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On January 1, 2024, an earthquake with a maximum seismic intensity of 7 struck the Noto Peninsula in Ishikawa Prefecture, Japan, causing significant casualties and displacement. The Noto Peninsula has a high aging rate, with 49.5% of its population aged 65 or older. This case study focuses on a 68-year-old woman who developed aspiration pneumonia after being admitted to a welfare shelter. The case highlights the challenges of managing chronic medical care during disasters, particularly for the elderly.
The minimum diameter of the patent ductus arteriosus measured in the lateral angiographic view is usually used to determine the device size. Sometimes the device can be easily removed from the patent ductus arteriosus, even if it appears to be the optimum size.
Methods:
From 2016 to 2021, 29 patients who underwent contrast-enhanced CT prior to patent ductus arteriosus closure included. Morphological evaluation of the narrowest part of the patent ductus arteriosus was performed on contrast-enhanced CT. We also examined whether there were differences in morphology depended on Krichenko classification, age, and the diameter of the narrowest portion of the patent ductus arteriosus.
Results:
At the time of treatment, the median age was 4.8 (range, 1–52) months, and the median weight was 5.0 (2.5–12.7) kg. The median minimum vertical diameter of patent ductus arteriosus was 2.9 (1.6–6.6) mm. The narrowest patent ductus arteriosus part in the contrast CT imaging showed horizontal-to-vertical diameter ratios in the range of 1.0–1.7, with no case where the vertical diameter was larger than the horizontal diameter. The median horizontal-to-vertical diameter ratio by Krichenko type was: A, 1.22; C, 1.29; E, 1.62(p = 0.017). When classifying the patients into a group aged under six months (n = 21) and a group aged six months or older (n = 8), the respective median horizontal-to-vertical diameter ratio was 1.34 and 1.15 (p = 0.027). The vertical patent ductus arteriosus diameter was not correlated with the elliptical shape.
Conclusions:
Most patent ductus arteriosus cases have a horizontally oriented elliptical shape in this study. This characteristic showed high reproducibility and is important information that angiography cannot evaluate.
The Concurrent Approach for Respiratory Epidemiological Surveillance and Symptom Screening (CARES) combines symptom screening to prevent external respiratory infections by managing staff and visitor health and surveillance to monitor the infection rates within the facility and take timely decisions on activity programs based on outbreak prevalence. This study examines the efficacy of the CARES strategy in preventing respiratory infection outbreaks in long-term care facilities.
Design:
Prospective cohort study utilizing historical controls including an intervention and control group.
Setting:
This study was conducted in two long-term care facility wards (total: 110 beds) in Japan.
Patients:
We enrolled patients aged 1–72 years from the target ward with severe intellectual and physical disabilities from October 1, 2018, to March 31, 2019, and from October 1, 2017, to March 31, 2018, for the intervention (n = 104) and control (n = 98) groups, respectively. The study included all admitted patients and excluded those hospitalized or discharged during the study period.
Intervention:
The total number of days that activity programs, new admissions, and visitations were cancelled in the two groups was compared before and after the introduction of CARES.
Results:
CARES reduced the duration of new admission cancellations and visitation cancellations by 16 and 23 days, respectively (α = 0.1, P value < 0.001). Additionally, the maximum duration of activity program cancellations was reduced by 2 days. Furthermore, five cases of presenteeism were prevented.
Conclusions:
CARES improves patients’ quality of life by continuation of activity programs, new patient admission, and ongoing visitations.
Clozapine-induced inflammation, such as myocarditis and pneumonia, can occur during initial titration and can be fatal. Fever is often the first sign of severe inflammation, and early detection and prevention are essential. Few studies have investigated the effects of clozapine titration speed and concomitant medication use on the risk of clozapine-induced inflammation.
Aims
We evaluated the risk factors for clozapine-associated fever, including titration speed, concomitant medication use, gender and obesity, and their impact on the risk of fever and the fever onset date.
Method
We conducted a case-control study. The medical records of 539 Japanese participants with treatment-resistant schizophrenia at 21 hospitals in Japan who received clozapine for the first time between 2010 and 2022 were retrospectively investigated. Of these, 512 individuals were included in the analysis. Individuals were divided into three groups according to the titration rate recommended by international guidelines for East Asians: the faster titration group, the slower titration group and the ultra-slower titration group. The use of concomitant medications (such as antipsychotics, mood stabilisers, hypnotics and anxiolytics) at clozapine initiation was comprehensively investigated. Logistic regression analysis was performed to identify the explanatory variables for the risk of a fever of 37.5°C or higher lasting at least 2 days.
