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In today's world, where clinical options are ever increasing and patients' needs are more diverse, it is not possible to conclude that simply practicing medical care based on pathophysiological data and medical evidence is sufficient for patients, particularly in terms of seeing each patient as an individual. Medical professionals must maintain a close relationship with their patients and seek treatment and care methods that reflect the patient's values and views on life and death, based on their own ethics in medical care. Ethics education should be provided on a continuing basis from the beginning of medical/pharmacy school. However, ethics education in pharmacy departments is often delivered in a lecture format attended by many students and/or as group training using case studies and hypothetical situations, i.e., "paper" patients. With these teaching methods, there are limited opportunities for the students to foster a sense of ethics or to think deeply about their values and views on life and death with respect to the patients they care for. Therefore, in this study, we conducted ethics exercises for pharmacy students in a group study format using a documentary film of real patients who were facing death. By retrospectively analyzing the results of the questionnaires collected before and after the assignments and exercises, we verified the educational effects and changes in the students' sense of ethics from participating in the group learning exercise; moreover, our results revealed the insight gained by the students in examining the experiences and challenges faced by terminally ill patients.

(Objective) The study aimed to retrospectively evaluate the therapeutic effects of adjuvant chemotherapy (AC) in patients following radical cystectomy (RC) in locally advanced bladder cancer. (Methods) A single-center-derived database registered 227 patients diagnosed with muscle-invasive bladder cancer and treated with RC and pelvic lymphadenectomy between March 2003 and December 2021. Of these, patients diagnosed with non-organ-confined diseases were classified as either pT3-T4 or pN-positive without distant metastasis. Platinum-based AC was administered for the following categories: two courses for patients with pT3-T4 and pN-negative and three courses for those with pTany and pN-positive. The primary endpoint was the disease-free survival (DFS) and overall survival (OS) between the patients receiving and not receiving AC. (Results) Among all patients, 90 were diagnosed with non-organ-confined disease: 43 (47.8%) were treated with AC and the remaining 47 (52.2%) were left untreated. The methotrexate, vinblastine, doxorubicin, and cisplatin regimen; the gemcitabine and cisplatin regimen; and the gemcitabine and carboplatin regimen were administered to 14 (32.6%), 25 (58.1%), and 4 (9.3%) patients, respectively. With a median follow-up period of 26 months, the groups that received and did not receive AC had 2-year DFS rates of 36.3% and 25.9% (median DFS time: 15 vs. 8 months, p=0.026) and 2-year OS rates of 64.3% and 41.4% (median OS time: 38 vs. 18 months, p=0.064), respectively. In patients with pT3-T4 and pN-negative, no significant difference in the median DFS and OS between the AC and non-AC groups was observed. However, in patients with pTany and pN-positive, the DFS (median: 14 vs. 4.5 months, p=0.002) and OS (38 vs. 11.5 months, p=0.009) were longer in the AC than those in the non-AC group, respectively. The multivariate Cox regression analysis revealed that AC administration was an independent predictor for DFS (hazard ratio: 0.44, 95% confidence interval: 0.24-0.79, p=0.006). (Conclusion) Platinum-based AC following RC significantly improved DFS in pN-positive patients with locally advanced bladder cancer.

Thoracoscopic plication for congenital diaphragmatic eventration in an adult. Diaphragmatic eventration is known to be abnormal elevation of diaphragm and congenital causes are due to abnormal diaphragm muscle development. Here we report surgical treatment of congenital diaphragmatic eventration. A 45-year-old woman who complained of cough was admitted to our hospital. She had history of cough and was diagnosed as diaphragmatic eventration in childhood. Chest X-ray showed elevated left hemidiaphragm with a bowel gas underneath. Under the diagnosis of congenital eventration of left hemidiaphragm, plication of the left diaphragm by video-assisted thoracoscopic surgery (VATS) was performed. One month after surgery, severe cough disappeared completely.

Background: Regorafenib(Rego)is the salvage line standard treatment for metastatic colorectal cancer(mCRC), which often causes severe toxicities, such as hand-foot syndrome. Previously, we reported that in phase Ⅱ study, S-1 plus bevacizumab( Bev)(SB)showed favorable anticancer activity and feasibility as a salvage line. The aim of this study was to evaluate 2 treatments for mCRC as salvage line., Patients and Methods: In this multicenter phase Ⅱ study, the patients were randomly assigned(1:1)to the Rego or SB group. In the Rego group, Rego 160 mg/kg body weight was orally administered every 28 days for 21 days. In the SB group, S-1 was orally administered every 42 days for 28 days, according to body surface area, and Bev 5 mg/kg was administered by intravenous infusion on days 1, 15, and 29. Administration of S-1 every 21 days for 14 days and Bev 7.5 mg/kg on day 1 was also permitted. The primary endpoint was overall survival(OS), and the planned sample size was 86., Results: This study was ended prematurely due to poor accrual. Overall, 8 patients were enrolled from 6 institutions between Oct 2013 and May 2015. Although 4 patients were assigned to each group, one patient in the Rego group was excluded after enrollment. The median OS in the Rego and SB groups was 30.2 months and 6.6 months, respectively(hazard ratio: 0.205, p=0.123). The median progression-free survival in the Rego and SB groups was 3.7 months and 1.6 months, respectively. The disease control rate in the Rego and SB groups was 100% and 75%, respectively. The Grade 3 or 4 adverse events were increased, including AST/ALT(n=1, 25%), hyponatremia(n=1, 25%), hand-foot syndrome(n=1, 25%), hypertension(n=1, 25%), and proteinuria(n=1, 25%)in the Rego group and colitis( n=1, 25%)in the SB group; the treatment was discontinued., Conclusion: Despite the fact that data could only be collected from a small number of patients, SB is not recommended as salvage line for mCRC.

