Mental health of working-age populations in Japan who provide nursing care for a person at home: A cross-sectional analysis

OBJECTIVES

This study investigated potential associations between having a person in need of nursing care at home and psychological distress amongst the Japanese working population, using a nationally representative sample.

METHODS

We extracted data from the 2013 Comprehensive Survey of Living Conditions conducted by the Ministry of Health, Labour and Welfare of Japan. The original survey was conducted amongst 295,367 households in 5,530 randomly selected municipalities. We analyzed participants aged 25-65 years who headed a household. The original questionnaire included questions about the specific qualifications required to receive long-term care insurance benefits, about psychological distress (measured using the K6 scale), and other covariates. If a family contained a member in need of nursing care at home, the person who headed that household was recognized as the participant who had a person in need of nursing care at home. Multiple logistic regression analysis was conducted to investigate the association between having a person in need of nursing care at home and psychological distress.

RESULTS

A total of 36,193 men and 2,765 women were included in the analysis, 2.9% of whom had a person in need of nursing care at home. Statistical analysis revealed an association between having a care-requiring older relative at home and psychological distress (odds ratio: 1.40, 95% confidence interval: 1.01-1.93).

CONCLUSIONS

Having a person in need of nursing care at home appears to be positively correlated with worsening mental health of working populations in Japan.

Reduction in the IL-6 level at 24 h after admission to the intensive care unit is a survival predictor for Vietnamese patients with sepsis and septic shock: a prospective study

Background

Sepsis and septic shock are common problems in intensive care units (ICUs). The mortality of patients with sepsis or septic shock is high. We investigated if reduction in the serum concentration of the cytokines tumor necrosis factor α, interleukin (IL)-6 and IL-10, and the rate of change in the IL-6 level at 24 h after ICU admission were survival predictors for patients with sepsis and septic shock in a Vietnamese population.

Methods

This was a prospective study conducted at an ICU in Cho Ray Hospital, Vietnam, from October 2014 to October 2016. Patients diagnosed with sepsis or septic shock using validated international guidelines were enrolled. Plasma samples were collected upon (T₀) and 24 h after (T₂₄) ICU admission for measurement of cytokine concentrations. Blood tests were done to detect organ dysfunction. The duration of ICU stays, hospital stay, APACHE II and SOFA scores, and the in-hospital mortality were compared between survival and non-survival groups. Univariate logistic regression and multivariate analysis were done to determine the association between survival and IL-6 reduction at 24 h after ICU admission.

Results

A total of 123 patients were enrolled. The concentration (in pg/mL) of IL-6 at T_o was 413.3 in survivors and 530.0 in non- survivors. At T₂₄, the IL-6 level was 65.4 for survivors and 286.9 for non-survivors. The survival rate was 39.0%. At T₂₄, the concentrations of IL-6 and the reduction in IL-6 level were predictors of survival in patients with sepsis and septic shock. We found a significant association between IL-6 reduction and survival at ≥86% with Odds Ratio (OR) 5.67, 95% Confidence Interval (CI); 1.27–25.3, compared with an increase in the IL-6 rate of change.

Conclusions

Our findings suggested that a reduction in the IL-6 level of ≥86% at 24 h from ICU admission is a survival predictor for patients with sepsis and septic shock in our population.

Health preparedness plan for dengue detection during the 2020 summer Olympic and Paralympic games in Tokyo

Background

Participants in mass gathering events are at risk of acquiring imported and locally endemic infectious diseases. The 2014 dengue outbreak in Tokyo gathered attention since it was the first time in 70 years for Japan to experience an autochthonous transmission. Preparation for emerging infectious threats is essential even in places where these outbreaks have been largely unknown. The aim of this study is to identify strategies for early detection and prevention of dengue infection during the 2020 summer Olympics and Paralympics in Tokyo.

Methodology/Principal findings

We modified and adapted the failure mode and effect analysis (FMEA) methodology, generally used in industrial manufacturing, to examine the current controls for dengue detection and assessment. Information on existing controls were obtained from publicly available resources. Our analysis revealed that the national infectious disease control system to detect dengue in Japan is robust. However, in the case of large assemblies of international visitors for special events when the spread of communicable and vector-borne diseases increases, there are three main gaps that could be reinforced. First, cyclical training or a certification program on tropical disease management is warranted for physicians, especially those working in non-infectious disease-designated hospitals or clinics. Second, multi-language communication methods need to be strengthened especially in the health and hospitality sector. Third, owners of accommodations should consider incorporating a formal tropical disease-training program for their staff members and have a contingency plan for infectious disease-suspected travelers.