Results
Fever risk significantly increased with faster titration, male gender and concomitant use of valproic acid or quetiapine. No increased fever risk was detected with the use of other concomitant drugs, such as olanzapine, lithium or orexin receptor antagonists. Fever onset occurred significantly earlier with faster titration. Multivariate analysis identified obesity as being a factor that accelerated fever onset.
Conclusion
A faster titration speed and concomitant treatment with valproic acid and quetiapine at clozapine initiation increased the risk of clozapine-associated fever. Clinicians should titrate clozapine with caution and consider both the titration speed and concomitant medications.
Montmorillonite-aminocaproic acid complexes (monomer complexes) were prepared by the intercalation of 6-aminocaproic acid to various homoionic (Na+, Ca2+, Mg2+, Co2+, and Cu2+) montmorillonites. Infrared spectra of the monomer complexes indicated that the interaction between the exchangeable cations and the 6-aminocaproic acid increased in the following order: Na-, Ca-, and Mg- < Co- < Cu-montmorillonite-aminocaproic acid complex. Montmorillonite-nylon complexes (polymer complexes) were prepared by thermal treatment of the monomer complexes, which was confirmed by X-ray powder diffraction and infrared spectroscopy the results of which indicated the condensation of 6-aminocaproic acid in the interlayer space.
Thermal degradation of montmorillonite-nylon complexes was studied by thermogravimetry. It was found that the thermal stability of the polymer complexes increased in the following order: Cu- < Co- < Na- < Mg- < Ca-montmorillonite-nylon complex.
It was suggested that the difference in thermal stability depended upon the length of the polymer chain which might be influenced by the interaction between the exchangeable cations and the 6-aminocaproic acid. The activation energy for the thermal degradation of each montmorillonite-nylon complex was obtained, and the value for Cu-montmorillonite-nylon complex was smaller than that for the other cation-exchanged montmorillonite-nylon complexes.
Antimicrobial-product package inserts and insufficient staffing impede routine carbapenem monitoring in the inpatient setting in Japan. The collaboration between antimicrobial stewardship teams and clinical pharmacists was associated with a sustained improvement in carbapenem dosing optimization. Our findings could be of use to countries with inadequate monitoring of carbapenem antimicrobial use.
The interactions of the following three kinds of racemic and enantiomeric cobalt(III) chelates with montmorillonite and saponite are studied: [Co(en)3]3+ (en = ethylenediamine), [Co(diNOsar)]3+ (diNOsar = (1,8-dinitro-3,6,10,13,16,19-hexaazabicyclo[6,6,6]-eicosane)cobalt(III))and [Co(diAMsar)]3+ (diAMsar = (1,8-diamino-3,6,10,13,16,19-hexaazabicyclo-[6,6,6]eicosane)-cobalt(III)). At neutral pH, these complexes are adsorbed as a trivalent cation up to 90%–100% of the cation exchange capacity of a clay. No difference is observed in the maximum adsorption amount between the racemic and enantiomeric isomers. The basal spacings of the clay-chelate adducts are determined by the X-ray diffraction measurements of non-oriented powder samples: 14.3 Å for [Co(en)3]3+ montmorillonite, 16.5 Å for [Co(diNOsar)]3+ montmorillonite, and 16.9 Å for [Co(diAMsar)]3+ montmorillonite. The results imply that the chelates form a monolayer in the interlayer space. From the one-dimensional Fourier analyses of the diffraction pattern of [Co(diNOsar)]3+ montmorillonite, the chelate is concluded to be adsorbed with its three-fold symmetry axis in parallel with the layer surface. This is in contrast with the previous results of [Ru(phen)3]2+ and [Ru(bpy)3]2+, which are adsorbed with their three-fold symmetry axes perpendicular to the surface. The conclusion is consistent with the angular dependence of the infrared absorption spectrum of the film of the adduct.
