Aims: To clarify the usefulness of preservative-free ophthalmic preparations equipped with a filter. Methods: A total of 1,615 samples of in-use ophthalmic preparations were examined for microbial contamination. Results: Of 1,094 samples of preservative-containing ophthalmic preparations, 31 (2.8%) showed microbial contamination. Of 289 samples of preservative-free ophthalmic preparations without a filter, 6 (2.1%) were contaminated, consisting of 4 (13.8%) of 29 samples of hospital preparations and 2 (0.8%) of 260 samples of commercially available new quinolone antimicrobial agents. On the other hand, the microbial contamination rate in preservative-free ophthalmic preparations equipped with a filter was 0% (0 of 232 samples).The major contaminants detected in these preservative-containing ophthalmic preparations and preservative-free ophthalmic preparations without a filter were glucose-nonfermentative Gram-negative bacilli such as Pseudomonas fluorescens, Acinetobacter spp., and P. aeruginosa, coagulase (-) staphylococci, and Candida spp. The contaminant level was 10-99 colony forming units (CFU)/mL in 37.8% (14 of 37 samples), and 10-10 CFU/mL in 62.2% (23 of 37 samples). Conclusions: Preservativefree ophthalmic preparations equipped with a filter not only have zero risk of the oculotoxic effects of preservatives, but are also safe in terms of their lack of microbial contamination.
Objective: To evaluate whether 3D magnetic resonance myelography (MR myelography) using fat-suppressed-three dimensional coherent oscillatory state acquisition for the manipulation of the image contrast (FS 3D-COSMIC) sequence has additional diagnostic value in the diagnosis of lumbar canal stenosis. Materials and Methods: The patient population consisted of 30 patients who were seen for the diagnosis of lumbar canal stenosis. The lumbar segments were divided into 15 groups, from L1-L2 to L5-S1; right, middle and left. Of all segments examined (450 segments), 180 segments confirmed to have stenosis by surgery were included in this study. The sensitivities, specificities, and accuracies of observer for diagnosing lumbar canal stenosis of the routine MRI + MR myelograpy were compared with those of the routine MRI alone. In addition, receiver operating characteristic analysis was performed. Results: In all segments, both the sensitivity, accuracy and Az value were significantly higher for the routine MRI + MR myelography than for the routine MRI alone (P < 0.05). Conclusion: The addition of MR myelography using the FS 3D-COSMIC sequence to routine MR imaging may be useful for evaluating lumbar canal stenosis; especially, the technique may contribute to improving the sensitivity for the diagnosis of lum-
After graduating from university, I became a clinical nurse and pursued outstanding nursing practice, and as a nursing educator I aimed for excellence in nursing education. For over 40 years, I have consistently explored outstanding nursing practices and teaching methods that facilitate excellent practice. I have been able to make great progress with this research at Yamaguchi University. Today I want to share my own history of research and education.
Background: Delirium is a common problem in intensive care units (ICUs) and is associated with poor outcomes. The association between inflammation and delirium in the peri-extubation period of mechanical ventilation (MV) is poorly understood. Methods: We conducted a prospective, observational study of adult patients on MV for >48 hours in an ICU. At extubation (0 h) and 24 h later, the Confusion Assessment Method for the ICU (CAM-ICU) and the following serum biomarkers were assessed: C-reactive protein (CRP), procalcitonin, white blood cell (WBC) count, interleukin (IL) -6 and -8. Patients were classified into delirious (D; at least one positive CAM-ICU) and nondelirious (N; negative CAM-ICU at both times) groups. Results: Of the 28 enrolled patients, 12 were in group D, and 16 were in group N. Patient characteristics were not different except for the Acute Physiology and Chronic Health Evaluation II score and Sequential Organ Failure Assessment score at 0 h. At 24 h, procalcitonin and IL-6 levels were higher in group D. During the 24-h period, CRP, IL-6, and IL-8 levels decreased in group N, and WBC count increased in group D. Conclusions: The results indicate an association between prolonged inflammation and delirium in the peri-extubation period of MV.
