The dose-response relationships of the direct scavenging activity of amide-based local anesthetics against multiple free radicals.

This study aimed to illustrate the dose-response relationships of the direct scavenging activity of amide-based local anesthetics against multiple free radicals in vitro. We have demonstrated that amide-type local anesthetics selectively and directly scavenge some free radicals. Three kinds of free radicals were eliminated by all the four local anesthetics examined. Mepivacaine, lidocaine, bupivacaine, and dibucaine scavenged hydroxyl radicals in dose-dependent manners. Ascorbyl free radicals were also scavenged in dose-dependent manners, and lastly singlet oxygen was scavenged in dose-dependent manners. Three other free radicals were not scavenged by all of the four local anesthetics; tert-butoxyl radical was scavenged by all the anesthetics examined but dibucaine, nitric oxide by mepivacaine but not by the other three, and tyrosyl radical by mepivacaine and lidocaine but not by the other two. Some free radicals (superoxide anion, tert-butyl peroxyl radical, DPPH) were not scavenged by any of the four local anesthetics. The local anesthetics were also shown to inhibit lipid peroxidation by TBARS assay. These results suggest that local anesthetics have antioxidant properties through their free radical scavenging activities.

A change in the timing of the Bacillus Calmette-Guérin vaccination in 2013 was associated with an increase in the incidence rate of infants with latent tuberculosis infection.

BACKGROUND: A change in the timing of the Bacillus Calmette-Guérin (BCG) vaccination among infants in Japan appears to be associated with an increase in the incidence rate of latent tuberculosis infection (LTBI). METHODS: Data on both active and latent tuberculosis (TB) infections from 2007 to 2019, which were reported by the Japan Anti-Tuberculosis Association, were statistically analyzed by comparing TB incidence rates in 2007-2012 and 2013-2019. RESULTS: Although the incidence rate for active TB disease did not statistically increase nor decrease in the infant age group for either sex (and in fact decreased for some of the other age groups), the incidence rates of LTBI for both sexes were increased in the infant age group, while the incidence rates decreased in the other age groups. Between 2007 and 2012, the incidence rate of LTBI in females was statistically greater than those of males in the 1-4-year-old age group. From 2013 to 2019, the incidence rates of females were greater than those of males in both the infant and 1-4-year-old age groups, suggesting a growing preponderance of infections among female children in the youngest age groups. CONCLUSION: It may be that the change of BCG vaccination timing in Japan which took place in 2013 affected the infant incidence rate of LTBI, with a more prominent effect on females than males. In order to control TB infection, the ramifications of a change in vaccination timing therefore need careful exploration, as one such change appears associated with increased numbers of infants with LTBI, with disproportionate effects on females.

Dose-dependency of multiple free radical-scavenging activity of edaravone.

BACKGROUND: Edaravone is a powerful free radical scavenger that is in clinical use. However, data concerning its dose-response relationship against multiple free radicals remain sparse. The purpose of the present study was to demonstrate the dose-dependency of direct scavenging activity of edaravone against multiple free radical species. MATERIALS AND METHODS: Free radical-scavenging activities of edaravone against six free radical species were evaluated by electron spin resonance spectroscopy using spin-trapping method. RESULTS: Edaravone scavenged the following free radicals in dose-dependent manners with reaction rate constants (kedaravone) or 50% inhibitory concentration (IC50) as indicated: hydroxyl radical (kedaravone = 5.2 × 1010 M-1 s-1), superoxide anion (kedaravone/kG-CYPMPO = 0.63), tert-butyl peroxyl radical (kedaravone/kG-CYPMPO = 8.8), ascorbyl free radical (IC50 = 0.17 ± 0.06 mM), 2,2-diphenyl-1-picrylhydrazyl (DPPH, IC50 = 4.7 ± 0.3 µM), and nitric oxide (kedaravone = 7.0 × 103 M-1 s-1). CONCLUSIONS: The dose-dependent scavenging activities of edaravone against multiple free radical species were clearly illustrated. It is speculated that edaravone acts as antioxidant by dose-dependently scavenging multiple free radical species along the chain reactions of oxidative stress in surgery.

Re-employment of people with chronic stroke: A single-centre retrospective study.

