Designing Medication-Related Profiles for Japanese ePrescriptions with HL7 FHIR.

HL7 FHIR is the standard for healthcare information exchange. In November 2022, our medication subgroup developed 8 profiles and 23 extensions for medication procedures in Japan, as part of the JP Core Implementation Guide 1.1. Our work demonstrates the ability of HL7 FHIR to describe Japanese prescription procedures while also addressing the requirements of other countries.

Temporal and interspecific dietary variation in wintering ducks in agricultural landscapes.

Farmlands are becoming more important as waterfowl foraging habitats, while natural wetlands are being lost globally. However, it is unclear how waterfowl coexist in agricultural landscapes by resource partitioning. We evaluated the diets of seven sympatric dabbling ducks foraging in rice paddy and lotus fields around Lake Kasumigaura, the second largest lake in Japan, during two wintering seasons (from November to February) by faecal DNA metabarcoding using chloroplast trnL and mitochondrial CO1 region sequences. We examined 420 faecal samples and found different patterns of dietary diversity and composition among the duck species. The pattern also differed between plant and invertebrate food. Dietary niche partitioning was clear in plant food. Large-bodied ducks intensively use crop plants, and other ducks might mediate competition by using terrestrial and aquatic plants that are suitable for their foraging behaviours or microhabitats. Dietary segregation among species was the most apparent in February, when the abundance of foraging ducks was the largest. This study illustrated the complex pattern of dietary niche partitioning of dabbling ducks in agricultural landscapes, which might be difficult to evaluate by conventional approaches. The availability of crop plants, as well as other plant food resources in flooted areas and farmland dikes, may enable ducks to coexist by spatial or behavioural resource partitioning.

Factors affecting patient satisfaction related to cost and treatment effectiveness in rheumatoid arthritis: results from the multicenter observational cohort study, FRANK Registry.

BACKGROUND: To further improve rheumatoid arthritis (RA) treatment, it is necessary to understand each RA patient's satisfaction and to identify the factors affecting their satisfaction. Despite the rise in medical costs for RA, little is known about the factors that influence patient satisfaction with the cost of treatment in RA patients. METHODS: This is a multicenter observational study of Japanese RA patients from the FRANK Registry with data analyzed from March 2017 to August 2020. We collected data on demographic characteristics, clinical data, quality of life which was evaluated using the EuroQol 5-dimensional questionnaire (EQ5D), and patient satisfaction. The four categories of patient satisfaction were evaluated individually (i.e., cost, treatment efficacy, activities of daily living [ADL], and global treatment satisfaction). We analyzed the factors that affected each patient's satisfaction, such as age, sex, EQ5D, disease duration, disease activity, and treatment. RESULTS: This study included 2235 RA outpatients (406 males, 1829 females). In RA patients, "very satisfied" and "satisfied" were given for nearly half of each satisfaction aspect (cost 49%; efficacy 72%; ADL 58%; global treatment 66%) at the time of the initial registration. To investigate the factors influencing each satisfaction, multivariate analysis has revealed that the use of b/tsDMARDs increased satisfaction of treatment effect (odds ratio [OR] 0.66) and ADL (OR 0.78) but decreased cost satisfaction (OR 2.21). Age (50-64 years; OR 0.91; 65-74 years, 0.55: ≥ 75 years, 0.35), female (OR 0.81), and history of musculoskeletal surgery (OR 0.60) all increased cost satisfaction. Patients with lower disease activity and higher EQ5D scores had higher levels of satisfaction in all areas. CONCLUSIONS: In this study, patient satisfaction in terms of cost, treatment effect, ADL, and overall treatment was generally higher, but some patients were dissatisfied. The cost of satisfaction increased with age and a history of musculoskeletal surgery, while it decreased with a lower EQ5D score and the use of b/tsDMARDs.

Waveband-shift-free optical phase conjugator based on difference-frequency generation.

