山のチーズと呼ばれる長期熟成ハードチーズが，紀元前2000年には冷涼なアルプス山岳地帯でつくられていた。フレッシュチーズと熟成ハードチーズの関連性の分析は，ヨーロッパにおけるチーズ発達史の再構築にとって極めて重要な論考となる。本稿では，イタリア北部山岳地帯のドロミテ地域を事例に，熟成ハードチーズとフレッシュチーズの加工工程を把握し，フレッシュチーズから熟成ハードチーズへの発達史過程について酪農科学・人文地理学的に考察することを目的とした。フレッシュチーズは，レンネット添加，カッティング，脱水，加塩することによって加工されている。フレッシュチーズは，風味の向上のため，塩水に漬けたまま数週間静置し，熟成されるようになっていった。この熟成フレッシュチーズを，塩水から取り出し，空気中で乾燥化を進めると，ドロミテ地域でつくられているドロミテと呼ばれるチーズのような熟成ハードチーズとなる。空気中で静置するため，表面は乾燥し，形成された外皮が内部のチーズを守るようになる。山岳地域では，熟成ハードチーズは長期熟成ハードチーズへと更に発展していった。より望ましい熟成を進展させるために，チーズつくりには乳脂肪含量を低くした脱脂乳が利用されるようになった。カードからよりホエイを除去するために，カードは42℃まで加温されるようになった。ここに，ドロミテ地域でみられる山のチーズのような長期熟成チーズが誕生することになる。このような発達へと向かわせた大きな要因は山岳地帯の冷涼・半湿潤性であり，ヨーロッパ山岳地帯でなるべくして変遷したチーズの発達だったと考えられた。

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　本研究の目的は，ヨーロッパ乳文化の熟成チーズ発達史を考察する一環として，1）サルデーニャで実践されているチーズ加工を把握し，2）暑熱環境下においてどのように生態環境を利用してチーズの熟成を実現させているかを分析することを通じて，3）サルデーニャにおける熟成チーズの発達史を考察することにある。サルデーニャでは，凝乳からホエイを抜く際に加熱しない pasta cruda 法によりカズ・クルドゥ(S)/フィオレ・サルド(I)と呼ばれる熟成ハードチーズをつくってきた。サルデーニャの移牧民はかつて，低地に滞在する冬・春期はつくりだてのチーズを主にすぐに売却したり食に供したりしていた。冬・春期は低地でも気温が低いため，チーズを熟成させることも可能であった。夏期には高地に移動して熟成チーズを加工していた。夏期の高温乾燥となる自然環境には，高地の涼しさとより涼しくできる住居を利用し，乾燥を防ぐにはオリーブオイルを表面に塗布し，チーズの熟成を実現させてきた。移牧という年間の高度差移動を巧みに利用し，冬期低温・夏期高温乾燥となる地中海性気候に対処してチーズの熟成を実現させてきた。それは，凝乳をホエイの中での保存から空気中への保存，凝乳のカッティングによる凝乳からの急速なホエイ排除，燻煙による脱水，加塩，涼しい場所を選んでの静置という加工法の発見・発達であったとも言える。サルデーニャの地形（低地から標高1000 m 以上の高地），環境利用（冬・秋期間に低地，夏期に高地を放牧），ライフスタイル（移牧）が，サルデーニャ独自の熟成ハードチーズを生み出していったといえる。

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Patients with combined carotid and coronary arterial diseases pose a high risk of cerebrovascular events, and the treatment of choice with either a simultaneous or a staged surgical procedure remains controversial. The literature of combined carotid and coronary arterial diseases of a recent decade in English was retrieved. Totally 41,901 patients undergoing simultaneous or staged carotid and coronary procedures from 53 reports were included. As a result, carotid endarterectomy plus coronary artery bypass remained the most commonly used procedure for the intervention of combined carotid artery stenosis and coronary artery disease, and was associated with higher incidences of perioperative transient ischemic attack, stroke and hospital mortality, but with less perioperative myocardial infarction comparing with the staged procedures. Patients with a simultaneous carotid endarterectomy and coronary artery bypass were generally related more to an advanced atherosclerotic coronary artery disease, so that a pure comparison between the two strategies was not always possible. To compare the efficacy of different surgical methods for combined carotid and coronary arterial diseases is of pronounced importance. The new hybrid approach consisting of the simultaneous carotid artery stenting and subsequent on-pump coronary artery bypass can be a safe approach, with the aim to reduce the surgical trauma as compared to surgical procedures, and to reduce the risk of myocardial infarction in the interval period required for the staged operations. Thus, for patients with combined carotid artery stenosis and coronary artery disease, the simultaneous surgical procedure, rather than the staged procedure, is recommended.

