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A series of the experiments was conducted to understand the effect of weight, size, shape, stiffness, material of collision object, and type of movement of collision object on mobilization characteristics of impact force. Results from the element rockfall test, rockfall test using slope model, are introduced in the paper. The relationships between the maximum amplitude of the impact force and the momentum were highly scattered depending on the shape, stiffness, constituent material, and type of the movement of the collision object. On the other hand, the results obtained from the tests indicated that the relationships between force product and momentum of the impact load can be expressed by single linear equation with high coefficient of determination although the test conditions were largely different. The knowledge obtained from the reduced scale tests, which are element rockfall test and rockfall test using slope model, extended to the prototype scale by referring to the results of the dynamic centrifuge model test and pendulum test conducted by authors and others. By reflecting these knowledges, a concept of the energy-based design approach, which makes it possible to rationalize the design of the protection wall for rockfall and sliding soil mass, is also proposed. [ABSTRACT FROM AUTHOR]

An obese man (height, 178 cm; weight, 160 kg; body mass index, 50.5 kg/m) with a history of recurrent ventricular tachycardia (VT), cardiomyopathy, coronary sclerosis, and insulin-resistant diabetes suffered a right femur fracture in a vehicular accident. His fracture was repaired the following day, but shortly after surgery, his serum potassium (K) level increased, presumably due to K leakage from the injured muscles, leading to persistent VT and death. An autopsy revealed severe cardiac hypertrophy, moderate coronary sclerosis, and histological findings of myocardial hypercontraction, but not myoglobin-related renal failure, pulmonary thrombosis, lipid emboli, or inflammation. The hyperkalemia was not corrected by glucose-insulin infusion and led to the death of the patient due to the preexisting cardiomyopathy, coronary sclerosis, and a predisposition to VT. In addition to the autopsy, the analysis of the clinical course was indispensable for determining the cause of death as hyperkalemia-related VT. [ABSTRACT FROM AUTHOR]

Beta-blockers are important for severe-status patients with atrial fibrillation-related tachycardia. Beta 1-selective intravenous injection are routinely used, but long-term administration is difficult due to cost-performance- or management-related issues. A bisoprolol patch, a beta-blocker to be percutaneously absorbed, recently became commercially available in Japan. As it may facilitate effective absorption and a mild elevation of the blood concentration, we retrospectively analyzed 16 patients with atrial fibrillation-related tachycardia who were admitted to the Intensive Care Unit of Hitachi General Hospital Emergency and Critical Care Center, and underwent switching therapy from landiolol to a bisoprolol patch. For switching, the bisoprolol patch (4 mg) was attached to each patient. The bisoprolol patch was introduced 88 h after the start of landiolol administration, when the rate was approximately 3 μg/kg/min. Landiolol injection was combined with bisoprolol for 15.4 ± 17.5 h. Switching therapy was successful in all subjects. The introduction of the bisoprolol patch did not induce any significant changes in the blood pressure or heart rate. After the completion of landiolol administration, there were also no significant changes in either parameter. There were no adverse events. In severe-status patients, switching therapy from landiolol injection to the bisoprolol patch can be conducted safely, and might be useful for heart-rate control. [ABSTRACT FROM AUTHOR]

This report highlights about one acute respiratory distress syndrome (ARDS) case after near-drowning resuscitated using extracorporeal membrane oxygenation (ECMO). Few cases have been reported about ECMO use for near-drowning and in most of these cases, ECMO was initiated within the first week. However, in our report, we would like to emphasize that seemingly irreversible secondary worsening of ARDS after nearly drowned patient was successfully treated by ECMO use more than 1 week after near-drowning followed by discharge without home oxygen therapy, social support, or any complication. This is probably due to sufficient lung rest for ventilator-associated lung injury during ECMO use. Based on our case's clinical course, intensive care unit physicians must consider ECMO even in the late phase of worsened ARDS after near-drowning. [ABSTRACT FROM AUTHOR]

