Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Factors contributing to mortality in healthcare-associated pneumonia (HCAP) have not been investigated fully. We reviewed the etiology and identified prognostic factors of HCAP in hospitalized patients. We conducted a retrospective study of 500 Japanese patients with HCAP to assess these factors, with special emphasis on microbial etiology. Patients with HCAP were older (73.4±11.4 years), more predominantly male (74.4%), and had more smoking history and comorbidity than did community-acquired pneumonia (CAP) patients. Microbes were identified in 52.8% of HCAP patients. The most frequent causative microbial agents were Streptococcus pneumoniae (n = 108, 21.6%), influenza virus (n = 47, 9.4%), and Pseudomonas aeruginosa (n = 40, 8.0%). Multiple drug-resistant (MDR) pathogens were more frequent in HCAP patients (9.8%) than CAP patients. Overall, 47 HCAP patients (9.4%) died, with mortality being higher in HCAP than CAP patients. The three leading causes of non-survival from HCAP were S. pneumoniae, influenza virus, and P. aeruginosa. MDR pathogens accounted for 21.3% of non-survivors. Multivariate analysis revealed disease severity on admission and treatment failure of initial antibiotics as independent factors for 30-day mortality. Among patients with treatment failure of initial antibiotics, 29.9% had received appropriate antibiotics. The most frequent pathogens in HCAP were S. pneumoniae, influenza virus, and P. aeruginosa, in both survivors and non-survivors. Disease severity on admission and treatment failure of initial antibiotics were independent factors for mortality. MDR pathogens are important therapeutic targets to mitigate negative results, and treatment strategies other than antibiotic selection are also required

Physical inactivity is associated with decreased growth differentiation factor 11 in chronic obstructive pulmonary disease

Rie Tanaka,1 Hisatoshi Sugiura,1 Mitsuhiro Yamada,1 Tomohiro Ichikawa,1 Akira Koarai,1 Naoya Fujino,1 Satoru Yanagisawa,1 Katsuhiro Onodera,1 Tadahisa Numakura,1 Kei Sato,1 Yorihiko Kyogoku,1 Hirohito Sano,1 Shun Yamanaka,1 Tatsuma Okazaki,1 Tsutomu Tamada,1 Motohiko Miura,2 Tsuneyuki Takahashi,3 Masakazu Ichinose1 1Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan; 2Department of Respiratory Medicine, Tohoku Rosai Hospital, Aoba-ku, Sendai, Japan; 3Department of Internal Medicine, Tohoku Medical and Pharmaceutical University Wakabayashi Hospital, Wakabayashi-ku, Sendai, Japan Background: Growth differentiation factor 11 (GDF11) is reported to possess anti-aging and rejuvenating effects, including muscle regeneration and to be highly expressed in skeletal muscle. Recently, we demonstrated that the levels of plasma GDF11 were decreased in COPD. However, the effect of decreased circulating GDF11 in the pathophysiology of COPD remains unknown. The aim of this study is to investigate the association between the plasma GDF11 levels and various clinical parameters in patients with COPD. Patients and methods: Eighteen ex-smokers as control subjects and 70 COPD patients participated in the current study. We measured the levels of plasma GDF11 using immunoblotting, lung function, physical activity using a triaxial accelerometer, quadriceps strength, exercise capacity, and systemic inflammatory markers. We investigated the association between the levels of plasma GDF11 and these clinical parameters. Results: The levels of plasma GDF11 in the COPD patients had significant positive correlations with the data of lung function. Furthermore, the levels of plasma GDF11 were significantly correlated with the physical activity, quadriceps strength, and exercise capacity. Moreover, the levels of plasma GDF11 were significantly correlated with the data of inflammatory markers. Although various factors were related to GDF11, the multiple regression analysis showed that physical activity was significantly associated with the levels of plasma GDF11. Conclusion: Physical inactivity was significantly related to the decreased GDF11 levels in COPD, which might be useful for understanding the pathogenesis of COPD. Clarifying the relationships between the physical inactivity and GDF11 may reveal a potentially attractive therapeutic approach in COPD via increasing the plasma levels of GDF11. Keywords: physical activity, muscle strength, rejuvenating factor, COP

