Perspectives on enteral tube feeding in Japan

[Introduction] The purpose of this study was to investigate the differences in the preference of enteral tube feeding between elderly inhabitants of Mugi town, Tokushima Prefecture, Japan, and their parents in various physical conditions. [Methods] This population-based questionnaire survey studied 300 randomly selected participants aged 65–80 years. Respondents were to consider a situation where eating was difficult, and were questioned on their desire for tube feeding, using a visual analogue scale (VAS) ranging from “do not want tube feeding (0)” to “want tube feeding (100).” [Results] Valid responses of 103 (34.4%) participants were analyzed. Under conditions of being “healthy,” “bedridden,” “with dementia,” and “bedridden and with dementia,” the median (IQR) of the VAS values for the desire for tube feeding were 31.8 (3.3 to 83.8), 19.3 (2.4 to 52.3), 5.2 (0.7 to 18.9), 4.0 (0.3 to 15.2) for respondents and 55.2 (11.6 to 92.2), 48.7 (5.5 to 85.5), 9.0 (1.2 to 46.8), 5.1 (0.1 to 36.5) for parents, respectively. The VAS values for the parents were significantly higher (p=0.001, 0.002, 0.001, and 0.01, respectively for the four conditions described) for the same items. [Conclusion] Surrogate decisions made by family members often differ from what the patients would have desired

PMR and RS3PE Syndrome

Polymyalgia rheumatica (PMR) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome are common inflammatory rheumatic diseases in the elderly. In this study, we investigated the difference of the therapeutic responses between patients with PMR and RS3PE syndrome. Twenty-four patients with PMR and 12 patients with RS3PE syndrome were treated with initial dosages of 10-20 mg per day oral prednisolone, and the dosages were then tapered. Percentages of patients with negative c-reactive protein (CRP) after 8-week treatment were significantly more in RS3PE syndrome than in PMR. Percentages of patients with relapse during one-year treatment were less likely to be in RS3PE syndrome than in PMR. These differences observed between the two disorders were not associated with the level of initial CRP. There was no significant difference in percentages of patients with prednisolone-free remission after two-year treatment between PMR and RS3PE syndrome. These results indicate that the early response to the treatment is greater in RS3PE syndrome than in PMR

Erbium-doped-fiber-based broad visible range frequency comb with a 30 GHz mode spacing for astronomical applications

Optical frequency combs have the potential to improve the precision of the radial velocity measurement of celestial bodies, leading to breakthroughs in such fields as exoplanet exploration. For these purposes, the comb must have a broad spectral coverage in the visible wavelength region, a wide mode spacing that can be resolved with a high dispersion spectrograph, and sufficient robustness to operate for long periods even in remote locations. We have realized a comb system with a 30 GHz mode spacing, 62 % available wavelength coverage in the visible region, and 40 dB spectral contrast by combining a robust erbium-doped-fiber-based femtosecond laser, mode filtering with newly designed optical cavities, and broadband-visible-range comb generation using a chirped periodically-poled LiNbO3 ridge waveguide. The system durability and reliability are also promising because of the stable spectrum, which is due to the use of almost all polarization-maintaining fiber optics, moderate optical power, and good frequency repeatability obtained with a wavelength-stabilized laser.Comment: 19 pages, 5 figure

Past infections and low ACPA in RA

Background : Rheumatoid arthritis (RA), an autoimmune disease of unknown etiology, is believed to occur as the result of actions of genetic and environmental factors. In this study, we examined the relation of past histories about infectious diseases with the levels anti-citrullinated protein autoantibodies (ACPA) in RA. Methods : Results of a questionnaire about histories of infectious diseases were obtained from 85 patients with RA, and were analyzed. Results : Significantly lower level of ACPA was detected in patients with the history of tonsillitis, otitis media or urinary cystitis than in those without it. There was no difference in the level of ACPA in RA patients between with and without cold / influenza, rubella, chickenpox, herpes labialis or herpes zoster. When RA patients were divided into two groups, high-level and low-level ACPA, multiple logistic regression analysis revealed that the history of otitis media was a significantly independent factor for the low level of ACPA. There was no significant relation between the level of rheumatoid factor and histories of infectious diseases. Conclusion : This study clarified that the past history of otitis media is associated with the low level of ACPA in RA

CRP in PMR and RS3PE syndrome

Polymyalgia rheumatica (PMR) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome are common inflammatory rheumatic diseases in the elderly. In this study, we investigate predictive factors which correspond to subsequent disease control of PMR and RS3PE syndrome. Twenty four patients, which contained 18 PMR and 6 RS3PE syndrome, were treated with initial dosages of 10-20 mg per day oral prednisolone, and the dosage of prednisolone was then tapered. Significantly higher initial CRP was observed in patients with poor disease control than in those with good disease control afterwards. The number of patients with negative CRP after 4 weeks was significantly more in patients with good disease control after 1 year than in those with poor disease control. Patients were shown to be in good disease control status after 1 year when CRP after 4 weeks became negative even if they had initial high CRP. Our study clarify that to make CRP negative after 4 weeks is associated with subsequent suppression of the disease activity and with decreased dosages of corticosteroids

Tracheal intubation by paramedics under limited indication criteria may improve the short-term outcome of out-of-hospital cardiac arrests with noncardiac origin.