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Milk and dairy products are staples of the human diet. Among them, cheese holds an important stance. Due to its biological and biochemically dynamic nature, cheese is a perishable product in need of innovative preservation methods. There have been an increasing trends for the application of natural-derived edible films/coatings and natural preservatives to extend its shelf-life. The present review focuses on the application of edible coatings and highlights their potential for prolonging the shelf-life up to one month, depending on the types of cheese, its antimicrobial type, and environmental conditions such as storage temperature.

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The recent randomized trials, North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and Asymptomatic Carotid Atherosclerosis Study, have demonstrated the effectiveness of carotid endarterectomy to reduce the incidence of cerebral infarction in patients with symptomatic and asymptomatic high-grade carotid artery stenosis. However, no studies on Japanese patients have been done until now, and recent progress in endovascular stent treatment has been made. The present prospective, multicenter (not randomized) trial, the Japan Carotid Atherosclerosis Study, has started to analyze present practice and propose treatment guidelines for Japanese patients. Here, the protocol and early results of 565 patients registered until the end of January 2004 are presented.

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This study aimed to report the clinical features and early and long-term outcomes of patients treated with carotid endarterectomy (CEA) combined with a routine shunt for carotid stenosis with the occlusion of the contralateral carotid artery (CCO), and to compare them with patients without contralateral occlusion (NO-CCO). A retrospective analysis included 301 patients who had carotid artery stenosis treated with CEA using a routine shunt. Of these patients, 35 patients and 266 patients were categorized into a CCO group and NO-CCO group, respectively. Demographics and short-term and long-term outcomes were documented and compared. The demographic characteristics were not significantly different between the two groups. The periprocedural mortality, stroke rate, and rate of periprocedural myocardial infarction were not significantly different between both groups. The mean follow-up period for long-term outcomes was 34.45 ± 22.99 months, and the Kaplan–Meier analysis showed no statistical difference between both groups regarding stroke, myocardial infarction, and mortality. CEA combined with the routine shunt is an effective and durable procedure for carotid artery stenosis patients with CCO.

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A 61-year-old male presented with left hand motor weakness associated with cerebral infarction in the right frontal lobe. Right common carotid angiography demonstrated a 66% stenosis and carotid duplex scan demonstrated intermediate echogenic plaque, indicating typical carotid plaque. Carotid endarterectomy was performed 22 weeks after the ischemic onset. During exposure of the carotid artery, a soft and yellowish mass (5 × 5 mm) was observed in the lateral wall of the carotid bulbus, which was not covered with adventitia but with thin connective tissue. The mass was removed en-bloc with a small part of the surrounding arterial wall combined with ordinary endarterectomy. The artery was closed with a collagen-impregnated polyester patch graft (Hemashield patch^TM) to maintain adequate arterial lumen. Histological examination of the removed plaque confirmed that atheroma had protruded from the intima through the media as well as the adventitia and formed an extra-arterial mass. Such a case requires great care to dissect the carotid artery to prevent premature disintegration of the atheroma.

