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1.
Sci Rep ; 14(1): 2119, 2024 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-38267520

RESUMEN

Recent earthquakes in several developing countries have shown that reinforced concrete (RC) buildings with improper structural detailing experience severe damage under seismic motions. Using low-quality construction materials such as brick aggregates, resulting in low-strength concrete, significantly impacts the bond between rebar and concrete. Accurate evaluation of the bond performance of such low-strength concrete is one of the key issues for seismic safety assessment of RC buildings, especially in Bangladesh; thus, the bond performance is usually evaluated through laboratory tests. However, conventional measurements of bond stress based on rebar strains measured by electrical resistance strain gauges are likely to negatively impact the bond behavior/performance because of the reduced total contact area between rebar and concrete as well as the changing rebar surface boundary conditions. Under the above social and academic backgrounds, in this study, a new measurement technique that applies fiber Bragg grating (FBG) sensors embedded in optical fiber to rebar strain measurements is developed, and its effectiveness is investigated to realize more accurate measurements of the bond stress between rebar and concrete. Two 70% scaled RC beam-column joint specimens in which the beam rebar was anchored in a straight manner were constructed with identical detailing, except for the beam rebar strain measuring methods. The specimens were then subjected to cyclic lateral loading until failure. By comparing the experimental data acquired by the above two different devices (the FBG sensors and conventional strain gauges), it was found that the experimental bond strength on the beam rebar based on the strain data measured by the FBG sensors was much higher than that from the data measured using conventional strain gauges. Which negatively impacted the test data on the beam-column joint's capacity in the specimen applied the conventional measuring method, indicating the necessity of the presented method not only for accurate evaluation of the bond stress between rebar and concrete but also for seismic safety assessments of RC buildings.

2.
J Am Chem Soc ; 146(8): 5088-5099, 2024 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-38112330

RESUMEN

Understanding the spatial distribution of the P1 centers is crucial for diamond-based sensors and quantum devices. P1 centers serve as polarization sources for dynamic nuclear polarization (DNP) quantum sensing and play a significant role in the relaxation of nitrogen vacancy (NV) centers. Additionally, the distribution of NV centers correlates with the distribution of P1 centers, as NV centers are formed through the conversion of P1 centers. We utilized DNP and pulsed electron paramagnetic resonance (EPR) techniques that revealed strong clustering of a significant population of P1 centers that exhibit exchange coupling and produce asymmetric line shapes. The 13C DNP frequency profile at a high magnetic field revealed a pattern that requires an asymmetric EPR line shape of the P1 clusters with electron-electron (e-e) coupling strengths exceeding the 13C nuclear Larmor frequency. EPR and DNP characterization at high magnetic fields was necessary to resolve energy contributions from different e-e couplings. We employed a two-frequency pump-probe pulsed electron double resonance technique to show cross-talk between the isolated and clustered P1 centers. This finding implies that the clustered P1 centers affect all of the P1 populations. Direct observation of clustered P1 centers and their asymmetric line shape offers a novel and crucial insight into understanding magnetic noise sources for quantum information applications of diamonds and for designing diamond-based polarizing agents with optimized DNP efficiency for 13C and other nuclear spins of analytes. We propose that room temperature 13C DNP at a high field, achievable through straightforward modifications to existing solution-state NMR systems, is a potent tool for evaluating and controlling diamond defects.

3.
iScience ; 26(12): 108536, 2023 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-38089585

RESUMEN

Animal adaptation to environmental goals to pursue rewards is modulated by dopamine. However, the role of dopamine in the hippocampus, involved in spatial navigation, remains unclear. Here, we studied dopaminergic inputs from the ventral tegmental area (VTA) to the hippocampus, focusing on spatial goal persistence and adaptation. Mice with VTA dopaminergic lesions struggled to locate and update learned reward locations in a circular maze with dynamic reward locations, emphasizing the importance of VTA dopaminergic neurons in the persistence and adaptation of spatial memory. Further, these deficits were accompanied by motor impairments or motivational loss even when dopamine receptors in the dorsal hippocampus were selectively blocked. Stimulation of VTA dopaminergic axons within the dorsal hippocampus enhanced the mice's ability to adapt to changing reward locations. These findings provide insights into the contribution of dopaminergic inputs within the hippocampus to spatial goal adaptation.

