In this study, we conducted interviews with staff members who had experience in discharge coordination to clarify the characteristics and efforts of discharge coordination for patients with pediatric cancer toward end-of-life. Focus group interviews were conducted with 11 individuals, including six medical social workers and five nurses (acceptance rate: 84.6%) and a qualitative inductive analysis was conducted. Seven categories were identified as characteristics of discharge coordination for patients with pediatric cancer toward the end-of-life, such as “few home physicians and home health care nurses who could accept terminally ill children” and “a small number of cases and lack of accumulated experience”. Seven categories were identified as efforts of discharge coordination, including “maintaining connections with the community” in three situations: coordination with home physicians and home-visit nursing care, coordination with children and their families, and coordination in hospitals. The number of children who spend their end-of-life days at home is increasing, and we believe that it is necessary to consider expanding the role of pediatric cancer base hospitals in the future, such as collecting information in the community and sharing good practices.

Background: The hollow-fiber infection model (HFIM) is a valuable tool for evaluating pharmacokinetics/pharmacodynamics relationships and determining the optimal antibiotic dose in monotherapy or combination therapy, but the application for personalized precision medicine in tuberculosis treatment remains limited. This study aimed to evaluate the efficacy of adjusted antibiotic doses for a tuberculosis patient using HFIM. Methods: Model-based Bayesian forecasting was utilized to assess the proposed reduction of the isoniazid dose from 300 mg daily to 150 mg daily in a patient with an ultra-slowacetylation phenotype. The efficacy of the adjusted 150-mg dose was evaluated in a timeto-kill assay performed using the bacterial isolate Mycobacterium tuberculosis (Mtb) H37Ra in a HFIM that mimicked the individual pharmacokinetic profile of the patient. Results: The isoniazid concentration observed in the HFIM adequately reflected the target drug exposures simulated by the model. After 7 days of repeated dose administration, isoniazid killed 4 log 10 Mtb CFU/mL in the treatment arm, while the control arm without isoniazid increased 1.6 log 10 CFU/mL. Conclusion Our results provide an example of the utility of the HFIM for predicting the efficacy of specific recommended doses of anti-tuberculosis drugs in real clinical setting.

Purpose: Chromosomal instability (CIN) contributes to intercellular genetic heterogeneity and has been implicated in paclitaxel (PTX) resistance in breast cancer. In this study, we explored polo-like kinase 1 (PLK1) as an important regulator of mitotic integrity and as a useful predictive biomarker for PTX resistance in breast cancer. Methods: We performed PTX resistance screening using the human kinome CRISPR/ Cas9 library in breast cancer cells. In vitro cell proliferation and apoptosis assays and in vivo xenograft experiments were performed to determine the effects of PLK1 on breast cancer cells. Immunofluorescence microscopy was used to measure the degree of multipolar cell division. Results: Kinome-wide CRISPR/Cas9 screening identified various kinases involved in PTX resistance in breast cancer cells; among these, PLK1 was chosen for further experiments.PLK1 knockdown inhibited the proliferation of MDA-MB-231 and MDA-MB-468 cells in vitro and in vivo. Moreover, PLK1 silencing sensitized breast cancer cells and mouse xenograft tumor models to PTX cytotoxicity. Silencing of PLK1 induced the formation of multipolar spindles and increased the percentage of multipolar cells. In addition, PLK1 silencing resulted in the downregulation of BubR1 and Mad2 in breast cancer cells. Furthermore, PLK1 upregulation in primary breast cancer was associated with decreased overall patient survival based on the analysis of The Cancer Genome Atlas and Molecular Taxonomy of Breast Cancer International Consortium databases. Conclusion PLK1 plays an important role in PTX resistance by regulating CIN in breast cancer cells. Targeting PLK1 may be an effective treatment strategy for PTX-resistant breast cancers.

