Self-harm and Suicide Attempts in a Japanese Psychiatric Hospital.

OBJECTIVE: Self-harm and attempted suicide are risk factors for suicide in psychiatric hospital in-patients. This study aimed to analyse the circumstances of self-harm and suicide attempts in a Japanese psychiatric hospital so as to improve management and care. METHODS: Incident reports of self-harm and suicide attempts during a 12.4-year period from November 2000 to March 2013 were reviewed. A descriptive analysis was conducted in terms of age, sex, and diagnosis of patients, as well as level, ward, situations, and causes of incidents. RESULTS: During the study period, 90 cases of self-harm and attempted suicide involving 58 patients were reported. The rate of self-harm and suicide attempts was 0.05 per 1000 patient-days. The types of selfharm and suicide attempts included hanging (n = 25), wrist cutting (n = 19), ingestion of foreign objects (n = 17), and others (n = 29). The single case of completed suicide involved hanging, in a patient with schizophrenia. Among 55 patients with relevant data, the most common clinical diagnosis was mood disorder (41.8%), followed by schizophrenia (36.4%). Mood disorder was 3.5 times as prevalent in females as in males (14 vs. 4). Fourteen patients with mood disorder (n = 8) or schizophrenia (n = 6) were repeatedly involved in 46 of 89 cases of self-harm or attempted suicide; 11 were female. One woman with mood disorder attempted suicide 9 times within the same year. The top 3 management and care factors related to self-harm and suicide attempts were failure to adhere to preventive procedures (28%), insufficient therapeutic communication (28%), and difficulty in predicting suicide (20%). CONCLUSION: Self-harm and suicide attempts at this psychiatric hospital occurred at a rate of 0.05 per 1000 patient-days between late 2000 and early 2013. Efforts are needed to increase compliance with suicide prevention procedures and therapeutic communication, so as to improve management and care of psychiatric in-patients and prevent them from committing suicide.

Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolated from a university teaching hospital in Japan.

Clostridium difficile infection control strategies require an understanding of its epidemiology. In this study, we analysed the toxin genotypes of 130 non-duplicate clinical isolates of C. difficile from a university hospital in Tokyo, Japan. Multilocus sequence typing (MLST) and eBURST analysis were performed for these isolates and nine strains previously analysed by polymerase chain reaction (PCR) ribotyping. Minimum inhibitory concentrations (MICs) were determined for six antibiotics, and the bacterial resistance mechanisms were investigated. Ninety-five toxigenic strains (73%), including seven tcdA-negative, tcdB-positive and cdtA/cdtB-negative strains (A(-)B(+)CDT(-)) and three A(+)B(+)CDT(+) strains, and 35 (27%) non-toxigenic strains, were classified into 23 and 12 sequence types, respectively. Of these, sequence type (ST)17 (21.8%) was the most predominant. MLST and eBURST analysis showed that 139 strains belonged to seven groups and singletons, and most A(+)B(+)CDT(-) strains (98%, 89/91) were classified into group 1. All isolates were susceptible to metronidazole, vancomycin and meropenem; the ceftriaxone, clindamycin and ciprofloxacin resistance rates were 49, 59 and 99%, respectively. Resistance rates to ceftriaxone and clindamycin were higher in toxigenic strains than in non-toxigenic strains (P < 0.001). All ST17 and ST81 strains were resistant to these antibiotics. The clindamycin- and fluoroquinolone-resistant strains carried erm(B) and mutations in GyrA and/or GyrB, respectively. To our knowledge, this is the first MLST-based study of the molecular epidemiology of toxigenic and non-toxigenic strains in Japan, providing evidence that non-toxigenic and toxigenic strains exhibit high genetic diversity and that toxigenic strains are more likely than non-toxigenic strains to exhibit multidrug resistance.

Laser-induced chemical reaction characterization in photosensitive aqueous solutions.

A dual-wavelength on/off-excitation thermal lens technique was used to identify and quantify a laser-induced chemical reaction in ionic aqueous solutions of Fe(II)-TPTZ. On/off modeling was used to fit the TL experimental data, which provided the primary effect generated during laser-excitation. The addition of HCl in the solutions reduced the activation barrier; this behavior followed the Arrhenius correlation. The nature of the photo-oxidation of Fe(II)-TPTZ complex is discussed. The results suggest that this technique may contribute to the understanding of the dynamics of complex reactions, which may lead to a more precise determination of the physicochemical properties involved in a photochemical reaction.

Foramen magnum decompression for the treatment of Arnold Chiari malformation type I with associated syringomyelia in an elderly patient.

