Delivery of external proteins into the cytoplasm using protein capsules modified with IgG on the surface, created from the amphiphilic two helix-bundle protein OLE-ZIP.

This study explores a new method for delivering therapeutic proteins into specific cells using OLE-ZIP capsules that present IgG. OLE-ZIP capsules is a spherical caspules prepared from amphihilic dimetic coiled-coil peptide, OLE-ZIP. Upon presenting cetuximab, these capsules showed preferential uptake in A431 cells and increased cytotoxicity when loaded with RNase A.

Burnout among kindergarten teachers and associated factors.

Burnout among kindergarten teachers is a subject of great concern. Although burnout is reported to be significantly associated with turnover intention and work engagement, few studies have examined factors associated with burnout among these teachers. Therefore, in the present study, we performed a cross-sectional survey of burnout and associated factors among kindergarten teachers. We distributed 3363 questionnaires to all 205 authorized kindergartens and childcare institutions in Nagasaki Prefecture and received 1086 responses (response rate: 32.3%). The participants were limited to full-time female class teachers. After excluding survey forms with incomplete content, we ultimately examined valid responses from 442 participants. The survey examined burnout (Maslach Burnout Inventory, MBI), teacher stress (Nursery Teacher's Stress Scale, NTSS), coping behaviors (Brief Scales for Coping Profile, BSCP), and social support (Social Support Scale, SSS). A multiple regression analysis revealed that all 3 MBI subscales were positively associated with "understanding of how to handle children" on the NTSS and negatively associated with "superiors" on the SSS. "Emotional exhaustion" was significantly associated with "interpersonal relations at work" and "lack of time" on the NTSS, and "avoidance and suppression" on the BSCP. "Depersonalization" was significantly associated with age, "disconnect in working conditions" on the NTSS, and "proactive problem solving" and "venting emotions to others" on the BSCP. "Diminished professional accomplishment" was significantly associated with age, "lack of time" on the NTSS, and "proactive problem solving" and "change in perspective" on the BSCP. These results suggest that support from superiors that enables teachers to better understand children and handle them appropriately is necessary to prevent burnout.

[Administering Ramucirumab Safely after Inserting an Intestinal Stent, Due to Peritoneal Metastasis of Gastric Cancer-A Case Report].

The recent phase Ⅲ trials REGARD and RAINBOW have shown survival benefits and acceptable safetyprofiles of ramucirumab( RAM)alone and RAM plus paclitaxel. Based on this result, RAM is recommended as a secondarytreatment for advanced and recurrent gastric cancer bythe Japanese Gastric Cancer Association. Although the frequencyis not high, gastrointestinal perforation has been reported as a serious side effect. RAM is a human anti-vascular endothelial growth factor receptor 2(VEGFR-2)monoclonal antibodythat acts on vascular endothelial cells to inhibit angiogenesis. The detailed mechanism has not been elucidated, but it is thought that the ischemic state and delayed wound healing due to the inhibition of vascular endothelial growth factors could be the cause of perforation. Thus, the usage of angiogenesis inhibitors such as RAM while intestinal stents are placed, mayincrease the risk of gastrointestinal perforation. We report a case in which RAM was administrated with no adverse events after multiple gastrointestinal metal stents being inserted.

[Efficacy of Palliative Radiotherapy in Hemorrhage Control in Patients with Unresectable Gastric Cancer].

We report the case of an 80-year-old man with unresectable, advanced gastric cancer and pulmonary cancer because of multiple liver metastases. The serum hemoglobin level declined to 5.3 g/dL during fourth-line chemotherapy. Radiation therapy of 30 Gy was administered in 10 fractions. After radiation treatment was completed, the serum hemoglobin level increased to 8.5g/dL. No new adverse event was observed. Subsequently, the progression of anemia stopped, and oral intake became possible. Thus, palliative radiation therapy is useful for hemorrhage control in unresectable, advanced gastric cancer patients with a poor general condition and difficult surgical treatment.

Comparison of the Influence of Right Atrial Septal Pacing and Appendage Pacing on an Atrial Function and Atrial Fibrillation in the Clinical Situation.