PURPOSE: It is not clear whether advanced airway management (AAM) with an endotracheal tube (ET) by paramedics may improve the outcome of out-of-hospital cardiac arrest (OHCA) compared with the use of a bag-valve-mask device (BVMD) and other AAM devices. METHODS: We analyzed 2,586 adult cases of OHCA without administration of adrenaline, witnessed or recognized by citizens in subjects transported to hospital by paramedics between 1 July 2004 and 31 March 2008 in Ishikawa, Japan, to determine whether AAM with an ET used under limited indication criteria may improve the outcome of OHCA. RESULTS: The airway was managed with an ET in 263 cases, other AAM devices in 660 cases, and a BVMD in 1,539 cases. The AAM failed or was discontinued in 124 cases, which were excluded from the analysis. The incidence of sustained return of spontaneous circulation (ROSC) was significantly higher in cases of AAM with an ET (30%) than in AAM with other devices (20.2%) and in the standard procedure with a BVMD (21.3%). The AAM with an ET did not significantly affect 1-year survival. Multiple regression analysis indicated that tracheal intubation (odds ratio = 1.503, 95% confidence interval 1.081-2078), but not patient management by paramedics qualified for ET use, was an independent factor associated with sustained ROSC. CONCLUSION: When subjects with difficult airway are excluded, tracheal intubation according to the limited indication criteria and well-organized protocol in Japan may improve the short-term outcome of OHCA of noncardiac origin. A large prospective study is needed to determine the general effects of tracheal intubation on the long-term outcome of OHCA with disturbed ventilation

Nexin-Dynein regulatory complex component DRC7 but not FBXL13 is required for sperm flagellum formation and male fertility in mice

Nexin-Dynein regulatory complex component DRC7 but not FBXL13 is required for sperm flagellum formation and male fertility in mice. Morohoshi A, Miyata H, Shimada K, Nozawa K, Matsumura T, et al. PLOS Genetics. 2020. 16(1) doi:10.1371/journal.pgen.100858

The effects of new CPR guideline on attitude toward basic life support in Japan

Background: There is no study regarding the influence of cardiopulmonary resuscitation (CPR) guideline renewal on citizen\u27s attitude towards all basic life support (BLS) actions. Methods and results: We conducted a questionnaire survey to new driver licence applicants who participated in the BLS course at driving schools either before (January 2007 to April 2007) or after (October 2007 to April 2008) the revision of the textbook. Upon completion of the course, participants were given a questionnaire concerning willingness to participate in CPR, early emergency call, telephone-assisted chest compression and use of an automated external defibrillator (AED). After the revision, the proportions of positive respondents to use of AED as well as to all the four scenarios significantly increased from 2331/3564 to 3693/5156 (odds ratio (OR)=1.34) and from 1889/3443 to 3028/5126 (OR=1.18), respectively. However, the new guideline slightly but significantly augmented the unwillingness to make an early call (236/3568 vs. 416/5283, OR = 0.83). Approximately 95% of respondents were willing to follow the telephone-assisted instruction of chest compression, while approximately 85% were eager to perform CPR on their own initiative. Multiple logistic regression analysis confirmed the results of mono-variate analysis, and identified previous CPR training, sex, rural area and student as other significant factors relating to attitude. Conclusions: Future guidelines should emphasise the significance and benefit of early call in relation to telephone-assisted instruction of CPR or chest compression. The course instructors should be aware of the backgrounds of participants as to how this may relate to their willingness to participate. © 2010 Elsevier Ireland Ltd

Characteristics of medical students who would like to be a generalist physician and contribute to remote area medicine

We administered a questionnaire to 5th grade medical students to examine the effect of communitybased clinical practice on their attitudes to remote areamedicine and their course after the graduation.Data from 192 students were obtained. The intensity of students’ attitudes was estimated by using visual analogue scale. The intensities of the interest and a sense of fulfillment in remotearea medicine were significantly increased after the practice. A significantly lower level of the intensity to becomea generalist than that to becomea specialist was seen inthe students with low intensity in a sense of fulfillment. The percentages of the students who answered that they can work for 5 years or more in remote area were significantly lower in students with low intensity of a sense of fulfillment than in those with high intensity. A significantly higher percentage in students who worked at a familiar prefecture to them after the graduation was seen in female than in male. This study shows that the community-based practice is meaningful in increasing motivation which desire to work in remote area medicine, and that themotivation may affect their course after the graduation