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Sleep deprivation (SD) causes several adverse functional outcomes, and understanding the associated processes can improve quality of life. Although the effects of SD on neuronal activity in several brain regions have been identified, a comprehensive evaluation of the whole brain is still lacking. Hence, we performed SD using two different methods, gentle handling and a dedicated chamber, in targeted recombination in active populations 2 (TRAP2) mice crossed with Rosa-ZsGreen reporter mice and visualized cellular activity in the whole brain. Using the semi-automated post-imaging analysis tool Slice Histology Alignment, Registration, and Cell Quantification (SHARCQ), the number of activated cells was quantified. From the analysis of 14 brain regions, cellular activity was significantly increased in the olfactory areas and decreased in the medulla by the two SD methods. From the analysis of the further subdivided 348 regions, cellular activity was significantly increased in the vascular organ of the lamina terminalis, lateral hypothalamic area, parabigeminal nucleus, ventral tegmental area, and magnocellular reticular nucleus, and decreased in the anterior part of the basolateral amygdalar nucleus, nucleus accumbens, septohippocampal nucleus, reticular nucleus of the thalamus, preoptic part of the periventricular hypothalamic nucleus, ventromedial preoptic nucleus, rostral linear nucleus raphe, facial motor nucleus, vestibular nuclei, and some fiber tracts (oculomotor nerve, genu of corpus callosum, and rubrospinal tract) by the two SD methods. Two subdivided regions of the striatum (caudoputamen and other striatum), epithalamus, vascular organ of the lamina terminalis, anteroventral preoptic nucleus, superior colliculus optic layer, medial terminal nucleus of the accessory optic tract, pontine gray, and fiber tracts (medial lemniscus, columns of the fornix, brachium of the inferior colliculus, and mammillary peduncle) were differentially affected by the two SD methods. Most brain regions detected from these analyses have been reported to be involved in regulating sleep/wake regulatory circuits. Moreover, the results from the connectivity analysis indicated that the connectivity of cellular activity among brain regions was altered by SD. Together, such a comprehensive analysis of the whole brain is useful for understanding the mechanisms by which SD and/or sleep disruption affects brain function.

With the recent shift in community pharmacist services toward in-person services and the growing need for centralized and continuous medication management/monitoring, pharmacist–patient information sharing is crucial. This study investigated the pharmacist–patient gap in the recognition of pharmacists’ behaviors regarding information sharing and assessed the potential impact of such recognition on patient trust and willingness to self-disclose. This cross-sectional study included 600 patients (aged 21–85 years) using pharmacy services (surveyed online in December 2020) and 591 community pharmacists with ≥1 year of experience (surveyed from September to November 2021). Both groups responded to items on the recognition of pharmacists’ behaviors regarding information sharing. There were patient-specific items on trust in community pharmacists and willingness to self-disclose. For all items on the recognition of pharmacists’ behaviors, patients’ scores were significantly lower (4–5) than pharmacists’ own scores (≥5), revealing a notable perception gap. Patients’ recognition had a positive, direct effect on trust and willingness, and trust had a positive, direct effect on willingness. Patients’ recognition and trust positively influenced their willingness to self-disclose. Pharmacist communication with clear intent is important to bridge the gaps in pharmacist–patient recognition and foster effective patient–pharmacist relationships.

In recent years, Japanese water utilities are facing pressing problems like staff shortage and climate-induced water quality deterioration. Utilization of online water quality monitoring data have received increasing attention to address these problems. A questionnaire survey was carried out for 32 water utilities to comprehend current situation of online water quality monitors (OWQMs), including installation of OWQMs and critical obstacles, water quality items monitored, utilization of water quality dataset, and future challenges. Turbidity, pH, and chlorine were mostly monitored using OWQMs from source to tap, for determining operating conditions of water purification process. Turbidity, pH, toxic substance, musty-odor substance, and residual chlorine were regarded as highly significant for both operational management and risk management. Initial/operational costs, measurement accuracy, and maintenance work volume were typical obstacles of OWQM installation. Nineteen out of the 32 water utilities have utilized water quality dataset obtained by OWQMs for predicting residual chlorine/bromate concentration, and for determining injection ratio of chemical coagulant and powdered activate carbon. Further OWQM installation and data utilization would be the key to strengthen the basis of water supply systems in Japan.

