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Objective: Employing a nationwide cross-sectional survey, we investigated the Japanese general population's attitudes toward disease and prognosis disclosure and related factors. Furthermore, we investigated Japanese medical practitioners' attitudes toward disease and prognosis disclosure for patients and decision making.Methods: A nationwide anonymous questionnaire survey was conducted. A total of 5000 individuals were randomly sampled from the general population and 3104 physicians and 6059 nurses were randomly sampled in Japan.Results: Finally, 2422 people from the general population (response rate, 48%), 1577 physicians (51%), and 3361 nurses (56%) returned questionnaires. Among the general population, 73% of participants answered that they 'want to know' about their disease and prognosis when in an incurable disease state. Ninety percent desired direct disclosure and 8% disclosure through their family. However, few medical practitioners answered 'patient himself' (physician 3%, nurses 4%) as the person whom they would primarily notify about the disease and prognosis when in charge of a patient with an incurable disease. On the other hand, physicians answered 'family' most frequently (59%), whereas nurses most commonly responded, 'depends on patient's condition' (63%).Significance of research: Several detailed analyses of factors associated with prognosis disclosure were conducted. Japanese physicians need to carefully communicate with the patients individually about whether direct disclosure or disclosure primarily to the family is preferred. [ABSTRACT FROM AUTHOR]

Although the place of death of patients with terminal cancer is influenced by multiple factors, few studies have systematically investigated its determinants. The purpose of this study was to examine the influence of the patients' sociodemographic, clinical and support network variables on the place of death of terminally ill cancer patients under the care of home care agencies in Japan. Among 528 patients from 259 home care agencies, 342 (65%) died at home and 186 (35%) died at a hospital. From the multivariate logistic regression model, patients who expressed the desire for receiving home care at referral [odds ratio (OR), 95% confidence interval (CI): 2.19, 1.09-4.40] in addition to the family caregiver's desire for the same (OR, 95%CI: 3.19, 1.75-5.81), who had more than one family caregiver (OR, 95%CI: 2.28, 1.05-4.94), who had the support of their family physician (OR, 95%CI: 2.23, 1.21-4.08), who were never rehospitalized (OR, 95%CI: 0.04, 0.02-0.07), who received more home visits by the home hospice nurse during the stable phase under home hospice care (OR, 95%CI: 1.25, 1.02-1.53), and who were in the greatest functionally dependent status during the last week prior to death (OR, 95%CI: 8.60, 4.97-14.89) were more likely to die at home. Overall, this model could accurately classify 95% of the places of death, which is higher than other published studies. A clearer understanding of factors that might influence the place of death of terminally ill cancer patients would allow healthcare professionals to modify healthcare systems and tailor effective interventions to help patients die at their place of preference. [ABSTRACT FROM AUTHOR]

The MLL gene is frequently rearranged in leukemias, and MLL chimeric proteins generated by chromosomal translocations play crucial roles in leukemogenesis. Targets of murine Mll include HOX proteins that regulate body pattern formation and hematopoiesis. However, it is not known whether or not the MLL chimeric proteins regulate the HOX gene expression in human leukemia. To address this issue, THP-1 cells, a human leukemia cell line expressing MLL-AF9, were treated with antisense oligodeoxyribonucleotide (ODN) complementary to the coding sequence of the MLL-AF9 junction. Down-regulation of the MLL-AF9 transcript was accompanied by the reduced expression of the HOXA7 and -A10 genes, but not of the HOXA2, -A4, -A5, and -A9 genes. The number of viable cells cultured with 20 microM antisense ODN for 5 days was 10-fold lower than that of the sense ODN-treated control. And the number of the annexin V-/propidium iodide- apoptotic cells in the antisense ODN-treated cells after 3 days of culture was two-fold higher than that in the control. Staining of the antisense ODN-treated cells with Hoechst 33258 showed the morphology characteristic to apoptosis. These results indicate that MLL-AF9 regulates the expression of the selected HOX genes as well as prevents the leukemic cells from apoptosis. [ABSTRACT FROM AUTHOR]

