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It is well known that the burden on the families of cancer patient extends across many aspects, but there have been no reports of family members developing delirium due to the burden of caring for a cancer patient.
We reported a caregiver who developed Wernicke encephalopathy (WE) while caring for a family member with advanced cancer.
The subject was a 71-year-old woman who had been caring for her husband, diagnosed with gastric cancer and liver metastases, for 5 months. She visited the “caregivers’ clinic” after referral by an oncologist who was worried about a deterioration in her mental condition that had appeared several weeks previously. The woman had a history of diabetes mellitus. Some giddiness was observed and, based on her inability to answer questions, her level of consciousness was checked and some disorientation was observed. She was diagnosed with delirium. A blood sample was collected to investigate the cause of the delirium, but the test data showed no hypoglycemia. Her appetite had declined since her husband was diagnosed with cancer. Thiamine deficiency was suspected as thiamine stores in the body are depleted within about 18 days and her loss of appetite had continued for 5 months. On intravenous injection of 100 mg of thiamine, her consciousness level was returned to normal in 1 h. A diagnosis of WE was supported by the patient's abnormally low serum thiamine level.
Significance of the results
The family members of cancer patients may develop a loss of appetite due to the burden of caring, resulting in WE. When providing care for signs of distress in family members, it is necessary to pay attention not only to the psychological aspects but also to their level of consciousness and physical aspects, particularly the possibility of serious illness resulting from reduced nutritional status.
Poultry red mites (Dermanyssus gallinae, PRM) are dangerous ectoparasites that infest chickens and threaten the poultry industry worldwide. PRMs usually develop resistance to chemical acaricides, necessitating the development of more effective preventive agents, and vaccination could be an alternative strategy for controlling PRMs. The suitability of plasma membrane proteins expressed in the midguts as vaccine antigens was evaluated because these molecules are exposed to antibodies in the ingested blood and the binding of antibodies could potentially induce direct damage to midgut tissue and indirect damage via inhibition of the functions of target molecules. Therefore, in the present study, a copper transporter 1-like molecule (Dg-Ctr1) was identified and its efficacy as a vaccine antigen was assessed in vitro. Dg-Ctr1 mRNA was expressed in the midguts and ovaries and in all the life stages, and flow cytometric analysis indicated that Dg-Ctr1 was expressed on the plasma membrane. Importantly, nymphs fed on plasma derived from chickens immunized with the recombinant protein of the extracellular region of Dg-Ctr1 showed a significant reduction in the survival rate. These data indicate that the application of Dg-Ctr1 as a vaccine antigen could reduce the number of nymphs in the farms, contributing to reduction in the economic losses caused by PRMs in the poultry industry. To establish an effective vaccination strategy, the acaricidal effects of the combined use of Dg-Ctr1 with chemical acaricides or other vaccine antigens must be examined.
Cancer patients often want to spend their final days at home, and it is essential that general practitioners have knowledge of and technical skills related to cancer medicine and symptom relief. Recent clinical studies have revealed that Wernicke encephalopathy (WE) is quite common in cancer patients. However, there have been no reports to date on WE in cancer patients undergoing home medical care.
From a series of cancer patient undergoing home medical care, we reported a patient with lung cancer who developed WE.
An 84-year-old female with lung cancer undergoing home medical care developed an impaired mental state and an attention deficit. Her symptoms fulfilled the diagnostic criteria for delirium. WE was suspected as the patient's food intake had fallen from normal a month previously to somewhere between 50% or just a few mouthfuls. This diagnosis was supported by abnormal serum thiamine and the disappearance of delirium after thiamine administration.
Significance of the results
When delirium occurs in cancer patients undergoing home treatment, it is necessary to suspect thiamine deficiency as a potential cause, as appropriate diagnosis and treatment can prevent irreversible brain-related sequelae.
To deliver mindfulness-based cognitive therapy (MBCT) efficiently, the present study aimed (1) to identify predictors and moderators of patients who benefit from MBCT for psychological distress and (2) to explore the initial treatment reaction to identify the optimal number of sessions that produce a significant clinical effect.
This is the secondary analysis of a randomized controlled trial of MBCT for breast cancer patients (N = 74). We classified the participants into remitters vs. non-remitters, and responder vs. non-responders, according to the total score of the Hospital Anxiety and Depression Scale at the end of the intervention. We conducted multivariate analyses to explore for predictors of response and remission. We adopted generalized estimating equations to explore the optimal number of sessions.
Sociodemographic and clinical backgrounds did not have significant influence on the treatment outcomes of the MBCT. Better program adherence, which was represented as the participants’ better attendance to the MBCT program, was a significant predictor of both remission and response [odds ratio (OR) = 1.90, 95% confidence interval (CI) 1.25–2.89, p = 0.003, and OR = 1.72, 95% CI 1.12–2.65, p = 0.013, respectively]. It was not until seventh session that the remission rate exceeded 50% and the response rate showed significance.
