Daijokito Administration in Critically III Patients Increasing the Stool Volume: A Retrospective Observational Study

Introduction:Daijokito, a traditional Japanese herbal medicine (Kampo), has been used to treat abdominal distention of the middle yang stage pattern. The use of Daijokito has not been thoroughly investigated in critical care. To investigate a new Kampo approach to defecation control in critically ill patients, our study aimed to assess the effects of Daijokito on fecal management.Methods: We analyzed 30 consecutive patients treated with Daijokito in the intensive care unit (ICU) between March 2017 and February 2021. The eligibility criteria were patients who were newly prescribed Daijokito in the ICU during the study period. Exclusion criteria were patients who were started on other laxatives within one day of beginning Daijokito. The study's primary outcome was defecation volume three days before and three days after starting Daijokito. We recorded the most dominant stool quality within three days after the start of Daijokito.Results: Twenty-one patients were included in the analysis. The median age was 69.0 years, and the median sequential organ failure assessment score on admission to the ICU was 6.0. Major diseases included trauma, pancreatitis, and burns. Administration of Daijokito resulted in defecation in 17 of twenty-one patients (81.0%). Comparison of defecation volume between 3 days before Daijokito administration and three days, including the day of Daijokito administration, showed that defecation volume increased significantly after Daijokito administration, with a median of 0 to 360 g (p < 0.001). At the three-day follow-up, six of 17 (35.3%) patients defecated on the day of Daijokito administration, and nine (52.9%) defecated on the day after administration. One patient was judged to have excessive defecation, and Daijokito administration was discontinued. Stool quality was normal in one (5.9%) of the 17 patients, soft-formed in two (11.8%), loose-unformed in 11 (64.7%), and liquid in three (17.6%).Discussion:Daijokito administration in critically ill patients caused defecation in 81% of the patients and significantly increased stool volume. The novelty of this study is that it sheds light on the Kampo treatment of defecation control in critically ill patients. In addition to the present report, further studies are warranted to quantify the therapeutic efficacy and safety of Daijokito

Survey on the current status of self-immolation attempts in Akita Prefecture: A cross-sectional survey

ObjectiveGiven the up to 70% fatality rate of self-immolation, with tragic consequences for survivors, proposals have been made for a global task force to prevent self-immolation. However, little research has recently been conducted on the actual situation of patients who attempt self-immolation in Japan. The current study aimed to investigate the actual situation of patients who attempt self-immolation in Akita Prefecture.ResultWithin Akita Prefecture, 13 individuals had attempted self-immolation in the past 5 years, with a predominance of a history of psychiatric disorders (46%). The following three novel findings were also revealed. First, patients with low a prognostic burn index tended to commit arson, while those with a high prognostic burn index tended to self-immolate. Second, patients attempting suicide tended to have a higher incidence of carbon monoxide poisoning. Third, those whose clothes caught on fire tended have more severe burns, regardless of whether suicide was attempted.ConclusionSelf-immolation tends to be serious, and prevention is imperative. In Akita Prefecture, the percentage of patients with a history of psychiatric disorders may be higher than commonly believed, and a more detailed understanding of the mental state of self-immolation is necessary in the future to develop effective prevention measures

A Novel RNA Synthesis Inhibitor, STK160830, Has Negligible DNA-Intercalating Activity for Triggering A p53 Response, and Can Inhibit p53-Dependent Apoptosis

RNA synthesis inhibitors and protein synthesis inhibitors are useful for investigating whether biological events with unknown mechanisms require transcription or translation; however, the dependence of RNA synthesis has been difficult to verify because many RNA synthesis inhibitors cause adverse events that trigger a p53 response. In this study, we screened a library containing 9600 core compounds and obtained STK160830 that shows anti-apoptotic effects in irradiated wild-type-p53-bearing human T-cell leukemia MOLT-4 cells and murine thymocytes. In many of the p53-impaired cells and p53-knockdown cells tested, STK160830 did not show a remarkable anti-apoptotic effect, suggesting that the anti-apoptotic activity is p53-dependent. In the expression analysis of p53, p53-target gene products, and reference proteins by immunoblotting, STK160830 down-regulated the expression of many of the proteins examined, and the downregulation correlated strongly with its inhibitory effect on cell death. mRNA expression analyses by qPCR and nascent RNA capture kit revealed that STK160830 showed a decreased mRNA expression, which was similar to that induced by the RNA synthesis inhibitor actinomycin D but differed to some extent. Furthermore, unlike other RNA synthesis inhibitors such as actinomycin D, p53 accumulation by STK160830 alone was negligible, and a DNA melting-curve analysis showed very weak DNA-intercalating activity, indicating that STK160830 is a useful inhibitor for RNA synthesis without triggering p53-mediated damage responses

Acute Esophageal Necrosis as an Unusual Cause of Epigastric Pain in the Emergency Department

Epigastric pain is a common complaint in the emergency department (ED). Clinicians require skills to differentiate the epigastric pain in the ED. Here, we report a case of acute esophageal necrosis (AEN) as a cause of epigastric pain in the ED. An 83-year-old woman with diabetes mellitus visited the ED because of worsening subacute epigastric pain, nausea, and anorexia. The patient’s vital signs and general condition did not seem serious at first in the ED. Esophagogastroduodenoscopy revealed circumferential inflammation and necrosis of the esophageal mucosa. The patient was diagnosed with AEN and admitted. The patient’s condition suddenly worsened on the sixth day. Citrobacter koseri was detected in blood culture, and although the patient was treated with antibiotics, she died on the twelfth day. In our case, epigastric pain, a common complaint in the ED in elderly women, was caused by AEN, an uncommon disease. The patient was seemingly stable at first but rapidly developed sepsis and died. In this case, we identified two important clinical issues: (1) AEN is an uncommon cause of epigastric pain in the ED, but it is worth considering. (2) Once AEN is diagnosed, the clinician should engage in further investigations such as esophageal and blood culture tests and close follow-up of the clinical course, even if patients’ condition does not appear to be serious

