A Scale of Parental Anxiety about Pediatric Emergency Medical Care Services of Japan: Development, Reliability, Validity, Generalizability and Usefulness

Aim: The purpose of this study was to develop a scale, “parental anxiety about pediatric emergency medical care services” (PAPEMCS), and to evaluate its psychometric properties. Methods: Participants were 14,510 parents with children 6 years old or younger in Kagawa Prefecture. Using each half of the participants, exploratory factor analysis was performed to generate items and factors for the PAPEMCS, and confirmatory factor analysis (CFA) was used to establish the construct validity. The generalizability of the PAPEMCS was evaluated by congruence tests and multigroup CFA. The usefulness of the PAPEMCS was established by the relationship between the PAPEMCS and non-urgent usage of pediatric emergency medical care services (PEMCS). Results: The PAPEMCS compromised 4 factors: “anxiety about quality of PEMCS”, “anxiety about PEMCS system”, “anxiety about public support”, and “anxiety about private support”. All reliability estimates (polychoric ordinal alpha coefficients, item-rest correlations), the item discrimination, 5 fit indices for CFA, the convergent validity (indicator reliabilities, composite reliabilities, average variance extracteds), and the discriminant validity fulfilled the acceptability thresholds. All generalizability estimates fulfilled the predetermined levels of acceptability (Tucker’s congruence coefficients, congruence tests, strict factorial invariance). The usefulness of the PAPEMCS was established by the higher scores of the PAPEMCS being related to non-urgent usage of PEMCS. Conclusions: The PAPEMCS demonstrated satisfactory reliability, validity, generalizability and usefulness. The PAPEMCS is useful to quantify the contents and extent of parental anxiety about PEMCS, and to clarify the mechanisms of non-urgent PEMCS usage.

Human hepatic sinusoidal endothelial cells can be distinguished by expression of phenotypic markers related to their specialised functions in vivo

The hepatic sinusoids are lined by a unique population of hepatic sinusoidal endothelial cells (HSEC), which is one of the first hepatic cell populations to come into contact with blood components. However, HSEC are not simply barrier cells that restrict the access of blood- borne compounds to the parenchyma. They are func- tionally specialised endothelial cells that have complex roles, including not only receptor-mediated clearance of endotoxin, bacteria and other compounds, but also the regulation of inflammation, leukocyte recruitment and host immune responses to pathogens. Thus understand- ing the differentiation and function of HSEC is critical for the elucidation of liver biology and pathophysiology. This article reviews methods for isolating and studying human hepatic endothelial cell populations using in vitro models. We also discuss the expression and functions of phe- notypic markers, such as the presence of fenestrations and expression of VAP-1, Stabilin-1, L-SIGN, which can be used to identify sinusoidal endothelium and to permit discrimination from vascular and lymphatic endothelial cells.

Perspectives on the role of Pannexin 1 in neural precursor cell biology

We recently reported that targeted deletion of Pannexin 1 in neural precursor cells of the ventricular zone impairs the maintenance of these cells in healthy and stroke-injured brain. Here we frame this exciting new finding in the context of our previous studies on Pannexin 1 in neural precursors as well as the close rela- tionship between Pannexin 1 and purinergic receptors established by other groups. Moreover, we identify important gaps in our understanding of Pannexin 1 in neural precursor cell biology in terms of the under- lying molecular mechanisms and functional/behavioural outcomes.

Health-related quality of life, anxiety, depression and impulsivity in patients with advanced gastroenteropancreatic neuroendocrine tumours

