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BackgroundThe lack of precise information on the epidemiology of peripheral intravascular catheter (PIVC)-related phlebitis and complications in critically ill patients results in the absence of appropriate preventive measures. Therefore, we aimed to describe the epidemiology of the use of PIVCs and the incidence/occurrence of phlebitis and complications in the intensive care unit (ICU).MethodsThis prospective multicenter cohort study was conducted in 23 ICUs in Japan. All consecutive patients aged ≥ 18 years admitted to the ICU were enrolled. PIVCs inserted prior to ICU admission and those newly inserted after ICU admission were included in the analysis. Characteristics of the ICU, patients, and PIVCs were recorded. The primary and secondary outcomes were the occurrence and incidence rate of PIVC-related phlebitis and complications (catheter-related blood stream infection [CRBSI] and catheter failure) during the ICU stay.ResultsWe included 2741 patients and 7118 PIVCs, of which 48.2% were inserted in the ICU. PIVC-related phlebitis occurred in 7.5% (95% confidence interval [CI] 6.9–8.2%) of catheters (3.3 cases / 100 catheter-days) and 12.9% (95% CI 11.7–14.2%) of patients (6.3 cases / 100 catheter-days). Most PIVCs were removed immediately after diagnosis of phlebitis (71.9%). Grade 1 was the most common phlebitis (72.6%), while grade 4 was the least common (1.5%). The incidence rate of CRBSI was 0.8% (95% CI 0.4–1.2%). In cases of catheter failure, the proportion and incidence rate per 100 intravenous catheter-days of catheter failure were 21% (95% CI 20.0-21.9%) and 9.1 (95% CI 8.7–10.0), respectively.ConclusionPIVC-related phlebitis and complications were common in critically ill patients. The results suggest the importance of preventing PIVC-related complications, even in critically ill patients.Trial registrationUMIN-CTR, the Japanese clinical trial registry (registration number:UMIN000028019, July 1, 2017).

With a large number of annotated non-coding RNAs (ncRNAs), repetitive sequences are found to constitute functional components (termed as repetitive elements) in ncRNAs that perform specific biological functions. Bioinformatics analysis is a powerful tool for improving our understanding of the role of repetitive elements in ncRNAs. This chapter summarizes recent findings that reveal the role of repetitive elements in ncRNAs. Furthermore, relevant bioinformatics approaches are systematically reviewed, which promises to provide valuable resources for studying the functional impact of repetitive elements on ncRNAs.

Herein, direct unactivated C-N borylation of aromatic amines by a photocatalyst was achieved under mild and metal-free conditions. The C-N borylation of aromatic amines with bis(pinacolato)diboron (B2pin2) proceeded in the presence of a pyrene catalyst under light irradiation (λ = 365 nm) to afford desired borylated products and aminoborane as a byproduct. The yield of borylated product improved under a CO2 atmosphere. Reactions conducted in the presence of a stoichiometric amount of aminoborane under N2 or CO2 indicated that CO2 reduced the inhibitory effect of aminoborane. Optimal reaction conditions were applied to a variety of aromatic amines. Mechanistic studies suggested that the C-N bond cleavage and C-B bond formation proceeded via a concerted pathway.

A comprehensive targeted intervention (CTI) was designed and deployed in the neighborhoods of cholera cases in the Kathmandu Valley with the intent of reducing rates among the neighbors of the case. This was a feasibility study to determine whether clinical centers, laboratories, and field teams were able to mount a rapid, community-based response to a case within 2 days of hospital admission. Daily line listings were requested from 15 participating hospitals during the monsoon season, and a single case initiated the CTI. A standard case definition was used: acute watery diarrhea, with or without vomiting, in a patient aged 1 year or older. Rapid diagnostic tests and bacterial culture were used for confirmation. The strategy included household investigation of cases; water testing; water, sanitation, and hygiene (WASH) intervention; and health education. A CTI coverage survey was conducted 8 months postintervention. From June to December of 2016, 169 cases of Vibrio cholerae O1 were confirmed by bacterial culture. Average time to culture result was 3 days. On average, the CTI Rapid Response Team (RRT) was able to visit households 1.7 days after the culture result was received from the hospital (3.9 days from hospital admission). Coverage of WASH and health behavior messaging campaigns were 30.2% in the target areas. Recipients of the intervention were more likely to have knowledge of cholera symptoms, treatment, and prevention than non-recipients. Although the RRT were able to investigate cases at the household within 2 days of a positive culture result, the study identified several constraints that limited a truly rapid response.

