According to the Building Management Regulation, indoor air quality is supposed to be measured only for the specific building with an area of more than 3,000 m^2. However, cooling capacity or ...ventilation volume for the smaller sized building might be insufficient needs. Therefore the owners might concern about energy saving without assuring indoor air quality. This field measurement was conducted about ventilation performance, indoor environment, and facilities' operation and revealed the problem that may arise at similar office space.
Laboratory evaluation of a 12-year-old male domestic shorthaired cat with a 2-month history of refractory anemia that had been treated with a few blood transfusions, disclosed pancytopenia, ...hyperproteinemia, increased serum-creatinine concentration, and hypercalcemia. Serum and urine electrophoresis revealed monoclonal gammopathy (M component). On the basis of immunoelectrophoretic evaluation, the serum M component was classified as immunoglobulin A (IgA) and the urine M component as Bence-Jones protein. Radiography identified no osteolytic foci. A bone-marrow aspirate revealed an increased plasma-cell ratio (59.8%), slight hypoplasia of the myeloid cells and megakarocytes, and severe hypoplasia of the erythroid cells. These findings confirmed a diagnosis of immunoglobulin-A multiple myeloma, in this case accompanied by hypercalcemia and pure red-cell aplasia.
CaseA 40-year-old man presented to the emergency room with visual impairment, dysesthesia of lower legs, and urinary retention. Two days before admission, he was consulted to the neurology department ...due to bilateral optic neuritis and scheduled the magnetic resonance imaging of spine. However, the urinary retention deteriorated acutely and he came to the emergency room. On arrival, the plain magnetic resonance image of his spine showed diffuse hyperintensity signals of the spinal cord in T2-weighted images. He was diagnosed with neuromyelitis optica and steroid pulse therapy was initiated. OutcomeWe began treatment immediately in the emergency room, cooperating with the neurology team. After admission, plasmapheresis was added for his fluctuating symptoms. On hospital day 7, he was discharged without complication. ConclusionIt is important to understand the various clinical manifestations of neuromyelitis optica. In emergency settings, immediate steroid therapy is necessary for better outcomes.
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The guidelines for Good Clinical Practice (GCP) in Japan have been harmonized with ICH-GCP. Both the protection of human rights and the carrying out of clinical trials ethically and scientifically, ...conforming to the GCP, are necessary for the safety and efficacy of clinical data of common technical documents. It is standard practice in Japan, the U.S., and the E.U. to ensure conformity with all data from raw data to application materials. In April, 2004, the new independent organization Pharmaceuticals and Medical Devices Agency (PMDA) was established in Japan. The PMDA provides services focusing on the three key areas of Review, Safety, and Relief. The Office of Conformity Audit is one of the offices in the Center for Product Evaluation of the PMDA. In the conformity audit service of the Office of Conformity Audit of the PMDA, the reliability and conformity with the GCP between case report forms (CRFs) as basis materials and application materials is confirmed by the document-based conformity review, and the conformity between medical records as raw data and CRFs is assessed through the on-site GCP review. Therefore, such application materials are considered to be consistent with international standards. The important issues raised by the GCP on-site review by the Office of Conformity Audit of the PMDA are summarized in this study. We hope that our findings at investigational sites will promote the protection of human rights and improve the quality of clinical trials in Japan.
CaseA 64-year-old man with complaints of dyspnea and orthopnea secondary to a hepatic hydrothorax refractory to diuretic medication underwent the transjugular intrahepatic portosystemic shunt (TIPS) ...procedure to decrease the portal vein pressure. The TIPS procedure failed due to severe liver stiffness. Direct intrahepatic portocaval shunt (DIPS), a modified TIPS procedure that directly inserts a stent from the inferior vena cava to the portal vein, was successfully carried out. OutcomeThe DIPS procedure significantly decreased the patient's pleural effusion and respiratory symptoms. ConclusionNo other medical treatment is available to control refractory pleural effusion caused by portal hypertension; however, the TIPS (or DIPS) procedure can be successfully carried out in patients <60 years old with a Model of End-Stage Liver Disease score <15.
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