Cell surface protein antigen (PAc) and glucosyltransferases (GTF) produced by Streptococcus mutans are considered major colonization factors of the organism, and the inhibition of these factors is thought to prevent dental caries. In this study, 8-mo-old pregnant Holstein cows were immunized with fusion protein PAcA-GB, a fusion of the saliva-binding alanine-rich region (PAcA) of PAc with the glucan binding (GB) domain of GTF-I, an enzyme catalyzing the synthesis of water-insoluble glucan from sucrose. High titers of immunoglobulin antibodies specific for the fusion protein were found in normal milk after reimmunization, and they persisted for approximately 3 mo. The immunoglobulin G (IgG) antibodies against PAcA-GB were purified from immunized milk. The antibodies significantly inhibited the adhesion of S. mutans cells to saliva-coated hydroxyapatite beads. IgG antibodies purified from immunized milk also inhibited total glucan synthesis by cell-associated GTF preparation and GTF-I from S. mutans. The immunized milk may be useful as a means of passive immunization for the prevention of dental caries in humans. [ABSTRACT FROM AUTHOR]

Objective: To evaluate hemostatic efficacy, complications, and subsequent pregnancy outcomes in women with placenta previa who underwent combined vertical compression sutures in the lower uterine segment and intrauterine balloon tamponade (Hot-Dog method) to achieve hemostasis after cesarean section., Methods: We retrospectively reviewed data for 117 women with singleton pregnancy diagnosed with placenta previa who underwent cesarean section between 29 and 38 weeks' gestation. Treatments were as follows: (1) conventional-intravenous oxytocin administration after placental detachment and suturing of bleeding points at the detachment site as needed (conventional group) (n = 47). (2) Intrauterine balloon tamponade alone (balloon group) (n = 41). (3) Vertical compression sutures + intrauterine balloon tamponade (Hot-Dog group) (n = 29)., Results: The placenta accreta spectrum prevalence was significantly higher in the balloon and Hot-Dog groups versus the conventional group. The prevalence of anteriorly located placenta was significantly higher in the Hot-Dog versus balloon groups. Intraoperative and total blood loss were significantly higher in the Hot-Dog versus conventional groups. Postoperative blood loss was significantly lower in the Hot-Dog versus balloon groups. Fewer additional procedures for managing postoperative hemorrhage were required in the Hot-Dog versus conventional and balloon groups. The number of subsequent pregnancies in the conventional, balloon, and Hot-Dog groups was 11 (23.4%), 8 (19.5%), and 4 (13.8%), respectively; all resulted in live births at term without serious obstetric complications., Conclusion: The Hot-Dog method is a straightforward and safe hemostasis technique for placenta previa that preserves fertility and controls severe bleeding., (© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