シンタイ ショウガイシャ フクシホウ ショウガイ ニンテイ センモンイ チョウサ ニ オケル ショウガイ ニンテイ ノ カダイ 1 シカク ショウガイ

身体障害者福祉法の障害の範囲は、成立当時の視覚障害、聴覚障害、肢体不自由等の障害から、現在は内部機能障害にまで障害の範囲が拡大されてきている。そのために、疾患との区別がわかりにくくなり障害の概念が複雑になった。そこで、著者らは、平成15年度から、身体障害者福祉法が本来目的としている更生援護を適切に達成し、かつ、真に必要な人に、必要なサービスを、適切な時期に提供するための障害認定のありかたについて検討してきた。本研究は、研究の基礎的資料を得るために平成17年2月から3月にかけて各都道府県の障害認定専門医に対して行った調査の結果の一部であり、視覚障害の認定に関する調査結果をまとめている。研究の結果、視覚障害の認定に関して、視力障害の測定を両眼視で行うこと、視野障害の測定方法を再検討すること、高次脳機能障害や言葉でのやりとりの出来ない幼児などの視覚機能の測定方法についての基礎的研究を行うこと、再認定の方法について基礎的研究を行うことなどの課題が明らかになった。The range of the disabilities of the Law for Persons with Physical Disabilities has been expanded to internal disabilities from formation. As the distinction between disability and disease has been confused, the definition of disability has been complicated. The authors have been discussing an adequate definition of disability to offer the sufficient service to those who really need when they need since 2003. An survey of medical evaluation experts of each prefecture was carried out to investigate the reality of disability determination in order to get a basic information. This article is one part of result of the survey and reports the problems of the disability determination of visual impairment. The measurement of visual acuity with both eyes, reexamining the measurement method of the visual field, the need of study about the measurement method of visual functions such as the infants who cannot speak and cognitive functional disorder, and the study about the method of reassessment of impairment are found as the problems

Design Guidelines on LED Costumes for Dance Performances

We present design guidelines on light emitting diode (LED) costumes for dance performances assuming repetitive use during concerts. We used LED costumes more than 120 times for large concerts of well-known artists at venues of approximately 50,000 capacity that were commercially successesful and we updated the LED costume design twice based on our experiences during these concerts. Through analyzing the position of broken LEDs and the types of breakage and the problems that occurred during actual performances, we devised 17 design guidelines on LED costumes for dance performances. Thanks to these design guidelines, the LEDs on the costume are more difficult to break and we can prepare for any contingencies that may occur during a performance. We fabricated an improved LED costume based on our design guidelines and conducted endurance tests involving dancing. Throughout the endurance tests, the LEDs did not break, and other factors that cause LED breakage were found. We participated in two exhibitions to conduct special LED dance performances

Reconfigurable Hardware Architecture for Saving Power Consumption on a

Abstract-We propose the use of a reconfigurable hardware architecture to reduce the power consumption of small sensor node that has various sensors and wireless communication facilities, that were the result of an adaptive function specialization mechanism. Traditional sensor nodes must have had a powerful and multi functional Micro-Controller Unit (MCU) to satisfy the requirements for processing any kinds of application. However, most of these systems only use a part of the functions provided by an MCU. In other words, such a unit often consumes a great dead of power for unused circuits. To avoid this situation, we propose the use of a reconfigurable architecture based on a Field Programmable Gate Array (FPGA) instead of an MCU because this array dynamically changes the circuit to the optimal one that is just used for the calculation required by an application. Moreover, we implemented a prototype system to do a preliminary evaluation of our proposed mechanism. In this evaluation, we show the performance of our proposed reconfigurable architecture by comparison with traditional architecture that uses processing time and power consumption. The experimental result shows that our proposed mechanism reduces enough power of its sensor nodes to prolong the lifetime of nodes without decreasing the processing time