Factors Related to Favorable Outcomes in Older Adults Undergoing Home-Visit Rehabilitation Therapy.

BACKGROUND: Increasing elderly population is a major health concern worldwide, requiring various at-home care services. The aim of home-visit rehabilitation therapy is to support at-home living of the elderly and to promote their participation in social activities. There is a paucity of data about the clinical conditions of this population that can contribute to the achievement of goals in-home visit rehabilitation therapy. AIM: This study aimed to clarify clinical variables that could be related to the achievement of goals in-home visit rehabilitation therapy. METHODS: We collected retrospective clinical data of the older adults who underwent home-visit rehabilitation therapy between July 2006 and June 2021. We searched the clinical variables of home-visit rehabilitation therapy users and their frequency of utilization of home-visit rehabilitation therapy services from the clinical record. The initial and final clinical variables evaluated in this study included the abilities of daily living, degree of being bedridden, dementia rating, and levels of support or long-term care. Those variables were evaluated by rehabilitation therapists and doctors. The users were divided into three groups according to the reason for terminating rehabilitation therapy: goal achievement (achieved group), aggravation of underlying disease (aggravated group), and treatment suspension because of their own/others' wish (suspended group). The clinical parameters concerning the rehabilitation program, care level, and activities of daily living were evaluated among the groups. The clinical parameters concerning the rehabilitation program, care level, and activities of daily living were statistically evaluated among those three groups, using the chi-square test and Kruskal-Wallis test. RESULTS: In the achieved, aggravated, and suspended groups, 45, 190, and 38 users were respectively enrolled. The aggravated group showed significantly higher final care level (p = 0.002), degree of being bedridden (p=0.001), and dementia rating (p = 0.017) and significantly lower Barthel index scores (p < 0.001) and Frenchay Activities Index scores (p = 0.001) than the achieved group. Persons requesting the therapy were significantly older adults themselves in the achieved group (p = 0.018). The therapy was significantly performed more than once per week in the achieved group (p = 0.018). CONCLUSIONS: Older adults undergoing self-motivated home-visit rehabilitation therapy more than once per week may contribute to the achievement of the goal.

Evaluation of a joint workshop on study design for hospital and community pharmacists: a retrospective cross-sectional survey.

BACKGROUND: Although pharmacists often identify numerous clinical questions, they face several barriers, including the lack of mentors for research activities in clinical settings. Therefore, a workshop for the appropriate selection of a study design, which is a fundamental first step, may be necessary. The purpose of this study was to evaluate the effectiveness of a workshop on study design for hospital and community pharmacists. Moreover, the characteristics of pharmacists with little involvement in research activities were extracted using decision-tree analysis to guide the design of future workshops. METHODS: A workshop was conducted on October 1, 2023. It comprised three parts: lectures, group work, and presentations. Questionnaire-based surveys were conducted with workshop participants regarding their basic information, their background that influenced research activities, their satisfaction, and their knowledge/awareness. For the questions on knowledge/awareness, the same responses were requested before and after the workshop using a five-scale scoring system. Multivariate logistic regression analysis was conducted to identify independent factors influencing research activities. Decision tree analysis was performed to extract low-effort characteristics of the research activities. RESULTS: Of the 40 workshop attendees, the overall satisfaction score for the workshop was 4.38 of 5, and the score for each question was 4 or higher. Significant increases were observed in the scores of knowledge/awareness after the workshop. Moreover, 95% of the pharmacists answered that it would be highly useful to conduct a joint workshop between hospitals and community pharmacists. Although independent influencing factors were not detected in the multivariate logistic regression analysis, the decision tree analysis revealed that pharmacists who were no member of an academic society (85%, 11/13) or members without any certifications or accreditations related to pharmacy practice (80%, 4/5) were the least active in clinical research. In contrast, those belonging to academic societies and holding certifications or accreditations related to pharmacy practice frequently conducted clinical research. CONCLUSION: The present study revealed that a joint workshop on study design may have the potential to change pharmacists' knowledge and awareness of research activities. Moreover, future workshops should be conducted with pharmacists who do not belong to academic societies.

