Sedation/agitation monitoring using a wearable device for ventilated children.

BACKGROUND: Developing continuous and labor-saving sedation/agitation monitoring methods in ventilated children is important to avoid undesirable events such as unplanned extubation. The existing scales are often challenging to use. We therefore aimed to evaluate the feasibility of sedation/agitation monitoring using a wearable device with a built-in accelerometer for ventilated children. METHODS: This prospective observational pilot study included children aged 15 years or less, admitted to the pediatric intensive care unit on mechanical ventilation after cardiac catheterization between December 2021 and April 2022. The wearable device with a built-in accelerometer was attached to either of the upper limbs, and accelerations due to upper limb movements were measured for 2 h after admission or until extubation, whichever was earliest. Accelerations were measured at 0.02 s intervals, with the mean acceleration calculated for each 1 min interval. The State Behavioral Scale (SBS) was completed at 1 min intervals, with the SBS score (-1, 0, 1, or 2) compared with the mean acceleration. RESULTS: The study included 20 children with a median age of 12 months. The mean accelerations and SBS scores were positively correlated (Kendall's τ, 0.22; p < 0.001), with an increase in the median (interquartile range) acceleration from an SBS score of -1 through 2, as follows: SBS -1, 0.200 (0.151-0.232) m/s2 ; SBS 0, 0.202 (0.190-0.235) m/s2 ; SBS, 1, 0.312 (0.236-0.427) m/s2 ; SBS 2, 0.455 (0.332-0.517) m/s2 . No adverse events were observed. CONCLUSIONS: This study showed that continuous, labor-saving sedation/agitation monitoring of ventilated children was feasible using a wearable device with a built-in accelerometer.

Challenges and lessons learned for REDD+ finance and its governance.

Discussion on reducing emissions from deforestation in developing countries began at the United Nations Framework Convention on Climate Change (UNFCCC) Conference of the Parties in 2005, and the agenda for "reducing emissions from deforestation and forest degradation, and the role of conservation, sustainable management of forests and enhancement of forest carbon stocks in developing countries (REDD+)" was introduced under the UNFCCC. The REDD+ framework was developed with the expectation that it would significantly contribute to climate change mitigation at a relatively low cost and produce benefits for both developed and developing countries. Finance is a key element of REDD+ implementation, and many financial sources, approaches, and mechanisms have supported REDD+-related activities in various developing countries. However, the comprehensive challenges and lessons learned for REDD+ finance and its governance have not been fully explored. This paper reviews the relevant literature to understand the challenges for REDD+ finance and its governance in two areas-(1) REDD+ finance aligned with the UNFCCC and (2) REDD+-related finance outside the UNFCCC-which have developed differently and have different implications. This paper first identifies the six key elements of REDD+ finance and its governance across the two fields, and then reviews the related challenges and lessons learned with respect to public and private finance. The challenges for REDD+ finance and its governance aligned with the UNFCCC include enhancing the performance of REDD+ finance using mainly public finance, such as results-based finance and the jurisdictional approach. In contrast, the challenges regarding REDD+-related finance outside the UNFCCC include enhancing the engagement of the private sector in REDD+ finance, mainly targeting the project level, and the relationship between voluntary carbon markets and other investment and finance mechanisms. This paper also identifies the common challenges across REDD+ finance and its governance in the two fields. These challenges include the need to enhance linkages between REDD+ and other objectives, such as carbon neutrality/net-zero, deforestation-free supply chains, and nature-based solutions, as well as the need to develop learning systems for REDD+ finance.

Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS).

Cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS) is a novel ataxic disorder consisting of the triad of cerebellar impairment, bilateral vestibular hypofunction, and a somatosensory deficit. We report the first Japanese case of CANVAS. The patient is a 68-year-old Japanese male. He was referred to our university for further evaluation of progressive gait disturbance and ataxia. He exhibited horizontal gaze-evoked nystagmus and sensory deficit. Nerve conduction studies showed sensory neuronopathy. Magnetic resonance imaging showed the atrophy of vermis but not of the brainstem. The caloric stimulation and video head impulse test (vHIT) showed bilateral vestibulopathy. The visually enhanced vestibulo-ocular reflex (VVOR) was also impaired. In addition to neurological and electrophysiological examinations, simple neuro-otological examinations (i.e., caloric stimulation, vHIT, and VVOR) may reveal more non-Caucasian cases.

