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Background: Hypertrophy of the labia minora is of concern to a subset of adolescents and adult women. The posterior wedge resection is a new labiaplasty technique with an anatomic approach to yield the optimal aesthetic outcome and yet continue the functional achievement of prior techniques. o bjective: The authors describe the results of their posterior wedge resection technique in a retrospective series of patients. Methods: A retrospective chart review was performed of 22 consecutive patients who underwent posterior wedge resection labiaplasty between February 2009 and February 2012. Complications and aesthetic outcomes were reviewed. Results: The average age of the patients in this study was 35 years (median, 33 years). Follow-up ranged from 2 weeks to 1.5 years. Two minor complications occurred without further sequelae. At follow-up, none of the patients reported any paresthesias, pain, or problems with penetrating vaginal intercourse. Conclusions: An increasing number of labiaplasties are being performed for aesthetic and functional concerns. The posterior wedge resection enables the surgeon to perform labiaplasty easily, safely, and effectively, ensuring symmetry and maintenance of the natural pigment, color, and texture of the defining free edge of the labia minora.

A numerical modelling of the dynamics of an edge-localized mode (ELM) crash in the spherical tokamak is proposed by means of a three-dimensional nonlinear magnetohydrodynamic simulation. The simulation result shows a crash of the edge pressure profile due to the spontaneous growth of the ballooning mode instability. The simulation result shows good agreement in several characteristic features of the experimental observation of large scale ELMs in an appropriate time scale: (1) relation to the ballooning instability, (2) intermediate-n precursors, (3) low-n structure on the crash, (4) formation and separation of the filament and (5) considerable amount of convective loss of plasma, where n is the toroidal mode number. Furthermore, the model is verified by examining the effect of diamagnetic stabilization and by comparing the nonlinear behaviour with that of the peeling modes. The ion diamagnetic drift terms are found to stabilize some specific components linearly; nevertheless they are not so effective in the nonlinear dynamics such as the filament formation and the amount of loss. For the peeling mode case, no prominent filament structure is found to appear in contrast to the ballooning mode case.

The factors contributing to a higher mortality rate in elderly thermal injury victims are not well delineated. The purpose of this study is to determine the impact of the initial injury, medical comorbidities, and burn size on patient outcome and to determine a level of injury in this population when comfort care is an appropriate first choice. Individual medical records of patients over 65 years of age admitted to our burn center over a 10-year interval were reviewed for patient demographics, mechanism of injury, total body surface area (TBSA) burned, medical comorbidities, use of Swan-Ganz catheters, evidence of inhalation injury, level of support, and patient outcome. The mechanisms of thermal injury were flame (68%), scald (21%) and electrical or chemical contact (11%). Twenty-six preventable bathing, cooking, and smoking-related injuries were seen (33%). The average TBSA was 25 per cent. Average length of stay varied depending on outcome. The overall mortality rate for this group was 45 per cent. Patients older than 80 years with 40 per cent or greater TBSA burned had a 100 per cent mortality rate despite aggressive treatment. Burn wound size correlated better with probability of poor outcome than age. Thermal injuries in the elderly are becoming more important with the aging of our population. Underlying medical problems—specifically chronic obstructive pulmonary disease—do play a role in increased patient morbidity and mortality. This study shows that age greater than 80 years in combination with burns greater than 40 per cent TBSA are uniformly fatal despite aggressive therapy. We believe that delaying the start of comfort-only measures in this situation only prolongs the pain and suffering for the patient, the family, and the physician.

Three dimensional MHD simulations are executed in a full toroidal geometry to clarify the physical mechanisms of the internal reconnection event (IRE) which is observed in spherical tokamak experiments. The simulation results reproduce several main properties of IREs. A notable property in the linear growth of modes is the simultaneous excitation of multiple low n modes, which grow together with similar growth rates. A spontaneous phase alignment mechanism among these excited modes is found in the non-linear stage of the development, which causes a bulge-like deformation of the torus and subsequent expulsion of heat energy to the external region through the occurrence of external reconnection.