In this paper, a waveband-shift-free optical phase conjugator based on difference-frequency generation (DFG-OPC) that enables broadband operation is proposed and theoretically investigated. First, the principle of phase-conjugated (PC) wave generation with the DFG-OPC is mathematically described. Using a Sagnac loop interferometer with a χ(2) optical nonlinear material and two dispersive elements (DEs), a PC wave with the same wavelength as a signal can be generated. Subsequently, the required DE length difference for the PC wave generation is theoretically calculated. The calculation results indicate the minimal DE length difference is 20.0 µm, and this is because the DFG-OPC enables broadband operation. Second, the wavelength characteristics of the DFG-OPC are investigated through numerical simulation. The operation bandwidth of the DFG-OPC depends on the DE length difference, and an operating bandwidth of the DFG-OPC of 54.5 nm can be achieved when the DE length difference is less than 0.01 m. Finally, the influence of the splitting ratio of an optical 3-dB coupler in the DFG-OPC is numerically studied. The results indicate that tolerance of the optical coupler splitting ratio is equal to or less than ±6% for the DFG-OPC.

The Development of an Electronic Phenotyping Algorithm for Identifying Rhabdomyolysis Patients in the MID-NET Database.

We aimed to develop rhabdomyolysis (RB) phenotyping algorithms using machine learning techniques and to create subphenotyping algorithms to identify RB patients who lack RB diagnosis. Two pattern algorithms, one with a focus on improving predictive value and one focused on improving sensitivity, were finally created and had a high area under the curve value of 0.846. Although we were unable to create subphenotyping algorithms, an attempt to detect unknown RB patients is important for epidemiological studies.

Effect of Governance Functionality for Data Standardization Management of the Medical Information Database Network Project.

Data standardiztion an important aspect to ensure data quality for utilizing large-scale, medical information databases such as the Medical Information Database Network (MID-NET) Project in Japan. We established a governance center to assess the consistency of standard codes across MID-NET-cooperating medical institutions. Moreover, we developed a real-time validation tool and determined its effect in improving data quality in medical institutions by providing a central feedback on the detected differences in standard disease-name codes.

Electron-tracking Compton camera imaging of technetium-95m.

Imaging was conducted using an electron tracking-Compton camera (ETCC), which measures γ-rays with energies in the range of 200-900 keV from 95mTc. 95mTc was produced by the 95Mo(p, n)95mTc reaction on a 95Mo-enriched target. A method for recycling 95Mo-enriched molybdenum trioxide was employed, and the recycled yield of 95Mo was 70%-90%. Images were obtained with the gate of three energies. The results showed that the spatial resolution increases with increasing γ-ray energy, and suggested that the ETCC with high-energy γ-ray emitters such as 95mTc is useful for the medical imaging of deep tissue and organs in the human body.

Establishment of Imaging Spectroscopy of Nuclear Gamma-Rays based on Geometrical Optics.

Since the discovery of nuclear gamma-rays, its imaging has been limited to pseudo imaging, such as Compton Camera (CC) and coded mask. Pseudo imaging does not keep physical information (intensity, or brightness in Optics) along a ray, and thus is capable of no more than qualitative imaging of bright objects. To attain quantitative imaging, cameras that realize geometrical optics is essential, which would be, for nuclear MeV gammas, only possible via complete reconstruction of the Compton process. Recently we have revealed that "Electron Tracking Compton Camera" (ETCC) provides a well-defined Point Spread Function (PSF). The information of an incoming gamma is kept along a ray with the PSF and that is equivalent to geometrical optics. Here we present an imaging-spectroscopic measurement with the ETCC. Our results highlight the intrinsic difficulty with CCs in performing accurate imaging, and show that the ETCC surmounts this problem. The imaging capability also helps the ETCC suppress the noise level dramatically by ~3 orders of magnitude without a shielding structure. Furthermore, full reconstruction of Compton process with the ETCC provides spectra free of Compton edges. These results mark the first proper imaging of nuclear gammas based on the genuine geometrical optics.

First On-Site True Gamma-Ray Imaging-Spectroscopy of Contamination near Fukushima Plant.

