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CSRP-TKAにおける術後屈曲可動域に対する影響について
Get PDFBackground: Various factors affect the improvement of range of motion (ROM) after total knee arthroplasty (TKA). However, there are few reports specific to cruciate-sacrificing rotating platform (CSRP) TKA. In this study, factors affecting postoperative ROM improvement of CSRP TKA were investigated. Methods: The study included 79 patients with knee osteoarthritis who underwent unilateral CSRP TKA at our institution. The group with an improvement of 5° or more (Δflexion angle) than the preoperative was defined as the good Δflexion group (38 knees), and that with less than 5° was defined as the poor Δflexion group (41 knees). The assessments were performed one day before and one year after surgery. Factors including rest and walking pain, knee flexion and extension angle, isometric knee extension strength, the five subscales of Knee injury and Osteoarthritis Outcome Score (KOOS), α, β, γ and δ angles, femoro-tibial angle (FTA), and condylar twist angle were assessed. Unpaired t-test, Mann-Whitney U test, and Chi-square test were used to test differences between the good and poor Δflexion groups. Multiple logistic regression examined the association between each factor and the dependent variables (good Δflexion or poor Δflexion). Results: Significant differences in the preoperative knee flexion, postoperative knee flexion, preoperative knee extension, and postoperative knee extension angles, postoperative KOOS pain and activity of daily living, β, ɤ angles were observed between the good and poor Δflexion groups. The model Chi-squared test revealed that the ɤ angle was significantly affected by the Δflexion angle. Conclusions: With the CSRP TKA, flexion insertion of the femoral component was associated with postoperative flexion ROM improvement.権利情報：© Copyright 2024. Matsuoka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
スルフォラファンは HDAC 活性阻害を介してゲムシタビンの肝内胆管癌に対する抗癌効果を増強させる
Get PDFIntrahepatic cholangiocarcinoma (iCCA), the second most common primary liver cancer, has high mortality rates because of its limited treatment options and acquired resistance to chemotherapy. Sulforaphane (SFN), a naturally occurring organosulfur compound found in cruciferous vegetables, exhibits multiple therapeutic properties, such as histone deacetylase (HDAC) inhibition and anti-cancer effects. This study assessed the effects of the combination of SFN and gemcitabine (GEM) on human iCCA cell growth. HuCCT-1 and HuH28 cells, representing moderately differentiated and undifferentiated iCCA, respectively, were treated with SFN and/or GEM. SFN concentration dependently reduced total HDAC activity and promoted total histone H3 acetylation in both iCCA cell lines. SFN synergistically augmented the GEM-mediated attenuation of cell viability and proliferation by inducing G2/M cell cycle arrest and apoptosis in both cell lines, as indicated by the cleavage of caspase-3. SFN also inhibited cancer cell invasion and decreased the expression of pro-angiogenic markers (VEGFA, VEGFR2, HIF-1α, and eNOS) in both iCCA cell lines. Notably, SFN effectively inhibited the GEM-mediated induction of epithelial-mesenchymal transition (EMT). A xenograft assay demonstrated that SFN and GEM substantially attenuated human iCCA cell-derived tumor growth with decreased Ki67+ proliferative cells and increased TUNEL+ apoptotic cells. The anti-cancer effects of every single agent were markedly augmented by concomitant use. Consistent with the results of in vitro cell cycle analysis, G2/M arrest was indicated by increased p21 and p-Chk2 expression and decreased p-Cdc25C expression in the tumors of SFN- and GEM-treated mice. Moreover, treatment with SFN inhibited CD34-positive neovascularization with decreased VEGF expression and GEM-induced EMT in iCCA-derived xenografted tumors. In conclusion, these results suggest that combination therapy with SFN with GEM is a potential novel option for iCCA treatment.権利情報：© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)