With the recent shift in community pharmacist services toward in-person services and the growing need for centralized and continuous medication management/monitoring, pharmacist–patient information sharing is crucial. This study investigated the pharmacist–patient gap in the recognition of pharmacists' behaviors regarding information sharing and assessed the potential impact of such recognition on patient trust and willingness to self-disclose. This cross-sectional study included 600 patients (aged 21–85 years) using pharmacy services (surveyed online in December 2020) and 591 community pharmacists with ≥1 year of experience (surveyed from September to November 2021). Both groups responded to items on the recognition of pharmacists' behaviors regarding information sharing. There were patient-specific items on trust in community pharmacists and willingness to self-disclose. For all items on the recognition of pharmacists' behaviors, patients' scores were significantly lower (4–5) than pharmacists' own scores (≥5), revealing a notable perception gap. Patients' recognition had a positive, direct effect on trust and willingness, and trust had a positive, direct effect on willingness. Patients' recognition and trust positively influenced their willingness to self-disclose. Pharmacist communication with clear intent is important to bridge the gaps in pharmacist–patient recognition and foster effective patient–pharmacist relationships. [ABSTRACT FROM AUTHOR]

Abstract Purpose To define the median endometrial thickness (ET) in office gynecology is thought to be important for clinical practice. However, there are few reports about ET that have included the general female population on a large scale. The median ET was determined prospectively in premenopausal women who attended office gynecology for cervical cancer screening. Methods In total, 849 women were enrolled. The median ET was determined by using transvaginal ultrasound and the relationships between the ET and various clinical factors were analyzed. Results The participants' median age was 38.5 years. The median ET was 8.6 mm (90% and 95% quantiles: 13.8 and 15.8 mm). The ET was not related to their age, symptoms, obstetric history, geographical location, or risk factors for endometrial cancer. In the women with a menstrual cycle length of 28–30 days, the ET was 7 mm on days 1–6, but it increased from 5.4 mm immediately after menstruation (day 7 or 8) to 9.2 mm on days 13–14. Subsequently, the ET increased further to 11.1 mm on day 18. Conclusion In all the women, the upper limit of the ET was 13.8 mm and 15.8 mm in the 90% and 95% quantile, respectively, in office gynecology.

Osamu Kano,1 Yoshihisa Urita,2 Hirono Ito,1 Takanori Takazawa,1 Yuji Kawase,1 Kiyoko Murata,1 Takehisa Hirayama,1 Ken Miura,1 Yuichi Ishikawa,1 Tetsuhito Kiyozuka,3 Jo Aoyagi,3 Yasuo Iwasaki11Department of Neurology, 2Department of General Medicine and Emergency Care, Toho University Omori Medical Center, Tokyo, Japan; 3Department of Neurology, Federation of National Public Service Personnel Mutual Aid Associations, Mishuku Hospital, Tokyo, JapanObjective: While acetylcholinesterase inhibitors, such as donepezil, galantamine, and rivastigmine, are beneficial in treating behavioral symptoms of patients with Alzheimer's disease (AD), their dose-limiting effects include gastrointestinal disturbances, such as nausea, vomiting, and diarrhea. We aimed to predict the occurrence of these gastrointestinal disturbances with rivastigmine therapy for optimal drug choice and improved compliance.Materials and methods: Thirty patients with mild-to-moderate AD (scores 10–22 on the Mini-Mental State Examination) were administered a rivastigmine 18 mg patch with domperidone 30 mg (RWD) and without domperidone (RWOD; n = 15 each) for 20 weeks. Gastrointestinal disturbances were evaluated using a frequency scale for symptoms of gastroesophageal reflux disease (FSSG), Bristol stool form scale, laboratory data (hemoglobin, albumin, total cholesterol), body weight, and amount of food intake.Results: After 12 weeks, FSSG scores were higher in the RWOD group compared to baseline scores; however, no significant differences were noted between the RWD and RWOD groups. We then subdivided each group based on high and low baseline scores; the RWOD high-score (≥4) subgroup showed increased FSSG after 12 weeks compared with the baseline score. In both RWD and RWOD groups, the low-score (≤3) subgroups showed no changes during the dose-escalation phase.Conclusion: For AD patients with higher FSSG scores at baseline, domperidone was effective in preventing rivastigmine-related gastrointestinal disturbances.Keywords: Alzheimer's disease, acetylcholinesterase inhibitors, domperidone, gastroesophageal reflux disease, gastrointestinal disturbance, rivastigmine

