Evaluation of efficacy and safety of lascufloxacin for nursing and healthcare associated pneumonia: single-arm, open-label clinical trial: A study protocol

Background: Lascufloxacin hydrochloride (LSFX) is a quinolone antibiotic that inhibits DNA gyrase and topoisomerase IV of bacteria, it is anticipated to minimize antibiotic resistance in bacteria. It exhibits antibacterial activity against a relatively wide range of bacterial species, including anaerobic bacteria, and its efficacy and safety against community-acquired pneumonia have been shown; however, its efficacy and safety against nursing and healthcare associated pneumonia (NHCAP) have not been verified.Methods/Design: Here, a single-arm, open-label, uncontrolled study was conducted in which LSFX was administered to patients with NHCAP at 24 facilities. The research subjects (77 cases) were orally administered 75 mg of LSFX once a day for 7 days. The primary endpoint was the clinical efficacy at the time of test of cure (TOC) (TOC; 5–10 days after the end of LSFX administration), while the secondary endpoints were the efficacy at the time of end of treatment, early clinical efficacy, microbiological efficacy at the time of TOC and end of treatment, and safety evaluation of LSFX.Discussion: NHCAP is a common pneumonia in clinical settings and a notable pneumonia whose mortality is high compared to community-acquired pneumonia. The present study showed the efficacy and safety of LSFX against NHCAP, which could lead to a larger number of therapeutic options for NHCAP

An adult female suspected case of herpangina presenting with fever, headache, and oral phlyctenula

　ヘルパンギーナは，発熱と口腔粘膜の水疱性の発疹が特徴の急性のウイルス性咽頭炎で，おもに小児にみられ，夏に流行する．我々は，発熱，頭痛，軟口蓋の小水疱を呈し，ヘルパンギーナが疑われた成人女性の１例を経験したので報告する．患者は25歳，女性．７月に発熱，頭痛，嘔気を主訴に受診し，入院となった．血液検査では，CRP とプロカルシトニンの上昇を認めた．頭部 CT では，出血や占拠性病変は見られなかった．胸腹部 CT では，熱源となる異常所見は見られなかった．抗菌薬投与と対症療法を行い，発熱，頭痛は改善を認めた．口腔内違和感の訴えがあり，口腔内所見で軟口蓋に紅暈を伴う小水疱を数個認め，エンテロウイルス属感染症（ヘルパンギーナ）が疑われた．エンテロウイルス属のウイルス抗体検査では，原因ウイルスは特定できなかった．夏期に発熱，口内炎を呈する場合には，成人でもへルパンギーナを鑑別に挙げる必要があると考える．　Herpangina is an acute viral pharyngitis which presents with fever and oral phlyctenula. It is commonly seen in children, usually during summer. We report an adult female suspected of having developed herpangina because on admission she presented with fever, headache, and oral phlyctenula. The 25-year-old female underwent a medical check at our hospital because of fever, headache, and nausea in July. She was admitted to our hospital. The blood test showed elevation of C-reactive protein and procalcitonin. Brain CT scan showed no bleeding nor any space occupying lesion. Chest and abdominal CT scan showed no lesion of fever origin. Her fever and headache improved after antibiotics and symptomatic treatment. But the patient felt that something was wrong within her oral cavity. Herpangina was suspected because of the presence of phlyctenula with a red halo in the soft palate. Viral antibody test of enteroviruses did not identify viruses that commonly cause herpangina. This case indicates that herpangina should be considered for the differential diagnosis during medical examination of an adult patient who presents with fever and stomatitis during summer

Impact of Care-Recipient Resistance During Care Provision on Caregiver Emotional/Physical Well-Being: A Sequential Mixed Method Design with Between- and Within-Person Analyses and Semi-Structured Interviews

To address some remaining questions in the extant family caregiving literature, the present study examined a specific care-recipient (CR) problematic behavior that could be the most critical to family caregiver (CG) emotional and physical well-being--CR-resistance or uncooperative behaviors vis-à-vis the CG. In order to provide detailed descriptions of CR-resistance and to determine the impact of CR-resistance on CG emotional and physical well-being, the present study applied a sequential quantitative-qualitative mixed method design approach with 8-day diary survey data on 63 family CGs and follow-up semi-structured interview data from 19 of those CGs.The quantitative data documented and revealed significant within- and between-person variance in CR-resistance. Hierarchical Linear Modeling (HLM) analyses results further revealed that neither the mean level nor the daily fluctuation of CR-resistance across 8 survey days by themselves appeared to have a significant impact on CG emotional or physical health. However, the combination of having relatively high mean level and daily fluctuation of CR-resistance brought had a significant impact on CG physical health; when CGs with relatively high mean level CR-resistance faced more than their usual amount of CR-resistance on a given day, they reported increases in physical health symptoms.The qualitative inductive thematic analyses revealed that based on the context in which CR-resistance occurred and the occurrence patterns, CR-resistance experiences could be divided into four types, and these four types of CR-resistance seem to pose different types and/or magnitude of impact on CG emotional well-being.Furthermore, informed by Social Cognitive Theory and Stress Theory, the present study also examined CG personal, interpersonal, and social resources as possible moderators of the link between CR-resistance and CG emotional/physical well-being. HLM analyses results revealed that CG sense of efficacy, community/professional service utilization, and family disagreement regarding care played significant moderating roles. The qualitative thematic analyses clearly suggested that specific CG cognitive resources--particularly those that were transferred and/or generalized from the CG's past professional or personal experiences--have a strong influence on CG resilience in the face of CR-resistance. The moderating results were interpreted light of theoretical frameworks and extant literature. Implications and future directions are discussed

