Behavior of total peroxy and total organic nitrate concentrations at Suzu on the Noto Peninsula, Japan : Long-range transport and local photochemical production

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Comparison of Surgeon Stress and Workload between Reduced-port and Laparoscopic Cholecystectomy : A Prospective Study

Single-port laparoscopic surgery（SPLS）has attracted attention in the field of minimally invasive surgery; however, the associated technical difficulty has delayed its adoption by all surgeons. Reduced-port laparoscopic surgery might be easier to perform than SPLS, and in this prospective study, we compared surgeon stress and workload between reduced-port laparoscopic cholecystectomy（RPLC）and conventional laparoscopic cholecystectomy（CLC）. Twenty consecutive patients were assigned to undergo either RPLC or CLC between July 2016 and April 2017. Two surgeons performed the operations. The differences in surgeon workload and stress between RPLC and CLC were evaluated. Patient factors and operative outcomes were not significantly different between RPLC and CLC. In the surgeon-reported Surgery Task Load Index, the task demand subscale was significantly higher for RPLC than for CLC（P＝0.005）, although the salivary amylase levels were not significantly different between RPLC and CLC. RPLC was similar to CLC with respect to surgeon stress. Considering workload, the task demand was higher in CLC than in RPLC, which therefore might be an acceptable alternative to CLC for treating benign gallbladder disease

Laparoscopic Extirpation of a Schwannoma in the Lateral Pelvic Space

Schwannomas in the lateral pelvic space are very rare. Here, we report the case of a 48-year-old woman who had a tumor detected in her abdomen by abdominal ultrasonography. Abdominal computed tomography and magnetic resonance imaging revealed a well-defined solid tumor of 65 mm in diameter in the right lateral pelvic space. We performed laparoscopic surgery under a diagnosis of a gastrointestinal tumor or neurogenic tumor. The tumor was safely dissected and freed from the surrounding tissues using sharp and blunt maneuvers. The tumor originated from the right sciatic nerve. Complete laparoscopic extirpation was performed with preservation of the right sciatic nerve. Pathological examination suggested schwannoma. The patient recovered well but had remaining sciatic nerve palsy in her right foot. Laparoscopic extirpation for a schwannoma in the lateral pelvic space was safe and feasible due to the magnified surgical field afforded by laparoscopy

Design report of the KISS-II facility for exploring the origin of uranium

One of the critical longstanding issues in nuclear physics is the origin of the heavy elements such as platinum and uranium. The r-process hypothesis is generally supported as the process through which heavy elements are formed via explosive rapid neutron capture. Many of the nuclei involved in heavy-element synthesis are unidentified, short-lived, neutron-rich nuclei, and experimental data on their masses, half-lives, excited states, decay modes, and reaction rates with neutron etc., are incredibly scarce. The ultimate goal is to understand the origin of uranium. The nuclei along the pathway to uranium in the r-process are in "Terra Incognita". In principle, as many of these nuclides have more neutrons than 238U, this region is inaccessible via the in-flight fragmentation reactions and in-flight fission reactions used at the present major facilities worldwide. Therefore, the multi-nucleon transfer (MNT) reaction, which has been studied at the KEK Isotope Separation System (KISS), is attracting attention. However, in contrast to in-flight fission and fragmentation, the nuclei produced by the MNT reaction have characteristic kinematics with broad angular distribution and relatively low energies which makes them non-amenable to in-flight separation techniques. KISS-II would be the first facility to effectively connect production, separation, and analysis of nuclides along the r-process path leading to uranium. This will be accomplished by the use of a large solenoid to collect MNT products while rejecting the intense primary beam, a large helium gas catcher to thermalize the MNT products, and an MRTOF mass spectrograph to perform mass analysis and isobaric purification of subsequent spectroscopic studies. The facility will finally allow us to explore the neutron-rich nuclides in this Terra Incognita.Comment: Editors: Yutaka Watanabe and Yoshikazu Hirayam

Needlescopic video-assisted wedge resection combined with the subcostal trans-diaphragmatic approach for undetermined peripheral pulmonary nodules