Conclusions/Significance

Our findings may facilitate physicians and public health officials where new controls would be beneficial for the 2020 summer Olympics and Paralympics. The FMEA framework has the potential to be applied to other infectious diseases, not just dengue.

Dengue is a mosquito-borne disease that is most prevalent among the emerging arboviruses. Most patients recover from dengue without complications, but a small portion of cases may progress to severe dengue which carries a high mortality rate if left untreated. In 2014, a dengue outbreak unexpectedly occurred in Tokyo, which was the first time in 70 years for Japan to experience an autochthonous transmission. Thus, preparation for dengue and other emerging infectious threats is essential even in places where these outbreaks have been largely unknown. Tokyo will be hosting the Olympic and Paralympic games in 2020, and interventions are warranted to mitigate the risks. We modified and adapted the failure mode effect analysis (FMEA) methodology to test the vulnerability and resiliency of the current controls. Although the FMEA methodology is generally used in industrial manufacturing, it has the potential to be utilized for health preparedness for other infectious diseases as well. Our analysis identifies three strategies to reinforce early detection of dengue infection and prevent further transmission during the Olympic and Paralympic Games.

A simplified protocol for molecular sexing in the emu (Dromaius novaehollandiae)

Male and female emus are nearly identical both as chicks and as adults. Although morphological differences of the internal genital tract can be used to distinguish the sexes, a high degree of diagnostic skill is required for accurate sexing. DNA-based sexing methods are highly accurate and can be used to diagnose sex without requiring a high degree of technical skill. However, conventional PCR-RFLP is time consuming and costly, requiring the digestion of PCR products. In this study, we simplified the protocol for sexing the emu by using multiplex PCR without restriction enzyme treatment. Multiplex PCR based on a W-specific primer, with the commonly designed primer set on both Z and W chromosomes, amplified both 197-bp and 272-bp bands in the female, and only the 272-bp band in the male. Sexing results obtained in this way were completely concordant with results obtained using the conventional PCR-RFLP method. Thus, we succeeded in simplifying the protocol for sexing the emu, and suggest that our protocol improves production efficiency by facilitating rapid pairing and selection of individuals to establish high-quality pedigrees.

Reversible Cerebral Vasoconstriction Syndrome After Heart Transplantation: A Case Report

BACKGROUND

Reversible cerebral vasoconstriction syndrome (RCVS) is a transient cerebrovascular disorder putatively caused by some immunosuppressive agents.

CASE REPORT

We recently encountered a 47-year-old female patient diagnosed with dilated cardiomyopathy who developed RCVS after heart transplantation. A triple-drug regimen consisting of tacrolimus, mycophenolate mofetil, and a corticosteroid was started after surgery. On postoperative day (POD) 11, the patient developed a severe headache, although computed tomography of the head demonstrated no signs of hemorrhage or infarction. At first, both a painkiller and migraine drugs were regularly administered to the patient. On POD 21, however, she developed an unbearable headache with a visual field defect and mild hemiparesis of the right hand. Magnetic resonance imaging (MRI) of the brain revealed a cerebral infarction in the left occipital lobe with diffuse vasoconstriction of both the middle and posterior cerebral arteries. A diagnosis of RCVS was made and tacrolimus, a drug suspected to cause RCVS, was discontinued. In its place, two doses of basiliximab followed by everolimus, both of which are alternatives for tacrolimus, were given. The corticosteroid dose was also increased. Furthermore, to release vasoconstriction, both verapamil and diltiazem were administered. On POD 27, cerebrovascular constrictions were shown to be relieved on brain MRI and the patient's neurological symptoms subsequently almost completely diminished.

CONCLUSION

RCVS should always be considered as a cause of headache in heart transplant recipients because tacrolimus, an immunosuppressive agent, may trigger RCVS. This will allow rapid intervention that is essential for avoiding irreversible neurological deficits.

Paradoxical Reaction of Tuberculosis in a Heart Transplant Recipient During Antituberculosis Therapy: A Case Report

INTRODUCTION

Tuberculous paradoxical reactions (PRs) are excessive immune reactions occurring after antituberculosis (TB) treatment and are commonly observed in immunocompromised hosts such as patients infected with the human immunodeficiency virus.