Significance of results
Sociodemographic and clinical characteristics did not significantly influence the treatment outcomes, while homework minutes and class attendance had significant effects on treatment outcomes. This implies that MBCT is recommended to any cancer patient, if he/she is motivated to the program, regardless of their sociodemographic and clinical characteristics. Patients are encouraged to attend a standard MBCT program (eight sessions) and do the assigned homework as intensely as possible. Further studies with larger sample and objective measurements are desired.
Cognitive dysfunction has a negative effect on cancer treatment; however, in a cancer setting, specific treatments can restore cognitive function. Such conditions are known as reversible dementia, with one of these being vitamin B12 (VB12) deficiency. However, there have been no reports of VB12 deficiency identified by preoperative evaluation in cancer patients.
We studied a patient who was referred to the Department of Psycho-oncology on suspicion of cognitive decline prior to lung cancer surgery. Preoperative evaluation revealed VB12 deficiency.
The patient was an 82-year-old woman diagnosed with lung cancer. She also presented with cognitive decline and, therefore, was referred to the Department of Psycho-oncology for preoperative evaluation. The patient scored 19 points on a Mini-Mental State Examination (MMSE), which is indicative of cognitive decline. As the onset of symptoms occurred several months previously and they were subacute, the possibility of reversible dementia was considered. Extensive examination revealed VB12 deficiency, and VB12 replacement therapy normalized the MMSE score to 25 points before surgery.
Significance of the results
When cognitive decline is observed in cancer patients, it is necessary to actively evaluate the serum levels of some B vitamins, including VB12.
The symptoms of thiamine deficiency vary considerably and asymptomatic cases; i.e., subclinical thiamine deficiency (SCTD), are known to exist. However, there is no information available on the treatment of SCTD.
We report a patient who underwent intravenous thiamine replacement therapy for about a month after being diagnosed with SCTD, but who developed SCTD again about three weeks after finishing the treatment.
The patient was a 64-year-old woman who, after starting treatment for cervical cancer, complained of anxiety and underwent an initial psychiatric examination. The psychiatric diagnosis was an adjustment disorder. Based on the possibility of SCTD complications due to her decreased appetite and weight loss, her serum thiamine concentration was measured and found to be low. Therefore, thiamine was administered intravenously for 29 days. At the end of treatment, thiamine administration was discontinued as there were no apparent neuropsychiatric symptoms or problems with appetite. Twenty-three days later, there were still no problems with appetite or neuropsychiatric symptoms, but a follow-up blood sample revealed that her serum thiamine was again below the normal range.
Significance of results
Currently, there is no information available regarding the diagnosis and treatment of SCTD in cancer patients. In some cases, such as this case, the deficiency recurs without any symptoms indicative of SCTD; therefore, further examination for diagnosis and treatment is necessary.
The Palaeolithic–Neolithic transition in East Asia is characterised by the transformation of mobile hunter-gatherer groups into sedentary communities. The existence of ‘ice-age’ pottery in the Japanese archipelago, however, is inconsistent with claims that directly link climatic warming with sedentism and the development of ceramics. Here, the authors reconsider the chronology and palaeoenvironment of the Maedakochi site in Tokyo. New AMS dating and environmental data suggest that intensified inland fishing in cold environments, immediately prior to the Late Glacial warm period, created conditions conducive to sedentism and the development of subsistence-related pottery.
Global seabird populations are in decline, with nearly half of all seabird species currently in an extinction crisis. Understanding long-term seabird population trends is an essential first step to inform conservation actions. In this study, we assembled historical breeding records of seabirds throughout the Japanese archipelago and quantified the long-term population trends of 10 major breeding seabird species using a hierarchical Bayesian state-space model. The model revealed that six species had increasing or no detectable trends (Short-tailed Albatross Phoebastria albatrus, Leach’s Storm Petrel Oceanodroma leucorhoa, Pelagic Cormorant Phalacrocorax pelagicus, Japanese Cormorant Phalacrocorax capillatus, Spectacled Guillemot Cepphus carbo, and Rhinoceros Auklet Cerorhinca monocerata). However, decreasing trends were found not only in nationally threatened species (Common Murre Uria aalge, and Tufted Puffin Fratercula cirrhata) but also common species that are often described as abundant (Black-tailed Gull Larus crassirostris and Slaty-backed Gull Larus schistisagus). These declining species have declined to 3–35% of baseline levels over the past 30 years. This study provides the first evidence of long-term declines in common and widespread seabirds in Japan.