Osamu Kano,1 Hirono Ito,1 Takanori Takazawa,1 Yuji Kawase,1 Kiyoko Murata,1 Konosuke Iwamoto,1 Tetsuro Nagaoka,1 Takehisa Hirayama,1 Ken Miura,1 Riya Nagata,1 Tetsuhito Kiyozuka,2 Jo Aoyagi,2 Ryuta Sato,2 Teruo Eguchi,3 Ken Ikeda,1 Yasuo Iwasaki11Department of Neurology, Toho University Omori Medical Center, 2Department of Neurology, Federation of National Public Service Personnel Mutual Aid Associations Mishuku Hospital, 3Sakura-kai Medical Group, Tokyo, JapanAbstract: Clinical trials have shown the benefits of acetylcholinesterase inhibitors, such as donepezil and galantamine, and an N-methyl-d-aspartate receptor antagonist, memantine, in patients with Alzheimer’s disease (AD). However, little is known regarding the effects of switching from donepezil 5 mg/day to galantamine 16 or 24 mg/day, or regarding the effects of adding memantine to established therapy compared with increasing the dose of donepezil. This report discusses two studies conducted to evaluate treatment with galantamine and memantine with respect to cognitive benefits and caregiver evaluations in patients with AD receiving donepezil 5 mg/day for more than 6 months. Patients with mild or moderate AD (scores 10–22 on the Mini-Mental State Examination) were enrolled in the Galantamine Switch study and switched to galantamine (maximum doses 16 mg versus 24 mg). Patients with moderate to severe AD (Mini-Mental State Examination scores 3–14) were enrolled in the Donepezil Increase versus Additional Memantine study and either had their donepezil dose increased to 10 mg/day or memantine 20 mg/day added to their existing donepezil dose. Patients received the study treatment for 28 weeks and their Disability Assessment for Dementia, Mental Function Impairment Scale, Cohen-Mansfield Agitation Inventory, and Neuropsychiatric Inventory scores were assessed with assistance from their caregivers. For the Galantamine Switch study after 8 weeks, agitation evaluated by the Cohen-Mansfield Agitation Inventory improved in both the 16 mg and 24 mg groups compared with baseline. However, there were no significant differences between the two galantamine groups. Agitation was also less in patients in the additional memantine group than in the donepezil increase group. In summary, switching to galantamine from donepezil and addition of memantine in patients with AD receiving donepezil were both safe and meaningful treatment options, and particularly efficacious for suppression of agitation.Keywords: Alzheimer’s disease, galantamine, memantine, donepezil, agitation, acetylcholinesterase inhibitors

Osamu Kano1,2, Ken Ikeda2, Tetsuhito Kiyozuka2, Konosuke Iwamoto2, Hirono Ito2, Yuji Kawase2, Ryuta Sato2, Toshiki Fujioka2, Yo Araki2, Shigeji Baba2, Yasuo Iwasaki21Department of Neurology, Methodist Neurological Institute, Houston, TX, USA; 2Department of Neurology, Toho University Omori Medical Center, Tokyo, JapanAbstract: We examined whether pramipexole (PPX) can influence depressive scale in normal and mild depressive parkinsonian patients. In an open study of PPX as an add-on to L-dopa therapy or single administration, 36 nondemented outpatients with Parkinson’s disease (PD) were entered first. All were in the stage II or III of Hoehn and Yahr scale (H&Y). PPX were started at 0.125 mg/day and daily doses were increased to 1.5 mg/day. At 3 months after PPX treatment, patients were re-evaluated. Hamilton Depression Rating Scale (HAM-D), Unified Parkinson’s Disease Rating Scale III, H&Y stage, and freezing of gait questionnaire were compared in patients before and after PPX treatment. These scores were significantly improved after PPX administration. There were no correlations between HAM-D and those motor functions. We suggest that PPX treatment has antidepressant effects in depressive PD patients and also ameliorates HAM-D score in nondepressive PD patients in addition to motor function.Keywords: Parkinson disease, pramipexole, motor function, depression, antidepressant effect

Objective: Acne vulgaris is caused by dyslipidemia, dyskeratosis and/or abnormal bacterial growth. The obstruction of skin pores due to hyperkeratosis of the infundibulum contributes to the formation of comedones. Thus, normalizing keratinization of epidermal cells in skin pores might be useful to improve acne. Recently, it has been found that the transcutaneous application of carbon dioxide (CO2) regulates imbalances of the desquamatory process. In this study, we evaluated the efficacy of a skin lotion containing CO2 on mild acne. Methods: Twenty‐four healthy Japanese males (20–29 years old) with mild acne attended this evaluation. The subjects were divided into 2 groups, one group used a skin lotion containing CO2 and the other group used a skin lotion without CO2. Following facial washing, each subject topically applied the skin lotion with or without CO2 twice a day for 4 weeks. Prior to the start of the evaluation (week 0) and following 2 and 4 weeks of treatment, acne symptoms were assessed by a dermatologist and by instrumental measurements. Results: Topical application of the skin lotion with CO2 for 4 weeks significantly improved acne symptoms, which was recognized by the subjects. However, treatment with the skin lotion without CO2 did not improve acne symptoms. This improvement of acne symptoms by CO2 was not accompanied by changes in sebum levels, skin surface pH, skin capacitance, or porphyrin levels. Conclusion: The transcutaneous application of a lotion with CO2 improves acne symptoms by normalizing keratinization without affecting skin surface conditions. [ABSTRACT FROM AUTHOR]