BACKGROUND/AIM: Re-employment is the goal of rehabilitation for many patients after stroke. This study retrospectively examined previously employed stroke survivors who were unable to return to work at time of discharge from hospital and identified factors which were correlated with successful re-employment following a rehabilitation programme involving occupational therapy at a support facility. Factors correlated with reactivation of drivers' licence after stroke were also investigated. METHODS: Participants were 150 post-stroke patients who were discharged from a support facility for persons with disabilities from April 2011 to March 2016. Data on patients' sociodemographic information, activities of daily living, and physical functions had been recorded at the time of admission into the facility. Employment status was recorded at discharge. Data were collected retrospectively in July 2017 from the medical records. Logistic regression models were prepared to examine factors correlated with successful re-employment and reactivation of drivers' licence after occupational therapy. RESULTS: A stepwise logistic regression model revealed that the following four factors were significantly correlated with successful re-employment: (i) the dressing-lower body item in the Functional Independence Measure (P < 0.001), (ii) the grooming item in the Functional Independence Measure (P = 0.002), (iii) marital status (P = 0.007), and (iv) the problem-solving item in the Functional Independence Measure (P = 0.028). Another stepwise logistic regression model revealed that the factors were significantly correlated with successful reactivation of drivers' licence: (i) the problem-solving item in the Functional Independence Measure (P = 0.002), (ii) the dressing-lower body item in the Functional Independence Measure (P = 0.011) and (iii) the residence area (P = 0.038). CONCLUSION: A single-centre retrospective study demonstrated several significant correlates of successful re-employment and reactivation of drivers' licence after stroke following rehabilitation training which employs occupational therapy to target skills critical for employment.

Age- and Sex-Related Differences in Morbidities of Sexually Transmitted Diseases in Children.

Sexually transmitted diseases (STDs) are causes of public health burden globally. The purpose of this study is to document age-specific and sex-related changes in the morbidity of four representative STDs in children. Japanese national surveillance data from 1999 to 2017 on morbidities of the following four STDs were analyzed by age and sex: Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), condylomata acuminate (CA), and genital herpes simplex virus (GHSV). The morbidities of males and females in each age group were compared through the male-to-female morbidity (MFM) ratios. The MFM ratios were not different from one in infants, less than one in children, and greater than one after puberty in all four STDs. The reversal of MFM ratio less than 1 to greater than 1 for NG infection was observed between 10-14 and 15-19 year of age, i.e., during the puberty, while that for GHSV infection was observed between 35-39 and 40-44 year of age, i.e., during adulthood. In conclusion, the morbidities of the four STDs were similar between the sexes in infants, and were higher in female children than in male children, while the morbidities in all four diseases were higher in men after puberty.

Performativity, identity formation and professionalism: Ethnographic research to explore student experiences of clinical simulation training.

Developing professional identity is a vital part of health professionals' education. In Auckland four tertiary institutions have partnered to run an interprofessional simulation training course called Urgent and Immediate Patient Care Week (UIPCW) which is compulsory for Year Five medical, Year Four pharmacy, Year Three paramedicine and Year Three nursing students. We sought to understand student experiences of UIPCW and how those experiences informed student ideas about professional identity and their emergent practice as health professionals within multidisciplinary teams. In 2018, we commenced ethnographic research involving participant observation, field notes, interviews, photography and observational ethnographic film. A total of 115 students participated in this research. The emergent findings concern the potentially transformative learning opportunity presented within high fidelity multi-disciplinary simulations for students to develop their professional identity in relation to peers from other professions. Our work also exposes the heightened anxiety and stress which can be experienced by students in such interdisciplinary simulations. Student experience suggests this is due to a range of factors including students having to perform in front of peers and staff in such simulation scenarios when their own professional identity and capabilities are still in emergent stages. Staff-led simulation debriefs form a critical success factor for transformative learning to be able to occur in any such simulations so that students can reflect on, and move beyond, the emotion and uncertainty of such experiences to develop future-focused concepts of professional identity and strategies to support effective interprofessional teamwork.

Ward calls not so scary for medical students after interprofessional simulation course: a mixed-methods cohort evaluation study.

Background: An interprofessional simulation 'ward call' course-WardSim-was designed and implemented for medical, pharmacy and nursing students. We evaluated this intervention and also explored students' experiences and ideas of both the course and of ward calls. Methods: We used a mixed-methods cohort study design including survey and focus groups. Descriptive statistical analysis and general purpose thematic analysis were undertaken. Results: Survey respondents who participated in WardSim subsequently attended more ward calls and took a more active role than the control cohort, with 34% of the intervention cohort attending ward calls under indirect supervision, compared with 15% from the control cohort (P=0.004). Focus group participants indicated that the situation they were most anxious about facing in the future was attending a ward call. They reported that their collective experiences on WardSim alleviated such anxiety because it offered them experiential learning that they could then apply in real-life situations. They said they had learnt how to work effectively with other team members, to take on a leadership role, to make differential diagnoses under pressure and to effectively communicate and seek help. Conclusions: An interprofessional, simulated ward call course increased medical students' sense of preparedness for and participation in ward calls in the next calendar year.