STUDY DESIGN: Report of a rare case of an elderly patient with late onset of Arnold Chiari malformation type I with associated syringomyelia that was successfully treated with foramen magnum decompression. OBJECTIVE: To report this rare case along with a literature review. SETTING: Gifu, Japan. METHODS: A 69-year-old woman with a 4-year history of dull pain in her right arm was referred to the clinic. After physical and radiographical examinations, she was diagnosed with Arnold Chiari malformation type I with associated syringomyelia. A foramen magnum decompression by the removal of the outer layer of the dura mater was performed. RESULTS: At 2 years postoperatively, MRI revealed a decrease in the size of the syringomyelia. Her symptoms had also remarkably improved. CONCLUSIONS: A rare case of symptomatic Arnold Chiari malformation type I with associated syringomyelia in an elderly woman was successfully treated with foramen magnum decompression by the removal of the outer layer of the dura mater.

Symmetry-resolved vibrational spectroscopy for the C 1s(-1)2 pi(u) Renner-Teller pair states in CO(2).

Symmetry-resolved excitation spectra have been measured for the Renner-Teller pair states A(1) and B(1) split from the core-excited C 1s(-1)2 pi(u) state in CO(2). A vibrational progression with the spacings of approximately 145 meV is found in both the A(1) and B(1) spectra at different energies and assigned to the symmetric stretching mode caused in the B(1) linear state, with the help of ab initio calculations. Appearance of the vibrations in the A(1) spectrum is interpreted as due to non-adiabatic coupling between the A(1) and B(1) states via the bending motion.

[Do patients and/or physicians have a right to control medical information].

An ongoing debate is underway on whether the right to control medical information required for objective evaluations and uncertain information should belong to the physician. In this study, the opinions of practicing physicians were examined. Information appearing on medical records was divided into 10 items, and physicians were asked whether the right to control each item belonged to the patient and/or the physician. More than 60% the physicians answered that both patients and physician have the right to control information such as the diagnosis, examination findings, informed consent, and treatment. All of these items can be categorized as personal data. On the other hand, more than 70% of the physicians believed that only physicians have the right to control information such as the process to reach a diagnosis, subjective patient information, uncertain information and discussion with other physicians. Those physicians who answered that that both patients and physicians have the right to control information such as subjective patient information were more in favor of the disclosure of medical records than the physicians who were against the patient's right to control such information (p<0.05). The results of this study suggest that the right to control medical information on medical records should be considered separately for each chart item. As the network of medical information advances, the right to control medical information will become a topic of increasing importance.

[Does disclosure of medical records to patients influence medical care?].

UNLABELLED: Disclosure of medical records to patients has been assessed, but the influence of disclosure on medical care has not been well researched. To address this situation, this study was conducted to test three hypotheses: 1) doctors think that the disclosure can influence medical care, 2) whether doctors think disclosure can influence medical care depends on how they rank medical records (for example, as evidence for diagnosis and treatment, a process to reach a diagnosis, a tool to communicate with other medical staff, etc), and on whether they think medical record disclosure could change the content of the record. Questionnaires were sent to 881 doctors who work at two hospitals affiliated with N Medical School and K Medical University. RESULTS: Four hundred eighty-eight doctors responded. The findings related to the hypotheses were as follows: 1) Those who answered that the disclosure could have an influence on medical care were 49.1% of the total. 2) There was no relation between how doctors ranked medical records and whether they thought disclosure could influence medical care. 3) Doctors who answered that there were things that they would not be able to write if medical records were disclosed accounted for 73.5% of the total. These doctors answered "yes" significantly higher to the question that the disclosure could influence medical care than others (Odds 3.6, P < 0.01). Doctors who thought they would not be able to enter the diagnosis, the name of the disease for insurance, self-evaluation, information that could be judged and subjective information answered that disclosure could influence on medical care (P < 0.05). It was assumed that disclosure of medical records to patients could change the content of the medical records and that could influence medical care. How to deal with information will become an important issue if records are disclosed.

A preliminary study on the knowledge and attitudes of physicians at two university hospitals towards the medical insurance system of Japan.

