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Major depressive disorder (MDD) is a psychiatric disorder that affects more than 300 million people worldwide and has a serious impact on society. Conventional antidepressants targeting monoamines in the brain based on the monoamine hypothesis are known to take a prolonged time to be effective or less effective in 30% of MDD patients. Hence, there is a need to develop antidepressants that are effective against treatment-resistant depression and have a new mechanism different from the monoamine hypothesis. An increasing number of research groups including us have been establishing that pituitary adenylate cyclase-activating polypeptide (PACAP) and one of its receptors, PAC1 receptor, are closely related to the etiology of stress-related diseases such as MDD. Therefore, it is strongly suggested that the PAC1 receptor is a promising target in the treatment of psychiatric disorders. We developed a novel, non-peptidic, small-molecule, high-affinity PAC1 receptor antagonists and conducted behavioral pharmacology experiments in mice to characterize a novel PAC1 receptor antagonist as a new option for MDD therapy. The results show that our novel PAC1 receptor antagonist has the potential to be a new antidepressant with a high safety profile. In this review, we would like to present the background of developing our novel PAC1 receptor antagonist and its effects on mouse models of acute stress.

A closed system drug transfer device (CSTD) helps to minimize unnecessary exposure of healthcare workers such as pharmacists to hazardous drugs. One of the concerns in using CSTDs to prepare anticancer drugs is their influence on preparation time. Therefore, we compared the time needed to prepare anticancer drugs with the CSTDs NEOSHIELD ® and BD PhaSeal ® system and with an injection needle. In the comparison of NEOSHIELD ® and an injection needle, the preparation time of the liquid formulations of the cytotoxic drugs irinotecan, eribulin, cisplatin, docetaxel, and paclitaxel was significantly shorter with the injection needle and that of gemcitabine was significantly shorter with NEOSHIELD ® , but that of oxaliplatin, carboplatin, and doxorubicin was not significantly different between the two methods; the preparation time of the liquid formulations of the molecular-targeted drugs atezolizumab, obinutuzumab, cetuximab, daratumumab and vorhyaluronidase alfa, nivolumab, ramucirumab, and rituximab was significantly shorter with NEOSHIELD ® and that of bevacizumab and pembrolizumab was significantly shorter with the injection needle; and the preparation time of the lyophilized formulation of cytotoxic and molecular-targeted drugs was not significantly different between the two methods. In the comparison of NEOSHIELD ® and BD PhaSeal ® system, the preparation time of cyclophosphamide and ifosfamide was significantly shorter with NEOSHIELD ® , but that of bendamustine was not significantly different between the two CSTDs. In conclusion, these results suggest that the preparation time with CSTDs may be similar to or shorter than that with an injection needle, depending on the type of CSTD and the drug formulation and type.

A 72-year-old man with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL) was treated with dasatinib (week1: 50 mg/day, week2: 70 mg/day, week3-: 100 mg/day) and prednisolone from June 2017. However, in January 2018, it relapsed with the T315I mutation. Although the treatment was changed to ponatinib 30 mg/day, he experienced a second relapse in June 2018. Following confirmation of CD22 positivity, he was treated with three cycles of inotuzumab ozogamicin (InO), resulting in CR. He was CR for 2.9 years before relapsing for the third time in May 2021. Because the patient was still CD22-positive, InO was given again, and the patient achieved CR at the end of the second cycle. We had a case where re-administering InO was effective as a salvage therapy for relapsed/refractory Ph+ALL (r/r Ph+ALL) in an elderly patient.

After washing the cooking utensils used to prepare liquid batter, flour may remain in the scrubbing sponge. Secondary contamination of cooking devices with wheat allergens is a concern if such scrubbing sponges are used to clean other equipment. Therefore, in this study, bowl washing with detergent, using a scrubbing sponge was evaluated as a cleaning method following liquid batter cooking. Multiple trials revealed that wheat allergens were transferred from a bowl coated with 10 g of liquid batter to an unused bowl via sponge scrubbing with a positive rate of approximately 80%. Residual batter was observed in the scrubbing sponge after cleaning and rinsing procedures, with a residual rate of about 20%. Detailed observation of the residue revealed that proteins such as gluten were attached to the cell skeleton, and between the skeletons of the sponge, and starch granules were attached to the proteins. Even with sponge rinsing conditions added to the protocol, complete removal of wheat allergen was difficult. These studies indicate that particular scrubbing sponges for cleaning the residual wheat on cooking utensils should be dedicated exclusively in cooking facilities that prepare allergy-friendly-foods to avoid risk of allergen contamination.