4.
Medicine (Baltimore) ; 102(30): e34492, 2023 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-37505136

RESUMEN

INTRODUCTION: Vasculitis does not usually induce glandular tissue lesions. Herein, we present a case of vasculitis with a distribution similar to that of immunoglobulin-G4-related disease (IgG4-RD), including that of the submandibular and lacrimal glands, and periaortitis. CASE REPORT: A 70-year-old man presented with shortness of breath. Laboratory findings revealed an IgG4 level of 191 mg/dL, negative antineutrophil cytoplasmic antibody test, and C-reactive protein level of 8.33 mg/dL. Magnetic resonance imaging of the head and computed tomography of the neck revealed bilaterally enlarged submandibular and lacrimal glands. Neck-to-pelvis computed tomography revealed bilateral infiltrative shadows in the lower lobes of both lungs, mass shadows in both lungs, and periaortitis of the abdominal aorta extending to the common iliac artery. Thus, the patient was diagnosed with IgG4-related respiratory disease and periaortitis/periarteritis. Prednisolone was administered at a dose of 35 mg (0.6 mg/kg daily). The dose was gradually tapered while observing the effects of the treatment. Imaging findings indicated an improvement and the C-reactive protein and IgG4 levels decreased, indicating a successful treatment course. However, after reexamination of the pathological findings, the diagnosis changed from IgG4-RD to vasculitis. One year after treatment initiation, the patient symptoms have stabilized. CONCLUSION: Vasculitis can present with lesions and pathological findings similar to those of IgG4-RD.


Asunto(s)
Arteritis , Enfermedad Relacionada con Inmunoglobulina G4 , Aparato Lagrimal , Masculino , Humanos , Anciano , Enfermedad Relacionada con Inmunoglobulina G4/patología , Aparato Lagrimal/patología , Proteína C-Reactiva , Inmunoglobulina G
5.
Neurobiol Learn Mem ; 199: 107731, 2023 03.
Artículo en Inglés | MEDLINE | ID: mdl-36764645

RESUMEN

Animals appear to possess an internal timer during action, based on the passage of time. However, the neural underpinnings of the perception of time, ranging from seconds to minutes, remain unclear. Herein, we considered the neural representation of time based on mounting evidence on the neural correlates of time perception. The passage of time in the brain is represented by two types of neural encoding as follows: (i) the modulation of firing rates in single neurons and (ii) the sequential activity in neural ensembles. Time-dependent neural activity reflects the relative time rather than the absolute time, similar to a clock. They emerge in multiple regions, including the hippocampus, medial and lateral entorhinal cortices, medial prefrontal cortex, and dorsal striatum. Moreover, they involve different brain regions, depending on an implicit or explicit event duration. Thus, the two types of internal timers distributed across multiple brain regions simultaneously engage in time perception, in response to implicit or explicit time demands.


Asunto(s)
Encéfalo , Corteza Entorrinal , Animales , Encéfalo/fisiología , Corteza Entorrinal/fisiología , Hipocampo/fisiología , Neuronas/fisiología , Mapeo Encefálico
6.
J Vis Exp ; (190)2022 12 02.
Artículo en Inglés | MEDLINE | ID: mdl-36533822

RESUMEN

Several maze shapes are used to test spatial navigation performance and behavioral phenotypes. Traditionally, each experiment requires a unique maze shape, thus requiring several separate mazes in different configurations. The maze geometry cannot be reconfigured in a single environment to accommodate scalability and reproducibility. The reconfigurable maze is a unique approach to address the limitations, allowing quick and flexible configurations of maze pathways in a repeatable manner. It consists of interlocking pathways and includes feeders, treadmills, movable walls, and shut-off sensors. The current protocol describes how the reconfigurable maze can replicate existing mazes, including the T-shaped, plus-shaped, W-shaped, and figure-eight mazes. Initially, the T-shaped maze was constructed inside a single experimental room, followed by modifications. The rapid and scalable protocol outlined herein demonstrates the flexibility of the reconfigurable maze, achieved through the addition of components and behavioral training phases in a stepwise manner. The reconfigurable maze systematically and precisely assesses the performance of multiple aspects of spatial navigation behavior.


