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Supplemental doses of antithrombin (AT) are widely used to treat sepsis-induced disseminated intravascular coagulation (DIC) in Japan. However, evidence on the benefits of AT supplementation for DIC is insufficient. This multicenter retrospective observational study aimed to clarify the effect of AT supplementation on sepsis-induced DIC using propensity score analyses. Data from 3,195 consecutive adult patients admitted to 42 intensive care units for severe sepsis treatment were retrospectively analyzed; 1,784 patients were diagnosed with DIC (n = 715, AT group; n = 1,069, control group). Inverse probability of treatment-weighted propensity score analysis indicated a statistically significant association between AT supplementation and lower in-hospital all-cause mortality (n = 1,784, odds ratio [95% confidence intervals]: 0.748 [0.572-0.978], P = 0.034). However, quintile-stratified propensity score analysis (n = 1,784, odds ratio: 0.823 [0.646-1.050], P = 0.117) and propensity score matching analysis (461 matching pairs, odds ratio: 0.855 [0.649-1.125], P = 0.263) did not show this association. In the early days after intensive care unit admission, the survival rate was statistically higher in the propensity score-matched AT group than in the propensity score-matched control group (P = 0.007). In DIC patients without concomitant heparin administration, similar results were observed. In conclusion, AT supplementation may be associated with reduced in-hospital all-cause mortality in patients with sepsis-induced DIC. However, the statistical robustness of this connection was not strong. In addition, although the number of transfusions needed in patients with AT supplementation increased, severe bleeding complications did not.

The cancellation task is a visual search task requiring rapid and accurate placement of a mark through each occurrence of a specific target displayed in an array of distractors on a sheet of paper. This study of 30 university students was conducted to examine the effects of visual field constriction on visual search in the cancellation task. Participants administered the orderly array cancellation task and the random array cancellation task while their visual fields were unrestricted (full vision), or restricted to 5°, 10°, or 15° by tunnel vision simulation goggles. The number of errors, time to completion, and the performance score as an index of cancelling efficiency were calculated. Results showed that the time to completion and the performance score were significantly greater in the random array cancellation task than in the structured array cancellation task, and in the narrowest visual field condition (5°) than in other visual field conditions (10°, 15°, and full vision). These results suggest that the visual search efficiency was degraded when the visual field was restricted to be less than 5° in the orderly and random array cancellation tasks used for this study.

Background The administration of low-dose intravenous immunoglobulin G (IVIgG) (5 g/day for 3 days; approximate total 0.3 g/kg) is widely used as an adjunctive treatment for patients with sepsis in Japan, but its efficacy in the reduction of mortality has not been evaluated. We investigated whether the administration of low-dose IVIgG is associated with clinically important outcomes including intensive care unit (ICU) and in-hospital mortality. Methods This is a post-hoc subgroup analysis of data from a retrospective cohort study, the Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study. The JSEPTIC DIC study was conducted in 42 ICUs in 40 institutions throughout Japan, and it investigated associations between sepsis-related coagulopathy, anticoagulation therapies, and clinical outcomes of 3195 adult patients with sepsis and septic shock admitted to ICUs from January 2011 through December 2013. To investigate associations between low-dose IVIgG administration and mortalities, propensity score-based matching analysis was used. Results IVIgG was administered to 960 patients (30.8%). Patients who received IVIgG were more severely ill than those who did not (Acute Physiology and Chronic Health Evaluation (APACHE) II score 24.2 ± 8.8 vs 22.6 ± 8.7, p

Severe sepsis is a major concern in the intensive care unit (ICU), although there is very little epidemiological information regarding severe sepsis in Japan. This study evaluated 3195 patients with severe sepsis in 42 ICUs throughout Japan. The patients with severe sepsis had a mean age of 70 ± 15 years and a mean Acute Physiology and Chronic Health Evaluation II score of 23 ± 9. The estimated survival rates at 28 and 90 days after ICU admission were 73.6 and 56.3 %, respectively. Electronic supplementary material The online version of this article (doi:10.1186/s40560-016-0169-9) contains supplementary material, which is available to authorized users.