The patient a 75-year-old man who was treated for diabetes and angina pectoris. He relapsed with an angina attack. Coronary angiography revealed three-vessel disease. We performed coronary artery bypass grafting (CABG). During surgery, we converted from off-pump CABG to on-pump beating CABG because of hemodynamic instability. After surgery, severe circulatory failure occurred with uncontrollable hyperglycemia and hyperlactatemia, which did not improve with catecholamine administration and insulin infusion. However, after continuous hemodiafiltration( CHDF) was initiated, in addition to aortic balloon pumping, his arterial blood pressure increased, and blood glucose and lactate levels decreased. Postoperative hyperinflammatory condition might have induced severe circulatory failure, hyperglycemia, and hyperlactatemia. CHDF might have contributed to improving the condition.

Introduction: Respiratory failure and respiratory tract infections are frequently observed as post-operative pulmonary complications, and significantly contribute to morbidity and mortality. However, the risk factors of post-operative respiratory failure and respiratory tract infections are controversial, and how these factors affect on incidence of complications is still unclear., Objective: To identify risk factors of post-operative respiratory failure and respiratory tract infections, and evaluate its impact on incidences after cardiovascular surgery., Methods: From June 2013 to May 2015, adult patients undergoing cardiovascular surgery in the department of cardiovascular surgery and post-operative rehabilitation of Nagasaki University Hospital (Nagasaki, Japan) were retrospectively investigated., Results: Fifty-two of 416 patients(12.5%)suffered from post-operative respiratory failure and respiratory tract infections. Identified risk stratification indicates the relevant operative factors were more important than pre-operative factors. The operative time (OR 1.696, 95% CI 1.302~2.211), post-operative water balance( OR 1.025, 95% CI 1.004~1.046)and emergency operation( OR 3.607, 95% CI 1.492~8.716)were significant independent risk factors in the development of post-operative respiratory failure and respiratory tract infections., Conclusions: These results indicated that the operative factors are more important as onset of post-operative respiratory failure and respiratory tract infections after cardiovascular surgery.

Kohka Public Hospital(KPH)focuses primarily on the treatment of acute diseases. However, as the only general hospital in the medical district and established under the National Health Insurance, KPH has a mandate in comprehensive medical care. With the aim of becoming a hospital that can cope with the anticipated super-aging society, a meeting was started to raise staff awareness of home care medicine. Senior managers were placed in each team along with staff with no involvement on the issue. Initially, a SWOT analysis was conducted to understand the current status. Views raised in the meetings will be summarized, and consequent measures will be announced both internally and externally as part of the Strengths Dissemination Project. Interest in home care medicine at acute medical care hospitals is undeniably low, but the reality is that many do not know how to get involved due to the lack of exposure. It is unquestionable that the need for home care medicine and regional cooperation will rise in our nation. We must direct the attention of health care providers there and start discussions.

As a method to visualize the professional competence of pharmacists, the Japanese Society of Pharmacists has collected and analyzed PreAVOID [be prepared to avoid adverse drug reactions (ADRs) I reports. PreAVOID reports, which refer to cases where ADRs were avoided, are classified into reports of ADR pre- vention and those of the avoidance of ADR aggravation. In the former, pharmacists predicted the develop- ment of ADRs based on their history, a decrease in physical function, the influences of medical treatment, blood drug concentration, and medication history, and made inquiries about prescriptions or gave prescription suggestions to physicians, resulting in avoidance of the development of ADRs before drug administration. In the latter, pharmacists evaluated ADRs that developed in the early stage based on patients' complaints, clini- cal symptoms, and laboratory examination values, and avoided their aggravation. In 2014, the number of PreAVOID reports was 33,348, which consisted of 32,587 reports of ADR prevention and 761 reports of the avoidance of ADR aggravation. Objective evaluation of the reports of the avoidance of ADR aggravation showed pharmacists' marked contribution in about 50%. If pharmaceutical care had not been performed, marked direct health damage may have occurred. ADRs could be prevented or avoided based on laboratory examination values in 32.4%, and patients' complaints in 34.9%. (Review].