The diagnosis of ventilator-associated pneumonia in the surgical intensive care unit continues to be problematic. The majority of intensive care units use clinical criteria based on chest x-ray; fever; leukocytosis; alterations in the pulse oximeter observations; the need to alter modes and amounts of ventilatory support; and more specific microbiologic studies, such as appropriate sputum, Gram stain, and culture to identify pneumonia. Diagnosing pneumonia based on clinical criteria alone is often difficult and inaccurate, which may lead to inappropriate use and choice of antibiotics. Invasive diagnostic techniques, such as protected specimen brush and bronchoalveolar lavage, provide an important microbiologic diagnosis. However, the cost and inconvenience limit broad usage. Furthermore, those results that return positive are often too late to dictate the need for, or direction of, therapy. Our use of a “pneumonia grid” may help identify patients likely to have a poor outcome. Until a readily available and cost-effective diagnostic study for pneumonia is developed, clinical criteria remain vital in routine practice.

The magnetic configuration of a field-reversed configuration (FRC) has a center closed region and open field region. Because of this geometrical property, an FRC can be translated from a formation ...

Hypertrophy of the labia minora is of concern to a subset of adolescents and adult women. The posterior wedge resection is a new labiaplasty technique with an anatomic approach to yield the optimal aesthetic outcome and yet continue the functional achievement of prior techniques.The authors describe the results of their posterior wedge resection technique in a retrospective series of patients.A retrospective chart review was performed of 22 consecutive patients who underwent posterior wedge resection labiaplasty between February 2009 and February 2012. Complications and aesthetic outcomes were reviewed.The average age of the patients in this study was 35 years (median, 33 years). Follow-up ranged from 2 weeks to 1.5 years. Two minor complications occurred without further sequelae. At follow-up, none of the patients reported any paresthesias, pain, or problems with penetrating vaginal intercourse.An increasing number of labiaplasties are being performed for aesthetic and functional concerns. The posterior wedge resection enables the surgeon to perform labiaplasty easily, safely, and effectively, ensuring symmetry and maintenance of the natural pigment, color, and texture of the defining free edge of the labia minora.

Equilibrium analyses have shown that the aspect ratio A is one of the important parameters for optimization of the RFP configuration because it affects the q profile or fraction of the pressure-driven bootstrap current. RELAX (A=R/a=0.5m/0.25m) is a low-A RFP machine to explore the potential advantages of low-A configurations. The discharge and plasma parameters in RELAX to date are as follows: plasma current up to 100kA, discharge duration of up to 2.5ms, electron density in the range from 0.2 to 2.0× 1019 m-3, and electron temperature

Postmastectomy radiation therapy (PMRT) is recommended for patients with four or more positive lymph nodes (LN+). Given the ramifications of PMRT for immediate reconstruction, we sought to create a model using preoperative and intraoperative factors to predict which patients with a positive sentinel lymph node will have less than four LN+.The database from a prospective multicenter study of 4,131 patients was used for this analysis. Patients with one to three positive sentinel lymph nodes (SLN) and tumors5 cm (n = 1,133) in size were randomly divided into a training set (n = 580) and a test set (n = 553). Multivariate logistic regression was used on the training set to create a prediction rule that was subsequently validated in the test set.Median patient age was 57 (range, 27-100) years, and median tumor size was 2.0 (range, 0.2-4.8) cm. In the training set, factors associated with having four or more LN+ on multivariate analysis were: tumor size [odds ratio (OR) = 2.087; 95% confidence interval (CI): 1.307-3.333, P = 0.002), number of positive SLN (P0.0005), and proportion of positive SLN (OR = 3.602; 95% CI: 2.100-6.179, P0.005). A predictive model was established with a point assigned to each positive SLN, T2 (vs. T1), and if proportion of positive SLN was50%, for a maximum of five points. In both the training and test sets, patients with one point had a low probability of having four or more LN+ (3.8% and 3.3%, respectively).Tumor size, number of positive SLN, and the proportion of positive SLN influence whether patients will have four or more LN+. A simple model can predict the probability of requiring PMRT.

Most conventional genetic algorithms (GAs) for function optimization always search all parameters simultaneously. As the result, the search space size increases exponentially with the number of parameters. Therefore, the search efficiency of these GAs deteriorates in high-dimensional function optimization because they requires a huge population size and enormous computation time. Generally, in order to find the optima, if a parameter has no interaction with the others, it can be searched independently and, if it has interactions with others, it must be searched with the ones which have interactions with it. We believe that, in many cases, all parameters do not need to be searched simultaneously because many evaluation functions in real-world applications have partially epistasis. We propose a new genetic hill climbing method. The proposed method, first, estimates all interactions among parameters and, then, incrementally improves a search point, using a neighborhood that is a subspace spaned by a parameter and the parameters having interactions with it, named epistasis neighborhood. The sampling method in an epistasis neighborhood is UNDX+MGG, which is a real-coded GA showing good performance on epistatic multimodal functions. We confirm that the proposed method shows better performance than conventional GAs on high-dimensional partially-epistatic functions by applying them to some benchmark problems.