Many cultures have had knowledge imposed from outside, whether by force or for reasons of power, to the detriment of their own endogenous knowledge and the wisdom developed throughout their history. Would Japan's acquisition of Western knowledge have led but to the development of a lesser know-how, devoid of meaning or sense, or even of knowledge which it might be better to ignore? Far from benefiting from an endogenous development or a modernization respectful of beings and of their environment, the developing countries that superficially adopt this unilateral knowledge undergo a type of ‘self-colonization’. Although concurring with biologist Keiko Nakamura's theory that scientific attitudes must be studied from within, Masahiro Hamashita considers that knowledge from outside allows for more solid internal reflection. He thus advocates the development of an integrated, hybrid knowledge, where external knowledge is mixed with internal knowledge in a spontaneous, harmonious way, as was the case with the traditional knowledge that Japan acquired from China.
Yanagita Kunio (1875-1962), one of the most representative of Japanese folklorists, sees the different aspects of forests as a composite whole comprising customs, legends and way of life of the inhabitants. Yanagita looks at this in detail, wishing to understand how the forest is related to the life and customs of the people living there, an attitude that could be called an understanding from within. Given the complexity of the issue of the earth's ecology, Yanagita suggests adopting the same attitude.
We aimed to examine differences in the severity of neuropsychiatric symptoms (NPS) subsyndromes according to education level among patients with amnestic-mild cognitive impairment (a-MCI) and to identify patient demographics related to NPS subsyndromes.
Methods:
Overall, 140 patients with a-MCI were included. We divided the patients into three groups according to their educational level (primary education, middle education, and high education) and compared their demographics. To explore the severity of NPS subsyndromes according to educational level, we used the Neuropsychiatric Inventory-Questionnaire (NPI-Q) after adjustments for the Mini-Mental State Examination (MMSE) score. Finally, NPS subsyndromes that were identified as being related to educational level were further explored using a general linear model (GLM).
Results:
Significant differences in several demographics were observed among the three groups. Among the NPS subsyndromes, the scores for aggressiveness were significantly higher in the primary and high education groups than in the middle education group, while the apathy/eating problem scores were significantly higher in the primary education group than in the other groups. The GLM analyses showed that aggressiveness was related to marital status and the Zarit Caregiver Burden Interview (ZBI-J) score, while apathy/eating problems was related to the instrumental activities of daily living (IADL) percentage, the ZBI-J score, and the education level in years.
Conclusion:
Among NPS subsyndromes, aggressiveness and apathy/eating problems differed according to education level in patients with a-MCI. A GLM analysis suggested that not only education level, but also various other factors should be considered when determining the need for NPS interventions.
Morita Therapy is a psychotherapy which originated in Japan. Conventionally, it had been applied to ‘neurosis’. The patients who have anxiety symptoms make various efforts in order to be free from the unpleasant emotion. Morita Therapy (1) does not try to eliminate anxiety and its symptoms and builds the patients’ attitude to leave these symptoms as a natural course, and (2) to focus on the feeling that they should aspire to enhancing their life and to encourage them to exert their lust for life. The authors presumed that this concept can be applied to anxiety symptoms in patients with mild cognitive impairment (MCI) and attempts to intervene. This case is for a male patient aged 74 years old with MCI with the complaint of subjective cognitive impairments. He had severe anxiety for his own cognitive impairment and recognized a severe decrease of Quality of Life (QOL) due to worrying about his own excessive anxiety. The authors implemented the therapeutic approach to address his anxiety and encouraged him to improve his QOL by accepting the anxiety, not excluding it. During the therapeutic process, various problems were evident, such as the caregiver’s excessive fear of dementia, so education about the nature of dementia was provided to dispel the stigma for the family members. As a result, the patient’s anxiety was decreased, and his daily activities were observed in spite of his subjective cognitive decline. This case suggested that Morita therapy was effective for anxiety symptoms in patients with MCI.
