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Introduction Polypharmacy induces side effects or drug interaction for elderly patients. Whether polypharmacy negatively affects stroke rehabilitation of patients is unclear in Japan. The aim of this study was to assess the relationship between polypharmacy and recovery of daily activity among convalescent stroke patients. Methods In this retrospective cohort study, we screened 719 stroke patients who were admitted to and discharged from the Sagami Rehabilitation Hospital or the Tsurumaki Onsen Hospital between April 2012 and July 2014 in Kanagawa, Japan. Among 719 patients screened, 509 were excluded because of propensity score matching. The primary outcome was Functional Independence Measure-Motor (FIM-M) effectiveness, and participants were divided according to FIM-M effective scores into the following two groups: non-improvement (105 patients) or improvement of FIM-M effectiveness (105 patients). Results Risk factors associated with non-improvement of FIM-M effectiveness included epilepsy and number of drugs used upon admission. FIM-M effectiveness in the patients in whom five or more drugs were used upon admission was significantly lower than in those in whom one drug was used. Through this finding, we defined the use of five or more drugs as polypharmacy. Drugs with significant differences regarding polypharmacy included antihypertensive and antidiabetic drugs. Conclusions These findings suggested that polypharmacy negatively affects stroke rehabilitation outcomes. Thus, pharmacists should make attempts to respond to individual patient outcomes to optimize prescriptions, which may minimize the brunt of polypharmacy on patient outcomes.

Povidone-iodine sugar ointment is an excellent preparation for the treatment of decubitus. It has been used as an intrahospital preparation made according to the formula each hospital decided on from experience. Although commercial products have also been developed and used, they are too expensive. The efficacy of a povidone-iodine sugar ointment formulation which can be prepared by a single method and which has the stability and antibacterial activity equal to commercially available products was evaluated. As the test drugs, one commercially available product (UP), and three preparations with different formulas (P-1, P-2 and P-3) were used. All of these test drugs were stored at 20 and 40 degrees C. Specimens were sampled immediately after storage and after 20, 60, 90, 120 and 150 days and examined pharmaceutically (measurement of pH value and determinations of available iodine and sucrose levels). For the determination of bacteriological effects, 5 standard strains of 5 genera and 5 strains of methicillin-resistant Staphylococcus aureus (MRSA) were used and the time required to kill the bacteria was determined. For UP and P-3, no changes were seen pharmaceutically after 150 days of storage at 20 and 40 degrees C. However, MRSA could not be killed within 30 min. P-1 and P-2 showed remarkable changes pharmaceutically after 60 days of storage at 40 degrees C and could not be used any more. It became possible to make a preparation of povidone-iodine sugar ointment which has a stability almost similar to that of UP. Moreover, such a preparation can be made at low cost. However, since the bactericidal activity against MRSA was not higher than those of other drugs, the future task is to improve the bactericidal activity.

This chapter examines the internalizing, externalizing, and total behavior problems of 119 preschool-age children with HIV/AIDS in Uganda. Variables are examined according to an ecological model of stress and coping consistent with the co-constructivist approach proposed by Li (Psychol Bull 129:171–194, 2003). Specifically, the context in which the child is living (e.g., health variables, demographic variables, home environment, and caregiver variables represented by who is caring for the child, caregiver anxiety and depression, and child outcomes (internalizing, externalizing, and total behavior concerns) are examined. A dynamic relationship between the context and child was discovered. Nearly 45 % of the children within the sample exhibited internalizing behavior concerns. The caregiving environment, as well as caregiver adjustment (anxiety and depression), was predictive of child internalizing behaviors. Furthermore, child characteristics and demographic variables (gender, medication status, and socioeconomic status) contributed to the adjustment of the caregiver. These findings demonstrate the dynamic and reciprocal relationship between young children with HIV/AIDS in Uganda and the context in which they live.

Every day, 1,100 children around the world are infected with human immunodeficiency virus (HIV), most as a result of mother-to-child transmission (MTCT) of the virus [United Nations Program on HIV/AIDS (UNAIDS) 2007]. In 2007 alone, an estimated 420,000 children worldwide were newly infected almost exclusively through MTCT (UNICEF 2008).

The distribution of coronary blood volume is of fundamental importance to cardiac function. Previous investigators have demonstrated that myocardial vascular volume varies with both perfusion pressure and contraction. The purpose of this study is to measure vascular volume in an isolated rabbit heart model under a variety of controlled mechanical conditions using 3-D MCE. Isolated rabbit hearts were perfused with a room temperature crystalloid solution in a Langendorff perfusion apparatus and a small balloon was placed inside the left ventricle and attached to a volume infusion pump. Digital images of the heart were acquired with a Volumetrics 3D ultrasound scanner at perfusion pressures of 0, 30, and 50 mmHg without and with a microbubble-based contrast agent. LV pressure was held at a constant level of 0 mmHg. Regional videointensity and LV area were measured from short axis images in six hearts. Background-subtracted videointensity increased linearly with normalized coronary blood flow (R/sup 2/=.99), demonstrating the ability of this method to noninvasively determine myocardial perfusion. Coronary vascular volume was estimated using a calibration technique and assuming the perfused myocardium may be modeled as a composite material, consisting of incompressible tissue and distensible vessels. Coronary volume was estimated to be 16-24% of the myocardium, comparable to values found in previous studies. Our method may be extended to noninvasively measuring regional coronary volume in patients, thereby providing an additional tool for physicians.