乳び胸の発症原因は胸部外科手術後，外傷，胸部悪性腫瘍などが知られているが，腸間膜腫瘍に合併するものは，これまで報告されていない．今回，われわれは腸間膜腫瘍手術後に乳び胸が消失した興味深い病態を経験したので報告する．症例は78歳，女性．平成16年4月に左側腹部痛が出現し，この時の腹部CTで，腸間膜に石灰化を伴う腫瘤を指摘．外来経過観察されていたが，平成19年9月より増大傾向を示し，平成21年10月のCTでは小腸の浮腫，腹水出現のほか，下痢，栄養状態悪化も認めるため，当科入院となった．入院時に右胸水貯留があり胸腔穿刺を行ったところ乳び胸水であった．腫瘍切除を試みたが，上腸間膜動静脈を巻き込み，周囲との強い癒着があったため生検に止め，浮腫をきたした部分のみ小腸切除した．術後に胸水の貯留はなく，下痢，栄養状態も改善し良好な経過であった．乳び胸の発生に腹腔内腫瘍の関与が推察され，念頭に置くべきと考えられた．

A 73-year-old man admitted for near drowning was found after 24 hours of mild therapeutic hypothermia to have pneumonia. Blood gas analysis showed metabolic acidosis, hypercapnia, and hyponatremia. Chest X-ray and computed tomography (CT) showed bilateral mainly lower-lobe consolidation. After being treated with 13.5 g of tazobactam/piperacillin and 1.0-1.25 g of vancomycin per day for two weeks, the man recovered from his severe respiratory failure. Enterococcus faecium was isolated twice from sputum and raising the dose of vancomycin was effective, but it took 10 days to wean him from ventilator support. While this case may be rare, therapeutic hypothermia and near drowning together were considered predisposing factors in the severity of the pneumonia caused by E. faecium. The possibility of pneumonia due to vancomycin-resistant Enterococci should thus be considered in similar cases.

The area near the left gastric vein (LGV) is a challenging site at which to perform dissection of the lymph nodes during gastrectomy. Therefore, knowledge of the precise location of the LGV is important. The objective of this study was to examine the usefulness of multidetector computed tomography (MDCT) for the identification of the LGV.Eighty-one patients with gastric cancer underwent MDCT, which was performed with contrast media in 76 patients and without contrast media in 5 patients. A 5-mm thin slice of the frontal image was reconstructed. These images were examined preoperatively to detect the location of the LGV. Upon gastrectomy, the LGV was identified and its location compared to that determined by MDCT.The LGV was identified by MDCT in 76 of the 81 patients (93.8%). The LGV was subsequently located during the operation in all 81 patients. The LGV was located dorsal to the common hepatic artery in 40 patients (49.4%), ventral to the common hepatic artery in 18 patients (22.2%), ventral to the splenic artery in 17 patients (21.0%), dorsal to the splenic artery in 2 patients (2.5%) and in other positions in 4 patients (4.9%). In all patients, the location of the LGV detected using MDCT was consistent with that identified during gastrectomy. In the 4 patients with relatively unusual locations of the LGV, these 4 LGV variants were identified preoperatively by MDCT.MDCT was useful for identifying the location of the LGV prior to gastrectomy.

もともと膿胸を発症する症例はハイリスクであり，可能な限り手術は回避したいところである．今回，われわれは急性膿胸に対しウロキナーゼの胸腔内投与直後から奏効した2症例を経験したので報告する．症例1は61歳男性．糖尿病で加療中．発熱，右胸部痛を認め，胸水は混濁し，胸部CTにて多房化胸水を認め当科紹介．症例2は60歳男性．左視床出血後の繰り返す誤嚥性肺炎にて気管切開を施行．高熱があり，胸部CTで多房化胸水を認めた．試験穿刺では混濁しており当科紹介．いずれの症例も線維素膿性期の急性膿胸と診断し胸腔ドレーン留置したが，十分に排液できず，発症12日目，15日目にウロキナーゼを胸腔内投与した．投与直後より良好な排液を認め，膿胸腔は縮小しドレーン抜去できた．その後再発なく，有害事象も認めなかった．線維素膿性期の急性膿胸にウロキナーゼ胸腔内投与は低侵襲で早期に奏効する可能性がある検討すべき治療手段の1つと考えられた．

