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Background Palliative care is an essential component of comprehensive care for patients with critical illnesses. In Japan, little is known about palliative care in intensive care units (ICUs), and palliative care approaches are not widespread. This study aimed to better understand the attitudes of physicians toward palliative care and the utilization and needs of specialized palliative care consultations in ICUs in Japan. Methods A nationwide, self-administered questionnaire was distributed ICU physician directors in all hospitals with ICUs. Results Questionnaires were distributed to 873 ICU physician directors; valid responses were received from 436 ICU physician director (50% response rate). Among the respondents, 94% (n = 411) felt that primary palliative care should be strengthened in ICUs; 89% (n = 386) wanted ICU physicians to collaborate with specialists, such as palliative care teams (PCTs); and 71% (n = 311) indicated the need for specialized palliative care consultations; however, only 38% (n = 166) actually consulted, and only 6% (n = 28) consulted more than 10 patients in the past year. Physicians most commonly consulted PCT for patients with serious end-of-life illness (24%) (n = 107), intractable pain (21%) (n = 92), and providing psychological support to family members (43%, n = 187). The potential barriers in providing primary and specialized palliative care included being unable to understand the patients' intentions (54%, n = 235), lack of knowledge and skills in palliative care (53%, n = 230), and inability to consult with PCTs in a timely manner (46%, n = 201). Conclusions These data suggest a need for primary palliative care education in ICUs and improved access to specialized palliative care consultations.

The dry-pulp direct-kneading method is an industrially viable, low-energy process to manufacture cellulose nanofiber (CNF) reinforced polymer composites, where chemically modified pulps can be nanofibrillated and dispersed uniformly in the polymer matrix during melt-compounding. In this study, cellulose fibers with different sizes, ranging from surface-fibrillated pulps with 20 µm in width to fine CNFs with 20 nm in width were prepared from softwood bleached kraft pulps (NBKPs) using a refiner and high-pressure homogenizer (HPH). These cellulose fibers were modified with alkenyl succinic anhydride (ASA), and then dried. The dried ASA-treated cellulose fibers were used as a feed material for melt-compounding in the dry-pulp direct kneading method to fabricate CNF reinforced high-density polyethylene (HDPE). When surface-fibrillated pulps were employed as a feed material, the pulps were nanofibrillated and dispersed uniformly in the HDPE matrix during the melt-compounding, and the composites had much better properties (i.e., much higher tensile modulus and strength and much lower coefficient of thermal expansion) than the composites produced using the pulps without pre-fibrillation. However, when CNFs were used as a feed material, the CNFs were shortened and agglomerated during the melt-compounding, thus deteriorating the properties of the composites. The study concludes that the pre-fibrillation of pulps had a significant impact on the morphology and properties of the composites. Unexpectedly, the surface-fibrillated pulp, which can be produced cost-effectively using a refiner at an industry scale, was a more suitable form than the CNF as a feed material for melt-compounding in the dry-pulp direct kneading method.

We report an integrated production process that simultaneously nanofibrillates dried pulp and uniformly disperses cellulose nanofibers (CNFs) in resins. Refiner-treated pulp were modified using alkenyl succinic anhydride (ASA) in N-Methyl-2-pyrrolidone (NMP). The ASA treated pulp with DS 0, 0.22, 0.43 and 0.57 was mixed with maleic anhydride-grafted polypropylene (MAPP) powder, CaCO3 and high density polyethylene (HDPE) powder (pulp content: 10 wt%). The mixture was melt-extruded at 140 °C with HDPE. The dumbbell-shaped specimens were prepared using injection molding. The SEM images of refiner-treated pulp (DS 0.43) and previously nanofibrillated CNFs (DS 0.44) using a bead mill as a comparison, both of which were extracted from the melt compounded composites, showed comparable degrees of nanofibrillation. The highest mechanical reinforcing efficiency was obtained at DS 0.43, which was shown to exhibit the most fibrillated morphology. The tensile modulus increased from 1.08 GPa for neat HDPE, to 3.46 GPa. The tensile strength also increased from 23 MPa (neat HDPE) to 56 MPa. The mechanical properties were very similar to the bead mill-fibrillated CNF-reinforced composite. This is the first report of nanofibrillation of dried pulp with uniform CNF dispersion into hydrophobic HDPE. We have termed the process the Pulp Direct-Kneading Method.

Objectives The objective of this study was to determine the optimal cut-off value of % uptake of simultaneous dual-isotope (99mTc-sestamibi/123I-BMIPP) SPECT in patients with acute myocardial infarction (AMI) for prediction of myocardial viability in chronic phase. Methods We evaluated 30 consecutive patients with AMI who had undergone both dual-SPECT in acute phase and stress myocardial SPECT using 99mTc-tracers in chronic phase by Discovery NM530c. Regional % uptake with a 17-segment model was obtained using QPS software. The presence of myocardial viability was defined when regional % uptake ≥50% in 99mTc SPECT at rest in chronic phase was observed. Receiver operating characteristic (ROC) curves were analyzed to determine the optimal cutoff values of regional % uptake in both left anterior descending artery (LAD) territory and non-LAD coronary territory in acute phase to predict the myocardial viability in chronic phase. Results The cutoff values for prediction of viable myocardium were %uptake ≥47% for 99mTc-sestamibi, %uptake ≥31% for 123I-BMIPP in acute phase in LAD territory and %uptake ≥52% for 99mTc-sestamibi, %uptake ≥48% for 123I-BMIPP in non-LAD territory. The respective sensitivities, specificities and the area under the ROC curve (AUC) values in the prediction of myocardial viability were 92%, 92% and 0.94 with 99mTc-sestamibi, 90%, 85%, 0.92 with 123I-BMIPP in LAD territory, and 81%, 93% and 0.92 with 99mTc-sestamibi, 81%, 90%, 0.92 with 123I-BMIPP in non-LAD territory. There were no significant differences in AUC values between 99mTc-sestamibi and 123I-BMIPP in both LAD territory and non-LAD coronary territory. Conclusions In the simultaneous 99mTc-sestamibi/123I-BMIPP dual-isotope imaging in patients with AMI, these results suggest that not only 99mTc-sestamibi SPECT, but also 123I-BMIPP SPECT may be possible to predict the presence of myocardial viability in chronic phase. But it should be noted that the optimal cutoff values of regional % uptake in acute phase to predict the myocardial viability may differ for LAD territory and non-LAD coronary territory. Funding Acknowledgement Type of funding source: None