We recently encountered a case of native valve endocarditis caused by Corynebacterium striatum (C. striatum) in the absence of immunosuppression and a prosthetic valve. A 49-year-old woman was urgently admitted for disturbance of consciousness and nosebleeds. Careful clinical examination revealed infective endocarditis caused by C. striatum, for which replacement of aortic and mitral valves was performed. The postoperative course was favorable, and we were able to save the patient with no postoperative complications. Detection of C. striatum may be recognized as contamination because this organism is a rare pathogen. However, elderly patients and patients with immunosuppression are rapidly increasing, and it is important to keep C. striatum in mind when Gram-positive bacilli are detected in the clinical examination.

Objective: We report the use of the elephant trunk technique at all anastomotic sites in acute type A aortic dissection surgery., Methods: Artificial graft carrying a 2-mm short elephant trunk were prepared for both distal and proximal anastomotic sites. Subjects were 82 patients with acute type A aortic dissection who underwent surgery using this procedure between March 2009 and August 2015. The mean age was 69.6 ±10.7 years( range, 43~89 years). Seventeen patients( 20.7%) had cardiac tamponade or shock, while 8 cases( 9.8%) had organ ischemia due to malperfusion., Results: Total aortic arch replacement was performed in 22 patients (26.8%), while replacement of the ascending aorta was performed in 60( 73.2%). The mean durations of surgery, extracorporeal circulation, and cardiac ischemia were 352 ± 64, 199 ± 37, and 123 ± 26 min, respectively. Five in-hospital deaths( 6.1%) occurred. With respect to early complications, 5 patients( 6.1%) had permanent encephalopathy. Nine (11.0%) had respiratory failure, and 4 (4.9%) required tracheotomy. None of the patients had bleeding requiring additional thoracotomy for hemostasis and none had complications attributed to preparation of the artificial vessels., Conclusion: Artificial graft were prepared using the elephant trunk technique for use at all anastomotic sites in acute type A aortic dissection surgery. This procedure, involving stepwise proximal anastomosis, is highly effective for hemostasis and safe.

A 51-year-old woman was stabbed in the chest with a kitchen knife. Twenty minutes after arrival at our hospital by ambulance, she was transferred to the operating room, and a cardiopulmonary bypass was established from the right femoral artery and vein, and a median sternotomy was performed. The knife had damaged the surface of the heart and penetrated the lingular segment of the left lung. Both wounds were directly sutured. Chest X-rays taken after closing the chest showed bleeding in the left lung probably because of the administration of heparin. Bleeding was controlled by lingulectomy. The postoperative course was uneventful.

Since general thoracic surgery requires a short fasting period, the number of cases that require nutrition support after surgery is limited and few reports exist about nutrition in general thoracic surgery and chronic empyema. Here we report 2 cases of chronic empyema treated with nutritional support team (NST) followed by omentopexy. For chronic empyema, a long period is required to sterilize the thoracic cavity by closed or open drainage before radical treatment. During this period, improvement of the nutrition status is important to control local infection, and to increase the volume of the omentum or muscle flaps used for filling the empyema space effectively. In our 2 cases, radical surgeries using omental flap were successfully performed after the improvement of general condition by aggressive nutritional support.

Annulus dilatation is present in almost all patients with mitral regurgitation, tricuspid regurgitation. Therefore annuloplasty is required to obtain normal leaflet coaptation. Annuloplasty ring or band offers more stability in valve repair, improving long-term outcome. Since annuloplasty ring and band of various types can be used, to understand the characteristics and to select proper size are important.

We report a case of hemothorax complicated with celiac artery compression syndrome (CACS). A 43-year-old man presented with a sudden onset left back pain. Computed tomography (CT) showed its hemothorax, esophageal artery aneurysm and severe stenosis of the celiac truncus with its anterior compression by median accurate ligament, and a diagnosis of CACS associated with rupture of the aneurysm was made. Emergent transcatheter arterial embolization of the aneurysm resulted in a technical failure, although the patient's condition was stable and performed esophageal artery ligation through video-assisted thoracoscopic surgery on day 5 after onset. After surgery, the patient recovered without significant incidents. A cause of this aneurysmal development was supposed to be a significantly increased esophageal arterial blood flow with its luminal dilation to compensate a decreased celiac blood flow. Segmental arterial mediolysis could not be excluded as another cause.

Background: Tracheal intubation (TI) is a difficult skill to acquire and its proficiency deteriorates over time if not regularly practiced. However, inexperienced personnel may be required to perform airway management in emergency situations. We compared a novel supraglottic device, i-gel, with laryngeal mask airway classic (cLMA) and TI devices in regard to total success count, time required for placement, and difficulties encountered by novice personnel using a manikin model., Methods: Following a brief training, 24 residents were asked to insert each of i-gel, cLMA, and TI in a randomize fasion using a manikin. Success counts for placement and time required to chest rise were recorded. After completing the tests, the participants scored the difficulty of each device using a visual ana-log scale (0-100 mm, very easy to very difficult)., Results: The total success count with i-gel (46 times) was significantly higher than those of both cLMA (32 times) and TI (38 times), and the time to chest rise with i-gel (14 +/- 6 seconds) was significantly shorter than with cLMA (38 +/- 26 seconds). The difficulty score for i-gel (12 [0-51] mm) was significantly lower than those for both cLMA (51 [0-94] mm) and TI (25 [0-73] mm)., Conclusions: An i-gel may be useful for emergency airway management by inexperienced personnel. Further studies in a clinical setting are necessary to confirm these findings.