The purpose of this paper is to understand the milk processing system practiced in the Mongolian nomadic Khalkha groups of Su'qbaatar and Dornod Provinces in eastern Mongolia through a field survey, to compare it with surrounding areas of Qentiy and Dundgowi Provinces, and then to analyze the transmission of processing techniques by further comparison with those of Syria, Jordan, Iran and Iraq in West Asia. The milk processing techniques of fermentation, cream separation and additive coagulation are all used in Su'qbaatar and Dornod Provinces. In fermentation processes, the technique of alcohol fermentation with churning is mainly used for cow milk to process alcoholic sour milk, followed by further processing to spirit, butter oil and non-matured dry cheese. In cream separation processes, the technique of heating/cream separation is used, in which cream is first separated from milk and non-matured dry cheese is processed from skim milk. In additive coagulation processes, the technique of fermented milk coagulation which utilizes lactic acid fermented whey as a coagulant is used to process non-matured dry cheese. These techniques are widely shared in the eastern part of Mongolia. It is characteristic of Su'qbaatar Province that the processing of cow milk is dominated by the technique of fermentation processes, mainly alcohol fermentation with churning. It is presumed that the technique of churning sour milk transmitted from West Asia to eastern Mongolia, and then the function of churning originally for butter processing was converted to allow for alcohol fermentation under the cooler environment in North Asia.
The southern Patagonian glaciers are known for having extremely high ablation rates. Foehn winds are one of the suspected causes, however, their influence on the annual ablation, their interannual variations, and their relationship with climate change is not well understood. We analysed the in-situ meteorological data from 2003–2020 recorded at Glaciar Perito Moreno. Daily temperature lapse rates varied substantially, from −7.8°C km−1 to 10.4°C km−1, due to foehn, fog, and katabatic winds. We find that, on average, foehn events occurred 1073 hours per year, and accounted for 20% of the annual surface ablation. This increase in surface ablation rates during foehn events occurs as a result of the enhanced sensible heat flux and net shortwave radiation. The downglacier-directed foehn winds warm the air mass over the glacier, but because of the high humidity of the foehn here, they often release latent heat by condensation. Variations in the Amundsen Sea Low influence foehn occurrence by modulating the westerly winds, which is related to the hemispherical ocean and atmospheric variability. Our results show that the local climate play an important role in the surface melting of Patagonian glaciers.
In this paper, I would like to argue that brain-dead small children have a natural right not to be invaded by other people even if their organs can save the lives of other suffering patients. My basic idea is that growing human beings have the right to grow in the form of wholeness, and dying human beings also have the right to die in the form of wholeness; in other words, they have the right to be protected from outside invasion, unless they have declared their wish to abandon that right beforehand. I call this the principle of wholeness. Natural rights, which were discussed by Hobbes and Locke in the 17th century, have to be extended to include the right to grow and die in the form of wholeness in the age of scientific civilization, where peripheral human lives are being threatened by aggressive biomedicine and other advanced technologies.
Control of the structure and morphology of clay crystals presents a challenge in the synthesis of materials for adsorption and catalysis. In the present study, direct crystallization of a phyllosilicate grafted with organosilyl (methylsilyl and phenylsilyl) groups on the surface of monodisperse spherical silica particles (2.6 μm) is reported. Methyl- and phenyltriethoxysilanes were allowed to react hydrothermally in a Teflon-lined autoclave with silica, MgCl2, and LiF in the presence of urea for 2 or 4 days. X-ray diffraction patterns revealed that the fine platy particles formed were a trioctahedral hectorite-like layered silicate. Greater temperature (150°C) was required to achieve homogeneous coverage of the original spherical silica particles with the hectorite-like particles. The diameter of the initial silica grains increased slightly to 3.0 μm after the hydrothermal reactions, while the original spherical shape and size distribution were maintained. Solid-state 29Si nuclear magnetic resonance analyses confirmed that the presence of resonances attributed to the RSi(OMg)(OSi)2 and RSi(OMg)(OH)(OSi) (R = methyl or phenyl) environments of the silicon proved the formation of covalent bonds between phyllosilicate sheets and the organic moieties. The crystallinity of the layered silicates increased when the reactions ran for a longer time (4 days).
Is, or has, democracy a universal value? This is the main question raised by this paper, which distinguishes between two aspects of democracy: political institution in opposition to despotism, and political belief against any kind of slavery and subordination. The role played by intellectuals in the development of contemporary democracy, and the relation of democracy to mass culture and the influence of mass media on a true democratic attitude, are studied within the frame of an overall ‘mass aesthetization' which characterizes contemporary societies.
