The Future of Long-term Care in Japan

This article reviews a decade of implementation of the public long-term care insurance (LTCI) program in Japan, which is now experiencing unprecedented pressure from its rapidly aging population. This overview of the program's features focuses on the incentive mechanisms and diversity and examines official future projections of LTC costs and their accompanying assumptions. Included is the discussion of possible reforms for the LTCI program, with an emphasis on the micro aspects of LTC, with evidence provided by the Japanese Study on Aging and Retirement (JSTAR).     

An autopsy case of intraoperative death due to pulmonary fat embolism—possibly caused by release of tourniquet after multiple muscle-release and tenotomy of the bilateral lower limbs

We report a case of a juvenile male with muscle rigidity caused by cerebral palsy who experienced intraoperative sudden death due to pulmonary fat embolism after multiple muscle-release and tenotomy of the bilateral lower limbs. Data were obtained through review of the surgical and anesthesia records, as well as from autopsy and histopathological examination. All surgical procedures were performed within the same operation, beginning with the right lower limb and then proceeding with the left lower limb, with application of a pneumatic tourniquet to avoid intraoperative hemorrhage. Slight changes in the hemodynamics were noticed after release of the right tourniquet. Further, sudden onset of hypotension, severe bradycardia, and a marked decrease in percutaneously monitored oxygen saturation occurred just after release of the left tourniquet when the left limb was raised for casting. The patient died despite immediate and vigorous cardiopulmonary resuscitation. At autopsy performed 20 h after death, examination of the lungs revealed a pale surface, slight edema, and obvious fat droplets in the vessels at the cut surfaces. Histopathological examination with fat staining was notable for the presence of pulmonary fat embolism. These results suggest that restoration of venous return after removal of the tourniquet combined with massive fat embolism from dead spaces was the likely cause of death.     

Dermal absorption of kerosene components in rats and the influence of its amount and area of exposure

The influences of amount and area of dermal exposure to kerosene upon the levels of kerosene components in biological samples were examined in vivo and in vitro. Thirty-two rats were randomly divided into four groups and exposed to kerosene through the abdominal skin for 2h. The amounts (soaked in cotton) and area of kerosene exposed were 1 ml/4 cm(2) in Group I, 4 ml/4 cm(2) in Group II, 4 ml/16 cm(2) in Group III and 16 ml/64 cm(2) in Group IV. Before, then 5, 10, 20, 30, 45, 60, 90 and 120 min after exposure, 0.5 ml of blood was collected. Solid tissue samples, including the exposed skin area, were harvested at 120 min. Kerosene components were analyzed by gas chromatography/mass spectrometry. Trimethylbenzens (TMBs) that are easily absorbed kerosene components, appeared at 5-20 min. The time course changes in TMB levels in blood were significantly different between Groups I and II or Groups I and III, and almost identical between Groups II and III. Similar trends were observed in tissue samples at 120 min. High concentrations of aliphatic hydrocarbons (AHCs) were detected in the exposed skin and the AHC levels were dependent on the amount of kerosene exposed per unit area. These results suggest that (1) dermal absorption of kerosene occurs soon after dermal exposure started, (2) absorption of TMBs is influenced by the total amount of kerosene rather than area of exposure, and (3) AHCs remaining in the skin at significant levels are influenced by the amount of kerosene per unit area exposed.     

Individual identification of disguised faces by morphometrical matching

The reliability of a morphometrical matching method for identifying disguised faces was examined experimentally using a computer-assisted facial image identification system. The 2D right oblique facial images of three target persons disguised with sunglasses, cap and gauze mask were each compared with each of the 3D facial images of 100 subjects, yielding 900 face-to-face superimpositions. The average perpendicular distance between the facial outlines and the average point-to-point distance of the corresponding landmarks in the 2D image of the disguised face and the 3D facial image, were calculated. As a matching criterion, the sum of the values of the average perpendicular difference of the facial outlines and the average point-to-point difference between the corresponding landmarks was used (abbreviation: average difference).The range of the average difference was 2.3-2.8mm for the same person (a match) and 4.0-14.6mm for different (non-matching) people, respectively. The ranges for matching and non-matching faces did not overlap. Even the 3D facial images of the non-matching person showing the closest value of average difference to the average difference for the matching person could be excluded easily. It was concluded that the morphometrical matching method can reliably identify disguised faces and the results produced by this method could be easily understandable by a court of law.