[Three Cases of Locally Advanced Breast Cancer with Skin Invasion Treated with Cadexomer Iodine for Local Control].

Advanced breast cancer with skin invasion are relatively often accompanied by bleeding, effusion, malodor, and pain, which reduce the quality of life(QOL)of the patients and their families. Therefore, local symptom control is as important as surgical treatment and chemotherapy. We control these symptoms by using cadexomer iodine, cadexomer iondine is expensive, but relatively easy for family to use and keep patients' QOL.

Efficacy, safety, and economic impact of diazepam suppositories with as-needed acetaminophen for prevention of seizure recurrence during the same fever episode in children with suspected simple febrile seizures.

OBJECTIVE: This study was undertaken to evaluate the efficacy, safety, and economic impact of diazepam suppositories with as-needed acetaminophen in comparison with as-needed acetaminophen alone for prevention of seizure recurrence during the same fever episode in suspected pediatric simple febrile seizures (SFS). METHODS: This single-center, prospective, observational study was conducted from July 29, 2019 to February 15, 2021 at a children's hospital. Children aged 6 months to 60 months presenting to the emergency department with suspected SFS were included. Participants receiving both diazepam suppositories and as-needed acetaminophen were compared with those receiving as-needed acetaminophen alone. The primary outcome was seizure recurrence during the same fever episode. The secondary outcomes included the incidence of central nervous system (CNS) pathologies, adverse events, and medical costs. RESULTS: Of the 316 participants, 228 (72.2%) had their first febrile seizure. Diazepam (.3-.5 mg/kg for up to two doses) was administered to 88 of 316 patients (27.8%). The outcomes were available for 306 patients. The recurrence rate was 3.5% (3/85) in the patients receiving diazepam with as-needed acetaminophen and 12.2% (27/221) in the patients receiving as-needed acetaminophen alone (relative risk = .29, 95% confidence interval [CI] = .09-.93, p = .03). The adjusted odds ratio of diazepam administration against recurrence was .23 (95% CI = .07-.78, p = .02). None of the patients had a CNS pathology. No severe adverse events occurred, although mild ataxia was observed significantly more often in the patients receiving diazepam and as-needed acetaminophen (29.4% vs. 18.7%, p = .04). The median medical cost was US $199 (interquartile range [IQR] = 86-244) for the group receiving both medications and US $202 (IQR = 114-242) for the group receiving as-needed acetaminophen alone. SIGNIFICANCE: Compared with as-needed acetaminophen alone, diazepam with as-needed acetaminophen may reduce seizure recurrence more during the same fever episode without severe adverse events or additional costs in children with suspected SFS.

Trends in Intraoperative Assessment of Spinal Alignment: A Survey of Spine Surgeons in the United States.

STUDY DESIGN: Survey. OBJECTIVES: To characterize national practices of and shortcomings surrounding intraoperative assessments of spinal alignment. METHODS: Spine surgeons in the US were surveyed to analyze their experience with assessing spinal alignment intraoperatively. RESULTS: 108 US spine surgeons from 77 surgical centers with an average of 19.2 + 8.8 years of surgical experience completed the survey. To assess alignment intraoperatively, 84% (91/108) use C-arm or spot radiographs, 40% (43/108) use full-length radiographs, and 20% utilize the T-bar (22/108). 88% of respondents' surgical centers (93/106) possessed a navigation camera and 63% of respondents (68/108) report using surgical navigation for 40% of their deformity cases on average. Reported deterrents for using current technology to assess alignment were workflow interruption (54%, 58/108), expense (33%, 36/108), and added radiation exposure (26%, 28/108). 87% of respondents (82/94) reported a need for improvement in current capabilities of making intraoperative assessments of spinal alignment. CONCLUSIONS: Corrective surgery for spinal deformity is a complex procedure that requires a high level of expertise to perform safely. The majority of surveyed surgeons primarily rely on radiographs for intraoperative assessments of alignment. Despite the majority of surveyed surgical practices possessing navigation cameras, they are utilized only for a minority of spinal deformity cases. With the majority of surveyed surgeons reporting a need for improvement in technology to assess spinal alignment intraoperatively, 3 of the top design considerations should include workflow interruption, expense, and radiation exposure.

[Adjuvant Capecitabine for Residual Disease after Standard Neoadjuvant Chemotherapy Among Patients with Triple-Negative Breast Cancer].

