Acta Med Okayama
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For many years, surgery alone was the standard treatment for patients with stage I-IIIA non-small-cell lung cancer (NSCLC). However, recent studies have demonstrated that adjuvant chemotherapy provides a survival benefit. The first adjuvant chemotherapy for NSCLC was performed in the 1960s using a key drug known as cyclophosphamide. ⋯ The Japan Lung Cancer Research Group (JLCRG) on Postsurgical Adjuvant Chemotherapy reported a 5-year overall survival advantage of 11% in the uracil-tegafur group patients with stage IB cancer. The efficacy of adjuvant chemotherapy with uracil-tegafur was confirmed in a meta-analysis. In conclusion, the results of phase III trials and a meta-analysis have confirmed the benefit of adjuvant chemotherapy for resected stage IB, II, and IIIA NSCLC.
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In modern emergency and critical care, physicians tend to choose the mode of mechanical ventilation based on spontaneous breathing for the purpose of promoting discharge of pulmonary secretion and preventing atelectasis in patients with acute respiratory insufficiency. However, we often observe "differences in recovery" among patients treated using the same PSV settings beyond "differences in individual characteristics." We evaluated the Pressure Support Ventilation (PSV) mode aiming to certify the difference among 7 representative mechanical ventilators using the Active Servo Lung 5000 (ASL5000) respiratory simulation system. The following parameters were measured: The time delay that resulted in the lowest inspiratory pressure from the point at which the ventilator recognized spontaneous breathing (TD), the lowest inspiratory airway pressure (cmH2O) generated prior to the initiation of PSV (DeltaPaw), the work of breathing while triggering required to achieve the lowest inspiratory negative pressure from the beginning of inspiratory support (WOBtrig), and the inspiratory work of breathing (WOBi). ⋯ The WOBtrig of the PB840 was significantly lower than those of others (p0.01). However, the WOBi values of the Servo-I and T-Bird were greater than the others, with the Evita series showing the smallest WOBi of the 7 ventilators tested. According to this simulation study using ASL 5000, we concluded that PB840 was the most rapid response ventilator, but the Evita series was the gentlest mechanical ventilator among 7 ventilators from the standpoint of the total work of breathing during the inspiration phase in the setting of PSV.
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Since clinical document architecture (CDA) became an American National Standards Institute (ANSI)-approved health level seven (HL7) Standard, many countries have begun making an effort to make local standards conform to CDA. In order to make CDA compatible with the many different local standards existing in different countries, we designed a prototype model using HL7 CDA R2 with medical markup language (MML), a Japanese medical data exchange standard. ⋯ We share herein the experience gathered in designing and implementing a referral letter system based on HL7 CDA, Release 2 (CDA R2). We also outline the challenges encountered in our project and the opportunities to widen the scope of this approach to other clinical documents.
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The induction of both long-term potentiation (LTP) and long-term depression (LTD) in the hippocampal CA1 region is triggered by the activation of N-methyl-D-aspartate (NMDA) receptors and the subsequent postsynaptic intracellular Ca2+ increase. However, how NMDA receptor activation differs between LTP and LTD induction is unclear. In the present study, we examined the effects of the magnitude and duration of NMDA receptor activation on the induction of LTP and LTD. ⋯ Finally, LTD induced by prolonged activation of NMDA receptors was not affected by inhibition of the desensitization of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptors. These results suggest that critical differences exist between the induction of LTP and that of LTD in terms of both the magnitude and the duration of NMDA receptor activation. The duration of the increase in intracellular Ca2+ concentration may be critical for determining whether LTP or LTD induction occurs.
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We describe herein 2 patients who developed Vogt-Koyanagi-Harada syndrome in the course of renal biopsy-proven immunoglobulin A (IgA) nephropathy. A 61-year-old man with an 11-year history of IgA nephropathy and a 16-year history of thyroiditis, and a 56-year-old man with a 5-year history of IgA nephropathy developed Vogt-Koyanagi-Harada syndrome. ⋯ Vogt-Koyanagi-Harada syndrome was successfully treated with intravenous administration of prednisolone tapered from 200 mg daily. Vogt-Koyanagi-Harada syndrome is associated with IgA nephropathy, suggesting a similar autoimmune mechanism for both diseases.