症例は55歳の男性で，食道癌に左開胸開腹下部食道噴門側胃切除（well diff. adenocarcinoma, Ae, 10 mm, T1aMM, n0, M0, stage 0）を施行した．周術期に出血傾向はなかった．術後53日目（53 POD）右股関節が腫脹，その後右背部も腫脹してきたため64 P0D当院を受診した．Hb 7.5 g/dlと貧血を認め緊急入院となった．CTで右腸腰筋から右股関節，背部の筋肉内に広範な出血を認めた．PTが軽度，APTTが高度に延長していた．輸血，FFPで経過を観察したが出血は持続，71 POD血管造影にて塞栓術を行った．しかし，貧血は進行，第VIII凝固因子活性が1％以下と判明したため全身疾患を疑い転院となった．精査の結果，第VIII凝固因子インヒビターによる後天性血友病であり，第VII凝固因子製剤によるBy-pass療法とステロイドで軽快した．消化器癌術後の凝固因子インヒビターによる出血はまれな疾患であるが，重篤な結果を招くこともあり，本疾患に対する認識と迅速な対応が必要であると思われた．

症例は50代男性．食道癌で右開胸胸部食道全摘，胃管による後縦隔経路再建を施行した．手術時Treitz靱帯より20cmの空腸に経腸栄養チューブを20cm挿入し，Stamm法で腸管に固定，刺入部を腹壁に固定した．術後経過良好であったが術後14日目に左下腹部痛が出現したので16日目にチューブを抜去した．その後も腹痛が持続，22日目に腹部CTを撮影し小腸の腸重積を指摘された．経過観察としたが27日目のCTでも腸重積が認められたため手術となった．開腹すると小腸を腹壁に固定していた部分より肛門側20cmの空腸に約10cmの順行性3筒性の腸重積を認めた．癒着で解除困難であったため小腸切除を行った．腸重積発生部は経腸栄養チューブが位置していた部分であり経腸栄養チューブが誘因になったと考えられた．経腸栄養チューブによる腸重積は非常に稀な合併症であるが，注意を要すると思われた．

The authors examined the relationship between visual acuity and daily behavior in people with severe motor and intellectual disabilities (SMIDs). The visual acuity of 15 subjects was assessed using two methods: Teller Acuity Cards and the STYCAR balls vision test. The subjects' caregivers evaluated the subjects' daily behavior and completed a questionnaire. Results implied that visual acuity and behavior were correlated.

In recent years, business transactions through electronic data interchange (EDI) have spread globally; usefulness of EDI has been anticipated in the market. Although EDI transactions require a standard code format, various problems have occurred through use of such code in actual markets. This paper presents a new data transmission code for seafood EDI, expanding conventional standard formats of the product code. Subsequently, we present a new EDI system model using the new code which includes two main functions: product definitions and learning of code transmission. The system test in a market showed efficiency and effectiveness of the model.

An isolated upper fourth premolar (P4) of the extinct red panda Parailurus was recovered from the Pliocene (3–4 Ma) Ushigakubi Formation near Tochio, Niigata Prefecture, Japan. This is the first report of Parailurus from Asia, a genus previously known from Europe and northwestern North America. The Tochio P4 is about 50 percent larger than that of the extant Ailurus fulgens, lacks an entostyle, but has a lingual cingulum, protoloph with paraconule, a marked posterior cingulum with fine wrinkles, and a distal buccolingual groove. The transverse width of the P4 is greater than the anteroposterior length; the reverse is true of Parailurus anglicus from Europe.

越後平野北部における沖積層層序と堆積環境の変遷を解析し,縄文海進期に形成された汽水湖沼の成立過程とその変遷について検討した.その結果は以下のとおりである.(1)8,000年前以前には胎内川扇状地と加治川扇状地との間は低地であった.約8,000年前に海水準の上昇とともに,低地前面に砂州が発達し,低塩分の汽水湖沼が形成された.汽水湖沼の出口は加治川以南に求められる.(2)汽水湖沼は次第に塩分を減少していき,海水や淡水が交互に流入する時期を経て,約5,000年頃までに淡水湖化した.(3)淡水湖は約5,000年前以降に北部から埋積されたが,9世紀になって水域が拡大し,現在の塩津潟となった.

