Human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2) are the causative agents of acquired immune deficiency syndrome. Our interests have focused on HIV entry into target cells and HIV cell tropism. The cell tropism of HIV and the determinants of a cell's susceptibility to HIV infection have been mainly explained by the combination of HIV surface proteins, Env, and expression of CD4 and coreceptors on the target cells. The coreceptors are molecules belonging to the G protein-coupled 7-transmembrane receptors, especially chemokine receptors. We propose that many researchers working in this field have noticed that our system of using a human glioma cell line, NP-2, has been quite useful for the identification of HIV coreceptors, for the determination of coreceptor usage in HIV strains and for the isolation of primary HIV-1 strains, and for the titration of infectivity. The properties of the assay systems using NP-2 cells that we have developed are summarized in this review through an introduction of some of our work.

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Diagnostic imaging is essential for the accurate diagnosis and therapy of most diseases due to the development of imaging modalities, such as CT, MRI, ultrasonography, PET (positron emission tomography) and so on. The diagnostic imaging is divided into the anatomical imaging (CT, US, MRI) and functional imaging (PET). The combinined imaging of anatomical and functinal imaging, CT and PET or MRI and PET, is useful for the accurate localization of the tumor and more than 500,000 PET/CT studies are performed in Japan this year. The original idea of combined imaging of CT and PET was dicovered at Gunma University Hospital in 1983, and contributes a lot to the development of PET studies. One picture taken from the patient or animal may result in the discovery of new drugs or new instruments. This paper is the summary of my final lecture held on the 14th December, 2010 for the 4th grade of medical students of Gunma University.

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Objective : To validate the Outcome and Assessment Scale for Dementia Care (OASDC) by comparison with the Multidimensional Observation Scale for Elderly Subjects (MOSES). Methods : The targets were 126 Japanese nurses, together with 126 of their demented patients. The self-administered questionnaire asked the nurses about the condition of their patients. The questionnaire consisted of 20 OASDC items, including the base attributes of the nurses and their patients, and 40 MOSES items. OASDC was subjected to a factor analysis and the correlations between OASDC and MOSES were explored. Results : The factor analysis revealed that OASDC had 5 factors : Self-care ; Tranquility ; Social role ; Behavioral and Psychological Symptoms of Dementia (BPSD),; and Caregiver and the cumulative contribution ratio of all five factors was 63.1%. There was a significant correlation between OASDC and MOSES except for the items of care factors (r= 0.201 to 0.926, p< 0.05). Conclusion : The evaluation almost completely secured the validity of the construct validity and contemporary validity of the OASDC.

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Objectives : To extract the educational and training needs of nurses, who provide care for elderly patients with dementia undergoing physical therapy at general hospitals, as the basis for developing educational programs. Subjects and Methods : Focus-group interviews were conducted on a total of 12 nurses (6 nurses from each hospital) working in the Orthopedics Department at two acute-care hospitals. Data obtained from these recorded interviews were analyzed. Results : Based on the interview records, 8, 5, and 4 categories were extracted in the areas of "difficulties in providing daily nursing care for patients with dementia," "important points to keep in mind when caring for elderly patients with dementia," and "expectations regarding an educational training program on nursing care for elderly patients with dementia," respectively. Conclusion : The educational needs are (1) understanding the psychological conditions of elderly patients with dementia, (2) understanding the behavior and psychological symptoms of dementia (BPSD) and unsafe behavior, (3) understanding underlying mechanisms of delirium, (4) understanding the environment surrounding elderly patients with dementia, and (5) methods of caring for elderly patients with dementia based on specific cases seen in acute care units. The details of an educational program that were extracted were (1) specific knowledge and treatment strategies for dementia, (2) assessment and understanding of elderly patients with dementia, (3) analysis of BPSD and unsafe behavior and actual intervention, (4) delirium and countermeasures, (5) understanding the speech and behavior of patients with dementia, (6) how to deal with elderly patients with dementia, (7) how to communicate with elderly patients with dementia, and (8) developing a nursing care scheme based on case examples in acute care units.

