The thermal resistance of fermenting microbes is a key characteristic of stable fermentation at high temperatures. Therefore, the effects of various metal ions on the growth of Zymomonas mobilis TISTR 548, a thermotolerant ethanologenic bacterium, at a critical high temperature (CHT) were examined. Addition of Mg 2+ and K + increased CHT by 1 • C, but the effects of the addition of Mn 2+ , Ni 2+ , Co 2+ , Al 3+ , Fe 3+ , and Zn 2+ on CHT were negligible. To understand the physiological functions associated with the addition of Mg 2+ or K + , cell morphology, intracellular reactive oxygen species (ROS) level, and ethanol productivity were investigated at 39 • C (i.e., above CHT). Cell elongation was repressed by Mg 2+ , but not by K + . Addition of both metals reduced intracellular ROS level, with only K + showing the highest reduction strength, followed by both metals and only Mg 2+ . Additionally, ethanol productivity was recovered with the addition of both metals. Moreover, the addition of Mg 2+ or K + at a non-permissive temperature in 26 thermosensitive, single gene-disrupted mutants of Z. mobilis TISTR 548 revealed that several mutants showed metal ion-specific growth improvement. Remarkably, K + repressed growth of two mutants. These results suggest that K + and Mg 2+ enhance cell growth at CHT via different mechanisms, which involve the maintenance of low intracellular ROS levels.

Polymyalgia rheumatica (PMR) is a disease commonly seen in elderly individuals, however, the etiology has not been reported. Typical clinical features include bilateral shoulder pain and morning stiffness, while serologic autoantibody test findings are negative. Approximately 40%–50% of affected patients present with low-grade fever, fatigue, and appetite loss, which we often experience in the field of general medicine, and thus, the condition should not be given low priority. However, knowledge regarding such constitutional manifestations is also limited. We encountered an elderly woman with a fever of unknown origin that developed following a parathyroidectomy for a single parathyroid adenoma, after which severe shoulder pain and morning stiffness emerged, leading to a diagnosis of PMR. The fever developed several days prior to appearance of severe pain, which is an uncommon presentation in PMR cases. Our patient had low-grade inflammation without pyrexia prior to the surgery, which might have been an important reason for the accelerated immoderate immune activation leading to PMR induced by surgery in this case. Furthermore, she was infected with the influenza A virus 3 weeks before coming to us. Some reports have suggested a relationship between the influenza virus or vaccine and PMR. It is difficult to conclude regarding the definite trigger in our patient, though the details of this case should be helpful for a better understanding of the disease.

End-of-life discussions are essential for patients with advanced cancer, but there is little evidence about whether these discussions affect general ward patients and family outcomes. We investigated the status of end-of-life discussions and associated factors and their effects on patients’ quality of death and their families’ mental health. Participants in this retrospective cross-sectional observational study were 119 bereaved family members. Data were collected through a survey that included questions on the timing of end-of-life discussions, quality of palliative care, quality of patient death, and depression and grief felt by the families. Approximately 64% of the bereaved family members participated in end-of-life discussions between the patient and the attending physician, and 55% of these discussions took place within a month before death. End-of-life discussions were associated with the patients’ prognostic perception as “incurable, though there is hope for a cure” and “patients’ experience with end-of-life discussions with family before cancer.” There was a small decrease in depression and grief for families of patients who had end-of-life discussions. Those who did not have end-of-life discussions reported lower quality of end-of-life care.