Background/Introduction Although both the presence of 99mTc-sestamibi/123I-BMIPP mismatch and the reverse redistribution of 99mTc-sestamibi in patients with acute myocardial infarction (AMI) are known to significant markers for predicting the improvement of left ventricular (LV) wall motion in the infarcted territory in chronic phase, few studies evaluated them by simultaneous dual-isotope (99mTc-sestamibi/123I-BMIPP) imaging using cadmium-zinc-telluride (CZT) SPECT system. Purpose The purpose of this study was to evaluate whether the presence of 99mTc-sestamibi/123I-BMIPP mismatch or the reverse redistribution of 99mTc-sestamibi make better prediction of the improvement of LV wall motion in the infarcted territory. Methods We evaluated 30 consecutive patients with AMI who had undergone both dual-isotope (99mTc-sestamibi/123I-BMIPP) SPECT in acute phase and stress myocardial SPECT using 99mTc-tracers in chronic phase by Discovery NM530c. Both 99mTc-sestamibi/123I-BMIPP mismatch and reverse redistribution of 99mTc-sestamibi were determined using traditional definition. The improvement of LV wall motion in the infarcted territory from acute phase to chronic phase was assessed using QGS. Results Of 30 patients, the improvement of LV wall motion in the infarcted territory from acute phase to chronic phase was found in 20 patients. Both the presence of 99mTc-sestamibi/123I-BMIPP mismatch and reverse redistribution of 99mTc-sestamibi were significantly linked to predict the improvement of LV wall motion (p=0.0001, p=0.011, respectively). The respective sensitivities, specificities and accuracies in the prediction of the improvement of LV wall motion in the infarcted territory were 90%, 90% and 90% with 99mTc-sestamibi/123I-BMIPP mismatch, and 60%, 90%, 70% with reverse redistribution of 99mTc-sestamibi. Conclusions In the simultaneous 99mTc-sestamibi/123I-BMIPP dual-isotope imaging using CZT SPECT system, both the presence of 99mTc-sestamibi/123I-BMIPP mismatch and the reverse redistribution of 99mTc-sestamibi in acute phase are useful for predicting the improvement of LV wall motion in chronic phase, but the presence of 99mTc-sestamibi/123I-BMIPP mismatch is superior to the reverse redistribution of 99mTc-sestamibi for it. Funding Acknowledgement Type of funding source: None

Objective Metabolic syndrome and the presence of metabolic syndrome components are risk factors for cardiovascular disease (CVD). However, the association between personality traits and metabolic syndrome remains controversial, and few studies have been conducted in East Asian populations. Methods We measured personality traits using the Japanese version of the Eysenck Personality Questionnaire (Revised Short Form) and five metabolic syndrome components—elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose—in 1322 participants aged 51.1 ± 12.7 years old from Kakegawa city, Japan. Metabolic syndrome score (MS score) was defined as the number of metabolic syndrome components present, and metabolic syndrome as having the MS score of 3 or higher. We performed multiple logistic regression analyses to examine the relationship between personality traits and metabolic syndrome components and multiple regression analyses to examine the relationship between personality traits and MS scores adjusted for age, sex, education, income, smoking status, alcohol use, and family history of CVD and diabetes mellitus. We also examine the relationship between personality traits and metabolic syndrome presence by multiple logistic regression analyses. Results “Extraversion” scores were higher in those with metabolic syndrome components (elevated waist circumference: P = 0.001; elevated triglycerides: P = 0.01; elevated blood pressure: P = 0.004; elevated fasting glucose: P = 0.002). “Extraversion” was associated with the MS score (coefficient = 0.12, P = 0.0003). No personality trait was significantly associated with the presence of metabolic syndrome. Conclusions Higher “extraversion” scores were related to higher MS scores, but no personality trait was significantly associated with the presence of metabolic syndrome.

Microfibrillated cellulose (MFC)-reinforced polypropylene (PP) was prepared via two engineering approaches: disintegration of the pulp by a bead mill followed by a melt-compounding process with PP (B-MFC-reinforced PP); and disintegration of the pulp mixed with PP by a twin screw extruder followed by a melt-compounding process (T-MFC-reinforced PP). The effects that the engineering process and the microfibrillation of the pulp had upon the dispersion and mechanical properties were investigated through tensile tests, rheological analysis and X-ray computed tomography. The bead-milling method enabled a uniform microfibrillation of the pulp to under 100 nm, which corresponded to a surface area of 133–146 m2/g for the pulp, found by the Brunauer–Emmett–Teller (BET) analysis. The T-MFC-reinforced PP with 30 wt% MFC content exhibited a tensile modulus of 5.3 GPa and a strength of 85 MPa, whereas the B-MFC-reinforced PP composites with the same content of MFC exhibited values of 4.1 GPa and 59.6 MPa, respectively. Rheological analysis revealed that the complex viscosity and storage modulus at 170 °C of T-MFC-reinforced PP with 30 wt% MFC content are 5–7 and 5–8 times higher than that of B-MFC-reinforced PP, respectively. This indicated that T-MFC was more dispersed in the PP than B-MFC. Therefore, T-MFC produced a more rigid interconnected network in the matrix during the melting state than B-MFC.