A 44-year-old female was diagnosed with follicular lymphoma (FL), grade 3A stage III, by right cervical lymph node biopsy at the age of 43 years. The patient chose to not receive the treatment despite the high tumor burden. The patient came back after 18 months with respiratory distress and had systemic infiltration and pleural effusion. Positron emission tomography (PET)/computed tomography (CT) showed fluorine-18 deoxyglucose accumulation with maximum standardized uptake value ranging from 10 to 18 in bone marrow, liver, spleen, lung, and systemic lymph nodes (cervical, supraclavicular, infraclavicular, axillary, mediastinal, hilar, para-aortic, iliac, and inguinal). Left inguinal lymph node biopsy revealed mixed cellularity classical Hodgkin lymphoma (CHL), which was thought to be an FL transformation or a composite condition. The patient was treated with A + AVD and achieved lymph node shrinkage as well as improvement of tumor fever and pleural effusion. Interim PET/CT showed improvement in most parts after two courses; however, it revealed some new or progressive lesions in the bone marrow and left cervical lymph nodes. Left cervical lymph node biopsy revealed nodular sclerosis CHL. The patient was treated with ESHAP, which resulted in stable disease; following this, the patient was treated with nivolumab, which was highly effective. FL transformation to CHL is rare, and this is the first report of such transformation without treatment.

As a preventive measure for occupational exposure to anticancer drugs, the use of a closed system drug transfer device (CSTD)is not widespread. The main reason for this is the high cost of the equipment. For inpatient chemotherapy(Ⅳ)at our hospital, CSTD was used for the following 3 drugs, cyclophosphamide, ifosfamide, and bendamustine; however, from Nov. 2018, CSTD was used for all chemotherapy drugs. Meanwhile, the personal protective equipment (PPE) for ward nurses was simplified. The purpose of this study was to determine the effects of increased CSTD use and simplification of PPE on the cost of medical materials. Information collected between Apr. and Sep. 2019 was extracted from health records. The total number of inpatient chemotherapy treatments during the study period was 970. The increase in the cost of drug administration equipment due to expansion of CSTD use was ¥1.74 million per half a year. However, the cost savings from simplifying PPE was approximately ¥290,000 per half a year, which is about 16.8% of the increase in cost. We hope that the amount of reimbursement will increase and that device prices will decrease as CSTD use becomes more widespread.

The Japanese government is making full-scale efforts to support working people who suffer from cancer and/or other diseases, as it seeks to support a balance of work and receiving medical treatment. The Hospital of the University of Occupational and Environmental Health, Japan, opened its Support Center of Treatment and Work Balance in 2018. This is a multi-disciplinary department for supporting the balance of work and medical treatment. It also opened its Department of Occupational Medicine, the first such department in Japan to provide medical diagnosis and treatment dedicated to supporting that same balance. Our team has supported 704 patients through our activities over the past 3 years. The number of patients supported has increased each year, while the number of departments providing support has also trended upward. There has also been an increase in opinions by attending physicians regarding employment, as well as the number of cases covered by public medical insurance. Here we suggest two factors in our hospital's growth in these activities: (1) many of the clinicians are qualified as occupational physicians, and (2) the organizational strength of our team, which has a vision for balancing support and subsequently promotes that vision. We hope that this report will lead to the balance of support activities in Japan and contribute to the model internationally.

