With a view to preventing surgical site infection (SSI), administration of antimicrobial agents during surgery should be performed every 3-4 hours after the first administration before surgery begins. In our hospital, the infection control team (ICT) tried to intervene with surgeons and all operating room staff to improve compliance with the administration of antimicrobial agents. The purpose of this study was to evaluate the impact of this intervention by the ICT on correct administration of antimicrobial agents during surgery. In total, 435 surgeries which included ≥ 210 min under anesthesia or 180 min of the operation were analyzed. All antimicrobial agents were first administered within 60 min before the start of surgery. At some point, the ICT intervened, recommending that antimicrobials be administered every 3 h during surgery. The compliance rate (CR) of surgeries for the correct administration of antimicrobial agents was investigated. Differences in CR were evaluated (1) among departments (gastroenterology and general medicine [GM], orthopedic surgery [OR], otorhinolaryngology [OL], gynecology [GY], and urology [UR]), (2) whether intervention of ICT was carried out or not, and (3) in terms of specific procedures (endoscopy and laparoscopy). Total CR was 51.0% (GM: 67.0%, OR: 27.1%, OL: 40.5%, GY: 45.5%, and UR: 37.5%). CR was significantly higher in GM than in any other departments. CR with and without intervention was 69.9% and 42.7%, respectively, and this was statistically significant. CR in endoscopy was 25.8%, which was significantly lower than that in other surgeries (55.2%). CR in laparoscopy was 63.1%, which was significantly higher than that in other surgeries (47.3%). Intervention by the ICT resulted in significant improvement of CR for correct administration of antimicrobial agents. However, CR was low in some situations. This could be improved by more careful dialogue with surgeons and operating room staff.

The external preparation Metronidazole (MTZ) is reported to be useful in controlling the malodor associated with advanced and recurrent breast cancer patients. We prepared two different MTZ external preparations, a 1% MTZ Hydrophilic Ointment and a 0.8% MTZ Carbopol Gel. These preparations were then used to control malodor associated with breast cancer and the results were clinically evaluated. Malodor disappeared within 1 week of administration of either preparation and no adverse reactions were observed. These MTZ external preparations were thus found to be useful in the elimination of malodor as part of the treatment of those patients with advanced and recurrent breast cancer.

The primary aim of this study was to estimate the number of cancer patients who wanted home death based on the bereaved family survey.A postal survey performed on 1,137 bereaved family members in 4 regions to clarify the degree what they believed that the patient actually died where s/he had wanted on the Good Death Inventory, and to explore the preferred place of death. We calculated estimated number of patients who had wanted home death as a total of (1) the actual number of home death × the percentages of the family members who agreed that the patient actually died where s/he had wanted, and × the actual number of hospital death × the percentages of the family members who disagreed that the patient actually died where s/he had wanted and home was the preferred place of death. Estimated number of cancer patients who wanted home death was 32.8%［95%C.I., 31.7, 33.9］ in the surveyed regions, and 31.2%［95%C.I., 31.1, 31.4］ for national data.

The purpose of this study was to explore the burden of introducing LCP-J in two wards（medical oncology and respiratory medicine）in Tohoku University Hospital. We administered audit evaluations about dying cancer patients and interviewed 2 doctors and 8 nurses regarding LCP-J intervention. LCP-J was used for 22 patients（38％）, and no significant difference in infusion, potent opioid analgesic and sedative medication within last 48 hours were seen between users and nonusers. Responses were categorized into［confirm directions about dying care among health care professionals］, and［training in dying care in a structured way］as usefulness facets of the LCP-J, and［difficulty in assessment of dying］,［burden of health care professionals］, and［difficulty using LCP-J without knowledge and training in dying care］as burdens of the LCP-J. We explored the burden of LCP-J in general wards, and found that use of the LCP-J could need education in dying care and backup of the palliative care team.

Vision loss in diabetic retinopathy (DR) is ascribed primarily to retinal vascular abnormalities—including hyperpermeability, hypoperfusion, and neoangiogenesis—that eventually lead to anatomical and functional alterations in retinal neurons and glial cells. Recent advances in retinal imaging systems using optical coherence tomography technologies and pharmacological treatments using anti-vascular endothelial growth factor drugs and corticosteroids have revolutionized the clinical management of DR. However, the cellular and molecular mechanisms underlying the pathophysiology of DR are not fully determined, largely because hyperglycemic animal models only reproduce limited aspects of subclinical and early DR. Conversely, non-diabetic mouse models that represent the hallmark vascular disorders in DR, such as pericyte deficiency and retinal ischemia, have provided clues toward an understanding of the sequential events that are responsible for vision-impairing conditions. In this review, we summarize the clinical manifestations and treatment modalities of DR, discuss current and emerging concepts with regard to the pathophysiology of DR, and introduce perspectives on the development of new drugs, emphasizing the breakdown of the blood-retina barrier and retinal neovascularization.
Adrenal Cortex Hormones ; Angiopoietins ; Animals ; Diabetic Retinopathy* ; Endothelial Cells ; Endothelial Growth Factors ; Ischemia ; Macular Edema ; Mice ; Models, Animal ; Neuroglia ; Pericytes ; Retinal Neovascularization ; Retinal Neurons ; Retinaldehyde ; Tomography, Optical Coherence ; Vascular Endothelial Growth Factors

PURPOSE: Few studies have compared fractional exhaled nitric oxide (FeNO) measurement by NIOX VERO® (NOV) and other devices in children. Moreover, there is no agreement between differences in FeNO values obtained using different devices in adults. Here, we compared FeNO values obtained using NOV and NObreath® (NOB) systems to derive a correction equation for children. METHODS: Eighty-eight participants (age 7–15 years) who were diagnosed with atopic bronchial asthma and visited Sagamihara National Hospital as outpatients between January and April of 2017 were included. We measured FeNO values obtained using NOB and NOV, and analyzed them using Wilcoxon tests and Altman-Bland plots. RESULTS: The median age of the participants was 11.5 years, and the scored Asthma Control Test (ACT) or Childhood ACT (C-ACT) was 25 (interquartile range, 24–25) or 26 (24–27). NOB and NOV values were significantly different (31 [14–52] versus 36 [20–59] ppb; P = 0.020) and strongly correlated (r = 0.92). An equation to convert NOB values into NOV values was derived using linear regression as follows: log NOV = 0.7329 × log NOB + 0.4704; NOB for 20, 40, 58, 80 and 100 ppb corresponded to NOV for 27, 44, 59, 73 and 86 ppb. Thus, NOB < 58 ppb suggested NOB < NOV, whereas NOB > 58 ppb suggested NOB > NOV. CONCLUSIONS: NOB and NOV values were strongly correlated. Participants whose FeNO values were relatively low represented NOB < NOV, whereas those whose FeNO values were relatively high represented NOB > NOV.
Adult ; Asthma ; Child* ; Exhalation ; Humans ; Linear Models ; Nitric Oxide* ; Outpatients