AIM To compare health-related quality of life(HRQoL),anxiety, depression, and impulsivity scores in patients with and without carcinoid syndrome(CS), and correlated them with serum 5-hydroxyindoleacetic acid(5-HIAA) levels.METHODS Patients with advanced gastroenteropancreatic neuroendocrine tumours(GEPNET), with and without CS completed HRQoL QLQ-C30 and QLQ-GI.NET21, Hospital Anxiety and Depression Scale(HADS) and Barratt Impulsivity Scale(BIS) questionnaires. Twosample Wilcoxon test was applied to assess differences in serum 5-HIAA levels, two-sample Mann-Whitney U test for HRQoL and BIS, and proportion test for HADS, between those with and without CS.RESULTS Fifty patients were included; 25 each with and without CS. Median 5-HIAA in patients with and without CS was 367 nmol/L and 86 nmol/L, respectively(P = 0.003). Scores related to endocrine symptoms were significantly higher amongst patients with CS(P = 0.04) and scores for disease-related worries approached significance in the group without CS, but no other statistically-significant differences were reported between patients with and without CS in responses on QLQ-C30 or QLQ-GI.NET21. Fifteen patients(26%) scored ≥ 8/21 on anxiety scale, and 6(12%) scored ≥ 8/21 on depression scale. There was no difference in median 5-HIAA between those scoring < or ≥ 8/21 on anxiety scale(P = 0.53). There were no statistically significant differences between groups in first or second-order factors(BIS) or total sum(P = 0.23).CONCLUSION Excepting endocrine symptoms, there were no significant differences in HRQoL, anxiety, depression or impulsivity between patients with advanced GEPNET, with or without CS. Over one quarter of patients had high anxiety scores, unrelated to peripheral serotonin metabolism.

Determining the mechanism behind yoga’s effects on preventing the symptoms of Alzheimer’s disease

Background on the relationship between meditation/yoga practice and its effect on Alzheimer's disease (AD): Dementia refers to a variety of conditions that affect the normal function of the brain, leading to symptoms like memory loss, issues with problem solving, difficulty in processing thoughts and disordered language (McKhann et al., 2011).

Evaluation of Effective Dose Using the k-Factor of Optimal Scan Range for CT Examination

The American College of Radiology opened the computed tomography (CT) dose index registry (DIR) for general participation by all facilities in 2011. For each CT examination, data on volume CT dose index (CTDIvol), dose-length product (DLP), and, for body examinations, size-specific dose estimate (SSDE) were collected. However, effective dose is not estimated in DIR. The primary objective of this study was to estimate k-factor profile in detail at various scan positions with modified the ImPACT CT patient dosimetry. A tool that easily estimates the k-factor of suitable scan areas is essential for practical dose estimation in the DIR. We evaluated k-factor (effective dose/ DLP) profiles between a medical international radiation dose-five (MIRD-5) phantom positions using aImPACT software. As a result of this study, practicality of the k-factor profile method in clinical use was clarified. We speculate that a flexible k-factor improves the appropriateness of the E in hospital settings.

Current perspectives on the antidepressant-like effects of guanosine

Purines have a recognized importance as intercellular mes- sengers. These molecules play an important role in the de- velopment and maintenance of the central nervous system （CNS）, as well as in its response to pathological conditions. Both adenine and guanine-based purines can be released from astrocytes, where they play a relevant role as extracel- lular signaling molecules. Particularly, the nucleoside gua- nosine has been proposed as an extracellular molecule that regulates the response of CNS to damage. Following injury, this nucleoside attains high concentrations in the extracel- lular space, where it activates multiple signaling pathways.

Management of synchronous lateral pelvic nodal metastasis in rectal cancer in the era of neoadjuvant chemoradiation: A systemic review

BACKGROUND Lateral pelvic lymph node(LLN)metastasis(LLNM)occur in up to 28%of patients with low rectal tumours.While prophylactic lateral pelvic lymph node dissection(LLND)has been abandoned by most western institutions in the era of neoadjuvant chemoradiation therapy(CRT),the role of selective LLND in patients with enlarged LLN on pre-CRT imaging remains unclear.Some studies have shown improved survival and recurrence outcomes when LLNs show"response"to CRT.However,no management algorithm exists to differentiate treatment for"responders"vs"non-responders".AIM To determine if selective LLND in patients with enlarged LLNs results in improved survival and recurrence outcomes.METHODS A systemic search of Pub Med and Embase databases for studies reporting on patients with synchronous radiologically suspicious LLNM(s-LLNM)in rectal cancer receiving preoperative-CRT was performed.RESULTS Fifteen retrospective,single-centre studies were included.793 patients with sLLNM were evaluated:456 underwent TME while 337 underwent TME with7,LLND post-CRT.In the TME group,local recurrence(LR)rates range from 12.5%to 36%.Five-year disease free survival(DFS)was 42%to 75%.In the TME with LLND group,LR rates were 0%to 6%.Five years DFS was 41.2%to 100%.Radiological response was seen in 58%.Pathologically positive LLN was found in up to 94%of non-responders vs 0%to 20%in responders.Young age,low tumour location and radiological non-response were associated with final positive LLNM and lowered DFS.CONCLUSION LLND is associated with local control in patients with s-LLNM.It can be performed in radiological non-responders given a large majority represent true LLNM.Its role in radiological responders should be considered in selected high risk patients.

