Patients often exhibit urinary retention following a stroke. Various neuropathological and animal studies have implicated the medulla oblongata, pons, limbic system, frontal lobe as areas responsible for micturition control, although the exact area responsible for urinary retention after stroke is not clear. The purpose of this study was to identify the stroke area responsible for urinary retention by localizing the areas where strokes occur. We assessed 110 patients with cerebral infarction and 27 patients with cerebral hemorrhage (78 men, 59 women; mean age, 73.0 years) who had been admitted to our hospital between October, 2012 and September, 2013. We used computed tomography (CT) and magnetic resonance imaging (MRI) to investigate the stroke location, and evaluated whether post-stroke urinary retention occurred. Twelve (8.8%) of the 137 patients (7 men, 5 women; mean age, 78.8 years) exhibited urinary retention after a stroke. Stroke occurred in the right/left dominant hemisphere in 7 patients; nondominant hemisphere in 1; cerebellum in 3; and brainstem in 1. Strokes in the dominant hemisphere were associated with urinary retention (P = 0.0314), particularly in the area of the insula (P < 0.01). We concluded that stroke affecting the insula of the dominant hemisphere tends to cause urinary retention.
Dienogest is a novel progestin with potent oral progestational activity that inhibits the clinical symptoms of endometriosis. We herein evaluated the effect of dienogest on ovarian endometriotic cysts via immunohistochemistry. Ovarian endometriotic cyst specimens were collected from 12 patients treated with dienogest and 20 patients not treated with hormones (controls). The expression of estrogen receptor (ER)-α, progesterone receptor A (PRA), and Ki-67 was studied by immunohistochemistry. As compared with the controls, the cell proliferation index was significantly reduced in both epithelial and stromal cells of the endometriotic cysts following the use of dienogest (P = 0.022 and P = 0.004, respectively). However, there was no significant difference between endometriotic cysts with and without the use of dienogest in the expressions of ER-α and PRA in the epithelial and stromal cells. Irrespective of the use of dienogest, the expression levels of ER-α and PRA in the epithelial cells were low (median: 32% and 8%, respectively). Conversely, the expression levels of ER-α and PRA in the stromal cells were well preserved (median: 68% and 92%, respectively). In the controls, there was no significant difference between endometriotic cysts in the expression levels of Ki-67, ER-α and PRA in epithelial and stromal cells during the proliferative and secretory phases. The finding of a reduction in the cell proliferation index by the use of dienogest with no change in the expressions of hormonal receptors may not support the direct progestational effect of dienogest on ovarian endometriotic cysts.
Under the basic tenet that syntactic derivation offers an optimal solution to both phonological realization and semantic interpretation of linguistic expression, the recent minimalist framework of syntactic theory claims that the basic unit for the derivation is equivalent to a syntactic propositional element, which is called a phase. In this analysis, syntactic derivation is assumed to proceed at phasal projections that include Complementizer Phrases (CP). However, there have been pointed out some empirical problems with respect to the failure of multiple occurrences of discourse-related elements in the CP domain. This problem can be easily overcome if the alternative approach in the recent minimalist perspective, which is called Cartographic CP analysis, is adopted, but this may raise a theoretical issue about the tension between phasality and four kinds of functional projections assumed in this analysis (Force Phrase (ForceP), Finite Phrase (FinP), Topic Phrase (TopP) and Focus Phrase (FocP)). This paper argues that a hybrid analysis with these two influential approaches can be proposed by claiming a reasonable assumption that syntactically requisite projections (i.e., ForceP and FinP) are phases and independently constitute a phasehood with relevant heads in the derivation. This then enables us to capture various syntactic properties of the Topicalization construction in English. Our proposed analysis, coupled with some additional assumptions and observations in recent minimalist studies, can be extended to incorporate peculiar properties in temporal/conditional adverbials and imperatives.
Approximately 140 different mutations of thyroid hormone receptor β (TRβ) have been identified in resistance to thyroid hormone (RTH). We report herein a middle-aged man with a negative family history who was diagnosed with RTH based on persistent palpitations. Genetic analysis showed a TRβ mutation causing the substitution of alanine for proline 453 (P453A) in exon 10. Since treatment of RTH is different from that of Graves’ disease and thyroid stimulating hormone-producing adenoma (TSHoma), a genetic analysis should be performed even in patients who have a negative family history of RTH and who are free of TSHoma when they present with persistent inappropriate secretion of thyroid stimulating hormone (SITSH).
We report a case of a patient with a history of surgery for insufficient pseudoarthrosis after a humeral diaphyseal fracture. Although most humeral nonunions are successfully treated with a single procedure, some humeral nonunions are more difficult to heal and require multiple procedures. A-61-year-old man presented at our hospital with pain and deformity in his left upper arm. The humeral diaphyseal fracture had been previously treated elsewhere with open reduction and internal fixation. Some days prior to his visit at our hospital, he had had pain in his left upper arm, without a particular cause, and was admitted to our hospital for initial evaluation. After a complete physical examination, symptoms of infection and any neurovascular deficit were ruled out. Radiographic examination revealed atrophic nonunion of the middle third of the humeral shaft associated with disuse osteopenia. Anterograde intramedullary nailing and bone grafting were performed for the resistant atrophic nonunion of the humeral diaphysis. In addition to the intramedullary nailing, additional fixation was performed for residual rotational instability. A postoperative evaluation revealed a periprosthetic fracture in the distal part of the humerus. Poor bone quality or a deficient plate technique might have lead to the facture. We performed open reduction and internal fixation (ORIF): he underwent fixation with a 2-plate construct for the nonunion of the humeral diaphyseal fracture, together with decortication, debridement, and bone grafting. Eight months after surgery, the patient’s bone had healed and he had recovered flexion (110°) and extension (−30°) without complications. An orthopedic surgeon should be aware of these complications when choosing open reduction and internal fixation for the treatment of a history of insufficient pseudoarthrosis. Patients should be closely followed up for evidence of any complications such as infections and malunions. Fracture fixation in patients with pseudoarthrosis requires strategies to overcome the technical difficulties faced during the procedure.