Background: Reduced mortality from lung cancer by computed tomography (CT) screening facilitates the use of video-assisted thoracic surgery (VATS) lung wedge resection to obtain a definite diagnosis and to treat tiny nodules. The authors evaluated their initial experience using novel needlescopic VATS wedge resection combined with the subcostal trans-diaphragmatic (SCTD) approach for managing undetermined peripheral pulmonary nodules. Methods: Between 2009 and 2012, 35 patients who had 36 operations underwent needlescopic VATS wedge pulmonary resection with the SCTD approach. Preoperative percutaneous CT-guided marking of the nodule was performed. Two 3-mm miniports were placed in the thorax for the thoracoscopic camera and minigrasper. Just anterior to the 10th rib, a 2-cm subcostal incision was made, and a 12- or 15-mm port was placed trans-diaphragmatically into the chest cavity. Wedge resection of the lung was performed with endostaplers introduced through a subcostal port. Results: The median tumor size was 1.1 cm. Localization of the tumor was widely distributed. The mean operation time was 51 min, and the mean blood loss was 4.2 mL. No patients required conversion to thoracotomy, and one patient required conversion to conventional VATS. Additional thoracic ports were placed in five patients, and the needlescopic incision was extended to 15 mm in one patient. The median duration of chest drainage was 1 day. Additional analgesia was not required for 22 patients and was used for less than 1 day for three patients, less than 2 days for seven patients, and less than 3 days for seven patients. The pathologic diagnosis of the nodules was malignant for 28 patients and benign for 8 patients. On postoperative day 7 or at admission, 34 patients were free of postoperative neuralgia. Conclusions: Needlescopic VATS wedge pulmonary resection combined with the SCTD approach is both safe and feasible and offers the specific advantages of minimal invasiveness and good cosmetic outcomes. © 2013 Springer Science+Business Media New York

Protocol of a phase II study investigating the efficacy and safety of trifluridine/tipiracil plus ramucirumab as a third-line or later treatment for advanced gastric cancer

In Japan, systemic chemotherapy is the standard treatment for unresectable, advanced, or recurrent gastric cancer. However, numerous patients with gastric cancer do not receive late-line treatment because of the rapid progression of gastric cancer. Additionally, late-line treatments, such as nivolumab, trifluridine tipiracil (FTD/TPI), or irinotecan, have limited effects on improving clinical symptoms and delaying the onset of symptoms associated with cancer progression. Recently, a combination of FTD/TPI and ramucirumab was reported to have a high response rate in late-line treatment; however, owing to patient selection bias and a high rate of hematologic toxicity in that previous study, this regimen may not be feasible in real-world clinical applications. Our objective is to conduct a single-arm phase II study to assess the safety and efficacy of FTD/TPI plus ramucirumab combination therapy for gastric cancer after third-line treatment under real-world clinical conditions. This study will recruit 32 patients according to eligibility criteria and administer FTD/TPI (35 mg/m^2) and intravenous ramucirumab (8 mg/kg). The primary endpoint will be the time to treatment failure. The secondary endpoints will include the overall survival time, progression-free survival time, overall response rate, disease control rate, relative dose intensity, and incidence of adverse events. The results will add new insights for improving the late-line treatment of advanced gastric cancer.departmental bulletin pape

Apelin Deficiency Accelerates the Progression of Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by the selective loss of motor neurons. Recent studies have implicated that chronic hypoxia and insufficient vascular endothelial growth factor (VEGF)-dependent neuroprotection may lead to the degeneration of motor neurons in ALS. Expression of apelin, an endogenous ligand for the G protein-coupled receptor APJ, is regulated by hypoxia. In addition, recent reports suggest that apelin protects neurons against glutamate-induced excitotoxicity. Here, we examined whether apelin is an endogenous neuroprotective factor using SOD1G93A mouse model of ALS. In mouse CNS tissues, the highest expressions of both apelin and APJ mRNAs were detected in spinal cord. APJ immunoreactivity was observed in neuronal cell bodies located in gray matter of spinal cord. Although apelin mRNA expression in the spinal cord of wild-type mice was not changed from 4 to 18 weeks age, that of SOD1G93A mice was reduced along with the paralytic phenotype. In addition, double mutant apelin-deficient and SOD1G93A displayed the disease phenotypes earlier than SOD1G93A littermates. Immunohistochemical observation revealed that the number of motor neurons was decreased and microglia were activated in the spinal cord of the double mutant mice, indicating that apelin deficiency pathologically accelerated the progression of ALS. Furthermore, we showed that apelin enhanced the protective effect of VEGF on H2O2-induced neuronal death in primary neurons. These results suggest that apelin/APJ system in the spinal cord has a neuroprotective effect against the pathogenesis of ALS