Pre-Enrichment of Estuarine and Fresh Water Environmental Samples with Sodium Chloride Yields in Better Recovery of <i>Vibrio parahaemolyticus</i>

Vibrio parahaemolyticus organisms cause acute gastroenteritis in humans. These bacteria are natural inhabitants of both marine and estuarine ecosystems. In the present study, we investigated the effectiveness of a non-selective enrichment of sediment samples with sodium chloride prior to selective enrichment with alkaline peptone water for a better recovery of V. parahaemolyticus. Sediment samples were collected with or without 1% NaCl from the river Buriganga, located besides Dhaka city and about 400 km away from the Bay of Bengal, and from the estuary of the river Karnaphuli which flows into the Bay of Bengal. Very small number of V. parahaemolyticus (<30 MPN/g) were detected in the sediments of both river and estuary, where NaCl was not added. On the other hand, the number of V. parahaemolyticus increased to more than 40 times (1500 MPN/g) in the river and 32 times (960 MPN/g) in the estuary where NaCl were added. River sediment sample contained the serotype O9:K41 of V. parahaemolyticus and the estuarine sample contained O3:K41 and O3:KUT Our results suggest that a pre-enrichment of environmental samples with 1% NaCl helps V. parahaemolyticus to survive for at least 7 days until they are enriched with alkaline peptone water, for better recovery.

Approaches to Improving Nursing Handoffs in Surgical Wards

Objective: To propose approaches to improve nursing handoffs for surgical patients, including standardization. Background: Handoffs, or the transfer of accountability and patient information, can generate potential risks for patient safety. Standardization has been proposed to help improve handoffs. Methods: After observing 333 nursing handoffs in the surgical wards of our institution, we conducted a thematic content analysis, comparing and contrasting the observations. Results: Handoff processes, including the use of support tools, varied among the observations. Common themes in the handoff content suggested possibilities of standardization. About half of the 51 interruptions occurring during the observed handoffs were by healthcare professionals. Conclusions: Standardization to improve handoffs should address both the content and the process. Interruptions were common and should be avoided whenever possible. Future studies should also consider the use of mobile applications to support handoffs and clinical documentation.

Predicting and Suppressing Oversensing of a Pacemaker in Plain X-Ray Photography

We conducted experiments of oversensing generation of pacemaker (PM) and X-irradiation direction dependency of PM, and examined the oversensing suppression method, using 8 different types of PMs. It was found out from this experiment that oversensing would occur when some conditions (X-irradiation direction, X-irradiation intensity) are met. Oversensing occurred with the most low irradiation conditions (kV × mA) when PM was irradiated at 90° (vertically to C-MOS;Complementary Metal Oxide Semiconductor). The acuter the angle of irradiation is (α > 90° < α), the higher the irradiation conditions (kV × mA) at which oversensing start to occur. In plain X-ray photography, oversensing was confirmed under the irradiation conditions of (cervical spine, thoracic spine, lateral thoracic spine, rib, shoulder joint, collarbone, humerus, and chest).Once the irradiation angle and irradiation conditions (kV × mA) are available, oversensing is predictable to some extent. Our findings will help to predict oversensing generation of plain X-ray photography and suppress oversensing. Oversensing can be suppressed in most of the radiography by lowering tube current to 100 mA, but a 1.0 mm High-Density Tungsten Sheet must be put on PM in high tube voltage radiography.