The reinforcement effect of microfibrillated cellulose (MFC) in high-density polyethylene (HDPE) was investigated by mechanical, thermal, and rheological analysis. The reinforcement effect using both maleic-anhydride-grafted polypropylene (MAPP) and cationic polymer using primary amine (CPPA) as coupling agents in MFC-reinforced polypropylene (PP) has been reported in our previous study (Suzuki et al. in Cellulose 21:507–518, 2014. doi: 10.1007/s10570-013-0143-9 ). The combined use of MAPP and CPPA showed a greater reinforcement effect in the MFC-reinforced HDPE composite than in MFC-reinforced PP. The tensile modulus of MFC-reinforced HDPE was about 22 % higher than that of MFC-reinforced PP. Rheological analysis showed that there was a drastic improvement in the interaction between MFC and HDPE using CPPA and MAPP. The storage modulus of the MFC/HDPE composite in the melt state using MAPP and CPPA as coupling reagents was about three times higher than that without the coupling reagents. Furthermore, differential scanning calorimetry analysis suggested that a chemical reaction occurred between MAPP and CPPA. In addition, the thermal properties of MFC-reinforced HDPE were remarkably improved using MAPP and CPPA: the coefficient of thermal expansion of the composite decreased from 237.2 (HDPE) to 57.1 ppm/K (MFC/HDPE/MAPP/CPPA) and the heat distortion temperature under 0.45 MPa load improved from 67.4 (HDPE) to 116.7 °C (MFC/HDPE/MAPP/CPPA).

Purpose: Phase analysis was recently developed to allow left ventricular(LV)mechanical dyssynchrony to be assessed by gated single-photon emission computed tomography(SPECT) . However, few studies have analyzed LV dyssynchrony during pharmacological stress and at rest by applying phase analysis to detect multivessel coronary artery disease(CAD)using the SyncTool TM . Methods: Adenosine triphosphate(ATP)loading electrocardiogram-gated 99m Tc-sestamibi SPECT was performed on 180 patients with suspected or known CAD. LV dyssynchrony was evaluated using the SyncTool TM ; the phase standard deviation(SD)and histogram bandwidth were derived. Results: The summed stress score(SSS) , summed difference score(SDS) , post-stress increase in phase SD, and histogram bandwidth were greater in 78 patients with multivessel CAD than in 102 patients with insignificant or single-vessel CAD. In the detection of multivessel CAD, SSS of >9 and SDS of >5 showed sensitivities of 74% and 74%,and specificities of 71% and 78% respectively, whereas an increase in phase SD>8.3°and in histogram bandwidth >16°after ATP loading had sensitivities of 62% and 74% and specificities of 77% and 68%, respectively. A multivariate logistic analysis revealed that the identification of multivessel CAD was superior with the combination of a post-ATP increase in phase SD, increase in histogram bandwidth, and SDS(sensitivity 82%, specificity 76%, chi-square=80.0)than with SDS alone (sensitivity 74%, specificity 78%, chi-square=58.9) . Conclusion: The addition of ATP-induced LV dyssynchrony parameters to conventional perfusion analysis enabled the superior identification of patients with multivessel CAD.

Although fractional flow reserve (FFR) measurements during coronary angiography are performed in routine clinical practice, few studies have evaluated FFR measurements in dialysis patients.We retrospectively studied 42 hemodialysis patients with suspected or known coronary artery disease (CAD) who underwent stress myocardial perfusion imaging and coronary angiography with FFR measurements for 61 coronary lesions. The cut-off value for FFR to detect myocardial ischemia was determined by receiver operating characteristic (ROC) curve analysis.There were 61 coronary vessels measured by FFR. The FFR range was 0.34-0.93 with a mean of 0.74±0.13. The ROC curve analysis revealed that the best cut-off value of FFR for detecting myocardial ischemia was 0.76 (p0.0001), with 70% sensitivity, 86% specificity, and 76% accuracy for myocardial ischemia. Compared with patients who had positive myocardial ischemia and an FFR≤0.76, those who had negative myocardial ischemia despite an FFR≤0.76 had less left ventricular (LV) mass index, whereas patients who had positive myocardial ischemia despite an FFR0.76 had greater LV mass indexor serum calcium-phosphorus product.The cut-off value of FFR for myocardial ischemia in chronic hemodialysis patients is similar to that in other CAD patients. However, caution is necessary when FFR measurements are applied to dialysis patients with significantly increased LV mass index or serum calcium-phosphorus product.

Background:Although the novel cadmium-zinc-telluride (CZT) camera system provides excellent image quality, its diagnostic value using thallium-201 as assessed on coronary angiography (CAG) and fractional flow reserve (FFR) has not been validated.Methods and Results:To evaluate the diagnostic accuracy of the CZT ultrafast camera system (Discovery NM 530c), 95 patients underwent stress thallium-201 single-photon emission computed tomography (SPECT) and then CAG within 3 months. Image acquisition was performed in the supine and prone positions after stress for 5 and 3 min, respectively, and in the supine position at rest for 10 min. Significant stenosis was defined as ≥90% diameter narrowing on visual estimation, or a lesion with