The authors present a real-time visual system for avoiding collision with moving obstacles and describe a realization of robots using the system to avoid collisions with moving objects. The visual sensor used in this system is a passive optical stereo type having no mechanical moving parts. Using two special slit patterns, the sensor is configured so as to split the two images obtained by individual cameras placed on the right and left, and to project the split images onto one CCD sensor, providing some 200 autofocusing subsystems. These subsystems can operate independently of one another, making real-time processing possible. >

The factors contributing to a higher mortality rate in elderly thermal injury victims are not well delineated. The purpose of this study is to determine the impact of the initial injury, medical comorbidities, and burn size on patient outcome and to determine a level of injury in this population when comfort care is an appropriate first choice. Individual medical records of patients over 65 years of age admitted to our burn center over a 10-year interval were reviewed for patient demographics, mechanism of injury, total body surface area (TBSA) burned, medical comorbidities, use of Swan-Ganz catheters, evidence of inhalation injury, level of support, and patient outcome. The mechanisms of thermal injury were flame (68%), scald (21%) and electrical or chemical contact (11%). Twenty-six preventable bathing, cooking, and smoking-related injuries were seen (33%). The average TBSA was 25 per cent. Average length of stay varied depending on outcome. The overall mortality rate for this group was 45 per cent. Patients older than 80 years with 40 per cent or greater TBSA burned had a 100 per cent mortality rate despite aggressive treatment. Burn wound size correlated better with probability of poor outcome than age. Thermal injuries in the elderly are becoming more important with the aging of our population. Underlying medical problems--specifically chronic obstructive pulmonary disease--do play a role in increased patient morbidity and mortality. This study shows that age greater than 80 years in combination with burns greater than 40 per cent TBSA are uniformly fatal despite aggressive therapy. We believe that delaying the start of comfort-only measures in this situation only prolongs the pain and suffering for the patient, the family, and the physician.

The diagnosis of ventilator-associated pneumonia in the surgical intensive care unit continues to be problematic. The majority of intensive care units use clinical criteria based on chest x-ray; fever; leukocytosis; alterations in the pulse oximeter observations; the need to alter modes and amounts of ventilatory support; and more specific microbiologic studies, such as appropriate sputum, Gram stain, and culture to identify pneumonia. Diagnosing pneumonia based on clinical criteria alone is often difficult and inaccurate, which may lead to inappropriate use and choice of antibiotics. Invasive diagnostic techniques, such as protected specimen brush and bronchoalveolar lavage, provide an important microbiologic diagnosis. However, the cost and inconvenience limit broad usage. Furthermore, those results that return positive are often too late to dictate the need for, or direction of, therapy. Our use of a "pneumonia grid" may help identify patients likely to have a poor outcome. Until a readily available and cost-effective diagnostic study for pneumonia is developed, clinical criteria remain vital in routine practice.

We have executed nonlinear magnetohydrodynamic simulations in a heliotron-type configuration with a large pressure gradient to reveal the nonlinear dynamics of a collapse phenomenon. The simulation results reproduce the qualitative characteristics of the experimental observation on the so-called core density collapse events in the Large Helical Device plasma with the super-dense core profile. A long-term nonlinear behaviour on the event, including the flushing mechanism of the core pressure, is clarified. The simulation result shows the linear growth of the ballooning-like resistive instability modes with the intermediate poloidal wavenumbers. The growth of the modes are eventually saturated, and the system experiences the energy relaxation in about 1 ms. It should be noted that the linear mode structures are localized in the edge region, whereas the core pressure rapidly falls as the system reaches the relaxed state. Such coexistence of the edge perturbation and the core collapse is consistent with the experimental observations. The lost pressure forms a wide base in the peripheral region. The core pressure is, on the other hand, remarkably reduced at a certain period, although it had well withstood the disturbance before it. The most salient feature on this period is the disordering of the magnetic field structure. The system keeps the nested-flux-surface structure well at the beginning, whereas part of them are abruptly lost in this period. Such a situation can induce a flattening of the pressure profile along the reconnected field lines. By checking the place where the plasma loss due to this mechanism occurs, such plasma outlets are found to be located mainly on the disordered region. Thus, one can conclude that the core collapse can be caused by the disturbance of the magnetic field.

