Human DNA topoisomerases Ⅰ and Ⅱα (Topo-Ⅰ and -Ⅱα) are essential for vital cellular processes such as DNA replication, transcription, translation, recombination, and repair. The purpose of this study was to investigate the clinical significance of the expression of Topo-Ⅰ and Topo-Ⅱα. Twenty-nine specimens of esophageal squamous cell carcinoma from patients who had been treated by complete resection of the esophageal tumor were studied by an immunohistochemical analysis. High expression of Topo Ⅰ and Ⅱα was identified in 48.7% and 55.2% of tumors, respectively. Neither the Topo-Ⅰ nor -Ⅱα expression level had any association with clinical characteristics, including differentiation and the depth of tumor invasion, lymph node metastasis, or the patient prognosis. However, a significant positive correlation was observed between the expression levels of Topo-Ⅰ and Topo-Ⅱα. Our study results underscore the potential role of topoisomerase expression in esophageal cancer and further exploratory investigation is necessary to evaluate topoisomerase expression as a surrogate marker in chemotherapy with topoisomerase inhibitor for esophageal cancer.

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Two women aged 48 and 73 years, respectively, presented with unilateral visual disturbance. On admission, magnetic resonance imaging (MRI) showed an extraaxial mass in the parasellar region. Contrast-enhanced fast imaging with steady-state acquisition (CE-FIESTA) showed that the optic nerves were compressed and encased by the tumors. At an early stage of surgery, we performed decompression of the optic nerves to avoid optic nerve injury. Both the patients were relieved of visual disturbances without any postoperative neurological deficit. In conclusion, CE-FIESTA is a useful diagnostic tool for preoperative evaluation of the optic nerves in patients with skull base meningiomas. Decompression of the optic nerves should be performed at an early stage of surgery in meningioma patients presenting with visual disturbance.

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A 75 year-old male patient presented with exertional dyspnea that he had suffered for 7days. The chest X-ray showed right-sided pneumothorax. Closed thoracostomy was performed on the 1st day of hospitalization and repeated with talc sclerotherapy and lower-power suction, but neither could improve air-leakage. On the 14th day of hospitalization, thoracoscopy via pleurodesis was performed and the pneumothorax resolved. We report here on a rare case of intractable pneumothorax treated by thoracoscopic pleurodesis with talc.

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We surveyed carbon fiber reinforced plastic orthoses (carbon orthoses) and their associated occupational and medical problems based on a questionnaire sent to 310 companies which were members of the Japan Orthotics and Prosthetics Association. Of all the companies, 232 responded: 77 of the 232 companies dealt with ready-made carbon orthoses, 52 dealt with fabricated custom-made orthoses, and 155 did not dealt with carbon orthoses. Although the total number of custom-made carbon ortheses in Japan was 829/5 years, there was a difference by region, and one company fabricated only 12 (per 5 years) custom-made carbon orthoses on average. The advantages of the carbon orthosis were the fact that it was "light weight", "well-fitted", had a "good appearance", and "excellent durability", while the disadvantages were that it was "expensive", "high cost of production", of "black color", and required a "longer time for completion", and "higher fabrication techniques". From the standpoint of industrial medicine, "scattering of fine fragments of carbon fibers", "itching on the skin" and "health hazards" were indicated in companies that manufacture the orthosis. In order to make the carbon orthosis more popular, it is necessary to develop a new carbon material that is easier to fabricate at a lower cost, to improve the fabrication technique, and to resolve the occupational and medical problems.

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We estimated the level of noise that telephone operators were exposed to through headphones by a two-step method using an artificial ear technique and a manikin technique. In the artificial ear technique, the sound pressure level (L_eq) of the total work hours was 81.5dB, whereas the L_eq of the total duration of phone calls was 89.3dB. Therefore, we conducted a more accurate measurement by the manikin technique (ISO11904-2). By this method, we could simulate the headphone-wearing condition of the workers and convert the measurements to a diffuse-field related L_Aeq. By this manikin technique, the corrected L_Aeq of the total work hours was 68.3dB, whereas the corrected L_Aeq of the total duration of call was 76.6dB, which was below the standard of the Occupational Exposure Limits of the Japan Society of Occupational Health. We confirmed that in a workplace where the background noise is low (51.3dBA), a good signal-noise ratio is maintained so that operators don't have to listen to loud sounds through headphones. Neither the gender nor the type of the telephone equipment of the callers affected the sound pressure levels.

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A review of the Survey on the State of Employees' Health by the Ministry of Health, Labour and Welfare (2008) shows that the most commonly implemented aspect as an activity of worksite health promotion is "Health counseling", and the second is "Workplace physical exercise." Physical exercise, "Taiso", is acceptable and sustainable for workers, as it is easy to do in a group or alone. Various modes of stretching are implemented for workplace physical exercise. However, articles suggesting negative or contradictory effects of stretching have increased in recent years. Several review articles have revealed that static stretching may induce impairments of muscle power performance and no stretching will prevent or reduce muscle soreness after exercise. There are various aims of workplace physical exercise, so we have to consider the situational method when we apply stretching to occupational health.

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A 78 year old Japanese woman was transferred to our hospital for the treatment of a fracture of the left femoral neck in April, 2010. She had been taking oral corticosteroid (prednisolone 5mg/day) for the treatment of idiopathic interstitial pneumonia since 2003, and had been treated by home oxygen therapy since 2007. She fell in the restroom at home and hurt herself, and was transferred to our hospital for treatment of a left femoral neck fracture in April, 2010. Her respiratory status was stable just after the transfer; however, she was transferred to the intensive care unit and started to receive mechanical ventilation due to rapidly progressive respiratory failure on the fourth day after admission. Chest X-ray and computed tomography revealed rapid progression of bilateral ground-glass attenuations, and acute exacerbation of interstitial pneumonia was clinically suspected. However, the elevation of D-dimer over time and characteristic findings of petechial hemorrhagic lesions on her palpebral conjunctivae and neck with microscopic findings of phagocytized lipid in alveolar macrophages in her endobronchial secretion led to the diagnosis of fat embolism syndrome. She was successfully treated with high-dose corticosteroid and sivelestat sodium, and she was discharged on the 21st day after admission. Although a differential diagnosis of acute exacerbation of interstitial pneumonia and fat embolism syndrome was necessary and difficult in the present case, characteristic findings of petechial hemorrhagic lesions of skin, palpebral conjunctiva and lipid-laden alveolar macrophages in endotracheal aspirate were useful for the accurate and prompt diagnosis of fat embolism syndrome.

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To determine the effects of an increase of four physical therapists in an acute hospital, we compared the number and outcomes of inpatients for whom rehabilitation doctors newly prescribed physical therapy between two periods (from October 1, 2008 to September 30, 2009 and from October 1, 2009 to September 30, 2010). The number of new inpatients and the total number of inpatients who underwent physical therapy significantly increased by 317 and 4,536, respectively (Wilcoxon test, P＜0.05), and the total number of inpatients who performed training in their own room in a ward also significantly increased by 3,341 (Wilcoxon test, P＜0.05). The mean length of hospital stay of the inpatients who were transferred to other hospitals decreased by 5.9 days after the increase in the staff ( t-test, P＜0.05). These changes suggest that the increase in the physical therapists contributed to the increases of the new inpatients and total number of inpatients who underwent rehabilitation, and possibly to the decrease in the length of hospital stay for the transferred inpatients by effectively providing a sufficient amount of physical therapy.

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