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Congenital lobar emphysema is often associated with CHD in early infancy; however, the surgical strategy for this condition is still controversial. We report three successful cases of emphysematous lung lobectomy before the surgical repair of associated CHD. Aggressive lobectomy preceding cardiac interventions is advised when the management of congenital lobar emphysema is difficult.

We present a 31 gestational weeks’ premature baby whose fetal echocardiogram showed ectopia cordis, single ventricle and severe pulmonary stenosis. At 31 gestational weeks, an emergency caesarean section was performed, and his birth weight was 1756 g, SpO2 was 80% on 100% O2. Epicardial echocardiogram showed double inlet right ventricle, severe valvular pulmonary stenosis and no ductus arteriosus. The risk of surgery was very high, so we decided to perform balloon valvuloplasty by direct puncture of the heart. We punctured the apex of the ventricle using a 16-gauge needle under echo guidance, advanced the guidewire to the pulmonary artery and performed balloon valvuloplasty. Soon after the procedure, the cyanosis improved dramatically. This is the first report of a transcatheter procedure performed by direct puncture of the heart for ectopia cordis with complex congenital heart disease.

Objective This study aims to investigate the changes in renal function and levels of urinary biomarkers before and after cardiac angiography in children with congenital heart disease (CHD). Setting Children with CHD are at a risk for kidney injury during contrast exposure in cardiac angiography. Outcome measures We measured urinary protein, albumin, N-acetyl-β-D-glucosaminidase (NAG), β2-microglobulin (BMG), and liver-type fatty acid-binding protein (L-FABP) levels, as well as serum creatinine and cystatin C levels, before and after cardiac angiography in 33 children with CHD. Results No significant decrease was noted in either the creatinine-based or cystatin C-based estimated glomerular filtration rate at 24 hours after angiography compared with that before angiography. Urinary protein, NAG, BMG, and L-FABP levels were significantly increased at 24 hours after angiography, all of which returned to baseline levels at more than 7 days after angiography. An increase in urinary level of protein, albumin, NAG, or BMG was mostly associated with increased urinary L-FABP level. An increase in both urinary BMG and L-FABP, but not that in urinary L-FABP alone, was associated with increased levels of urinary protein and NAG, as well as the greater dose of contrast media. Conclusions Transient increases of kidney injury biomarkers following cardiac angiography are not necessarily associated with the impairment of renal function in a short time period; however, the increase in urinary protein, albumin, NAG, or BMG level may indicate greater stresses to the kidneys than the increase in urinary L-FABP alone in children with CHD.

It is necessary to estimate the risk for strategic decision of offshore software outsourcing projects. In this paper we propose an experimental risk estimation method based on questionnaire for externalizing the know-how of experienced project managers. Introducing three parts of questionnaire contents, this paper describes the estimation method and presents the implementation procedure. Focusing on five client companies, this paper reports five types of risk estimation methods considering the bias of respondents with different backgrounds, and discusses the Recall, Precision together with Accuracy of these estimation methods. This paper also applies the t-test and vector analysis to study the bias in vendor countries, software types, as well as client companies. Copyright © 2008 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.

症例は51歳女性. 15年来の糖尿病歴があり, 1995年7月, 糖尿病性腎症により血液透析導入. 当初より上腸間膜動脈血栓症に対する空腸切除術後のためと考えられる断続的な下痢症を認め, インスリンによる血糖コントロールは不良であった.1996年8月10日頃から徐々に全身倦怠感が出現. その後, 歩行時のふらつきと軽度の構語障害が出現したため, 頭部CTを施行するも特に病変を認めなかった. 8月20日にはNa 125mEq/lと低Na血症を認めたため, 食塩の摂取を促した. 8月21日に頭部MRIを施行したところ, 橋中央部に低信号域を認めた. 他の臨床所見と併せてcentral pontine myelinolysis (CPM) と診断した. 8月24日入院. 少量のNa補充と止痢剤の強化, および除水と厳密な血糖コントロールにより緩徐なNa補正を行い, 著明な神経学的改善を認めた.低Na血症の主な原因として, 断続的な下痢症によるNaの喪失や食事摂取量低下によるNa不足, および不適切な基準体重設定や高血糖に起因した高浸透圧血症による水過剰などが考えられた. また通常組成 (Na; 140mEq/l) の透析液による予期せぬ急速なNa補正がCPMを発症, あるいは増長した可能性が考えられた. 透析患者では電解質異常が起こりやすく, さらに透析療法自体が急速な電解質補正になりうるため, 臨床的にCPMが疑われた場合は迅速な診断かつ慎重な対処が必要であると考えられた.

The aim of this study was to examine whether the frequent short-time hemodiafiltration (FSHDF) could remove beta2-microglobulin (beta2m), an amyloidogenic factor, more effectively compared with the conventional hemodiafiltration (CHDF). A uremic patient underwent FSHDF (each 90 min, 6 times/week) for 6 weeks after CHDF (each 4 h, 3 times/week) for 6 months. Pretherapeutic plasma concentrations of beta2m, small molecules, electrolytes and bicarbonate were measured every Monday for 4 weeks during CHDF and for 6 weeks during FSHDF. The body weight gain during these weeks was also determined. The time average concentrations in beta2m and blood urea nitrogen (TACbeta2m and TACBUN) were evaluated based on their concentrations in pre-, post- and intertherapeutic plasmas frequently collected for 1 week each during CHDF and FSHDF. The quantities of total protein, albumin and beta2m in the removed fluids for the same week were determined. The pretherapeutic concentration in beta2m was significantly lower (18.7 +/- 1.3 mg/l) during FSHDF than CHDF (32.4 +/- 2.8 mg/l). The TACbeta2m was decreased during FSHDF (from 23.5 to 13.7 mg/l), while the TACBUN did not change. The pretherapeutic bicarbonate concentration was higher and the gain of body weight per week was lower during FSHDF although the other parameters were not different. It is concluded that FSHDF therapy is more effective to decrease beta2m concentration and correct acidosis together with an adequate urea removal and clinical safety.