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A 62-year-old man and a 44-year-old man with unilateral cervical carotid artery stenosis (less than 50% with echolucent plaque and ulceration) suffered recurrent ischemic stroke events despite treatment with antiplatelet and anticoagulation drugs. Carotid endarterectomy (CEA) was performed under transcranial Doppler monitoring for the detection of micro-emboli using a microscope inserted through a skin incision to minimize pressure on the carotid arteries. The atheroma plaque included an ulcer with fresh thrombi in both patients. Both patients awoke from anesthesia without new neurological deficits, and no ischemic stroke events have recurred since CEA. Endarterectomy is an effective method for preventing stroke in patients with severe carotid stenosis (>70%), but the efficacy of this procedure for mild carotid stenosis (<50%) remains uncertain, regardless of carotid plaque characteristics. The present cases suggest that even mild stenosis of the cervical carotid artery may result in ischemic stroke events that are refractory to medical treatment if the stenosis is associated with echolucent plaque with ulceration. Endarterectomy is recommended to prevent further stroke in such patients.

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We review our recent results in 18 patients with asymptomatic severe (75%<) carotid artery stenosis complicated with coronary, valvular, or aortic disorder that requires surgical treatments. According to our treatment protocol, 4 patients underwent carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) or off-pump CABG (OPCABG) simultaneously. Ten patients underwent 2-staged therapy including CEA or carotid artery stenting (CAS) and cardiovascular surgery. CEA following OPCABG was selected in 2 patients with 75% carotid artery stenosis. Two other complicated patients required 2-staged cardiovascular surgery combined with CEA or 3-staged therapy comprising CAS, CEA, and OPCABG. Overall morbidity and mortality was 11.1% and 5.6%, respectively.
Based on our 5-year experiences, we emphasize the importance of thorough multidisciplinary discussion, informed consent, and a skilled team in treating the patients with complicated carotid and coronary artery disorders.

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  The clinical utility of anticancer drugs is seriously limited by the development of adverse effects and acquisition of resistance to these drugs by tumor cells. The mechanism underlying the toxicity of anticancer drugs is still not fully understood. To elucidate the mechanisms underlying the toxicity of anticancer drugs in greater detail, we performed a screen for determinants of sensitivity to adriamycin, an anthracycline antitumor antibiotic, using budding yeast as a model eukaryote. We found that overexpression of Akl1, a protein kinase of uncertain function, confers resistance to adriamycin. We investigated the function of Akl1 in adriamycin resistance and found that downregulation of the internalization step in endocytosis by Akl1 might be closely involved in the mechanism of adriamycin resistance. In human cells, overexpression of AAK1 and a human homologue of Akl1, also decreased adriamycin toxicity, suggesting that downregulation of endocytosis via phosphorylaiotn might be involved in the acquisition of adriamycin resistance not only in yeast cells but also in human cells. Further detailed investigation of the relationship between the endocytosis pathway and adriamycin toxicity might contribute further information for the improvement of chemotherapy with adriamycin.

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We searched the effect of the muscular valve on the management of short bowel syndrome. The motility of the remnant intestine with a special muscular valve after 80% massive distal small bowel resection (MSBR) was evaluated in conscious dogs. The valve (muscular ring) was made by the autointestinal muscle layer holding vascular pedicle. Interdigestive and postprandial bowel motility using bipolar electrodes and/or contractile strain gauge force transducers 2-4 weeks after the surgery, and data of this group (Group I) were compared to the motility in dogs after MSBR without valve construction (Group II) and in controls (Control). Results; Fasting duodenal migrating myoelectric (or motor) complexes (MMCs) in Group I occurred at longer intervals than in Control and almost similarly to those in Group II. MMCs arising from the duodenum were often interrupted before the jejunum above the valve and the anastomosis. The velocity of duodenal MMC propagation was slowed in every intestinal segment including that from the duodenum to the proximal jejunum, and to the jejunum above the anastomosis. Transit time in MSBR group (I and II) from the duodenum to the terminal ileum was extremely shorter than in Control, but there were no differences between in Groups I and II. The duration of the postprandial period without duodenal MMCs in Group I was significantly prolonged than in Control, but was shorter than that in Group II. The muscular valve was frequently activated, and the jejunum covered with the valve was contracted frequently which synchronized with the valve activity. It seemed the valve worked as sphincter. However, intestinal obstruction was not occurred through the jejunum covered by the valve. In conclusion, changes in gut motility after MSBR with the valve construction compensate for the shortened intestine and maintain the bowel content earlier postoperatively in comparison with the MSBR alone, and also contribute to the adaptive increase in the remnant intestinal absorption.

