Nationwide Database Analysis of Risk Factors Associated with Decreased Activities of Daily Living in Patients with Alzheimer's Disease.

BACKGROUND: Preserving activities of daily living (ADL) is the key issue for Alzheimer's disease (AD) patients and their caregivers. OBJECTIVE: To clarify the ADL level of AD patients at diagnosis and the risk factors associated with decreased ADL during long-term care (≤3 years). METHODS: Medical records of AD patients in a Japanese health insurance claims database were analyzed retrospectively to determine ADL using the Barthel Index (BI) and identify the risk factors associated with decreased ADL. RESULTS: A total of 16,799 AD patients (mean age at diagnosis: 83.6 years, 61.5% female) were analyzed. Female patients were older (84.6 versus 81.9 years; p < 0.001) and had lower BI (46.8 versus 57.6; p < 0.001) and body mass index (BMI) (21.0 versus 21.7 kg/m2; p < 0.001) than male patients at diagnosis. Disability (BI≤60) increased at age≥80 years and was significantly higher in females. Complete disability was most frequent for bathing and grooming. Risk factors for decreased ADL were determined separately by sex through comparing the ADL-preserved and ADL-decreased groups using propensity score matching by age and BI and multivariable logistic regression analysis. In males, decreased ADL was significantly associated with BMI < 21.5 kg/m2, stroke, and hip fracture, and inversely associated with hyperlipidemia. In females, decreased ADL was significantly associated with BMI < 21.5 kg/m2 and vertebral and hip fractures, and inversely associated with lower back pain. CONCLUSION: AD patients with low BMI, stroke, and fractures had increased risks of decreased ADL; such patients should be identified early and managed appropriately, including rehabilitation to preserve ADL.

Nationwide database analysis of insomnia, depression, and sleeping pill prescriptions in hepatocellular carcinoma patients.

OBJECTIVE: To clarify the status of insomnia and depression and the prescription of sleeping pills in hepatocellular carcinoma (HCC) patients before and after HCC diagnosis and treatment. METHODS: Patients' data from a Japanese health insurance claims database were analyzed retrospectively to determine the incidence of insomnia and depression and their association with sleeping pill prescriptions during the 6 months before and after HCC diagnosis and treatment. RESULTS: A total of 9,109 HCC patients (median age at diagnosis = 71.5 years, 68.1% male) were analyzed. The incidences of insomnia and depression increased significantly after HCC diagnosis. Insomnia was reported in 15.0% of patients before diagnosis, and it increased to 27.6% after diagnosis. Similarly, depression was reported in 6.3% and 11.3% before and after diagnosis, respectively. The incidences of insomnia and depression before diagnosis were higher in patients with concomitant liver diseases including hepatitis, cirrhosis, and hepatic encephalopathy. However, the rate of sleeping pill prescription was significantly lower in patients with concomitant liver diseases after diagnosis. The incidence of fracture was higher in insomnia or depression patients than others and in patients treated with sleeping pills than without before and after diagnosis. CONCLUSIONS: HCC patients had increased risks of insomnia and depression after diagnosis. The high risk of fracture in HCC patients with insomnia and depression and treated with sleeping pills suggests that it is difficult to optimize the management of HCC patients, especially those with concomitant liver diseases.

One step fabrication of aligned carbon nanotubes using gas rectifier.

We report the one-step fabrication of aligned and high-quality carbon nanotubes (CNTs) using floating-catalyst chemical vapor deposition (FCCVD) with controlled fluidic properties assisted by a gas rectifier. The gas rectifier consists of one-dimensional straight channels for regulating the Reynolds number of the reaction gas. Our computational fluid dynamics simulation reveals that the narrow channels of the gas rectifier provide steady and accelerated laminar flow of the reaction gas. In addition, strong shear stress is induced near the side wall of the channels, resulting in the spontaneous formation of macroscopic CNT bundles aligned along the direction of the gas flow. After a wet-process using chlorosulfonic acid, the inter-tube voids inherently observed in as-grown CNT bundles are reduced from 16 to 0.3%. The resulting CNT fiber exhibits a tensile strength of 2.1 ± 0.1 N tex-1 with a Young's modulus of 39 ± 4 N tex-1 and an elongation of 6.3 ± 0.6%. FCCVD coupled with the strong shear stress of the reaction gas is an important pre-processing route for the fabrication of high-performance CNT fibers.

Hydrogen-Bonded Structure of Water in the Loop of Anchored Polyrotaxane Chain Controlled by Anchoring Density.

