Introduction: Reimbursement for breathing care services was started with the revision of the nation's medical service fee system in 2010. Our hospital was not properly equipped in the light of certain standards governing facilities. Nonetheless, we started giving instructions to nurses on how to check the respirator at work. In addition to the on-the-job training, we are engaged in educational activity and information gathering. Out team comprises clinical engineers, physical therapists and registered nurses. They are all certified respiratory therapists. We hereby report our activities and refer to future problems.　　Activities: 1. Safety checks of respirators while in use. 2. Respiratory rehabilitation during hemodialysis. 3. Respirator-related workshops. 4. Review of accidents.　　Results: 1. It has become easier to discover potential problems and meet them at once. This is because our team is made up of different specialists, each used to looking at things differently. 2. Being constantly on the alert for any indication of a trouble ensures safety during breathing rehabilitation. 3. The number of accidents during 2012 decreased from 2011.　　Future: We think that since “safety management” is the center piece of our activity, our team ought to be recognized as an official organization of the hospital.

The Wnt signaling pathway is conserved in various species from worms to mammals, and plays important roles in cellular proliferation, differentiation, and migration. Wnt stabilizes cytoplasmic beta-catenin and then the accumulated beta-catenin is translocated into the nucleus, where it activates the transcriptional factor T-cell factor (Tcf)/lymphoid enhancer factor (Lef), and thereby stimulates the expression of genes including c-myc, c-jun, fra-1, and cyclin D1. Tight regulation of this response involves post-translational modifications of the components of the Wnt signaling pathway. Phosphorylation, ubiquitination, and sumoylation have been shown to affect the half-life of beta-catenin and the transcriptional activity of Tcf/Lef. The precise spatio-temporal patterns of these multiple modifications determine the driving force of various cellular responses.
Animals ; Binding Sites ; Gene Expression Regulation ; Humans ; Models, Biological ; Protein Binding ; *Protein Processing, Post-Translational ; *Signal Transduction ; TCF Transcription Factors ; *Trans-Activators ; Wnt Proteins/classification/genetics/*metabolism ; beta Catenin

We have previously reported on a predictive model for deficiency-excess pattern diagnosis that was unable to predict the medium pattern. In this study, we aimed to develop predictive models for deficiency, medium,and excess pattern diagnosis, and to confirm whether cutoff values for diagnosis differed between the clinics. We collected data from patients' first visit to one of six Kampo clinics in Japan from January 2012 to February 2015. Exclusion criteria included unwillingness to participate in the study, missing data, duplicate data, under 20 years old, 20 or less subjective symptoms, and irrelevant patterns. In total, 1,068 participants were included. Participants were surveyed using a 153-item questionnaire. We constructed a predictive model for deficiency, medium, and excess pattern diagnosis using a random forest algorithm from training data, and extracted the most important items. We calculated predictive values for each participant by applying their data to the predictive model, and created receiver operating characteristic (ROC) curves with excess-medium and medium-deficiency patterns. Furthermore, we calculated the cutoff value for these patterns in each clinic using ROC curves, and compared them. Body mass index and blood pressure were the most important items. In all clinics, the cutoff values for diagnosis of excess-medium and medium-deficiency patterns was > 0.5 and < 0.5, respectively. We created a predictive model for deficiency, medium, and excess pattern diagnosis from the data of six Kampo clinics in Japan. The cutoff values for these patterns fell within a narrow range in the six clinics.