A case of epithelioid hemangioma of the duodenum causing bleeding was encountered. A 32-year-old man was admitted because of anemia. Endoscopic examination revealed a submucosal tumor with central depression in the 2nd portion of the duodenum. It was considered to be the bleeding focus of anemia. A partial resection of the duodenum was performed. The macro- and microscopic examination of the specimen revealed an epithelioid hemangioma. Hemangiomas of the intestinal tract are rare, representing only 0.3% of all tumors of the intestinal tract, and among them, hemangiomas of the duodenum are extremely rare, representing only 3.4% of those of the intestinal tract. Most hemangiomas of the duodenum are cavernous hemangiomas or capillary hemangiomas. We report the first case of epithelioid hemangioma of the duodenum.

Unlabelled: Lentinula edodes mycelia extract(LEM) may mitigate the immunosuppression caused by regulatory T cells(Tregs), and it is therefore expected that LEM will be useful with cancer immunotherapy. In this study, we evaluated the quality of life (QOL) and immune function in cancer patients receiving a combination of immunotherapy and oral administration of LEM., Methods: Ten patients who had received cancer immunotherapy were enrolled. They received cancer immunotherapy alone for the first 4 weeks, and were then administered LEM (1,800 mg/day) with cancer immunotherapy for the next 4 weeks. QOL scores and immune parameters were evaluated at weeks 0, 4, and 8., Results: The total score for QOL was improved during the period with LEM administration compared to the period with immunotherapy alone. Interferon (IFN)-γ secretion from peripheral blood cells was increased during the period with LEM administration. The change in IFN-γ secretion in the LEM administration period possibly correlated with changes in the Treg population., Conclusion: Oral administration of LEM may improve QOL and immunity in patients receiving cancer immunotherapy.

In recent years, quality of life(QOL) has received much attention as a subjective health outcome by which to measure and adopt patient treatment. Few studies, however, have examined how the QOL of cancer patients differs depending on treatment methods, or the effects of immunotherapy on patients' QOL. Thus, this study aimed to reveal: 1) the differences in QOL between patients treated with immunotherapy and other methods, and 2) whether the QOL of cancer patients treated with immunotherapy improves in accordance with the duration of immunotherapy. Thirty-nine cancer patients receiving immunotherapy who completed a Quality of Life Questionnaire for Cancer Patients Treated with Anti-Cancer Drugs(QOL-ACD) were the subjects for statistical analyses. The result indicated that patients treated with immunotherapy exhibited a higher physical conditions score than did patients receiving chemotherapy (p<0.01). Given that the side effects of immunotherapy are fewer than those of chemotherapy, the results suggested that the presence of side effects during cancer treatment plays an important role in determining patients' QOL.

Major radiological emergencies include criticality in nuclear power plants or terrorist attacks using dirty bombs or nuclear device detonation. Because irradiation itself does not cause any immediate death of the victims, and there is a minimum risk of secondary irradiation to medical personnel during decontamination procedures, lifesaving treatments should be prioritized. When a major radiological accident occurs, information is scarce and/or becomes intricate. We might face with significant difficulties in determining the exact culprits of the event, i.e., radiological or chemical or others. Therefore, it is strongly recommended for the national and local governments, related organizations and hospitals to develop comprehensive systems to cope with all hazards(chemical, biological, radiation, nuclear, and explosion) under the common incident command system.

False positive elevation of carcinoembryonic antigen (CEA) was observed in a 65-year-old woman who was treated with dendritic cell therapy (DCT) and activated lymphocyte therapy (ALT) for intrahepatic cholangiocarcinoma. Three months after the initiation of these therapies, her CEA value measured by AIA (TOSOH) began to increase without any evidence of worsening of cholangiocarcinoma. CEA was measured by several different methods, and only the result measured by AIA was high, indicating the presence of a false positive phenomenon. To clarify this phenomenon, we evaluated the patient's serum precisely. Gel filtration chromatography of her serum showed that CEA was detected in the elution fraction of IgG, which was different from the reference samples. Furthermore, this peak disappeared after incubation of patient's CEA and HBR-1. The immunoglobulin absorption test revealed that CEA value was decreased only after absorption of IgG and absorption tests using HBR-1 and MAK-absorbents showed a dramatic decrease in CEA value. These findings indicated the presence of IgG type human anti-mouse antibodies (HAMA), which interfered the measurement by AIA. Although we could not identify the reason why HAMA was produced in this patient, the facts that the false positive phenomenon was observed after the initiation of DCT and ALT, and that CEA value decreased after theses therapies were discontinued, indicated that immuno-modulaton by DCT and ALT may have a close relationship to HAMA production. It was probable that DCT and ALT activated preexisting heterophile-antibody-producing cells, which stimulated HAMA production. The incidence of such false positive reaction of CEA by HAMA in patients with DCT and ALT was low, but as the number of the patient with immuno-cell therapy increases, the incidence of such phenomenon surely increases. Because HAMA reacts to all types of immunoassay, careful attention should be paid to the evaluation of laboratory findings in patients undergoing with such immuno-cell therapies.