We performed genome-wide linkage analysis in 58 patients and nine unaffected members among 28 families with no mutation in BRCA1 or BRCA2, employing a set of 410 microsatellite markers. We initially screened the whole genome, including the X chromosome, by a non-parametric method using the GENEHUNTER program. As a result, chromosome 3p22-p25 showed a suggestive score for linkage [LOD = 3.49 and non-parametric LOD (NPL) = 2.77 at D3S3611] based on a multipoint analysis. Additionally, based on a two-point analysis using dense markers, this 3p22-p25 region showed a P-value0.05 at 10 markers and there is suggestive evidence for linkage at two markers within approximately 19 cM (NPL = 2.60 and 2.49 at D3S1597 and D3S3611, respectively). To explore whether the candidate gene in this 3p22-p25 region contributed to carcinogenesis of familial ovarian cancer in a similar fashion to the tumor suppressor gene, we performed loss of heterozygosity (LOH) analysis. It was observed that the frequency of LOH at four markers in this region was50% only in tumor tissues from patients with no mutation in BRCA1 or BRCA2, not in those with a BRCA1 mutation.

We examined the subcellular localization of BRCA1 proteins using immunohistochemical staining with C‐terminal (GLK‐2 antibody) and N‐terminal (Ab‐2 antibody) monoclonal antibodies in 44 familial ovarian cancers. Among these, 24 cases were associated with 13 independent germ‐line mutations of BRCA1, and loss of heterozygosity (LOH) at one or more BRCA1 microsatellite markers was found in all 21 informative tumors tested. With GLK‐2 antibody, cytoplasmic staining was observed in 15 of 16 tumors (93.8%) with mutation in exon 11, and BRCA1 staining was absent in 8 of 8 tumors (100%) with mutation in exons other than exon 11. When immunohistochemical staining was performed with Ab‐2 antibody, both nuclear and cytoplasmic staining were observed in 14 of 16 tumors (87.5%) with mutation in exon 11. Interestingly, nuclear staining was observed in 3 of 3 tumors (100%) with mutation downstream of exon 11, even though no staining was detected in 5 of 5 tumors (100%) with mutation upstream of exon 11. On the other hand, in familial ovarian cancers without BRCA1 mutations, nuclear staining or both nuclear and cytoplasmic staining was observed in 18 of 20 specimens (90%) and 20 of 20 specimens (100%) with GLK‐2 antibody and with Ab‐2 antibody, respectively. These results suggest that an immunohistochemical assay in combination with employing the C‐terminal and the N‐terminal antibodies appears to have potential as a reliable and useful technique for the screening of BRCA1 mutations, at least to predict the status of mutation, upstream or downstream of exon 11.

The stratigraphy of Late Cenozoic Niigata sedimentary basin has been examined since 1900's for exploring of oil and gas. The basic stratigraphical division was established by these works. Recent stratigraphical methods, biostratigraphies of planktonic foraminifers, diatoms and calcareous nannoplanktons, tephra-stratigraphy and paleomagneto-stratigraphy are very useful for detailed correlation and age determination. A combined method of several stratigraphies is effective for the purposes. In Niigata sedimentary basin the technique is adopted for stratigraphical studies.The history of the Sea of Japan has been discussed on the basis of field data taken from Niigata and Sado regions. The important events of geologic history are explained as following. 1) Early Miocene: the age of the eastern margin of continent, 2) Early/Middle Miocene: the age of great transgression, 3) early Middle Miocene: the age of deepening of a marginal sea I, 4) Middle and Late Miocene: the age of a deep sea, 5) Late Miocene/Early Pliocene: the age of uplifting and subsiding of a marginal sea, 6) Pliocene to Holocene: the age of climatic sea-level changes, subsiding of a sedimentary basin and uplifting of backbone ranges. The last age in Niigata region is divided into Pliocene marginal sea II, Early Pleistocene paleo-Uonuma plain, Middle-Late Pleistocene paleo-Echigo plain and Holocene Echigo plain.