Objectives　Although previous studies have discussed the "voluntary" withdrawal of older drivers' driving license to prevent traffic accidents, there is less evidence about the experience of giving up driving. The present study investigated the decision-making process in the "voluntary" withdrawal of the driver's license and the conceptual meaning of "voluntary" among individuals who have experienced or shortly plan the event, as well as the transitions in their social relationships, social interactions, and body image perceptions.Methods　Qualitative research was undertaken to examine the explanatory research question in City A, Ibaraki prefecture, Japan. A semi-structured interview was conducted with eight male participants. They were asked related questions, for example, the meaning of driving, lifestyle changes, and so on. Data were recorded and transcribed into transcripts to be analyzed using the grounded theory approach.Results　The qualitative data revealed that when participants perceived their "body" as alienated from their "self" during driving or daily living, they became confused because they needed to be conscious of the aroused existence of the "self" that operates their "body," which was previously integrated with their "self." This awareness led the individuals to the process of "voluntary" withdrawal from driving in coping with their reflected "self" while they gradually distrusted their "self" regarding their deteriorating "body." Some participants lost their "self" and felt that they were forced to stop driving "voluntarily" when their "self" was determined as belonging to a risky "body," whereas others could decide "voluntary" driving cessation and realize their "self" through social interactions when they "re-evaluated" their "self" in light of their life stories. Both types of participants had "difficulties" after driving cessation; however, the latter effectively emphasized the re-construction of the "self" and "self"-based decision-making process due to aging.Conclusion　The decision-making process in the withdrawal of a driver's license due to aging resembled the process of coping with disabilities. Previous relationships between "self," "body," and society might be affected by age- or illness-triggered events. Encouraging the re-construction of "self" and its relationships might alleviate the psychological impact on elderly people facing "voluntary" retirement from driving.

Chemotherapy induced nausea and vomiting(CINV)have been improved by several clinical trials. However, it is necessary to select antiemetic therapy for each patient, as there are cases where nausea and vomiting have not improved or are experiencing unpleasant adverse events. In this report, we would like to introduce the latest findings in antiemetic therapy for highly emetic chemotherapy by categorized NK1 receptor antagonist, steroids, and olanzapine. Especially for olanzapine, we are going to introduce the J-FORCE as one of the latest findings. This study was confirmed the usefulness of 5 mg olanzapine to improve side effects such as sleepiness caused by olanzapine 10 mg used in the United States. We hope that these findings will be fully utilized to help provide the best antiemetic therapy for many patients.

The neuronal activity forms the basis of functional circuits and brain functions. To understand how the brain operates, recording of neural activity at micro-, meso-, and macro-scales is required. Recently, improved optical microscopic technology helps us to develop a whole-brain imaging system at a single-cell resolution. The combination of a whole-brain imaging system and a reporter system of neuronal activation enables a whole-brain mapping of neuronal activity. In this review, we first describe the high-speed and scalable whole-brain imaging system including our recently developed system, named FAST, and then present the instances of whole-brain mapping of neuronal activity and its analytical methods.

A 40-year-old male was referred to our hospital because of a nodular shadow detected in the left lower lobe with the tendency to increase gently. Because fluoro-2-deoxy-D-glucose (FDG) uptake was extremely low on a FDG positron emission tomography (PET-CT), the tumor was highly suspected of the benign tumor. Five years later, a follow-up computed tomography (CT) showed the shadow to be enlarged. FDG uptake was changed to be high, and serum level of pro-gastrin-releasing peptide (Pro-GRP) was extremely elevated. Surgical treatment was chosen under suspicious diagnosis of neuroendocrine tumor, such as small cell carcinoma, large cell neuroendocrine carcinoma, and carcinoid. By the intraoperative aspiration cytology, a small cell carcinoma or a carcinoid was suspected and left lower lobectomy with systemic lymph node dissection was performed. The final histological diagnosis was a typical carcinoid. The elevated serum ProGRP immediately decreased to normal postoperatively.

