Dementia Scale Classification with Sequential Model from Sleep Activity Data.

Dementia, a disorder caused by brain diseases, has been found to influence the sleep patterns of patients. The finding indicates that monitoring sleep activity is helpful to detect the change in cognitive status. With this in mind, the aim of this study is to explore the possibility to develop a machine learning model for classifying the scores of dementia screening tests based on sleep activity data which could be recorded with less burden for participants. In this study, We collected sleep activity data from 124 elderly patients with varying cognitive states, including heart rate, respiratory rate and depth of sleep, using a single sensor. The score of Mini Mental State Estimation (MMSE) cognitive test is used to determine the level of cognitive states. First, we conducted a statistical analysis of the measured sleep activity data to find specific features observed in people with low-MMSE scores. Second, we utilized an efficient sequence model for capturing time-series changes in sleep activity for binary classification of the dementia scale to detect such low-MMSE people. Our findings revealed significant distinctions in sleep patterns between high and low cognitive status groups, and in the classification task, a maximum macro F1 score of 0.67 was achieved using LSTM models. Our results suggest the validity of using sleep activity data for the prediction of dementia classification.

Cochineal dye-induced immediate allergy: Review of Japanese cases and proposed new diagnostic chart.

BACKGROUND: Cochineal dye is used worldwide as a red coloring in foods, drinks, cosmetics, quasi-drugs, and drugs. The main component of the red color is carminic acid (CA). Carmine is an aluminum- or calcium-chelated product of CA. CA and carmine usually contain contaminating proteins, including a 38-kDa protein thought to be the primary allergen. Severe allergic reactions manifest as anaphylaxis. The aim of this study was to review all Japanese reported cases and propose useful diagnostic chart. METHODS: All reported Japanese cases of cochineal dye-induced immediate allergy were reviewed, and newly registered cases were examined by skin prick test (SPT) with cochineal extract (CE) and measurement of CE and carmine-specific serum IgE test. Two-dimensional (2D) western blotting using patient serum was conducted to identify the antigen. RESULTS: Twenty-two Japanese cases have been reported. SPT and the level of specific IgE test indicated that six cases should be newly registered as cochineal dye allergy. All cases were adult females, and all cases except three involved anaphylaxis; 13 cases involved past history of local symptoms associated with cosmetics use. Japanese strawberry juice and fish-meat sausage, and European processed foods (especially macarons made in France) and drinks were recent major sources of allergen. 2D western blotting showed that patient IgE reacted to the 38-kDa protein and other proteins. Serum from healthy controls also weakly reacted with these proteins. CONCLUSIONS: SPT with CE and determination of the level of CE and carmine-specific IgE test are useful methods for the diagnosis of cochineal dye allergy.

Guide for medical professionals (i.e., dermatologists) for the management of Rhododenol-induced leukoderma.

Because some users develop depigmentation after the use of melanogenesis-inhibiting products containing the quasi-drug ingredient Rhododenol, Japanese Dermatological Association (JDA) established a Special Committee on the Safety of Cosmetics Containing Rhododenol on July 17, 2013 and management guide for dermatologists has been updated on the website in order to delineate the diagnostic criteria for Rhododenol-induced leukoderma and provides a broad guide for standard treatment based on current knowledge. This guide is produced on the basis of the guide (version 7) updated on June 20, 2014 in the website. Rhododenol-induced leukoderma refers to depigmentation of varying severity that develops after the use of cosmetics containing Rhododenol, mainly at the site of use. In most cases, repigmentation of part or all the affected area is evident after discontinuation. Histopathologically cellular infiltration around the hair follicles and melanophages are present in most cases. The number of melanocytes in the lesion is declined but not totally absent in most cases. Rhododenol itself is a good substrate for tyrosinase, resulting in the formation of Rhododenol metabolites (e.g., Rhododenol quinone). Melanocytes are damaged by Rhododenol metabolites during the subsequent metabolic process. The continued use of cosmetics containing Rhododenol thus induces tyrosinase activity-dependent cytotoxicity in melanocytes in the epidermis at application sites, resulting in decreasing the amount of melanin produced by melanocytes; the addition of some other factor to this process is believed to subsequently cause the decrease or disappearance of melanocytes themselves from the epidermis.

Testing the degradation effects of three reagents on various antineoplastic compounds.

