Search

A coronavirus disease 2019 (COVID-19) outbreak in a psychiatry hospital revealed specific challenges in its response such as difficulty in isolation, transfer, and identification of close contacts, suboptimal infection control practices, and shortage of personal protective equipment, which were overcome by support from the public health center and a neighboring university hospital.

We retrospectively examined 106 cases of tapentadol use in Japan in August 2014 for cancer pain at our hospital.The advantage of the opioid medication tapentadol is that its introduction is suitable in patients undergoing anti-cancer treatment because of the low incidence of gastrointestinal symptoms, with glucuronidation involved in the metabolism, and lack of interactions with other drugs.However, depending on the dosage form and presence of swallowing disorders, the administration should be considered carefully.

本研究の目的は、認知症高齢者とのコミュニケーションを課題とした演習で、高齢者役をつとめた模擬患者の演習に向けた準備から実施までの一連の過程における経験の内容を明らかにすることである。研究方法は、演習に参加した模擬患者8名に「看護学生との演習や看護学生へのフィードバックを通して感じたこと、考えたことについて」インタビューからデータを得て質的に分析した。結果、〈認知症を演じる不安を乗り越え、経験と学びを生かして演じる〉、〈将来の自分を思い描く〉、〈看護学生との思いの違いを感じる〉、〈看護学生の不安やあせり、失敗を受容する〉、〈看護学生の気づきを拡げる手助けをする〉の5個のカテゴリーで構成されていた。演習に参加した模擬患者の一連の経験は、模擬患者自身の成長や老いと向き合う機会となっているという自分自身に向けた経験と、若い人々の成長に貢献したいという助言者としての役割を果たすという経験であった。, Patients' experiences were simulated and investigated from preparation to execution during a practical on “communication with elderly people with dementia.” Interviews were conducted with simulated patients (N=8) that were role played by participants in communication training. Interviews were conducted on simulated feelings of patients and thoughts about role playing with nursing students, as well as on providing feedback. The data were analyzed qualitatively. Results indicated the following categories: (1) overcoming anxiety about playing the role of elderly people with dementia and performing based on experience and learning, (2) imagining the future of oneself, (3) differences in thinking between nursing students and simulated patients, (4) accepting nursing students' anxieties, impatience, and failures, and (5) helping nursing students expand their awareness. It was suggested that the experience of being simulated patients' provided the students with opportunities to develop themselves and helped them face the process of their own aging. Furthermore, this experience was educational because it contributed to the development of the students.

Opioid-induced constipation(OIC)occurs with high frequency in patients with cancer undergoing pain treatment using opioids. Osmotic or irritant laxatives are usually used to prevent OIC. Recently, naldemedine has become operational for OIC. Although naldemedine achieved the desired effect, diarrhea is a little feared from the results of clinical phase III study(V9236 clinical trial). We herein report the use of naldemedine to alleviate diarrhea and expect the improvement of the quality of the bowel habits in outpatients with cancer undergoing pain treatment using opioids.

Breakthrough cancer pain is divided into "predictable breakthrough pain" and "unpredictable breakthrough pain". Uncontrolled breakthrough pain in cancer negatively affects the quality of life of the patients. The short-acting opioid(SAO) requires considerable time to produce analgesia, and is not adequate as a rescue drug. The rapid-onset opioid(ROO)immediately produces analgesia, but its appropriate usage is difficult. For instance, the frequency and interval of ROO usage is limited, making the optimization of dosage cumbersome. Therefore, ROO has not yet gained popularity. Here, we report that a combinatorial use of ROO and SAO is effective against breakthrough cancer pain, with SAO and ROO being suitable for "predictable breakthrough pain", and "unpredictable breakthrough pain", respectively. The effectiveness and safety of this combination were assessed for many patients with breakthrough cancer pain.