CASE REPORT

We recently encountered a 63-year-old male heart transplant recipient who developed tuberculous PR after treatment for miliary TB. The patient had been receiving immunosuppressive therapy with cyclosporine and mycophenolate mofetil for over 15 years. The diagnosis of miliary TB was made based on the presence of intermittent fever and fatigue; thus, anti-TB treatments (isoniazid, levofloxacin, ethambutol, and pyrazinamide) were started, which led to rapid defervescence and regression of the granular shadow and pleural effusion. However, a new persistent fever and confused state developed 1 month after the anti-TB therapy was started. After excluding possible etiologies of the patient's symptom, a PR was suspected, and anti-TB drugs were continued; corticosteroids were added as anti-inflammatory agents. After that, he has shown a favorable course with long-term anti-TB chemotherapy.

CONCLUSION

A PR should always be considered when the patients' symptoms of tuberculosis re-exacerbate after an appropriate anti-TB therapy. A PR commonly occurs in patients with various immunologic conditions including heart transplant recipients.

Four new C19-diterpenoid alkaloids from Delphinium elatum

Diterpenoid alkaloids with remarkable chemical properties and biological activities are frequently found in plants of the genera Aconitum, Delphinium, and Garrya. Accordingly, several C19-diterpenoid alkaloid components from Delphinium elatum cv. Pacific Giant, as well as their derivatives, exhibited cytotoxic activity against lung, prostate, nasopharyngeal, and vincristine-resistant nasopharyngeal cancer cell lines. Four new C19-diterpenoid alkaloids, elapacigine (1), N-deethyl-N-formylpaciline (2), N-deethyl-N-formylpacinine (3), and N-formyl-4,19-secoyunnadelphinine (4), together with 11 known C19-diterpenoid alkaloids were isolated in a phytochemical investigation on the seeds of D. elatum cv. Pacific Giant. Their structures were elucidated by extensive spectroscopic methods including NMR (1D and 2D), IR, and MS (HRMS). Three of the new C19-diterpenoid alkaloids (2-4) and five of the known diterpenoid alkaloids were evaluated for cytotoxic activity against five human tumor cell lines.

Alterations in the morphological, sugar composition, and volatile flavor properties of petai (Parkia speciosa Hassk.) seed during ripening

Petai seeds are one of the well-known strong-smelling foods of the Southeast Asian region that have been harvested and commercially offered in different ripening forms. The current study focused on alterations in the size, color, sugar composition, and volatile flavor properties of petai seeds in the four ripening stages (unripe, mid ripe, ripe, and over-ripe). The ripening process was mainly indicated by the increase in size and weight as seed color turned paler and less greenish. The total sugar content gradually increased during ripening, and then elevated from 1.60 g/100 g (ripe seed) to the level of 2.82 g/100 g in the over-ripe seed. Ripening also altered the volatile flavor composition of petai seed, wherein the predominant aldehydes (hexanal and acetaldehyde) were decreased, and the sulfuric compounds (hydrogen sulfide, methanethiol, and 1,2,4-trithiolane) tended to increase. Additionally, gas chromatography-olfactometry (GC-O) analysis revealed alterations in the perceived odor strength and sensation of each volatile compound and demonstrated volatile flavor profiles, viz. detection percentages of volatile group odor strengths and descriptive odors, of petai seed. These results provide valuable information for monitoring alterations in the physical appearance, sugar composition, and aroma that represent the flavor quality in seasonal petai seed.

Acute Inflammatory Syndrome Paradoxically Induced by De Novo Purine Inhibitors Synthesis Before Renal Transplantation: A Case Report and Review of the Literature

BACKGROUND

Mycophenolate mofetil (MMF) and mizoribine (MZR) are increasingly used as immunosuppressive agents for organ transplantation and chronic inflammation. We report a patient with rheumatoid arthritis who had an acute inflammatory syndrome triggered by preoperative immunosuppression therapy with both MMF and MZR.

CASE REPORT

A 41-year-old woman with IgA nephropathy was referred to our department for living donor renal transplantation. She had rheumatoid arthritis that was adequately treated with prednisolone 5 mg once a day and salazosulfapyridine 2000 mg once a day. MMF 1000 mg twice a day was started for desensitization therapy. Three days later, the patient developed arthritis in the joints of her left hand and elevated inflammatory markers. On day 7, MMF was switched to MZR 150 mg 3 times a day. However, the symptoms extended to both shoulders and the joints of the right foot; MZR was discontinued. The arthritis and inflammatory markers improved. Two months later, the patient was rechallenged with MMF followed by MZR, resulting in a similar clinical course as previously. Tacrolimus (TAC) 3 mg twice a day and everolimus (EVL) 0.5 mg twice a day were introduced as alternative immunosuppressant therapies. No arthritis occurred. ABO-compatible living donor renal transplantation was successfully performed. The patient received TAC, EVL, prednisolone, rituximab, and basiliximab, and her postoperative course was uneventful without arthritis or rejection. At 9 months postoperatively, the serum creatinine was 0.79 mg/dL.