We estimate the sea-ice extent and basal melt of Antarctic ice shelves at the Last Glacial Maximum (LGM) using a coupled ice-shelf-sea-ice-ocean model. The shape of Antarctic ice shelves, ocean conditions and atmospheric surface conditions at the LGM are different from those in the present day; these are derived from an ice-shelf-ice-sheet model, a sea-ice-ocean model and a climate model for glacial simulations, respectively. The winter sea ice in the LGM is shown to extend up to ∼7° of latitude further equatorward than in the present day. For the LGM summer, the model shows extensive sea-ice cover in the Atlantic sector and little sea ice in the other sectors. These modelled sea-ice features are consistent with those reconstructed from sea-floor sedimentary records. Total basal melt of Antarctic ice shelves in the LGM was ∼2147 Gt a–1, which is much larger than the present-day value. More warm waters originating from Circumpolar Deep Water could be easily transported into ice-shelf cavities during the LGM because the full glacial grounding line extended to shelf break regions and ice shelves overhung continental slopes. This increased transport of warm water masses underneath an ice shelf and into their basal cavities led to the high basal melt of ice shelves in the LGM.
A novel and fundamental method was reported to judge states of lithium ion batteries (LIBs) using the capacitance and the voltage of the cells that were estimated from the real-time currents and voltage characteristics of the cells. We measured the differential capacitance, that is, dQ/dV or delta Q/ delta V that is equal to the currents (I) divided by differential voltages (dV/dt) calculated from the current and the voltage characteristics of the cell during the charging/ discharging, where Q is the charge that flows through the cell, V is the voltage of the cell and t is time. It is thought that the capacitance decrease with the degradation of the cell because the effective area of the electrodes is decreasing due to formation of undesirable compounds. The differential capacitance in some specific voltage range for the LIBs was approximately directly proportional to the state of the degradation of the cell. Therefore, it is concluded that the novel method is very useful to judge the state of the LIBs.
Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult.
Participants and Setting.
Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan.
We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution.
With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study.
Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.
Partial sequences of the DNA polymerase delta (pold) gene from Taenia saginata-like adult worms were sequenced. Phylogenetic analysis revealed that pold gene sequences were clearly divided into two clades, differing from each other in five to seven nucleotides. There is little doubt that T. saginata and Taenia asiatica were once separated into two distinct taxa as has been concluded in previous studies. On the other hand, most of the adult worms, which were identified as T. asiatica using mitochondrial DNA, were homozygous for an allele that originated from the allele of T. saginata via single nucleotide substitution. These results indicate that most of the adult worms, which had been called T. asiatica, are not actually ‘pure T. asiatica’ but instead originated from the hybridization of ‘pure T. saginata’ and ‘pure T. asiatica’.
Shape-controlled CaF2 and sapphire crystals were grown by a micro-pulling-down (μ-PD) method and the crystallinities were investigated. By the μ-PD method with crucibles which have special configurations, circular tube-shaped CaF2 crystal, square tube-shaped CaF2 crystal and square tube-shaped sapphire crystal with high transparency were obtained. The grown crystals indicated a single phase of CaF2 and Al2O3 in the XRD measurements. X-ray rocking curve of square tube-shaped sapphire indicated the crystal has no mosaic structure in the crystal and it has high crystallinity comparable to crystals grown by Cz method.
Although most Kawasaki disease with giant coronary aneurysms is asymptomatic, conventional investigations might not identify previous lesions, or all Kawasaki disease with giant aneurysms at risk of future myocardial lesions. We evaluated the long-term histopathology of the myocardium, especially of intramural small vessels in asymptomatic Kawasaki disease with giant aneurysms.
The initial study comprised 16 consecutive Kawasaki patients – male-to-female ratio was 12:4 – aged from 2 to 12 years, and in the subsequent study, the same patients were aged from 4.9 to 16 years. Endomyocardial biopsies were histopathologically evaluated. Microangiopathies, mitochondrial abnormalities, and loss or disarray of myofibrils were compared by electron microscopy.
The incidence of histopathological abnormalities such as degeneration, hypertrophy, and inflammatory cell infiltration was quite high in the initial study, and inflammatory cell infiltration, interstitial fibrosis, and disarray were very noticeable at follow-up biopsies. The area of fibrous tissue was significantly higher in patients administered with intravenous immunoglobulin at follow-up biopsies. Electron microscopy showed microangiopathies including microthrombi within intramural small vessels in some patients at follow-up biopsies. The sites of the coronary aneurysms did not seem to have an impact on the biopsy findings, suggesting that the underlying pathophysiology is related to the original disease process.
