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Perioperative increase in oxidative activity in surgical patients reportedly prevents postoperative surgical site infection (SSI). Several clinical studies have shown that oxidative activity under sevoflurane anaesthesia was higher than that under propofol anaesthesia. Therefore, we hypothesised that sevoflurane anaesthesia would discourage SSI compared with propofol anaesthesia. To examine the effect of anaesthesia maintained with sevoflurane and propofol on SSI, a total of 265 consecutive adult patients, with American Society of Anesthesiologists physical status 1-3, who underwent elective open gastrointestinal surgery under general anaesthesia, were surveyed for SSI between January 2007 and December 2008. Sevoflurane or propofol was selected to maintain anaesthesia in 95 and 170 patients, respectively. A propensity score was used for pairwise matching of these patients to avoid selection biases between the two methods of anaesthesia. Propensity matching yielded 84 pairs of patients. We compared standardised infection ratios (SIRs), i.e. the quotient of the number of SSI cases observed and the number of SSI cases expected, calculated using data from the National Nosocomial Infection Surveillance, between sevoflurane and propofol anaesthesia. After propensity matching, SIR after sevoflurane anaesthesia was 1.89 [95% confidence interval (CI): 1.46-2.32], which was significantly lower than after propofol anaesthesia (4.78; 95% CI: 4.30-5.27) (P=0.02). This study suggests that sevoflurane tends to suppress SSI after elective open gastrointestinal surgery compared with propofol.

The purpose of this study is to examine a normal conduction pathway of the left atrium. During pulmonary vein isolation using a three-dimensional mapping system, we observed the characteristics of the conduction pattern. Subjects consisted of 15 patients with paroxysmal atrial fibrillation (mean age, 62.8 ± 8.4 years). Left atrial activation conduction begins in the interatrial septum, and moves toward the peak of the ridge between the left atrial appendage and left pulmonary vein. In coronary sinus or appendage pacing, conduction was in the opposite direction at the same location. The mean conduction velocity in this area was 2.03 ± 0.43 m/s. Features of decrement conduction were not present. Anatomical position of the appendage differed greatly between patients. A detailed observation using the inner-cavity view of a three-dimensional mapping system also showed that the peak of the ridge reached the center of the roof.

症例は53歳の女性.下腹部痛,発熱,頭痛,嘔吐にて救急車にて救急外来を初診.両季肋部に圧痛を,腹部CT検査にて肝両葉に低吸収域を認め,肝膿瘍と診断し,超音波下に膿瘍ドレナージ術を施行した.入院後便への血液付着に気付き,精査にてS状結腸癌の診断となった.また上部消化管内視鏡検査にて胃体上部大弯にIIc病変を認め,生検にてgroup 4であった.開腹にて,肝外側と胃は強固に癒着,S状結腸癌は直腸に浸潤しており,胃全摘,肝外側区域合併切除,低位前方切除術を施行した.病理診断にても肝に転移所見はなく,膿瘍で矛盾しない所見であった.大腸癌に肝膿瘍を形成することは比較的まれであり,大腸癌から経門脈的に肝膿瘍を形成したと考えられた.胃癌を合併し,結腸癌が肝膿瘍の原因と考えられた症例を経験したので報告した.

Photoluminescence (PL) spectra, time profiles of PL intensity and PL excitation spectra (PLE) for inter 3d multiplets (3d-MS) transition of Mn2‡ are observed in the semimagnetic semiconductor CdMnTe under high pressures. Those of inter 3d-MS and inter quantum levels (QL) transitions are also observed in quantum wells (CdTe/Cd0.4Mn0.6Te). The decay processes in these excited states are discussed. The decay process to the excited states of infrared photoluminescence is also discussed for various concentrations. In these excited states it is considered that large lattice relaxation is essential.

Time-resolved measurement is performed for photoluminescence around 2.0 eV which originates from internal transition between 3d multiplet states in Mn based semimagnetic semiconductors. Observed emission spectra show red shift with delay time after excitation. Larger shift is observed in the sample with larger width of the emission spectrum, which implies that the shift is caused by the energy relaxation in the inhomogeneous distribution of the Mn energies. To confirm this, we perform simple Monte-Carlo simulation in a wide range of time scale. The results well explain the magnitude of the shift and its logarithmic dependence on delay time. The dependences on excitation energy, temperature and pressure are also investigated.