We developed a Handheld Integrating Sphere Snow Grain Sizer (HISSGraS) for field use to measure the specific surface area (SSA) of snow. In addition to snow samples, HISSGraS can directly measure snow surfaces and snow pit walls. The basic measurement principle is the same as that of the IceCube SSA instrument. The retrieval algorithm for SSA from reflectance employs two conversion equations formulated using spherical and nonspherical grain shape models. We observed SSAs using HISSGraS, IceCube and the gas adsorption method in a snowfield in Hokkaido, Japan. Intercomparison of the results confirmed that with HISSGraS direct measurement, SSA profile observations can be completed in just ~1/10 the time required for measurement of snow samples. Our results also suggest that HISSGraS and IceCube have similar accuracy when the same snow samples are measured using the same grain shape model. However, SSAs of near-surface snow layers measured using the three techniques exhibited some biases, possibly due to rapid snow metamorphism or melting during measurement and some technical issues with optical techniques. When excluding SSA data for the surface layer, which metamorphosed remarkably during measurement, IceCube- and HISSGraS-derived SSAs correlated strongly with those obtained by gas adsorption and HISSGraS accuracy is 21–34%.
This study aimed to expand our understanding of myelin basic protein (MBP), a key component of central nervous system myelin, by developing a protocol to track and quantifying individual MBP particles during oligodendrocyte (OL) differentiation. MBP particle directionality, confinement, and diffusion were tracked by rapid TIRF and HILO imaging of Dendra2 tagged MBP in three stages of mouse oligodendroglia: OL precursors, early myelinating OLs, and mature myelinating OLs. The directionality and confinement of MBP particles increased at each stage consistent with progressive transport toward, and recruitment into, emerging myelin structures. Unexpectedly, diffusion data presented a more complex pattern with subpopulations of the most diffusive particles disappearing at the transition between the precursor and early myelinating stage, before reemerging in the membrane sheets of mature OLs. This diversity of particle behaviors, which would be undetectable by conventional ensemble-averaged methods, are consistent with a multifunctional view of MBP involving roles in myelin expansion and compaction.
Inflammatory bowel disease (IBD) is a chronic disease characterised by repeated relapses and remissions and a high recurrence rate even after symptom resolution. The primary method for IBD diagnosis is endoscopy; however, this method is expensive, invasive, and cumbersome to use serially. Therefore, more convenient and non-invasive methods for IBD diagnosis are needed. In this study, we aimed to identify biological gas markers for the development of gut inflammation. Using dextran sulphate sodium (DSS)-induced colitis mouse models, five biological gases were analysed to identify predictive markers for the development of gut inflammation. Additionally, the correlation between the changes in gas composition, gut microbiota, and inflammatory markers was assessed. The hydrogen (H2) level was found to be negatively correlated with the level of lipocalin-2 (LCN2), a gut inflammation biomarker, and weight loss due to DSS-induced colitis. Furthermore, gut microbes belonging to the Rikenellaceae and Akkermansiaceae families were positively correlated with LCN2 levels and weight loss, whereas Tannerellaceae abundance was negatively correlated with LCN2 level and weight loss and positively correlated with H2 levels. This study provides new insights for IBD diagnosis; the H2 levels in biological gases are a potential biomarker for intestinal inflammation, and specific gut microbes are associated with H2 level changes.
Let $\pi$ be a discrete group, and let $G$ be a compact-connected Lie group. Then, there is a map $\Theta \colon \mathrm {Hom}(\pi,G)_0\to \mathrm {map}_*(B\pi,BG)_0$ between the null components of the spaces of homomorphisms and based maps, which sends a homomorphism to the induced map between classifying spaces. Atiyah and Bott studied this map for $\pi$ a surface group, and showed that it is surjective in rational cohomology. In this paper, we prove that the map $\Theta$ is surjective in rational cohomology for $\pi =\mathbb {Z}^m$ and the classical group $G$ except for $SO(2n)$, and that it is not surjective for $\pi =\mathbb {Z}^m$ with $m\ge 3$ and $G=SO(2n)$ with $n\ge 4$. As an application, we consider the surjectivity of the map $\Theta$ in rational cohomology for $\pi$ a finitely generated nilpotent group. We also consider the dimension of the cokernel of the map $\Theta$ in rational homotopy groups for $\pi =\mathbb {Z}^m$ and the classical groups $G$ except for $SO(2n)$.