It is wellknown that cholinomimetic side effects, such as sedation, abdominal pain, nasal flow and watery eyes, may develop in patients in the early stage of Irinotecan (CPT-11) administration; however, there have been no investigations concerning methods for preventing the development of these side effects. To assess the protective effects of pre-treatment with d-CM on cholinomimetic side effects in the early stage after Irinotecan (CPT-11) administration, we prescribed d- Chlorpheniramine maleate (d-CM) to a group of patients prior to Irinotecan (CPT-11) administration. Twenty members from the group of non-d-CM-treated patients (n=39) and 4 members from the group of treated patients (n=20) complained of side effects. The pre-administration of d-CM significantly reduced the number of patients with side effects (p<0.05). The relative risk (RR) for the frequency of side effects was 0.39 (95% CI; 0.15-0.98), demonstrating that the frequency of side effects was significantly reduced. Based on theses findings, we concluded that the pre-administration of d-CM had protective effects against side effects that might develop in the early stage after Irinotecan (CPT-11) administration.

Leprosy is suspected to develop after a long period of latency following infection with Mycobacterium leprae (M. leprae) during infancy, but definitive proof has been lacking. We found a rare case of leprosy in a chimpanzee (Pan troglodytes) born in West Africa (Sierra Leone) and brought to Japan around 2 years of age. At 31, the ape started exhibiting pathognomic signs of leprosy. Pathological diagnosis, skin smear, serum anti-phenolic glycolipid-I (PGL-I) antibody, and by PCR analysis demonstrated lepromatous leprosy. Single-nucleotide polymorphism (SNP) analysis verified the West African origin of the bacilli. This occurrence suggests the possibility of leprosy being endemic among wild chimpanzees in West Africa, potentially posing a zoonotic risk.

Background: The backward, upward and rightward pressure (BURP) maneuver and cricoid pressure (CP) are easily confused because of their similarities. We surveyed nurses to determine their knowledge and skills regarding these maneuvers., Methods: Forty nurses (OR, n=20; ER, n=20) answered questionnaires regarding BURP and CP, and were then asked to apply CP to a laryngopharynx model equipped with a digital scale to measure compression force., Results: As for the BURP maneuver, 26 nurses (OR 20, ER 6) noted previous experience, while only 13 (OR 3, ER 10) and 1 (OR) nurses answered correctly regarding the compression point and correct direction, respectively. As for CP, 16 nurses (OR 14, ER 2) noted previous experience, but only 3 (all ER) answered correctly. Twenty-six nurses (OR 16, ER 10) incorrectly compressed the thyroid cartilage on the laryngopharynx model, and 24 (OR 18, ER 6) incorrectly applied backward and upward pressure, which was significantly frequent among the OR nurses. The measured forces of CP were 2.11 +/- 1.3 kg (mean +/- SD) and 2.5 +/- 2.1 kg for the OR and ER nurses, respectively, which were not significantly different., Conclusions: We found that the nurses are confused with the BURP and CP maneuvers. Unless applied correctly, these maneuvers may interfere with tracheal intubation. Constant education and training are essential for effective and safe implementation of these maneuvers.

Completion of Mycobacterium leprae genome sequence revealed that there are many pseudogenes and non-coding regions, but rather small numbers of protein-coding genes. Although it was thought that pseudogenes and non-coding regions were silent and junk, our previous studies indicated that RNA expression was detected from these regions. To elucidate comprehensive RNA expression pattern on M. leprae whole genome, tiling array was designed and total RNA of M. leprae Thai-53 strain was analyzed. As a result, highly expressed regions were detected among not only the gene regions but also pseudogenes and non-coding regions. Since some of the RNA expression levels were modulated by MDT, evaluation of RNA expression pattern might be a good indicator for the treatment of leprosy.

Completion of Mycobacterium leprae genome sequence revealed that there are many pseudogenes and non-coding regions, but rather small numbers of protein-coding genes. This result indicates that M. leprae is a very unique organism, and this future is important to understand the biological nature and/or pathogenicity of M. leprae, which remain unclear. We attempted to find the biological nature of M. leprae by detecting the gene and pseudogene regions transcribed at high level. We detected the genomic regions including pseudogenes and demonstrated that six out of twelve high expression regions were pseudogenes. In addition, its transcription level was changed when M. leprae infects macrophage. RNA was detected from genes, pseudogenes and non-coding regions. The expression levels of these regions were different among patients and a part of them is disappeared just after treatment. These results suggested that RNA derived from pseudogene and non-coding region have some function concerning the infection and/or intracellular parasitism and that the analysis of pseudogene and non-coding region expression pattern of M. leprae is available as a criterion for therapeutic effect and disease type of leprosy, and a prognostic marker.