CREATE-X trial demonstrated the effectiveness of additional capecitabine therapy in prolonging disease-free survival among patients who are HER2 negative, especially those with triple-negative breast cancer who had residual invasive disease after standard neoadjuvant chemotherapy. We investigated our data regarding adjuvant capecitabine for residual disease. Ten patients were enrolled, and the average age of the patients was 54.2 years. All patients completed 8 courses of treatment; all adverse events were Grade 2 or lower. Five-year disease-free survival rate was 70.0% in an average observation period of 40.9 months. Three patients recurred within 2 years, and all patients had brain metastasis. In the CREATE-X trial, the rate of disease-free survival was 69.8% in the capecitabine group versus 56.1% in the control group; our results were same as those of CREATE-X. Brain metastasis may be detected by the early phase of enhanced brain MRI.

Different Waterlogging Depths Affect Spatial Distribution of Fine Root Growth for Pinus thunbergii Seedlings.

The increase of waterlogged environments at forests and urban greenery is of recent concern with the progress of climate change. Under waterlogging, plant roots are exposed to hypoxic conditions, which strongly affect root growth and function. However, its impact is dependent on various factors, such as waterlogging depth. Therefore, our objective is to elucidate effects of different waterlogging depths on Pinus thunbergii Parl., which is widely used for afforestation, especially at coastal forests. We conducted an experiment to examine growth and morphology of fine roots and transpiration using 2-year-old seedlings under three treatments, (1) control (no waterlogging), (2) partial waterlogging (partial-WL, waterlogging depth = 15 cm from the bottom), and (3) full waterlogging (full-WL, waterlogging depth = from the bottom to the soil surface, 26 cm). As a result, fine root growth and transpiration were both significantly decreased at full-WL. However, for partial-WL, fine root growth was significantly increased compared to control and full-WL at the top soil, where it was not waterlogged. Additionally, transpiration which had decreased after 4 weeks of waterlogging showed no significant difference compared to control after 8 weeks of waterlogging. This recovery is to be attributed to the increase in fine root growth at non-waterlogged top soil, which compensated for the damaged roots at the waterlogged bottom soil. In conclusion, this study suggests that P. thunbergii is sensitive to waterlogging; however, it can adapt to waterlogging by plastically changing the distribution of fine root growth.

Administration of Enterococcus faecium HS-08 increases intestinal acetate and induces immunoglobulin A secretion in mice.

A probiotic is considered a live microbial feed supplement that has beneficial effects on the host. In this study, the probiotic property by which Enterococcus faecium HS-08 strengthens the immune system was investigated. Using a murine model, we evaluated the abilities of this strain to increase intestinal short-chain fatty acid contents and to induce the production of mucosal immunoglobulin A (IgA), which are crucial for mucosal immune systems. Various amounts (0%, 0.0038%, 0.038%, or 0.38%) of strain HS-08 cells were administered to BALB/cAJcl mice, which resulted in a dose-dependent increase of fecal IgA levels. A qRT-PCR analysis of Peyer's patch cells revealed that the gene expression of retinal-dehydrogenase, interleukin 6, B-cell-activating factor, and a proliferation-inducing ligand were increased, which leads to IgA secretion via a T-cell-independent mechanism. The administration of 0.038% and 0.38% of strain HS-08 cells also increased fecal acetate levels, which plays an important role for maintaining immune functions. This cecal floral analysis and the stability of strain HS-08 against gastrointestinal digestion suggest that this strain can inhabit the host intestine. In conclusion, the administration of E. faecium HS-08 increased intestinal acetate levels and enhanced IgA secretion, which may result in strengthening of the mucosal immune system.

[A case of transverse colon cancer with idiopathic mesenteric phlebosclerosis].

A 74-year-old male was diagnosed with transverse colon carcinoma with idiopathic mesenteric phlebosclerosis (IMP). Extended right hemicolectomy with regional lymph node dissection was performed. It has been reported that IMP develops after taking Chinese herbs containing SANSIS for a long time. In this case, the patient had taken such an herb for more than 3 years. In Japan, total 6 cases have been reported on a tumor with IMP, including this case. Immunohistological examination showed that the IMP findings were particularly strong around the tumor. Thus, this case suggests that there is a link between the tumor and IMP.

Pilot study of a smartphone application designed to socially motivate cardiovascular disease patients to improve medication adherence.

