 0.010), and there was a significant decrease in the occurrence of reflux symptoms such as heartburn, odynophagia, and cough when jejunal interposition with an SPE was done. Furthermore, reflux esophagitis and Barrett's epithelium were found in six out of 12 cases (50%) of the control group by postoperative endoscopy, while no cases in the SPE group had either condition (P < 0.01). Conclusions: This reconstruction method is a promising option to improve postoperative quality of life, mainly due to the long-term elimination of reflux esophagitis, which assists in the recovery of postoperative weight loss

Nanocellulose Xerogels With High Porosities and Large Specific Surface Areas

Xerogels are defined as porous structures that are obtained by evaporative drying of wet gels. One challenge is producing xerogels with high porosity and large specific surface areas, which are structurally comparable to supercritical-dried aerogels. Herein, we report on cellulose xerogels with a truly aerogel-like porous structure. These xerogels have a monolithic form with porosities and specific surface areas in the ranges of 71–76% and 340–411 m2/g, respectively. Our strategy is based on combining three concepts: (1) the use of a very fine type of cellulose nanofibers (CNFs) with a width of ~3 nm as the skeletal component of the xerogel; (2) increasing the stiffness of wet CNF gels by reinforcing the inter-CNF interactions to sustain their dry shrinkage; and (3) solvent-exchange of wet gels with low-polarity solvents, such as hexane and pentane, to reduce the capillary force on drying. The synergistic effects of combining these approaches lead to improvements in the porous structure in the CNF xerogels

痛みの神経生理学的機構に基づく理学療法の重要性

総説Review articles　日本人の多くが痛みを経験するが，現代のリハビリテーション医療では，治療効果が得られにくい患者もおり，症状の慢性化に至る例も少なくない．慢性疼痛の原因は，痛みを長期間，頻回に受けることにより，痛みの神経生理学的機構における中枢神経系の可塑的変化が生じることにより起きている．痛み治療において，集学的アプローチが重要であり，医師の薬物治療は，痛みの神経生理学的機構に基づいて行われて，効果を発揮している．本稿では，現在解明されている痛みの神経生理学的機構とその破綻による慢性疼痛のメカニズムについて概要し，痛みの神経生理学的機構に基づいた理学療法の重要性について，論述した．　A large number of Japanese people have experienced pain, however modern rehabilitation treatment is less likely to treat their pain completely, and the pain may lead to chronic symptoms. A primary cause of chronic pain is the mechanism of occurrence of plastic changes in the central neuro system. The neurophysiological plastic change results from repeated pain in a long period. As to pain therapy, a multimodal approach is essential for the therapeutic effect and physician’s medication based on the neurophysiological mechanism of pain makes more effective results rather than the modern medical treatment. In this article, we expounded the outline of neurophysiological mechanism of pain and the existing problem of mechanism of chronic pain. Finally, we discussed the importance of the current physical therapy based on the neurophysiological mechanism of pain

Detectability of colorectal neoplasia with fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT)

The purpose of this study was to analyze the detectability of colorectal neoplasia with fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT). Data for a total of 492 patients who had undergone both PET/CT and colonoscopy were analyzed. After the findings of PET/CT and colonoscopy were determined independently, the results were compared in each of the six colonic sites examined in all patients. The efficacy of PET/CT was determined using colonoscopic examination as the gold standard. In all, 270 colorectal lesions 5 mm or more in size, including 70 pathologically confirmed malignant lesions, were found in 172 patients by colonoscopy. The sensitivity and specificity of PET/CT for detecting any of the colorectal lesions were 36 and 98%, respectively. For detecting lesions 11 mm or larger, the sensitivity was increased to 85%, with the specificity remaining consistent (97%). Moreover, the sensitivity for tumors 21 mm or larger was 96% (48/50). Tumors with malignant or high-grade pathology were likely to be positive with PET/CT. A size of 10 mm or smaller [odds ratio (OR) 44.14, 95% confidence interval (95% CI) 11.44-221.67] and flat morphology (OR 7.78, 95% CI 1.79-36.25) were significant factors that were associated with false-negative cases on PET/CT. The sensitivity of PET/CT for detecting colorectal lesions is acceptable, showing size- and pathology-dependence, suggesting, for the most part, that clinically relevant lesions are detectable with PET/CT. However, when considering PET/CT for screening purposes caution must be exercised because there are cases of false-negative results

せん妄の早期発見・予防と理学療法の重要性

総説Review articles　せん妄は急性期病院だけでなく医療現場全体に渡る問題である．せん妄の発症はADL やQOL の低下に関連するだけでなく，生命予後の独立不良因子である．せん妄は早期発見と予防が重要であるが，現状では正確にせん妄を評価することができておらず見逃されることが多い．せん妄と評価される手前の閾値下せん妄は，症状の出現が分かりづらく，発見が遅れるといった問題がある．せん妄の発症メカニズムは脳内ネットワークの障害があり，理学療法評価・治療によりせん妄の早期発見・予防ができる可能性がある．せん妄を症状のみから捉えるのではなく，発症メカニズムに基づいて脳の反応から捉えることが必要である．本稿では，せん妄発症による問題点と，発症メカニズムの仮説から理学療法がせん妄の早期発見・予防にとって重要であることを，早期発見ツール・発症予防プログラムの開発の観点から論じる．　Delirium, a common clinical problem in hospitalized individuals, has been found to be a strong independent prognostic factor in critically ill patients, with a large effect on the impairment of their activities of daily living and quality of life. Early diagnosis and prevention are important strategies for delirium; however, it is often not diagnosed accurately. Subsyndromal delirium is difficult to evaluate clinically. Evaluating the dysfunction and restriction of the brain network, which is thought to be the cause of delirium, may provide new strategies for its prevention. We discuss the properties of a tool for the screening and early diagnosis of delirium based on the discontinuation and restriction of the brain network. Furthermore, we focus on the importance of physiotherapy as a new treatment strategy for delirium

Research and Design of a Routing Protocol in Large-Scale Wireless Sensor Networks

无线传感器网络，作为全球未来十大技术之一，集成了传感器技术、嵌入式计算技术、分布式信息处理和自组织网技术，可实时感知、采集、处理、传输网络分布区域内的各种信息数据，在军事国防、生物医疗、环境监测、抢险救灾、防恐反恐、危险区域远程控制等领域具有十分广阔的应用前景。 本文研究分析了无线传感器网络的已有路由协议，并针对大规模的无线传感器网络设计了一种树状路由协议，它根据节点地址信息来形成路由，从而简化了复杂繁冗的路由表查找和维护，节省了不必要的开销，提高了路由效率，实现了快速有效的数据传输。 为支持此路由协议本文提出了一种自适应动态地址分配算——ADAR（AdaptiveDynamicAddre...As one of the ten high technologies in the future, wireless sensor network, which is the integration of micro-sensors, embedded computing, modern network and Ad Hoc technologies, can apperceive, collect, process and transmit various information data within the region. It can be used in military defense, biomedical, environmental monitoring, disaster relief, counter-terrorism, remote control of haz...学位：工学硕士院系专业：信息科学与技术学院通信工程系_通信与信息系统学号：2332007115216

Classifiation of parabolic generating pairs of Kleinian groups with two parabolic generators

We give an alternative proof to Agol's classification of parabolic generating pairs of non-free Kleinian groups generated by two parabolic transformations. As an application, we give a complete characterisation of epimorphims between 2-bridge knot groups and a complete characterisation of degree one maps between the exteriors of hyperbolic 2-bridge links