Background Postprandial elevation of triglycerides impairs endothelial function and contributes to the development of atherosclerosis. We investigated the effects of omega-3 fatty acids on postprandial endothelial function and lipid profiles. Methods Healthy volunteers [10] were given supplementation at 4 g/day omega-3 fatty acids (or were not treated) for 4 weeks in a randomised crossover study. Postprandial levels of various lipids were monitored and endothelial function assessed by brachial artery flow-mediated dilation during fasting and after a standard cookie test. Results Omega-3 fatty acids reduced postprandial endothelial dysfunction compared with the control diet (flow-mediated dilation at 4 h = −0.5 ± 1.2 vs. −2.0 ± 1.6%, P = 0.03). Postprandial levels of triglycerides, apolipoprotein B-48, and remnant lipoprotein-cholesterol increased in untreated subjects, peaked at 2–4 h, and returned to baseline at 8 h, whereas low-density lipoprotein-cholesterol levels did not change. Supplementation with omega-3 fatty acids significantly suppressed postprandial elevation of triglycerides (incremental area under the curve = 220 ± 209 vs. 374 ± 216 mg/h/dL, P = 0.04) and remnant lipoprotein-cholesterol (incremental area under the curve = 21.7 ± 13.8 vs. 13.3 ± 12.9 mg/h/dL, P = 0.04). Supplementation with omega-3 fatty acids significantly suppressed the increase in triglyceride content in chylomicrons as well as in very-low-density lipoproteins from baseline to 4 h after the cookie test. Conclusion Omega-3 fatty acids significantly decreased postprandial triglyceride elevation and postprandial endothelial dysfunction, suggesting that omega-3 fatty acids may have vascular protective effects in postprandial state.

Residual risk of cardiovascular disease from increased small dense low-density lipoprotein (sdLDL)-cholesterol levels and low n-3 polyunsaturated fatty acid (PUFA) levels is a considerable therapeutic issue. The purpose of this study was to evaluate the effect of ezetimibe as an add-on to statins and supplemental eicosapentaenoic acid (EPA) on sdLDL cholesterol and absorption of EPA in patients with coronary artery disease. The study population consisted of ten male patients who were concurrently receiving statins and EPA 1,800 mg/day. Serum lipids and PUFAs, including EPA and arachidonic acid, were measured in blood samples collected before ezetimibe (baseline), 4 weeks after starting 10-mg/day ezetimibe, and 4 weeks after discontinuing ezetimibe. Ezetimibe significantly decreased sdLDL-cholesterol levels after 4 weeks of treatment (baseline 35 ± 13 mg/dl; treatment 27 ± 9 mg/dl), but the levels returned to baseline after discontinuation of ezetimibe (37 ± 13 mg/dl). The concentration of EPA did not significantly change during the study. Ezetimibe shows great promise as an add-on therapy to statins to reduce sdLDL-cholesterol-related residual risk of cardiovascular disease without affecting absorption of supplemental EPA in patients with coronary artery disease.

Background Several lines of evidence suggest that atrial fibrillation (AF) may be a consequence of vascular disease. We investigated the relationship between cardio-ankle vascular index (CAVI), a new index of arterial stiffness, and the presence of paroxysmal AF (PAF). Methods and results 181 outpatients (91 patients with PAF and 90 age- and gender-matched subjects without PAF) were analysed for their sinus rhythm. The CAVI was significantly higher in patients with PAF than in subjects without PAF (9.0±1.0 vs 8.7±0.8, p

高齢者看護学における模擬患者または訓練を受けていない演者(準模擬患者とする)を活用した演習の効果について10件の文献を検討した。結果、両演者の演習の共通点は、リアリティのある演習ができる、高齢者の現実の姿に適合するコミュニケーション技術を獲得するための教育方法になることがわかった。さらに、模擬患者の演習では、症状の表現が難しい認知症事例や、障害をもち生活の不安を抱えた患者を社会背景も含めて演じる事例、継続した患者の過程を再現できる一連の看護過程演習の実施が可能である。加えて、認知症高齢者の世界に寄り添おうとする姿勢を育み、対象を理解する力と個別の援助の工夫と実施ができる効果が得られる。一方準模擬患者の演習は、演者の実年齢が高齢期であれば、自身の体験談を語ることで、身体的機能低下や「死の受容」の発達課題など高齢者の特徴とその人の生き方による個人差があることの理解が深まる。および大勢の演者を準備することが可能であり、その場合は全学生のロールプレイが実施できる。