Aim: Children with attention-deficit/hyperactivity disorder (ADHD) show cognitive impairments such as disrupted attention and impaired learning and memory. The multi-source interference task (MSIT) combines multiple dimensions of cognitive interference and recruits the cingulo-frontal-parietal cognitive/attention network. The aim of this study was to determine whether children with ADHD show fronto-parietal dysfunction during the MSIT by using functional near-infrared spec- troscopy (NIRS). Methods: Nineteen boys with ADHD and 14 age- and IQ-matched controls were studied. We measured oxygenated hemoglobin concentration ((oxy-Hb)) changes in the fronto-parietal region by using a 46-channel functional NIRS imaging system. The behavioral performance and mean (oxy-Hb) of the two groups during the MSIT were compared.Results: The behavioral data of the MSIT were not signifi- cantly different between the two groups. Compared to the control group, the ADHD group showed higher (oxy-Hb) changes in the left dorsolateral prefrontal region (ADHD, 0.17 ⊗ 10 -1 ∓ 0.11; control, -0.65 × 10 -1 ∓ 0.62 ⊗ 10 -1 ; P = 0.02). Conclusion: Our results suggest that compared to controls, children with ADHD have abnormal pre- frontal activation in response to multiple interference control, in order to achieve fa- vorable outcomes of cognitive demand. These findings may provide insights into the pathophysiology of ADHD.
Background and Aim: Image definition and complete small bowel examination rate are possible factors contributing to missed lesions during capsule endoscopy. This study aimed to determine the effect of coadministration of polyethylene glycol (PEG) and dai-kenchu-to (DKT) on these factors using PEG and DKT as pretreatment before capsule endoscopy. Methods: Patients who underwent capsule endoscopy at our hospital between November 2007 and August 2012 were included in the study. Patients were divided into the following three groups: those receiving no pretreatment (control, n=133), those orally administered PEG (PEG, n=20), and those orally administered PEG and DKT (15g) (PEG + DKT, n=25). Image definition and complete small bowel examination rate were examined retrospectively between the three groups. Results: Image definition in the PEG + DKT group was significantly higher than that in the control group (p<0.05), but there was no significant differences between the PEG and control groups. The complete small bowel examination rate was significantly lower in the PEG group than in the control and PEG + DKT groups (p<0.05). Conclusions: Coadministration of PEG and DKT improved image definition and prevented a reduction of the complete small bowel examination rate due to PEG in capsule endoscopy.
Continuous interventional programs such as the development of the practice of journal writing have recently been recommended as one way of helping prevent dementia in older people. We used the Kana Pick-out Test, a screening test for cognitive function, to investigate the journal writing status of 227 older people and determine whether journal writing had any positive effect to maintain cognitive function. Forty-seven percent of people (106 people) kept journals; 70% of these people had done so for at least 10 years, and 88% had kept journals every day. Both at home and in care facilities, t-tests revealed a significant difference in the numeric value of the Kana Pick-out Test between the group with some journal writing practice and that without it (at home, P < 0.01; in care facilities, P < 0.05). The results indicated that many older people kept a journal, and that this had some positive effect on maintaining cognitive function.
Purpose: Strict control of arterial blood pressure is required if cerebral hyperperfusion after carotid stenting for internal carotid artery stenosis occurs. Here we retrospectively examined the occurrence and management of cerebral hyperperfu- sion after carotid stenting. Methods: We assessed 23 patients who underwent carotid stenting and whose cerebral perfusion on xenon-enhanced computed tomography was evaluated just after the procedure. The use of nicardipine and propofol was compared between patients whose cerebral blood flow ratio to the contralateral hemisphere in- creased >1.0 (n=8; hyperperfusion group) and those without cerebral hyperperfusion (n=15; normal perfusion group).Results: Pre-procedural cerebrovascular reactivity to acetazolamide was <20% in 8 patients (100%) in the hyperperfusion group and in 8 patients (53%) in the normal perfusion group (p=0.052). Intravenous administration of nicardipine and propofol was necessary in 5 (63%) and 4 (50%) patients in the hy- perperfusion group compared with 2 (13%, p=0.026) and 0 (0%, p=0.008) patients in the normal perfusion group, respectively. No neurological deterioration remained in any patients on discharge from the intensive care unit. Conclusion: In patients with ce- rebral hyperperfusion, post-procedural hypertension can be treated using nicardipine or propofol.