BACKGROUND: Social support received by patients from family and community has been identified as a key factor for success in improving medication adherence in those patients. This pilot study aimed to investigate the usability and feasibility of PillPal, a smartphone application that uses video-chatting as a social motivation medium to encourage medication adherence in cardiovascular disease (CVD) patients. We additionally gathered feedback on the Physician Calendar, an accompanying web platform that allows clinicians to view patient adherence data generated from the app. METHODS: Thirty patients were recruited from the Johns Hopkins Hospital (JHH) Lipid Clinic (n=14) and Inpatient Cardiology Service (n=16) to pilot test the app. Data were obtained through in-person interviews in which patients tested out the app and answered standardized questions regarding the app's feasibility as a means to enhance social support, as well as its usability measured in terms of ease of use and patient comfort level with the video-chat technology. Cardiologists (n=10) from JHH were interviewed to gain feedback on the Physician Calendar. RESULTS: We recorded 43.4% participants who stated that PillPal would increase their motivation to take their medications; 96.7% stated the app was easy to use; and 70% stated they were comfortable with video-chatting while taking their medications. Patient factors such as current adherence level, disease severity, and personality were more predictive of positive app reviews than the perceived level of social support. Clinicians generally approved of the Physician Calendar, as they would be able to quickly screen for non-adherence and begin conversations with patients to address the root cause of their non-adherence. CONCLUSIONS: Based on pilot testing and interviews, using a smartphone app for video-chatting as a social support medium to improve patient medication adherence is feasible and has potential to increase medication adherence depending on certain patient characteristics. The Physician Calendar was deemed a useful tool by clinicians to quickly identify and understand reasons for medication non-adherence.

Effects of simulated nitrogen deposition on ectomycorrhizae community structure in hybrid larch and its parents grown in volcanic ash soil: The role of phosphorous.

With the rapid industrial development and modern agricultural practices, increasing nitrogen (N) deposition can cause nutrient imbalance in immature volcanic ash soil commonly found in Japan. Larch species, widely distributed in northeast Eurasia, are associated with ectomycorrhizal (ECM) fungi which play a critical role in nutrient acquisition for their hosts. In this study, we investigated species richness and diversity of ECM fungi associated with a hybrid larch (F1) and its parents, Dahurian larch (Larix gmelinii var. japonica) and Japanese larch (L. kaempferi), under simulated N deposition (0 and 100kgha-1yr-1) with/without phosphorous (P) (0 and 50kgha-1yr-1). Seedlings planted in immature volcanic ash with low nutrient availability were subjected to the N and P treatments for fifteen months. We found that response of ECM community structure to the increased nutrient availability depended on host genotypes. Nutrient addition significantly affected ECM structure in Japanese larch, but no such significant effect was found for Dahurian larch. Effects of the nutrient addition to ECM fungal community in F1 were intermediate. F1 was tolerant to high N loading, which was due to consistent, relatively high association with Suillus sp. and Hebeloma sp. F1 showed heterosis in relative biomass, which was most apparent under high N treatments. This co-variation of ECM fungal community structure and F1 biomass in response to N loading suggest that ECM community structure might play an important role in host growth. The present findings indicate effects of N deposition on ECM fungal community structure can depend on larch species, thus it is challenging to predict general trends.

Quantifying and Visualizing Medication Adherence in Patients Following Acute Myocardial Infarction.

Medication adherence is a critical component for recovery following acute myocardial infarction (AMI). Currently, numerous smartphone applications are capable of tracking medication adherence through patient-generated data (PGD), but few are integrated with the electronic health record (EHR). Integration of medication adherence PGD into the EHR can give both healthcare providers and patients increased insight into patterns of missed doses, effects on vital signs, and correlation with side effect symptomology to inform healthcare decisions. We propose the generation of a medication adherence "vital sign", a score calculated based upon the patient's reported doses taken collected through a smartphone application and streamed into the EHR on a daily basis. We also propose the creation of Patient Health Reports that incorporate relevant patient history, information from previous visits, and the medication adherence scores to give providers a comprehensive view of patients' health prior to clinic visits. These features are intended to incorporate PGD into clinical care to inform decision making in way that streamlines patient visits, reduces healthcare costs, and improves health outcomes.

Effects of the spaces available for cations in strongly acidic cation-exchange resins on the exchange equilibria by quaternary ammonium ions and on the hydration states of metal ions.

The spaces (voids) available for cations in the five exchange resins with varying exchange capacities and cross-linking degrees were estimated, on the basis of the additivity of molar volumes of the constituents. Tetraalkylammonium ions (NR(4)(+); R: Me, Et, Pr) may completely exchange potassium ion on the resin having a larger void radius. In contrast, the ratio of saturated adsorption capacity to exchange capacity of the resin having a smaller void radius decreased with an increase in size of NR(4)(+) ions, due to the interionic contacts. Alkali metal ions could be exchanged quantitatively. While the hydration numbers of K(+), Rb(+), and Cs(+) were independent of the void radius, those of Li(+) and Na(+), especially Na(+), decreased with a decrease in void radius. Interionic contacts between the hydrated ions enhance the dehydration. Multivalent metal ions have the hydration numbers, comparable to or rather greater than those in water. A greater void volume available due to exchange stoichiometry released the interionic contacts and occasionally promoted the involvement of water molecules other than directly bound molecules. The close proximity between ions in the conventional ion-exchange resins having higher exchange capacities may induce varying interactions.