CONCLUSIONS

Acute inflammatory syndrome is an extremely rare complication triggered by preoperative immunosuppression therapy. If antimetabolites cannot be used in immunologically high-risk patients, transplantation becomes very difficult. Clinicians should keep in mind this paradoxical reaction.

Clinical Outcomes of Patients With the HeartMate II Left Ventricular Assist Device: A Single-center Experience From Japan

BACKGROUND

Left ventricular assist device (LVAD) therapy is the "gold standard" alternative therapy for patients with advanced heart failure. However, LVAD therapy is still uncommon in the Asia-Pacific region. Therefore, we aimed to elucidate the clinical outcomes of patients from Japan supported with the HeartMate II (HM-II) LVAD at our institution.

METHODS

Ninety-two patients (mean 44.3 ± 12.1 years, 68 men, average body mass index 1.65 ± 0.28 m²; 81 with nonischemic cardiomyopathy) who underwent HM-II implantation for bridge to transplantation (n = 91) or for destination therapy in a clinical study (n = 1) at the National Cerebral and Cardiovascular Center between April 2013 and October 2017 were enrolled in this analysis. Preoperatively, most patients (n = 73, 79%) had an INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile of between level 2 and 4. Postoperatively, the average pump speed was 8602 ± 258 rpm and the hemodynamics were well compensated.

RESULTS

Adverse events consisted of 38 (41.3%) hemolysis, 30 (32.6%) major infection, 27 (29.3%) major bleeding (6 [6.5%] with gastrointestinal bleeding), and 18 (19.6%) neurologic dysfunction events. Eighteen patients underwent heart transplantation (HTx) after an average of 32.9 ± 8.9 months of VAD support, and overall survival at both 6 months and 3 years was 96.3%.

CONCLUSION

Clinical outcome among patients with HM-II at our institution is satisfactory for both survival and adverse events. The HM-II can provide effective hemodynamic support during the extremely long waiting period for HTx in Japan.

Flavor characteristics and antioxidant capacities of hihatsumodoki (Piper retrofractum Vahl) fresh fruit at three edible maturity stages

To determine the effect of maturity stage on the food attributes of hihatsumodoki (Piper retrofractum Vahl) fresh fruit, the flavor characteristics and antioxidant capacities were investigated at green (GM), orange (OM), and red maturity (RM) stages. Total organic acids, total free amino acids (FAA), and piperine decreased with increasing fruit maturation, reaching minima at the RM stage. Conversely, total sugars and the FAA that contribute to both umami and sweetness were the highest RM stage. Principal component analysis revealed that the volatile composition of the fruit at the GM stage was clearly different from that at the other stages. The DPPH radical scavenging activity and total phenolic content, as measures of antioxidant capacity, decreased with increasing fruit maturation from GM to RM, which was consistent with the changes in piperine content. Therefore, the maturity stage has a significant influence on the flavor and antioxidant characteristics of hihatsumodoki fresh fruit.

Extended aroma extract dilution analysis profile of Shiikuwasha ( Citrus depressa Hayata) pulp essential oil

Shiikuwasha pulp is an important raw material for producing citrus essential oils. The volatile aroma composition of pulp essential oil was evaluated using gas chromatography (GC) methods, and its aroma profile was assessed using GC-olfactometry with an extended aroma extract dilution analysis (AEDA) technique in regard to alterations of odor strength and sensorial perception throughout serial dilution steps. The essential oil comprised a mixture of 55 aroma compounds, including monoterpene hydrocarbon, sesquiterpene hydrocarbon, alcohol, aldehyde, ester, and oxide compounds. The predominant compounds were limonene [57.36% (4462.80 mg/100 g of pulp)] and γ-terpinene [25.14% (1956.21 mg/100 g of pulp)]. However, linalool was identified as one of the key aroma components providing the highest flavor dilution factor in AEDA, whilst three sesquiterpene hydrocarbons (δ-elemene, germacrene B, and bicyclosesquiphellandrene) and two esters (heptyl acetate and decyl acetate) had superior relative flavor activities. The extended AEDA profile identified variations in assessed odor perceptions, intensity, and duration of aroma components over dilution, whereas the 12 most odor-active compounds showed comparable odor strengths.