INTRODUCTION: Recently right atrial septal (RAS) pacing is often selected, but the benefit brought by RAS pacing has not been clear. The aim of this study was to evaluate the differences between RAS pacing and right appendage (RAA) pacing. METHODS: 223 consecutive new patients with a right atrial (RA) electrode during the period from January 2004 to December 2012 were studied retrospectively. They were observed regularly at our pacemaker (PM) clinic, and we measured paced P - sensed QRS interval (pPQi) and left atrial dimension (LAD) during the observation period, furthermore the onset of atrial fibrillation (AF) was assessed. RESULTS: Mean age was 74.5 years and 104 were men. Mean follow-up period was 4.5 years. 177 patients received RAA pacing and 46 received RAS pacing. There was no difference of LAD and pPQi between patients with RAA pacing and with RAS pacing with more than 50% of percentage as the atrial pacing (%AP). About the comparison between intrinsic PQ interval and pPQi, only RAA pacing made long significantly from intrinsic PQ interval to pPQi (p=0.020, 172.3±46.3 vs. 189.7±38.0). The %AP more than 50% brought less probability of the onset AF. On the other hand, none of pacing sites of RA, pacing mode, and the percentage of ventricular pacing influenced on the probability of the onset of AF. Although in patients with 50% as %AP RAA pacing made patients with AF increased (from 17 to 22), RAS pacing made them decreased (from 14 to 12). CONCLUSIONS: This study did not show the superiority of RAS pacing to RAA pacing, it seems that %AP is more important for the onset of AF. The possibility was seen that RAS pacing reduces the onset of AF.

Perioperative management of tumor necrosis factor-alpha blocker-treated psoriatic patients: Case reports and review.

Regarding appropriate timings of discontinuation and resumption of biologics for psoriasis patients before and after elective surgeries, an international consensus has yet to be reached. The Japanese Dermatological Association of Guideline and Safety Manual for the use of Biologic Agents in Psoriasis 2013 states that infliximab (IFX) and adalimumab (ADA) should be withheld at least 4 and 2 weeks, respectively, before surgery and can be restarted as neither postoperative infection nor delayed wound healing is recognized. We experienced three generalized pustular psoriasis (GPP) patients and one plaque-type psoriasis patient undergoing surgeries during tumor necrosis factor (TNF)-α blocker therapy. Three GPP cases experienced uneventful post-surgical course. One psoriasis vulgaris patient on IFX had a wound healing delay with deterioration of psoriatic plaques which was restored by restarting IFX. The timing of suspension and resumption of TNF-α blockers in all cases were determined following the Japanese guideline.

Sirolimus-eluting stent implantation for ostial right coronary artery lesions: five-year outcomes from the j-Cypher registry.

Ostial right coronary artery (RCA) lesions are associated with a high restenosis rate after bare-metal stent implantation. However, long-term outcomes after drug-eluting stent (DES) implantation for ostial RCA lesions have not been adequately evaluated. Among 12824 patients enrolled in the j-Cypher registry, 5-year outcomes were compared between 397 patients with ostial RCA lesions, and 3716 patients with non-ostial RCA lesions treated with sirolimus-eluting stents (SES). Through 5-year follow-up, patients with ostial RCA lesions had a significantly higher cumulative incidence of target lesion revascularization (TLR) (28.2 versus 13.7 %, P < 0.0001) than those with non-ostial RCA lesions. After adjusting for confounders, excess TLR risk of the ostial group relative to the non-ostial group was significant for both early TLR within 1-year and late TLR beyond 1-year (HR 2.14 [95 % CI 1.59-2.84], P < 0.0001, and HR 1.58 [95 % CI 1.06-2.26], P = 0.02, respectively). Although the cumulative incidence of death was also significantly higher in the ostial group than in the non-ostial group (25.7 versus 14.4 %, P < 0.0001), the excess risk of the ostial group relative to the non-ostial group was no longer significant after adjusting for confounders (HR 1.25 [95 % CI 0.99-1.57], P = 0.07). SES implantation for ostial RCA lesions was associated with higher risk for TLR as compared with that for non-ostial RCA lesions. Restenosis, both early and late, remains an issue in coronary DES implantation for ostial RCA lesions.

Utility of nicorandil for the measurement of coronary fractional flow reserve.

Nicorandil, an adenosine triphosphate (ATP)-sensitive potassium channel opener, has been used as an anti-angina drug that causes coronary vasodilation of both epicardial and resistance vessels. We assessed the hyperaemic efficacy of nicorandil for the measurement of coronary fractional flow reserve (FFR). In this prospective, single-centre study, we enrolled 20 consecutive patients (20 lesions) with intermediate coronary artery stenosis. Hyperaemic efficacy of intracoronary bolus injection of nicorandil (2 mg) was compared with that of continuous intravenous infusion of adenosine triphosphate (ATP, 150 µg/kg/min). The intra-patient difference of FFR value between the two hyperaemic stimuli was evaluated using a non-inferiority design with the margin of 0.03. Among study patients, no serious event occurred with administration of either stimulus. A strong and linear correlation of FFR with ATP and nicorandil was observed (r (2) = 0.98, P < 0.0001). The intra-patient difference of the FFR between nicorandil and ATP was 0.003 (95 % confidence interval -0.004 to 0.011), and the probability for the non-inferiority margin of 0.03 was <0.0001. In conclusion, bolus intracoronary injection of nicorandil was non-inferior to continuous intravenous injection of ATP in achieving maximal hyperaemia. Nicorandil could be considered as an alternative option for achieving maximal coronary and myocardial hyperaemia for the assessment of FFR.