Sociocontextual Circumstances in Daily Stress Reactivity Among Caregivers for Elder Relatives

Using a daily diary design, we examined whether emotional and physical reactivity in the face of care-related stressors is more intense for caregivers (CGs) living with lower levels of available socioemotional support and higher numbers of extrinsic stressors. Sixty-three CGs reported their experiences based on the past 24 hr (i.e., number of caregiving tasks, care recipient problem behaviors, family disagreements regarding care, depressive symptoms, feelings of burden, physical symptoms) on eight consecutive survey days; they also reported on extrinsic stressors and available socioemotional support. Multilevel analyses indicated significant moderator effects: within-person patterns of reactivity to care-related stressors were especially strong for CGs with lower levels of available socioemotional support and higher numbers of extrinsic stressors. For example, managing additional care recipient problem behaviors on a given day was more strongly associated with increased depressive and physical health symptoms as well as feelings of burden for CGs with relatively high numbers of extrinsic stressors. Implications for intervention are discussed. Copyright 2010, Oxford University Press.

Dietary Intake of Sulforaphane-Rich Broccoli Sprout Extracts during Juvenile and Adolescence Can Prevent Phencyclidine-Induced Cognitive Deficits at Adulthood

<div><p>Oxidative stress and inflammation play a role in cognitive impairment, which is a core symptom of schizophrenia. Furthermore, a hallmark of the pathophysiology of this disease is the dysfunction of cortical inhibitory γ-aminobutyric acid (GABA) neurons expressing parvalbumin (PV), which is also involved in cognitive impairment. Sulforaphane (SFN), an isothiocyanate derived from broccoli, is a potent activator of the transcription factor Nrf2, which plays a central role in the inducible expressions of many cytoprotective genes in response to oxidative stress. Keap1 is a cytoplasmic protein that is essential for the regulation of Nrf2 activity. Here, we found that pretreatment with SFN attenuated cognitive deficits, the increase in 8-oxo-dG-positive cells, and the decrease in PV-positive cells in the medial prefrontal cortex and hippocampus after repeated administration of phencyclidine (PCP). Furthermore, PCP-induced cognitive deficits were improved by the subsequent subchronic administration of SFN. Interestingly, the dietary intake of glucoraphanin (a glucosinolate precursor of SFN) during the juvenile and adolescence prevented the onset of PCP-induced cognitive deficits as well as the increase in 8-oxo-dG-positive cells and the decrease in PV-positive cells in the brain at adulthood. Moreover, the <i>NRF2</i> gene and the <i>KEAP1</i> gene had an epistatic effect on cognitive impairment (e.g., working memory and processing speed) in patients with schizophrenia. These findings suggest that SFN may have prophylactic and therapeutic effects on cognitive impairment in schizophrenia. Therefore, the dietary intake of SFN-rich broccoli sprouts during the juvenile and adolescence may prevent the onset of psychosis at adulthood.</p></div

Metabolic abnormalities induced by mitochondrial dysfunction in skeletal muscle of the renal carcinoma Eker (TSC2+/−) rat model

<p>Tuberous sclerosis complex 2 (TSC2) is a mediator of insulin signal transduction, and a loss of function in TSC2 induces hyperactivation of mTORC1 pathway, which leads to tumorigenesis. We have previously demonstrated that Eker rat model, which is heterozygous for a TSC2 mutation, exhibits hyperglycemia and hyperketonemia. The present study was to investigate whether these changes also can affect metabolism in skeletal muscle of the Eker rat. Wild-type (TSC2+/+) and Eker (TSC2+/−) rats underwent an oral glucose tolerance test, and the latter showed decrease in whole-body glucose utilization. Additionally, reductions in the expression of glycolysis-, lipolysis-, and ketone body-related genes in skeletal muscle were observed in Eker rats. Furthermore, ATP content and mitochondrial DNA copy number were lower in skeletal muscle of Eker rats. These data demonstrate that heterozygous to mutation TSC2 not only affects the liver metabolism, but also skeletal muscle metabolism, via mitochondrial dysfunction.</p> <p>Eker rats exhibit glucose intolerance due to the inhibition of glucose uptake at the skeletal muscle, which was explained by low number and dysfunction of mitochondria.</p

Interaction between <i>NRF2</i> gene variant and <i>KEAP1</i> gene variants on intellectual ability in patients with schizophrenia.

<p>(A): There was a significant (P = 0.0036) epistatic effect of <i>NRF2</i> gene (rs10930781) and <i>KEAP1</i> gene variant (rs1048290) on working memory in patients with schizophrenia, but not controls (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127244#pone.0127244.s001" target="_blank">S1 Table</a>). On the other hand, a significant (<i>P</i> = 0.0035) effect of these variants on processing speed was due to the <i>NRF2</i> gene variant. (B): There was a significant (<i>P</i> = 0.012) epistatic effect of <i>NRF2</i> gene (rs10930781) and <i>KEAP1</i> gene variant (rs11545829) on working memory in schizophrenia, but not controls (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127244#pone.0127244.s002" target="_blank">S2 Table</a>). On the other hand, a significant effect (<i>P</i> = 0.0024) of these variants on processing speed in schizophrenia was due to the <i>NRF2</i> gene variant (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127244#pone.0127244.s002" target="_blank">S2 Table</a>).</p