Influence of Fruit Ripening on Color, Organic Acid Contents, Capsaicinoids, Aroma Compounds, and Antioxidant Capacity of Shimatogarashi (Capsicum frutescens)

Shimatogarashi (Capsicum frutescens) is a typical chili pepper domesticated in southern Japan. Important traits of Shimatogarashi peppers, such as color; proportion of organic acids, capsaicinoids, and aromatic compounds; and antioxidant activity in three stages of maturity (green (immature), orange (turning), and red (mature) stages) were characterized. The results indicated that the concentration of organic acids, including ascorbic, citric, and malic acid, increased during ripening. In addition, the amount of capsaicinoids, which are responsible for the pungent taste of chili peppers, increased as the fruit matured to the orange and red stages. The volatile compound profile of Shimatogarashi was dominated by the presence of esters, which mainly contributed to fruity notes. The total amount of volatile compounds analyzed by gas chromatography-headspace solid-phase microextraction (GC-HS-SPME), especially esters, decreased as the fruit changed in color from green to red. This was in contrast to the amount of terpenoids, especially limonene, which increased at the red stage, denoting a change in flavor from fruity to a more citrus-like aroma. Based on the total phenolic content (TPC), the oxygen radical absorbance capacity (ORAC) and the diphenylpicrylhydrazyl (DPPH) free radical method, the antioxidant capacity of Shimatogarashi showed an increase at the mature red stage. However, while the red stage showed higher pungency and antioxidant capacity as well as an attractive color, the results of aromatic compound analysis revealed that the immature green stage had the advantages of having pleasant fruity smell, making it suitable for use in condiments.

Volatile aroma components and MS-based electronic nose profiles of dogfruit (Pithecellobium jiringa) and stink bean (Parkia speciosa)

Dogfruit (Pithecellobium jiringa) and stink bean (Parkia speciosa) are two typical smelly legumes from Southeast Asia that are widely used in the cuisines of this region. Headspace/gas chromatography/flame ionization detection analysis and mass spectrometry (MS)-based electronic nose techniques were applied to monitor ripening changes in the volatile flavor profiles of dogfruit and stink bean. Compositional analysis showed that the ripening process greatly influenced the composition and content of the volatile aroma profiles of these two smelly food materials, particularly their alcohol, aldehyde, and sulfur components. The quantity of predominant hexanal in stink bean significantly declined (P < 0.05) during the ripening process, whereas the major volatile components of dogfruit changed from 3-methylbutanal and methanol in the unripe state to acetaldehyde and ethanol in the ripe bean. Moreover, the amount of the typical volatile flavor compound 1,2,4-trithiolane significantly increased (P < 0.05) in both ripened dogfruit and stink bean from 1.70 and 0.93%, to relative amounts of 19.97 and 13.66%, respectively. MS-based nose profiling gave further detailed differentiation of the volatile profiles of dogfruit and stink bean of various ripening stages through multivariate statistical analysis, and provided discriminant ion masses, such as m/z 41, 43, 58, 78, and 124, as valuable “digital fingerprint” dataset that can be used for fast flavor monitoring of smelly food resources.

Four new diterpenoid alkaloids from Aconitum japonicum subsp. subcuneatum

Diterpenoid alkaloids with remarkable chemical properties and biological activities are frequently found in plants of the genera Aconitum, Delphinium, and Garrya. Accordingly, several diterpenoid alkaloid constituents of Aconitum and Delphinium plants as well as their derivatives exhibited cytotoxic activity against lung, prostate, nasopharyngeal, and vincristine-resistant nasopharyngeal cancer cell lines. Four new C₁₉-diterpenoid alkaloids, 14-anisoyllasianine (1), 14-anisoyl-N-deethylaconine (2), N-deethylaljesaconitine A (3), and N-deethylnevadensine (4), together with 17 known C₁₉- and C₂₀-diterpenoid alkaloids, were isolated in a phytochemical investigation of rhizoma of Aconitum japonicum THUNB. subsp. subcuneatum (NAKAI) KADOTA. Their structures were elucidated by extensive spectroscopic methods including NMR (1D and 2D), IR, and MS (HRMS). Eight known diterpenoid alkaloids, lipoaconitine, lipomesaconitine, aconine, nevadenine, talatisamine, nevadensine, ryosenamine, and dehydrolucidusculine, were isolated the first time from A. japonicum subsp. subcuneatum. Three of the new C₁₉-diterpenoid alkaloids (1, 3, 4) and six of the known diterpenoid alkaloids were evaluated for cytotoxic activity against five human tumor cell lines.