OBJECTIVE: Studies for decontamination of antineoplastic compounds have been conducted for decades. Nevertheless, recent studies indicate the contamination of work place in hospitals, and the exposure of workers. In this study, to develop an effective cleaning method for contaminated environments, the degradation efficacies of antineoplastic compounds by reagents were evaluated. METHODS: The degradation efficacies of various combinations of three reagents (sodium hypochlorite, sodium thiosulfate, and sodium hydroxide) were evaluated with four antineoplastic compounds (cyclophosphamide, epirubicin, cisplatin, and carboplatin). The residues of antineoplastic compounds were measured with high-performance liquid chromatography. RESULTS: Of the three reagents, sodium hypochlorite was the most effective to all antineoplastic compounds used in this study. Although sodium hypochlorite degraded 86.6% of cyclophosphamide, it degraded other three antineoplastic compounds completely. The combination with sodium hypochlorite and sodium thiosulfate degraded only 3.3% of cyclophosphamide, since sodium thiosulfate inhibited the degradation ability of sodium hypochlorite. Similarly, the combinations used in all three reagents failed to degrade cyclophosphamide. CONCLUSION: Although three of four antineoplastic compounds were degraded successfully, any combinations of three reagents could not degrade cyclophosphamide completely. However, the addition of sodium thiosulfate which inhibits the corrosion of metal by sodium hypochlorite is essential for daily cleaning. Therefore, the evaluation of reaction time before the addition of sodium thiosulfate may be required. We will continue to investigate the reagents for degradation.

[Measures of preventing occupational exposure to hazardous drugs-based on new insights].

Little attention has been paid to the hazards that healthcare professionals may be exposed to when administering drugs to patients. Hazardous drugs, even in very low concentrations, can produce adverse reactions in patients and in healthcare professionals who handle the drugs or work in the vicinity. Small amounts of hazardous drugs have been detected in the urine of healthcare professionals who prepare or administer these drugs even with the use of safety protection. Moreover, environmental contamination of hazardous drugs has been reported in a survey of patient care surroundings even when handling guidelines have been followed. The academic subcommittee of the Japanese Society of Hospital Pharmacy has established guidelines for the handling of hazardous drugs; however, reports suggest that there are problems with compliance to the guidelines. Recently, closed system devices have been marketed for use in healthcare settings to reduce environmental contamination during drug preparation. However, these devices have not gained widespread use because of their high cost and incompatibility with certain products like ampules. In addition, it is not clear whether the hazardous drugs are deactivated by these devices. In an effort to prevent healthcare professionals from being exposed to hazardous drugs, it is important to clean up contaminated surfaces and also to prevent dangerous drugs from spreading.

Multicenter study for environmental and biological monitoring of occupational exposure to cyclophosphamide in Japan.

PURPOSE: A multicenter field survey of environmental contamination and exposure of healthcare professionals to anticancer drugs were performed. SETTING: Three university hospitals, one cancer specialty hospital and two corporate hospitals from across Japan. METHOD: The environmental contamination with cyclophosphamide (CP) was investigated. A wipe examination was performed at six sites apiece in two divisions. The urinary excretion of the CP over 24 h was determined. The subjects of the survey included physicians, pharmacists, and nurses, for a total of seven at each facility irrespective of job title. The wipe samples were collected at 12 sites within two divisions at each facility. For the exposure survey, the total urine volume was determined, and a portion of the urine sample was then collected from each participants at each facility. Urine was collected for 24 h. The samples were determined by using the GC-MS method. RESULTS: Wipe examination: contamination with CP was identified at 50% of the sites. The concentration was high (CP > 1.00 ng/cm(2)) in the general environment in two hospitals and in the safety cabinet in one hospital. In the survey for the exposure of staff to anticancer drugs, 276 samples were obtained from 41 healthcare professionals. CP was detected in 90 samples obtained from 23 subjects. The amount of exposure was greatly different among the facilities. The urinary excretion of CP per subject was between 2.7 and 462.8 ng/24 h. The range of urinary excretion for each hospital was between 4.6 and 211.2 ng/24 h.

Risks to health professionals from hazardous drugs in Japan: a pilot study of environmental and biological monitoring of occupational exposure to cyclophosphamide.

PURPOSE: In Japan, concerns exist regarding the dangers inherent when handling cytotoxic drugs, particularly drugs such as 5-FU, Thiotepa, Cytarabine, Tegaful, and Sizofiran which are contained in ampoules or vials, since nurses and medical doctors have been preparing these cytotoxic drugs in the open spaces of wards in the absence of appropriate garments and personal protective equipment. In addition, the administration tubes for these dangerous drugs have been exchanged at the patients' bedside, typically in rooms shared by several patients. To gain insight into the severity of the occupational hazards posed by these practices, we conducted a pilot study of environmental and biological monitoring of occupational exposure to cyclophosphamide (CP). SETTING: At Nagoya University Hospital, Nagoya, Japan, in February 2006, two departments, A and B, were monitored with surface-wipe, and urine samples were analyzed using the Sessink method (exposure control, The Netherlands). Department A had a preparation room with biological safety cabinet (BSC) where the pharmacists prepare cytotoxic drugs. Department B did not have a BSC. RESULTS: Many areas of the treatment rooms were contaminated with CP. CP was detected on tables and telephone stands where cytotoxic drugs were not used as well as tables used to prepare cytotoxic drugs. Significant differences in CP concentrations were detected from the urine of two of the three nurses who cared for the same patients without gloves. The nurses rotated and inherited the patient who had the highest risk of contamination. CP was detected only once from the urine of the medical doctor who prepared CP. He was not wearing any PPE other than gloves. All of the pharmacists wearing PPE were free from contamination of CP. DISCUSSION: Regardless of the use of BSC, wards were contaminated with CP. The contamination may not occur due to the sealing used in CP containers and administration tubes when discarding them. CP was detected only once in the urine of a medical doctor who prepared CP by warming it. The cause may be inhalation of CP gas from the injector. The contamination of the nurses may be from dermal absorption because absorption continued even after the shift ended and the nurses left the facility. CP was not detected in pharmacists who followed the guidelines for preparation of CP. All of the medical staff should follow the guidelines when they handle CP.