In this preliminary study, we surveyed the physicians at two academic hospitals on their knowledge of and attitudes toward the medical insurance system in Japan. Most of the physicians had not read the "Ministerial Ordinance on Insurance Medical Institutions' and Insurance Medical Doctors' Medical Treatment under Health Insurance." Of the 433 physicians who filled out the questionnaire completely, 34% had either not read or rarely read the "Medical Fee Point List." Most (89.1%) of the physicians knew that there is a stepwise reduction in the hospitalization fee as the length of a patient's hospital stay increases. However, approximately 30% did not know the stipulation of obtaining an informed consent from the patient prior to blood transfusion. As for the right of patients to see their medical care remuneration statements, which was decided by the government in 1997, 26.8% of the physicians did not know this rule. Physicians who had read the "Ministerial Ordinance on Medical Treatment," were more likely to read the "Medical Fee Point List" frequently; were more likely to know the stipulation about diminishing hospitalization fee; were more likely to know that an informed consent must be obtained prior to blood transfusion; and were more likely to know that patients had a right to see their medical care remuneration statements. The longer the clinical experience of the physician, the more likely that the physician had read the "Ministerial Ordinance on Medical Treatment" and know the other stipulations well. In these two academic hospitals, it is important to establish educational seminars for physicians on the guidelines of the medical insurance system so that physicians will become familiar with the medical insurance system quickly.

[Lifestyle and health status of homeless people around Shibuya Station, Tokyo].

The number of homeless people in Tokyo is estimated to be 3,200-3,300. While studies on the health status of homeless people, including illness, injury and deaths have been previously reported, most of these reports concern the homeless who resided in housing facilities for the homeless or who admitted to hospitals. We undertook a comparison of lifestyle and health status between homeless people and people who live in houses (as a control group). Health status was also analyzed for differences among homeless people. Subjects were asked by questionnaire regarding their age, the length of being homeless, former and present employment, sleeping condition, food, whether they have friends or not, the amount of smoking per day, and Short-Form-36 Health Survey (SF36). As objective findings, measurement of blood pressure and blood testing were also performed. Fifty-three homeless people, 49 male, 4 female, average age 52, from the areas around Shibuya station and Yoyogi park, were enrolled. While 98% of the homeless people had previous employment, 73% were not working when the study was performed. Compared with control group, the homeless had fewer meals per day, fewer friends, excessive smoking, greater history of gastro-duodenal ulcer and injury, greater limitation due to physical problems, and higher general mental health as measured by SF36. The diastolic blood pressure of the homeless was higher than that of the control. The blood testing showed higher white blood cell counts and platelet counts. It was suggested that changes in the social structures were largely influential in causing life, and that access to health care was limited because of financial and social barriers. Further studies with more samples, survey of social volunteers involved in care of homeless and qualitative data would be necessary to find and develop better support system for the homeless.

The psychological and physiological effects of an intensive-care unit environment on healthy individuals.

OBJECTIVE: The ideal inpatient environment would be one in which patient stress and anxiety are alleviated, but current inpatient hospital settings often do not seem to take this fact into consideration. To date, the effects of the actual hospital environment itself on patients is poorly understood. The purpose of the present study was to investigate the types of psychological and physiological changes that people undergo in response to being placed in an inpatient setting. DESIGN AND SETTING: Ten healthy volunteers were admitted to an intensive-care unit (ICU) for 4 days and 3 nights. The psychological and physiological changes before and after admission were examined. A qualitative assessment was also performed. RESULTS: Most healthy individuals at times develop feelings of depression, which can be measured by the Profile of Mood States and the Zung Self-Rating Depression Scale (P < .05). In this study, participants' fatigue and confusion increased (P < .05) and vigor decreased (P < .01) as measured by the Profile of Mood States. There was also an increase in the General Health Questionnaire scores (P < .01). However, no significant physiological effects were apparent, as measured by peripheral lymphocyte counts, natural killer cells activity, and urinary 17-kerosteroid and 17-hydroxycorticosteroid levels. Subjects often engaged in introspection during hospitalization and often had a negative attitude towards the hospital environment. CONCLUSIONS: The findings of increased feelings of depression attributable solely to being in an ICU setting are inconsistent with the type of environment generally considered necessary to alleviate patient anxiety and tension in a critical-care-ward environment. The negative perception of this environment strongly suggests room for improvement. Efforts in this regard should focus on improving the five senses, particularly sight, sound, and taste within the ICU.

A low catalase activity in dog erythrocytes is due to a very low content of catalase protein despite having a normal specific activity.

Catalase was purified to an apparent homogeneity from dog erythrocytes and its properties were compared with those of human erythrocyte catalase. Purification was unsuccessful without the use of glycerol as the stabilizing agent. Molecular weight of the purified dog catalase was estimated to be about 63,000 Da in monomer and about 230,000 Da in native tetramer form. The ratio of A405/A280, the index of hematin content relative to protein, was 1.15. The isoelectric point was in the range of 5.8 to 6.4. These properties of dog catalase were very similar to those of human catalase. Dog catalase also possessed the same partial amino acid sequence as human catalase. However, the specific activity of dog enzyme was about threefold less than that of human enzyme. The amount of catalase protein in dog erythrocytes determined by immunoblotting analysis was about tenfold less than that of human erythrocytes. This was consistent with the fact that the catalase activity in dog hemolysate was about 1/30 of that in human hemolysate.