We have developed an Electron Tracking Compton Camera (ETCC), which provides a well-defined Point Spread Function (PSF) by reconstructing a direction of each gamma as a point and realizes simultaneous measurement of brightness and spectrum of MeV gamma-rays for the first time. Here, we present the results of our on-site pilot gamma-imaging-spectroscopy with ETCC at three contaminated locations in the vicinity of the Fukushima Daiichi Nuclear Power Plants in Japan in 2014. The obtained distribution of brightness (or emissivity) with remote-sensing observations is unambiguously converted into the dose distribution. We confirm that the dose distribution is consistent with the one taken by conventional mapping measurements with a dosimeter physically placed at each grid point. Furthermore, its imaging spectroscopy, boosted by Compton-edge-free spectra, reveals complex radioactive features in a quantitative manner around each individual target point in the background-dominated environment. Notably, we successfully identify a "micro hot spot" of residual caesium contamination even in an already decontaminated area. These results show that the ETCC performs exactly as the geometrical optics predicts, demonstrates its versatility in the field radiation measurement, and reveals potentials for application in many fields, including the nuclear industry, medical field, and astronomy.

Optical pump phase locking to a carrier wave extracted from phase-conjugated twin waves for phase-sensitive optical amplifier repeaters.

In this paper, an optical phase-locked loop assisted by sum-frequency and second-harmonic generation (SS-OPLL) for frequency nondegenerate optical parametric phase-sensitive amplifier repeaters is experimentally demonstrated. First, theoretical derivations show that carrier extraction from phase-conjugated twin waves (PCTWs) and reference light generation are achieved by sum-frequency generation; therefore, the SS-OPLL circuit enables optical phase locking between PCTWs and a pump wave by a simple architecture based on a balanced OPLL. Then, optical phase locking between 20-Gbit/s quadrature phase-shift keying PCTWs and an individual pump source is experimentally demonstrated. Experimental results indicate that phase errors were reduced during the SS-OPLL operation.

Phase-noise characteristics of a 25-GHz-spaced optical frequency comb based on a phase- and intensity-modulated laser.

We investigated phase-noise characteristics of both a phase/intensity-modulated laser with 25-GHz mode spacing and a mode-locked fiber laser with carrier-envelope-offset (CEO) locking. As the separation from the frequency of the continuous wave (CW) laser diode (LD) for a seed light source increases, the integrated phase noise of each comb mode of both the phase/intensity-modulated laser and supercontinuum light originating from it increases with the same slope as a function of mode number. The dependence of the integrated phase noise on mode number with the phase/intensity-modulated laser is much larger than with the mode-locked fiber laser of the CEO locking. However, the phase noise of the phase/intensity-modulated laser is extremely lower than that of the mode-locked fiber laser with CEO locking in the frequency region around the CW LD. The phase noise of the phase/intensity-modulated laser with 25-GHz mode spacing and that of the mode-locked fiber laser with the CEO locking could be estimated and were found to be almost the same at the wavelengths required in an f-to-2f self-referencing interferometer. Our experimental results indicate the possibility of achieving an offset-frequency-locked frequency comb with the phase/intensity-modulated laser.

Two patients requiring surgical management for leakage of calcium hydroxide paste from root canal into infraorbital space.

Two patients requiring surgical management for leakage of calcium hydroxide paste from a root canal into the infraorbital space are reported. A paste root canal treatment material used at the time of maxillary root canal treatment had leaked out of the root canal in both patients. Computed tomography confirmed displacement of the root canal treatment material into the soft tissue, with extension into the infraorbital space. In both cases, foreign body removal was performed. Root canal treatment using a calcium hydroxide paste should be performed carefully without strong pressure.

[Complete disappearance of pulmonary metastases in a case of rectal cancer treated with oral tegafur-uracil (UFT) and leucovorin (LV)].