こどもコミュニティセンターでは、親子のひろば「ぽっけ」の参加者である親子を対象に、学生による保育付きのプログラムを実施してきた。今回、新たに親子それぞれが並行してプログラムに参加する親子並行プログラムを実施した。親プログラムは、名称を「My Own Time～わたしの時間～」とし、参加者である母親にひとときの子どもと離れた自由時間を提供する内容とした。子どもプログラムは名称を「おにいさんおねえさんと遊べるタイム」とし、親から離れて1人で学生と一緒に遊ぶ内容とした。終了後のアンケートでは、親プログラムは気持ちがリフレッシュし、子どもへの気持ちを再確認できる機会となり、子どもはプログラムへの参加が社会的経験となり、親子で共に成長する機会となった等の感想が得られた。アンケートの内容、子どもプログラムの観察と学生への聞き取り、その後の親子の様子から、プログラムの内容について考察し、大学でプログラムを行うことの意義を検討する。, At the Child Community Center, the programs for parents with childcare by college students have been held since it was found. This time new programs were conducted as parents and children could join separately in the different programs at the same time. The name of the programs for the parents was “My Own Time”, designed for giving them two-hours free time away from their children. Another program for children was called “Playing with Big Brothers and Sisters” which was planned for enabling the children to play with college students in the drop-in“Pokke” as they were separated from their parents. According to the results of the questionnaires, parents gained a relaxation time and found an opportunity to rediscover how they love their children. Consequently, the programs have supported the growth of both parents and children. We will examine the meanings of these programs by analyzing the results of the questionnaires, observing the children’ program, listening to the students voices, and investigating continually to the relationship between parents and children.

Nucleic acids like siRNA and pDNA are remarkable for treatment of ophthalmic diseases in posterior segment of eye such as age-related macular degeneration (AMD). However, hydrophilic and high molecule compounds are restricted in intraocular distribution through anterior segment of the eye. In addition, the ocular tissue has a blood-retinal barrier which restricts drug delivery thorough systemic administration. Therefore the invasive intravitreal injection has been generally applied for treatment of retinal diseases. The objective in this study is to prepare nucleic acid-loaded liposomes for effective gene delivery to posterior segment of eye by non-invasive ophthalmic administration such as eye-drops. The pDNA/PEI-complex loaded liposomes were prepared using detergent removal method. The obtained liposomes were lyophilized with optimal amount of a cryoprotectant to avoid changes in physical properties and, followed by adjustment of an appropriate volume and osmotic pressure as ophthalmic solution. The liposomes show high pDNA encapsulation efficiency and good cellular uptake ability in human retinal pigment epithelial cells (ARPE-19 cells). We further demonstrate that the modification of ligand which binds to specific receptor on the RPE cells to the liposomes may improve gene delivery efficacy to the posterior segment of eye by non-invasive ocular instillation.

BACKGROUND Although stress single-photon emission computed tomography (SPECT) using a cadmium-zinc-telluride (CZT) camera facilitates radiation dose reduction, only a few studies have evaluated its diagnostic accuracy in Japanese patients by applying fractional flow reserve (FFR) measurements. METHODS AND RESULTS We prospectively evaluated 102 consecutive patients with suspected or known coronary artery disease with a low-dose stress/rest protocol ((99m)Tc radiotracer 185/370 MBq) using CZT SPECT. Within 3 months, coronary angiography was performed and a significant stenosis was defined as ≥90% diameter narrowing on visual estimation, or as a lesion of

To obtain data on the brachial-ankle pulse wave velocity (baPWV) distribution during adolescence, a total of 3215 Japanese adolescents ranging from 12 to 18 years of age were studied. The brachial-ankle pulse wave velocity increased substantially with age and was significantly higher in males than in females. Multivariate regression analysis revealed that age, weight, and systolic and diastolic blood pressures were the major determinants of baPWV for both genders. Age-specific centile curves of baPWV were constructed for males and females by regression curve analysis. The proposed distribution curves of baPWV and its derived cutoff values may allow the atherosclerotic risk profile among adolescents of different ages to be more precisely estimated.

日本の折り紙のはじまりは神事や贈答儀礼に用いられる「儀礼折り紙」であった。江戸時代になると、折り紙は礼法や決まりから離れ、折り方そのものを楽しむ「遊戯折り紙」がおとなの遊びとして広まった。江戸時代中期には、それまで祖母や母から女子の躾として伝承されていた折り紙が、「子どもの遊び」となり普及していくようになる。一方西欧では、フレーベルが子どもの創造的活動衝動を自由に表現するための「作業具」の1つとして、折り紙を位置づけた。フレーベルの教育理論を導入した日本の幼稚園でも折り紙は保育教材として採用されたが、フレーベルが折り紙に込めた教育的意図は理解されないまま、折り紙はやがて保育教材・教具から放逐されていった。しかし折り紙遊びはその後も現代に至るまで家庭や幼稚園、保育園で子どもたちに親しまれている。折り紙あそびの普遍的魅力を再考し、折り紙の教材的価値や折り紙遊びにおける子どもへの適切な援助に関する研究が望まれる。, The purpose of the study is to reassess the changeless appeal of Origami play through examination of its historical correlates. In the Heian era, origami was “courtesy origami” for “Act of God” or exchange of presents courtesy. From the middle of the Edo era, origami had become a popular play among children. In the Meiji era, Froebel’s origami was introduced in Japan as one of his occupations for creative activity of children and the origami was taken in as the teaching materials of kindergarten and primary school. But in Japan, origami was intended to develop the process of accuracy and skillfulness of the fingers. Therefore the origami was not utilized positively as the childcare teaching materials. But the origami play is high in popularity in the present age. It is necessary for us to revaluate a meaning of the origami play as the childcare teaching materials.