LD/Hb比をPLASMICスコアと一緒に使用することで、破砕赤血球の識別なしにTTPと敗血症性DICの区別が容易になる
Get PDFIn some cases, differentiating thrombotic thrombocytopenic purpura (TTP) from septic disseminated intravascular coagulation (DIC) without measuring ADAMTS13 activity is critical for urgent lifesaving plasma exchange. To investigate whether PLASMIC score without identifying the presence of schistocytes, D-dimer, fibrin/fibrinogen degradation products (FDP), FDP/D-dimer ratio, prothrombin time-international normalized ratio (PT-INR), lactate dehydrogenase (LD), hemoglobin (Hb), and LD/Hb ratio are useful in differentiating patients with TTP from those with septic DIC. Retrospective analysis was conducted on the medical records of the patients with septic DIC (32 patients) or TTP (16 patients). The PLASMIC score and other laboratory measurements all were helpful in differentiating TTP from septic DIC. When dichotomized between high risk (scores 6-7) and intermediate-low risk (scores 0-5), the PLASMIC score predicted TTP with a sensitivity of 75.0% and a specificity of 100%. However, 4 of 16 patients with TTP and 19 of 32 patients with septic DIC showed comparable PLASMIC scores of 4 or 5, making it difficult to distinguish between the two by PLASMIC score alone. Among the measurements examined, the LDH/Hb ratio was the most useful for differentiation. Receiver operating characteristic analysis of the LD/Hb ratio for predicting TTP revealed a cutoff of 53.7 (IU/10 g) (sensitivity 0.94, specificity 0.91). If the LD/Hb ratio was less than 53.7, it was unlikely that the patient had TTP. A combination of the LD/Hb ratio and the PLASMIC score may be useful for distinguishing between TTP and DIC and identifying patients who need rapid plasma exchange or caplacizumab administration.権利情報：Nishimura N, et al. The Combination of the Lactate Dehydrogenase/Hemoglobin Ratio with the PLASMIC Score Facilitates Differentiation of TTP from Septic DIC Without Identification of Schistocytes. Clinical and Applied Thrombosis-Hemostasis. 2023. 29:10760296231207629. Copyright © The Author(s) 2023. doi: 10.1177/1076029623120762
Issues of Pregnant Women and Mothers with Mental Disorders and Support from Midwives
Get PDF精神障害のある特定妊婦を訪問し支援を行う助産師が捉えた特定妊婦の問題と助産師による支援の現状を明らかにすることを目的に，特定妊婦を訪問する助産師10名に半構成的面接を行った。
質的データより訪問する助産師が捉えた精神障害のある特定妊婦の問題と訪問助産師の支援を抽出し， SCATによる分析を行った。分析事例は10例であった。精神障害のある特定妊婦は，心身症状の管理困難，子どもの生命を守る育児力不足，意思疎通困難，育児環境の整備困難支援的な家族の欠如，就労困難による経済的困窮の問題がみられた。これらの問題に対し助産師は，特定妊婦の精神症状に対応した支援的関係の構築に努め，母体の健康安定支援，子どもの安全な成長発育支援，家族のサポートカのエンパワメントを行っていた。一方で精神障害の特性によるコミュニケーション困難，多職種連携の非構築を感じていた。支援する上では，精神症状を理解した対応スキルの向上，多職種連携における支援目的の共有と連携の見直しが必要である。This study aimed to identify the problems of pregnant women and mothers with mental disorder and the social support they receive from midwives. Semistructured interviews of 10 midwives who visited pregnant women and mothers with mental disorders were conducted.
The Steps for Coding and Theorization method was used to analyze the qualitative date obtained after identifying the problems faced by pregnant women and mothers with mental disorders and the social support provided to them. The problems faced by pregnant women with mental disorders include difficulty in managing physical and mental health, communication disorder, lack of parenting skills to protect their children's lives, difficulty in creating and environment suitable for childcare, lack of family support, and financial instability caused by inability to work.
The midwives established a relationship with the mothers based on their psychiatric symptoms and provided support to help them maintain a good physical and mental state of mind. They also assessed the child's safety and development and provided parenting guidance to the family.