A survey on clinical training stress among students of Judo therapist training schools : focus on differences in grade-specific training modes

The accreditation rules for judo therapist training schools have been revised, and the scope of clinical training has been expanded in terms of its contents, duration, and so on. Consequently, the importance of clinical training has increased. While these schools develop clinical training based on the guidelines for (on-site) clinical training, each school independently selects the training location, duration, contents, and so on. However, the actual condition of the students undergoing clinical training remains unknown. Although there have been many reports on the stress of students in other healthcare fields who undergo clinical training, there are few studies on the stress of students who undergo clinical training at judo therapist training schools. Therefore, this study aimed to investigate the psychological and physical responses to stress in students at judo therapist training schools that implement different training modes for each grade. The participants were 252 second- to fourth-year students who underwent clinical training. Psychological responses were measured using the State-Trait Anxiety Inventory (STAI), and physical responses were measured by salivary alpha-amylase activity assay and acceleration plethysmography. The results showed that the STAI scores, which represent the level of psychological response, were higher before the clinical training for the second-year students and after for the third- and fourth-year students. As for physical re-sponses, acceleration plethysmography showed higher heart rates before the clinical training in the second- and third-year students. Moreover, it was observed that the participants had low stress levels during the clinical training. Thus, the results revealed that during the clinical training, the participants exhibited significant psycho-logical responses, but there were no marked changes in their physical responses. A possible reason for the absence of excessive stress is that the implementation of participatory clinical training through a step-by-step approach of observation, imitation, and practice helped alleviate the participants’ anxie-ty-related stress. The results of this study indicate that the participants underwent clinical training with moderate levels of stress.柔道整復師学校養成施設指定規則が改正され，臨床実習の実施内容および実施時間などの拡大が進んだことで，その重要性が高まっている。柔道整復師学校養成施設の臨床実習は，臨床（地）実習ガイドラインに基づいて展開されるが，実習場所や実施時間および実習内容などは，各学校単位で選定し臨床実習が進められている。しかし，臨床実習に臨む学生の実態が未だ明確となっていない。すなわち，他のコメディカルでは，臨床実習に臨む学生のストレスに関わる報告が多いなか，柔道整復師学校養成施設での臨床実習に臨む学生のストレス調査に関した報告は少ない。 本研究では，柔道整復師学校養成施設での臨床実習形態が異なる各学年について，学生の心理的反応と身体的反応のストレスを調査することを目的とした。 対象は，臨床実習を履修した2年次から4年次の学生252名とした。心理的反応は状態－不安尺度（STAI）を用いて測定し，身体的反応は唾液アミラーゼ活性測定（SAA）と加速度脈波測定を用いて測定した。研究結果から，心理的反応のSTAIでは2年次の実習前に高値を示し，3年次と4年次では実習後に高値を示した。身体的反応の加速度脈波では，2年次と3年次の実習前に高値を示した。また，本研究での臨床実習における学生へのストレスは，低ストレスにて経過したことが示唆された。 本研究の臨床実習では，心理的反応において有意な反応を示したが，身体的反応では大きな変化が生じず実習を経過したことが示唆された。その要因として，診療参加型臨床実習を原則とした見学・模倣・実施を段階的に実践し，学生の不安に関わるストレスを軽減させたことが，過度なストレスに至らなかった要因と考える。結果，本研究での臨床実習では適度な緊張範囲のストレスにて実習を経過したことが結果より考察される。原著論文departmental bulletin pape