BASIC: We treated mice inoculated LLC tumors with hyperthermia or activated lymphocytes. Both of hyperthermia and activated lymphocytes therapy reduced not only a tumor growth but also lung metastasis. And a combination therapy of hyperthermia and activated lymphocytes therapy reduced more of the tumor growth and lung metastasis synergistically. CLINICAL: We proceeded with hyperthermia (HT) for 472 cancer patients and activated lymphocytes (CAT) therapy for 384 patients and dendritic cell (DC) therapy for 94 patients. Two-hundred-thirty-eight patients of them underwent a combination therapy with hyperthermia and CAT therapy. And 92 patients received a combination therapy with hyperthermia and DC therapy. We proceeded with hyperthermia or immunotherapy for 526 cancer patients. And we have 67 clinical benefit cases including 8 complete response (CR) cases. These basic and clinical results indicate an effectiveness of a combination therapy with hyperthermia and cellular-immunotherapy for cancer patients.

The aim of education in the Medical Laboratory Science course, Kitasato University School of Allied Health Sciences, is to bring up train students who have Kitasato spirit, for careers in laboratory medicine of hospital or scientific staff of medical companies or as researchers. General and enlightening education concerning "Kitasato spirit" and professional education composed of major subjects was carried out in the first and during the 2nd and two third of 3rd grade, respectively. Medical practice and research training were alternatively carried out for 6 months between November of the 3rd year and November of the 4th year, in order to gain practical experience. Two problem-based learning (PBL) tutorial courses, "Infectious Diseases Course" and "Team Medical Care--Interprofessional Collaborations" were also carried out at the end of the 3rd and beginning of the 4th years, respectively, in order to convert a memory to knowledge. Team medical care course enrolls 1000 students at the School of Allied Health Sciences, Medicine, Nursing, Pharmacy and Kitasato College Applied Clinical Dietetics Course, is now one of special courses available at our university. This attempt is thought to result in a way of thinking that recognizes the importance of co-operation as a team member and personal contributions to actual team medical care.

It was previously demonstrated that TLR2 and CORO1A (TACO, Coronin 1, p57) localize phagosome membrane of macrophage. However, the functional relationship between TLR2 and CORO1A was not known. We show here that there is a functional counteraction between TLR2 and CORO1A.

Although Mycobacterium shinshuense and M. leprae infections are relatively rare in the fields of dermatology, an early diagnosis is one of the important prognostic factors of these infections. Applications of the genetical examinations such as PCR and 16S rDNA sequencing are helpful in early diagnosis with culture nagative cases. Short target PCR tests are available to detect DNA of M. shinshuense or M. leprae from clinical specimens including formalin fixed-paraffin embedded samples. A partial 16s rDNA sequencing is functional with enough intact bacterial DNA. A similarity search based on the partial 16S rDNA sequences using RIDOM database is an easy and powerful tool to estimate the species of mycobacteria, however, it is not enough for the identification in some cases. For instance, a clinical isolate of M. shinshuense is clearly discriminated from M. leprae (92.75% sequence identity), however, difficult to be identified from M. marinum and M. ulcerans (99.77% sequence identity). The phylogenetic tree based on 16S rDNA sequences is illustrating that both M. leprae (closely related to M. haemophilum) and M. shinshuense (closely related to M. marinum and M. ulcerans, and also M. tuberculosis) are relatively related species and distantly related to rapidly growing species among 30 species of pathogenic mycobacteria which have been isolated in Japan.

It seems that mitral valve surgery in patients older than 80 years increase against the background of the aging society. Basically, there are not particular differences between elderly patients and younger patients in procedures for diagnosis and operative indication in mitral valve diseases. However, cardiac surgery for patients older than 80 years has been reported to have high mortality rate. Therefore, it is necessary that we should evaluate and treat complications of important organs such as brain/coronary artery/lungs/liver/kidney, adequately. Our mortality rate of the whole mitral valve operations was 2.4% and that of patients older than 75 years was 7.9%. This result compares favorably with those reported from other institutions. However, when we perform mitral valve operations for patients older than 80 years, it is necessary to investigate activities of daily living and quality of life before and after the operation.

Although an expression of MHC molecules and tumor associated antigens of the cancer are not uniform, we consider that the cancer immunotherapy for some specific tumor antigens cannot correspond to molecular biological varieties of the cancer. Consequently, we tried to develop a method to separate dendritic cells (DC), T-cells and natural killer (NK) cells from peripheral blood mononuclear cells (PBMC) obtained from healthy volunteers. PBMC were separated by centrifugation on Ficoll-Hypaque gradients from peripheral blood obtained from healthy volunteers. After separating these cells, the cells were put into a plastic flask, and we isolated monocyte fraction (dendritic cells), NK cell fraction and T-cell fraction one after another by the difference in its ability to adhere to a plastic flask. We analyzed surface markers and activation states of these groups. We could induce dendritic cells from the monocyte fraction, CD3-activated T-cells (CAT) from the T-cell fraction, and adherent lymphokine activated-killer cells (A-LAK) from the NK cell fraction. Therefore, we indicate the possibility of the combined cell therapy with three immune cell fractions in which we can induce from the same blood at once.