Background In Japan, the most commonly used hemofilters for patients with acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) are made of polysulfone membranes. The aim of this study was to compare the efficacy of two commercially available polysulfone membranes for the removal of solutes. Methods This single-institution, prospective cross-over study was conducted between December 2010 and January 2012. Two polysulfone membranes, Hemofeel SHG (Toray) and Excelflo AEF (Asahi Kasei Medical), were compared in eight intensive care unit patients (median age, 80 years; seven men) who had severe sepsis that required CRRT and who required vasopressor treatment to maintain their mean blood pressure above 65 mmHg. The primary outcome measure was the efficacy of solute removal, evaluated for high-mobility group protein 1 (HMGB-1) and myoglobin. Results The main cause of sepsis was abdominal infection (50%); the mortality was 62.5%. Blood clearance of myoglobin in 1 h was significantly greater with SHG (p = 0.02), particularly at 24 h (p = 0.17). Blood creatinine clearance did not differ significantly between the two membranes after 1 h, but SHG demonstrated slightly greater appearance at 24 h. There were no significant differences between the two membranes in the clearance of other solutes including HMGB-1. Conclusions This preliminary study compared the use of two polysulfone membranes in patients with sepsis requiring CRRT and showed that the polysulfone membrane SHG was capable of removing myoglobin with greater efficacy.

Speakers sometimes modify their gestures during the process of production into adaptors such as hair touching or eye scratching. Such disguised adaptors are evidence that the speaker can monitor their gestures. In this study, we investigated when and how disguised adaptors are first produced by children. Sixty elementary school children participated in this study (ten children in each age group; from 7 to 12 years old). They were instructed to watch a cartoon and retell it to their parents. The results showed that children did not produce disguised adaptors until the age of 8. The disguised adaptors accompany fluent speech until the children are 10 years old and accompany dysfluent speech until they reach 11 or 12 years of age. These results suggest that children start to monitor their gestures when they are 9 or 10 years old. Cognitive changes were considered as factors to influence emergence of disguised adaptors

This study investigates the development of bi-modal reference maintenance by focusing on how Japanese elementary school children introduce and track animate referents in their narratives. Sixty elementary school children participated in this study, 10 from each school year (from 7 to 12 years of age). They were instructed to remember a cartoon and retell the story to their parents. We found that although there were no differences in the speech indices among the different ages, the average scores for the gesture indices of the 12-year-olds were higher than those of the other age groups. In particular, the amount of referential gestures radically increased at 12, and these children tended to use referential gestures not only for tracking referents but also for introducing characters. These results indicate that the ability to maintain a reference to create coherent narratives increases at about age 12.

Previous studies of the development of gestures have examined gestures in infants. In recent years, together with the rise of interest in spontaneous gestures accompanied by speech, research on spontaneous gestures in preschool-age children has increased. But little has been reported in terms of systematic developmental changes in children's spontaneous gestures, especially with respect to preschool-age children. The present paper surveys domestic and international research on the development of spontaneous gestures in preschoolers. When gestures seen in infants and preschool-age and older children were categorized, it was found that spontaneous gestures begin to appear together with speech semantically and temporarily by the end of the one-word period; during this same period, gestures that were seen earlier gradually decrease. It is suggested that the development of spontaneous gestures relates to a sentence level, not to a vocabulary level. Based on growth point theory (McNeill, 1992), it is also argued that spontaneous gestures develop with “thinking for speaking” and symbol ability.

A phase II study of cisplatin, ifosfamide, and irinotecan with recombinant human granulocyte colony stimulating factor (rhG-CSF) support was conducted in previously untreated patients with stage IIIB or IV non-small-cell lung cancer (NSCLC). Between June 1998 and August 2001, 50 patients were registered in this phase II study. Cisplatin (20 mg m(-2)) and ifosfamide (1.5 g m(-2)) were administered on days 1-4 and irinotecan (60 mg m(-2)) was given on days 1, 8, and 15, respectively. This regimen was repeated every 4 weeks. rhG-CSF was administered subcutaneously at a dose of 50 microg m(-2) on days 5-18 except on the days of irinotecan treatment. In total, 49 patients were assessable for toxicity and response and 50 for survival. In all, 33, patients (67.3%; 95% confidence interval 57.4-77.2%) achieved an objective response. The median response duration was 192 days and the median time to progression for 49 patients was 170 days. The median survival time was 540 days with 1- and 2-year survival rates of 63.5 and 30.7%, respectively. Grade 3 or 4 neutropenia and thrombocytopenia developed in 63.3 and 38.8% of the patients, respectively. In conclusion, the combination of cisplatin, ifosfamide, and irinotecan with rhG-CSF support was highly effective for the treatment of stage IIIB or IV NSCLC with acceptable toxicities.