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Carotid endarterectomy (CEA) is the main treatment for atherosclerotic plaque of the cervical internal carotid artery. The surgical anatomy of the carotid arteries was studied in the carotid triangle of 49 cadavers. The carotid bifurcation was located at the level of the lower third of C-3. The superior thyroid artery arose from the anterior wall of the external carotid artery in 70% of specimens and from the distal portion of the common carotid artery in 30%. The lingual artery arose as a separate trunk between the origins of the superior thyroid and facial arteries in 81% of specimens, with the facial artery from a common trunk in 18%, and with the superior thyroid artery in 1%. The occipital artery arose from the posterior aspect of the external carotid artery above the level of origin of the facial artery in 57% of specimens, between the origins of the facial and lingual arteries in 32%, and below the origin of the lingual artery in 11%. The origin of the occipital artery was positioned low and the distal portion of the occipital artery was crossed by the hypoglossal nerve in 20%. The ascending pharyngeal artery arose from the posterior wall of the external carotid artery above the level of origin of the lingual artery in 66% of specimens, below the origin of the lingual artery in 9%, from the proximal portion of the occipital artery in 19%, from the carotid bifurcation in 2%, and from the internal carotid artery in 2%. The branches of the external carotid artery are the key landmarks for adequate exposure and appropriate placement of cross-clamps on the carotid arteries. It is necessary to understand the surgical anatomy of the carotid arteries to carry out successful removal of plaque and minimize postoperative complications in a bloodless surgical field.

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A 61-year-old man presented with a severe external carotid artery (ECA) stenosis with concomitant ipsilateral internal carotid artery (ICA) occlusion manifesting as amaurosis fugax. The left ophthalmic artery was supplied from the left ECA. The left intracranial ICA was supplied by the collateral flow from the contralateral ICA and ipsilateral ECA through the ophthalmic artery. The left vertebral artery also participated in the latter collateral pathway through the left occipital artery and ascending pharyngeal artery. Percutaneous revascularization of the ECA was performed using a nitinol self-expanding stent. To prevent embolic complications through the ophthalmic or vertebral arteries, distal protection was performed using a balloon. During a 22-month follow-up period, the patient was completely free from any ocular or neurological symptoms. The present case of severe ECA stenosis with ipsilateral ICA occlusion showed that percutaneous balloon angioplasty with stenting is feasible and effective. This intervention requires cautious evaluation of the anastomotic pathways connecting the ECA to the cerebral circulation to avoid embolic complications.

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The problem of early thrombosis-occlusion and recurrent carotid artery stenosis has raised a controversy over whether primary closure or patch graft closure is better. In 17 patients treated by CEA between 1998 and 2002, patch grafts were used in our institute to avoid acute thrombosis-occlusion and restenosis. In this study, we investigated the following: surgical complications, ischemic events in the follow-up term and restenosis in the follow-up term.
No surgical complications developed. During the follow-up term (26.2±16.7, no patient showed any ischemic symptoms. In 15 patients, follow-up angiography was performed. The mean follow-up was 15.0±17.0 months. On follow-up angiography, no patient showed restenosis of more than 50%.
We suggest endarterectomy with patch graft as an effective treatment of atherosclerotic carotid stenosis.

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症例は66歳，女性．消化管出血の診断で近医より当院紹介受診となる．CT，内視鏡検査にて下十二指腸曲の壁外性粘膜下腫瘍からの管腔内出血と診断した．内視鏡下に止血を行うも出血を繰り返し，入院3日後に吐血，出血性ショックを呈したために手術にて出血源である腫瘍を切除することとした．手術は気腹下に腫瘍を含めた腹腔鏡下十二指腸部分切除術を施行した．気腹開始後，血圧は上昇し術中バイタルサインは安定し，鏡視下に手術が可能であった．術後経過良好で術後16日目に退院となる．病理組織診断はgastrointestinal stromal tumorであった．
気腹による腹腔内圧上昇は血圧を上昇させることが知られている．しかし出血性ショックに陥った症例に対する気腹下鏡視下手術は，術中の循環動態に大きく影響することから，その有用性については今後さらに検討が必要と考えられた．