An Adult Case of Anti-Myelin Oligodendrocyte Glycoprotein (MOG) Antibody-associated Multiphasic Acute Disseminated Encephalomyelitis at 33-year Intervals.

Acute disseminated encephalomyelitis (ADEM) followed by optic neuritis (ON) has been reported as a distinct phenotype associated with anti-myelin oligodendrocyte protein (MOG) antibody. We herein report the case of a 37-year-old woman who was diagnosed with ADEM at 4 years old of age and who subsequently developed ON followed by recurrent ADEM 33 years after the initial onset. A serum analysis showed anti-MOG antibody positivity. This phenotype has only previously been reported in pediatric cases. Neurologists thus need to be aware that the phenotype may occur in adult patients, in whom it may be assumed to be atypical multiple sclerosis.

Nerve and behavioral responses of mice to various umami substances.

Food contains various taste substances. Among them, umami substances play an important role with regard to the perception of the taste of food, but, few studies have examined the taste characteristics of representative umami substances other than monosodium L-glutamate (MSG). By conducting mouse behavioral studies (the 48-h 2-bottle preference test and the conditioned taste aversion test) and assessing gustatory nerve responses, we investigated the taste characteristics of unique umami substances, including sodium succinate, L-theanine, betaine, and the enantiomer of MSG, D-MSG. Furthermore, we examined the synergy of umami with inosine 5'-monophoshate (IMP). In the case of the mice, sodium succinate had an umami taste and showed strong synergy with IMP. L-theanine showed synergy with IMP but did not have an umami taste without IMP. In contrast, betaine did not have an umami taste or synergy with IMP. D-MSG might have weak synergy with IMP.

L-theanine elicits an umami taste with inosine 5'-monophosphate.

We investigated the taste synergy between L-theanine and the flavour enhancer, inosine 5'-monophosphate (IMP), by using a human sensory evaluation. When L-theanine was added to IMP, only the umami taste was enhanced. We then investigated this synergistic effect of L-theanine in mice by gustatory nerve recording. We confirmed the synergism between L-theanine and IMP for the umami taste.

Fluorophotometric determination of hydrogen peroxide and other reactive oxygen species with fluorescein hydrazide (FH) and its crystal structure.

Methods for the fluorophotometric determination of hydrogen peroxide (H(2)O(2)) and other reactive oxygen species (ROS) were proposed by using the fluorescence reaction between H(2)O(2) or other ROS and fluorescein hydrazide (FH). In the determination of H(2)O(2), the calibration curve exhibited linearity over the H(2)O(2) concentration range of 2.1-460 ng ml(-1) at an emission wavelength of 527 nm with an excitation of 460 nm and with the relative standard deviations (n=6) of 4.06%, 1.78%, and 2.21% for 3.1 ng ml(-1), 30.8 ng ml(-1), and for 308 ng ml(-1) of H(2)O(2), respectively. The detection limit for H(2)O(2) was 0.7 ng ml(-1) due to three blank determinations (rho=3). The calibration curves for ROS-related compounds were also constructed under the optimum conditions. This method was successfully applied in the assay of H(2)O(2) in human urine. In addition, we performed the characterization of FH, and interesting information was obtained with regard to the relationship between the chemical structure and fluorescence.

Search for carrier-mediated transport systems in the rat colon.

Several nutrients and drugs, which are known to be absorbed by specific carrier-mediated transport systems in the small intestine, had their transport investigated in the rat colon, by measuring uptake into everted sacs, to find if carrier-mediated transport systems may also be present in the colon. Among those transported by Na+-dependent carriers in the small intestine, D-glucose and taurocholate were found to be transported in an Na+-dependent manner in the colon, while 5-fluorouracil and ascorbate were not. It was also found that the colonic transports of D-glucose and taurocholate were saturable. These results suggest the presence in the colon of Na+-dependent carrier-mediated transport systems for D-glucose and taurocholate, but not for 5-fluorouracil and ascorbate. For nicotinate and methotrexate, which are transported by H+-dependent carriers in the small intestine, their transport was elevated at a lower pH (5.0) than the pH 7.4 in the colon, but not saturable. Therefore, the elevated transport of these acidic compounds may be explained by an increase in passive flux due to an increase in the fraction of the unionized and/or neutral forms, without postulating the presence of H+-dependent carrier-mediated transport systems in the colon. The transport activity of the suggested colonic transport systems for D-glucose and taurocholate was much lower than those of their respective counterparts in the small intestine. However, it may be possible to use them for oral drug delivery via the colon. Their physiological roles would also be of interest.