Inhibition of the Oversensing of Cardiac Pacemakers in Chest CT

Objectives: The purpose of this study is to identify how to manage oversensing of pacemakers in chest CT. Methods: Four different models of pacemakers were examined to select the pacemaker generating oversensing. To the pacemaker with oversensing, intermittent switching X-ray was exposed using ECG-gated CT helical scan system at prospective CTA mode. IVY Model was used to synchronize the ECG. Only during in the alert period that is non-refractory and sensing is available, intermittent switching X-ray (300 msec/sec) was exposed in chest CT. For comparison, the same intermittent switching X-ray (300 msec/sec) was exposed in the refractory period when sensing was not available. Results: Oversensing was detected only in one of the four pacemakers tested. In this pacemaker, oversensing was generated by exposure of the intermittent switching X-ray in the alert (non-refractory) period, but oversensing was not observed in the refractory period. Conclusion: A pacemaker has alert and refractory periods. Oversensing of a pacemaker was found to be inhibited by selective ECG-synchronized exposure in the refractory period. Since all pacemakers have the refractory period, the results of this study can be widely applied to the patients with pacemakers in chest CT, and their chest CT can be operated safely.

A Neuronal Activity-Boosting Microglial Function in Post-Anesthetic Emergence:How Microglial-Neuronal Crosstalk May Alter States of Consciousness

Glial cells have often been referred to as the support cells of the brain.While they do have numerous supportive functions,there is emerging research showing they play an active role in shaping the brain and behaviour.Studying the cellular and molecular crosstalk between brain cell types is immensely valuable as this research topic continues to demonstrate that many brain functions are a result of a system of cells working together,rather than any cell type independently.

Fat cell-secreted adiponectin mediates physical exercise-induced hippocampal neurogenesis: an alternative anti-depressive treatment?

Psychological depression is drawing accumulating attention nowadays, due to the skyrocketing incidence worldwide and the enormous burdens it incurs. Physical exercise has been long recog- nized for its therapeutic effects on depressive disorders, although knowledge of the underlying mechanisms remains limited. Suppressed hippocampal neurogenesis in adult brains has been regarded, at least partly, contributive to depression, whereas physical exercise that restores neuro- genesis accordingly exerts the anti-depressive action. Several recent publications have suggested the potential role of adiponectin, a protein hormone secreted by peripheral mature adipocytes, in mediating physical exercise-triggered enhancement of hippocampal neurogenesis and alleviation of depression. Here, we briefly review these novel findings and discuss the possibility of counter- acting depression by modulating adiponectin signaling in the hippocampus with interventions including physical exercise and administration of pharmacological agents.

Male-mediated developmental toxicity

Male-mediated developmental toxicity has been of concern for many years. The public became aware of male-mediated developmental toxicity in the early 1990s when it was reported that men working at Sellafield might be causing leukemia in their children. Human and animal studies have contributed to our current understanding of male-mediated effects. Animal studies in the 1980s and 1990s suggested that genetic damage after radiation and chemical exposure might be transmitted to offspring. With the increasing understanding that there is histone retention and modification, protamine incorporation into the chromatin and DNA methylation in mature sperm and that spermatozoal RNA transcripts can play important roles in the epigenetic state of sperm, heritable studies began to be viewed differently. Recent reports using molecular approaches have demonstrated that DNA damage can be transmitted to babies from smoking fathers, and expanded simple tandem repeats minisatellite mutations were found in the germline of fathers who were exposed to radiation from the Chernobyl nuclear power plant disaster. In epidemiological studies, it is possible to clarify whether damage is transmitted to the sons after exposure of the fathers. Paternally transmitted damage to the offspring is now recognized as a complex issue with genetic as well as epigenetic components.

^(68)Gallium-labelled PSMA-PET/CT as a diagnostic and clinical decision-making tool in Asian prostate cancer patients following prostatectomy