We explored the feasibility of high-speed and high-accuracy quantification of active pharmaceutical ingredient (API) content in tablet products by near-infrared (NIR) spectroscopy to improve the reliability of pharmaceuticals. For this purpose, we employed a high-power NIR time-stretch transmission spectrometer recently developed by us. By using this transmission spectrometer with a multivariate calibration model, we demonstrated the ability to quantify API content with a short measurement time of 3.9 ms per tablet for model pharmaceuticals. For the model tablet, the quantification ability of our spectrometer was comparable to that achieved by a commonly used Fourier-transform NIR (FT-NIR) spectrometer with a measurement time of several seconds. We also confirmed that the effect of irradiating tablets with the NIR pulses used in our spectrometer was negligible., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Koji Nakayama reports writing assistance was provided by Japan Agency for Medical Research and Development. Koji Nakayama has patent #JPA2020159971, JPA2023036975 issued to Ushio Inc., TOWA PHARMACEUTICAL CO., LTD. Koji Nakayama has patent #EPA3951366, USA2022/0178848, CNA113614518, INA202117044615 pending to Ushio Inc., TOWA PHARMACEUTICAL CO., LTD. Aya Ikarashi (Ota) has patent #JPA2020159971, JPA2023036975 issued to Ushio Inc., TOWA PHARMACEUTICAL CO., LTD. Aya Ota has patent #EPA3951366, USA2022/0178848, CNA113614518, INA202117044615 pending to Ushio Inc., TOWA PHARMACEUTICAL CO., LTD. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Despite advancements in coronary computed tomography angiography (CTA), challenges in positive predictive value and specificity remain due to limited spatial resolution. The purpose of this experimental study was to investigate the effect of 2nd generation deep learning-based reconstruction (DLR) on the quantitative and qualitative image quality in coronary CTA., Methods: A vessel model with stepwise non-calcified plaque was scanned using 320-detector CT. Image reconstruction was performed using four techniques: hybrid iterative reconstruction (HIR), model-based iterative reconstruction (MBIR), DLR, and 2nd generation DLR. The luminal peak CT number, contrast-to-noise ratio (CNR), and edge rise slope (ERS) were quantitatively evaluated via profile curve analysis. Two observers qualitatively graded the graininess, lumen sharpness, and overall lumen visibility on the basis of the degree of confidence for the stenosis severity using a five-point scale., Results: The image noise with HIR, MBIR, DLR, and 2nd generation DLR was 23.0, 21.0, 16.9, and 9.5 HU, respectively. The corresponding CNR (25% stenosis) was 15.5, 15.9, 22.1, and 38.3, respectively. The corresponding ERS (25% stenosis) was 203.2, 198.6, 228.9, and 262.4 HU/mm, respectively. Among the four reconstruction methods, the 2nd generation DLR achieved the significantly highest CNR and ERS values. The score of 2nd generation DLR in all evaluation points (graininess, sharpness, and overall lumen visibility) was higher than those of the other methods (overall vessel visibility score, 2.6±0.5, 3.8±0.6, 3.7±0.5, and 4.6±0.5 with HIR, MBIR, DLR, and 2nd generation DLR, respectively)., Conclusions: 2nd generation DLR provided better CNR and ERS in coronary CTA than HIR, MBIR, and previous-generation DLR, leading to the highest subjective image quality in the assessment of vessel stenosis., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-1204/coif). D.U. reports that he has received research grants from Canon Medical Systems paid to Department of Diagnostic Radiology at Yokohama City University Graduate School of Medicine. T.T. reports that he is an employee of Canon Medical Systems Corporation. The other authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Accelerating the measurement for discrimination of samples, such as classification of cell phenotype, is crucial when faced with significant time and cost constraints. Spontaneous Raman microscopy offers label-free, rich chemical information but suffers from long acquisition time due to extremely small scattering cross-sections. One possible approach to accelerate the measurement is by measuring necessary parts with a suitable number of illumination points. However, how to design these points during measurement remains a challenge. To address this, we developed an imaging technique based on a reinforcement learning in machine learning (ML). This ML approach adaptively feeds back "optimal" illumination pattern during the measurement to detect the existence of specific characteristics of interest, allowing faster measurements while guaranteeing discrimination accuracy. Using a set of Raman images of human follicular thyroid and follicular thyroid carcinoma cells, we showed that our technique requires 3,333 to 31,683 times smaller number of illuminations for discriminating the phenotypes than raster scanning. To quantitatively evaluate the number of illuminations depending on the requisite discrimination accuracy, we prepared a set of polymer bead mixture samples to model anomalous and normal tissues. We then applied a home-built programmable-illumination microscope equipped with our algorithm, and confirmed that the system can discriminate the sample conditions with 104 to 4,350 times smaller number of illuminations compared to standard point illumination Raman microscopy. The proposed algorithm can be applied to other types of microscopy that can control measurement condition on the fly, offering an approach for the acceleration of accurate measurements in various applications including medical diagnosis., Competing Interests: Competing interests statement:The authors declare no competing interest.

Although time-stretch spectroscopy is an emerging ultrafast spectroscopic technique, the applications in industrial fields have been limited due to the low output power caused by undesirable nonlinear effects occurred in a long optical fiber used for pulse chirping. Here, we developed a high-power time-stretch near infrared (NIR) spectrometer utilizing arrayed waveguide gratings (AWGs). The combination of AWGs and short optical fibers allowed large amounts of chromatic dispersion to be applied to broadband supercontinuum pulses without the power limitation imposed by employing the long optical fiber. With the proposed configuration, we achieved chirped pulses with the output power of 60 mW in the 900-1300 nm wavelength region, which is about 10 times higher than conventional time-stretch spectrometers using long optical fibers. With the developed spectrometer, the NIR absorption spectra of a standard material and liquid samples were observed with high accuracy and precision within sub-millisecond measurement time even with four orders of magnitude optical attenuation by a neutral density filter. We also confirmed the quantitative spectral analysis capability of the developed spectrometer for highly scattering samples of an oil emulsion. The qualitative comparison of the measurement precision between the developed spectrometer and the previous time-stretch spectrometer was also conducted., (© 2023. Springer Nature Limited.)

