Physician requests by patients with malignant pleural mesothelioma in Japan.

BACKGROUND: Malignant pleural mesothelioma (MPM) is a fatal and rare disease that is caused by the inhalation of asbestos. Treatment and care requests made by MPM patients to their physicians were collected and analyzed. METHODS: This cross-sectional survey was part of a larger study (N = 133) regarding the quality of life of MPM patients. Specific responses to two open-ended questions related to patients' requests regarding treatment and care were quantified, analyzed and divided into categories based on content. RESULTS: Responses (N = 217) from MPM patients (N = 73) were categorized into 24 subcategories and then abstracted into 6 categories. The majority of requests were related to patient-physician communication. Patients wanted clear and understandable explanations about MPM and wanted their physician to deliver treatment based on the patient's perspective by accepting and empathizing with their anxiety and pain. Patients expected physicians to be dedicated to their care and establish an improved medical support system for MPM patients. CONCLUSION: Patients with MPM had a variety of unmet needs from their physicians. Physicians who provide care to MPM patients should receive training in both communication skills and stress management. A multidisciplinary care system that includes respiratory and palliative care for MPM patients should be established.

Quality of life of survivors of malignant pleural mesothelioma in Japan: a cross sectional study.

BACKGROUND: Previous studies have indicated that people with malignant pleural mesothelioma (MPM) have a poor quality of life (QOL); however, information about the QOL of people with MPM in Japan is anecdotal. The aims of this study were to investigate the QOL of survivors of MPM in Japan and to determine the factors that correlate with their QOL. METHODS: This was a cross sectional study. The included patients were those diagnosed with MPM in Japan. We created a self-administered questionnaire consisting of 64 questions. The questionnaires were sent to hospitals and patient advocacy groups, distributed to the patients, completed, and sent back to the researchers by postal mail. QOL was assessed with the European Organization for Research and Treatment of Cancer 16 questionnaire (QLQ) and the short version of the core domains of the Comprehensive Quality of Life Outcome questionnaire (CoQoLo). RESULTS: In total, 133 questionnaires were collected. The QLQ assessments demonstrated that the survivors of MPM most frequently complained of fatigue, pain, sleep disturbances, and dyspnea. The symptom scales were acceptable, but the functional scales were significantly poorer for the patients with poor performance statuses (PSs). The short CoQoLo assessment was very unfavorable for 'Being free from physical pain.' Being a long-term survivor and a survivor with a poor PS were significantly correlated with poor global health status. CONCLUSIONS: Survivors of MPM have impaired function, a variety of symptoms, and lower QOL. Survivors of MPM, even those in good physical condition, need broad support.

A relationship between a level of hemoglobin after delivery and exclusive breastfeeding initiation at a baby friendly hospital in Japan.

BACKGROUND: The recent National Nutrition Survey of 2013 demonstrated that 16.7% of women in childbearing age are underweight, and 5.0-10.0% of these women manifested a Hemoglobin (Hb) level less than 11.0 g/dl. The purpose of this study was to investigate if such maternal nutritional status affects success of exclusive breastfeeding (EBF) practice. METHODS: This cross-sectional study investigated 1532 dyads of mothers and infants with full-term singleton pregnancies delivered during 2011 at a perinatal center in Tokyo. Outcome is EBF initiation defined as the successful practice at discharge and 1 month after discharge. A logistic regression model was applied to investigate the impact of Hb levels (<9.0, 9.0-10.9, and ≥11.0 g/dl) measured within 2-3 days after delivery on successful EBF initiation adjusting for covariates including bleeding at delivery. RESULTS: Mean age was 34 years, 23.0% were underweight and 63.0% were nulliparous. The success rate for EBF initiation at discharge and at 1 month after discharge was 72.7 and 63.0% for a Hb level <9.0 g/dl, 81.9 and 68.9% for a Hb level of 9.0-10.9 g/dl, and 85.7 and 75.9% for a Hb level ≥11.0 g/dl, respectively. A logistic regression model showed that risk factors of unsuccessful EBF practice at discharge and 1 month after discharge included lower level Hb categories (P < 0.001 and P < 0.001), postpartum hemorrhage > 500 ml (P = 0.089 and P = 0.011), maternal age (P < 0.001 and P < 0.001), nulliparity (P < 0.0001 and P < 0.001), pregnancy-induced hypertension (P = 0.002 and P = 0.012), gestational week (P = 0.006 and P = 0.002), Low Birth Weight (LBW) (P < 0.001 and P < 0.001), and immediate separation (P < 0.001 and P = 0.020). After adjusting for the covariates, compared with a Hb level ≥11.0 g/dl, a Hb level <9.0 g/dl was significantly associated with unsuccessful EBF initiation at discharge [odds ratio (OR): 2.15; 95% confidence interval (CI): 1.37-3.39] and at 1 month after discharge (OR: 1.63; 95% CI: 1.10-2.42), and a Hb level of 9.0-10.9 g/dl also was significant at 1 month after discharge (OR: 1.35; 95% CI: 1.04-1.75). Pre-pregnancy underweight was not associated with success of EBF practice both at hospital discharge and 1 month after discharge. CONCLUSION: Maternal severe anemia after delivery was associated with the risk of unsuccessful initiation of EBF even after adjusting for bleeding at delivery, suggesting the importance of dietary management especially in the later trimester.

