I outline the current situation and future tasks for psychiatric services in Japanese prisons. I describe the provision of facilities specializing in psychiatric services, preparation of legal aspects related to involuntary treatment, provision of therapeutic educational programs regarding addictive crimes, and the measures required for continuation of treatment after release from prison. I also discuss how, in the current system, under the "Act on Mental Care and Treatment for Persons who have Caused Serious Cases under the Condition of Insanity," unfairness arises in the treatment of mentally disordered offenders, requiring a division between medical care and justice (correctional institutions).

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Intrahepatic cholangiocarcinoma (ICC), which arises in the small bile ducts of the liver, is the second most common liver malignancy. Although modulation of microRNA (miRNA) expression has been shown to be a potent sign of malignant tumors, miRNA profiles of ICC remains unclear. We performed sequencing analysis of the small RNA libraries of 2 ICC cell lines (HuCCT1 and MEC) and one normal intrahepatic biliary epithelial cell line (HIBEpiC) to produce the miRNA profiles of ICC in vitro. Furthermore, by means of the real-time polymerase chain reaction (PCR) we validated the differential expression of miRNAs cloned exclusively or predominantly from each of the cell lines. A total of 35,759 small RNA clones were obtained from the 3 cell lines. We identified 27 miRNAs that were expressed exclusively or predominantly in each cell line. Subsequent validation with the real-time PCR confirmed that the miRNAs hsa-miR-22, -125a, -127, -199a, -199a*, -214, -376a, and -424 were expressed specifically in HIBEpiC but were downregulated in the ICC cell lines. Our study provides important information for facilitating studies of the functional role(s) of miRNAs in carcinogenesis of the hepatobiliary system. The biliary epithelial cell-specific miRNAs identified in this study may serve as potential biomarkers for ICC.

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Although the homing of hematopoietic stem cells (HSC) to the bone marrow (BM) is a crucial step in hematopoietic development and BM repopulation, the mechanisms underlying these processes have not been fully clarified. Recent studies suggest that interaction between the chemokine receptor CXCR4 and its ligand, stromal cell-derived factor 1 (SDF-1), plays a critical role in these processes. In addition, dextran sulfate increases plasma SDF-1 levels in mice and nonhuman primates. Thus, we examined the effects of preconditioning with SDF-1 and dextran sulfate on the homing efficiency of HSCs following BM transplantation in mice. We found that the preconditioning of donor mice with either SDF-1 or dextran sulfate enhanced the homing efficiency of infused HSCs in vivo. The greatest effects were obtained with dextran sulfate. Moreover, reverse transcriptase polymerase chain reaction analysis demonstrated that SDF-1 and dextran sulfate increased transcription of a variety of homing-related genes, including those for CXCR4, lymphocyte function associated antigen-1, matrix metalloproteinase-9, very late antigen-4/5, and macrophage inflammatory protein-1. We suggest that whereas SDF-1 directly acts to upregulate CXCR4 expression in HSCs, dextran sulfate acts via multiple pathways involved in the induction of various homing-related molecules, in addition to SDF-1. Thus, preconditioning donors with dextran sulfate offers a novel clinical approach for improving the homing and engraftment of HSCs in the BM.

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No information has been available regarding middle cerebral artery (MCA) dissection occurring as a result of athletics. We describe a case of cerebral infarction in the right MCA region that occurred in young, right-handed tennis player while he was serving. Angiography with a contrast medium and a 3-dimensional rotational system revealed proximal M2 stenosis, and emergency superficial temporal artery-MCA anastomosis was performed. As a result, the patient showed a complete recovery and resumed all activities of daily life, including playing tennis. Because sports such as tennis, in which players vigorously swing their heads while serving, could lead to intracranial artery dissection, we advise that the possibility of MCA dissection should be considered in athletes with certain neurological symptoms, including headache.

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We report a case of giant mucinous cystic neoplasm (MCN) of the pancreas that was successfully treated with laparoscopic surgery. A 29-year-old woman was admitted to our hospital for evaluation of an abdominal tumor that had been detected during a routine medical examination. The tumor was diagnosed as an MCN of the pancreas. We performed laparoscopic distal pancreatectomy and splenectomy. The patient could begin oral feeding 3 days after the operation. No complications occurred either during or after surgery. The outcome in this patient was excellent, with cosmetically acceptable small scars in the skin. Therefore, laparoscopic distal pancreatectomy may become a therapeutic option for patients with large MCNs of the pancreas.

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A 54-year-old man with suspected cirrhosis and a hepatic tumor on positron emission tomography presented to our hospital for assessment and treatment in January 2007. Laboratory tests and diagnostic imaging revealed that the patient had cirrhosis due to hepatitis B virus infection and advanced hepatocellular carcinoma (HCC) along with portal vein tumor thrombosis (PVTT) (T4N1M0, Child's B). After hospitalization, the serum levels of total and direct bilirubin increased markedly within several days (26.0 and 20.0 mg/dL), and biliary obstruction by the tumor appeared to have caused this sudden jaundice. To treat the biliary obstruction, selective transcatheter chemoembolization (TACE) was performed via the feeding arteries of the tumor in the anterior segment of the right lobe. After TACE, total bilirubin decreased to 7.0 mg/dL, and the patient survived for 4 more months.

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A 40-year-old woman was referred to our Department of Surgery because of an abdominal wall mass. Sixteen years earlier, she had undergone surgical resection of an inguinal tumor that had been diagnosed as a hemangiosarcoma. Fourteen months after the initial resection, the tumor recurred locally, and complete resection was performed. Twenty-nine months later, computed tomography showed multiple metastatic tumors in the lung. All these tumors were resected during thoracoscopic surgery. Thirteen years after the patient's 3rd operation, a firm mass was detected in the left lower quadrant of the abdominal wall. Magnetic resonance image showed a well-defined mass with heterogeneous contrast enhancement within the rectus abdominis muscle. Positron emission tomography-computed tomography demonstrated no recurrent tumors other than this mass. Complete resection was performed. Microscopic examination showed that this tumor was composed of hypercellular spindle cells and staghorn-shaped blood vessels. The average number of mitotic figures was 28 per 10 high-power fields. Immunohistochemical examination of the tumor showed focal positivity for CD34. Therefore, the tumor was diagnosed as a metastatic hemangiopericytoma with malignant potential. Careful long-term follow-up is required because metastases can develop after an extended disease-free interval. Aggressive surgical treatment is recommended for distant metastases.

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In 2008, 84% (459) of 548 women with pregnancies initially considered "low risk" requested to give birth under midwifery care at Japanese Red Cross Katsushika Maternity Hospital. Of these, 42% (191) were referred to obstetric care during labor at term; however, we found no evidence that midwifery primary obstetric care is less safe for women with "low-risk" pregnancy than is standard obstetric care. Therefore, we recommend that midwifery care be promoted with an international collaborative effort.

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