本研究の目的は、認知症高齢者の模擬患者を導入した高齢者看護学演習での学生の学びを明らかにし、今後の演習プログラム精錬への示唆を得ることである。看護系短期大学に在籍する2年次生から演習終了後、「演習で学んだこと」に対する回答を得た。調査協力が得られた78名の回答を質的に分析した結果、《高齢者と接する私たちの態度》《コミュニケーションの工夫》《道具の活用・環境づくり》《回避的な対話》の4カテゴリーが抽出された。認知症高齢者と接する際の学生自身の態度や、コミュニケーションを行ううえでの具体的な技術にまで考えがおよび自分の学びとしていた。しかし一方で、認知症模擬患者の帰宅願望や不安を回避するような消極的な対応方法を学びとしてしまう可能性がみられたことから、認知症高齢者がもっている本質的な不安にたちかえるといった演習の振り返りを充実させる必要性があることが示唆された。, The purpose of this paper is to sheld light on what students have learned in the nursing seminar for the elderly that uses simulated elderly dementia patients, and to gain pointers on how to refine or improve future seminar programs. After the seminar, the second year students in nursing college were asked to answer the question, "What did you learn in the seminar?" On the basis of the qualitative analysis of the responses from 78 people, I derived the following four categories: 1) "Attitudes of those who are in contact with the elderly," 2)"Communication schemes," 3)"Tool utilization and environment creation," and 4)"Evasive interaction." The categories cover the attitudes of students at the time of contact with elderly dementia patients, as well as their thinking and learning about specific techniques in communication. However, at the same time, it is possible that some students learned about dementia simulated patients, desire to return to their homes and about passive methods for avoiding anxiety. This suggests that a complete review of the seminar is necessary in order to obtain feedback from elderly dementia patients about their inner anxiety.

BACKGROUND No study has investigated whether pioglitazone (an agonist of peroxisome proliferator-activated receptor gamma) protects against ischemia and reperfusion (IR)-induced endothelial dysfunction in humans. METHODS AND RESULTS In the first crossover study, 20 volunteers were randomized to 1 week of pioglitazone (30 mg/d, postoperatively) or control (no treatment). In the second single-arm study, 15 volunteers received pioglitazone and the cyclooxygenase-2 inhibitor meloxicam for 1 week. On day 7, endothelium-dependent flow-mediated dilation (FMD) of the distal brachial artery was measured before and after IR (15 minutes of ischemia followed by 15 minutes of reperfusion in the proximal upper arm). Pre-IR brachial-artery diameter and FMD were similar across the 2 sessions (control, pioglitazone) in protocol 1 and between the 2 protocols. IR significantly blunted FMD after no treatment (pre-IR FMD: 10.2% ± 2.6%; post-IR FMD: 3.5% ± 1.9%, P < 0.01) but not after pioglitazone administration (pre-IR FMD: 9.7% ± 2.5%; post-IR FMD: 8.8% ± 2.9%, P = 0.11). This protective effect was accompanied by an increase in serum levels of the antioxidant enzyme extracellular superoxide dismutase and was not affected by concomitant administration of the cyclooxygenase-2 inhibitor meloxicam (P = 0.10). CONCLUSIONS In humans, pioglitazone provides potent protection against IR-induced endothelial dysfunction.

Background Postprandial elevation of triglyceride-rich lipoproteins impairs endothelial function, which can initiate atherosclerosis. We investigated the effects of bezafibrate on postprandial endothelial dysfunction and lipid profiles in patients with metabolic syndrome. Methods Ten patients with metabolic syndrome were treated with 400 mg/day bezafibrate or untreated for 4 weeks in a randomized crossover study. Brachial artery flow-mediated dilation (FMD) and lipid profiles were assessed during fasting and after consumption of a standardized snack. Serum triglyceride and cholesterol contents of lipoprotein fractions were analyzed by high-performance liquid chromatography. Results Postprandial FMD decreased significantly and reached its lowest value 4 h after the cookie test in both the bezafibrate and control groups, but the relative change in FMD from baseline to minimum in the bezafibrate group was significantly smaller than that in the control group (-29.0 ± 5.9 vs. -42.9 ± 6.2 %, p = 0.04). Bezafibrate significantly suppressed postprandial elevation of triglyceride (incremental area under the curve (AUC): 544 ± 65 vs. 1158 ± 283 mg h/dl, p = 0.02) and remnant lipoprotein cholesterol (incremental AUC: 27.9 ± 3.5 vs. 72.3 ± 14.1 mg h/dl, p