Purpose: The obesity prevention and management program led by public health centers are important in the community.This study aims to identify the current status of obesity prevention and management programs at public health centers and perceptions regarding facilitators and barriers when implementing programs. Methods: This study used a concurrent mixed methods design. A survey was conducted to investigate the current status and infrastructure of the obesity prevention and management program at eighty-three public health centers nationwide. Nine program managers and six local residents with experience in the program were interviewed by using a semi-structured questionnaires. Results Most of the infrastructure facilities for the program were inadequate, and insufficient budgets and lack of professional staff were identified as barriers. Facilitators included diversification of program delivery methods, operator competence, and visible outcomes and rewards. For the effectiveness of the program, it is vital to have adequate assistants, a sufficient budget, various promotional methods, and connections with various institutions in the community. On this basis, it is acknowledged that the public health center serves as a platform for preventing and managing obesity in the community. Conclusion: It is expected that infrastructure improvements in public health centers and the link with community resources are needed. In addition, there is an urgent need to set standards for obesity prevention and management programs implemented in public health centers to ‘resolve regional disparities’.

The purpose of this study is to analyze the long-term plans of the central and local governments in order to plan policy and implementing programs. Through this, the governments is find out to reduce administrative burden. Based on the national health plan, evidence and related laws were collected and analyzed. As a quantitative methodology analyzed the contents of related laws in the overall plan. The qualitative methodologies analyzed and categorized the planning status of cities and provinces in the plan and were collated. There are a total of 39 plans for long-term plans by laws. The role of the central and local governments in the public health sector, there are a total of four plans (10.3%) that need to establish long-term and annual plans for the central and local (cities, provinces) government. A total of seven plans (17.9%) were required to establish a plan by the only local government. In terms of the public health sector on the local governments, 20 plans (51.3%) by cities and 12 plans (30.8%) by provinces were established by law. And in the health sector should be established 9 plans (40.9%) by cities and 7 plans (31.8%) by provinces. The plan needs to be reformed and merged between plans so that governments can focus on the program through planning central government policies, reducing local government administration.

PURPOSE: This study was designed to verify the effectiveness of Mastocheck, a new diagnostic tool developed with proteomics techniques using plasma proteins. In addition, checked the current state of mammography used for breast cancer screening. METHODS: A total of 305 cases were analyzed (normal 122, breast cancer 183) and used for validation after Mastocheck development. First, screening mammograms of normal patients and pre-diagnosis mammography of cancer patients were reviewed retrospectively. The results were compared with Mastocheck, a newly developed blood test. Imaging tests were blinded and analyzed by dividing the readings of breast specialists and non-breast specialists among radiologists. We confirmed how much better the results would be if only the mammography was used and if both tests were used together. RESULTS: The sensitivity, specificity, and accuracy of mammography alone, reviewed by non-breast specialists among radiologists, were 63.0%, 85.7%, and 71.3%, respectively. In dense breasts, the values were 59.2%, 84.8% and 69.0%, which were too low to be considered interpretable. The sensitivity, specificity and accuracy of the test was 93.9%, 83.8%, and 90.2% when using mammography and Mastocheck together. From these results, an improvement in sensitivity of about 30% and an improvement in accuracy of about 15% or more in concomitant use than mammography alone can be seen. CONCLUSION Mastocheck can be widely used for screening breast cancer, especially in dense breasts, patients with low accuracy in mammography, and patients with mammography side effects. In addition, it has the advantage of increasing the diagnosis rate when used with mammography, the current screening method of choice.

Urinary tract infection is common in the pediatric population. The most common causative agents are bacteria, among which Escherichia coli is the most frequent uropathogen. Although fungal urinary tract infection is rare in the healthy pediatric population, it is relatively common among hospitalized patients. Fungus may be isolated from the urine of immunocompromised patients or that of patients with indwelling catheters. The most common cause of funguria is Candida albicans. Although more than 50% of Candida isolates belong to non-albicans Candida , the prevalence of non-albicans candiduria is increasing. Herein, we report a case of community-acquired candiduria in a 4-month-old immunocompetent male infant who had bilateral vesicoureteral reflux and was administered antibiotic prophylaxis. He was diagnosed with urinary tract infection caused by Candida lusitaniae and was managed with fluconazole.
Antibiotic Prophylaxis ; Bacteria ; Candida ; Candida albicans ; Catheters, Indwelling ; Escherichia coli ; Fluconazole ; Fungi ; Humans ; Immunocompromised Host ; Infant ; Male ; Prevalence ; Urinary Tract Infections ; Urinary Tract ; Vesico-Ureteral Reflux

