Exploring Risk Factors of Patient Falls: A Retrospective Hospital Record Study in Japan.

Patient falls are common adverse medical events in hospitals. The objectives of this study were to clarify the factors of patient falls at hospitalization or transfer to another ward, which could be assumed that patients experience new environment. Patients who were hospitalized or transferred to another ward at a hospital in Japan, between January 14 and February 14, 2014 were included. We used a risk assessment sheet and applied stepwise regression analysis to identify factors of patient falls. We also investigated changes in patient conditions on the risk assessment sheet by the chi-square test. A total of 1,362 patients (53.2% female; mean age, 57.1 ± 18.0 years) were eligible for analysis, and 38 (2.8%) fell during the study period. The fallers were significantly older than the non-fallers (63.8 ± 18.0 vs. 56.9 ± 18.7 years, P = 0.03), but no significant difference was seen in sex (55.3% vs. 53.1% female). "History of falls", "Tubes inserted", "Need assistance/supervision for toileting" and "Excretion more than two times per night" were significantly related to patient falls (adjusted odds ratios [95% confidence interval]: 2.41 [1.05-5.53], 3.64 [1.57-8.43], 4.52 [2.00-10.23] and 3.92 [1.38-11.09]). Among 30 fallers, "Overestimation or non-understanding of own physical abilities" was significantly more frequent after falls (30.0%) than before falls (6.7%, P = 0.02). The factors found in this study might be useful for identifying patients at higher risk of falls.

Simultaneous determination of pancuronium, vecuronium and their related compounds using LC-ESI-MS.

A simultaneous determination method of quaternary amino steroidal muscle relaxants, pancuronium (PAN), vecuronium (VEC), and 17-monodesacetyl pancuronium (17-OH-PAN), 3,17-bisdesacetyl pancuronium (3,17-OH-PAN), 3-monodesacetyl vecuronium (3-OH-VEC), 3,17-bisdesacetyl vecuronium (3,17-OH-VEC) in human serum was developed using liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS). The weak cation exchange cartridge was useful for the extraction of these compounds. Under optimized LC-ESI-MS conditions, these compounds were almost fully separated within 6.5 min. Linear responses over the concentration range 0.25-50.0 ng/mL were demonstrated for each compound. The developed method successfully detected VEC, 3-OH-VEC and 3,17-OH-VEC in serum intravenously administered with VEC. The level of 3-OH-VEC was higher than other compounds. This suggested that 3-OH-VEC was useful as a forensic probe in VEC administration.

Transport of fluorescent chenodeoxycholic acid via the human organic anion transporters OATP1B1 and OATP1B3.

This study sought to clarify the contributions of organic anion-transporting polypeptide (OATP) 1B1 and 1B3 to the liver uptake of chenodeoxycholic acid (CDCA). We synthesized a fluorescent version of CDCA, chenodeoxychilyl-(Nepsilon-NBD)-lysine (CDCA-NBD), to characterize transporter-mediated uptake. CDCA-NBD is efficiently transported by OATP1B1 and OATP1B3 with high affinities. The Michaelis-Menten constants for CDCA-NBD uptake by OATP1B1 and OATP1B3 were 1.45 +/- 0.39 microM and 0.54 +/- 0.09 microM, respectively. By confocal laser scanning microscopy, CDCA-NBD, which is taken up by OATP1B1 and OATP1B3, was observed to localize to the cytosol. We also examined the transport of newly synthesized fluorescent bile acids. NBD-labeled bile acids, including cholic acid, deoxycholic acid, lithocholic acid, and ursodeoxycholic acid, were all transported by OATP1B1 and OATP1B3. CDCA-NBD exhibited the highest rate of transport of the five NBD-labeled bile acids examined in OATP1B1- and OATP1B3-expressing cells. Our results suggest that OATP1B1 and OATP1B3 play important roles in CDCA uptake into the liver. Fluorescent bile acids are useful tools to characterize the uptake properties of membrane transporters.

Quantitative liquid chromatography-tandem mass spectrometric analysis of 11-dehydro TXB2 in urine.

A simple and selective determination method of 11-dehydrothromboxane B2 (11-dehydroTXB2), which is urinary metabolite of TXA2, has been developed employing liquid chromatography-tandem mass spectrometry (LC-MS-MS). 11-DehydroTXB2 and its deuterium-labeled analogue as an internal standard were extracted from urine by simple solid-phase extraction (SPE). These compounds were analyzed using LC-MS-MS in the selected reaction monitoring (SRM) mode, by monitoring the transitions from m/z 367 to m/z 161 for 11-dehydroTXB2 and from m/z 371 to m/z 165 for its internal standard. A good linear response over the range 50 pg-10 ng per tube was demonstrated. The values determined by LC-MS-MS were well validated and closely corresponded to the values determined by gas chromatography-mass spectrometry (GC-MS). The mean concentration of 11-dehydroTXB2 in urine of healthy adults was 635 +/- 427 pg/mg creatinine (mean +/- S.D., n = 13). This simple, accurate and selective determination method described in this study should greatly aid in evaluating the role of TXA2 in vivo.

Determination of urinary 12(S)-hydroxyeicosatetraenoic acid by liquid chromatography-tandem mass spectrometry with column-switching technique: sex difference in healthy volunteers and patients with diabetes mellitus.

We developed a determination method for human urinary 12-hydroxyeicosatetraenoic acid (12-HETE) using LC-MS-MS. This method, which includes simple extraction and detection in the SRM mode, allows precise and accurate determination of 12-HETE. There was a significant sex difference in urinary 12-HETE levels. Chiral analysis of 12-HETE using LC-MS-MS with column-switching technique revealed that the major enantiomer was 12(S)-HETE. Furthermore, the urinary level in patients with diabetes mellitus (DM) was analyzed. The present in vivo findings indicate that there could be difference in production of 12(S)-HETE between genders and 12(S)-HETE may play a role in the pathogenesis of DM.