Background: Although stress-induced left ventricular (LV) wall motion abnormality is a well-known marker for extensive coronary artery disease (CAD), no study has yet analyzed whether phase analysis of exercise-induced LV mechanical dyssynchrony may have enhanced diagnostic value over conventional perfusion analysis in the detection of multivessel CAD. Methods and Results: A total of 278 patients with suspected or confirmed CAD underwent both exercise stress 99mTc-sestamibi gated single-photon emission computed tomography and coronary angiography. LV mechanical dyssynchrony was evaluated using the SyncTool to obtain the phase SD and histogram bandwidth. In the detection of 128 patients with multivessel CAD, a summed stress score (SSS) of ≥9 showed a sensitivity of 84% and a specificity of 53%, while an increase in phase SD of ≥4.4° and a bandwidth of ≥14° after exercise had sensitivities of 74% and 68%, and specificities of 84% and 91%, respectively. On multivariate analysis the combination of post-stress increases in phase SD, histogram bandwidth, transient ischemic dilation (TID) ratio and SSS best identified multivessel CAD (sensitivity 77%, specificity 88%, χ2=181.8), compared with TID ratio and SSS only (sensitivity 70%, specificity 76%, χ2=68.9). Conclusions: The addition of phase analysis to evaluate exercise-induced LV mechanical dyssynchrony on conventional perfusion analysis enabled better identification of patients with multivessel CAD. (Circ J 2012; 76: 1942–1952)

Background: Although poststress myocardial stunning is regarded as a marker for severe coronary artery disease (CAD), no study has yet compared the diagnostic value of poststress stunning with transient ischemic dilation (TID) of the left ventricle (LV) for detecting multivessel CAD. Methods and Results: A total of 271 patients with suspected or known CAD underwent adenosine triphosphate (ATP) loading and at-rest gated single-photon emission computed tomography. We assessed myocardial perfusion with a 20-segment model, and analyzed the changes in LV volumetric analysis induced by ATP and an automatically derived TID ratio. In 147 patients with multivessel CAD, the prevalence of multi-territorial ischemia was higher, and the post-ATP increase in end-systolic volume (ESV) and TID ratio were greater, than in the 124 with insignificant or single-vessel CAD (P

Summary Objectives Although ischemic electrocardiographic (ECG) changes during dipyridamole or adenosine infusion have been reported as a marker for severe coronary artery disease (CAD), few studies have focused on ST-segment changes with adenosine triphosphate (ATP)-loading myocardial single-photon emission computed tomography (SPECT). Methods and subjects Between January 2003 and August 2008, 4650 consecutive patients underwent ATP-loading SPECT. After 1412 patients with left bundle branch block, pacemaker rhythm, or previous coronary revascularization were excluded, 16 out of 3238 patients (0.5%) showed ischemic ST-segment depression during ATP-loading myocardial SPECT. They were aged 67 ± 11 years; 10 were men and 6 women. Of these patients, 8 demonstrated perfusion abnormalities, whereas the remaining 8 showed normal myocardial perfusion imaging. In 6 of the 8 patients with abnormal SPECT, coronary angiography was performed, revealing left main trunk disease in 1 patient, 3-vessel disease in 4, 1-vessel disease with proximal left ascending artery occlusion in 1, and an insignificant lesion in 1. By contrast, no major cardiac event was observed in the 8 patients with normal SPECT during follow-up for an average of 2 years. Conclusion The prevalence of ischemic ST-segment changes during ATP loading is very rare. However, this finding should be taken into account since almost half of the patients, particularly those with perfusion abnormalities, may have severe CAD which requires coronary revascularization.

Summary Background: Although stress-induced myocardial stunning often develops after exercise testing, determinants of this phenomenon have not been evaluated. Methods and results: Thirty-one patients with 1-vessel coronary artery disease, limited to the left anterior descending artery (LAD), were evaluated by quantitative coronary angiography (QCA) and intracoronary pressure measurements to calculate fractional flow reserve (FFR). In addition, electrocardiogram-gated technetium-99m sestamibi myocardial imaging was acquired >30 min after exercise and 4 h later to assess the development of stunning. Exercise-induced myocardial stunning was observed in 11 patients (35%). In patients with myocardial stunning, a summed stress score (17.3 ± 7.1 vs. 8.1 ± 6.2, p < 0.001), summed difference score (10.3 ± 4.1 vs. 2.7 ± 1.9, p < 0.0001), and wall motion difference score (4.8 ± 2.8 vs. 0.9 ± 1.1, p < 0.0001) were greater than in those without, while diameter stenosis calculated by QCA (55.1 ± 17.3% vs. 29.8 ± 17.3%, p < 0.0001) was greater and FFR reduced significantly (0.54 ± 0.13 vs. 0.83 ± 0.06, p < 0.0001). Of note, 4 out of 21 patients (19%) with

Although the presence of coronary heart disease (CHD) was the major determinant of perioperative mortality and long-term prognosis in patients with aortic aneurysm (AA) and peripheral artery disease (PAD), the prevalence and severity of CHD in patients with individual vascular diseases was unknown. Adenosine triphosphate-loading myocardial single-photon emission computed tomography therefore was performed in 788 patients with vascular diseases of the aorta and peripheral arteries, with AA in 500, PAD localized in the lower-limb arteries in 183, and combined AA and PAD in 105. Patients with known CHD, such as those with previous myocardial infarction or revascularization procedures, were excluded. Myocardial single-photon emission computed tomography was analyzed using a 20-segment model, and summed stress scores and summed difference scores were calculated. Stress-induced myocardial ischemia was defined as a summed difference scoreor=2. The presence of myocardial ischemia was highest in patients with combined PAD and AA (73%), followed by PAD (55%; p = 0.005), and the lowest in patients with AA (37%; p0.0001). Summed stress score was also the highest in patients with combined PAD and AA (11.6 +/- 9.9), followed by PAD (7.8 +/- 8.8; p0.0001), and the lowest in patients with AA (4.0 +/- 6.2; p0.0001 for both). Similarly, summed difference score was the highest in patients with combined PAD and AA (6.4 +/- 6.1), followed by PAD (4.4 +/- 5.7; p = 0.001) and AA (2.3 +/- 4.0; p0.0001 for both). In conclusion, the prevalence of CHD in patients with PAD was50%, and although myocardial ischemia was observed in only (1/3) of patients with AA, its prevalence not only doubled, but also indicated extensive myocardial ischemia when combined with PAD. Thus, cardiac evaluation was particularly important in patients with combined AA and PAD.