Decomposition characteristics of toluene vapor by titanium dioxide photocatalyst and zeolite that are prepared by thermal spraying on an aluminum fiber filter (photocatalyst filter) were investigated. Toluene vapor was injected into a small chamber made of stainless steel, and an air cleaner equipped with the photocatalyst filter was operated. The vapor concentration in the chamber decreased exponentially. The decreasing rate of toluene vapor in the chamber depended on the initial toluene concentration, and the higher the initial vapor concentration was, the lower the decreasing rate was obtained. The decreasing rate was constant during each decomposition experiment, although the concentration decreased with time. To investigate the effect of zeolite on the reduction of the vapor concentration, we compared the decreasing rates of toluene vapor by photocatalyst filters with and without zeolite.The decreasing rate of toluene concentration using the filter without zeolite was larger than that with zeolite. The reason for this would be that photocatalyst decomposed toluene not only in air but also adsorbed in zeolite.
The conditions for stroke rehabilitation such as individual therapeutic procedure and medical treatment system in Japan have drastically changed over the past decade: increasing incidence of ischemic stroke, the use of intravenous recombinant tissue plasminogen activator, hospital specialization, introduction of convalescent rehabilitation wards, and public long-term care insurance. However, it is not known whether these changes have influenced the time course of return to work (RTW) after stroke. In this study we compared the time course of RTW after stroke in Japan that was reported in two cohort studies performed 20 years apart. The cumulative rate of RTW after first stroke was similar in the two studies, even though they were separated by an interval of two decades. This shows that advances in stroke rehabilitation have not impacted RTW, and we suggest that the social security system, particularly sickness benefit, has a strong influence on RTW.
The aim of this study was to explore the relations between nurses’ difficulties in caring for persons living with mental disorders and negative feeling about hospitalization of these persons in general wards. Out of 150 nurses working in a local general hospital in Japan, 86 were eligible for this study. Exploratory factor analysis of the question items for symptoms and conditions with which the nurses had difficulty revealed two principal factors: symptoms like psychosis and neurosis. These factors were then compared in terms of the attitudes that nurses had toward hospitalizing those persons with mental disorders. The greater the negative attitudes toward hospitalizing the persons with mental disorders, the greater the difficulty in caring for them. It is thought that symptoms like psychosis were considered to be caused by schizophrenia, epilepsy, and dementia, and symptoms like neurosis were caused by mood disorder, personality disorder and depression. These principal factors seemed to be with two different difficulties. One is about dealing with their symptoms, another is to distinguish them. Non-psychiatric nurses seemed to be working without confidence in caring for those with mental health disorders. We thought the workloads were increased by symptoms like psychosis and mental burdens on nurses as emotional labors were increased by symptoms like neurosis. Therefore, it is necessary for nurses working in general wards to improve the consultation support system about mental disorders.
Oxytocin (OXT), which is a well-known neurohypophysial hormone that is synthesized in the paraventricular (PVN) and supraoptic nuclei (SON) of the hypothalamus, is secreted from the posterior pituitary (PP) into the systemic circulation, where it plays an essential role in reproduction, especially during and after childbirth. Many recent studies have shown that OXT contributes to the modulation of several functions, such as social recognition, trust building, anti-nociception, anti-inflammation, stress relief and suppression of feeding. However, little is known about the neuronal networks responsible for OXT effects. Endogenious OXT has two regulations: the 1st regulation is humoral regulation, in which OXT is delivered to target organs from PP via the bloodstream; the 2nd regulation is nerve regulations, in which OXT from parvocellular neurosecretory neurons in the PVN directly project to the central nerve system (CNS). OXT binding sites, as well as OXT receptor expression, are located in various regions of the CNS, including the dorsal horn of spinal cord in rats, where it plays an important role in nociception. We examined the response to acute and chronic nociception/-inflammation in rat models using OXT-monomeric red fluorescent protein 1 (mRFP1) transgenic rats. We used formalin test as acute nociceptive/-inflammatory rat models and adjuvant arthritis as chronic nociceptive/-inflammatory rat models. We studied the effects of acute and chronic nociception/-inflammation on OXT-mRFP1 expression in the hypothalamus, posterior pituitary and spinal cord, and examined the role that OXT plays in acute and chronic nociceptive responses in rats. This review focuses on pain modulation and anti-inflammation by OXT according to previous clinical and animal research.
The recent progress in angiography technology bestows benefits on patients for minimally invasive than surgery, while there has been an increase in the number of cases involving stochastic effects, such as radiation dermatitis, resulting from upgrading of the procedure because of an extension of the time for fluoroscopy and the number of shots. Recent CT equipment saves the dose data along with image data about the information management for patient exposure dose, which is used for management of individual cumulative dose and the presumed effective dose, using digital imaging and communication in medicine (DICOM). We extracted detailed information about shooting conditions and dose from the DICOM radiation dose structured report (DICOM RDSR) in the angiography area, and evaluated the trend of patient exposure dose in each procedure. As a result, we found that cases exceeding 3 Gy which needed observation in the head region were 16.7% and in the heart region were 27.3%. We also found that angiography had a higher dose of shooting than did fluoroscopy, and that the diagnosis and treatment with tumor involvement required a exposure dose than did vascular lesion. In this paper, we review the shooting conditions as a root of DICOM RDSR information and consider the possibility of planning for further reduction of the exposure dose.