Indocyanine green (ICG) has been demonstrated to be a reliable indicator for the estimation of plasma volume in man. Since this dye is bound to plasma protein when administered intravenously, overestimation of the plasma volume would occur during the presence of protein leak from plasma. However, to our knowledge, up to now no report has described whether or not plasma volume determined by the indocyanine green dilution method (PVICG) is clinically significantly overestimated under such conditions. We report two burned patients who temporally had an unusual large PVICG even though other clinical variables did not support the presence of hypervolemia. From the case described it can be concluded that a possible overestimation of PVICG occurs when the vascular permeability for proteins is increased.

Objective: Our experimental studies have indicated that the initial distribution volume of glucose (IDVG) has potential to evaluate the central extracellular fluid (ECF) volume status in the body. The purpose of the present study was to compare the IDVG and cardiac output (CO) in critically ill patients with or without expansion of the central ECF volume and to test whether a larger IDVG is observed during the presence of increased central ECF volume than during the absence of it. Design and Setting: The study was prospective and was conducted in the intensive care unit, University of Hirosaki Hospital, after approval of the institutional ethical committee. Patients: Fourteen patients with accumulation of the central ECF volume (the accumulation group) and 29 patients without it (the non-accumulation group) were studied. Interventions: Glucose 5 g was infused over 30 s when the patients’ hemodynamic states were relatively stable. Blood samples were taken immediately before infusion and during 7 min post-infusion. Thermodilution CO was also measured before each glucose challenge. A total of 81 comparisons were performed. Measurements and Results: The IDVG was calculated using a one-compartment model. A linear correlation was obtained between the IDVG and CO in the non-accumulation group (r = 0.89, n = 54, p < 0.001). The IDVG-CO ratio was higher in the accumulation group than in the non-accumulation group (p < 0.01). The increased plasma glucose concentrations at 3 min postinfusion were inversely proportional to the IDVG (r = -0.90, n = 81, p < 0.001). Conclusions: Results demonstrated that a larger IDVG was obtained during accumulation of the central ECF volume and support the hypothesis that the IDVG reflects the central ECF status in critically ill patients characterized in our study, even though CO influences the IDVG.

We have developed an experimental approach that allows us to estimate the performance of a large-scale enterprise network for the updating of routing information. The estimation was applied in the integration of the UFJ Bank network system on January 15, 2002. The main characteristic of this approach is the application of a formula that represents the delays in the updating of routing information that accompany reductions in CPU resources. The procedure consists of two steps: (1) estimating the reduction in the availability of CPU resources which is caused by the forwarding of data packets at a router; (2) estimating the levels of CPU resources needed to reply to a query about a new route and for the updating of routing information. These steps were applied to estimate the performance of the UFJ Bank network in terms of the convergence of routing information. The results of the experiments on the network showed that it was possible to update the routing information as long as the level of CPU utilization at the routers was below 40%. We were able to apply this guideline to, and thus confirm the stability of, the UFJ Bank network.

Modern information technology utilizes the charge degree of freedom of electrons to process information in semiconductors and the spin degree of freedom to store information in magnetic materials. The next step is to explore the combination of the two degrees of freedom to look into the possibility of realizing new functionalities.

We demonstrate electrical electron spin injection via interband tunneling in ferromagnetic/nonmagnetic semiconductor Esaki diodes. An interband tunnel junction between ferromagnetic p+-(Ga,Mn)As and nonmagnetic n+-GaAs under reverse-bias allows spin-polarized tunneling of electrons from the valence band of (Ga,Mn)As to the conduction band of n+-GaAs. The spin polarization of tunneled electrons is probed by circular polarization of electroluminescence (EL) from an n-GaAs/InGaAs/p-GaAs light emitting structure integrated with the diode. Clear hysteresis loop with +-6.5% remanence is observed in the magnetic-field dependence of the EL polarization at 6 K, below the Curie temperature of (Ga,Mn)As., 11pages, 4figures. Submitted Japanese Journal of Applied Physics Pt2 Express Letter

Performance results from field trial of band hopping OFDM are presented in this paper. Band hopping OFDM utilizes OFDM and slow frequency hopping techniques to provide essential needs for future wireless communications systems. OFDM is currently utilized in digital audio and video broadcasting and DSL. It has been also standardized for wireless LAN applications. A testbed was developed and used in field trials in a suburban area to prove the performance of the band hopping OEDM system. The results indicate that the system is robust against impaired mobile channel conditions. They also show that the system provides superior performance in a multi-path fading environment. Finally, these results support the feasibility of band hopping OFDM techniques for high-speed wireless packet data applications.