BACKGROUND: Age-related musculoskeletal diseases are becoming increasingly burdensome in terms of both individual quality of life and medical cost. We intended to establish a large population-based cohort study to determine environmental, lifestyle, and genetic risk factors of musculoskeletal and other age-related diseases, and to clarify the association between vitamin D status and such diseases. METHODS: We targeted 34,802 residents aged 40-74 years living in areas of northern Niigata Prefecture, including Sekikawa Village, Awashimaura Village, and Murakami City (Murakami region). The baseline questionnaire survey, conducted between 2011 and 2013, queried respondents on their lifestyle and environmental factors (predictors), and self-reported outcomes. Plasma 25-hydroxyvitamin D (25[OH]D) concentration, an indicator of vitamin D status, was determined with the Liaison® 25OH Vitamin D Total Assay. The primary outcome of this study was osteoporotic fracture; other outcomes included age-related diseases including knee osteoarthritis, perception of chronic pain, dementia, and long-term care insurance use. Mean ages of men and women were 59.2 (SD = 9.3, N = 6907) and 59.0 (SD = 9.3, N = 7457) years, respectively. From the blood samples provided by 3710 men and 4787 women, mean 25(OH)D concentrations were 56.5 (SD = 18.4) nmol/L (22.6 ng/mL) and 45.4 (SD = 16.5) nmol/L (18.2 ng/mL), respectively. DISCUSSION Follow-up surveys are planned every 5 years for 15 years, and incident cases of our targeted diseases will be followed at hospitals and clinics in and nearby the cohort area. We anticipate that we will be able to clarify the association between vitamin D status and multiple disease outcomes in a Japanese population.
Aged ; Aging ; Cohort Studies ; Epidemiologic Research Design ; Female ; Humans ; Incidence ; Japan ; epidemiology ; Male ; Middle Aged ; Musculoskeletal Diseases ; epidemiology ; prevention & control ; Predictive Value of Tests ; Quality of Life ; Risk Factors ; Vitamin D ; analogs & derivatives ; blood

The nucleus accumbens (NAc) is the major component of the ventral striatum that regulates stress-induced depression. The NAc receives dopaminergic inputs from the ventral tegmental area (VTA), and the role of VTA-NAc neurons in stress response has been recently characterized. The NAc also receives glutamatergic inputs from various forebrain structures including the prelimbic cortex (PL), basolateral amygdala (BLA), and ventral hippocampus (vHIP), whereas the role of those glutamatergic afferents in stress response remains underscored. In the present study, we investigated the extent to which descending glutamatergic neurons activated by stress in the PL, BLA, and vHIP project to the NAc. To specifically label the input neurons into the NAc, fluorescent-tagged cholera toxin subunit B (CTB), which can be used as a retrograde neuronal tracer, was injected into the NAc. After two weeks, the mice were placed under restraint for 1 h. Subsequent histological analyses indicated that CTB-positive cells were detected in 170~680 cells/mm² in the PL, BLA, and vHIP, and those CTB-positive cells were mostly glutamatergic. In the PL, BLA, and vHIP regions analyzed, stress-induced c-Fos expression was found in 20~100 cells/mm². Among the CTB-positive cells, 2.6% in the PL, 4.2% in the BLA, and 1.1% in the vHIP were co-labeled by c-Fos, whereas among c-Fos-positive cells, 7.7% in the PL, 19.8% in the BLA, and 8.5% in the vHIP were co-labeled with CTB. These results suggest that the NAc receives a significant but differing proportion of glutamatergic inputs from the PL, BLA, and vHIP in stress response.
Animals ; Basolateral Nuclear Complex ; Cholera Toxin ; Depression ; Hippocampus ; Mice ; Neurons* ; Nucleus Accumbens* ; Prosencephalon ; Ventral Striatum ; Ventral Tegmental Area