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We performed the CEA for 100 consecutive patients of asymptomatic carotid stenosis from May 1993 to December 2004. There were 81 men and 19 women (48-83 years old) with a mean age of 69. The high cervical lesion (distal end is higher than C2 vertebral body) was recognized in 14 patients and contralateral occlusion was seen in 12 pacients. Five patients were over 80 years old. Fifty-five patients had coronary heart disease, and 21 patients received coronary artery bypass. Another 21 patients had percutaneous coronary intervention before CEA. Of the 42 patients treated for coronary artery disease, 16 patients had no history of previous ischemic heart attack. The electroencephalogram and the flow of internal shunt were monitored during operation. Although perioperative morbidity was 2% and there was no mortality, transient complications were recognized. Two patients had transient hemiparesis; 8 had cranial nerve palsy; 1 had postoperative arteriovenous fistula; 1 had mild acute myocardial infarction; 2 had wound infections; and there were 4 hematomas (2 operations).
To minimize complications, preoperative examination of the coronary artery disease, meticulous operative procedures and prevention of hyperperfusion syndrome are important.

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The main goal of this article is to understand the trends of spatial- temporal changes of vegetation cover in relation to soil salinity under different land use patterns in Central Kyzylkum of Uzbekistan. For mapping the spatial distribution of plant communities, two main factors (soil salinity and vegetation classification) were recorded for assessing transect-ecological zones (TEZ) of vegetation cover in Central Kyzylkum. For assessing the ongoing processes of degradation of vegetation cover and its changes, we selected satellite images (Landsat TM, ETM+) for beginning of seasonality within the early period of April, 1987 and May, 2010; and seasonal variation of vegetation (greenness) in various plant communities was monitored at ecological scales within the TEZ. Computerized regression for spring seasons with environmental driving factors influencing plant biomass for different plant communities including dominate species of Artemisia and Salsola; which is appropriate for phytoindicators were modified and designed for different ecological scales of desert zones in Central Kyzylkum.

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Unchecked development and land occupation tend to occur during disaster recovery efforts, leading to land degradation. To investigate the influence of the 2004 Indian Ocean tsunami recovery process on land use and land cover (LULC) in Banda Aceh, Indonesia, a time-series of LULC changes was analyzed using Google Earth images from 2004 to 2013. During the first post-disaster recovery period (2004–2009), inland bare land and green spaces changed to built-up land because temporary shelters had been built in safer areas farther from the coast. Conversely, in coastal areas, the change from bare land to built-up land was greater during the second period (2009–2013) than the first period, possibly because evacuees had returned and rebuilt their houses. The increase in patch density in 2009 might have resulted from the evacuation and construction of temporary shelters in the inland area, forming an urban sprawl-like pattern. The Shannon Diversity Index of the inland area was smaller than that of the coastal area in all monitored years, although it decreased over time in both areas; this indicated that the coastal area was more homogeneous than the inland area, but the homogeneity increased over time in both areas. We observed LULC changes not only in the area affected directly by the tsunami, but also in the evacuation area. Although recovery efforts typically focus on LULC changes in areas directly affected by disasters, they should also consider evacuation areas.

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Diffusion tensor (DT) imaging provides quantitative information about the magnitude and the directionality (anisotropy) of water diffusion in vivo and can detect pathologic changes in brain ischemia. This study tried to detect ischemic brain damage using DT imaging in patients with symptomatic chronic major cerebral artery occlusive disease. DT imaging was performed using a 3.0 Tesla magnetic resonance (MR) scanner in 50 patients with unilateral internal carotid artery or middle cerebral artery stenosis or occlusion, who had no obvious infarct lesions on conventional MR imaging. Thirty-three patients underwent DT imaging before and after vascular reconstruction surgery. Fractional anisotropy (FA) was calculated in the middle cerebral artery territory. Preoperative FA values in the ipsilateral side were significantly lower than those in the contralateral side. After surgery, the FA value was significantly increased. DT imaging may indicate ischemic brain damage, not visualized by conventional MR imaging, in patients with major cerebral artery occlusive disease.

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