Whether the abnormalities were due to direct myocardial injury, chronic ischaemia, repeated small-vessel thrombosis, or other problems associated only with biopsies, is difficult to determine. However, this subgroup had residual abnormal lesions in the myocardium. Follow-up should be more aggressive in this group of patients to identify myocardial damage that could be asymptomatic.
In ICSI procedures, it is well known that the selection of viable (live) spermatozoa and certain types of immobilization prior to injection is very important for obtaining successful results, but unfortunately there are rare situations when only immotile spermatozoa are available (such as in severe asthenozoospermia or necrozoospermia). In such cases, failure of oocyte activation after ICSI often occurs and may be due to the lack of SOAF (sperm-borne oocyte activating factor) activity. In order to investigate the SOAF activities of dead spermatozoa, mouse and human spermatozoa were immobilized (killed by sonication), maintained in THF medium for varying time intervals (up to 72 h) and then injected into mature unfertilized mouse oocytes. Injected mouse oocytes were examined for their activation, development into blastocysts and Ca2+ responses by imaging and confocal laser scanning microscope. The rates of oocyte activation, blastocyst development and normal patterns of Ca2+ oscillation from the killed-sperm-injected oocytes decreased gradually in accordance with the maintenance interval between sonication and injection. For injection with mouse sonicated spermatozoa, the rate of normal Ca2+ oscillations declined first (after a 3 h maintenance interval) and then blastocyst development was gradually obstructed (after approx. 10 h). The oocyte activation-inducing ability of dead spermatozoa was maintained for a relatively long period, but began to decline after 20 h. The activation rates and Ca2+ response of the oocytes that were injected with human sonicated spermatozoa decreased earlier than those injected with mouse spermatozoa. Although the oocyte activation-inducing ability was maintained for a relatively long time after the death of the spermatozoa, embryo development into blastocysts and the rate of normal Ca2+ oscillations declined after a short maintenance interval between sonication and injection. The Ca2+ response seemed to be the most sensitive indicator for the evaluating the SOAF activity of dead (killed) spermatozoa.
Joining between Nylon-film and Silicone-rubber was successfully developed. Effects of EB-irradiation on joining strength of different polymers without adhesive materials were investigated by using homogeneous EB irradiation. The EB irradiation increased the joining strength of the joining sample between Nylon-film and Silicone-rubber. Excess EB-irradiation more than 0.3 MGy apparently decreased the joining strength. To discuss the influences of electron beam irradiation on the joining strength, ESR signals related to dangling bonds were observed. Since the EB irradiation produced detectable dangling bonds on Nylon-film, using dangling bonds probably joined the different polymers.
We deposited a-SiCN:H films by HWCVD using a gas mixture of hexamethyldisilazane, H2 and N2, and fabricated cast polycrystalline silicon solar cells with the a-SiCN:H passivation and anti-reflection layer. N2 addition led to the reduction of the refractive index of the a-SiCN:H films due to the increase in nitrogen concentration of the films. This improved performance of the antireflection layer. The advantage of adding N2 to the process was demonstrated by the improvement in short circuit current (JSC) and efficiency of cast polycrystalline silicon solar cells. At present, the efficiency of cast polycrystalline silicon solar cell using a-SiCN:H film as a passivation layer reached 14.2%.
The photoluminescence spectra of the rod-shaped pure and Ti-doped MgAl2O4 single crystals, grown by the micro-pulling-down (μ-PD) method, have been systematically investigated under high-intensity pulsed Nd3+: YAG laser excitation in the ultraviolet (UV) region (266 nm). The chemical properties of the grown crystals under reducing argon atmosphere will be reported and the annealing effect under oxidizing atmosphere will be discussed. The room temperature luminescence properties of Ti-doped MgAl2O4 single crystals were performed before and after annealing as a function of the titanium concentration. Three broad bands absorption in the UV/VIS (visible) spectral regions and a broadband visible blue emission were observed from Ti-doped MgAl2O4. An estimation of the decay time value of theses emissions was determined from the time-resolved spectra and the energies of the vibrational modes of the MgAl2O4 crystal are obtained from the infrared spectra.
Binder-free macroscopic single-walled carbon nanotube (SWCNT) solids were prepared by spark plasma sintering (SPS) of purified SWCNTs. The effects of processing temperatures and pressures on the mechanical properties of the SWCNT solids and structural change of SWCNTs in the SWCNT solids were investigated. Transmission electron microscope observation of the SWCNT solids revealed thatthe high-temperature treatment has transformed some part of the SWCNTs into amorphous-like structure and the rest of the SWCNTs remained buried into the above structure. The mechanical properties of the SWCNT solids increased with the increasing processing temperature, probably reflecting the improvement of interfacial strength between SWCNTs and disordered structure of carbon due to the spark plasma generated in the SPS process.