Whereas the increase in insulin requirement in late gestation is well described in diabetic pregnancy, a decrease in insulin dosage in the end of the third trimester has also been noted in clinical experience and the prevention of hypoglycaemia is important. Here we report a large decrease (over 50%) in the final few weeks of her two gestations in a woman with type 1 diabetes mellitus.

Intraperitoneal injection of benzodiazepine receptor agonists (estazolam, zopiclone, triazolam: 0.03–0.24 mmol/kg) induces the head twitch response (HTR). The present study was undertaken to examine the possible participation of the serotonergic system in the mechanism of head twitches induced by benzodiazepine receptor agonists (BZ-RAs). The HTR induced by BZ-RAs was suppressed by pretreatment with ketanserine (1 mg/kg, i.p.), a selective 5-HT2 receptor antagonist. Pretreatment with fluoxetine (10 mg/kg, i.p.), a 5-HT reuptake inhibitor, and 8-hydroxy-2-(di-n-propylamino)tetralin, a 5-HT1A receptor agonist, also suppressed the HTR induced by BZ-RAs. These results suggest that the HTR induced by BZ-RAs may be the result of an activation of postsynaptic 5-HT2 receptors, probably due to direct action.

Purpose Recurrence of tearing following rotator cuff repairs are thought to result from varying strain within the cuff as the shoulder is moved through different anatomical positions. The purpose of this study was to measure strains in the anterior, midline, and posterior aspects of the rotator cuff tendon under dynamic loading with internal and external rotation. Methods Two fresh bovine shoulders (16-week old) were dissected, leaving the infraspinatus tendon intact. Shoulders were mounted to a servohydraulic materials testing machine modified to allow internal and external rotation of the humeral head. Three soft tissue strain gages were attached to the tendon at the anterior, middle, and posterior positions. After preconditioning, the tendon underwent cycling loading between 10-100N of tension for 200 cycles. Strain gage data (mm) was recorded at 5Hz for the duration of the test. Testing was repeated at 15 and 30 degrees of both internal and external rotation. (Table) Conclusion Assessing the repair sensitivity to its location on the tendon, and hence the loading profile of the tendon, is important in evaluating repair and subsequent treatment. The strain magnitudes seen in the data show dramatically greater strains in the posterior aspect of the tendon when the shoulder is rotated. The directions of strain are partially explained by an artifact of the clamping mechanism utilized. Further investigation is necessary to refine these techniques and further elucidate the relationship between local strain and shoulder position.

Purpose Pediatric tibial eminence avulsion fractures occur when immature subchondral bone structurally yields before the anterior cruciate ligament (ACL). Repairs with screw fixation may provide the greatest stability to fracture fragments. The purpose of this study was to evaluate the performance of metal screws for fixation of pediatric tibial eminence avulsion fractures compared to bioabsorbable (polymer) screws. Methods Data for bioabsorbable screws were compiled from a previous phase of the study.* For comparison, six 16-week old bovine knees were dissected, leaving the ACL intact. Tibial eminence avulsion fractures were created using a curved osteotome. These fractures were repaired by a surgeon using metal screws. The repaired knees were then mounted to a servohydraulic materials testing machine at 30 degrees of flexion. After preconditioning, cyclic tensile loads simulating anterior tibial translation were applied to the tibia (5-150N, 1Hz, 200 cycles) then tested to failure. Displacement (mm) and force (N) were recorded for the duration of testing. Gross mechanical stiffness was determined by taking the rate of deformation over the initial loading. Statistics were compared using a one-way ANOVA. (Table) Conclusion Polymer screws have been shown to be difficult to place and prone to breakage. This was reflected in the variable performance of the polymer screws. The primary disadvantage of metal screw fixation is that pediatric patients require implant removal to prevent early physeal arrest. Based upon the data of this study, the metal screws showed less deformation during cyclic testing and more consistent mechanical behavior. Both fixation methods may withstand a maximum force greater than a pediatric ACL would experience during rehabilitation. However, the low initial deformation suggests that the metal screw would better maintain repair integrity.

Reading is a foundation for literacy and education, yet it presents formidable problems for learning disabled children. Although some of these difficulties may have specific perceptual or phonological roots, we argue that they become pervasive roadblocks to learning and motivation. Thus, children who cannot decode words, identify main ideas, or summarize text well become frustrated. We discuss how, as a result of such frustration, learning disabled children develop counterproductive coping strategies and fail to use effective cognitive strategies. Interventions that teach students (a) how to use strategies selectively and (b) how to set goals, persevere, and make accurate attributions while reading help learning disabled readers significantly. The metacognitive and motivational characteristics of these successful interventions will be considered in terms of “cognitive coaching.” Instruction that incorporates the twin goals of enabling and empowering students is likely to lead to stable improvements in both acquisition and use of adaptive learning strategies.

A new glucose 6-phosphate dehydrogenase (G6PD) variant associated with chronic nonspherocytic hemolytic anemia was discovered in Japan. The patient showed hemolytic crises after upper respiratory infections. The enzyme activity was about 3.8% of the normal. The partially purified enzyme revealed slow anodal electrophoretic mobility, high Km NADP, marked thermal-instability, and increased affinity for a substrate analogue (deamino-NADP). A particular characteristic of this enzyme was a biphasic pH curve with a greatly increased activity at low pH values. From these results, this variant was clearly different from hitherto observed G6PD variants, and was designated G6PD Asahikawa.