Verification of reliability and validity of a face scale for pain assessment of preterm infants (FSPAPI) <Original Articles>

本研究の目的は, 上部顔面運動の三次元行動解析により, 臨床で活用しやすい早産児の痛みのアセスメント・ツールとして開発したフェース・スケール(FSPAPI)の信頼性と妥当性を検証することである. 調査は, III次レベルのNICUにおいて16名の早産児に実施された61の処置場面(採血, 皮下注射, 栄養チューブ交換, 電極除去)について, 34名の看護師の観察によって行った. 評定者間信頼性はベッドサイドでの看護師間の観察結果の一致度を, 評定者内信頼性はベッドサイドの観察と同じ場面のビデオ録画との一致度を分析した. 妥当性については, PIPPによる併存妥当性を分析した. 評定者間信頼性について, 一致度は0.809(信頼できる一致度), κ係数は0.707(p<0.001)で「かなりの一致」を得ることができ, FSPAPIの同等性を確認できた. 評定者内信頼性については, 一致度は評定者間よりも低値で0.761と「満足できる一致度」ではなかったが, κ係数は0.626(p<0.001)であり, 「かなりの一致」を得ることができた. FSPAPIで重要となる皺形成の判断は, ベッドサイドで直接観察するよりもビデオ画像のほうが難しく, そのため評定者内一致度は低く出ることが予想されていたが, 本研究ではかなりの一致を得ることができ, FSPAPIの安定性が得られたものと考える. 併存妥当性については, FSPAPIレベルとPIPPスコアの相関係数(ρ)は0.766(p<0.001)であり, 両者間に強い相関を確認することができた. 以上から, FSPAPIはPIPPよりも少ない項目, すなわち上部顔面表情のみを用いて, 早産児に実施されるベッドサイド処置に伴う痛みのアセスメントに使用できると考えられる.The purpose of this study is to examine reliability and validity of the face scale for pain assessment of preterm infants developed by the applicant based on quantification of facial motions by 3-D behavioral analysis in order to facilitate pain assessment of preterm infants in clinical settings. The investigation was conducted at three tertiary-level NICU facilities, with 61 recorded images of scenes from 16 preterm infants and observational data of 34 nurses. As for intra-evaluator reliability, agreement was 0.761, k coefficient 0.626 (pretty much agree), whereas for inter-evaluator reliability, agreement was 0.809 (agreement with reliability) and k coefficient 0.707 (pretty much agree). Dependence validity was compared with PIPP and was strongly correlated, with correlation coefficient (p) of 0.766 (p<0.001). The reason why intra-evaluator reliability was lower than inter-evaluator reliability, which was high, was considered to be because of the poor quality of recorded images which were used for reproducing the scenes, due to low intensity of illumination at NICU. However, because of the good inter-evaluator reliability and good correlation with PIPP used for research, the scale developed by the applicant was considered to be convenient in clinical settings

The Diagnostic Value of the Interstitial Biomarkers KL-6 and SP-D for the Degree of Fibrosis in Combined Pulmonary Fibrosis and Emphysema

The combined pulmonary fibrosis and emphysema (CPFE) was reported first in 1990, but it has been comparatively underestimated until recently. Although the diagnostic findings of both emphysematous and fibrotic regions are detectable by high-resolution computed tomography (HRCT) of the chest, the degree of progressive fibrosis, which increases with emphysematous lesions, is difficult to evaluate. In this study, we hypothesized that the biomarkers for pulmonary fibrosis, surfactant protein D (SP-D), and KL-6 would serve as good indicators of fibrotic lesions in CPFE. We recruited 46 patients who had been diagnosed in our hospital with both emphysema and fibrosis by their CT scan image from April 2003 to March 2008. The correlation among their pulmonary function tests, composite physiologic index (CPI), and the serum levels of SP-D and KL-6 was evaluated. We found a correlation between KL-6 and %VC, %TLC, or CPI and between SP-D and %VC or CPI. Interestingly, the combined product of KL-6 and SP-D (KL-6xSP-D) was found to highly correlate with %VC and %TLC or CPI. These results show that both KL-6 and SP-D, and especially the product of SP-D and KL-6, are good indicators of the presence of fibrotic lesions in the lungs of CPFE patients

A water channel closely related to rat brain aquaporin 4 is expressed in acid- and pepsinogen-secretory cells of human stomach

