Impact of home and community-based services on hospitalisation and institutionalisation among individuals eligible for long-term care insurance in Japan

Abstract Background This population-based retrospective cohort study aimed to clarify the impact of home and community-based services on the hospitalisation and institutionalisation of individuals certified as eligible for long-term care insurance (LTCI) benefits. Methods Health insurance data and LTCI data were combined into a database of 1,020 individuals in two farming communities in Hokkaido who were enrolled in Citizen's Health Insurance. They had not received long-term care services prior to April 1, 2000 and were newly certified as eligible for Long-Term Care Insurance benefits between April 1, 2000 and February 29, 2008. The analysis covered 565 subjects who had not been hospitalised or institutionalised at the time of first certification of LTCI benefits. The adjusted hazard ratios (HRs) of hospitalisation or institutionalisation or death after the initial certification were calculated using the Cox proportional hazard model. The predictors were age, sex, eligibility level, area of residence, income, year of initial certification and average monthly outpatient medical expenditures, in addition to average monthly total home and community-based services expenditures (analysis 1), the use or no use of each type of service (analysis 2), and average monthly expenditures for home-visit and day-care types of services, the use or no use of respite care, and the use or no use of rental services for assistive devices (analysis 3). Results Users of home and community-based services were less likely than non-users to be hospitalised or institutionalised. Among the types of services, users of respite care (HR: 0.71, 95% confidence interval [CI]: 0.55-0.93) and rental services for assistive devices (HR: 0.70, 95% CI: 0.54-0.92) were less likely to be hospitalised or institutionalised than non-users. For those with relatively light needs, users of day care were also less likely to be hospitalised or institutionalized than non-users (HR: 0.77, 95% CI: 0.61-0.98). Conclusions Respite care, rental services for assistive devices and day care are effective in preventing hospitalisation and institutionalisation. Our results suggest that home and community-based services contribute to the goal of the LTCI system of encouraging individuals certified as needing long-term care to live independently at home for as long as possible. </jats:sec

Critical contribution of MCL-1 in EMT-associated chemo-resistance in A549 non-small-cell lung cancer

Non-small cell lung cancer (NSCLC) is one of the leading causes of death in all lung cancer patients due to its metastatic spread. Even though cisplatin treatment after surgical resection of the primary tumor has been established as a standard chemotherapy for residual disease including metastatic spread, NSCLC often acquires a resistance against chemotherapy, and metastatic disease is often observed. Amongst many potential mechanisms, epithelial-to-mesenchymal transition (EMT) has been considered as an important process in acquiring both metastatic spread and chemo-resistance of NSCLC. In this study, we identified MCL-1 as a critical molecule for chemoresistance in A549 cells associated with TGF-β-induced EMT. Importantly, downregulation of MCL-1 by siRNA or inhibition of MCL-1 with pan-BCL2 inhibitor to inhibit MCL-1 was able to overcome the EMT-associated chemo-resistance in A549 cells. Collectively, MCL-1 can be a new therapeutic target for overcoming EMT-associated chemo-resistance in NSCLC patients in the context of post-operative chemotherapies

Detrusor overactivity induced by intravesical application of adenosine 5 '-triphosphate under different delivery conditions in rats

Objectives. We investigate the effects of intravesical application of adenosine 5'-triphosphate (ATP) on bladder activity to elucidate the role of urothelial barrier function and ecto-ATPase activity in the ATP-mediated mechanism inducing detrusor overactivity. Methods. Continuous cystometry by an intravesical catheter inserted from the bladder dome was performed in conscious female rats. Results. ATP solutions adjusted to pH 6.0 did not elicit significant detrusor overactivity at a concentration of 60 mM. However, in bladders pretreated with protamine sulfate (10 mg/mL) to increase urothelial permeability, ATP solution (pH 6.0) induced detrusor overactivity by decreasing the intercontraction intervals. These irritant effects of ATIP after protamine treatment were antagonized by P2X receptor antagonists, such as pyridoxal-5-phosphate-6-azophenyl-2',4-disulfonic acid (70 mu mol/kg) and 2',3'-O-(2,4,6, trinitrophenyl) ATP (30 mu mol/kg). These were also suppressed in rats pretreated with systemic capsaicin (125 mg/kg subcutaneously). Alpha,beta-methylene ATP (5 mM, pH 6.0) or ATP (60 mM, pH6) after intravesical infusion of 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (5 mM, pH 6.0), an ecto-ATPase inhibitor, induced detrusor overactivity without protamine pretreatment, but the reduction in intercontraction intervals was smaller compared with that with ATP after protamine treatment. Conclusions. Low permeability of bladder epithelium and ecto-ATPase activity can prevent ATP activation of subepithelial P2X receptors to induce bladder overactivity. Thus, enhanced penetration of endogenous ATIP owing to urothelial damage may contribute to urinary frequency and bladder pain in hypersensitive bladder disorders such as interstitial cystitis.</p