Purpose: The purposes of this experimental study were to compare the quantitative and qualitative visibility of in-stent restenosis between conventional-resolution CT (CRCT) and ultra-high-resolution CT (U-HRCT) and to investigate the effects of the image reconstruction techniques on the visualization of in-stent restenosis., Materials and Methods: A vessel tube with non-calcified plaque in a 3.0-mm stent was scanned by using CRCT and U-HRCT at 4 stent directions (0, 30, 60, and 90 degrees) to the through-plane direction. Hybrid iterative reconstruction (HIR); model-based iterative reconstruction (MBIR); deep-learning-based reconstruction (DLR) were used as reconstruction methods. The lumen size was assessed using the full width at half maximum method, and image quality was visually evaluated using 4-point scale., Results: U-HRCT had the significantly wider lumen sizes and narrower stent strut thickness than CRCT in three types of the reconstruction methods (P < 0.01). The lumen sizes for U-HRCT with 90 degrees were narrower than those with the other angle directions regardless of the reconstruction methods. Visual score was significantly higher for U-HRCT than CRCT (3.2 ± 0.7 vs 2.0 ± 0.4, P < 0.001)., Conclusions: U-HRCT quantitatively and qualitatively provided better visualization of in-stent restenosis compared to CRCT. Image quality of U-HRCT may be affected by stent angle., (© 2021. Japan Radiological Society.)

Although Raman spectroscopy has been used for the quantitative analysis of samples in many fields, including material science, biomedical, and pharmaceutical research, its low sensitivity hindered the application of the analytical capability for high-throughput screening. Here, we developed a high-throughput Raman screening system that can analyze hundreds of specimens in a multiwell plate simultaneously. Multiple high numerical aperture (NA) lenses are assembled under each well in the multiwell plate to detect Raman scattering simultaneously with high sensitivity. The Raman spectrum of 192 samples loaded on a standard 384-well plate can be analyzed simultaneously. With the developed system, the throughput of Raman measurement was significantly improved (about 100 times) compared to conventional Raman instruments based on a single-point measurement. By using the developed system, we demonstrated high-throughput Raman screening to investigate drug polymorphism and identify a small-molecule binding site in a protein. Furthermore, the same system was used to demonstrate high-speed chemical mapping of a centimeter-sized pork slice., (© 2021. The Author(s).)

We demonstrate a method for label-free monitoring of hydrolytic activity of crystalline-chitin-degrading enzyme, chitinase, by means of Raman spectroscopy. We found that crystalline chitin exhibited a characteristic Raman peak at 2995 cm-1, which did not appear in the reaction product, N,N'-diacetylchitobiose. We used this Raman peak as a marker of crystalline chitin degradation to monitor the hydrolytic activity of chitinase. When the crystalline chitin suspension and chitinase were mixed together, the peak intensity of crystalline chitin at 2995 cm-1 was linearly decreased depending on incubation time. The decrease in peak intensity was inversely correlated with the increase in the amount of released N,N'-diacetylchitobiose, which was measured by conventional colorimetric assay with alkaline ferricyanide. Our result, presented here, provides a new method for simple, in situ, and label-free monitoring of enzymatic activity of chitinase.

The use of infrared (IR) photothermal microscopy (IR-PTM) is emerging for imaging chemical substances in various samples. In this research, we demonstrated the use of a nitrile group as a vibrational tag to image target molecules in the low water-background region. We performed IR photothermal imaging of trifluoromethoxy carbonyl cyanide phenylhydrazone (FCCP) in cells and confirmed the high spatial resolution by photothermal detection using visible light as a probe beam. We imaged FCCP-treated HeLa cells and confirmed that the photothermal signal was indeed produced from the vibrational tag in lipid droplets. We also compared the results with nitrile imaging by stimulated Raman scattering (SRS) microscopy. From both the calculated and experimental results, IR-PTM demonstrated a signal-to-noise ratio (SNR) several tens of times better than that of SRS microscopy on the basis of the same power input.

Mitochondrial activity is a widely used criterion to judge the metabolic condition of a living specimen. Numerous methods have been developed for related analyses, including the detection of O2 consumption, trans-membrane potential, and ATP production. In this study, we demonstrate that the redox state of cytochromes can serve as a sensitive mitochondrial activity indicator in glutamate-stressed neuronal cells. Mitochondrial dysfunction was detected by Raman imaging as early as 30 min after glutamate-stress induction. By comparing this result with other commonly used mitochondrial function assays, we found Raman imaging has a similar sensitivity to ATP production and trans-membrane potential assays. Other viability tests, such as MTT assay and ROS production tests, showed a slower response than our method. A thorough understanding of cytochrome dynamics with our new method will help establish Raman spectroscopy as a competitive clinical diagnosis tool for neurodegenerative diseases involving mitochondrial dysfunction.