[Alcoholic problem among homeless people around Shibuya Station].

It has been reported that the general public has the impression that many of the homeless people have alcoholic problems, and that these problems make their life problems worse. While there has been some research on this subject, most of them focus on the people who use public or private services. So, this study was conducted to investigate the alcoholic problems focused on the homeless people who were around Shibuya station. An investigation covering the questions about their job, company, sleeping style, amount of alcohol taken per day, CAGE and blood examination was compiled using questionnaires. The results were compared with people who are not homeless people and among homeless people. There were forty-nine homeless people who responded to the questionnaire and 34 homeless people who responded to the blood examination. The mean age of the homeless people was 53.1 years and no significant difference was seen between the homeless and the control. About 46% of the homeless reported that they do not drink. Sixteen per cent of the homeless respondents answered positively to the CAGE, No difference was found in having past history of liver dysfunction and in blood examination between them. There was a tendency that the amount of alcohol increases when the homeless have company. The level of gamma GTP increased significantly according to the amount of alcohol (p < 0.05). This study can be valued because of the attempt to focus not on the homeless who use services but on the homeless who stayed in the city. But the number of the targeted homeless people was small and there was selection bias that is not easy to be excluded in this type of research. Further studies on the impact of alcohol etc. should be developed to improve their lives.

Ultrasound biomicroscopy in the diagnosis of persistent hypotony after vitrectomy.

PURPOSE: To describe a case of persistent hypotony after an otherwise successful vitreous surgery for epiretinal membrane, in which ciliochoroidal detachment was detected by ultrasound biomicroscopy but not by ophthalmoscopy. METHOD: We used ultrasound biomicroscopy to determine the cause of persistent postoperative hypotony. RESULTS: Ultrasound biomicroscopy clearly disclosed ciliochoroidal detachment. In an attempt to resolve ciliochoroidal detachment, we performed vitrectomy and fluid-gas exchange combined with diathermy around the sites of sclerotomy. Postoperatively, the regression of ciliochoroidal detachment was confirmed by ultrasound biomicroscopy. CONCLUSIONS: Using ultrasound biomicroscopy, we were able to visualize ciliochoroidal detachment and its regression clearly, which we had not observed during ophthalmoscopy.

Myofibrils and Meat Texture of Broilers Fed on a Diet of Tochu Leaf Powder.

Feeding of Tochu leaf to broiler was done to discover the role of myofibrilar protein and the effects of Tochu on meat toughness. The quality and quantity of myofibrillar protein was the same between Tochu-fed muscle and the controls. The improvement of meat quality should be concluded to be due to collagen as reported before and not due to the myofibrillar proteins.

[Study on azithromycin in treatment of diffuse panbronchiolitis].

In the treatment of diffuse panbronchiolitis, azithromycin (AZM), a new macrolide antibiotic with 15-membered lactone ring, was studied for its efficacy and safety. AZM, 250 mg, was intermittently administered to a total of 60 patients twice a weeks, for 3 months as a rule, and its efficacy was clinically evaluated in 52 patients and the safety in 55. The rate of efficacy was 84.6% (44/52). Clinical findings 12 weeks after the start of administration showed a decrease in sputum volume in 30 of 46 patients and amelioration of dyspnea on exertion in 23 of 46 patients, and no worsening of symptoms was observed in the patients. Vital capacity (4/22), FEV1.0 (6/21), cold agglutination reaction (22/28), and CRP (16/36) were also improved. The rate of eradication of organisms isolated from the sputum except for indigenous organisms was 39.5% (15/38); 4 of the 22 strains of Pseudomonas aeruginosa were eradicated. Adverse reactions were observed in 4 of the 55 patients (7.3%), 1 patient each with rash, itching, diarrhea, and a gastric symptom (heavy feeling in the stomach). 4 of the 54 patients (7.4%) exhibited abnormal changes in clinical laboratory test values values. These were an increase in eosinophil count in 2, elevation of GOT in 1, and elevation of Al-P in 1. These adverse reactions and abnormal changes in laboratory tests were mild or moderate. Therefore, long-term intermittent administration of AZM, twice a week, is expected to have the same effect in the treatment of diffuse panbronchiolitis as long-term small-dose administration of 14-membered macrolides such as erythromycin and clarithromycin, whose effects have already been established.