Two stage surgical treatments for a chronic type B dissecting aortic aneurysm with aberrant right subclavian artery and Kommerell Diverticulum ; a case report

We report a case of two stage operations for a chronic type B dissecting aortic aneurysm with aberrant right subclavian artery(ARSA) and Kommerell’s diverticulum (KD). A 62-year-old man with a type B aortic dissection from 9 years before underwent follow-up Computed Tomography (CT) revealing aortic arch with KD expanded to 53mm and aberrant right subclavian artery expanded to 23mm in diameter. We performed two stage operations. In the first, we performed ARSA division at the proximal part of vertebral artery and transposed the distal end to right common carotid artery transposition. Subsequently, we performed replacement of descending aortia and over sewing of the aneurysmal of the origin ARSA under circulatory arrest. KD with ARSA is a rare anomaly of the aortic arch, and it may develop complications such as distal embolization, subclavian-esophageal fistula, dissection and rupture. We performing in two stages, subclavian reconstruction before the intrathoracic repair would be expected to reduce the subsequent risk of distal ischemia or subclavian steal.Article我々は，異所性右鎖骨下動脈（ARSA）とKommerell憩室（KD）を伴った慢性B型解離性大動脈瘤に二期的手術を行った1 例を報告する。症例は， 9 年前にB型大動脈解離を来した62歳の男性でCTによる定期検査を受け，KDを伴う53mmに拡大した大動脈弓と直径23mmに拡大した異所性右鎖骨下動脈を認めた。治療は， 2 期的手術の方針とし，初回は椎骨動脈の近位部でARSAを離断し，末端部を右総頸動脈に転位吻合した。二期目は，循環停止下で下行大動脈置換と瘤化したARSAの起始部を縫合した。ARSAを伴ったKDは稀な大動脈弓異常であり，末梢部の塞栓形成，鎖骨下動脈食道瘻，解離や破裂などの合併症を呈する可能性がある。我々が二期的に行った，大動脈置換前の鎖骨下動脈の再建は，末梢の虚血または鎖骨下動脈盗血のリスクを低下させると思われた。Toyama medical journal, 29(1), 2019.03.31, Page 40-43departmental bulletin pape

A new unifying heuristic algorithm for the undirected minimum cut problems using minimum range cut algorithms

AbstractGiven a connected undirected multigraph with n vertices and m edges, we first propose a new unifying heuristic approach to approximately solving the minimum cut and the s-t minimum cut problems by using efficient algorithms for the corresponding minimum range cut problems. Our method is based on the association of the range value of a cut and its cut value when each edge weight is chosen uniformly randomly from the fixed interval. Our computational experiments demonstrate that this approach produces very good approximate solutions. We shall also propose an O(log2 n) time parallel algorithm using O(n2) processors on an arbitrary CRCW PRAM model for the minimum range cut problems, by which we can efficiently obtain approximate minimum cuts in poly-log time using a polynomial number of processors

Experimental and numerical evaluation of effects of kidney-shape carbon fiber on transverse cracking of carbon fiber reinforced plastics

This study aims to investigate the effects of fiber cross-sectional shape on the trans- verse crack extension of carbon fiber reinforced plastics (CFRP) both experimentally and numerically. Kidney-shape carbon fiber was compared with the laminates using conventional round-shape carbon fiber by monitoring the transverse crack accumu- lation behavior during static tensile tests. The experimental results showed that kidney-shape carbon fibers retard the initiation of transverse cracks and suppress their accumulation. Moreover, a micromechanical simulation based on finite ele- ment method was performed to consider the effects of fiber cross-sectional shape on crack propagation. In the case of the major damage process of the two kinds of CFRPs to be different in the simulations, the numerical results agreed well with the experimental ones. It was experimentally and numerically demonstrated that the kidney-shape carbon fiber suppresses the transverse crack accumulation and retards the crack initiation in CFRP laminates compared with round-shape carbon fiber.journal articl