Severe acute respiratory distress syndrome caused by Otsujito

Abstract Background Kampo prescriptions can cause drug‐induced lung injury (DLI) and acute respiratory distress syndrome (ARDS). However, severe respiratory failure induced by Otsujito (OJT) is extremely rare. High‐dose steroid pulse therapy is generally given to patients with severe DLI. Case Presentation A 63‐year‐old man with respiratory distress was admitted to our hospital. The patient was diagnosed with severe ARDS caused by OJT, which had been prescribed 4 weeks prior to admission. Thus, OJT was discontinued, and intensive care for ARDS, including ventilation and prone positioning, was implemented. His respiratory condition rapidly improved after treatment with an initial methylprednisolone dose (1.5 mg/kg/day). He was extubated on day 4 and discharged on day 16. The steroid dose was gradually reduced and discontinued by day 116. Conclusion A severe case of ARDS caused by OJT was successfully treated with low‐dose steroids and specialized intensive care

De novo discovery of a tissue-specific gene regulatory module in a chordate

We engage the experimental and computational challenges of de novo regulatory module discovery in a complex and largely unstudied metazoan genome. Our analysis is based on the comprehensive characterization of regulatory elements of 20 muscle genes in the chordate, Ciona savignyi. Three independent types of data we generate contribute to the characterization of a muscle-specific regulatory module: (1) Positive elements (PEs), short sequences sufficient for strong muscle expression that are identified in a high-resolution in vivo analysis; (2) CisModules (CMs), candidate regulatory modules defined by clusters of overrepresented motifs predicted de novo; and (3) Conserved elements (CEs), short noncoding sequences of strong conservation between C. savignyi and C. intestinalis. We estimate the accuracy of the computational predictions by an analysis of the intersection of these data. As final biological validation of the discovered muscle regulatory module, we implement a novel algorithm to search the genome for instances of the module and identify seven novel enhancers

Survey on the current status of self-immolation attempts in Akita Prefecture: A cross-sectional survey

Objective: Given the up to 70% fatality rate of self-immolation, with tragic consequences for survivors, proposals have been made for a global task force to prevent self-immolation. However, little research has recently been conducted on the actual situation of patients who attempt self-immolation in Japan. The current study aimed to investigate the actual situation of patients who attempt self-immolation in Akita Prefecture. Result: Within Akita Prefecture, 13 individuals had attempted self-immolation in the past 5 years, with a predominance of a history of psychiatric disorders (46%). The following three novel findings were also revealed. First, patients with low a prognostic burn index tended to commit arson, while those with a high prognostic burn index tended to self-immolate. Second, patients attempting suicide tended to have a higher incidence of carbon monoxide poisoning. Third, those whose clothes caught on fire tended have more severe burns, regardless of whether suicide was attempted. Conclusion: Self-immolation tends to be serious, and prevention is imperative. In Akita Prefecture, the percentage of patients with a history of psychiatric disorders may be higher than commonly believed, and a more detailed understanding of the mental state of self-immolation is necessary in the future to develop effective prevention measures

Association of fish intake with menstrual pain: A cross-sectional study of the Japan Environment and Children's Study.

The relationship between fish eating habits and menstrual pain is unknown. Elucidating this relationship can inform dietary guidance for reproductive age women with menstrual pain. The aim of this study was to clarify the relationship between fish intake frequency/preference and menstrual pain. This cross-sectional study was conducted at the Miyagi Regional Center as an adjunct study of the Japan Environment and Children's Study, and 2060 eligible women (mean age, 31.9 years) participated. Fish intake frequency ("< 1 time/week," "1 time/week," "2-3 times/week," or "≥ 4 times/week"), preference ("like," "neutral," or "dislike"), and menstrual pain (no/mild or moderate-to-severe) were assessed at 1.5 years after the last delivery through self-administered questionnaires. The association between fish intake frequency/preference and prevalence of moderate-to-severe menstrual pain was evaluated through logistic regression analyses. Our results show that, compared with the "< 1 time/week" (38.0%) group, the "1 time/week" (26.9%), "2-3 times/week" (27.8%), and "≥ 4 times/week" (23.9%) groups showed a lower prevalence of moderate-to-severe menstrual pain (p < 0.01). The prevalence of moderate-to-severe menstrual pain was 27.7%, 27.6%, and 34.4% in the "like," "neutral," and "dislike" groups, respectively. Multivariate logistic regression showed that frequent fish intake was associated with a lower prevalence of moderate-to-severe menstrual pain ("1 time/week": odds ratio [OR] = 0.59; 95% confidence interval [CI], 0.41-0.86, "2-3 times/week": OR = 0.64; 95% CI, 0.45-0.90 and "≥ 4 times/week": OR = 0.52; 95% CI, 0.34-0.80; trend p = 0.004). Multivariate logistic regression showed no association between fish preference and moderate-to-severe menstrual pain ("dislike" vs "like": OR = 1.16; 95% CI, 0.78-1.73). There was a significant negative association between fish intake frequency and menstrual pain. It is suggested that fish intake can reduce or prevent menstrual pain