[Current situation of available back-up beds for terminal home care patients].

The Palliative Care Unit at Heiwa Hospital has 16 beds, and offers inpatient support in general wards, as well as back-up beds in emergencies in collaboration with local home care support clinics. For two years from January 2012 to December 2013, there were 1,213 cases where patients were seen for initial outpatient visits at the Department of Palliative Care. At the time of the initial visit, visiting medical care had been introduced for 25% of the cases.

Acetic acid can catalyze succinimide formation from aspartic acid residues by a concerted bond reorganization mechanism: a computational study.

Succinimide formation from aspartic acid (Asp) residues is a concern in the formulation of protein drugs. Based on density functional theory calculations using Ace-Asp-Nme (Ace = acetyl, Nme = NHMe) as a model compound, we propose the possibility that acetic acid (AA), which is often used in protein drug formulation for mildly acidic buffer solutions, catalyzes the succinimide formation from Asp residues by acting as a proton-transfer mediator. The proposed mechanism comprises two steps: cyclization (intramolecular addition) to form a gem-diol tetrahedral intermediate and dehydration of the intermediate.

Differential impact of fosaprepitant on infusion site adverse events between cisplatin- and anthracycline-based chemotherapy regimens.

Background: Fosaprepitant may be associated with infusion site adverse events (AEs), and these adverse events possibly vary according to chemotherapy regimen.

Patients And Methods: 267 oncology patients who were administered anthracycline- or cisplatin-based regimens were retrospectively studied. Multivariate logistic regression was performed in stratified analyses to evaluate potential regimen-specific effects of fosaprepitant.

A predictive rule for mortality of inpatients with Staphylococcus aureus bacteraemia: A classification and regression tree analysis.

Objective: To create a predictive rule to identify risk factors for mortality among patients with Staphylococcus aureus bacteraemia (SAB).

Design, Setting And Patients: This was a retrospective cohort study of all adult patients with SAB at a large community hospital in Tokyo, Japan, from April 1, 2004 to March 31, 2011. Baseline data and clinically relevant factors were collected from electronic charts.

Lower urinary tract function in dementia with Lewy bodies (DLB).

Objectives: Dementia with Lewy bodies (DLB) is the second most common degenerative cause of dementia, whereas lower urinary tract (LUT) function in DLB patients has not been fully delineated. We investigated LUT function in DLB by clinical-urodynamic observations.

Methods: We examined 32 patients with DLB (23 men, 9 women; aged 59-86 [mean, 75.

Pathology of embolic debris in carotid artery stenting.

Background: The relationship between magnetic resonance (MR) plaque imaging and the pathology of distal embolic debris is unknown. We aimed to evaluate the relationship between the pathology of embolic debris in the embolic filter during carotid artery stenting (CAS), MR plaque imaging, and new ischemic lesions on diffusion-weighted imaging (DWI).

Method: We prospectively reviewed the 36 patients who underwent CAS using a filter-type embolic protection device.

Risk factors for mortality in patients with non-traumatic pontine hemorrhage.

Objectives: For patients with non-traumatic pontine hemorrhage (PH) who will survive, determining prognosis is vital for appropriate therapeutic planning in the acute stage. This study aimed to determine reliable prognostic factors of mortality in patients with PH.

Materials And Methods: The cases of a total of 118 consecutive PH patients were reviewed.

Predicting the structures of complexes between phosphoinositide 3-kinase (PI3K) and romidepsin-related compounds for the drug design of PI3K/histone deacetylase dual inhibitors using computational docking and the ligand-based drug design approach.

Predictions of the three-dimensional (3D) structures of the complexes between phosphoinositide 3-kinase (PI3K) and two inhibitors were conducted using computational docking and the ligand-based drug design approach. The obtained structures were refined by structural optimizations and molecular dynamics (MD) simulations. The ligands were located deep inside the ligand binding pocket of the p110α subunit of PI3K, and the hydrogen bond formations and hydrophobic effects of the surrounding amino acids were predicted.

Comparison of cardiovascular disease risk associated with 3 lipid measures in Japanese adults.

Background: To assess dyslipidemia, measurement of low-density lipoprotein cholesterol via either Friedewald equation (LDL-F) or direct assay (LDL-D), and non-high-density lipoprotein cholesterol (non-HDL-C) are recommended with some guidelines showing preference to direct over calculated measurements. However, direct comparisons of their respective associations with cardiovascular disease (CVD) risk are currently unavailable.

Objective: In this study, we evaluated the clinical effectiveness of LDL-F and non-HDL-C vs LDL-D and their associations with CVD.

Arterial stiffness as a risk factor for cerebral aneurysm.

Objectives: A low ankle-brachial index (ABI) is associated with increased mortality and risk of myocardial infarction and stroke in the general population. Arterial stiffness can be assessed non-invasively by the measurement of brachial-ankle pulse wave velocity (PWV), a simple and reproducible method. Because the importance of ABI and baPWV in the pathogenesis of cerebral aneurysms remains uncertain, we aimed to measure ABI and baPWV in patients with intracranial saccular and dissecting aneurysms to clarify whether these aneurysms are associated with arterial stiffness and atherosclerosis.

Kinetics and dynamics on the formation of S2(X3Σg–,a1Δg) in the S(1D) + OCS reaction.

The reaction of electronically excited sulfur S((1)D) with OCS has exothermic channels generating S(2) in two electronic states X(3)Σ(g)– and a(1)Δ(g). The a(1)Δ(g) state is correlated directly to the reactants via the spin-allowed singlet surface; the X(3)Σ(g)– state, on the other hand, is a product of the spin-forbidden channel. There has been no report on kinetic evidence for the simultaneous generation of the two electronic states, although the two electronic states have been detected so far.