Multiproxy analyses including grain size, total organic carbon (TOC), total sulfur (TS), total nitrogen (TN), calcium carbonate (CaCO3) contents, diatom as well as sedimentary properties of the boring core KM-11 (54m in length) collected from a brackish lake, Lake Kamo, are used to reconstruct paleoenvironment and coastal evolution of northeast coast of Sado Island in central Japan. Anoxic and normal marine sediments can be detected by TOC-TS relationship, and the origin of organic matter is inferred from the TOC/TN ratio. Geochemical characteristics of the sediments respond striking to sea-level change. In the Late Pleistocene, fluvial sediments are characterized by high TOC, very low TS and terrigenous organic matter. The overlying coastal marsh sediments are characterized by high TOC and abruptly increasing trend of TS suggesting sea water spilled into the site, and are overlain by estuarine sediments which obviously indicates the beginning of the Holocene transgression. Embayment sediments are characterized by low TOC, marine organic matter and low productivity condition indicating the rapid relative sea-level rise. The maximum Holocene transgression could be inferred between 6, 500 and 5, 000yrs BP. After that fluctuations of relative sea-level are characterized by high TOC, high TS, a mixed type of marine/terrigenous organic matter and high productivity condition to be inferred marine/brackish lagoonal sediments. Diatom floral changes of the core KM-11 also support the geochemical data to interpret the paleoenvironment and evolution of the coastal deposits.

高齢者の肺血栓塞栓症例を経験した.症例は81歳の男性で,呼吸不全,僧帽弁閉鎖不全と心房細動性頻脈,脱水,肝腎機能障害と凝固異常を伴っていた.エコー検査上右心房内血栓と右下肢深部静脈内血栓がみられた.心エコー図で右心房内血栓の消退を指標に,低分子ヘパリンとウロキナーゼで抗凝固・線溶療法を施行した.さらに深部大腿静脈結紮,Kimray-Greenfieldフィルターを下大静脈に挿入し,血栓症の増悪を予防した.肺動脈カテーテルを挿入しなかったため循環管理が困難で,一時肺水腫に陥ったが人工呼吸,利尿薬,強心薬で改善し,入室後19日目に転科した.心疾患の既往のある高齢者の肺血栓塞栓症の治療では,血栓の増悪の予防と循環管理が重要である.

越後平野の地下に分布する第四系は,他の平野に比べて非常に厚く,その最大層厚は新潟周辺で3,500m以上に達する.これは,越後平野が沈降性堆積盆地という特異な地域的特性にかかわっていることによる.この堆積物は第四紀における日本海側の歴史の一端をきわめて良好に記録しているとみなされる.越後平野の堆積盆は南北に長く,その堆積物は大規模な向斜構造を形成し,大きな断層帯あるいは急傾斜帯が平野の両側に沿って存在する.第四系は下位から西山層,灰爪層,未呼称中部更新統,蒲原層群,埋没段丘堆積物,西蒲原層,白根層,黒鳥層に区分される.西山層の上半部は下部更新統であり,Globorotalia inflataの層を伴う漸深海性の泥岩・砂岩からなる.灰爪層も同時代であり,Globorotalia inflataの層を伴う漸深海性の泥岩からなる.未呼称中部更新統はおもに漸深海から浅海相であり,蒲原層群は浅海性種の化石を伴うシルトと砂質礫の交互層からなる浅海ないしデルタ相である.埋没段丘堆積物は更新世後期および完新世の堆積物であり,西蒲原層は河川の礫からなる更新世最末期の堆積物である.白根層は最上部更新統～完新統であり,泥炭層を伴うシルトと砂の互層,海成シルト層などからなる.黒鳥層は完新統で,泥炭層を伴う泥・砂からなる.ここでは,越後平野の地下の第四系の層序,古環境などについて記述する.

第5回臨界安全性国際会議ICNC'95が1995年9月に米国アルバカーキにて開催された。参加者は17ヶ国から約300名,発表は約150件あった。今回の会議では,これまではよく知られていなかった旧ソ連の臨界実験施設,臨界安全研究のほか,臨界事故について初めて報告された。そのほか,燃焼度クレジット,動特性解析などで地道な研究の進歩が見られた。本稿では,このようなICNC'95での発表を通じて臨界安全性研究の現状を解説する。