A national survey conducted in 2016 aimed to evaluate the current status and needs of the field of oncofertility and to consider optimized medical delivery systems. A total of 739 oncologists, excluding gynecological and urological specialists, were surveyed. Of these, 99.2% thought that providing information on fertility preservation was important. Of the surveyed oncologists, 48% were affiliated with facilities providing assisted reproductive technology, and 79.3% practiced in university hospitals. Of 238 (32.2%) specialists who provided information on the risk of reproductive damage resulting from treatment in their facility, 163 (44.9%) and 75 (19.9%) practiced in university hospitals (n=363) and non-university hospitals (n= 376), respectively. In contrast, 14.3% and 32.7% of oncologists who practiced in university hospitals and non-university hospitals, respectively, collaborated with local obstetricians and gynecologists. Among oncologists who use a gradually expanding regional oncofertility network, 0.6% practice in university hospitals and 2.7% practice in non-university hospitals. Patients were advised that the risk of infertility was 92.3% and the likelihood of fertility preservation was 66.9%. Furthermore, as an ideal way of providing information on preservation of fertility, 22.9% of oncologists collaborate with local gynecologists, and 26.3% do so at a public cancer and reproductive medical counseling center. In addition, 34.7% and 55.1% of oncologists at university and non-university hospitals, respectively, thought that implementation of a fertility preservation program at a public facility would be desirable. Although most oncologists recognize the importance of providing information on reproductive medicine, the support system for reproductive function and fertility in adolescent and young adult (AYA) generation cancer patients is limited because of the lack of agreement on patient referral. The limited number of referrals in turn limits data collection in the field of oncofertility. Grant: A Health and Labour Sciences Research Grant: H27-Cancer Control-Ippan.

Clinical charts of 95 patients who underwent holmium laser enucleation of the prostate (HoLEP) between May 2012 and January 2016 were reviewed for complications and their causative factors, as well as treatment outcomes. Of 23 intraoperative complications and 3 cases of prolonged post prostatectomy incontinence, 23 incidents (89%) occurred within the initial 20 cases performed by each surgeon. The details of the intraoperative complications were : bladder injury, 6 (6.3%) ; perforation at 6 o'clock beneath the bladder neck, 2 (2.1%) ; capsular perforation, 4 (4.2%) ; and equipment failure, 9 (9.5%). Bladder injury and capsular perforation resulted frompoor hemostasis, while perforation beneath the bladder neck resulted fromforceful retrograde dissection under disorientation. Excessive tension in the external sphincter during retrograde dissection, but not antegrade, could lead to prolonged incontinence. HoLEP improved bladder outlet obstruction subjectively and objectively. During the initial phase of HoLEP, adequate hemostasis and meticulous plane dissection at the bladder neck and antegrade dissection at the apical portions are of paramount importance to prevent significant surgical complications.

Optimal salvage chemotherapy has not been established for patients with acute myeloid leukemia (AML) who fail to attain complete remission (CR) after one course of induction chemotherapy. This retrospective study aimed to assess the efficacy and safety of an MEC (mitoxantrone, 6 mg/m 2 , 1-3 days; etoposide, 80 mg/m 2 , 1-6 days; cytarabine, 1 g/m 2 , 1-6 days) regimen in patients with AML who failed to attain CR after one course of induction chemotherapy. Twenty-four patients were included in this study (median age, 58 years; range, 28-79 years). After one course of MEC, 11 patients (45.8%) attained CR. Febrile neutropenia was observed in all patients, and acute infection was observed in 7 patients (29.2%). However, no therapy-related death occurred. All patients eligible for transplantation and who attained CR after MEC salvage chemotherapy underwent allogeneic hematopoietic stem cell transplantation. The MEC regimen exhibited a good response rate with tolerable adverse events. Therefore, the MEC regimen can be safely used as a salvage treatment for patients with AML who failed to attain CR after one course of induction chemotherapy.

The advent of the genomic era has led to the discovery of linkages of several genes and pathways to schizophrenia and autism spectrum disorder (ASD) that may serve as new biomarkers or therapeutic targets for these diseases. Two large-scale genetic studies published early in 2011 provided evidence that functional microduplications at 7q36.3, containing VIPR2, are a risk factor for schizophrenia. 7q36.3 microduplications were also reported to be significantly increased in ASD. VIPR2 encodes VPAC2, a seven transmembrane heterotrimeric G protein-coupled receptor that binds two homologous neuropeptides with high affinity, PACAP and VIP. These clinical studies demonstrate a VIPR2 genetic linkage to schizophrenia and ASD and should lead to novel insights into the etiology of these mental health disorders. However, the mechanism by which overactive VPAC2 signaling may lead to schizophrenia and ASD is unknown. In the present review, we will describe recent advances in the genetics of schizophrenia and attempt to discuss the pathophysiological role of altered VPAC2 signaling in psychiatric disorders.

