Attitude of young psychiatrists toward coercive measures in psychiatry: a case vignette study in Japan

<p>Abstract</p> <p>Background</p> <p>Every psychiatrist must pay careful attention to avoid violating human rights when initiating coercive treatments such as seclusion and restraint. However, these interventions are indispensable in clinical psychiatry, and they are often used as strategies to treat agitated patients. In this study, we investigated young psychiatrists' attitudes toward psychiatric coercive measures.</p> <p>Methods</p> <p>A total of 183 young psychiatrists participated as subjects in our study. A questionnaire with a case vignette describing a patient with acute psychosis was sent to the study subjects via the Internet or by mail. This questionnaire included scoring the necessity for hospitalization, and the likelihood of prescribing seclusion and/or restraint, on a 9-point Likert scale (with 9 indicating strong agreement).</p> <p>Results</p> <p>There was general agreement among the study subjects that the case should be admitted to a hospital (8.91 ± 0.3) and secluded (8.43 ± 1.0). The estimated length of hospitalization was 13.53 ± 6.4 weeks. Regarding the likelihood of prescribing restraint, results showed great diversity (5.14 ± 2.5 on 9-point scale); psychiatrists working at general hospitals scored significantly higher (6.25 ± 2.5) than those working at university hospitals (5.02 ± 2.3) or psychiatric hospitals (4.15 ± 2.6). A two-group comparison of the length of inpatient care revealed a significant difference between those psychiatrists who scored 1-3 (n = 55, 14.22 ± 7.4 wks) and those who scored 7-9 (n = 62, 12.22 ± 4.0) regarding the need to use restraint.</p> <p>Conclusion</p> <p>Our results may reflect the current dilemma in Japanese psychiatry wherein psychiatrists must initiate coercive measures to shorten hospitalization stays. This study prompted its subject psychiatrists to consider coercive psychiatric treatments.</p

Surrounding Gastric Mucosa Findings Facilitate Diagnosis of Gastric Neoplasm as Gastric Adenoma or Early Gastric Cancer

Background and Aim. It is difficult to master the skill of discriminating gastric adenoma from early gastric cancer by conventional endoscopy or magnifying endoscopy combined with narrow-band imaging, because the colors and morphologies of these neoplasms are occasionally similar. We focused on the surrounding gastric mucosa findings in order to determine how to discriminate between early gastric cancer and gastric adenoma by analyzing the characteristics of the gastric background mucosa. Methods. We retrospectively examined 146 patients who underwent endoscopic submucosal dissection for gastric neoplasm between October 2009 and January 2015. The boundary of atrophic gastritis was classified endoscopically according to the Kimura-Takemoto classification system. Of 146 lesions, 63 early gastric cancers and 21 gastric adenomas were ultimately evaluated and assessed. Results. Almost all gastric adenomas were accompanied by open-type gastritis, whereas 47 and 16 early gastric cancers were accompanied by open-type and closed-type gastritis, respectively (p = 0.037). Conclusions. The evaluation of the boundary of atrophic gastritis associated with gastric neoplasms appears to be useful for discrimination between early gastric cancer and gastric adenoma. When gastric neoplasm is present in the context of surrounding localized gastric atrophy, gastric cancer is probable but not certain

Two cases of cavitary lung cancer with concomitant chronic infectious disease

The existence of a lung cavity on chest radiographs suggests the presence of lung disease, including benign or malignant disease. Lung cancer, tuberculosis, and fungal infection are all known for developing lung cavity. In addition, there are some characteristic findings in the differential diagnosis of cavitary disease, although these cavitary diseases often coexist. Here, we report two cases that presented cavitary lung cancer with concomitant chronic infectious disease. One patient showed pulmonary aspergillosis and lung adenocarcinoma, the other patient showed Mycobacterium avium complex lung disease and lung adenocarcinoma. These chronic infectious diseases develop slowly, and clinicians often follow up over several months. To reduce the delay in diagnosis of malignancy, clinicians should aggressively collect the specimens from cavitary lesions and make a correct diagnosis when encountering lung cavity in diagnostic clinical imaging. Keywords: Lung cavity, Lung cancer, Aspergillus, Nontuberculous mycobacteri

Introduction of chemically labile substructures into Arabidopsis lignin through the use of LigD, the C-dehydrogenase from Sphingobium sp. strain SYK-6

Bacteria-derived enzymes that can modify specific lignin substructures are potential targets to engineer plants for better biomass processability. The Gram-negative bacterium Sphingobium sp. SYK-6 possesses a C-dehydrogenase (LigD) enzyme that has been shown to oxidize the -hydroxy functionalities in -O-4-linked dimers into -keto analogues that are more chemically labile. Here, we show that recombinant LigD can oxidize an even wider range of -O-4-linked dimers and oligomers, including the genuine dilignols, guaiacylglycerol--coniferyl alcohol ether and syringylglycerol--sinapyl alcohol ether. We explored the possibility of using LigD for biosynthetically engineering lignin by expressing the codon-optimized ligD gene in Arabidopsis thaliana. The ligD cDNA, with or without a signal peptide for apoplast targeting, has been successfully expressed, and LigD activity could be detected in the extracts of the transgenic plants. UPLC-MS/MS-based metabolite profiling indicated that levels of oxidized guaiacyl (G) -O-4-coupled dilignols and analogues were significantly elevated in the LigD transgenic plants regardless of the signal peptide attachment to LigD. In parallel, 2D NMR analysis revealed a 2.1-to 2.8-fold increased level of G-type -keto--O-4 linkages in cellulolytic enzyme lignins isolated from the stem cell walls of the LigD transgenic plants, indicating that the transformation was capable of altering lignin structure in the desired manner