Investigation of antimicrobial therapy for aspiration pneumonia in elderly nursing homes: a retrospective observational study in Japan

Objective: Poor prognostic factors in the treatment of infectious diseases in home care have not been studied to date. Further, there have been no studies on the appropriate use of antimicrobial agents for aspiration pneumonia in elderly nursing home. Therefore, this study was retrospectively investigated the status of antimicrobial use for aspiration pneumonia in elderly nursing homes, and the clinical efficacy of each antimicrobial therapy. Methods: Patients who received antimicrobial therapy for aspiration pneumonia between 2020 and 2022 were included. This study was investigated the compliance of antimicrobial therapy with recommended Japanese guidelines. The clinical efficacy and safety of the recommended and non-recommended antimicrobial therapies were examined. Results: Fifty patients with aspiration pneumonia were administered antimicrobials. The rate of compliance to the guidelines for the appropriate selection, dose, and duration of antimicrobials were 46%, 66%, and 66%. This investigation indicated that all three indicators were appropriate showed a higher clinical cure rate and lower mortality rate than those in groups for which all three indicators were inadequate (clinical cure, 91.7% vs. 0%, p = 0.008; 30-days mortality, 8.3% vs. 33.3%, p = 0.371). In addition, appropriate drug selection resulted in lower mortality, and appropriate dosing duration was significantly associated with better clinical cure rates (p<0.0001). Conclusions: Overall, the appropriate use of antimicrobials according to the guidelines appears to be associated with improved clinical outcomes in the treatment of aspiration pneumonia in elderly nursing homes (AU)

Vortex dynamics in the two-dimensional BCS-BEC crossover.

The Bardeen-Cooper-Schrieffer (BCS) condensation and Bose-Einstein condensation (BEC) are the two limiting ground states of paired Fermion systems, and the crossover between these two limits has been a source of excitement for both fields of high temperature superconductivity and cold atom superfluidity. For superconductors, ultra-low doping systems like graphene and LixZrNCl successfully approached the crossover starting from the BCS-side. These superconductors offer new opportunities to clarify the nature of charged-particles transport towards the BEC regime. Here we report the study of vortex dynamics within the crossover using their Hall effect as a probe in LixZrNCl. We observed a systematic enhancement of the Hall angle towards the BCS-BEC crossover, which was qualitatively reproduced by the phenomenological time-dependent Ginzburg-Landau (TDGL) theory. LixZrNCl exhibits a band structure free from various electronic instabilities, allowing us to achieve a comprehensive understanding of the vortex Hall effect and thereby propose a global picture of vortex dynamics within the crossover. These results demonstrate that gate-controlled superconductors are ideal platforms towards investigations of unexplored properties in BEC superconductors.

Determination of probability of causative pathogen in infectious keratitis using deep learning algorithm of slit-lamp images.

Corneal opacities are important causes of blindness, and their major etiology is infectious keratitis. Slit-lamp examinations are commonly used to determine the causative pathogen; however, their diagnostic accuracy is low even for experienced ophthalmologists. To characterize the "face" of an infected cornea, we have adapted a deep learning architecture used for facial recognition and applied it to determine a probability score for a specific pathogen causing keratitis. To record the diverse features and mitigate the uncertainty, batches of probability scores of 4 serial images taken from many angles or fluorescence staining were learned for score and decision level fusion using a gradient boosting decision tree. A total of 4306 slit-lamp images including 312 images obtained by internet publications on keratitis by bacteria, fungi, acanthamoeba, and herpes simplex virus (HSV) were studied. The created algorithm had a high overall accuracy of diagnosis, e.g., the accuracy/area under the curve for acanthamoeba was 97.9%/0.995, bacteria was 90.7%/0.963, fungi was 95.0%/0.975, and HSV was 92.3%/0.946, by group K-fold validation, and it was robust to even the low resolution web images. We suggest that our hybrid deep learning-based algorithm be used as a simple and accurate method for computer-assisted diagnosis of infectious keratitis.

Ferromagnetism and giant magnetoresistance in zinc-blende FeAs monolayers embedded in semiconductor structures.