Breast cancer and spaceflight: risk and management.

Spaceflight exposes astronauts to a host of environmental factors which could increase their risk for cancer. Epidemiological studies have shown an increased incidence of breast cancer in female commercial flight attendants, with occupational risk factors as one of the proposed mechanisms for the higher incidence in this cohort. Since female astronauts are exposed to similar occupational conditions as flight attendants, they too may be at an increased risk for breast cancer. With the planning of exploration class missions to the Moon and to Mars it is important to assess and minimize the risk for breast malignancy, and to have a well-defined protocol for the diagnosis and treatment of a breast mass discovered during a mission. Risk factors for development of breast cancer in the female astronaut include ionizing radiation, disrupted melatonin homeostasis secondary to circadian shifting, chemical exposure, and changes in immune function. Preflight, in-flight, and postflight screening and management modalities include imaging and fine needle aspiration (FNA). Employing such a strategy may provide a viable management approach in the case of a newly diagnosed breast mass inflight.

Incidence of cancer among female flight attendants: a meta-analysis.

BACKGROUND: Airline flight personnel work in a unique environment with exposure to known or suspected carcinogens and mutagens including ionizing cosmic radiation. A meta-analysis was conducted to study whether the occupational exposure of female flight attendants (FA) increased their relative risk of cancer incidence. METHODS: A bibliographical computer search from 1966 to 2005 of cancer incidence cohort studies of female FA was performed. Combined relative risks (RRc) in cancer incidence were calculated by means of meta-analysis. RESULTS: RRc and 95% confidence interval (CI) for malignant melanoma and breast cancer in female FA were 2.13 (95% CI: 1.58-2.88) and 1.41 (1.22-1.62) (p < 0.0001). Excess risk was not significant for all-site cancer with RRc of 1.10 (0.99-1.21). CONCLUSIONS: The meta-analysis confirmed the significantly increased risks for malignant melanoma and breast cancer in female FA. Increased exposure to cosmic radiation during flight has been suggested as a potential occupational risk factor. Ultraviolet radiation exposure on board seems an unlikely occupational risk, but nonoccupational leisure time sun exposure is a possible risk factor. The etiology of the observed increase in incidence of some cancers remains controversial because assessment of possible confounders, especially nonoccupational exposure factors, has thus far been limited.

Neurovestibular symptoms following space flight.

Neurovestibular symptoms experienced by astronauts in the post-flight period were examined using data from medical debriefs contained in the NASA Longitudinal Study of Astronaut Health database. Ten symptoms were identified (clumsiness, difficulty concentrating, persisting sensation aftereffects, nausea, vomiting, vertigo while walking, vertigo while standing, difficulty walking a straight line, blurred vision, and dry heaves), of which eight were crossed with twelve demographic parameters (mission duration, astronaut gender, age, one-g piloting experience, previous space flight experience, g-suit inflation, g-suit deflation, in-flight space motion sickness, in-flight exercise, post-flight exercise, mission role, fluid loading). Three symptoms were experienced by a majority of subjects, and another two by more than a quarter of the subjects. Intensity of the symptoms was mild, suggesting that they are unlikely to pose a risk to the crew during landing and the post-flight period. Seven of the symptoms and eight of the parameters under study were found to be significantly associated with each other.

A concept of operations for contingency medical care on the International Space Station.

The U.S.-based health care system of the International Space Station (ISS) provides the resources to care for an in-flight medical contingency. The current system was designed for use in conjunction with a return vehicle possessing medical capabilities that would allow rapid and safe transport of an ill or injured crew member to a terrestrial medical facility. Because plans for such a vehicle have been indefinitely delayed, a mismatch has been created between the limited onboard medical capabilities and the current mission profile. This has driven the medical concept of operations to one in which as many medical conditions as possible must be treated on orbit, with return to Earth delayed or avoided. This article describes this proposed new plan, the implementation of which will require numerous changes to the medical system, including modifications to training practices, treatment guidelines, diagnostic and therapeutic resources, and informatics.

Age-specific sex-related differences in infections: a statistical analysis of national surveillance data in Japan.