Evaluation of the intravascular blood volume is an important assessment in emergency and critical care medicine. Measurement of the inferior vena cava (IVC) respiratory variation by ultrasound echography is useful, but it entails subjective problems. We have hypothesized that IVC cardiac variation is also correlated with intravascular blood volume and analyzed it automatically using computer software of two kinds, later comparing the results. Snakes, software to track boundaries by curve line continuity, and template matching software were incorporated into a computer with an ultrasound machine to track the short-axis view of IVC automatically and analyze it with approximation by ellipse. Eight healthy volunteers with temporary mild hypovolemia underwent echography before and after passive leg raising and while wearing medical anti-shock trousers. IVC cardiac variation was visually decreased by both leg raising and medical anti-shock trousers. The collapse index (maximum − minimum/maximum) of area during three cardiac beats was decreased showing a good relationship to fluid load simulations; 0.24 ± 0.03 at baseline versus 0.11 ± 0.01 with leg raising and 0.12 ± 0.01 with medical anti-shock trousers. In conclusion, IVC cardiac variation has the potential to provide an evaluation of water volume. It presents some advantages in mechanical analysis over respiratory variation. At the very least, we need to exercise some caution with cardiac variation when evaluating respiratory variation. [ABSTRACT FROM AUTHOR]

Recent study revealed that photodynamic therapy (PDT) with a novel photosensitizer (ATX-S10(Na)) shows more potent effects for various skin diseases than ALA-PDT. The effect of ATX-S10(Na)-PDT on dermal fibroblasts is still unknown. Using dermal fibroblasts derived from normal and scleroderma patients, and mouse skin in vivo, we compared the effects of ATX-S10(Na)-PDT and ALA-PDT. Fibroblasts from normal, scleroderma patients or mice skin were treated with ATX-S10(Na)-PDT or ALA-PDT. After the PDT treatments, the expression of matrix metalloproteinases (MMPs) Tissue inhibitors of metalloproteinases (TIMPs) and collagen synthesis was assayed using ELISA and reverse transcription-PCR (RT-PCR). The expression of MMP-1 and MMP-3 was slightly decreased and collagen I mRNA was significantly increased in scleroderma fibroblasts compared with normal fibroblasts. Both ATX-S10(Na)-PDT and ALA-PDT increased the expression of MMP-1 and MMP-3 in protein and mRNA levels in both normal and scleroderma fibroblasts with more potent effect by ATX-S10(N)-PDT. Collagen I synthesis was markedly decreased by ATX-S10(Na)-PDT and by ALA-PDT again with more potent effect by ATX-S10(Na)-PDT in both normal and scleroderma fibroblasts. In mice skin the effect of PDT for MMPs and collagen I was also detected and the effect was more potent in ATX-S10(Na)-PDT. In contrast, MMP-2, TIMP-1, TIMP-2, and collagen III expression was not affected by the ATX-S10(Na)-PDT or ALA-PDT treatment. ATX-S10(Na)-PDT is more potent modulator for dermal matrix components than ALA-PDT and might be useful for scleroderma patients. [ABSTRACT FROM AUTHOR]

Therapeutic results of gastric cancer have been improved by early detection of gastric cancer with the mass screening system in Japan. The objective of our study was to assess the efficacy of mass screening for gastric cancer by using a barium meal. A series of 1050 patients (364 in the screened group and 686 in the nonscreened group) were included in this study from April 1992 to March 2000. Patient characteristics, therapeutic results, and prognostic factors were compared in the two groups. The screened patients tended to be younger and male, with tumors in the middle third of the stomach that were of a macroscopically superficial type, with a smaller diameter, and at an earlier stage. They had fewer metastatic lymph nodes and underwent more frequent curative resection. Among the screened patients with curatively resected disease, tumors tended to be of a smaller diameter, and there were fewer metastatic lymph nodes in both early and advanced cases. Disease-specific survival was significantly better in the screened cases among all registered and curatively resected patients. Mass screening achieved significantly better surgical results in early or advanced gastric cancer patients who received curative resection. Multivariate analysis revealed that mass screening was an independent prognostic factor (hazard ratio, .3949; P < .0001), together with depth of invasion, lymph node metastasis, age, and tumor diameter. Mass screening by using barium meal examination for gastric cancer detects cancer at an early stage and produces good therapeutic results. [ABSTRACT FROM AUTHOR]

We studied hydrophilic photosensitizer ATX-S10Na(II) mediated photocytotoxicity against macrophage-like cell under pulsed irradiation. We found that photocytotoxicity suppression under high intensity irradiation was directly induced by a decrease in the Type-II photoreaction. We showed that this decrease was not attributable to absorption saturation with the high intensity irradiation. We found the cell lethality change from 70% to 13% with the pulse peak power density ranging from 0.29 MW/cm(2) to 1.36 MW/cm(2), at the light dose of 20 J/cm(2) and the pulse repetition rate at 40 Hz. To investigate the Type-II reaction, we measured the photobleaching, oxygen consumption and singlet oxygen luminescence of the photosensitizer solution. The transient absorption from the photosensitizer during the irradiation was measured with the pump-and-probe technique. We believe that the photocytotoxicity suppression induced by the high intensity irradiation might be useful for the treatment of depth-controlled photodynamic therapy without the wall damage of a hollow organ. [ABSTRACT FROM AUTHOR]