Asunto(s)
Navegación Espacial , Animales , Aprendizaje por Laberinto , Roedores , Reproducibilidad de los Resultados , Conducta Espacial
7.
Ann Plast Surg ; 89(6): e39-e44, 2022 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-36416701

RESUMEN

BACKGROUND: Although the deep inferior epigastric artery perforator flap is the criterion standard for autologous breast reconstruction, lumbar artery perforator (LAP) and superior gluteal artery perforator (SGAP) flaps are recent trends as alternatives. The purpose of our study was to clarify differences of these flaps based on multislice CT findings of the same patient. METHODS: Retrospective study was conducted on 58 patients who underwent preoperative contrast-enhanced multislice CT for breast reconstruction using deep inferior epigastric artery perforator. Of these, 32 patients' data were evaluated excluding 26 patients' data either for the lumbar or gluteal fat being outside the imaging range or for nondepiction of the vascular pedicle origin of LAP or SGAP flap. Vascular pedicle diameter, pedicle length, and subcutaneous fat thickness were measured for LAP and SGAP flaps. RESULTS: The vascular pedicle diameter, pedicle length, and fat thickness were 2.1 (SD, 0.3) mm, 3.4 (SD, 0.4) cm, and 4.9 (SD, 1.0) cm, respectively, for LAP flaps; and 1.7 (SD, 0.2) mm, 5.6 (SD, 1.1) cm, and 2.7 (SD, 0.7) cm, respectively, for SGAP flaps. CONCLUSIONS: The LAP flaps had thicker subcutaneous fat and a larger vascular pedicle diameter, whereas the SGAP flaps had a longer vascular pedicle. As donor material for breast reconstruction, the LAP flap is indicated for cases where absolute volume is needed; otherwise, the SGAP flap is more advantageous as it facilitates vascular anastomosis with its longer vascular pedicle.


Asunto(s)
Mamoplastia , Colgajo Perforante , Humanos , Colgajo Perforante/irrigación sanguínea , Estudios Retrospectivos , Nalgas/diagnóstico por imagen , Nalgas/cirugía , Nalgas/irrigación sanguínea , Mamoplastia/métodos , Arterias/diagnóstico por imagen , Tomografía Computarizada por Rayos X
8.
J Phys Chem C Nanomater Interfaces ; 126(41): 17777-17787, 2022 Oct 20.
Artículo en Inglés | MEDLINE | ID: mdl-36304670

RESUMEN

We use microwave-induced dynamic nuclear polarization (DNP) of the substitutional nitrogen defects (P1 centers) in diamond to hyperpolarize bulk 13C nuclei in both single crystal and powder samples at room temperature at 3.34 T. The large (>100-fold) enhancements demonstrated correspond to a greater than 10 000-fold improvement in terms of signal averaging of the 1% abundant 13C spins. The DNP was performed using low-power solid state sources under static (nonspinning) conditions. The DNP spectrum (DNP enhancement as a function of microwave frequency) of diamond powder shows features that broadly correlate with the EPR spectrum. A well-defined negative Overhauser peak and two solid effect peaks are observed for the central (m I = 0) manifold of the 14N spins. Previous low temperature measurements in diamond had measured a positive Overhauser enhancement in this manifold. Frequency-chirped millimeter-wave excitation of the electron spins is seen to significantly improve the enhancements for the two outer nuclear spin manifolds (mI = ±1) and to blur some of the sharper features associated with the central manifold. The outer lines are best fit using a combination of the cross effect and the truncated cross effect, which is known to mimic features of an Overhauser effect. Similar features are also observed in experiments on single crystal samples. The observation of all of these mechanisms in a single material system under the same experimental conditions is likely due to the significant heterogeneity of the high pressure, high temperature (HPHT) type Ib diamond samples used. Large room temperature DNP enhancements at fields above a few tesla enable spectroscopic studies with better chemical shift resolution under ambient conditions.