BACKGROUND: To prevent and control infectious diseases, it is important to understand how sex and age influence morbidity rates, but consistent clear descriptions of differences in the reported incidence of infectious diseases in terms of sex and age are sparse. METHODS AND FINDINGS: Data from the Japanese surveillance system for infectious diseases from 2000 to 2009 were used in the analysis of seven viral and four bacterial infectious diseases with relatively large impact on the Japanese community. The male-to-female morbidity (MFM) ratios in different age groups were estimated to compare incidence rates of symptomatic reported infection between the sexes at different ages. MFM ratios were >1 for five viral infections out of seven in childhood, i.e. male children were more frequently reported as infected than females with pharyngoconjunctival fever, herpangina, hand-foot-and-mouth disease, mumps, and varicella. More males were also reported to be infected with erythema infectiosum and exanthema subitum, but only in children 1 year of age. By contrast, in adulthood the MFM ratios decreased to <1 for all of the viral infections above except varicella, i.e. adult women were more frequently reported to be infected than men. Sex- and age-related differences in reported morbidity were also documented for bacterial infections. Reported morbidity for enterohemorrhagic Escherichia coli infection was higher in adult females and females were reportedly more infected with mycoplasma pneumonia than males in all age groups up to 70 years. CONCLUSIONS: Sex-related differences in reported morbidity for viral and bacterial infections were documented among different age groups. Changes in MFM ratios with age may reflect differences between the sexes in underlying development processes, including those affecting the immune, endocrine, and reproductive systems, or differences in reporting rates.

A comparison of Maori and non-Maori experiences of general practice.

AIM: To compare Maori and non-Maori experiences in relation to access to general practice care. METHODS: A semi-structured personal questionnaire was administered in telephone surveys of random samples of 651 Maori and 400 non-Maori consumers. Differences in these groups of consumers' experiences of accessing general practice care were compared statistically. RESULTS: Compared with the non-Maori, the Maori respondents on average were younger and less advantaged in their socioeconomic and health status. Maori were more likely to report needing their last visit urgently. Most respondents reported seeing a GP when they wanted, but non-Maori were more likely than Maori to have this preference met. Fewer Maori said they were offered a choice of appointment times or were seen on time. CONCLUSIONS: Maori still report high health needs and being less likely to be offered choices at their general practice, to be seen on time, or to be seen within their preferred timeframe. Additional work is needed to align Maori and non-Maori experiences of general practice care.

Sex- and age-related differences in morbidity rates of 2009 pandemic influenza A H1N1 virus of swine origin in Japan.

BACKGROUND: The objective of the present study was to determine whether the morbidity rates of the 2009 pandemic influenza A H1N1 virus (pdmH1N1) varied by age and/or sex. METHODS AND FINDINGS: Retrospective analysis of 2,024,367 cases of pdmH1N1 was performed using the national surveillance data from influenza sentinel points in Japan. The male-to-female morbidity ratios (M/F ratios) in nineteen age groups were estimated as the primary outcome. The M/F ratios for pdmH1N1 influenza were: >1 in age groups <20 years and ≥80 years (p<0.001); <1 in age groups 20-79 years (p<0.001). This data suggests that males <20 years of age may be more likely to suffer from pdmH1N1 influenza than females in the same age categories. When the infection pattern for pdmH1N1 was compared with that of seasonal influenza outbreaks between 2000 and 2008, the M/F ratio for pdmH1N1 influenza was higher in ages 3-29 years and lower in ages 40-79 years. Because the present study was based on the national surveillance, it was impossible to estimate the morbidity rate for the Japanese population. It is also likely that the data did not capture asymptomatic or mild infections. CONCLUSIONS: Although exposure to the pdmH1N1 virus is assumed to be similar in both boys and girls, M/F ratios were >1 in those younger than 20 years. The subsequent reversal of the M/F ratio in the adult generation could be due to several possibilities, including: greater immunity among adult males, more asymptomatic infections among males, less reporting of illness by males, or differences in exposure to the virus and probability of visiting a clinic. These results suggest that the infection and virulence patterns of pdmH1N1 are more complex than previously considered.

GuideView: structured multi-modal delivery of clinical guidelines.

GuideView is a system designed for structured, multi-modal delivery of clinical guidelines. Clinical instructions are presented simultaneously in voice, text, pictures or video or animations. Users navigate using mouse-clicks and voice commands. An evaluation study performed at a medical simulation laboratory found that voice and video instructions were rated highly.