Effects of artificial sunlight and fluorescent light were compared for the visual tasks in human, and the power of EEG and near-infrared spectroscopy (NIRS) were examined. The subjects were 12 healthy students, and the Raven′s Coloured Progressive Matrices were used for the visual task. The artificial sunlight lighting increased the beta power of EEG (P = 0.023), Oxy Hb (P = 0.049) and Total Hb (P = 0.034) by NIRS (Wilcoxon signed-rank test) compared with the fluorescent light lighting. These results indicate that artificial sunlight lighting may be useful for the activation of human brain during eye opening and visual tasks comparing with fluorescent light lighting. It has been reported that the circadian rhythm of melatonin production in mammals is regulated by the retinohypothalamic projection system, which includes the medial forebrain bundle and the reticular formation, and this retinohypothalamic projection system may have an important role in the activation of the brain under artificial sunlight lighting.

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The patient was a 3-year-old girl with clustering left-side tonic clonic seizures. There was a focal hyper-intensity lesion over the right frontal area and the right hippocampus upon T2-weighted image on MRI, which showed hypoperfusion over the same region on SPECT. Her EEG showed a negative peak at the right frontal regions and a tendency towards generalization inside the right cerebral hemisphere. Dipoles were localized to the right frontal region, corresponding to the early phase of the EEG spikes. Therefore it thought that her epileptic focus was in the right frontal region. She underwent right hemispherotomy and her seizures have since improved. Our results suggest that the dipole tracing method is useful for estimating the epileptic focus of childhood epilepsy.

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In patients with aortic stenosis and severe pulmonary hypertension, the prognosis is generally poor and the results of surgical treatment are not satisfactory. A 58-year-old male undergoing hemodialysis was admitted emergently with the chief complaint of dyspnea and he was diagnosed with acute heart failure due to aortic stenosis. In the preoperative examination, severe pulmonary hypertension was observed. He underwent aortic valve replacement after pulmonary hypertension was improved by preoperative treatment with a PDE III inhibitor. His prognosis was good and he was subsequently discharged without complications. There have been no reports on surgery after treatment with aPDE III inhibitor for preconditioning, as was performed in this patient. Our experience suggested that preoperative improvement of pulmonary hypertension by a PDE III inhibitor can help to determine whether or not to perform surgery.

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Multiple osteolysis and hypercalcemia are rare conditions accompanying diffuse large B-cell lymphoma (DLBCL). There have been no reports demonstrating the protein expression of osteoclast-activating factors in such cases. Herein, we report a case of a 38-year-old man with DLBCL, who initially presented with hypercalcemia, multiple osteolysis and renal insufficiency that mimicked multiple myeloma with poor outcome. Immunohistochemical analysis was conducted to examine the expression of macrophage inflammatory protein (MIP)-1α, MIP-1β and receptor activator of NF-kappa B ligand (RANKL) in a lymph node that was obtained at diagnosis. Compared with a control DLBCL sample, we observed increased expression of MIP-1α in lymphoma and vascular endothelial cells and MIP-1β in stromal cells in our case. RANKL expression was not observed in either our case or control cases. MIP is likely associated with the development of osteolysis and hypercalcemia in some lymphoma cases.

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A72-year-old man went to a clinic complaining of a lack of appetite and weight loss (10 kg/1.5 M) and underwent upper gastrointestinal endoscopy. The details of the findings were ambiguous due to food residue. Furthermore, he complained of abdominal pain after eating and he was sent from the clinic to our hospital for high level CEA. The results of upper gastrointestinal endoscopy in our hospital were similar to those in the clinic. Small intestinal radiography revealed a stricture in the jejunum about 15 cm from the duodenojejunal flexure. Abdominal computer tomography showed a small bowel obstruction with a tumor and the remarkable small bowel dilatation on the oral side of the tumor. Radical resection was performed as a jejunal tumor, which was regarded as the cause of the lack of appetite and weight loss. Laparotomy showed a 3 cm tumor 15 cm distal from Treitz′s ligament with lymph node swelling and a 2 cm tumor in the omentum. We performed a 30 cm jejunal resection containing the tumor and reconstruction by end-to-end anastomosis. Histologically, the small bowel tumor was diagnosed as tubular adenocarcinoma invading to the greater omentum, but there was no lymph node metastasis. Small bowel carcinoma is relatively rare compared to other gastrointestinal malignancies. Thus, this report presents a rare case of primary jejunal carcinoma.

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[in Japanese]

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