9.
Micromachines (Basel) ; 13(9)2022 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-36144152

RESUMEN

Simultaneous monitoring of animal behavior and neuronal activity in the brain enables us to examine the neural underpinnings of behaviors. Conventionally, the neural activity data are buffered, amplified, multiplexed, and then converted from analog to digital in the head-stage amplifier, following which they are transferred to a storage server via a cable. Such tethered recording systems, intended for indoor use, hamper the free movement of animals in three-dimensional (3D) space as well as in large spaces or underwater, making it difficult to target wild animals active under natural conditions; it also presents challenges in realizing its applications to humans, such as the Brain-Machine Interfaces (BMI). Recent advances in micromachine technology have established a wireless logging device called a neurologger, which directly stores neural activity on ultra-compact memory media. The advent of the neurologger has triggered the examination of the neural correlates of 3D flight, underwater swimming of wild animals, and translocation experiments in the wild. Examples of the use of neurologgers will provide an insight into understanding the neural underpinnings of behaviors in the natural environment and contribute to the practical application of BMI. Here we outline the monitoring of the neural underpinnings of flying and swimming behaviors using neurologgers. We then focus on neuroethological findings and end by discussing their future perspectives.

10.
Sci Adv ; 8(5): eabl6848, 2022 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-35119935

RESUMEN

Animals exhibit remarkable navigation abilities as if they have an internal compass. Head direction (HD) cells encoding the animal's heading azimuth are found in the brain of several animal species; the HD cell signals are dependent on the vestibular nuclei, where magnetic responsive cells are present in birds. However, it is difficult to determine whether HD cell signals drive the compass orientation in animals, as they do not necessarily rely on the magnetic compass under all circumstances. Recording of HD cell activities from the medial pallium of shearwater chicks (Calonectris leucomelas) just before their first migration, during which they strongly rely on compass orientation, revealed that shearwater HD cells prefer a north orientation. The preference remained stable regardless of geolocations and environmental cues, suggesting the existence of a magnetic compass regulated by internally generated HD signals. Our findings provide insight into the integration of the direction and magnetoreception senses.

11.
Semin Oncol ; 49(6): 439-455, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36759235

RESUMEN

Immune checkpoint inhibitors (ICI) are widely used for the treatment of various malignant neoplasms. Interstitial lung disease is a well-known immune-related adverse event, however, ICI-induced airway disease remains under-recognized. Herein, we report two similar cases of pembrolizumab-induced tracheobronchitis presenting as persistent chronic cough and dyspnea. Blood tests revealed elevated C-reactive protein levels without eosinophilia. Spirometry demonstrated mild airflow obstruction. Computed tomography revealed diffuse thickening of the tracheobronchial walls and bronchiectasis predominantly in the lower lobes. Bronchoscopy revealed edematous and erythematous tracheobronchial mucosa, and bronchial biopsy tissue exhibited marked inflammation with predominant infiltration of CD8+ lymphocytes. Subsequently, pembrolizumab-induced tracheobronchitis was diagnosed in both cases. Cessation of pembrolizumab and initiation of erythromycin, inhaled corticosteroids, and long-acting beta-agonists gradually improved the symptoms, airflow obstruction, and radiographic findings. These were completely resolved in one case. The other case initially showed a poor response to systemic corticosteroids combined with the aforementioned drugs, but improved gradually and almost completely. These cases exemplify ICI-induced airway disease that is, an under-recognized manifestation of immune-related adverse events. In addition, we have systematically searched the PubMed database for articles on ICI-induced airway disease, categorized the retrieved articles as eosinophilic and non-eosinophilic airway diseases, and reviewed the differences in treatment and prognoses between these two categories.