We investigated the axial resolution and signal-to-noise ratio (SNR) characteristics in deep-tissue imaging by 1.7-μm optical coherence tomography (OCT) with the axial resolution of 4.3  μm in tissue. Because 1.7-μm OCT requires a light source with a spectral width of more than 300 nm full-width at half maximum to achieve such high resolution, the axial resolution in the tissue might be degraded by spectral distortion and chromatic dispersion mismatching between the sample and reference arms. In addition, degradation of the axial resolution would also lead to reduced SNR. Here, we quantitatively evaluated the degradation of the axial resolution and the resulting decrease in SNR by measuring interference signals through a lipid mixture serving as a turbid tissue phantom with large scattering and absorption coefficients. Although the axial resolution was reduced by a factor of ∼6 after passing through a 2-mm-thick tissue phantom, our result clearly showed that compensation of the dispersion mismatching allowed us to achieve an axial resolution of 4.3  μm in tissue and improve the SNR by ∼5  dB compared with the case where dispersion mismatching was not compensated. This improvement was also confirmed in the observation of a hamster’s cheek pouch in a buffer solution.

Optical coherence microscopy (OCM) is a label-free, high-resolution, three-dimensional (3D) imaging technique based on optical coherence tomography (OCT) and confocal microscopy. Here, we report that the 1700-nm spectral band has the great potential to improve the imaging depth in high-resolution OCM imaging of animal tissues. Recent studies to improve the imaging depth in OCT revealed that the 1700-nm spectral band is a promising choice for imaging turbid scattering tissues due to the low attenuation of light in the wavelength region. In this study, we developed high-resolution OCM by using a high-power supercontinuum source in the 1700-nm spectral band, and compared the attenuation of signal-to-noise ratio between the 1700-nm and 1300-nm OCM imaging of a mouse brain under the condition of the same sensitivity. The comparison clearly showed that the 1700-nm OCM provides larger imaging depth than the 1300-nm OCM. In this 1700-nm OCM, the lateral resolution of 1.3 μm and the axial resolution of 2.8 μm, when a refractive index was assumed to be 1.38, was achieved.

An attempt was made to synthesize artificial mixed-layered compounds between montmorillonite silicate and α-zirconium phosphate using a ship-in-bottle approach. The interlayer cations of montmorillonite were first exchanged with hydroxy-zirconium oligomeric cations, which were then subjected to a reaction with phosphoric acid or phenylphosphoric acid to develop α-zirconium phosphate layers (Zr(R-OPO3)2; R = H, C6H5) between the clay silicate layers. The attempt of the reaction with phosphoric acid failed; hydroxy-zirconium cations were removed out of the interlayer space, forming α-zirconium phosphate outside of montmorillonite. The phenylphosphate derivative, montmorillonite/Zr(C6H5OPO3)2, with a regular mixed-layered structure has been successfully obtained, showing a basal spacing corresponding to the sum of the thicknesses of the individual layers. When a polyvinyl alcohol (PVA) aqueous solution was used in the preparation of the hydroxy-zirconium exchanged montmorillonite, PVA was incorporated with hydroxy-zirconium complex cations between the silicate layers. The resulting compound can adsorb phosphate ions. Although this is not a mixed-layered compound in the context of this study, the selective and reversible phosphate ion exchange properties are worth noting for future study.

Introduction: Even now, cystic duct cancer (CDC) as defined by Farrar is rare and has a better prognosis than gallbladder cancer, although CDC as defined by Ozden et al., the definition of which could apply to early and advanced cases of CDC, is not rare and has a poorer prognosis than the CDC defined by Farrar., Presentation of Case: A 78-year-old woman with no complaints was found to have a tumor restricted to the cystic duct. Three cytology examinations of the patient's bile could not establish that the tumor was an adenocarcinoma. However, adenocarcinoma was suspected due to the hypervascularity shown on contrast-enhanced computed tomography. Cholecystectomy and extrahepatic bile duct resection with D2 lymph node dissection was performed. The pathological study revealed it to be CDC. Her postoperative course has been uneventful and without recurrence for 21 months., Discussion: At their first medical examination, many CDC patients are found to have such advanced spread of the cancer to adjacent organs that an extended operation might be necessary. As in our case, better patient outcome results when no lymph node or remote metastasis is present., Conclusion: Diagnosing CDC as early as possible contributes to curative resections and favorable patient outcomes and also allows surgeons to recommend a mini-invasive procedure to their patients rather than extended resection including that of adjacent organs., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)