Postprandial hypertriglyceridemia impairs endothelial function and plays an important role in the devel- opment of atherosclerosis. The aim of the present study was to examine the postprandial effects of the dipeptidyl pepti- dase-4 inhibitor vildagliptin and the α-glucosidase inhibitor voglibose on endothelial dysfunction and lipid profiles following a single administration. A randomized cross-over trial using 11 normoglycemic individuals was performed. The postprandial effects of a single administration of vildagliptin (50 mg) or voglibose (0.3 mg) on endothelial function were analyzed using brachial artery flow‑mediated dilation (FMD) and lipid profiles during fasting and 1.5 and 3 h after an oral cookie-loading test. Compared with voglibose, vildagliptin significantl y suppressed postprandial endothelial dysfunction, (%FMD, -1.6±0.9 vildagliptin vs. -4.0±0.7 voglibose; P=0.01) and the postprandial incremental increase in the triglyceride level (28±18 vildagliptin vs. 51±26 mg/dl voglibose; P=0.01) 3 h after a cookie-loading test. In addition, vildagliptin significantly increased the levels of glucagon-like peptide-1 compared with voglibose 3 h after a loading cookie test (4.4±0.6 vs. 2.9±0.7 pmol/l, respectively; P=0.04). No signifi - cant differences in the levels of glucose, apolipoprotein B-48, glucagon or insulin were observed between vildagliptin and voglibose treatments. In conclusion, a single administration of vildagliptin attenuated postprandial endothelial dysfunction and postprandial hypertriglyceridemia, suggesting that vilda- gliptin may be a promising antiatherogenic agent.

Adrenoleukomyeloneuropathy (ALMN) usually occurs in adulthood, it being extremely rare in childhood. We reported a quite atypical clinical case of ALMN as a variant of adrenoleukodystrophy (ALD). The onset was at 5 years 7 months and ataxia was the major symptom. His condition progressed rapidly to a vegetative state within 1 year. At the age of 11 years and 11 months he died of pneumonia and an autopsy was performed. We herein reported the neuropathological findings in this rare case. The autopsy revealed marked atrophy with diffuse demyelination and astrogliosis throughout the cerebrum, cerebellum and brainstem. Massive degeneration of the pyramidal tracts and loss of neurons were also seen in the spinal cord. The adrenal cortex showed marked atrophy with a striated cytoplasm in ballooned cells. These findings include pathological characteristics of both ALD and adrenomyeloneuropathy (AMN), suggesting ALMN. However, diffuse demyelination with gliosis in the cerebrum and cerebellum is quite atypical for ALMN. They might explain his atypical clinical course, especially the early onset of the disease with ataxia and rapid deterioration.

We investigated the prognosis of epilepsy in 54 patients with severe motor and intellectual disabilities syndrome (SMIDS). The prevalence of epilepsy was 75.7% in our institution for SMIDS. We assessed activities of daily living (ADL) of them at the onset of epilepsy and at present, according to the scores in locomotion, language, toileting, dressing and feeding. Among them, patients with uncontrolled epilepsy constituted 40.3%. ADL scores worsened in the uncontrolled group, while they improved in other cases. Early seizure control is very important in SMIDS for improving patients' quality of life.