Hydrogen-bonded network of water surrounding polymers is expected to be one of the most relevant factors affecting biocompatibility, while the specific hydrogen-bonded structure of water responsible for biocompatibility is still under debate. Here we study the hydrogen-bonded structure of water in a loop-shaped poly(ethylene glycol) chain in a polyrotaxane using synchrotron soft X-ray emission spectroscopy. By changing the density of anchoring molecules, hydrogen-bonded structure of water confined in the poly(ethylene glycol) loop was identified. The XES profile of the confined water indicates the absence of the low energy lone-pair peak, probably because the limited space of the polymer loop entropically inhibits the formation of tetrahedrally coordinated water. The volume of the confined water can be changed by the anchoring density, which implies the ability to control the biocompatibility of loop-shaped polymers.

A deep learning algorithm for sleep stage scoring in mice based on a multimodal network with fine-tuning technique.

Sleep stage scoring is important to determine sleep structure in preclinical and clinical research. The aim of this study was to develop an automatic sleep stage classification system for mice with a new deep neural network algorithm. For the purpose of base feature extraction, wake-sleep and rapid eye movement (REM) and non- rapid eye movement (NREM) models were developed by extracting defining features from mouse-derived electromyogram (EMG) and electroencephalogram (EEG) signals, respectively. The wake-sleep model and REM-NREM sleep model were integrated into three different algorithms including a rule-based integration approach, an ensemble stacking approach, and a multimodal with fine-tuning approach. The deep learning algorithm assessing sleep stages in animal experiments by the multimodal with fine-tuning approach showed high potential for increasing accuracy in sleep stage scoring in mice and promoting sleep research.

Real-world database analysis of the characteristics and treatment patterns of patients with endometrial cancer in Japan.

OBJECTIVE: The aim was to identify the characteristics and treatment patterns of early and advanced stage endometrial cancer patients using real-world data. METHODS: Patients' data extracted from a Japanese health insurance claims database were analyzed. RESULTS: Of the 12,449 endometrial cancer patients, 74.4% were in stage I, 5.1% in stage II, 12.0% in stage III, and 8.4% in stage IV. Their median age was 60.5 years, higher in advanced stages (III/IV) than in early stages (I/II). Overall, 11,055 patients (88.8%) underwent surgery, and 4977 patients (40.0%) received post-surgery treatment, including chemotherapy (4441: 35.7%), chemoradiation therapy (379: 3.0%), and radiation therapy (157 patients: 1.3%); 1394 patients (11.2%) were not treated by surgery, and 742 patients (6.0%) received other treatment, with chemotherapy (548: 4.4%), radiation therapy (105: 0.8%), and chemoradiation therapy (89: 0.7%). The rate of patients undergoing surgery decreased, and that receiving chemotherapy increased significantly as cancer stage progressed. Paclitaxel/carboplatin was the most frequent first-line regimen (85.4% of patients), whereas various combination and monotherapy regimens were used as second- and third-line regimens. The most frequent second-line monotherapy was paclitaxel. The rate of monotherapy increased as the treatment line progressed (first-line 3.5%, second-line 22.0%, and third-line 36.4%). CONCLUSIONS: The characteristics and treatment patterns of endometrial cancer patients differed between early and advanced stages, as did the chemotherapy regimens among first-, second-, and third-lines. Since various regimens were used for second- and third-line chemotherapies, development of appropriate second- and third-line chemotherapy regimens is warranted. A real-world analysis of cancer patients using a nationwide claims database may be a valuable approach to identifying unmet medical needs.

Soft X-ray emission spectroscopy for the electronic state of water molecules influenced by plasma-treated multi-walled carbon nanotubes.

In this study, soft X-ray emission spectroscopy of an aqueous colloidal dispersion of multi-walled carbon nanotubes modified via the plasma process in an aqueous solution was performed for investigating the electronic state of water molecules on the colloidal particles. In the aqueous dispersion, reconstruction of the hydrogen-bonded network was implied by the O 1s spectral changes in the 1b1' and 1b1'' peaks. Furthermore, the O 1s spectral intensity around the 3a1 state was enhanced to an unusually broad energy range in comparison with previous studies. This unusual spectral change might be attributed to the hybridization of the electronic states of oxygen-containing functional groups on the surface of the plasma-modified multi-walled carbon nanotubes and that of the surrounding water molecules. Our observation indicates not only reconstruction of the hydrogen-bonded network in the aqueous dispersion but also a significant interaction of the electronic states between the water molecules and the plasma-modified multi-walled carbon nanotubes.

Work Function Lowering of Graphite by Sequential Surface Modifications: Nitrogen and Hydrogen Plasma Treatment.