Background Although transient left ventricular (LV) dilation is a well-known marker for extensive coronary artery disease (CAD), few studies performed quantitative analysis of LV function of post adenosine triphosphate (ATP) stress and at rest to detect extensive CAD.

Background: Although B-type natriuretic peptide (BNP) has emerged as an important predictor for cardiac events, its effect on scintigraphic parameters is unknown. Methods and Results: The Q-PROVE study is a multicenter study to evaluate the prognostic value of ECG-gated SPECT in 175 Japanese elderly patients. In addition, BNP was assessed in 102 patients. Outcome assessment included cardiac events and noncardiac deaths. Twelve elderly patients (12%) had increased BNP >130 pg/ml. The summed stress score (SSS) was greater in patients with increased BNP than in those with normal BNP. Kaplan-Meier survival estimation indicated event-free survival rates at 3 years of 83%, 78%, 88%, 80%, respectively, in patients with BNP >130 pg/ml, SSS ≥7, summed difference score (SDS) ≥2, and dilated end-diastolic volume (EDV), but 98%, 98%, 100%, 94% in those with BNP ≤130 pg/ml, SSS

高度経済成長期以降、子育て機能は家族から外部化、社会化され、ケアワーカーである保母（現保育士）によって部分的に代替されるようになったが、依然として乳幼児の子育ての大部分は専業主婦の母親の手に委ねられてきた。しかし1990年代に入ると、在宅で子育てをしている母親の育児不安やストレスが顕在化し、政府は次世代育成支援対策として、在宅での子育てを支援する「子育て支援」という、新しい形の「子育ての社会化（再社会化）」を打ち出した。本稿ではこのような子育てをめぐる状況、施策の変遷をたどり、新たな「子育ての再社会化」の下、保育士の専門性として、保育というケアワークの知識・技能とともに新たにソーシャルワーク的機能が求められていることを明らかにし、その専門性を担保する一つの例として、カナダにおける子育て支援者（家族支援者）の養成カリキュラムについて紹介した。, Since the 1960's, the industrialization and urbanization had promoted the socialization of childcare in a form of childcare workers raising children for parents, but childcare had been still largely undertaken by mothers. In the 1990's, the family nuclearization and the community bond dilution had increased stresses of mothers devoted to raising children at home, which had become a social problem. Since the introduction of the Angel Plan, a new socialization （resocialization） has been encouraged as a governmental measure as well as a regional practice. This new socialization is to promote a method in which childcare workers accompany mothers in raising children. This paper is to examine the role of such workers who need to support families as an additional responsibility after the qualification became legal under the new socialization, and to clarify the needs for the function of childcare workers as social workers given the current parenting family environment. As a means for training such workers, this paper also introduces the curriculum of the continuing education school at Ryerson University offering certification for family supports.

SummaryObjectivesAlthough the Heston index, derived left ventricular (LV) volumetric analysis, is reported to best represent transient LV dilation on non-gated single-photon emission computed tomography (SPECT), its diagnostic performance has not been proven to identify extensive coronary artery disease (CAD) as assessed by coronary angiogram. Accordingly, we sought to evaluate the diagnostic utility of Heston index to detect multi-vessel CAD.MethodsPost-stress and resting electrocardiogram-gated 99mTc-sestamibi SPECT was performed in 223 patients with suspected or known CAD. All of the patients underwent coronary angiography within 3 months of gated SPECT. The summed stress, summed rest, and summed difference scores were calculated using a 20-segment model. The left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) were calculated automatically with the QGS program. In addition, stress-to-rest ratios of EDV, ESV, and (ESV×5+EDV) were calculated; the latter was defined as Heston index.ResultsIn the 104 patients with multi-vessel CAD, the summed stress score (17.5±10.0 vs. 11.7±9.2, p

Many out-patients with mental disorders are prescribed hypnotics at mental hospitals.Although we explain in detail how hypnotics should be taken when they are first prescribed,we do not always explain their use to patients who have been taking hypnotics for a long-time.In consideration of this situation,we performed a questionnaire survey on the actual usage of hypnotics by out-patients,with the purpose of raising awareness of the proper way of using them.The total number of patients responding was 161,78.9% of whom went to bed within 30 minutes of taking hypnotics,and 74.5% fell asleep within 60 minutes.The average total sleeping time was 7.1 hours and 71.4% felt that hypnotics were effective.On the other hand,21.1% did not go to bed for more than 30 minutes after taking hypnotics.Based on these findings,we should advise patients on the use of hypnotics more frequently.

Although transient left ventricular (LV) dilation is a well-known marker for extensive coronary artery disease (CAD), few studies have performed quantitative analysis of LV function after stress and at rest to detect extensive CAD.Poststress and resting gated single photon emission computed tomography (SPECT) was performed in 175 patients with suspected CAD. All of the patients underwent coronary angiography within 3 months of gated SPECT. In the 83 patients with multivessel CAD, the summed difference score was greater (9.2 +/- 7.0 vs 3.3 +/- 4.0, P.0001), the poststress increase in end-systolic volume (ESV) was larger (7.0 +/- 8.0 mL vs -0.8 +/- 4.7 mL, P.0001), and the poststress increase in ejection fraction (EF) was less (-4.7% +/- 5.4% vs -0.4% +/- 4.5%, P.0001) than in the 92 patients with insignificant or single-vessel CAD. In the detection of multivessel CAD, a summed difference score of 9 or greater showed a sensitivity of 46% and specificity of 90%, whereas an increase in ESV of 5 mL or greater and a decrease in EF of 5% or greater after exercise had a sensitivity of 66% and 52%, respectively, and specificity of 87% and 83%, respectively. The multivariate discriminant analysis revealed that the combination of poststress increase in ESV, summed difference score, and diabetes mellitus best identified multivessel CAD, with a sensitivity of 72% and specificity of 84% (chi(2), 81.7).The addition of poststress and at-rest LV functional analysis by use of gated SPECT to conventional perfusion analysis helps to better identify patients with multivessel CAD.