The purpose of this study was to identify whether the central extracellular fluid volume status following hypo- and hypervolaemia can be measured by the initial distribution volume of glucose or by the extravascular lung water. These two estimates were compared with the initial distribution volume of sucrose which has been used as an indicator for the measurement of the extracellular fluid volume. The above three estimates were determined by the administration of glucose, chilled saline and sucrose solutions, before and after haemorrhage (30 mL kg-1), and subsequent fluid load (lactated Ringer's solution 90 mL kg-1). The distribution volumes of glucose and sucrose decreased after haemorrhage and increased after fluid load compared with normovolaemic values, and a linear correlation was obtained between these two distribution volumes (r = 0.93, P < 0.001, n = 36). However, the extravascular lung water remained statistically unchanged throughout the procedure, despite a weak linear correlation with the sucrose distribution volume (r = 0.38, n = 33, P < 0.05). These results indicate that the initial distribution volume of glucose is more useful as an indicator of the central extracellular fluid volume status than the extravascular lung water.

Background Standard therapy for refractory or resistant relapsed small-cell lung cancer (SCLC) has not yet been established. We conducted an open-label, multicenter, non-randomized phase II study to confirm the efficacy and safety of amrubicin, a topoisomerase inhibitor, in the treatment of refractory or resistant SCLC. Material and methods Patients with SCLC that is refractory or relapsed within 90 days of completing previous treatment received amrubicin at a dose of 40 mg/m2 for 3 consecutive days, every 21 days.The study treatment was repeated until disease progression or intolerable toxicity. The primary end point was overall response rate (ORR), and secondary end points were progression-free survival (PFS), overall survival (OS), and safety. Planned sample size was 80 patients to achieve power of at least 80% with one-sided alpha of 0.05, and expected and threshold value for primary endpoint as 20% and 10%. All patients were followed-up until one year after the last patient enrollment. Results Between November 2009 and February 2011, 82 patients were enrolled from 25 institutions. The median number of treatment cycles was four (range, one to 22 cycles).The ORR was 32.9% (p Conclusions Amrubicin demonstrated the favorable tumor response and survival with acceptable toxicity. Single-agent amrubicin could be considered as a standard regimen in the treatment of refractory or resistant relapsed SCLC. Disclosure All authors have declared no conflicts of interest.

Automated external defibrillator (AED) has been available for out-of-hospital ventricular fibrillation (VF). The algorithm of AED concerning VF was excellent in sensitivity and specificity. However, little information is available on the possible interactions between AED and implanted cardiac pacemaker. We report failure of AED due to impulse of pacemaker. A 68-year-old woman was operated with mitral valvulotomy and replacement, and implantation of pacemaker (VVI) because of bradycardia. Testing of the pacemaker function showed normal resistance of the ventricular lead. She lost consciousness in a bus suddenly, bystander cardio-pulmonary resuscitation was done and an ambulance was called soon. When paramedics arrived at the scene, electrocardiogram showed combination with coarse VF (high amplitude) and impulse of pacemaker. AED did not work at the scene at all. After transfer to our hospital, she received advanced cardiac life support including defibrillation and drugs, and finally restoration of spontaneous circulation was obtained and the patient was carried to intensive care unit. Unfortunately, she later died because of hypoxic brain. We can conclude that a clear understanding of the possible interactions between AED and pacemaker is necessary for further refining the diagnostic algorithms of AED.

Purpose Electrical cardioversion for ventricular arrhythmias (VAs) contained of ventricular tachycardia (VT), ventricular fibrillation (VF) and torsades de pointes (TdP), was established to be effective for VAs. Little is known about which case should have an effect on chest thump version (TV) in patients with VAs. Method Subjects were 18 patients (Male: Female = 9:9, mean age 61±20 years old). TV was done for 28 episodes in VT, 8 episodes in VF, and 5 episodes in TdP. TV was performed after onset of symptoms within one minutes, and electrocardiogram (ECG) monitor was analyzed. Heart beats were averaged with 10 beats of VF and TdP. The time from Q wave to TV was measured from ECG monitoring in VT patients. Result TV successfully terminated VT in 12 of 28 episodes, VF in 1 of 8 episodes, and 1 of 5 episodes. TV terminated VT in the range between -20ms and +60ms. The mean cycle length of VT was 284±30ms, VF was 238±21ms, and TdP was 270±25ms, respectively. The mean cycle length of successful TV was significantly longer than that of failed TV in VT (358±57ms vs 289±59ms, p