Factors related to the uncertainty stroke patients experience during treatment

[Purpose] The purpose of this study was to clarify the factors associated with the uncertainty patients with mild stroke experience regarding their illness. [Method] The participants in the study included stroke patients who had suffered a stroke but were able to communicate without cognitive impairment in an outpatient clinic or who were being hospitalized in a stroke care unit (SCU) or ward. Uncertainty regarding their illness was investigated using the Universal Uncertainty in Illness Scale (UUIS) (26 item, 6 subscale measurement scale, with scores ranging from 26–130) and Health-Related Quality of Life (QOL) SF-8 (8 item, 5–6 level Likert system) questionnaire. Data extracted from medical records included patient age, sex, type of stroke, time since onset, overlapping diseases, presence or absence of recurrent stroke, the National Institutes of Health Stroke Scale (NIHSS), ADL assessments using the Barthel Index (BI), and the presence or absence of family members living in the same house. For the analysis, Spearman rank correlation coefficients were calculated for the correlation between UISS and SF-8 in stroke patients after analyzing basic statistics. Comparisons of UUIS scores based on age, stroke type, BMI, time since onset, stroke severity (NIHSS), and ADL (BI) between the three groups were performed using the Kruskal-Wallis test, and comparisons between the two groups based on sex, the presence or absence of overlapping diseases, the presence or absence of stroke recurrence, the presence or absence of stroke sequelae, and the presence or absence of cohabitating families were performed using the Mann-Whitney test. Subsequently, multiple regressions with UUIS as an independent variable were performed on factors that showed significant differences in order to explore the factors related to UUIS. Approval was obtained from the Institutional Review Board of Tokushima University Hospital (Approval number 3134-1). [Results] Responses were obtained from 146 stroke patients. The mean age was 65.9 years (SD 13.9), 82 were men (56.2%), 64 were women (43.8%), 38 were acute phase patients (26.0%), 39 were recovery phase patients (26.7%) and 69 were maintenance phase patients (47.3%). The mean UUIS score in stroke patients was 72.0 (SD 23.1) and was high, at 82.0 (SD 23.3), in acute phase patients, in particular. In addition, significant differences in UUIS were seen based on age (p = .031), stroke type (p = .031), time since onset (p = .006), the presence or absence of stroke sequelae (p = .013), stroke severity (NIHSS) (p = .000), and ADL (BI) (p = .001). In multiple regression analyses, stroke severity, time since onset, and age were associated with stroke patient uncertainty (R2 = .221). [Conclusions] Stroke patients were characterized by uncertainty based on age, stroke type, time since onset, stroke severity (NIHSS), and ADL (BI). In particular, the uncertainty of acute phase stroke patients was higher compared to other chronic diseases due to time since onset, stroke severity (NIHSS), and ADL (BI). The three factors of stroke severity, time since onset, and age were associated with stroke uncertainty. In patients with high stroke severity (NIHSS 2 or higher), there was an indication that careful explanation and supplementation of information regarding the disease was required and that complicated information, such as disorders caused by the stroke and treatments, should be carefully explained to those 75 years and older (older people) as well as patients who experienced disease onset within less than 1 month

Ctf18 is required for homologous recombination-mediated double-strand break repair

The efficient repair of double-strand breaks (DSBs) is crucial in maintaining genomic integrity. Sister chromatid cohesion is important for not only faithful chromosome segregation but also for proper DSB repair. During DSB repair, the Smc1–Smc3 cohesin complex is loaded onto chromatin around the DSB to support recombination-mediated DSB repair. In this study, we investigated whether Ctf18, a factor implicated in the establishment of sister chromatid cohesion, is involved in DSB repair in budding yeast. Ctf18 was recruited to HO-endonuclease induced DSB sites in an Mre11-dependent manner and to damaged chromatin in G2/M phase-arrested cells. The ctf18 mutant cells showed high sensitivity to DSB-inducible genotoxic agents and defects in DSB repair, as well as defects in damage-induced recombination between sister chromatids and between homologous chromosomes. These results suggest that Ctf18 is involved in damage-induced homologous recombination