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Background and Objectives : Suicide related with depression is serious problem in Japan. This study aimed to clarify the association between depressive state and lifestyle factors in a rural area in Gunma prefecture. Subjects and Methods : In a rural village in Japan, 144 men and 217 women were recruited to answer the "Kokoro check sheet" (KCS), a depression screening questionnaire. We divided the subjects into 4 groups by sex and age, and the structural equation models (SEM) were separately fitted to explore the association between depressive state and lifestyle factors for these 4 groups. Results : The two latent variables were associated with depressive state in all 4 models, where the first one was common to all 4 groups, termed ‘social dysfunction’. The second latent variables were ‘affluent life’ in males younger than age 60, ‘good human relation’ in elder males, ‘sickness’ in females younger than age 60, and ‘introversion’ in elder females, respectively. Conclusion : The relationship structures of lifestyle factors and depressive state differed by sex and age but the social dysfunction. Sex and age specific intervention measures might be needed.

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A 62-year-old male presented with appetite loss, abdominal fullness, tarry stool, and vertigo. Gastrointestinal endoscopy showed advanced gastric cancer, type 3, which was diagnosed as poorly differentiated adenocarcinoma with severe pyloric stenosis. Computed tomography (CT) showed hugely enlarged lymph nodes in the para-aortic region. He was diagnosed with gastric cancer stage IV and treated with paclitaxel chemotherapy weekly. However, the treatment was ineffective. A nasogastric tube was required for persistent vomiting with gastric outlet obstruction. We recommended a gastrojejunostomy bypass operation, but the patient refused. After obtaining informed consent, a WallFlex stent was inserted, but did not relieve the obstruction. Endoscopy showed that the stent was obstructed with tumor ingrowth. An UltraFlex covered stent was inserted within the WallFlex stent and was effective. Subsequently, the patient was able to eat solid food for 9 months, received chemotherapy, and died 11 months after stent insertion. Stent therapy should be considered for palliative care in gastric outlet obstruction caused by gastric cancer.

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Severe liver injury is one of the most difficult lifesaving cases in the emergency room. We herein report on the successful treatment on a case of severe type IIIb liver injury with transcatheter arterial embolization (TAE).
A 14-year-old boy was transferred to our emergency room by ambulance after a traffic accident in May 2003. His systolic blood pressure was 60 mmHg on arrival, but it rose up to 90 mmHg in response to fluid resuscitation. The patient underwent computed tomography, and a severe type IIIb liver injury was confirmed. TAE was first performed in this case. We were worried whether damage control surgery (DCS) was needed as a consecutive method because extravasations were detected from the right portal vein after the TAE. His condition demonstrated the deadly triad. However, because his bood pressure was maintained, conservative therapy in the intensive care unit, but not DCS, was selected as the post-TAE treatment. Drainage of bloody ascites was sometimes performed to prevent abdominal compartment syndrome under observation of the patient's intra-abdominal pressure and vital signs. In addition to one more TAE, two more surgical interventions, one for biliary peritonitis and the other for a small intestinal perforation, were required before the patient could be discharged. The period in hospital was approximately 10 months after the accident.

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A 52-year-old male visited Ishii Hospital with abdominal fullness, body weight loss, fatigue, and appetite loss. Computed tomography (CT) showed ascites, but no tumor. On positron emission tomography (PET)-CT, fluorodeoxyglucose (FDG) accumulated near the parietal peritoneum in the right abdominal cavity and near the descending colon. We were unable to make a definitive diagnosis from aspiration cytology. Therefore, we performed a laparoscopic biopsy. There was a large volume of ascites in the abdominal cavity and a white quail-egg sized mass in the right flank abdominal wall, as noted on PET-CT. We were unable to find a mass near the descending colon. The mass was resected and diagnosed as a malignant peritoneal mesothelioma pathologically. He was referred to Gunma University Hospital for chemotherapy and received a combination of gemcitabine and carboplatin.

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