Background Exercise gated single-photon emission computed tomography (SPECT) using technetium-99m (99mTc)-sestamibi evaluates both myocardial perfusion during stress and wall motion >30 min after the stress, which has the potential to assess not only exercise-induced myocardial ischemia but also the development of myocardial stunning. Methods and Results To evaluate the incidence of post-stress myocardial stunning, as well as comparing the effects of different stress methods on the development of stunning, 179 consecutive patients with known or suspected coronary artery disease (CAD) underwent 99mTc-sestamibi SPECT with either exercise (n=135) or adenosine triphosphate disodium (ATP) (n=44). Electrocardiogram-gated SPECT images were acquired >30 min after the stress and again 4 h later, and perfusion and wall motion were evaluated. Post-stress myocardial stunning occurred in 24 patients (13%): 22 after exercise and 2 after ATP stress. The magnitude of the transient wall motion abnormality after exercise was greater in patients with severe ischemia, compared with those with mild-to-moderate ischemia (p

The purposes of this paper were to evaluate the serum leptin levels in healthy adolescents and to establish standard age variation curves.Nine hundred six (414 boys and 492 girls) healthy adolescents were investigated. The maximum increment age in height (MIA) was identified in 124 boys and 130 girls. The menarcheal age (MA) was obtained for 130 girls. Fasting leptin levels were measured by enzyme immunoassay. The MIA was calculated by proportional allotment of yearly height increments.Serum leptin levels did not change in boys and girls from the ages of 9 to 11. They decreased after the age of 11 in boys, while they increased in girls. Stepwise multiple regression analysis revealed that serum leptin levels were closely related to pubertal stage. The levels decreased remarkably after MIA in boys and increased remarkably after MA in girls. We drew standard age variation curves of serum leptin levels by calculating the 25th, 50th and 75th percentiles for each age in both boys and girls. The percentile curves for boys were divided into pre-MIA and post-MIA curves. Those for girls were divided into pre-MA and post-MA curves.We have devised a potentially useful method for evaluating serum leptin levels in adolescents considering the effects of gender and growth.

Background: Previous studies have reported controversial results for the association between green tea consumption and low-density lipoprotein (LDL)-cholesterol and body weight. Objective: The objective of this trial was to determine the effects of two kinds of green tea on LDL-cholesterol and body weight. Methods: We randomly assigned 151 participants (98 men, 53 women) aged 30–70 years into three groups: Yabukita green tea group, Benifuuki green tea group, or placebo group. Participants consumed 1.8 g/day of green tea extract powder or placebo for 12 weeks. The primary outcomes were LDL-cholesterol level and body weight, and the secondary outcomes were risk factors for cardiovascular disease. Results: Both Yabukita and Benifuuki green tea significantly lowered LDL-cholesterol. The magnitudes of the lipid-lowering effect of both types of tea were significantly larger than that of placebo. No differences with respect to changes in LDL-cholesterol were observed between the Yabukita and Benifuuki green tea groups. Neither Yabukita nor Benifuuki green tea had any effect on body weight and no difference was observed among groups regarding changes in body weight. Conclusion: Both Yabukita and Benifuuki green tea lowered LDL-cholesterol, and the lipid-lowering effects of these two green teas were not different. Neither tea lowered body weight.

Most group B streptococcus (GBS) infections in newborns are with capsular type Ia, Ib, or III. To prevent these infections more effectively, we developed a real-time PCR method to simultaneously detect GBS species and identify these 3 capsular types in vaginal swab samples from women at 36-39 weeks of gestation. DNA to be detected included those of the dltS gene (encoding a histidine kinase specific to GBS) and cps genes encoding capsular types. PCR sensitivity was 10 CFU/well for a 33-35 threshold cycle. Results were obtained within 2 h. Direct PCR results were compared with results obtained from cultures. Samples numbering 1226 underwent PCR between September 2008 and August 2012. GBS positivity rates by direct PCR and after routine culture were 15.7% (n = 192) and 12.6% (n = 154), respectively. Sensitivity and specificity of direct PCR relative to culture were 96.1% and 95.9%. Of GBS positive samples identified by PCR, capsular types determined directly by real-time PCR were Ia (n = 24), Ib (n = 32), and III (n = 26). Real-time PCR using our designed cycling probe is a practical, highly sensitive method for identification of GBS in pregnant carriers, allowing use of prophylactic intrapartum antibiotics in time to cover the possibility of unexpected premature birth.

High-molecular-weight kininogen (HMWK) deficiency is a very rare hereditary disorder. We herein report a case of HMWK deficiency with splenic infarction. The HMWK activity of the proband was markedly decreased (0.9%). Direct sequencing of his HMWK gene showed a homozygous "TC" insertion at c523-524 in exon 4. This insertion led to an amino acid substitution, Ser175Ser, resulting in a frameshift mutation and a premature stop codon in amino acid 183. Furthermore, the HMWK activity was also reduced in the patient's three children, who exhibited the heterozygous "TC" insertion at c523-524 in exon 4. This is the first report of this gene alteration in a patient with HMWK deficiency.