The use of neoadjuvant chemotherapy for pancreatic cancer has been advocated for its potential ability to optimize patient selection for surgical resection and to downstage locally advanced tumors, especially for patients with Stage IV b (Japan criteria). We report our experience with a six-drug chemotherapeutic regimen that resulted in sufficient downstaging of the tumor in some patients to justify surgical resection. From Jan. 2001 through December 2003, 6 patients received 5-FU as a continuous infusion (200 mg/m2/day), calcium leucovorin weekly by intravenous bolus injection (30 mg/m2), mitomycin-C every 6 weeks (10 mg/m2 intravenously), and dipyridamole daily orally (75 mg), according to the UCLA regimen and gemcitabine weekly (600 mg/m2) and heparin as a continuous infusion (0-3,000 U/day) for locally advanced unresected pancreatic cancer. All of these patients were evaluable for response and survival. There were 5 partial responses (83% response rate) and 1 no response. Four of 5 responding patients had sufficient tumor regression to meet clinical criteria for resectability, three of whom underwent a curative resection. All patients who underwent downstage operation were still alive for the follow-up period (4-23 months).

Background: Emergency tracheal intubation in the pre-hospital environment is generally more difficult than when performed at a hospital. Among the reasons making it more challenging, is the rescuer's position. We compared tracheal intubation between 2 settings, on a table and on the ground., Methods: Ten staff anesthesiologists were asked to intubate mannequins placed on a table and on the ground. Measured variables included intubation time, Cormack grade, incidence of esophageal intubation, "crick" sound from the teeth of the mannequin, and degree of head tilt during intubation attempts., Results: Mean intubation times on the table and ground were 12.6 +/- 3.9 and 14.7 +/- 6.5 seconds, respectively. No esophageal intubation occurred. Cormack grades and incidence of teeth click were significantly higher on the floor, whereas there was no difference regarding degree of head tilt between the 2 settings., Conclusions: Our results indicate that intubation on the ground is more difficult and may require a longer time to accomplish, even for experienced anesthesiologists. Therefore, those involved in airway management training for emergency personnel should acquire appropriate skills to teach tracheal intubation in such a difficult situation.

We have developed guidelines of pharmaceutical activity which describes how pharmacists are actively involved in supporting the initial treatment of poisoning and overdosed patients in the Intensive Care Unit (ICU). These guidelines are derived from the original procedural manual that consisted of protocol charts. The charts provide the pharmacist including ICU staff members with directions for the collection of clinical information and the forms to use for documentation. We focused on appropriate collection and proper preservation of collected samples in order to perform diagnostic analysis when needed. The original Information Record Form, completed by the participating pharmacist, documents all information regarding the patient's care. This record provides for integration of the diverse and complicated clinical information of the patient so that the physician can gain a comprehensive picture of the patient. The guidelines, manual book, materials for sample collection and the Information Record Form are stored in a container called the "Poisoning Aid Set", which will be available in the ICU. The guidelines are activated once an emergency call from paramedics is received regarding a suspected poisoning patient. According to the guidelines, the emergency room (ER) physician immediately contacts the pharmacist who will provide his professional services as a member of the treatment team. We have applied these guidelines to 29 poisoning patients and have critically evaluated for effectiveness. Early participation by pharmacists, by reviewing timely, accurate and competent clinical information enabled the pharmacist to identify the suspected drug from the biological samples obtained. From our experiences, we conclude that this active involvement of pharmacist in the initial treatment of poisoning and overdosed patients in the ICU was both supportive and beneficial to the patient. In addition, the participation of pharmacist as a member of a treatment team provided an excellent opportunity to collaborate with the entire ICU staff members.

In the present study, we examined the contributions of lymphocyte subpopulations in lymphokine activated killer (LAK) activity. LAK cells prepared from peripheral blood mononuclear cells (PBMC) of healthy donors showed highly cytotoxic activities against target tumor cells. When CD16 and CD56 positive cells in LAK cells were depleted by magnetic cell sorting, their cytotoxic activities were dramatically decreased. In contrast, little change was observed by the depletion of CD3 positive cells, suggesting that CD16 and/or CD56 positive populations, but not CD3 positive populations, including natural killer (NK) cells are the major cell types involved in LAK activity. Indeed, NK-enriched LAK cells prepared by culturing PBMC with IL-2 and OK-432 showed a more potent LAK activity than conventional LAK cells and CD3-activated T cells. These results suggest that selective expansion and activation of CD16 and CD56 positive cells in LAK cells is a useful strategies to improve their anti-tumor potential in nonspecific immunotherapy, and possibly in combination therapy with other target immunotherapies as well.