Graphite-related materials play an important role in various kinds of devices and catalysts. Controlling the properties of such materials is of great significance to widen the potential applications and improve the performance of such applications as field emission devices and catalyst for fuel cells. In particular, the work function strongly affects the performance, and thus development of methods to tune the work function widely is urgently required. Here, we achieved wide-range control of the work function of graphite by nitrogen and hydrogen plasma treatments. The time of hydrogen plasma treatment and the amount of nitrogen atoms doped beforehand could control the work function of graphite from 2.9 to 5.0 eV. The formation of a surface dipole layer and the nitrogen-derived electron donation contributed to such lowering of the work function, which is advantageous for applications in various fields.

Microscopic photoelectron analysis of single crystalline LiCoO2 particles during the charge-discharge in an all solid-state lithium ion battery.

We report synchrotron-based operando soft X-ray microscopic photoelectron spectroscopy under charge-discharge control of single crystalline LiCoO2 (LCO) particles as an active electrode material for an all solid-state lithium-ion battery (LIB). Photoelectron mapping and the photoelectron spectrum of a selected microscopic region are obtained by a customized operando cell for LIBs. During the charge process, a more effective Li extraction from a side facet of the single crystalline LCO particle than from the central part is observed, which ensures the reliability of the system as an operando microscopic photoelectron analyzer that can track changes in the electronic structure of a selected part of the active particle. Based on these assessments, the no drastic change in the Co 2p XPS spectra during charge-discharge of LCO supports that the charge-polarization may occur at the oxygen side by strong hybridization between Co 3d and O 2p orbitals. The success of tracking the electronic-structure change at each facet of a single crystalline electrode material during charge-discharge is a major step toward the fabrication of innovative active electrode materials for LIBs.

Database analysis of patients with hepatocellular carcinoma and treatment flow in early and advanced stages.

Despite recent developments in treatment modalities and diagnosis, the prognosis of advanced hepatocellular carcinoma (HCC) remains unsatisfactory. To gain insight into treatment decisions for HCC patients, their characteristics and treatment flow in the early and advanced stages were examined. HCC patients' characteristics and treatment flow were retrospectively analyzed using the Japanese medical claims database. The 8999 patients' mean age at HCC diagnosis was 71.1 years, with no difference between early (Stage I/II) and advanced (Stage III/IV) stages. The mean observation period was 26.2 months, shorter in advanced than in early stages. HCV hepatitis was reported in 52.0% of HCC patients, with concomitant hypertension in 53.4%, type 2 diabetes in 45.8%, cirrhosis in 39.3%, and hyperlipidemia in 15.5%. The rates of HCV hepatitis, hypertension, and hyperlipidemia decreased with stage progression. Analysis of treatment flow showed that, at all disease stages, transcatheter arterial chemoembolization (TACE) was the most common first to fourth-line treatment. Epirubicin was the most frequently (44.1%) used chemotherapeutic agent for first-line TACE, followed by miriplatin (23.6%) and cisplatin (12.3%). With stage progression, cisplatin use increased. Sorafenib was used concomitantly for first-line TACE in 3.2% of patients, and its use increased significantly in advanced stages. Clear differences in baseline characteristics and treatment flow between early and advanced stages were identified. Continuous analysis of the database with longer follow-up may provide useful information about treatment selection and prediction of outcome such as survival.

High degree reduction and restoration of graphene oxide on SiO2 at low temperature via remote Cu-assisted plasma treatment.

A high throughput synthesis method of graphene has been required for a long time to apply graphene to industrial applications. Of the various synthesis methods, the chemical exfoliation of graphite via graphene oxide (GO) is advantageous as far as productivity is concerned; however, the quality of the graphene produced by this method is far inferior to that synthesized by other methods, such as chemical vapor deposition on metals. Developing an effective reduction and restoration method for GO on dielectric substrates has been therefore a key issue. Here, we present a method for changing GO deposited on a dielectric substrate into high crystallinity graphene at 550 °C; this method uses CH4/H2 plasma and a Cu catalyst. We found that Cu remotely catalyzed the high degree reduction and restoration of GO on SiO2 and the effect ranged over at least 8 mm. With this method, field-effect transistor devices can be fabricated without any post treatment such as a transfer process. This plasma treatment increased electron and hole mobilities of GO to 480 cm2 V-1 s-1 and 460 cm2 V-1 s-1 respectively; these values were more than 50 times greater than that of conventional reduced GO. Furthermore, the on-site conversion ensured that the shape of the GO sheets remained unchanged after the treatment. This plasma treatment realizes the high throughput synthesis of a desired shaped graphene on any substrate without any residue and damage being caused by the transfer process; as such, it expands the potential applicability of graphene.