A 73-year-old female was hospitalized with thrombotic microangiopathy (TMA) diagnosis because of consciousness disturbance, anemia, thrombocytopenia, renal dysfunction, and electrocardiogram abnormality. The patient died on day 12 of the symptom onset. The immunohistochemical analysis of microclot found in the autopsy of coronary artery confirmed TMA. It was suggested that the relationship to collagen disease by antinuclear antibody positive and the necessity of initiating circulation management and plasma exchange immediately before approximately 1×10 4 of platelets for the prognosis. The findings suggested considering TMA at the time of an unidentified shock, particularly acute adrenal insufficiency.

Psychiatric disorders such as schizophrenia and depression are considered to be complex diseases that result from an interaction of many ge- netic and environmental risk factors associated with the diseases. The underlying molecular mechanisms, however, remain largely unknown and there are conditions, the treatment of which is not necessarily satisfactory due to inadequate therapeutic effect or treatment resistance. Therefore, scientific research on the brain functions and dysfunctions as well as development of better treatments is crucially important. In the present review, I will attempt to discuss such a research using animal disease models together with genetic studies in human disorders and point out future directions of the translational research on psychiatric disorders.

Background: Since wheat flour, a cause of food allergy, tends to disperse rapidly in air, it can unintentionally mix other foods during the sieving process. Our aim was to analyze the dispersal of wheat flour dust in air in order to prevent unintentional mixing., Methods: We measured particle size distribution of wheat flour, photographed the scattered flour for 60 seconds every 10 seconds after sieving through three types of flour sifter, constructed a velocity vector diagram of flour dust dispersal by each type of sifter, and measured the distance of wheat allergen dispersal over 20 minutes using a petri dish and immunochromatographic test., Results: The particles were mainly 14.2μm and 60.4μm in diameter and settled at terminal velocities of about 8mm/s and 150mm/s, respectively. Wheat flour particles of more than 60μm (released in air by sifting) dropped mainly in the perpendicular direction, while particles of less than 30μm remained suspended and traveled 5m after sifting by all flour sifters., Conclusion: Our results suggested that wheat flour dust dispersed by sifting (regardless of sifter) could unintentionally mix other foods. To prevent contamination, it is necessary to control the flow of air or sift flour in a separate room.

We developed a phantom using a hollow-fiber hemodialyzer to evaluate the quantitative reliability of cerebral computed tomography (CT) perfusion. Our phantom consisted of a hollow-fiber hemodialyzer and a syringe-shaped X-ray device made up of resin. The phantom can give theoretical true values for cerebral blood volume, cerebral blood flow, and mean transit time. We compared the values measured in the phantom with predicted theoretical values. The purpose of the current report is to describe the theory and experimental technique used to obtain an absolute value in a phantom.

Transcatheter aortic valve implantation (TAVI) is a novel treatment option for inoperative high-risk pa- tients with severe aortic stenosis (AS). However, there is a risk of cerebral ischemia by the two times of rapid ventricular pacing (RVP) procedure during valvulo- plasty and prosthesis implantation. An 86-year-old man was diagnosed with old myocardial infarction and severe AS, and was scheduled to undergo TAVI and off-pump coronary artery bypass grafting (OPCAB). He had the risk of cerebral ischemia due to total occlu- sion of the right common carotid artery, and was monitored with bilateral bispectral index (BIS) and cerebral regional saturation of oxygen (rSO2). In order to maintain his cerebral blood flow, we used low dose catecholamine during OPCAB. During prosthesis implantation, RVP was performed as quickly as pos- sible to maintain cerebral perfusion. Hemodynamics of the patient was restored with no reduction of either bilateral BIS or rSO2 values after RVP. He did not develop neurological complications and was discharged on postoperative day 15. Rapid ventricular pacing followed by unstable hemo- dynamics during valvuloplasty and prosthesis implan- tation is challenging to the anesthesiologists.

