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Objective Acute cholangitis is occasionally life-threatening and requires immediate treatment. For the management of acute cases, globally accepted diagnostic criteria and the use of severity grading, as defined in the Tokyo Guidelines 2018 (TG18), are recommended. This study was performed to explore the association between acute cholangitis and the level of adenosine 5'-triphosphate (ATP) in blood as determined with a simple measurement method. Methods Twenty-three consecutive patients admitted for acute cholangitis and 14 healthy individuals were enrolled. Based on the TG18, the patients were categorized according to the degree of severity as Grade I, II, or III. We measured the amount of ATP in blood samples using a bioluminescence meter and evaluated the correlation with the degree of severity. Results The ATP/total hemoglobin (tHgb) level showed a significant decline in association with an increase in severity, as that in the healthy controls was 236.60 ± 8.10 and in the Grade I, II, and III groups was 238.56 ± 6.98, 186.88 ± 7.62, and 154.60 ± 11.01, respectively (p<0.01). While no significant difference was observed between the healthy controls and Grade I patients (p=0.649), there was a statistically significant difference between Grade I and Grade II (p<0.01) in the ATP/tHgb level. According to a receiver operating characteristic analysis, the area under the curve for ATP/tHgb, used as an index for predicting the need for emergency biliary drainage (Grade II, III cases), was the highest among various examined factors. Conclusion The present novel measurement method was found to be simple to perform and useful for detecting acute cholangitis patients with a low ATP level who may require emergency biliary drainage.

We examined the applicability of the home-care supporting clinics in Japan(HCSC-J)scale to measure the quality of home-care services provided by HCSC. We conducted an anonymous mailed survey of 349 bereaved family members who received home-care services in 23 wards of HCSC in Tokyo, Japan. Of 143 responders, 77(clinic A: 44; clinic B: 33)were finally evaluated. The total scores of the HCSC-J subscale revealed a significant correlation with the overall assessment of home care. Our results suggest that the HCSC-J scale is effective for measuring the quality of home-care services of HCSC in Japan.

Aim: HCSCs were introduced in Japan in April 2006 with the aim of playing a central role in providing end-of-life care at home. However, it is unclear how the HCSCs are operated because statistical data regarding their activities have not been disclosed to the Japanese public. The purpose of this study was to describe the trends associated with the HCSC activity in Tokyo, Japan., Methods: We submitted an application to the relevant government ministry to disclose the annual activity reports from 2008 to 2010 of the HCSCs located in Tokyo. Reports from each HCSC contained information on the number of patients, the number of deceased patients, their place of death and the number of home visits by physicians and nurses., Results: The number of HCSC activity reports for each year was 1166 (2008), 1209 (2009) and 1246 (2010), while the total number of patients for each year was 67,765 (2008), 67,094 (2009) and 83,486 (2010). Patients who died at home each year under the care of HCSCs was 4431 (2008), 4786 (2009) and 5234 (2010). It is of note that in 2010 about 87% of patients were cared by HCSCs that cared for >50 patients a year and as many as 26.9% of patients who died at home utilized clinics that cared for >50 deceased patients a year., Conclusion: The advent of HCSCs caring yearly for >50 patients and deceased patients has led to a shift in the location in which patients receive end-of-life care., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

We examined a yearly change of the relationship between the place of death and the activity of home care supporting clinics(HCSC)in Tokyo, Japan. The number of HCSCs by the Japanese Ministry of Health, Labor and Welfare has edged up slightly from 1, 166 in 2008 to 1, 246 in 2010. The number of total patients provided the care by HCSC has increased by 24. 4% from 2009 to 2010. There was a 9. 3% increase in the patients provided the care by HCSC, and died at home from 2009 to 2010. These results suggested that the home care support system has proceeded gradually in Tokyo, Japan.

We examined the relation between the activity of home care supporting clinics and the place of death in Tokyo, Japan. Of 1,209 clinics certified home care supporting clinics by the Japanese Ministry of Health, Labor and Welfare, 9.1% were not functioning for a year and 34.7% of them did not deal with patient's home death. Of patients who died at home, 64.3% utilized home care supporting clinics which dealt with 11 or more patient's death at home per year.