We report a case of complete remission after treatment with tegafur-uracil (UFT)/Leucovorin (LV) therapy for pulumonary metastasis of rectal cancer. A 56-year-old male was admitted to our hospital with a diagnosis of rectal cancer (Ra, type2). Chest CT on admission demonstrated bilateral lung metastases (rt S2 and lt S4). After anterior resection of the primary tumor, oral UFT/LV was administered (UFT 400 mg/LV 75 mg, 4-week administration and 1-week no-administration period) on an outpatient basis. After 2 courses, chest CT revealed reduction of both metastases, and complete resection of the metastases by video assisted thoracic surgery (VATS) was planned. Pathological findings of a specimen revealed no residual cancer cells, indicating a complete response to UFT/LV therapy. After these treatments, combined therapy of UFT/LV was continued for 3 months, and the single administration of UFT was continued for 1 year. The patient experienced no adverse reactions, and has had no recurrent disease in 4 years. Oral UFT/LV therapy is considered to be a promising regimen for patients with resectable metastatic lesion from a standpoint of clinical efficacy and safety.

Risk factors for predicting severe neutropenia induced by amrubicin in patients with advanced lung cancer.

BACKGROUND: Neutropenia is one of the most frequent and dose-limiting toxicities in amrubicin (AMR) therapy. However, the predictive factors for the development of severe neutropenia in AMR therapy remain unknown. METHODS: The subjects were 61 advanced lung cancer patients treated with AMR monotherapy. All data were retrospectively collected from the electronic medical record system. A stepwise logistic regression analysis was performed to identify risk factors for grade 3-4 neutropenia. RESULTS: Of a total 61 patients, 50 were male and 11 were female. The median dose of AMR was 35.0 mg/m(2). The incidence of grade 3-4 neutropenia during the first course was 62%. In multivariate analysis, female gender (OR = 6.68; 95% CI 1.01-134.15; p = 0.049), higher AMR doses (40 mg/m(2) or more) (OR = 5.98; 95% CI 1.77-23.74; p = 0.003), and lower hematocrit values (OR = 2.04 per 5% decrease; 95% CI 1.04-4.38; p = 0.036) were significantly associated with severe neutropenia induced by AMR. CONCLUSION: The present results suggest that female gender, higher doses of AMR, and lower baseline hematocrit values are predictive factors associated with severe neutropenia induced by AMR in patients with advanced lung cancer. Patients who have these predictive factors should be monitored carefully and considered for early granulocyte colony-stimulating factor support.

Generation of 120-fs laser pulses at 1-GHz repetition rate derived from continuous wave laser diode.

We report the first demonstration of continuous-wave laser diode based 100-fs-class pulse lasers operating at a gigahertz repetition rate without a mode-locking technique. We describe the performance of a 1-W, 120-fs optical pulse train at 1 GHz and a 1-W, 80-fs optical pulse train at 250 MHz by using a simple configuration. Sub-100-fs pulse durations are achieved by using a progressive expansion of the spectrum in the self-phase modulation process in an erbium-doped fibre amplifier. Our scheme can achieve continuously tunable repetition rate in the range of ± 20%, and develop powerful tools for use in nanomechanical systems and nanobiotechnology.

A case of drug-induced hypersensitivity syndrome due to carbamazepine.

The patient was a 51-year-old man who had been prescribed carbamazepine for right third-branch trigeminal neuralgia. He had stopped taking the medication after the neuralgia resolved. When the neuralgia recurred, he resumed medication, and about 1 month later he developed fever, fatigue, cervical lymphadenopathy, generalized skin flushing, facial edema and perioral vesicles, and was admitted to Ichikawa General Hospital, Tokyo Dental College. Oral findings showed reddening and erosion of the buccal mucosa. Routine laboratory examination revealed leukocytosis and hepatic dysfunction. Human herpesvirus 6 antibody titer remarkably increased during development of eruptions. These findings led to a diagnosis of drug-induced hypersensitivity syndrome. Carbamazepine was discontinued, and prednisolone (30 mg/day) was started and tapered based on improvement of symptoms. Because skin symptoms recurred after he was discharged 15 days after admission, the dose of prednisolone was increased and the symptoms finally disappeared. The patient has experienced no further recurrence.

Splenocyte cytokine profile in mouse with oral mucosa-sensitization and oral-tolerization by NiSO(4).