Stimulating effect of spermine on bulblet formation in bulb-scale segments of Lilium longiflorum.

When bulb-scale segments of Lilium longiflorum were cultured on a medium containing auxin and cytokinin, the proportion of the expiants with newly-formed bulblets was significantly increased by the application of different polyamines. The most effective polyamine was spermine, where more than 90% of segments formed an average of 5 bulblets as compared to controls where less than 50% explants formed an average of 1.5 bulblets. Application of arginine one of the precursors putrescine biosynthesis, slightly promoted bulblet formation. The putrescine-stimulated bulblet formation was strongly inhibited by simultaneous addition of an inhibitor of the spermidine synthase, cyclohexylamine. The spermidine-promoted bulblet formation, however, could not be suppressed by this inhibitor. The promotive effect of spermidine on bulblet formation was reversed by an inhibitor of the spermine synthase, N-(3-aminopropyl)cyclohexylamine, but application of this inhibitor with spermine did not show any apparent effect on the bulblet formation. Endogenous level of spermine increased in common during bulblet formation that were stimulated by exogenous polyamines. Thus, spermine seemed to be the main stimulating chemical on bulblet formation in lily bulb-scale segments.

Implication that potassium flux and increase in intracellular calcium are necessary for the initiation of sperm motility in salmonid fishes.

Flux of K+ and changes in intracellular Ca2+ in the sperm of salmonid fishes were measured with spectrophotometry, ion electrode, microscopic fluorometry, and radioisotope accumulation. Release of K+ occurred at the initiation of sperm motility which is induced by decrease in external K+ and the K+ efflux and sperm motility were inhibited by K+ channel blockers. Intracellular Ca2+ increased within a short period in K(+)-free condition, and the accumulation of 45Ca in sperm cells was higher in motile sperm than that in immotile sperm. The efflux of K+ and the increase in intracellular Ca2+ were suppressed when external K+ concentration increased, i.e., sperm remained immotile. These results suggest that efflux of K+ through K+ channel and subsequent increase in intracellular Ca2+ are prerequisite for the initiation of sperm motility.

Oral absorption of FK506 in rats.

The oral absorption of FK506 in solid dispersion formulation was studied in rats. The obtained area under the concentration versus time curve (AUC) increased in a nonlinear fashion with a small dose-dependent increase in the peak blood concentrations (Cmax). The peak concentration time (Tmax) was observed within 30 min after administration in all dosing groups (1-10 mg/kg) with or without feeding, whereas the oral absorption of FK506 was reduced to about 50% by gavage at a dose of 1 mg/kg. Participation of first-pass elimination was suggested by comparing the blood levels after infusion via the portal vein with those after infusion via the femoral vein. Further, in an in vitro stability study and an in situ loop absorption study, FK506 was fairly stable in the gastrointestinal juice and was absorbed predominantly from the upper part of the small intestine.

On the substituent effect of tert-butylaminoxyl group for the acid-dissociation equilibria of alpha-substituted acetic acids.

alpha-Substituted acetic acids with tert-butylaminoxyl groups, t-BuN(O.)-CHX-COOH, were produced as spin adducts in gamma-irradiated aqueous solutions of amino acids and peptides with a spin trap, 2-methyl-2-nitrosopropane. The spin adducts were isolated and characterized by means of high-performance liquid chromatography and EPR spectroscopy. Their EPR spectra in acidic region changed reversibly with pH through the acid-dissociation of the carboxyl groups. The spectra at pH around the pK value were weighted averages of acid forms and conjugate base forms. The pKCOOH values for the dissociation were determined to be 3.0, 3.2, 2.0, 1.8, and 1.6 for t-BuN(O.)-CH2COOH, t-BuN(O.)-CH(CH3)COOH, NH3+CH2CONHCH(COOH)N(O.)-t-Bu, and NH3(+)-*CH(CH3)-CONH-*CH(COOH)N(O.)-t-Bu [a pair of diastereomers], respectively. The electron-withdrawing character of the aminoxyl group is responsible for the observation that the pKCOOH values are lower than those of X-CH2-COOH. The substituent effect of the tert-butylaminoxyl group on the acid-dissociation equilibria of alpha-substituted acetic acids was investigated in relation to the Taft equation. The aliphatic polar substituent constant (sigma*) has been evaluated to be approximately +0.9 for the t-BuN(O.)CH2 group [or the inductive substituent constant sigma 1 approximately +0.4 for the t-BuN(O.) group].