Performance Assessment of EMR Systems Based on Post-Relational Database

Post-relational databases provide high performance and are currently widely used in American hospitals. As few hospital information systems (HIS) in either China or Japan are based on post-relational databases, here we introduce a new-generation electronic medical records (EMR) system called Hygeia, which was developed with the post-relational database Caché and the latest platform Ensemble. Utilizing the benefits of a post-relational database, Hygeia is equipped with an “integration” feature that allows all the system users to access data—with a fast response time—anywhere and at anytime. Performance tests of databases in EMR systems were implemented in both China and Japan. First, a comparison test was conducted between a post-relational database, Caché, and a relational database, Oracle, embedded in the EMR systems of a medium-sized first-class hospital in China. Second, a user terminal test was done on the EMR system Izanami, which is based on the identical database Caché and operates efficiently at the Miyazaki University Hospital in Japan. The results proved that the post-relational database Caché works faster than the relational database Oracle and showed perfect performance in the real-time EMR system.     

Quickly Updatable Hologram Images Using Poly(N-vinyl Carbazole) (PVCz) Photorefractive Polymer Composite

Quickly updatable hologram images using photorefractive (PR) polymer composite based on poly(N-vinyl carbazole) (PVCz) is presented. PVCz is one of the pioneer materials of photoconductive polymers. PR polymer composite consists of 44 wt % of PVCz, 35 wt % of 4-azacycloheptylbenzylidene-malonitrile (7-DCST) as a nonlinear optical dye, 20 wt % of carbazolylethylpropionate (CzEPA) as a photoconductive plasticizer and 1 wt % of 2,4,7-trinitro-9-fluorenone (TNF) as a sensitizer. PR composite gives high diffraction efficiency of 68% at E = 45 V μm⁻¹. Response speed of optical diffraction is the key parameter for real-time 3D holographic display. The key parameter for obtaining quickly updatable holographic images is to control the glass transition temperature lower enough to enhance chromophore orientation. Object image of the reflected coin surface recorded with reference beam at 532 nm (green beam) in the PR polymer composite is simultaneously reconstructed using a red probe beam at 642 nm. Instead of using a coin object, an object image produced by a computer was displayed on a spatial light modulator (SLM) and used for the hologram. The reflected object beam from an SLM was interfered with a reference beam on PR polymer composite to record a hologram and simultaneously reconstructed by a red probe beam.     

Clinical psychological tests useful for differentiating depressive state with Alzheimer's disease from major depression of the elderly

Background:  A depressive state with Alzheimer's disease (AD) is difficult to differentiate from major depression (MD) in many cases. The purpose of this study was to identify differences between the two disorders using a battery of clinically available psychological tests.
Methods:  We evaluated depression and apathy using the Geriatric Depression Scale consisting of 30 items (GDS30) and Apathy Scale in 38 patients with AD and 31 with MD who were diagnosed based on clinical symptoms and radiological findings. In addition, the Cornel Medical Index (CMI) was employed to compare the psychological features of the two disorders.
Results:  In AD patients, the Apathy Scale score was greater than the GDS30 score, suggesting a strong tendency toward apathy. There was a significant difference in the GDS30/Apathy Scale score ratio between the two groups ( P  < 0.05, OR: 3.11). When examining the downstream mental items of the CMI, the values of tension-category parameters were significantly greater in AD patients, whereas those of depression-category parameters were significantly higher in MD patients. In individual patients, we compared the scores for the two categories, and there was a marked difference ( P  < 0.001, OR: 10.6).
Conclusion:  These results suggest that the GDS30, Apathy Scale, and CMI are useful for differentiating MD from AD and evaluating their psychological features.     

Serum concentration of L‐kynurenine predicts the clinical outcome of patients with diffuse large B‐cell lymphoma treated with R‐CHOP

Purpose: Introduction of rituximab has largely improved the prognosis of patients with diffuse large B‐cell lymphoma(DLBCL). Such change in therapeutic outcome necessitates the identification of additional prognostic factors to conventional indexes that have been validated for CHOP without rituximab. Indoleamine 2,3‐dioxygenase (IDO) exerts intense immunomodulatory effects because of enzymatic activities that catalyze the breakdown of the essential amino acid L‐tryptophan. The activity of IDO can be estimated by measuring the serum concentration of L ‐kynurenine. Here, we investigated the role of L ‐kynurenine as a prognostic marker in R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) therapy. Experimental design: Data from 73 consecutive patients treated with eight cycles of R‐CHOP or R‐THP (tetrahydropyranyl adriamycin)‐COP between December 2002 and March 2007 were analyzed. L ‐kynurenine concentrations in serum samples obtained at admission were measured by high‐performance liquid chromatography. Results: The median serum L ‐kynurenine level was 1.575 μm (range 0.537–9.588). The complete response (CR) rates of patients with L ‐kynurenine <1.5 and ≥1.5 μm were 83% and 61%, respectively (P < 0.05). The three‐yr overall survival (OS) rates for patients with L ‐kynurenine <1.5 and ≥1.5 μm were 89% and 58%, respectively (P < 0.005). In addition, higher age, poor performance status, elevated serum lactate dehydrogenase, and unfavorable as well as revised International Prognosis Index were significantly worse factors for CR rate and OS. Multivariate analyses revealed only L ‐kynurenine as an independent prognostic factor for OS. Conclusions: Serum L ‐kynurenine might be a novel prognostic factor to determine the treatment outcome of DLBCL with the R‐CHOP regimen.     