Asunto(s)
Neoplasias , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Pulmón , Neoplasias/tratamiento farmacológico , Tos/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico
12.
Nat Commun ; 12(1): 5519, 2021 09 17.
Artículo en Inglés | MEDLINE | ID: mdl-34535659

RESUMEN

Since the variables inherent to various diseases cannot be controlled directly in humans, behavioral dysfunctions have been examined in model organisms, leading to better understanding their underlying mechanisms. However, because the spatial and temporal scales of animal locomotion vary widely among species, conventional statistical analyses cannot be used to discover knowledge from the locomotion data. We propose a procedure to automatically discover locomotion features shared among animal species by means of domain-adversarial deep neural networks. Our neural network is equipped with a function which explains the meaning of segments of locomotion where the cross-species features are hidden by incorporating an attention mechanism into the neural network, regarded as a black box. It enables us to formulate a human-interpretable rule about the cross-species locomotion feature and validate it using statistical tests. We demonstrate the versatility of this procedure by identifying locomotion features shared across different species with dopamine deficiency, namely humans, mice, and worms, despite their evolutionary differences.


Asunto(s)
Atención , Conducta Animal , Redes Neurales de la Computación , Animales , Atención/fisiología , Caenorhabditis elegans/fisiología , Escarabajos/fisiología , Dopamina/metabolismo , Neuronas Dopaminérgicas/metabolismo , Neuronas Dopaminérgicas/patología , Humanos , Ratones Endogámicos C57BL , Enfermedad de Parkinson/patología , Especificidad de la Especie
13.
Neuropsychopharmacol Rep ; 41(2): 192-198, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33749139

RESUMEN

PURPOSE: Multiple sleep latency test (MSLT) is performed as objective assessment of sleepiness, on the following day after polysomnography (PSG). In most clinics, patients are required to stay for 2 days. However, if patients have chronic sleep debt before the examination, even if they get adequate nocturnal sleep during the initial PSG, their sleep debt would not be fully resolved, affecting MSLT results. This may lead to improper administration of psycho-stimulant medication. To clarify the sleep debt for the patients who showed short sleep latencies, we compared the mean sleep latencies of MSLTs. METHODS: Twelve hypersomnolent males, who underwent MSLTs (1st MSLT with 1 night and 2nd MSLT with more than 3 nights), were enrolled. We selected these cases based on the longer total sleep time on PSG night compared to the mean total sleep time on pre-examination sleep logs and shortened sleep latencies on PSG. To evaluate the effect of the sleep debt for the patients who showed short sleep latencies, we extended their hospitalization or re-hospitalized them. RESULTS: The mean sleep latency of 1st MSLT was 5.8 minutes and that of 2nd was 13.9 minutes (P < .001). Among these 12 cases, 5 cases altered from short to normal sleep latencies at the 2nd MSLT. These 5 cases were prevented from over-diagnoses by the extension of evaluations. CONCLUSIONS: The sleep debt may produce false-positive results when patients are examined by standard PSG and MSLT. Accumulation of sleep debt will cause shortened sleep latencies in the following nights. Patients should be advised to extend their hospitalization before PSG and MSLT to reduce the chronic sleep debt for accurate diagnosis of hypersomnia.