AbstractWe isolated a cDNA clone encoding a water channel protein, aquaporin (AQP), from human stomach. The encoded protein consisted of 323 amino acid residues, containing six putative transmembrane domains. The protein was designated human aquaporin 4 (hAQP4) because of its 94% sequence similarity to rat brain AQP4. Expression of hAQP4 cRNA in Xenopus oocytes resulted in a significant increase in osmotic water permeability, indicating that this protein functions as a water channel. Northern blot analysis demonstrated a strong signal of hAQP4 mRNA in brain, lung, and skeletal muscle as well as in stomach. Immunohistochemical experiments with human stomach tissues showed that hAQP4 as a protein is expressed mainly in cells located in the glandular portion of the fundic mucosa. These include chief cells which secrete pepsinogen and parietal cells which secrete hydrochloric acid. These results strongly indicate that hAQP4 is a principal factor involved in the osmotic regulation of pepsinogen and acid secretion in the stomach

Endoscopic therapy using an endoscopic variceal ligation for minute cancer of the esophagogastric junction complicated with esophageal varices: a case report

<p>Abstract</p> <p>Introduction</p> <p>Standard endoscopic mucosal resection or endoscopic submucosal dissection is a procedure for patients with minute cancers, complicated with esophageal varices that puts them at high risk of bleeding.</p> <p>Case presentation</p> <p>We present the case of a 77-year-old Japanese man with alcoholic cirrhosis who underwent a routine endoscopy examination as a screening procedure for esophageal varices and was incidentally diagnosed as having minute cancer of the esophagogastric junction with esophageal varices. Endoscopic ultrasonography findings suggested that the minute cancer was a non-invasive carcinoma (carcinoma <it>in situ</it>) and a 2 mm in diameter blood vessel, feeding the esophageal varices, pierced the lesion. Following the examination, we carried out endoscopic treatment of the minute cancer and esophageal varices. Endoscopic variceal ligation was performed using a pneumo-activated device (Sumitomo Bakelite, Tokyo, Japan). Two years after the treatment, during the follow-up endoscopic examination on the patient, recurrence of carcinoma was not detected endoscopically or histologically.</p> <p>Conclusion</p> <p>Endoscopic therapy using an endoscopic variceal ligation device for minute cancer of the esophagogastric junction, complicated with esophageal varices, may be an acceptable and easily applicable method.</p

Purified F-ATP synthase forms a Ca2+-dependent high-conductance channel matching the mitochondrial permeability transition pore

The molecular identity of the mitochondrial megachannel (MMC)/permeability transition pore (PTP), a key effector of cell death, remains controversial. By combining highly purified, fully active bovine F-ATP synthase with preformed liposomes we show that Ca2+ dissipates the H+ gradient generated by ATP hydrolysis. After incorporation of the same preparation into planar lipid bilayers Ca2+ elicits currents matching those of the MMC/PTP. Currents were fully reversible, were stabilized by benzodiazepine 423, a ligand of the OSCP subunit of F-ATP synthase that activates the MMC/PTP, and were inhibited by Mg2+ and adenine nucleotides, which also inhibit the PTP. Channel activity was insensitive to inhibitors of the adenine nucleotide translocase (ANT) and of the voltage-dependent anion channel (VDAC). Native gel-purified oligomers and dimers, but not monomers, gave rise to channel activity. These findings resolve the long-standing mystery of the MMC/PTP and demonstrate that Ca2+ can transform the energy-conserving F-ATP synthase into an energy-dissipating device

死別体験における悲嘆の回復過程に関する要因の分析

スマトラ沖大地震・インド洋津波によって，突然肉親と死別体験をもった２遺族に面接調査を行った．死別による悲嘆から回復する過程に，どのような要因が関連しているのかについて分析した．その結果，この地域が敬虔な仏教徒であったことから，対象となった２遺族は，信仰が悲しみを緩和する要因として働いていた．さらに近隣の人びとの精神的な支援や，新たな生命の誕生は将来への希望につながり，悲嘆から回復する要因の一つとなっていることが明らかとなった．Two families that experienced the sudden death of relatives in the Sumatra earthquake and Indian Ocean tsunami were interviewed, and the kinds of factors in the process of healing that sadness were analysed. As a result, it was discovered that, given the devoutly Buddhist nature of the area, the two families’ faith worked to relieve their sadness. There was also psychological support from neighbours and hope for the future embodied in the birth of children, which were also factors in healing their sadness