The Latent Risk of Acidosis in Commercially Available Total Parenteral Nutrition (TPN) Products: a Randomized Clinical Trial in Postoperative Patients.

To evaluate the latent risk of acidosis in commercially available total parenteral nutrition (TPN) products, three types of commercially available TPN products were compared in postoperative patients. Sixty-four hospitalized patients with gastro-intestinal disease who undertook curative gastro intestinal resection were studied prospectively and administered with TPN solutions. Three types of commercially available TPN products were assigned randomly to eligible patients. Serial studies of blood acid-base status, serum electrolytes, and urinary acid-base status were conducted in the three groups administered with different TPN solutions. Patients received appropriate electrolytic solutions on the operation day and TPN solution from 2 to 7 days after operation. There were no differences among any of the serum electrolytes in the three groups. In one group, urinary pH decreased slightly and urinary net acid excretion (NAE) increased significantly after administration. This TPN product contains about 40 mEq/L of non-metabolizable acid to avoid the Maillard reaction that produces a complex of glucose and amino acids. Urinary NAE did not change in the other two groups. These TPN products do not use non-metabolizable acid to adjust pH. The present results suggest that the non-metabolizable acid may be a risk factor of metabolic acidosis.

Trends in drug use in intensive care units in Japan: determinants of drug utilization under an evidence-based approach to medicine.

OBJECTIVE: To clarify actual drug expenditures used in ICUs, and to evaluate the relationship between these expenditures and therapeutic evidence. Test Sites: Ten university hospitals located in six different regions of Japan (Tohoku, Kanto, Chuubu, Kinki, Chuugoku and Kyuushuu areas). DESIGN: Cross-sectional surveys of drug expenditures in ICUs throughout Japan. METHOD: The 10 leading pharmaceutical products, based on drug expenditures per month, were investigated. The ICUs at 10 facilities (national, public, and private university hospitals) were randomly selected from the attendees of the annual university training seminar. A postal questionnaire was sent to ten university hospitals located in six different regions (Tohoku, Kanto, Chuubu, Kinki, Chuugoku, and Kyuushuu areas) of Japan. The level of evidence was investigated to determine whether the use of the most expensive drug is rational or not. RESULTS: The response rate was 80% (8/10). Pharmacists in each hospital filled in the questionnaire to determine drug expenditure per ICU bed. The consumption of protease inhibitors based on drug expenditure per bed ranked the highest out of 14 different drugs used in the ICUs studied. The average drug expenditures ranked as follows: protease inhibitors > antithrombin III (AT III) > albumin-derived products > intravenous immunoglobulin > human haptoglobin. There was a 100-fold difference in the expenditures on protease inhibitor drugs between Nagoya university hospital and the hospital which consumed the most. It has been reported that there is little evidence of the effectiveness of protease inhibitors and AT-III for critically ill patients in the ICU. CONCLUSION: We analyzed the data from a questionnaire about drug expenditures in ICUs, responded to by 8 Japanese university hospitals. Although protease inhibitors accounted for a large percentage of all drug expenditures in the ICUs, the evidence supporting their usage was insufficient. Therapeutic evidence is important for determining physicians' prescriptions.

A survey of the use of synthetic surgical sutures.

UNLABELLED: We conducted a survey of the use of synthetic surgical sutures for the purpose of making clear the current status of their use. METHOD: We collected the suture packages used from each surgery over a one month period, and counted the number of sutures. RESULT: We found that for aortic aneurysm surgeries, liver surgeries, pancreatic tumor surgeries, etc., over 100,000 yen worth of synthetic surgical sutures were used. Also, for surgeries such as plastic surgery procedures that involve microsurgery, cardiovascular surgery, thyroid surgery, liver surgery, pancreatic tumor surgery, and open gynecological surgeries, the average cost of synthetic sutures is over 10% of the surgical charge. As is seen above, for surgeries which used a great amount of synthetic surgical sutures, the cost of synthetic surgical sutures occupied the surgical technical fee. Based upon the concept of separating the technical fee and the device cost, the cost of synthetic surgical sutures should be excluded from the surgical charge, and a process should be put into place whereby they can be billed to insurance separately.