A 19-year-old woman complaining of fever and a sore throat was diagnosed with very severe aplastic anemia (AA) by bone marrow examination at a local hospital. Despite administration of antibiotics and granulocyte-colony stimulating factor to treat the soft tissue infection in her neck, her neutrophil count showed no increase. Because emergent allogeneic stem cell transplantation (SCT) was necessary, she was referred to our hospital. On admission, computed tomography revealed right-sided severe pharyngitis and lymphadenitis causing tracheal stenosis, and emergent intubation was required the next day. Granulocyte transfusion therapy (GTX) from related donors coupled with broad-spectrum antibiotic administration controlled the otherwise overwhelming infection. The patient received allogeneic peripheral blood SCT using a reduced-intensity conditioning regimen. After allogeneic SCT, successful engraftment was obtained. She was discharged from the hospital 59 days after allogeneic SCT. She remains alive and well, as of the latest follow up. This case clearly demonstrates that GTX is useful for controlling severe infection and enables patients with severe AA to receive allogeneic SCT safely.

Median artery of the corpus callosum(MACC)refers to the median artery of the triplicate anterior cerebral artery(ACA). When MACC distributes to one or to both hemispheres, it is known as the accessory ACA. We performed detailed angiographic analysis of 32 consecutive patients operated upon for distal ACA(DACA)aneurysms, and noted that all DACA aneurysms occurring in the supracallosal portion were accompanied by an accessory ACA as vascular malformation. Such relationship between accessory ACA and DACA aneurysm in the supracallosal portion has not been previously reported.

We surveyed the presence of allergenic substances such as egg, milk, wheat, buckwheat, peanut, shrimp and crab in foods produced or distributed in Chiba Prefecture during the fiscal years 2004-2014. Six hundred and ninety-five samples that did not display the target allergenic substances were screened by using ELISA. Three percent of the samples (21/695 samples) were found to be positive. Wheat had the highest positivity rate of 9.7% (10/103 samples). Among the samples tested, advisory labeling was displayed in the case of 109 samples. Among these samples, 77.1%(84/109 samples) contained less than 1.0 μg/g of the specified allergen. Out of the 21 samples that tested positive in the screening-test, 16 did not display the advisory labeling.

From fiscal year 2012 to 2014, we surveyed the concentration of radioactive cesium in 39 wild animal meats obtained from 20 wild boars and 19 deer caught in Chiba prefecture, using a germanium semiconductor detector. Four wild boar meats in the fiscal years 2012 and 2013 exceeded the radioactive cesium limit in general foods (100 Bq/kg), whereas none of the deer meats exceeded the limit. The left side of the wild boar that showed a radioactive cesium concentration above 100 Bq/kg was divided into 14 parts. We compared the radioactive cesium concentration in the ham used for the screening test with those in other parts. The concentration was highest in ham, among the edible parts.

Drug cost is considered an important factor in treatment compliance for cancer patients. However, it is difficult to calculate individual drug costs. We were previously unable to provide sufficient information on costs to cancer patients starting drug therapy. Therefore, we developed a tool, in the form of a spreadsheet, which calculates drug costs for breast cancer treatment. This software tool runs on every terminal for electronic medical charts in our hospital. To evaluate the tool, we created 10 fictional breast cancer patient sets. Five pharmacists calculated the drug costs for a single regimen using method A (without software) and method B (with software). The pharmacists then calculated the drug costs for 3 regimens in the same way. We compared the time taken to calculate costs using method A and method B. For the single regimen, the mean time for method B (22.6±6.9 s) was 6.4-times shorter than that for method A (145.2±28.3 s, p<0.0001). For the 3 regimens, the mean time for method B (35.5±5.0 s) was 8.9-times shorter than that for method A (315.8±43.1 s, p<0.0001). The differences observed were statistically significant. By using the software, we were able to shorten the calculation time for drug costs, and therefore, alleviate the burden on medical staff.