Background: The detection of significant coronary artery disease (CAD) in patients with heart failure (HF) from left ventricular (LV) systolic dysfunction is crucial. We evaluated the usefulness of LV mechanical dyssynchrony as assessed by phase analysis compared with conventional gated single-photon emission computed tomography to identify ischemic etiology in patients with HF. Methods and Results: Forty-one consecutive patients who were initially admitted to hospital due to HF resulting from systolic dysfunction were evaluated. All patients underwent cardiac catheterization. LV mechanical dyssynchrony was evaluated using SyncTool™ to obtain the phase SD and histogram bandwidth. The changes in phase SD and histogram bandwidth with stress were calculated. The summed stress score, summed difference score, and changes in phase SD and histogram bandwidth with stress were greater in 26 patients with CAD than in 15 patients without CAD (P=0.001 and P=0.01). On multivariate analysis a phase SD of >14° (odds ratio [OR], 16.7) and a summed stress score of >17 (OR, 8.0) best differentiated LV dysfunction of ischemic and non-ischemic etiologies, with a sensitivity of 89% and a specificity of 87% (χ2=20), compared with summed stress score only (sensitivity, 46%; specificity, 87%; χ2=4.5). Conclusions: The addition of phase analysis to conventional perfusion analysis enables better differentiation of the etiology of HF in patients with systolic dysfunction. (Circ J 2014; 78: 141–150)

Inactivation of cyclin B–Cdc2 kinase at the exit from M phase depends on the specific proteolysis of the cyclin B subunit, whereas the Cdc2 subunit remains present at nearly constant levels throughout the cell cycle. It is unknown how Cdc2 escapes degradation when cyclin B is destroyed. In Xenopus egg extracts that reproduce the exit from M phase in vitro, we have found that dissociation of the cyclin B–Cdc2 complex occurred under conditions where cyclin B was tethered to the 26S proteasome but not yet degraded. The dephosphorylation of Thr 161 on Cdc2 was unlikely to be necessary for the dissociation of the two subunits. However, the dissociation was dependent on the presence of a functional destruction box in cyclin B. Cyclin B ubiquitination was also, by itself, not sufficient for separation of Cdc2 and cyclin B. The 26S proteasome, but not the 20S proteasome, was capable of dissociating the two subunits. These results indicate that the cyclin B and Cdc2 subunits are separated by the proteasome through a mechanism that precedes proteolysis of cyclin B and is independent of proteolysis. As a result, cyclin B levels decrease on exit from M phase but Cdc2 levels remain constant.

The title compound was prepared by addition of 4,5-dimethoxybenzyne to 9,9′-bianthryl. The rotational isomers, ap and ±sc, were separated by HPLC. The ±sc isomers were treated with sodium ethanethiolate to produce 3,3′-dihydroxy-2,2′-dimethoxy-9,9′-bitriptycyl, which was converted to the ester of (1S,5R,7R)-4-[(2-carboxy)benzoyl]-3-thia-4-azatricyclo[5.2.1.01,5]decane 3,3-dioxide. The resulting diastereomers were separated by HPLC. The isomers were hydrolyzed and methylated with dimethyl sulfate to yield optically active 2,2′,3,3′-tetramethoxy-9,9′-bitriptycyl. The absolute conformation of the tetramethoxy compound was determined by X-ray structure analysis of 3′-ester of (1S,5R,7R)-4-(2-carboxybenzoyl)-3-thia-4-azatricyclo[5.2.1.01,5]decane 3,3-dioxide derived from 3-hydroxy-2,2′,3′-trimethoxy-9,9′-bitriptycyl, followed by hydrolysis and then methylation. The CD spectrum of Msc-2,2′,3,3′-tetramethoxy-9,9′-bitriptycyl is reported.

Background: Although the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is used to characterize coronary anatomy based on 9 anatomic criteria such as lesion location and complexity, the relationship between SYNTAX score and myocardial ischemia has yet to be elucidated. Methods and Results: A total of 158 consecutive patients with suspected or known coronary artery disease (CAD), who underwent both 99mTc-sestamibi single-photon emission computed tomography (SPECT) and coronary angiography, were evaluated. Stress SPECT was assessed using a 17-segment model, and the percentage of the myocardial defect scores (DS) was calculated. In 37 patients with intermediate-high SYNTAX scores (>22), the number of men and the prevalence of multi-vessel CAD were significantly higher, and the % stress and ischemic DS were significantly greater than in 121 patients with low SYNTAX scores (≤22). Coronary risk factors, however, were similar between the 2 groups. The % stress and ischemic DS significantly correlated with SYNTAX score. In patients with a low SYNTAX score, % stress and ischemic DS also significantly correlated with the SYNTAX score, whereas no such correlation was observed in the intermediate-high SYNTAX score group. Conclusions: SYNTAX score correlated well with myocardial ischemia as assessed on stress SPECT in general. The higher the SYNTAX score, however, the less clear was the correlation with the extent of myocardial ischemia. (Circ J 2013; 77: 2772–2777)

Background Cadmium-zinc-telluride (CZT) solid-state detectors have been recently introduced into the field of myocardial perfusion imaging. The aim of this study was to prospectively compare the diagnostic performance of the CZT high-speed gamma camera (Discovery NM 530c) with that of the standard 3-head gamma camera in the same group of patients. Methods and results The study group consisted of 150 consecutive patients who underwent a 1-day stress-rest (99m)Tc-sestamibi or tetrofosmin imaging protocol. Image acquisition was performed first on a standard gamma camera with a 15-min scan time each for stress and for rest. All scans were immediately repeated on a CZT camera with a 5-min scan time for stress and a 3-min scan time for rest, using list mode. The correlations between the CZT camera and the standard camera for perfusion and function analyses were strong within narrow Bland-Altman limits of agreement. Using list mode analysis, image quality for stress was rated as good or excellent in 97% of the 3-min scans, and in 100% of the ≥4-min scans. For CZT scans at rest, similarly, image quality was rated as good or excellent in 94% of the 1-min scans, and in 100% of the ≥2-min scans. Conclusions The novel CZT camera provides excellent image quality, which is equivalent to standard myocardial single-photon emission computed tomography, despite a short scan time of less than half of the standard time.