Wired Microfabricated Electrochemical Systems.

Metal wires have been used as an alternative to liquid junctions for the connection of solutions in microfabricated electrochemical devices. They exhibit similar performance to liquid junctions, provided that the interfacial potentials at both ends of the wires were appropriately canceled. Cyclic voltammograms of devices with liquid junctions and metal wires were very similar when no current or a low current flowed through the metal wire between the working and reference electrodes. Iridium wires with iridium oxide at both ends facilitated canceling of the interfacial potentials at either end of the junction particularly well, and were used effectively for voltammetry, amperometry, and potentiometry by adjusting the pH of the solutions in the working and reference electrode compartments to be equal. This approach was used to effectively integrate a reliable common reference electrode between multiple working electrodes and to conduct automated electrochemical control of solution transport in microfluidic systems.

Microdevice with an Integrated Clark-Type Oxygen Electrode for the Measurement of the Respiratory Activity of Cells.

A microdevice for the measurement of the respiratory activity of cells was fabricated using a microfabricated Clark-type oxygen electrode. The oxygen electrode was completed in a dry state and was activated by introducing water necessary for the reduction of oxygen in the form of water vapor through an oxygen-permeable membrane, which significantly facilitated handling of the device even by nonspecialists. The use of a thin paper layer stabilized the current response and enabled stable continuous operation of the oxygen electrode without current disturbance caused by the evaporation of water. The microdevice was tested in some model experiments including the measurement of the respiratory activity of Escherichia coli (E. coli), evaluation of the efficacy of antibiotics, and measurement of the antibacterial activity of neutrophils, all of which demonstrated that the consumption of dissolved oxygen by cells can be monitored clearly by following an easy procedure for the preparation of the measurements.

The Principles of Revised Clinical Guidelines about Palliative Sedation Therapy of the Japanese Society for Palliative Medicine.

Background: When the suffering of a terminally ill patient is intolerable and refractory, sedatives are sometimes used for symptom relief. Objective: To describe the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Design: Consensus methods using the Delphi technique were used. Results: The main principles of the guidelines that were newly defined or developed are as follows: (1) palliative sedation was defined as "administration of sedatives for the purpose of alleviating refractory suffering" (excluding the aim of reducing patient consciousness); (2) palliative sedation was classified according to the method of administration of sedatives: respite sedation versus continuous sedation (including (continuous) proportional sedation and continuous deep sedation); (3) a description of state-of-the-art recommended treatments for difficult symptoms such as delirium, dyspnea, and pain before the symptom was determined as refractory was included; (4) the principle of proportionality was newly defined from an ethical point of view; and (5) families' consent was regarded as being desirable (mandatory in the previous version). Conclusions: We described the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Further consensus building is necessary.

[Rhabdomyolysis associated with long-term treatment of esomeprazole].

Proton pump inhibitors (PPIs) have been widely used in the treatment of gastroesophageal reflux disease and peptic ulcer disease. Although they have a potent acid suppressive effect and excellent efficacy in acid-related diseases, PPI-induced rhabdomyolysis has been reported. Here, we report the case of a patient with reflux esophagitis who developed rhabdomyolysis after esomeprazole treatment. A 67-year-old man with reflux esophagitis who had started esomeprazole treatment for the preceding 10 months complained of back and limb fatigue and myalgia. His serum creatinine kinase (CK) level was markedly elevated, and CK isozyme exhibited an MM pattern. He was diagnosed with rhabdomyolysis induced by esomeprazole. The cessation of esomeprazole rapidly improved his symptoms, and the serum CK level was normalized within 16 days. PPI-induced rhabdomyolysis is a rare complication. In most cases, PPI-induced rhabdomyolysis occurs within 3 months after starting PPIs. However, rhabdomyolysis occurred at 10 months after starting esomeprazole treatment in our patient. Early diagnosis of PPI-induced rhabdomyolysis is required even in long-term PPI users.

Spontaneous mesenteric hematoma of the sigmoid colon associated with rivaroxaban: A case report.

INTRODUCTION: Mesenteric hematoma is a rare condition caused by bleeding localized in the mesenteric vascular tree. This is a first report of spontaneous mesenteric hematoma caused by rivaroxaban. PRESENTATION OF CASE: The patient was a 71-year-old man who had taken rivaroxaban for paroxysmal atrial fibrillation. He had experienced abdominal pain and diarrhea for the prior 3 days. He had little melena and was referred to our institute. He presented with hypotension on arrival. Computed tomography (CT) revealed a 10 cm mass in the mesentery of the sigmoid colon with extravasation. Active bleeding from the sigmoid colic arteries was embolized with angiography on the day of admission. On the second day, we operated on the patient. We detected 200 mL of bloody ascites accumulated in the abdomen. The serosa of the sigmoid colon was ruptured along the tenia due to the compression of the hematoma in the mesentery. The sigmoid colon was resected and a descending colostomy was reconstructed. Operative and pathological findings did not reveal the cause of bleeding. We finally diagnosed the patient with spontaneous mesenteric hematoma associated with rivaroxaban. DISCUSSION: Previous reports of mesenteric hematoma with anticoagulant were associated with warfarin. Since rivaroxaban is not affect to the value of prothrombin time (PT) and activated partial thromboplastin time (APTT) and mesenteric hematoma presents non-specific symptoms, it is difficult to diagnose mesenteric hematoma in the patients taking rivaroxaban. CONCLUSION: It is important to keep in mind that mesenteric hematoma is one of the critical complications in patients taking rivaroxaban.

[Communication with important others regarding their preferences for end-of-life care].

AIM: Our aim in this study was to explore individual factors that make it likely for Japanese older adults to engage in communication with important other persons regarding their preferences for end-of-life care. METHODS: We conducted a questionnaire survey of outpatients at Tokyo Metropolitan Geriatric Hospital in the last six days of March 2012. Nine-hundred and sixty-eight outpatients consented in writing to participate in this survey. Two items on the questionnaire concerned the participants' attempts to communicate their preferences regarding end-of-life care; that is, whether they had discussed this issue with their significant others and whether they had written notes indicating how they want to be cared for in the final days of their lives. RESULTS: The participants who had designated a surrogate decision-maker were more likely to report answers of both than only discussion (OR=2.52) and less likely to reports answers of no communication than only discussion (OR=0.37). In addition, (a) those who did not wish to rely on artificial nutrition or hydration (OR=0.68) and (b) those who often thought about their death were more likely to be in the only discussion group than in the no communication group, although these factors were not significantly associated with whether the participants were likely to be in the both or only discussion groups. CONCLUSIONS: Our findings indicate that individuals often attempt to clarify their preferences in order to make it easier for their significant others to make end-of-life care decision on their behalf, so that they may receive their desired care.

[Withdrawal of life-support from ALS patients in so called totally locked in state: from the viewpoint of clinical ethics].

In Japanese context, there has been a controversy concerning the withdrawal of life-support, i.e. respiratory system, from ALS patients when, along of the progress of the disease, they have become not able to express themselves at all to people around them, i.e. when they are in so called 'totally locked in state (TLS)'. Basing himself on the system of clinical ethics he has been developing in accord with Japanese culture, the author (1) reconstitutes the logic of justifying the withdrawal in dispute, (2) examines objections against officially recognizing such withdrawal, and (3) proposes an appropriate process of decision making which he hopes to be acceptable to both sides in the controversy.