The role of perforant pathway-dentate granule cell synapses in cognitive behavior was examined focusing on synaptic Zn(2+) signaling in the dentate gyrus. Object recognition memory was transiently impaired when extracellular Zn(2+) levels were decreased by injection of clioquinol and N,N,N',N'-tetrakis-(2-pyridylmethyl) ethylendediamine. To pursue the effect of the loss and/or blockade of Zn(2+) signaling in dentate granule cells, ZnAF-2DA (100 pmol, 0.1 mM/1 µl), an intracellular Zn(2+) chelator, was locally injected into the dentate molecular layer of rats. ZnAF-2DA injection, which was estimated to chelate intracellular Zn(2+) signaling only in the dentate gyrus, affected object recognition memory 1 h after training without affecting intracellular Ca(2+) signaling in the dentate molecular layer. In vivo dentate gyrus long-term potentiation (LTP) was affected under the local perfusion of the recording region (the dentate granule cell layer) with 0.1 mM ZnAF-2DA, but not with 1-10 mM CaEDTA, an extracellular Zn(2+) chelator, suggesting that the blockade of intracellular Zn(2+) signaling in dentate granule cells affects dentate gyrus LTP. The present study demonstrates that intracellular Zn(2+) signaling in the dentate gyrus is required for object recognition memory, probably via dentate gyrus LTP expression.

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Many studies have analyzed the effects of clinical pathways, but most have considered only single diseases. The purpose of the present study was to exploratively analyze electronic medical records related to the use of clinical pathways, seeking trends that could usefully benefit clinical activity. From the data warehouse of University of Miyazaki Hospital, collected from April 2014 to March 2016, we retrospectively identified 6523 patients for whom a clinical pathway was applied. Other inclusion criteria were single hospitalization, the type of medical fee was comprehensive, and data were available so that all clinical indicators could be calculated. Two types of deviation from the clinical pathway were defined: cancellation (described in the clinical pathway but not implemented) and addition (not described in the clinical pathway but nevertheless implemented). If the code of International Classification of Diseases describing the clinical pathway differed from that describing where the medical resource was mostly spent, we considered this as indicating a complication. We compared principal clinical indicators (length of hospital stay, mortality rate, and comprehensive-volume ratio) by completion rate for the clinical pathway. Regardless of whether patients had complications, completing the clinical pathway was associated with a significant reduction in length of hospital stay. This finding indicated that length of hospital stay could be shortened if all medical treatments described in the clinical pathway were implemented. Our results demonstrated that it is possible to shorten the length of hospital stay by improving clinical pathways to include medical treatment for preventing complications.

We have previously demonstrated that clinical pathway completion helps reduce hospital stays. However, our previous results showed only a correlation, not causation. Therefore, the current study's aim was to analyze the causation between clinical pathway completion and reduced hospital stays for patients with lung cancer. Data were collected from April 2013 to March 2018 from the electronic medical records of the University of Miyazaki Hospital. We used propensity score matching to extract records from 227 patients. Patients were further divided into a pathway completed group and a pathway not completed group; 74 patients in each group were available for data analysis. Our main analysis involved estimating the discharge curve, which was comprised of the in-hospital rate and hospital stay. Additional analyzes were performed to compare the frequency of medical treatments registered in the clinical pathway but not implemented (termed deviated medical treatments). The occurrence of these treatments meant that the clinical pathway was not completed. The main results indicated a decrease in the in-hospital rate of the completion group, compared with the not completed group. The p value of the log-rank test was <0.001 for total patients and patients who underwent resection, and 0.017 for patients who did not undergo resection. Additional results indicated that a number of intravenous drips were not implemented, despite their registration on clinical pathways. Our results indicate that clinical pathway completion contributes to improved efficiency and safety. This simplified procedure is expected to be applicable to other diseases and clinical indicators.