原発性副甲状腺機能亢進症患者3名に対し,セボフルランによる麻酔管理を経験した。このうち2名の患者で生理食塩水とエルカトニンによる高Ca血症と脱水の術前補正を必要とした。麻酔中は,1名の患者で血清Ca値が術前値より上昇したが,3症例とも術中不整脈などの合併症もなく,術後覚醒も良好であった。本疾患の麻酔では,術中の安定した循環動態管理と,術後低Ca血症の早期発見が重要である。セボフルラン麻酔の麻酔調節性と速やかな術後覚醒は,これらの面で他の麻酔方法に比べ有用と思われた。

Experimental and computational studies have been performed on the temperature coefficients of reactivity in light-water moderated and reflected UO2 cores with soluble poisons such as boron and gadolinium. Experiments were carried out using the Tank-type Critical Assembly (TCA) in Japan Atomic Energy Research Institute (JAERI). Temperature coefficients of the cores with soluble poisons were measured by changing the temperature of the moderator and reflector from the room temperature to about 60°C. The dependence of temperature coefficients on the core configuration and the concentration of soluble poison was studied with the water level worth method. Temperature coefficients were calculated with a diffusion code CITATION included in the SRAC code system and a perturbation code CIPER for comparison with the experimental data. It was found that the temperature coefficients are always negative in the experimental cores (the water to fuel volume ratio (Vm/Vf) of 1.83) containing boron as soluble poison. On the...

The stratigraphical study of the Mio-Pliocene sedimentary rocks distributed in the Higashikubiki district, Niigata Prefecture, is important to make clear the geohistory of the northern Fossa Magna.These rocks are divided into the Sugawa, the Tamugigawa, the Higashigawa Formations and the Uonuma Group in ascending order. The Sugawa Formation consists of massive siltstone. The Tamugigawa Formation is composed of sandstone, mudstone and flysh type alternation of sandstone and mudstone. The Tamugigawa Formation is further subdivided into four members, that is, the Lower, the Middle, the Upper and the Shobu mudstone Members. The Higashigawa Formation is composed of sandy siltstone. These formations conformably superpose each other.The distribution of tephra marker beds in the Tamugigawa Formation indicates that the flysh type alternating beds of the Lower, the Middle and the Upper Members change laterally into the mudstone of the Shobu Member.Nine tephrozones are discriminated on the basis of the lithology and frequency of marker tephra beds. All tephra beds range in composition from rhyolite to dacite, except for the tephrozone VII, which is composed of andesitic tephras and especially effective to the correlation of Mio-Pliocene strata in this area.From the result of the F. T. dating of tuff layers and biostratigraphical data, each formation is correlative with the strata in the district of the Nishiyama Hill as follows; the Sugawa Formation with the Shiiya Formation, the Tamugigawa Formation with the Hamatsuda Formation, the Higashigawa Formation with the Nishiyama Formation.

A Late Pleistocene peat bed, the Chugenmachi peat bed, yielding abundant plant fossils, was found in the northern part of Niigata Prefecture, Central Japan. The bed unconformably overlies the Middle Pleistocene and Pliocene and is three meters thick. The 14C age of wood from the peat bed is 23, 000±350y.B.P.. The age of the peat bed indicates the later Last Glacial Age. Most palnt remains in the bed were transported from the surrounding area, as indicated by the location of the bed in a small valley and the well-preserved condition of the remains.The plant fossil assemblage consists of 7 families, 13 genera and 14 species. The result of pollen analysis indicates a consistent floral composition. The species are mainly of submontane evergreen conifers such as Picea jezoensis var. hondoensis, Pinus koraiensis and Tsuga diversifolia. They are not presently found in the fossil locality. The composition of the fossil assemblage indicates the cold climate of the Glacial Age. In addition to cold elements, the flora consist of cool-temperate conifers, such as Cryptomeria japonica and Thuja Standishii, and also of a few temperate broad-leaved trees, such as Fagus crenata, Corylus heterophylla and Styrax japonica. They indicate that the mild climatic floral elements survived at that time especially in areas bordering the Sea of Japan. Moreover, the fossil assemblage includes a few evergreen conifers which are not found in high snowfall areas, such as Abies homolepis, Picea jezoensis var. hondoensis, Tsuga diversifolia. The index species of the cool-temperate zone of the Pacific coast, such as Abies homolepis, are also commonly found.These facts are an interesting contribution to the study of paleo-climatology and the paleovegetation of the Last Glacial age of the Sea of Japan coast.