Material structures containing tetrahedral FeAs bonds, depending on their density and geometrical distribution, can host several competing quantum ground states ranging from superconductivity to ferromagnetism. Here we examine structures of quasi two-dimensional (2D) layers of tetrahedral Fe-As bonds embedded with a regular interval in a semiconductor InAs matrix, which resembles the crystal structure of Fe-based superconductors. Contrary to the case of Fe-based pnictides, these FeAs/InAs superlattices (SLs) exhibit ferromagnetism, whose Curie temperature (TC) increases rapidly with decreasing the InAs interval thickness tInAs (TC ∝ tInAs-3), and an extremely large magnetoresistance up to 500% that is tunable by a gate voltage. Our first principles calculations reveal the important role of disordered positions of Fe atoms in the establishment of ferromagnetism in these quasi-2D FeAs-based SLs. These unique features mark the FeAs/InAs SLs as promising structures for spintronic applications.

A van der Waals interface that creates in-plane polarization and a spontaneous photovoltaic effect.

Van der Waals interfaces can be formed by layer stacking without regard to lattice constants or symmetries of individual building blocks. We engineered the symmetry of a van der Waals interface of tungsten selenide and black phosphorus and realized in-plane electronic polarization that led to the emergence of a spontaneous photovoltaic effect. Spontaneous photocurrent was observed along the polar direction and was absent in the direction perpendicular to it. The observed spontaneous photocurrent was explained by a quantum-mechanical shift current that reflects the geometrical and topological electronic nature of this emergent interface. The present results offer a simple guideline for symmetry engineering that is applicable to a variety of van der Waals interfaces.

Gate-controlled BCS-BEC crossover in a two-dimensional superconductor.

Bardeen-Cooper-Schrieffer (BCS) superfluidity and Bose-Einstein condensation (BEC) are the two extreme limits of the ground state of the paired fermion systems. We report crossover behavior from the BCS limit to the BEC limit realized by varying carrier density in a two-dimensional superconductor, electron-doped zirconium nitride chloride. The phase diagram, established by simultaneous measurements of resistivity and tunneling spectra under ionic gating, demonstrates a pseudogap phase in the low-doping regime. The ratio of the superconducting transition temperature and Fermi temperature in the low-carrier density limit is consistent with the theoretical upper bound expected in the BCS-BEC crossover regime. These results indicate that the gate-doped semiconductor provides an ideal platform for the two-dimensional BCS-BEC crossover without added complexities present in other solid-state systems.

Antiferromagnet-Semiconductor Van Der Waals Heterostructures: Interlayer Interplay of Exciton with Magnetic Ordering.

Van der Waals (vdW) heterostructures have attracted great interest because of their rich material combinations. The discovery of two-dimensional magnets has provided a new platform for magnetic vdW heterointerfaces; however, research on magnetic vdW heterointerfaces has been limited to those with ferromagnetic surfaces. Here, we report a magnetic vdW heterointerface using layered intralayer-antiferromagnetic MPSe3 (M = Mn, Fe) and monolayer transition-metal dichalcogenides (TMDs). We found an anomalous upshift of the excitonic peak in monolayer TMDs below the antiferromagnetic transition temperature in the MPSe3, capturing a signature of the interlayer exciton-magnon coupling. This is a concept extended from single materials to heterointerfaces. Moreover, this coupling strongly depends on the in-plane magnetic structure and stacking direction, showing its sensitivity to their magnetic interfaces. Our finding offers an opportunity to investigate interactions between elementary excitations in different materials across interfaces and to search for new functions of magnetic vdW heterointerfaces.

[A case of recurrent liposarcoma treated with bevacizumab chemotherapy resulting in prolonged disease-free survival and long-term overall survival].

Retroperitoneal dedifferentiated liposarcoma is associated with a poor prognosis, and the efficacy of chemotherapy in such cases is controversial. We report a case of long -term survival in a patient with dedifferentiated liposarcoma treated with bevacizumab after repeated local recurrences. A 65-year-old man complained of abdominal pain. Abdominal computed tomography (CT) showed a well-enhanced retroperitoneal tumor. The tumor was resected together with the right kidney and adrenal gland. On the basis of histopathological findings, the tumor was diagnosed as a dedifferentiated liposarcoma adenocarcinoma. Eleven months later, local recurrence was diagnosed and the tumor was resected. Thereafter, repeated local recurrences were diagnosed, and repeated tumor resections were performed. Local recurrence and distant metastasis in the axilla and scapula soft tissue was detected 5.9 years after the initial operation. Bevacizumab therapy was initiated, and the tumor markedly reduced in size. Bevacizumab treatment has been continued for 6.7 years after the initial operation, with no tumor recurrence or metastasis.