We report herein a case of cerebellar hemangioblastoma complicated by pregnancy and concerns about the period in which surgery could be performed successfully. A 19-year-old woman, who was also 35 weeks pregnant, was admitted to our hospital with headache, nausea, and general fatigue. Neurological examination on admission revealed disturbed consciousness, and the patient's general condition was poor. Computed tomography and magnetic resonance imaging showed a large tumor in the cerebellar vermis along with an obstructive hydrocephalus. Computed tomographic angiography with three-dimensional reconstruction revealed feeding arteries and a draining vein in this tumor. Based on the clinical features, hemangioblastoma was suspected, and surgical excision and extraction of the fetus were scheduled. However, because of rapid neurological deterioration due to tumor progression, an emergency cesarean section was performed under general anesthesia. After extracting the fetus, the level of consciousness improved, so a tumor resection was planned after the patient's general condition improved. However, the neurological state deteriorated again due to the worsening hydrocephalus, which was suspected to be caused by the increased cerebral blood flow following uterine contraction. Emergency surgery for the brain tumor was performed two days after delivery. The tumor was resected completely and histopathological examination confirmed a diagnosis of hemangioblastoma. The postoperative course was uneventful, and the patient and newborn were discharged with no neurological deficits three weeks after the operation. This case suggested that if we encounter patients with brain tumors complicated by pregnancy, not only is earlier diagnosis from clinical features important, but also persistent additional treatment should be carried out without delay to effectively control intracranial pressure.

An aberrant left subclavian artery is a rare variant that has been reported to coexist with the right-sided aortic arch in many cases. We encountered a case in which percutaneous transluminal angioplasty using a stent was performed for an aberrant left subclavian artery and left carotid artery. The patient was a 63-year-old man in whom left carotid artery stenosis and abnormal flow pattern of the left vertebral artery was accidently found during an ultrasound screening of his carotid artery. The right-sided aortic arch with the aberrant left subclavian artery was revealed by a cerebral angiogram via the right femoral artery. Despite difficulty in inserting a catheter at the origin of the aberrant left artery, the treatment was completed successfully. To our knowledge, endovascular treatment for an aberrant left subclavian artery has not been reported until date.

Background: The aim of this study was to evaluate the analgesic efficacy and safety of rectus sheath block combined with intraperitoneal instillation using two doses of ropivacaine in patients undergoing laparoscopic gynecological surgery., Methods: Altogether 53 consenting women were randomized to receive intraperitoneal infiltration with 0.25% ropivacaine or 0.5% ropivacaine followed by rectus sheath block with 0.375% ropivacaine. The outcomes of clinical safety were measured using plasma concentration of local anesthetics and occurrence of toxic symptoms. The analgesic efficacy was assessed using numerical rating scales for pain and morphine consumption up to 24 hours after surgery., Results: Patients' baseline characteristics, surgical factors, and analgesic outcomes were comparable between the two groups. Although peak plasma concentration of ropivacaine was significantly higher in patients receiving 0.5% ropivacaine, none of analyzed concentrations was above the toxic ones. Besides, no patients showed any symptoms of local anesthetic toxicity., Conclusions: The present study showed that the combination of rectus sheath block with intraperitoneal instillation of ropivacaine was safe and potent enough to relieve pain after laparoscopic surgery.

A 44-year-old man (ASA-PS 1) underwent right lobectomy of the liver under total intravenous anesthesia with propofol, remifentanil, ketamine and rocuronium. In order to evade allogeneic blood transfusion, 1,200 g of the patient's blood was taken and hemodilution was induced for autologous blood transfusion (HAT) after the induction of anesthesia. As intraoperative blood loss amounted to about 4,000 g, Hb level decreased from 13.6 to 6.2 g x dl(-1). However, as intraoperative hemodynamics was relatively stable with crystalloidal and colloidal transfusion with no ischemic change on ECG and no metabolic acidosis, autologous blood transfusion was withheld. After returning the autologous blood, Hb increased to 9.8 g x dl(-1). Any postoperative complications related to the low Hb level were not recognized. HAT is a useful method to evade or at least decrease the amount of allogeneic blood transfusion by anesthesiologists.