Metals used in the oral cavity have been reported to cause various allergic diseases of the skin and mucosa. Skin manifestations due to dental restorations appear not only in the oral cavity, but also on the hands, feet or the whole body, as in the cases of pustulosis palmoplantaris and lichen planus. These phenomena implicate different pathogeneses from that of conventional skin sensitization and tolerance. Therefore, we compared skin and oral mucosa sensitization with nickel and oral tolerance for nickel in a mouse model. Female C57BL/6J mice were sensitized by injection of NiSO(4) into the skin or oral mucosa. Allergic reactions were evaluated by the mouse ear swelling test and splenocyte proliferation and cytokine profiles. Skin and oral mucosa sensitization succeeded in all mice. Ear swelling was significantly greater in the skin- than in the oral mucosa-sensitized mice at 48 hr after challenge. Ear swelling was also suppressed by single oral administration of NiSO(4) in both the skin- and oral mucosa-sensitized mice to the level of that in nonsensitized mice. Splenocytes from skin-sensitized mice proliferated similarly to those from oral mucosa-sensitized mice. Splenocytes from orally-tolerized mice also showed similar proliferation activity to those from skin and oral mucosa-sensitized mice. In the challenge phase, IL-2, IFN-γ, and IL-10 production was induced in splenocytes from both skin- and oral mucosa-sensitized mice. However, IL-4 was induced only in those from skin-sensitized mice. In addition, IL-4 in splenocytes from oral mucosa-sensitized mice was up-regulated to the level in those from skin-sensitized mice by oral tolerance. These results suggest that sensitization sites in mice influence not only the degree of excitation, but also Th-1 and Th-2 balance in the challenge phase and oral tolerance.

Phase sensitive degenerate parametric amplification using directly-bonded PPLN ridge waveguides.

We constructed the first CW pumped degenerate parametric amplifier based on periodically poled and ZnO-doped LiNbO3 ridge waveguides. An in-phase gain of + 11 dB was achieved owing to the high conversion efficiency and high damage resistance of the waveguide obtained by employing direct bonding and dry etching techniques. Nearly identical amplification and deamplification were obtained owing to a sufficient spatial and temporal overlap between the pump and signal beams. No secondary wavelength conversion process was observed, and a maximum output of 22 dBm was obtained. We also successfully demonstrated the phase sensitive amplification of a modulated signal light.

Effects of the nematicide imicyafos on soil nematode community structure and damage to radish caused by Pratylenchus penetrans.

The effects of the non-fumigant nematicide imicyafos on soil nematode community structure and damage to radish caused by Pratylenchus penetrans were evaluated in two field experiments in consecutive years (2007 and 2008). Nematode densities in soil at 0 - 10 cm (the depth of nematicide incorporation) and 10 - 30 cm were measured. The application of imicyafos had a significant impact on the density of P. penetrans at 0 - 10 cm but had no effect on free-living nematode density. PCR-DGGE analysis conducted using extracted nematodes showed that the nematode community structure 12 d after application in 2007 was altered by the application of imicyafos at the 0 - 10 cm depth, but not at 10 - 30 cm. No significant differences were observed in the diversity of the nematode community at harvest (89 and 91 d after application) between the control and imicyafos treatments in both depths and both years. In both years, the damage to radish caused by P. penetrans was markedly suppressed by the nematicide. Overall, the nematicide imicyafos decreased populations of P. penetrans in soil and thereby decreased damage to radish, while having little impact on the soil nematode community.

Timing of expression of blood coagulation abnormality in patients treated with warfarin and s-1 concomitantly.

Although S-1 is frequently used in cancer chemotherapy, the drug interaction with warfarin, an anticoagulant agent, is not fully paid attention. In the present study, we investigated retrospectively the timing of expression of blood coagulation abnormality in nine patients treated with warfarin and S-1 concomitantly. In five patients, the dose of warfarin was reduced or interrupted after concomitant use of S-1. The International Normalized Ratio (INR) was significantly increased after combination with S-1 compared with the former value. In all patients, the INR was increased in three weeks after combination with S-1. On the other hand, serum creatinine, aspartate aminotransferase, alanine aminotransferase or serum albumin was not different before and after combination with S-1. These results suggest that the careful monitoring of the blood coagulation ability is necessary in all patients receiving warfarin and S-1 concomitantly.