[Vanishing glottis cyst following difficult intubation].

A 68-year-old male patient underwent laparoscopic cholecystectomy under general anesthesia. Following anesthesia induction and muscle relaxation, laryngoscopy using Macintosh laryngoscope found a tumor of thumb size above the glottis completely obscuring the vocal cords. There appeared to be a possibility of tumor impaction into the glottis leading to total obstruction when the tumor was pushed down by a tracheal tube. Consent was obtained for emergency tracheostomy if necessary. The glottis and its surrounding were thoroughly observed using a fiberscope via the Fastrach laryngeal mask. The tumor appeared to be a soft cyst. A fiberoptic bronchoscope, tentatively introduced into the gap between the cyst and the epiglottis, went unexpectedly and smoothly into the trachea. A tracheal tube was introduced railroading over it. Information collected so far suggested that the patient was able to breathe without tracheal tube. As expected the patient did not show any difficulty in breathing and phonation following extubation. Seven days afterward, E.N.T. surgeon found no evidence of scarring or healing in the throat. The cyst might have been ruptured at the time of extubation or afterward, or absorbed.

Role of nitric oxide in the regulation of superoxide dismutase and prostaglandin F(2alpha) production in bovine luteal endothelial cells.

Prostaglandin F(2alpha) (PGF) induces a rapid reduction in progesterone production (functional luteolysis) followed by tissue degeneration and cell death (structural luteolysis). Reactive oxygen species (ROS) including nitric oxide (NO) play crucial roles in the luteolytic action of PGF. The local concentration of intraluteal ROS is controlled by superoxide dismutase (SOD), the main enzyme involved in the control of intraluteal ROS. To clarify the roles of NO in the regulation of SOD in luteolysis, we examined the effects of NO on SOD expression and activity in cultured bovine luteal endothelial cells (LECs) during short-term (2 h, mimicking functional luteolysis) and long-term (24 h, mimicking structural luteolysis) incubation. We also investigated whether NO modulates PGF production by LECs. LECs were isolated from mid-luteal phase CLs, and exposed to NONOate (a NO donor) for 2 or 24 h. SOD mRNA expression was stimulated by NONOate (10-100 microM) at 2 h (P<0.05). Moreover, 10 microM NONOate stimulated SOD protein expression and SOD activity at 2 h (P<0.05), whereas NONOate inhibited SOD mRNA and protein expressions at 24 h (P<0.05). NONOate stimulated PGF biosynthesis at both incubation times. The overall findings suggest that NO differently regulates SOD in cultured LECs, depending on the exposure time. Acute elevation of SOD may represent a response of LECs to protect themselves against oxidative stress induced by PGF during functional luteolysis, whereas a later reduction of SOD levels by NO may facilitate an excess of intraluteal ROS during structural luteolysis.

A long-term survivor after pancreaticoduodenectomy for metastatic undifferentiated carcinoma of an unknown primary.

Undifferentiated carcinoma of unknown primary (CUP) is a relatively rare disease and carries a dismal prognosis. With this context, there is no report of a long-term (> 5-year) disease-free survivor after a pancreaticoduodenectomy (PD). A 53-year-old female had complaints of intermittent high fever and a large palpable epigastric tumor. A CT scan revealed that a very large well-circumscribed solid mass occupied the posterior portion of the head of the pancreas and extended to the hepatic hilum. The serum carcinoembryonic antigen (CEA), CA-125 and carbohydrate antigen 19-9 (CA19-9) levels were within the normal ranges. A PD with hepatic arterial reconstruction was performed. Histologically, the tumor showed solid or diffuse proliferation of pleomorphic cells, and the immunohistochemistry suggested a metastatic tumor originating from the epithelium, the primary site was not determined despite of full review of all metastatic lesions to pancreas handled surgically and non-surgically. Adjuvant oral chemotherapy of UFT and cimetidine continued for 3 years and the patient alive and healthy 6 years after surgery. Even for dismal prognostic undifferentiated CUP, radical surgery would be an effective component of multidisciplinary treatment, provided that the tumor is respectable without elevation of serum tumor markers and adjuvant chemotherapy is able to appropriately supplement.