We report the successful surgical treatment of a dural arteriovenous fistula(AVF)located in the lateral wall of the cavernous sinus. A 44-year-old woman presented with facial numbness in the left V3 area. Magnetic resonance imaging showed a flow void sign around the sphenoid ridge on a T2-weighted image. Digital subtraction angiography(DSA)demonstrated a dural AVF that was supplied by feeding arteries from the C4 portion of the left internal carotid artery. Without sinus enhancement, the draining vein flowed directly through the superficial sylvian vein into the vein of Labbé. Following treatment of the dural AVF located in the anterior cranial fossa, we ligated the draining vein at the penetrating point in the intradural region using surgical management. Intraoperative findings showed that the shunt point was located in the left lateral wall of the cavernous sinus. The postoperative course was uneventful and DSA showed no evidence of the AVF. The patient was discharged with no neurological deficits. Few studies have reported the use of direct surgery alone for the treatment of dural AVFs located in the cavernous sinus with a perfusion pattern as in this case.

A 77-year-old man was admitted because of fever. A small number of large CD20-positive neoplastic cells were seen in the bone marrow specimen. Clinical symptoms improved with oral prednisolone. After 11 months, abdominal CT scan revealed a liver mass. The biopsy specimen from the liver mass showed diffuse infiltration of large CD20-positive neoplastic cells. The patient was diagnosed as having diffuse large B-cell lymphoma. It was of particular interest that only neoplastic B cells within small blood vessels in the liver mass were positive for CD5. The patient died of lymphoma three months after diagnosis.

A 74-year-old man was referred to our hospital because of abdominal distension. Upper gastrointestinal endoscopy revealed advanced gastric cancer and early gastric cancer. HER2-positive and AFP-producing gastric cancer with peritonitis carcinomatosa showing no indication for operation was diagnosed by histopathological and radiological examinations. He was treated with trastuzumab, docetaxel, and S-1 combination chemotherapy. At the end of the second course of therapy, the primary lesion was remarkably decreased in size and was associated with a significant decrease in serum AFP level. No serious adverse events occurred except for grade 3-4 leukopenia and neutropenia. We carried out eight courses of chemotherapy. Trastuzumab, docetaxel, and S-1 combination chemotherapy promise to be one of the effective treatments for HER2-positive and AFP-producing gastric cancer that have no indication for radical cure excision.

Studies on genetically modified mice for investigating the role of pituitary adenylate cyclase-activating polypeptide (PACAP) in the brain have revealed a previously uncharacterized function of this neuropeptidergic signaling in the regulation of psychomotor behaviors. In addition, recent clinical studies investigating single nucleotide polymorphisms and copy number variations in the PACAP and its receptor genes have associated the variations with major psychiatric disorders and stress-dependent mental disorders. Here, I briefly review these recent advances in the field and make this an opportunity to consider future direction of research.

Objectives: Objective of this study is to clarify damages in operating rooms after the 2011 Tohoku Earthquake., Method: To survey structural and non-structural damage in operating theaters, we sent questionnaires to 155 acute care hospitals in Tohoku area., Results: Questionnaires were sent back from 105 hospitals (70.3%). Total of 280 patients were undergoing any kinds of operations during the earthquake and severe seismic tremor greater than JMA Seismic Intensity 6 hit 49 hospitals. Operating room staffs experienced life-threatening tremor in 41 hospitals. Blackout occurred but emergency electronic supply unit worked immediately in 81 out of 90 hospitals. However, emergency power plant did not work in 9 hospitals. During earthquake some materials fell from shelves in 44 hospitals and medical instruments fell down in 14 hospitals. In 5 hospitals, they experienced collapse of operating room wall or ceiling causing inability to maintain sterile operative field. Damage in electric power and water supply plus damage in logistics made many operating rooms difficult to perform routine surgery for several days., Conclusions: The 2011 Tohoku earthquake affected medical supply in wide area of Tohoku district and induced dysfunction of operating room. Supply-chain management of medical goods should be reconsidered to prepare severe natural disaster.