Photodynamic therapy (PDT) using 5-aminolevulinic acid (ALA) is available for the treatment of actinic keratosis (AK). Recently, we developed a new PDT photosensitizer, ATX-S10(Na), and have shown that ATX-S10(Na) PDT is effective for the treatment of various human skin diseases, such as squamous cell carcinoma, Bowen’s disease, basal cell carcinoma, and psoriasis. In the present study, we compared the effects of ATX-S10(Na) PDT and ALA PDT on hyperproliferative skin induced by 12-O-tetradecanoylphorbol-13-acetate (TPA), on the squamous cell carcinoma cell line, SCC15, in vitro, and on UVB-induced skin tumors in vivo. TPA treatment induced epidermal acanthosis, which was more markedly suppressed by ATX-S10(Na) PDT than by ALA PDT. ATX-S10(Na) PDT more effectively eliminated UVB-induced AK and squamous cell carcinoma (SCC) than ALA PDT. Furthermore, both ATX-S10(Na) PDT and ALA PDT induced the death of SCC15 cells, and the effect of ATX-S10(Na) PDT was greater than that of ALA PDT. Our results indicate that ATX-S10(Na) PDT might be more effective than ALA PDT for the treatment of various skin diseases. [ABSTRACT FROM AUTHOR]

Background/purpose. Photodynamic therapy (PDT) is a potent treatment for skin tumors. Although the therapeutic effect of PDT is supposed to be due to cellular cytotoxicity, the precise mechanism is still unknown. ATX-S10(Na) [13,17-bis(1-carboxypropionyl)carbamoylethyl-8-ethenyl-2-hydroxy-3-hydroxyiminoethylidene-2,7,12,18-tetramethylporphyrin sodium salt], a novel hydrophilic chlorin photosensitizer, shows good accumulation in tumors and is suitable for use in PDT. In this study, we investigated the mechanism of PDT-induced cell death using ATX-S10(Na). Methods. Following ATX-S10(Na) treatment for 12 h, normal human keratinocytes (NHK) were irradiated using a diode laser. PDT-induced cell death and the activity of various caspases were measured. Activation of Fas antigen was also determined by immunoprecipitation analysis. The expression of Bax, cytochrome c, and apoptosis-inducing factor (AIF) was determined by Western blotting. Results. ATX-S10(Na)-PDT had induced apoptosis of NHK by 2 h and the maximal effect was observed at 6 h following irradiation. The effect was suppressed by pretreatment of NHK with inhibitors of caspases 3, 6, 8 and 9. A caspase activity assay revealed the sequential activation of caspases 8, 3 and 6, and caspases 9, 3 and 6, respectively. Immunoprecipitation analysis indicated multimerization of Fas antigen without Fas ligand binding in ATX-S10(Na)-PDT-treated NHK. Western blotting revealed cytosolic release of cytochrome c and AIF accompanied by decreased Bax expression in the cytosol. Conclusions. ATX-S10(Na)-PDT induces apoptosis of NHK, and this was mediated by sequential activation of two caspase cascades, caspases 8, 3 and 6, and caspases 9, 3 and 6. This was accompanied by multimerization of Fas antigen and cytosolic release of cytochrome c and AIF. [ABSTRACT FROM AUTHOR]

From 1977 to 1983 we have used electric drill needle biopsy of suspicious masses in the breast in 437 patients. In 104 patients with primary breast carcinoma 94 were diagnosed correctly by the initial biopsy, 9 were found on the second or third biopsy and one on the subsequent excisional biopsy. The rate of accuracy of the initial biopsy was 90.4 per cent. The diameters of the 104 carcinomas were less than 2 cm in 62 (59.6 per cent), 2-5 cm in 39 (37.5 per cent) and 5 cm or more in 3 (2.9 per cent). There were 17 patients (16.3 per cent) with a tumor 10 mm or less in diameter. Three hundred and thirty three patients had benign lesions. This drill needle biopsy method can be performed easily and accurately on nodules less than 2 cm, or even 10 mm or less nodules. For a diagnosis of early breast carcinoma made in the outpatient clinic or in screening examination programs, this method may be the most appropriate. [ABSTRACT FROM AUTHOR]