We examined several culture methods to induce proliferation of natural killer (NK) cells from peripheral blood mononuclear cells (PBMC). In the presence of IL-2, a remarkable proliferation of NK cells was observed when PBMC were co-cultured with MMC-treated K562, which is known as a highly sensitive in vitro target cell for the NK assay. Addition of OK-432 or TNF-alpha and IL-1 beta also induced marked NK proliferation in a dose dependent manner. These NK-enriched lymphokine activated killer (LAK) cells showed highly cytotoxic activities against various MHC class I positive or negative tumor cells. They also showed potent ADCC activities against Herceptin-coated SK-BR-3, a HER2/neu positive breast cancer cell line. These results indicated that NK-enriched LAK cells are potent effector cells, and suggested novel therapeutic strategies for nonspecific immunotherapy as well as target immunotherapy in combination with anticancer antibodies, such as Herceptin.

An 18-year-old man underwent emergency craniotomy for acute epidural hematoma under general anesthesia using suxamethonium and isoflurane. Marked rises in end-tidal carbon dioxide, body temperature, and serum potassium occurred during the surgery. After intravenous dantrolene sodium administration, the body temperature dropped rapidly. No conspicuous postoperative elevation of serum creatine kinase levels were observed. Postoperative muscle biopsy specimen revealed increased calcium-induced calcium release.

To determine how the education of basic life support (BLS)/advanced cardiac life support (ACLS) and emergency medicine for anesthesiologists is conducted, we performed a survey of chairpersons at university departments and newly board certified anesthesiologists in 1999. Basic and advanced life support courses for residents were provided in more than half of the anesthesiology departments that responded to this survey. However, approximately only 10% of the respondents had regular BLS/ACLS courses for residents. On the other hand, more than 80% of respondents considered a rotation in emergency medicine desirable as a part of anesthesia training. To improve the resuscitation skills of anesthesiologists, an urgent need to establish regular BLS/ALS courses and educational programs in emergency medicine in anesthesia training does exist.

The rationale for surgery in achalasia is to reduce lower esophageal sphincter (LES) pressure and recontruct an antireflux mechanism. Fundopexy as an antireflux procedure after LES myotomy (modified Heller myotomy), called the Jekler and Lhotka method or the Heller and Dor operation, is commonly performed as standard surgery. In our institution, this method has been used since 1982. We have performed the modified Jekler and Lhotha method including long myotomy to confirm complete reduction of LES pressure as measured by intraoperative manometry and fundopexy plus posterior wall fixation to contract the long abdominal esophagus since 1986. Satisfactory results with this procedure have been obtained and reported. Furthermore, we have recently performed this procedure with minilaparotomy. In this review, we describe the modified Jekler and Lhotha method in minimized laparotomy and evaluate this procedure using intraoperative manometry.

This study was undertaken to evaluate thirteen elements of basic life support skills of the First Aid Course II/Standard First Aid Course (FAC II/SFAC) ambulance personnel and to determine the effects of FAC II/SFAC education and basic life support instructor courses. Ninety-eight FAC II/SFAC ambulance personnel were enrolled in this study. It was found that only half of the personnel possessed the skills required for assessing respiration, mask holding and producing adequate tidal volume by the bag-valve-mask devices at the acceptable levels. Regarding the effect of the time that had passed following FAC II/SFAC education, we did not find any correlation between the time and the levels of skills. However, there was a tendency in which the skills for assessing mental status/respiration and for manual airway control were less adequately possessed by FAC II/SFAC personnel who did not take basic life support instructor courses, particularly those who had completed FAC II/SFAC education more than four years prior to this study. Since airway control and respiratory management play a key role in saving patients in life-threatening conditions, we need to critically reevaluate how the initial FAC II/SFAC education and continuing education programs can best be implemented.

The points of the postoperative care in radical operation of esophageal cancer are followings. 1) Postoperative nutritional management: In the reconstruction using gastric tube, we make Witzel's gastrostomy in antrum of regardless of the reconstructive routes and transfer to enteral tube-feeding to assist the oral food-taking amount. These management is not only attributing to assist early return to working but also effective to prevent the loss of postoperative physical strength in older patients. 2) Postoperative adjuvant therapy: The esophageal cancer is the diseases that react chemo- and radio-therapy, so most of advanced cases were treated with adjuvant therapy. Nowadays, it is essential for patients to explain the real diagnosis, treatment regimen, then to agree to the informed concent. After informed, the tender mental consult during treatment and outpatient service is required for mental burden. 3) Postoperative follow-up: The recognition of postoperative QOL, early detection of recurrence are mostly emphasized during 2 years after operation. The occurrence of secondary cancer (gastric cancer, cervico-pharyngeal cancer, colorectal cancer etc.) are seen in even 5-10 years after operation. Then the long-term periodical examination and life care are needed.