A long-term survivor of repeated inguinal nodes recurrence of papillary serous adenocarcinoma of CUP: case report.

BACKGROUND: Tumor spread beyond the peritoneal cavity in cases of papillary serous adenocarcinoma of the unknown primary (CUP) is a rare late event and carries a poor prognosis. CASE PRESENTATION: A 71-year-old female was referred to our hospital because of a large right inguinal tumor with biopsy evidence of carcinoma as well as an elevated serum CA125 (cancer antigen 125). She underwent complete resection of the right inguinal tumor and multiple pelvic tumors, which involved the rectum, ovary and uterus. Pathological examination revealed the tumors to be metastases of a papillary serous adenocarcinoma with a psammoma body of CUP. On the 28th postoperative day, newly developed asymptomatic small left inguinal node metastases in the setting of a normal CA125 level were removed. Four and a half years after the primary resection, the CA125 level increased again and newly developed asymptomatic metastases were found in the right deep inguinal nodes and extirpated at that time. All surgical resections followed the modified FAM (5FU, Adriamycin; ADM, MMC) regimen, including protracted dairy oral administration of UFT or 5'-FDUR, Cimetidine and PSK (protein-bound polysaccharide K) as an immunomodulator or biological response modifier in conjunction with intermittent one-day continuous infusion (ADM+MMC) or intermittent single bolus injection of ADM+MMC. At present, the patient has been living in good health for almost 7 years with no evidence of relapse. CONCLUSION: Aggressive resection surgery followed by effective adjuvant chemotherapy is necessary for surviving long time without relapse of poorly prognostic patients with metastases outside of the abdominal cavity from peritoneal papillary serous adenocarcinomas.

[A successful combination therapy with resection and infusion chemotherapy for a patient with metastases from cancer of unknown origin].

A 71-year-old female was admitted to our hospital because of a right inguinal mass in June 1999. She was diagnosed as having cancer of unknown origin with metastases of the right inguinal and pelvic space. These tumors were resected in July 1999, followed by resection of early postoperative relapse in the left inguinal nodes. Histopathological examination revealed that surgical specimens were metastases of bilateral inguinal nodes and pelvic peritoneum from adenocarcinoma of unknown origin. She received adjuvanting combination chemotherapy consisting of continuous oral administration of fluoropyrimidin derivatives and intermittent 24-hour continuous infusion of adriamycin plus mitomycin C for 2 years after resection. No significant adverse effects encountered in any treatment course. She is living healthily 42 months after surgery with no evidence of recurrence. Complete resection in combination with appropriate adjuvant chemotherapy was effective for cancer of unknown origin that had a poor prognosis.

A salvage treatment for solid liver metastasis after radical resection of Klatskin tumour.

BACKGROUND: Long-term survival has not been described following surgical resection for liver metastasis after radical resection of an advanced hilar bile duct carcinoma (Klatskin tumour). One such patient who developed liver metastasis after radical treatment for stage IVA (pTNM) hilar cholangiocarcinoma has survived 5.5 years after resection of the liver metastasis followed by chemotherapy. CASE REPORT: A 50-year-old man developed a solid liver metastasis in segment VIII 17 months after radical resection of a stage IVA (pT3 pN I MO) Klatskin tumour followed by postoperative radiotherapy (54 Gy) and systemic chemotherapy (oral UFT 450 mg/day plus intravenous cisplatin 20 mg on 5 consecutive days each month). The patient is alive at 7 years after the primary resection followed by resection of the liver metastasis plus further systemic chemotherapy comprising oral UFT combined with intravenous adriamycin (ADM) and mitomycin C (MMC). CONCLUSION: Aggressive salvage resection surgery can be an effective component of a multidisciplinary treatment regimen, even for a postoperative liver metastasis that developed after radical resection of an advanced Klatskin tumour, provided that the metastasis is solid and has not failed local-regional control.