While providing support, the midwives found it difficult to cope with the mothers' psychiatric symptoms and collaborate with various professions. In providing support, it is necessary to improve understanding of psychiatric symptoms and response skills, and to share the purpose of support and review collaboration in multidisciplinary cooperation
うつ症状が室温低値と血圧高値の関連に及ぼす影響
Get PDFObjectives: Cold exposure accounts for more than 7% of all-cause mortality worldwide, and cold-induced blood pressure (BP) elevation and consequent cardiovascular events are partially responsible. For prevention, it is important to identify risk factors for exaggerated temperature-sensitivity of BP but this is not fully understood. This study investigated whether depressive symptoms affect the relationship between indoor temperature and BP.
Methods: We conducted a cross-sectional analysis of 1076 community-based individuals who were at least 60 years of age. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale at a cutoff point of 4/5. We performed ambulatory BP monitoring and indoor temperature measurement on two consecutive days during the cold season in Nara, Japan.
Results: When using daytime SBP as a dependent variable, multilevel linear regression analyses showed that lower daytime indoor temperature was significantly associated with higher daytime SBP in the depressive group (n = 216, β = -0.804, P < 0.001) but not in the nondepressive group (n = 860, β = -0.173, P = 0.120); moreover, a significant interaction between depression and daytime indoor temperature was observed (P = 0.014). These relationships were independent of potential confounders including age, gender, BMI, medications, and physical activity. Similar results were obtained for morning SBP, nocturnal SBP dipping, and morning BP surge.
Conclusion: The results suggest that depressive participants are more likely to have cold-induced BP elevation than nondepressive participants. Further longitudinal studies are warranted to determine whether people with depressive symptoms are at a high risk for cold-related cardiovascular events.博士（医学）・甲第859号・令和5年3月15日© 2022 Wolters Kluwer Health, Inc. All rights reserved.
This is a non-final version of an article published in final form in Okumura, Kazuki et al. Influence of depression on the association between colder indoor temperature and higher blood pressure. Journal of Hypertension. 2022, 40(10), p.2013-2021, doi: 10.1097/HJH.0000000000003221
リファキシミンは腸-肝臓-筋肉軸の調節により肝硬変ラットの骨格筋萎縮に対するL-カルニチンを介した予防効果を増強する
Get PDFThe gut‑liver‑muscle axis is associated with the
development of sarcopenia in liver cirrhosis. The present
study aimed to illustrate the combined effects of rifaximin
and L‑carnitine on skeletal muscle atrophy in cirrhotic rats
with steatohepatitis. For this purpose, a total of 344 Fischer
rats were fed a choline‑deficient L‑amino acid‑defined
(CD AA) diet with the daily oral administration of rifaximin
(100 mg/kg) and/or L‑carnitine (200 mg/kg), and measurements
of psoas muscle mass index and forelimb grip strength
were performed. After feeding for 12 weeks, blood samples,
and liver, ileum and gastrocnemius muscle tissues were
harvested. The effects of L‑carnitine on rat myocytes were
assessed using in vitro assays. Treatment with rifaximin
attenuated hyperammonemia and liver fibrosis in the
CD AA‑fed rats. Moreover, it improved intestinal permeability
with the restoration of tight junction proteins and
suppressed the lipopolysaccharide (LPS)‑mediated hepatic
macrophage activation and pro‑inflammatory response. In
addition, rifaximin prevented skeletal muscle mass atrophy
and weakness by decreasing intramuscular myostatin and
pro‑inflammatory cytokine levels. Moreover, rifaximin
synergistically enhanced the L‑carnitine‑mediated improvement
of skeletal muscle wasting by promoting the production
of insulin‑like growth factor‑1 and mitochondrial biogenesis,
resulting in the inhibition of the ubiquitin‑proteasome system
(UPS). The in vitro assays revealed that L‑carnitine directly
attenuated the impairment of mitochondrial biogenesis,
thereby inhibiting the UPS in rat myocytes that were stimulated
with LPS or tumor necrosis factor‑α. On the whole, the
present study demonstrates that the combination of rifaximin
with L‑carnitine may provide a clinical benefit for liver
cirrhosis‑related sarcopenia.博士（医学）・甲第863号・令和5年3月15日© Murata et al.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License