Relationship between α-melanocyte-stimulating hormone- and neuropeptide Y-containing neurons in the goldfish hypothalamus

Intracerebroventricular (ICV) injection of α-melanocyte-stimulating hormone (α-MSH) inhibits, whereas ICV injection of neuropeptide Y (NPY) stimulates food intake in the goldfish. However, there is little information about the functional relationship between α-MSH-induced anorexigenic and NPY-induced orexigenic actions in the goldfish. In this study we examined the relationship between α-MSH- and NPY-containing neurons in the goldfish hypothalamus to investigate whether these α-MSH- and NPY-containing neurons have direct mutual inputs. α-MSH- and NPY-like immunoreactivities were distributed throughout the brain, especially in the diencephalon. In particular, α-MSH-containing nerve fibers or endings lay in close apposition to NPY-containing neurons in a specific region of the hypothalamus, the nucleus posterioris periventricularis (NPPv). NPY-containing nerve fibers or endings also lay in close apposition to α-MSH-containing neurons specifically in the interior part of the nucleus lateralis tuberis (NLTi). We also investigated the effect of ICV injection of melanocortin 4 receptor agonist (melanotan II) at 100 pmol/g body weight (BW), which is enough to suppress food intake, or NPY at 10 pmol/g BW, which is enough to enhance food intake, on expression levels of mRNA for NPY or proopiomelanocortin (POMC) in the hypothalamus. ICV injection of melanotan II and NPY induced a significant decrease in the expression levels for NPY and POMC mRNA, respectively. These observations suggest that α-MSH- and NPY-containing neurons share direct mutual inputs in the NPPv and the NLTi of the hypothalamus, and that α-MSH and NPY functionally interact or exhibit mutual inhibition to regulate feeding behavior in the goldfish.     

A case of adalimumab-associated interstitial pneumonia with rheumatoid arthritis

A 64-year-old woman with rheumatoid arthritis (RA) began to complain of recurrent non-productive cough 5 months after starting adalimumab. The chest radiograph and high-resolution computed tomographic findings revealed diffuse ground-glass attenuation. Her clinical course suggested that interstitial pneumonia (IP) may have been induced by adalimumab, and she was successfully treated with a medium dose of corticosteroid. This case indicates that adalimumab-associated IP should be considered if a RA patient develops non-productive cough following adalimumab therapy.     

Impact of preoperative serum sodium concentration in living donor liver transplantation

Background and Aims: The importance of hyponatremia in deceased donor liver transplantation (DDLT) has been recently discussed frequently. However, its impact on the outcomes in living donor liver transplantation (LDLT) has not yet been elucidated. The current study was designed to demonstrate the impact of pre‐transplant sodium concentration on postoperative clinical outcomes. Methods: One hundred and thirty‐four patients who underwent LDLT for end‐stage liver diseases were examined to evaluate the significance of pre‐transplant hyponatremia (Na ≤ 130 mEq/L) on the short‐term clinical outcomes and the efficacy of the Model for End‐Stage Liver Disease and serum sodium (MELD‐Na) score using the sodium concentration and original MELD score. Results: The preoperative sodium and MELD score for all patients were 133.9 mEq/L (range: 109–142) and 16.2 (range: 6–38), respectively. According to a multivariate analysis, not only the MELD score (P = 0.030) but also the sodium concentration (P = 0.005) were found to be significant predictive factors for short‐term graft survival. Preoperative hyponatremia was a significant risk factor for the occurrence of sepsis (P < 0.001), renal dysfunction (P < 0.001) and encephalopathy (P = 0.026). The MELD‐Na score was 19.6 (range: 6–51) and the area under the receiver–operator curve of that (c‐statistics: 0.867) was higher than MELD score and sodium concentration (c‐statistics: 0.820 and 0.842, respectively). Conclusion: Preoperative hyponatremia was a significant risk for postoperative complications and short‐term graft loss. The addition of sodium concentration to MELD score might therefore be an effective predictor for post‐transplant short‐term mortality in LDLT.     

Delayed neural damage is induced by iNOS-expressing microglia in a brain injury model

Most CNS diseases begin with inflammation with subsequent neural damage eventually occurring; however, the process leading from the onset of inflammation to neural damage remains obscure. We used an artificial brain injury mouse model and examined how neural damage occurred in the brain parenchyma. The damaged area in each mouse was clearly observed by magnetic resonance imaging (MRI), and the progression of damage was observed to occur in a biphasic manner (acute damage, within 1 week; delayed damage, after 2 weeks). We found that the delayed neural damage was absent in iNOS-deficient mice (iNOS-KO mice). Then, we analyzed brain tissues and determined that delayed neural damage was accompanied by an increase in the levels of NO end products and iNOS expression, with accumulation of iNOS-expressing microglia around the injured area. In addition, the expression of IL-1β mRNA was increased in areas affected by acute damage, but not in those affected by delayed damage. These findings suggest that delayed neural damage might arise from NO production by iNOS-expressing activated microglia and that such activated microglia might become a therapeutic target for many CNS diseases.