Objective: Prostate cancers(PCa) in Asian individuals are molecularly distinct from those found in their Caucasian counterparts.There is no risk stratification tool for Asian men with rapid biochemical recurrence(BCR) following radical prostatectomy(Rad P). This study aims to assess the detection rate of ^(68)Ga-prostate-specific membrane antigen-positron emission tomography/computed tomography(PSMA-PET/CT) for diagnosis of clinical recurrence and as a treatment decision making tool in Asian patients with BCR post-Rad P.Methods: ^(68)Ga PSMA-PET and CT body with/without bone scan [conventional workup(CWU)] were performed in 55 Asian patients with BCR within 36 months post-Rad P. Two blinded reviewers assessed the images. Detection rates of ^(68)Ga PSMAPET/CT were evaluated, and impact on management was reviewed by comparison with CWU.Results: Median time to BCR post-Rad P was 8.1 months. Detection rate for ^(68)Ga PSMA-PET/CT was 80%(44/55). A positive scan was significantly associated with increasing prostate-specific antigen(PSA) level [odds ratio(OR) = 1.13(95% CI 1.05–1.30), P =0.017], but not with higher Gleason grade or shorter PSA doubling time. Compared to CWU, ^(68)Ga PSMA-PET/CT detected an additional 106 lesions in 33/44 patients with a positive scan, resulting in a change in management in 25/44(56.8%) patients: 10 to hormonal therapy(HT) and whole pelvis radiotherapy(RT) in addition to bed RT, and 15 to palliative HT alone.Conclusions: In the present report, we demonstrated the diagnostic and treatment decision utility of ^(68)Ga PSMA-PET/CT in Asian men with rapid BCR. Detection of small volume nodal and systemic recurrences at low PSA levels(< 1.0 ng/mL) highlights the role of the tool in assigning patients to treatment intensification with HT-RT or palliative HT in polymetastatic disease.

Changes in oral trace gas concentrations following orthognathic surgery and intermaxillary fixation: a case study using selected ion flow tube mass spectrometry

Orthognathic surgery is frequently accompanied by intermaxillary fixation. Intermaxillary fixation impedes the maintenance of effective oral hygiene and prolonged fixation can result in periodontal disease. A potential shorter term effect is the generation of oral malodour. It is unclear, however, as to how the production of malodorous compounds in the oral cavity is altered post-surgery. Oral air concentration of sulphur containing compounds, short chain organic acids, ammonia, isoprene and acetone were measured using selected ion flow tube-mass spectrometry in a patient who had undergone orthognathic surgery with subsequent intermaxillary fixation. Total sulphide levels rose approximately 5-fold during fixation with metal ties, with smaller increases recorded for the other compounds measured with the exception of isoprene which remained close to baseline levels. Organic acid levels declined markedly once elastic ties had replaced metal ties, with a lesser reduction being observed in sulphide levels, with both declining further after the commencement of a chlorhexidinecontaining mouthwash. These data suggest that bacterial generation of a variety of malodorous compounds increases markedly following intermaxillary fixation. This single case also suggests that the use of elastic ties and effective oral hygiene techniques, including the use of chlorhexidine mouthwash, may help ameliorate such post-surgical effects.

Barrett's metaplasia:clinical implications

The incidence of Barretts metaplasia (BM) as well as Barrett' s adenocarcinoma (BA) has been increasing in western populations. The prognosis of BA is worse because individuals present at a late stage. Attempts have been made to intervene at early stage using surveillance programmes, although proof of efficacy of endoscopic surveillance is lacking, particularly outside the specialist centres. The management of BM needs to be evidencebased as there is a lack clarity about how best to treat this condition. The role of proton pump inhibitors and antireflux surgery to control reflux symptoms is justified.Whether adequate control of gastroesophageal reflux early in the disease alters the natural history of Barrett' s change once it has developed and or prevents it in patients with gastroesophageal reflux disease but with no Barrett' s change remains unanswered. There is much to be learned about BM. Thus there is great need for carefully designed large randomised controlled trials to address these issues in order to determine how best to manage patients with BM.

Engineering personalized neural tissue using functionalized transcription factors

Diseases and disorders of the central nervous system often require significant interventions to restore lost function due to their com- plexity. Examples of such disorders include Parkinson＇s disease, Alzheimer＇s disease, multiple sclerosis, traumatic brain injury, and spinal cord in）ury. These diseases and disorders result trom healthy cells being destroyed, which in turn causes dysfunction in the cen- tral nervous system, The death of these cells can trigger a cascade of events that affect the rest of the body, causing symptoms that become progressively worse over time. Developing strategies for repairing the damage to the central nervous system remains chal- lenging, in part due to its inability to regenerate.