透析患者の社会復帰状態を把握し, 問題点を明らかにするため, 7施設で調査を実施した. 労働年齢の維持透析患者280名を対象に, 社会復帰状況を調査し, 心理テスト (Y-G性格検査, 日本版CMI, SDS, MAS) を施行した. 結果として, 166名 (59.3%) の者が社会復帰を果たしていた. 社会復帰を果たしていない者は87名 (31.0%) であった. そのうち16名の者が, 求職の意志すらなく, 就職活動をしていなかった. 今回の調査ではこの16名の中で, 調査に協力の得られた15名を非求職群とした. また就業の意志はあるが適当な職がなく, 社会復帰を果たせないでいる者は19名であった. この中から同様の理由で15名を求職群とした. まず, 非求職群と完全社会復帰群との間で社会復帰の妨げとなりうると考えられた社会的因子 (性別・年齢・透析期間・学歴・婚姻状態) を比較した. 次に完全社会復帰群の中から非求職群と求職群に対しては各々30名ずつの社会的因子に関してのマッチドコントロール群を抽出した. その上で各心理テストの結果を, 非求職群とそのコントロール群, 求職群とそのコントロール群との間で比較した. 結果として非求職群は, 完全社会復帰群に比し, 有意に男性, 配偶者のいない者の割合が多く, 比較的透析期間が短い者が多かった. 更に低学歴も社会復帰を妨げる因子のひとつになっている可能性も示唆された. また完全社会復帰群から抽出した社会的因子をマッチさせたコントロール群との比較では, 非求職群に神経症傾向・抑うつ傾向・不安傾向の高い者の占める割合が高かった.今回の調査で, これら不安が強かったり, 意欲に問題があると考えられる社会復帰を果たしていない透析患者に対し, 社会的サポートや心理面でのケアが必要性であると思われた.

To let a user know the user's personal trend on the user's computer, this paper proposes a method to explore and visualize one's personal trend on the premise that the Gnowsis semantic desktop is used. The proposed method classifies information items into four attention areas with a popularity change measure by using three indicators (direct attention score (DAS), indirect attention score (IAS) (using spreading activation) and popularity change (PC)). Comparing the proposed method with two existing tools (PIMO timeline and PIMO cloud) in the gnowsis, this paper describes the following advantages about the proposed method: (1) To deal with both touched concepts and neighbor concepts, (2) To consider frequency, (3) To consider trend, (4) To catch seven operations in the gnowsis. Moreover, from an experimental usage, which shows more than three subjects answered the proposed method provided good results in every question, this paper suggests the proposed method would be useful to show one's personal trend.

With the steady increase of volumes of software development, most Japanese companies are interested in offshore software outsourcing. In order to find out the know-how of experienced project managers and assess the risk bias brought by vendor countries and software types, this paper utilizes conjoint analysis method on questionnaire for project preference to externalize the tacit knowledge. After analyzing the range, maximum, minimum and average value of total utilities of three kinds of properties, we have the following findings: 1) the project property is the main item affecting success of outsourcing projects, which could lead to big success or severe failure, 2) the risk analysis result for vendors of India is different from that of China, which should be deeply investigated, 3) the risk value of middleware software is lower than that of the other two software types, which should be paid more attention to.

To analyze the causal relationship between comfort environment vote and thermal sensation votes (of face, chest, hands, buttocks, and soles of the foot), this paper presents how three methods work in experimentation: multiple regression analysis, conjoint analysis and structural equation modeling (SEM). The samples for the experimentation consisted of 1,584 (22 subjects x 9 conditions x 8 times) questionnaire data. Our main interest is whether there are any differences in the causal relationship among subjects, conditions or methods. Paying attention to preprocessing, we found the following: (1) the importance of each thermal sensation vote differed not only according to subject but also according to the analysis method; (2) SEM is the most suitable method to explain the causal relationship; and (3) the lower body is more important than the upper body in controlling thermal comfort.

To investigate the pathogenetic mechanisms of mesangial interposition (MI) in IgA nephropathy, we examined renal biopsy samples from 20 patients with IgA nephropathy. Electron microscopic morphometric analysis showed that cytoplasmic protrusion of mesangial cells (MCs) into endothelial cells (ECs) or capillary lumina, and widening of the lamina rara interna (LRI) were significantly more prominent in glomeruli with MI than in those without. Immunoelectron microscopy revealed that the ratio of positive endothelial staining with a polyclonal antibody against human platelet-derived growth factor (PDGF) BB was significantly higher in capillary loops with MI than in those without. Enhanced capillary staining of fibronectin related to MI was not recognized. These results suggest that MI in IgA nephropathy is caused by factors such as enhancement of cytoplasmic extensibility of the MCs, widening of the LRI and chemotactic influence of PDGF-BB located in the glomerular ECs.