Validity of direct ophthalmoscopy skill evaluation with ocular fundus examination simulators.

Objective: We examined how direct ophthalmoscopy (DO) skills can be evaluated in a clinical setting using a simulator, and determined the appropriate assessment criteria for the DO skills in practical tests such as the Objective Structured Clinical Examination (OSCE).

Design: Cross-sectional study.

Participants: Medical students, residents, and attending physicians (73 total participants).

Roles of intramolecular and intermolecular hydrogen bonding in a three-water-assisted mechanism of succinimide formation from aspartic acid residues.

Aspartic acid (Asp) residues in peptides and proteins are prone to isomerization to the β-form and racemization via a five-membered succinimide intermediate. These nonenzymatic reactions have relevance to aging and age-related diseases. In this paper, we report a three water molecule-assisted, six-step mechanism for the formation of succinimide from Asp residues found by density functional theory calculations.

Differences in residents' self-reported confidence and case experience between two post-graduate rotation curricula: results of a nationwide survey in Japan.

Background: In Japan, all trainee physicians must begin clinical practice in a standardized, mandatory junior residency program, which encompasses the first two years of post-graduate medical training (PGY1 - PGY2). Implemented in 2004 to foster primary care skills, the comprehensive rotation program (CRP) requires junior residents to spend 14 months rotating through a comprehensive array of clinical departments including internal medicine, surgery, anesthesiology, obstetrics-gynecology (OBGYN), pediatrics, psychiatry, and rural medicine. In 2010, Japan's health ministry relaxed this curricular requirement, allowing training programs to offer a limited rotation program (LRP), in which core departments constitute 10 months of training, with electives geared towards residents' choice of career specialty comprising the remaining 14 months.

Effects of geometrical uncertainties on whole breast radiotherapy: a comparison of four different techniques.

Purpose: The purpose of this study was to quantify the target coverage, homogeneity, and robustness of the dose distributions against geometrical uncertainties associated with four whole breast radiotherapy techniques.

Methods: The study was based on the planning-computed tomography-datasets of 20 patients who underwent whole breast radiotherapy. A total of four treatment plans (wedge, field-in-field [FIF], hybrid intensity-modulated radiotherapy [IMRT], and full IMRT) were created for each patient.

Association between helicopter with physician versus ground emergency medical services and survival of adults with major trauma in Japan.

Introduction: Helicopter emergency medical services with a physician (HEMS) has been provided in Japan since 2001. However, HEMS and its possible effect on outcomes for severe trauma patients have still been debated as helicopter services require expensive and limited resources. Our aim was to analyze the association between the use of helicopters with a physician versus ground services and survival among adults with serious traumatic injuries.

Long-term, low-dose erythromycin monotherapy for Mycobacterium avium complex lung disease: a propensity score analysis.

Multidrug regimens are initially withheld in mild cases of pulmonary Mycobacterium avium complex (MAC) disease. Based on the anti-inflammatory effects of macrolides, some patients are treated with erythromycin, which does not appear to exhibit cross-resistance with clarithromycin in MAC. The aim of this study was to evaluate the effects and adverse events of erythromycin monotherapy in patients with pulmonary MAC disease.

Dynamics of oxygen Rydberg atom generation following O 1s inner-shell excitation of H₂O.

The emission of low-energy electrons from H2O has been investigated at photon excitation energies in the vicinity of the O 1s ionization threshold. Neutral oxygen Rydberg atoms (O*) were found to form, and the correlation between the initial inner-shell excited state of H2O and the Rydberg state of O* was determined. The initially excited electron in a Rydberg orbital is shown to remain associated with O* even after the cleavage of two O-H bonds.

A new method for differentiating benign and malignant pleomorphic clustered calcifications in mammography.

Objective: Retrospective study to determine whether new mammography imaging characteristics can improve identification of an isolated cluster of coarse heterogeneous and fine pleomorphic calcifications as benign or malignant.

Materials And Methods: Institutional review board approval and informed consent were obtained. The study included 123 women (mean age, 50 years: age range, 34-79 years), in whom mammograms had found pleomorphic clustered calcifications, but without abnormal ultrasound findings and who underwent stereotactically-guided vaccum-assisted breast biopsy.

Evaluation of influence of single nucleotide polymorphisms in cytochrome P450 2B6 on substrate recognition using computational docking and molecular dynamics simulation.

In this study, we investigated the influence of single nucleotide polymorphisms on the conformation of mutated cytochrome P450 (CYP) 2B6 proteins using molecular dynamics (MD) simulation. Some of these mutations influence drug metabolism activities, leading to individual variations in drug efficacy and pharmacokinetics. Using computational docking, we predicted the structure of the complex between the antimalarial agent artemether and CYP2B6 whose conformations were obtained by MD simulation.

Solvation dependence of valence electronic states of water diluted in organic solvents probed by soft X-ray spectroscopy.

Knowledge of hydrogen bonds is important in a wide range of scientific fields. However, information on the electronic state of hydrogen bonded molecules in liquids and solutions is still limited. We applied X-ray emission and absorption spectroscopy to observe the electronic state around oxygen of water and investigate the solvent dependence of occupied and unoccupied valence electronic states of water in acetonitrile, 3-methylpyridine, and ethylenediamine at room temperature under atmospheric pressure.

Osteopenia and osteoporosis among 16-65 year old women attending outpatient clinics.

Women living in developing countries are more prone to osteoporotic fractures than women in developed countries. The objectives of this study were to estimate the burden of osteopenia and osteoporosis and examine their correlates among Bangladeshi women. This cross-sectional study consisted of 500 women aged 16-65 years attending gynecology and family planning clinics of a tertiary hospital which cares urban/suburban low income population in Dhaka, Bangladesh.