Asunto(s)
Trastornos de Somnolencia Excesiva , Latencia del Sueño , Humanos , Masculino , Polisomnografía , Sueño , Privación de Sueño
14.
Nano Lett ; 20(12): 8668-8674, 2020 Dec 09.
Artículo en Inglés | MEDLINE | ID: mdl-33205986

RESUMEN

Scaling information bits to ever smaller dimensions is a dominant drive for information technology (IT). Nanostructured phase change material emerges as a key player in the current green-IT endeavor with low power consumption, functional modularity, and promising scalability. In this work, we present the demonstration of microwave AC voltage induced phase change phenomenon at ∼3 GHz in single Sb2Te3 nanowires. The resistance change by a total of 6-7 orders of magnitude is evidenced by a transition from the crystalline metallic to the amorphous semiconducting phase, which is cross-examined by temperature dependent transport measurement and high-resolution electron microscopy analysis. This discovery could potentially tailor multistate information bit encoding and electrical addressability along a single nanowire, rendering technology advancement for neuro-inspired computing devices.

15.
Nat Commun ; 11(1): 5316, 2020 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-33082335

RESUMEN

A comparative analysis of animal behavior (e.g., male vs. female groups) has been widely used to elucidate behavior specific to one group since pre-Darwinian times. However, big data generated by new sensing technologies, e.g., GPS, makes it difficult for them to contrast group differences manually. This study introduces DeepHL, a deep learning-assisted platform for the comparative analysis of animal movement data, i.e., trajectories. This software uses a deep neural network based on an attention mechanism to automatically detect segments in trajectories that are characteristic of one group. It then highlights these segments in visualized trajectories, enabling biologists to focus on these segments, and helps them reveal the underlying meaning of the highlighted segments to facilitate formulating new hypotheses. We tested the platform on a variety of trajectories of worms, insects, mice, bears, and seabirds across a scale from millimeters to hundreds of kilometers, revealing new movement features of these animals.


Asunto(s)
Aves/fisiología , Aprendizaje Profundo , Insectos/fisiología , Ratones/fisiología , Ursidae/fisiología , Animales , Conducta Animal , Femenino , Movimiento , Redes Neurales de la Computación , Programas Informáticos
16.
iScience ; 23(1): 100787, 2020 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-31918045

RESUMEN

Multiple mazes are routinely used to test the performance of animals because each has disadvantages inherent to its shape. However, the maze shape cannot be flexibly and rapidly reproduced in a repeatable and scalable way in a single environment. Here, to overcome the lack of flexibility, scalability, reproducibility, and repeatability, we develop a reconfigurable maze system that consists of interlocking runways and an array of accompanying parts. It allows experimenters to rapidly and flexibly configure a variety of maze structures along the grid pattern in a repeatable and scalable manner. Spatial navigational behavior and hippocampal place coding were not impaired by the interlocking mechanism. As a proof-of-principle demonstration, we demonstrate that the maze morphing induces location remapping of the spatial receptive field. The reconfigurable maze thus provides flexibility, scalability, repeatability, and reproducibility, therefore facilitating consistent investigation into the neuronal substrates for learning and memory and allowing screening for behavioral phenotypes.

17.
Neurosci Res ; 153: 62-67, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31002837

RESUMEN

Operant conditioning of neuronal activity is a core process for better operation of brain-machine interfaces. However, few studies have investigated the role of reinforcement schedules in neuronal operant conditioning, although they are very effective in behavioral operant conditioning. To test the effect of different reinforcement schedules, the authors trained single-neuron activity in the motor cortex using fixed ratio (FR) and variable ratio (VR) schedules in rats. Neuronal firing rates were enhanced in the FR but not in the VR schedule during conditioning, suggesting that the principles of operant conditioning of neuronal activity are different from those of behavioral responses.


Asunto(s)
Condicionamiento Operante/fisiología , Neuronas/fisiología , Esquema de Refuerzo , Animales , Masculino , Corteza Motora/fisiología , Ratas , Ratas Wistar
18.
Elife ; 82019 11 12.
Artículo en Inglés | MEDLINE | ID: mdl-31711567

RESUMEN

The basal ganglia are critical for the control of motor behaviors and for reinforcement learning. Here, we demonstrate in rats that primary and secondary motor areas (M1 and M2) make functional synaptic connections in the globus pallidus (GP), not usually thought of as an input site of the basal ganglia. Morphological observation revealed that the density of axonal boutons from motor cortices in the GP was 47% and 78% of that in the subthalamic nucleus (STN) from M1 and M2, respectively. Cortical excitation of GP neurons was comparable to that of STN neurons in slice preparations. FoxP2-expressing arkypallidal neurons were preferentially innervated by the motor cortex. The connection probability of cortico-pallidal innervation was higher for M2 than M1. These results suggest that cortico-pallidal innervation is an additional excitatory input to the basal ganglia, and that it can affect behaviors via the cortex-basal ganglia-thalamus motor loop.