Background Postprandial hyperlipidemia impairs endothelial function and participates in the development of atherosclerosis. We investigated the postprandial effects of a dipeptidyl peptidase IV inhibitor, alogliptin, on endothelial dysfunction and the lipid profile. Methods A randomized cross-over trial design in 10 healthy volunteers (8 males and 2 females, 35 ± 10 years) was performed. The postprandial effects before and after a 1-week treatment of 25 mg/day alogliptin on endothelial function were assessed with brachial artery flow-mediated dilation (FMD) and changing levels of lipids, apolipoprotein B48 (apoB-48), glucose, glucagon, insulin, and glucagon-like peptide-1 (GLP-1) during fasting and at 2, 4, 6, and 8 h after a standard meal loading test. Results Alogliptin treatment significantly suppressed the postprandial elevation in serum triglyceride (incremental area under the curve [AUC]; 279 ± 31 vs. 182 ± 32 mg h/dl, p = 0.01), apoB-48 (incremental AUC; 15.4 ± 1.7 vs. 11.7 ± 1.1 μg h/ml, p = 0.04), and remnant lipoprotein cholesterol (RLP-C) (incremental AUC: 29.3 ± 3.2 vs. 17.6 ± 3.3 mg h/dl, p = 0.01). GLP-1 secretion was significantly increased after alogliptin treatment. Postprandial endothelial dysfunction (maximum decrease in%FMD, from −4.2 ± 0.5% to −2.6 ± 0.4%, p = 0.03) was significantly associated with the maximum change in apoB-48 (r = −0.46, p = 0.03) and RLP-C (r = −0.45, p = 0.04). Conclusion Alogliptin significantly improved postprandial endothelial dysfunction and postprandial lipemia, suggesting that alogliptin may be a promising anti-atherogenic agent.

当科で経過観察中の131例の重症心身障害 (重障) 児・者のてんかんについて予後を中心に検討を行い, 次の2つの特徴をまとめた。(1) 重障児・者のてんかんの予後においても, 一般のてんかんの予後と同様に思春期前後で発作コントロールの得られる一群がある。(2) 一方, 大部分は発作コントロールが不良である。コントロール良好な群の特徴としては (1) 基礎疾患として, 痙性両麻痺とアテトーゼの型の脳性麻痺が多い。(2) 脳障害の既往のない例が多い。(3) 発作型では全般性強直間代発作が多い。コントロール不良な群の特徴としては (1) 基礎疾患として, 重度痙性四肢麻痺の型の脳性麻痺が多い。(2) 成因として出生時・出生後要因による脳障害を有する例が多い。(3) 発作型では混合型発作, ミオクロニー発作, 脱力発作が多い。(4) てんかん分類では未決定てんかんが多い。

The suppression of alpha-fluoro-beta-alanine (FBAL) formation from 5-fluorouracil (FU) is an important subject in relation to tumor chemotherapy. This is the first comparative study of FU, 1-(2-tetrahydrofuryl)-5-fluorouracil (FT, a prodrug of FU) and of FT+uracil as a coadministration system (UFT) under an oral dose using the in vivo 19F NMR method. The slow release of FU from FT and the suppression of the catabolism of FU to FBAL in mouse livers and tumors by the coadministration of uracil with FT were demonstrated using consecutive NMR measurements. The applicability of the in vivo 19F NMR method to the drug evaluation in tumors and livers of small animals was successfully tested.

In this paper, we discuss transport layer protocols to support real-time data transmission overnetworks using Differentiated Services (Diffserv) where bandwidth is guaranteed. Assuming that an application transmits streaming video data over a Diffserv network, we have performed simulation experiments to evaluate performance of real-time transmission using standard internet protocols, UDP and TCP as a transport layer protocol. The application is designed to buffer a portion of the data on the receiver before starting the playback and to operate in a streaming mode. Consequently, when packets are lost over Diffserv networks, TCP shows better performance than UDP. Simulation results show that employment of SACK option for TCP can recover lost packets efficiently and improve performance of real-time transmission. Currently, a growing number of real-time media applications over Internet are being implemented using UDP, because reliable delivery mechanism of TCP can obstruct real-time data transmission that is timing critical. However, in our experimental environment, retransmission and congestion control mechanism of TCP make use of bandwidth guaranteed by Diffserv, and help to provide more reliable delivery of real-time data than UDP without serious impacts on time-sensitive delivery. Therefore, despite of the general belief that TCP is not suitable for time-sensitive delivery, in our experiment, we show that TCP is a transport layer protocol suitable for real-time data transmission over Diffserv networks.© (2001) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.