A 63-year-old male with four intrahepatic recurrences of surgically resected hepatocellular carcinoma was admitted to our hospital in June 1985. He underwent lateral segmentectomy of the liver in November 1983. Pathologic finding of Edmondson II with liver cirrhosis had been confirmed by the operative specimen. Sizes of four recurrent tumors were assessed by CT as 3.5 x 2.2 cm, 2.6 x 2.2 cm, 2.2 x 2.2 cm and 2.2 x 2.2 cm, respectively. During five years until July 1990, the patient was treated with hepatic arterial infusion of Lipiodol-anticancer drug suspension eight times (total 5-FU 900 mg, ADM 77 mg, MMC 73 mg, and Lipiodol 36 ml) and hepatic arterial chemoembolization of MMC microcapsules one time. In addition, two hepatic arterial infusions of CDDP (total 70 mg) were given and 5-FU (total 10 g) was administered intravenously. Partial response (PR) was obtained for 19 months. Hepatic arterial infusion of Lipiodol-anticancer drug suspension was given only once every 6 months, and he maintained a good quality of life for over four and half years. The man died in July 1990. In general, multiple intrahepatic recurrence of surgical resected hepatocellular carcinoma has a poor prognosis. Therefore it was considered that hepatic arterial infusion of this drug brought about the relatively long survival of more than five years.

Nonlinear simulations based on the magnetohydrodynamic model have been executed to reveal the dynamics of the ballooning mode in the spherical tokamak plasma. The simulation results have reproduced the characteristic features of the edge-localized mode crash phase, where the filamentary structures are formed along the magnetic field in the edge region, and separated from the core plasma. Moreover, the finite Larmor radius effect is addressed.

This paper presents the numerical modeling of nonlinear magnetohydro-dynamic (MHD) instabilities containing the effects of finite Larmor radius (FLR) in spherical tokamak geometry. Our results contain the comparison of small, inter-mediate, and large effects of the FLR. For small values, the linear and nonlinear behavior is not greatly modified, but with intermediate and large FLR, stabilizing effects on the higher wave number components are observed in the linear phase but in the nonlinear phase the overall properties are dominated by MHD effects. Similar filamentary structures are reproduced as found in some of the experimental observations as a result of the development of ballooning modes. The formation and the properties of filamentary type structures during edge-localized modes are also discussed.

症例は58歳女性, 昭和60年12月より臍周囲痛が出現, 症状は間欠的で, 近医にて治療を受けていたが, 昭和61年6月16日, 食 欲不振, 下腹部痛を主訴に秋田県成人病医療センターを受診し, 腹部単純X線検査で腸閉塞と診断した. 入院後の注腸検査で, 上行結腸に重積した腸重積症と診断し, 同日開腹手術を施行した. 回腸が内筒となって盲腸に重積し, その先進部の回腸には, 内翻憩室がみられた. 重積部位の回腸は壊死に陥っていた. 切除標本の病理検査で, 憩室は全層性で, 異所性胃粘膜を持ち, Meckel憩室の内翻による腸重積症と確定診断した. 症例報告に加えて, Meckel憩室による腸重積症について文献的考察を加えた.

Short-term results of chemo-hyperthermia of gastric carcinoma were reported. Complete regression was noted in 15%, partial regression in 42% of cases.

Small charcoal particles adsorbing Mitomycin C (MMC-CH) were used in the treatment of lymphnode metastasis of gastric cancer. Immediately after injection of MMC-CH into the gastric wall, lymph capillaries and regional lymphnodes were stained in black and the high concentration of MMC was delivered with charcoal particles. MMC-CH was injected preoperatively using endoscope into the gastric wall of 20 patients with gastric cancer. MMC-CH was observed in 70% of metastatic regional lymphnodes. Systemic side effect was not noted at all. Erosion and shallow ulcers were observed at the site of injection but no perforation occurred.