Asunto(s)
Globo Pálido/anatomía & histología , Globo Pálido/fisiología , Corteza Motora/anatomía & histología , Corteza Motora/fisiología , Vías Nerviosas/anatomía & histología , Vías Nerviosas/fisiología , Neuronas/fisiología , Animales , Conectoma , Ratas
19.
Clinicoecon Outcomes Res ; 11: 579-590, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31576157

RESUMEN

BACKGROUND: In Japan, the medical expenditures associated with dialysis have garnered considerable interest; however, a cost-effectiveness evaluation of peritoneal dialysis (PD) is yet to be evaluated. In particular, the health economics of the "PD first" concept, which can be advantageous for clinical practice and healthcare systems, must be evaluated. METHODS: This multicenter study investigated the cost-effectiveness of PD. The major effectiveness indicator was quality-adjusted life year (QALY), with a preference-based utility value based on renal function, and the cost indicator was the amount billed for a medical service at each medical institution for qualifying illnesses. In comparison with hemodialysis (HD), a baseline analysis of PD therapy was conducted using a cost-utility analysis (CUA). Continuous ambulatory PD (CAPD) and automated PD (APD) were compared based on the incremental cost-utility ratio (ICUR) and propensity score (PS) with a limited number of cases. RESULTS: The mean duration since the start of PD was 35.0±14.4 months. The overall CUA for PD (179 patients) was USD 55,019/QALY, which was more cost effective (USD/monthly utility) compared with that for HD for 12-24 months (4,367 vs. 4,852; p<0.05). The CUA reported significantly better results in the glomerulonephritis group than in the other diseases, and the baseline CUA was significantly age sensitive. The utility score was higher in the APD group (mean age, 70.1±3.5 years) than in the CAPD group (mean age, 70.6±4.2 years; 0.987 vs. 0.860; p<0.05, 9 patients). Compared with CAPD, APD had an overall ICUR of USD 126,034/QALY. CONCLUSION: The cost-effectiveness of PD was potentially good in the elderly and in patients on dialysis for <24 months. Therefore, the prevalence of PD may influence the public health insurance system, particularly when applying the "PD first" concept.

20.
Diabetol Int ; 10(3): 153-179, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31275782

RESUMEN

To ensure that experiences and lessons learned from the unprecedented 2011 Great East Japan Earthquake are used to improve future disaster planning, the Japan Diabetes Society (JDS) launched the "Research and Survey Committee for Establishing Disaster Diabetes Care Systems Based on Relevant Findings from the Great East Japan Earthquake" under the supervision of the Chairman of the JDS. The Committee conducted a questionnaire survey among patients with diabetes, physicians, disaster medical assistance teams (DMATs), nurses, pharmacists, and nutritionists in disaster areas about the events they saw happening, the situations they found difficult to handle, and the needs that they felt required to be met during the 2011 Great East Japan Earthquake. A total of 3,481 completed questionnaires were received. Based on these and other experiences and lessons reported following the 2011 Great East Japan Earthquake and the 2004 Niigata-Chuetsu Earthquakes, the current "Manual for Disaster Diabetes Care" has been developed by the members of the Committee and other invited authors from relevant specialties. To our knowledge, the current Manual is the world's first to focus on emergency diabetes care, with this digest English version translated from the Japanese original. It is sincerely hoped that patients with diabetes and healthcare providers around the world will find this manual helpful in promoting disaster preparedness and implementing disaster relief.

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