Factors Associated with Blood Loss after Delivery in 1,294 Mothers with Full-Term Singleton Baby.

OBJECTIVES: To clarify the predisposing factors associated with blood loss after delivery in mothers with full-term singleton babies. METHODS: In this retrospective cohort study, we investigated 1,294 women who delivered singleton babies vaginally in 2011 at a medical center in Tokyo. We determined the amount of blood loss after delivery and covariates of age, parity, pre pregnancy body mass index (BMI), gestational weight gain (GWG), gestational week, pregnancy complications, lifestyles of smoking and drinking, placental weight, and infant weight and sex. RESULTS: The majority of participants had lost less than 500 ml of blood (n=868, 67%), 21% lost between 500-799 ml of blood (n=273), 12% lost 800 ml or more of blood (n=153). The amount of blood loss statistically increased (p<0.001) as pre pregnancy BMI category level increased from underweight (<18.5 kg/m2), normal (18.5-22.9 kg/m2), to overweight/obesity (≥23 kg/m2). Compared with the least category of GWG <8.2 kg, ≥8.2 kg GWG was statistically associated with a larger amount of blood loss category (p=0.032). Multinomial logistic regression analyses demonstrated that with the reference pre pregnancy BMI 18.5-22.9 kg/m2, obese and obesity mothers with pre pregnancy BMI ≥23 kg/m2 were at an increased risk of blood loss [OR 2.28, 95%confidence interval (95%CI): 1.48-3.50 for the category of 500-799 ml and OR 2.15, 95%CI: 1.29-3.59 for a category of 800 ml≤)]. In addition, pregnancy induced hypertension (PIH) (p=0.010) and infant weight (p<0.0001) significantly increased the risk of blood loss. CONCLUSIONS: In mothers with full-term singleton babies, increased pre pregnancy BMI overweight/obesity, PIH, and infant weight, were suggested to be risk factors for increased amount of blood loss.

Contribution of intramolecular NH···O hydrogen bonds to magnesium-carboxylate bonds.

A series of magnesium carboxylate complexes containing intramolecular NH···O hydrogen bonds were synthesized. Their molecular structures were determined by X-ray analysis. A direct NH···O hydrogen bond to the coordinated oxygen atom elongated the Mg-O bond, while a hydrogen bond to the carbonyl group shortened the Mg-O bond. Double NH···O hydrogen bonds significantly lowered the basicity of the carboxylate anion and prevented coordination to the Mg ion in a trans configuration; however, a cis-dicarboxylate complex was successfully obtained. Strong coordination of water to the Mg(2+) ion stabilizes the weak Mg-carboxylate bond at the trans position. In contrast, a weak Mg-carboxylate bond strengthens the Mg-O(water) bond, probably increasing the acidity. Based on the experimental results and theoretical calculations, a new switching mechanism is proposed. In the proposed mechanism, the acidity of the coordinated water on magnesium is controlled during catalytic hydrolysis in endonuclease.

Suppression of zinc-induced p53 phosphorylation and p21 expression by wortmannin in A549 human pulmonary epithelial cells.

In A549 cells treated with zinc sulfate (ZnSO(4)), the levels of p53 phosphorylated at Ser15 and total p53 protein increased. Treatment with wortmannin, an inhibitor of phosphatidylinositol 3-kinase (PI3K)-related kinases, suppressed ZnSO(4)-induced phosphorylation and accumulation of p53 protein. Expression of cyclin-dependent kinase inhibitor p21, one of the genes regulated by p53, was up-regulated following exposure to ZnSO(4), and suppressed by preincubation with wortmannin. These results suggest that zinc might induce the phosphorylation of p53 at Ser15 through wortmannin-sensitive pathway(s) at least in part, and result in the transactivation of the p21 gene in this human pulmonary epithelial cell line.

Phosphorylation of Stats at Ser727 in renal proximal tubular epithelial cells exposed to cadmium.

The effects of cadmium exposure on serine phosphorylation of signal transducers and activators of transcription (Stats) and an upstream kinase were examined in renal proximal tubular cells. In porcine LLC-PK1 cells treated with cadmium, Stat1 and Stat3 proteins were phosphorylated at Ser727 without changing total Stat protein levels. While phosphorylated forms of the members of mitogen-activated protein kinases (MAPKs) increased in response to cadmium exposure, treatment with a p38 inhibitor, SB203580 reduced Ser727 phosphorylation of Stat1 and Stat3 markedly in LLC-PK1 cells. The expression of human matrix metalloproteinase-3 (MMP-3), a Stats-inducible gene, was found to be up-regulated in human HK-2 cells exposed to cadmium, and suppressed by preincubation with SB203580. These results suggest that cadmium might induce the phosphorylation of Stat1 and Stat3 at Ser727 via the p38 pathway at least in part, and modulate gene expression in these proximal tubular cells.

Recurrent extensor tendon rupture in adult-onset dermatomyositis: a case report.

We report on a case in which recurrent extensor tendon rupture was caused by tenosynovitis without skin ulcer and calcinosis in adult-onset dermatomyositis involving the hand. Proliferative tenosynovitis of the extensor tendons led to recurrent elongation or rupture of the extensor tendons, and tendon graft produced the good postoperative result in this case.